The First, Comprehensive, Open-Source Culinary Medicine Curriculum for Health Professional Training Programs: A Global Reach

Abstract

Providing a strong foundation in culinary medicine (CM)—including what constitutes a healthy diet and how to find, obtain, and prepare healthy and delicious food—is a cornerstone of educating health professionals to support patients in achieving better health outcomes. The Culinary Medicine Curriculum (CMC), published in collaboration with the American College of Lifestyle Medicine, is the first, comprehensive, open-source guide created to support the implementation of CM at health professional training programs (HPTPs) worldwide. The CMC is modeled after the successful CM elective course for Stanford University School of Medicine students. Key goals of the CMC include presenting healthy food as unapologetically delicious, quick, and inexpensive; translating lessons learned to healthy eating on-the-go; practicing motivational interviewing on healthy dietary behavior changes; and demonstrating how to launch a CM course. The CMC highlights a predominantly whole food, plant-based diet as seen through the lenses of different world flavors and culinary traditions. It was developed, published, and distributed with the aim of expanding CM by reducing barriers to creating CM courses within most types of HPTPs and practice settings. During the first 2 months the CMC was available, it was downloaded 2379 times in 83 countries by a wide variety of health care professionals interested in teaching CM. The global interest in this first, freely available, evidence-based CMC underscores the demand for CM resources. Such resources could prove foundational in expediting development of CM courses and expanding the reach of CM and counseling on dietary behavior changes into patient care.

Diet has been identified as the most important risk factor for morbidity and mortality in the United States.

Culinary medicine (CM) is an emerging, evidence-based field that integrates nutrition education with culinary knowledge and skills to assist patients in maintaining health and preventing and treating food-related diseases by choosing high-quality, healthy food in conjunction with appropriate medical care.^1,2 Diet has been identified as the most important risk factor for morbidity and mortality in the United States³ and is associated with 11 million deaths across the globe annually,⁴ yet most health care providers fail to meet the recommended number of hours studying nutrition during their training.^5,6 The majority of nutrition education offered is didactic and focused on the biochemistry of nutrients and health consequences of deficiency states—content that is of limited use in clinical settings where the risk of overnutrition looms far greater due to high intake of ultra-processed, calorie-dense foods. CM fills this educational gap by focusing on practical dietary behavior changes, nutrition knowledge, and cooking skills needed to make food that is delicious, healthy, and accessible. Consideration of time availability, financial resources, and cultural food traditions are also important parts of any successful CM program.

In recent years, understanding of the importance of the CM approach to nutrition education in health professional training programs (HPTPs) has increased. However, the lack of an easily accessible, evidence-based guide to implementing CM has constituted a major barrier at most institutions. The Culinary Medicine Curriculum (CMC),⁷ published in collaboration with the American College of Lifestyle Medicine in December 2019, is the first, comprehensive, open-source guide created to support the implementation of CM at academic institutions worldwide.

The CMC is modeled after the successful CM elective course for medical and physician assistant students at Stanford University School of Medicine.² Both the Stanford CM course and the CMC were developed by a group of experts whose training includes internal medicine, family medicine, pediatrics, obesity medicine, lipidology, integrative medicine, lifestyle medicine, nutrition science, epidemiology, public policy, medical school curriculum design, and culinary arts. The success of the course and many requests for dissemination of the curriculum, prompted author, physician-chef Michelle Hauser, to partner with the American College of Lifestyle Medicine (ACLM) to expand the reach of this curriculum beyond Stanford’s campus.

The Stanford CM course was taught by dually trained physician-chefs with nutrition expertise. Understanding that this combination of training is rare among health professionals, the CMC was adapted to enable a wide variety of health professionals to teach CM in their training programs. Examples of combinations of instructors likely to be successful in teaching a CM course using the CMC include (a) a professional with training in culinary arts, nutrition, and the same health profession as students taking the course (eg, a nutrition-savvy physician-chef); (b) a clinician-educator who is knowledgeable about nutrition and cooking; or (c) 2 or more instructors trained in complementary fields that cover formal or informal culinary training, nutrition expertise, and direct patient care experience (eg, a chef, dietitian, and physician). For the example class size of 12 students, it is recommended to include at least 2 instructors per session to divide the workload and ensure adequate student oversight; however, this number can be increased or decreased proportionally according to actual class size and kitchen or classroom space. To increase the generalizability of the content, lead instructors can invite other faculty members from a variety of specialties or focus areas to join on a rotating basis. This helps students understand how CM content is applicable broadly in medicine and other health professions. Class sessions can also be taught individually, rather than as a full course, and can be customized, if desired.

The CMC incorporates lessons learned in medical practice caring for diverse patients of all ages and with varying levels of education and resources. Key goals of the curriculum include presenting healthy food as unapologetically delicious, simple, filling, and inexpensive; translating lessons learned to healthy eating on-the-go; practicing motivational interviewing on healthy dietary behavior changes; and discovering how to set up and run a CM course from the ground up. The CMC includes detailed instructions and content needed to accomplish these goals and suggestions for modifications to adapt content to alternative CM session or course formats such as one-time or limited-session classes (Table 1).

Table 1.

Contents of the Culinary Medicine Curriculum.

• Descriptions of personnel and equipment needed for nine, 2-hour, in-person class sessions

• Suggestions for modifying curriculum content for use in one-time or limited-session CM classes

• Example course syllabus

• Explanations of faculty expertise required to teach a course

• Draft email invitations to invite faculty to join CM sessions

• A detailed Instructor’s Outline with all content needed for each session

• Goals and objectives for students for each class session

• Suggestion for class pre-work (in lieu of homework)

• Selected nutrition content to highlight during sessions

• Suggestions for supplemental materials, videos, references, and other resources

• Flow and content of each hands-on teaching kitchen session

• Menus, recipes, and handouts for each class session

• Discussion starters and patient-provider role play examples for interactive dinner discussions

• Health and safety considerations for CM courses

• Financial considerations in starting a CM course

• Equipment list for stocking a pop-up teaching kitchen

Abbreviations: CM, culinary medicine.

This open-source curriculum was developed to be used as a foundation for the creation of elective CM courses within most types of health professional training programs. As written, student time commitment includes 9 class sessions, each of 2 hours duration, with an average of approximately 30 minutes of preparatory work for each session. This can be done weekly for those on the quarter system. Class sessions encompassing more than 1 topic—Soups and Salads, for example—can be divided into 2 sessions to give more time to cover the material in detail while sticking with a weekly class schedule for those on the semester system. Instructor preparation for each session varies and is indicated in the Instructor’s Outline—a detailed guide to leading each course session (Table 2). Topics and techniques covered include common and high-yield healthy cooking techniques that can be easily incorporated into the repertoires of families from a variety of cultural food traditions that are common in the United States.

Table 2.

Instructor’s Outline.

Sessions

Each Session Includes

1. Introduction to Kitchen Basics 2. Sauté, Stir-fry, Simmer, Braise 3. Roasting 4. Soups & Salads 5. Beans & Whole Grains 6. Healthy Breakfasts 7. Pastas and Sauces 8. The Dessert Flip & Healthy Desserts 9. Final Potluck

• Goals (for students) • Objectives (for students) • Materials to Review Before Class Session (Required and Optional Materials) • Meal Description • Recipes • Class Session Outline (ie, timing, instructor preparation, content, session flow) • Key Points for Instructors/Faculty Volunteers to Discuss with Students • Dinner Discussion (with patient motivational interviewing role play activity) • Related Nutrition/Clinical Correlates in the Curriculum • Optional References

While CM does not endorse a single dietary philosophy, the CMC has been designed to focus on whole food, plant-based (WFPB) nutrition. It highlights the dietary principles supported by the ACLM as outlined in the official position statement: “For the treatment, reversal, and prevention of lifestyle-related chronic disease, the ACLM recommends an eating plan based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts, and seeds.”^8,9 Because patients come from a variety of backgrounds and food traditions, the curriculum introduces a predominantly WFPB diet through the lenses of different world flavors and culinary traditions while keeping in mind resource constraints.

Western diets fall short of the major goals of a predominantly WFPB diet¹⁰ and most people find it difficult to abruptly change engrained eating patterns. Commonly cited challenges include lack of nutrition knowledge and food preparation skills, existing taste preferences for less healthy foods, limited availability of healthier options, family demands, financial resources, and time constraints. Given that any level of behavior change can potentially yield improved health and well-being,^11,12 the CMC focuses on meeting individuals where they are and using motivational interviewing to tailor dietary assessment, recommendations, and interventions according to a patient’s personal goals and readiness for change.^13-15 Concrete strategies are given for health care providers who wish to partner with their patients on improving dietary choices, thereby assisting them in transitioning along a spectrum toward more plant-centric diets emphasizing the consumption of whole foods.

Though the CMC was created for health professional training programs (eg, medical schools, nursing, psychology, and dietetic programs), it is easily adaptable to a variety of other educational environments, including residency programs, health and wellness coaching, and master’s-level courses. To adapt for patient care, patient education, public-facing education, or undergraduate studies, one can simply omit the portions of the curriculum focused on teaching providers to coach patients on making dietary lifestyle changes. The majority of the curriculum is broadly applicable.

The CMC was written, published, and distributed with the aim of expanding CM by reducing barriers to creating CM courses (e.g., financial, knowledge, etc) within most types of HPTPs and practice settings. Permission to use the materials can be obtained simply by emailing a request to the address indicated in the copyright statement, following downloading of the CMC from https://lifestylemedicine.org/culinary-medicine. Use permission is granted on the condition that appropriate attribution accompanies all materials whether used as-is or in edited form. There is no charge.

To evaluate the reach of the CMC and demand for evidence-based, open-source, CM content, descriptive statistics were used to analyze self-reported data for those who downloaded the curriculum during the first month it was available (December 2019 to January 2020). For this initial analysis, total downloads, total number of countries in which downloads occurred, proportion of those downloading who had targeted credentials, and proportion who planned to teach CM within 2 years were calculated. Those listing credentials were allowed to list more than one applicable credential. A follow-up analysis was conducted for data collected during the first 2 months the CMC was available (December 2019 to February 2020) and included total downloads and total number of countries in which downloads occurred.

During the first month the CMC was available, it was downloaded 1481 times in 63 countries. Of those listing targeted credentials (N = 1226; 82.8%), the most frequently reported included physicians (N = 711; 58.0%), registered dietitians (N = 130; 10.6%), public health professionals (N = 102; 8.3%), nurses (N = 78; 6.4%), nurse practitioners (N = 60; 4.9%), and health coaches (N = 60; 4.9%), with smaller numbers in the categories of doctors of philosophy or psychology, physician assistants, and physical or occupational therapists. More than two thirds planned to teach CM within 2 years either in a HPTP or patient care context. At 2 months, the CMC had been downloaded 2379 times in 83 countries.

Providing health care professionals with a strong foundation in CM—including what constitutes a healthy diet and how to find, obtain, and prepare healthy and delicious food—is a cornerstone of educating health professionals to support patients in achieving better health outcomes. Based on the analysis of data from the first 2 months during which the Culinary Medicine Curriculum was available, evidence of substantial global interest emerged. This interest included the development of CM courses across the spectrum of HPTPs and for patient care. The global interest in this first, freely available, evidence-based CMC underscores the demand for CM resources. Such resources could prove foundational in expediting development of CM courses and, by extension, expanding the urgently needed reach of CM and counseling on dietary behavior changes into patient care. Future research is needed to determine frequency of use of curricular materials, impact on clinical practice for those who have taken related CM courses, and effects on patient health outcomes.