Culinary Medicine for Family Medicine Residents

Abstract

Background

Physicians are inadequately trained to effectively provide lifestyle counseling to manage the obesity epidemic.

Activity

Family and community medicine residents participated in a culinary medicine course taught by two Registered Dietitian Nutritionists (RDNs) in University Park, PA, in March 2020.

Results

All residents (n = 13) reported increased knowledge, 92% (n = 12) reported increased confidence, and 84.6% (n = 11) reported they intended to make changes to their practice based on the class. Most participating residents (85%, n = 11) would attend follow-up classes.

Discussion

Residents recognized the importance of nutrition in clinical care and found the information to be applicable to practice.

Background

Globally, more than 13% of the adult population has obesity [1], and poor dietary choices are a known risk factor for obesity. Medical training inconsistently addresses nutrition interventions [2, 3], and obesity management counseling is often overlooked in the training of future physicians [4]. Consequently, providers express low levels of self-efficacy in providing weight-reduction counseling [5–7].

In 2013, the American Medical Association designated obesity as a disease [8] and authoritative guidelines for the diagnosis and management of obesity are available [9]. While diagnosing the disease can help lead to counseling and prevention, less than half of patients with obesity receive a diagnosis of obesity [10]. In an effort to increase obesity diagnosis and counseling in clinical practice, the Office of Disease Prevention and Health Promotion has prioritized counseling and education of patients with overweight or obesity on weight reduction by their physician with a Healthy People 2030 goal [11].

This educational intervention utilized an evidence-based culinary medicine (CM) curriculum (Health meets Food) [12], a program that brings together the basic sciences and clinical applications inherent to medical education, with nutrition and cooking skills [13]. The aims of this class were to overcome misconceptions regarding the complexity of preparing healthy, appealing, affordable meals and to provide practical information on weight management for clinical care.

Activity

A group of family and community medicine residents participated in a 3-h culinary medicine class [14] as a part of their annual retreat day. Access to the Health meets Food curriculum was provided by a license held by Penn State College of Medicine [15]. The hands-on class was held in a teaching kitchen at The Pennsylvania State University, University Park. Two Registered Dietitian Nutritionist (RDN) doctoral students worked with the chief resident to determine the nutrition topic of most interest to the group; the group voted for obesity management. Residents were emailed one scholarly article on the effectiveness of different diets [16] and recipes to be prepared in class to review in advance of the class. When the residents arrived, they were divided into self-selected groups of 2–4 and each group was given a patient case to discuss that focused on obesity management in clinical practice. The RDNs led the larger group discussions on the patient case, fad diets, and weight loss supplements. Next, the RDNs introduced the recipes and instructions for the hands-on cooking class.

The 3-h workshop took place in a teaching kitchen that is similar to a home kitchen with all necessary ingredients, equipment, and supplies to successfully complete each recipe. Groups were assigned to pre-determined recipes which were developed as part of the Health meets Food culinary medicine curriculum. There were nine recipes, and two to three recipes were assigned to each group. Once all dishes were completed, each group presented the recipes they prepared to the larger group, summarizing the preparation, and sharing tips and perspectives. Residents then shared a meal while discussing how what they learned related to patient care.

Before concluding the workshop, residents were asked to complete a voluntary, anonymous survey adapted from the Health meets Food continuing medical education (CME) resources. The survey focused on perceived nutrition knowledge and confidence in nutrition counseling. The purpose of the survey was to determine if this program should be offered to residents in the future. This program was an enrichment course (not a planned curricular element) and did not provide the residents with continuing education units nor course credits. The additional cost was $75 (cost of ingredients) and was paid by the residency program.

Results

Thirteen resident physicians attended the single day workshop in March of 2020. All residents (n = 13) reported that the workshop increased their knowledge. Nearly all residents (n = 12, 92%) reported that the class increased their confidence (1 response was omitted due to illegibility). The majority (n = 11, 84.6%) of residents reported they intended to make changes to their practice based on the nutrition information taught in the class. All residents reported that the information was relevant to their practice, and 69% (n = 9) reported that it was relevant to their daily practice. Nine residents (69%) reported that the knowledge gained in this class was relevant to > 25 of their patients per week (Fig. 1).

Fig. 1.

Benefit to weekly patients, n = 13

Reported barriers to making changes to practice were lack of time/resources, patient non-adherence, and lack of training on overcoming major barriers to change. When asked to provide insight on overcoming barriers, six residents provided feedback including: a journal club for preventative medicine, standardized nutrition assessment in the electronic medical record (EMR), meal cost analysis, recipe resources, and extended/ongoing nutrition education. A majority of residents (n = 11, 84.6%) reported they would attend similar programs in the future.

Discussion

In our first ever culinary medicine class for medical residents at Penn State Health, all residents reported that this activity increased their knowledge related to nutrition and weight management, and almost all reported that it increased their confidence related to nutrition counseling. However, they also reported barriers to making these changes. Importantly, residents reported that the information conveyed in this hands-on cooking class would be relevant to many of the patients they see each week.

Nutrition in medical education seems like a “natural fit” to educate and prepare physicians to counsel their patients on nutrition-related conditions and diseases. Still, less than 25% of medical schools across the country offer nutrition education [17] and few residency programs offer training in nutrition-related topics [18]. Even if nutrition training is provided in undergraduate medical education, it is likely to be lost if not reinforced in residency and fellowship (if applicable) training [19]. Lack of training leaves physicians largely unprepared to provide nutrition counseling to patients.

In recognition of this, a growing number of medical schools and a smaller number of residency programs and CME programs offer culinary medicine education. Increasing Culinary Health Opportunities for Professionals (iCHOP) [20] focuses on knowledge and attitudes about nutrition and self-efficacy in discussing nutrition with patients, as well as improving personal dietary choices of practitioners. A workshop series at Johns Hopkins University aimed to improve confidence in nutrition counseling among preventive medicine residents and participants reported significantly improved culinary competency [21]. One culinary medicine elective course piloted with 4th year medical students demonstrated increased nutrition knowledge, improved confidence in discussing nutrition with patients, and increased confidence in their ability to impact patient behavior, an aspect that has applications across the practice of medicine [22]. These programs increased self-reported nutrition knowledge and confidence in counseling, as well as improved culinary skills and student enthusiasm.

Physicians are considered to be reliable sources of nutrition information [23] and when physicians discuss nutrition with their patients, outcomes improve [24]. Registered Dietitian Nutritionists are nutrition experts with the training and experience to provide long-term, evidence-based medical nutrition therapy and behavior change support. RDNs are excellent partners for physicians in training from UME to CME; RDNs can teach physicians about the effectiveness of nutrition for the prevention and treatment of noncommunicable diseases, which can increase the likelihood that physicians will refer patients to RDNs for ongoing nutrition counseling [25].

The overarching goal of this class was to utilize evidence-based dietary recommendations to improve weight management in clinical care. There are over 20 modules in the Health meets Food curriculum, the required resources were of low cost, and the collaboration between the Nutritional Sciences Department and the residency programs fosters interprofessional education and team-based care. In the future, we hope to offer further nutrition training opportunities for residents because there is a need for this education and residents rated this activity highly. Future programs should collect additional data about participants, including demographic information, previous nutrition training, and intention to access further nutrition training, in addition to the CME survey. Nutrition counseling rates in clinical practice may benefit over the long term from increased interventions such as hands-on culinary and nutrition education courses offered to physicians in their training programs.

Declarations

Ethical Approval

N/A; data was collected for quality improvement and justification of future programming.

Conflict of Interest

The authors declare no competing interests.