Abstract
The aim of this study was to determine how a brief culinary medicine curriculum impacted medical students’ nutrition knowledge, attitudes, and self-efficacy and to evaluate which parts of the curriculum students found to be most helpful. This preliminary intervention study enrolled participants in a 2-week culinary medicine elective course and measured pre- and post-elective. Students attending an Appalachian medical school (n = 16) participated in this study. Participants were surveyed on their nutrition knowledge, self-efficacy in providing nutrition advice, and attitudes towards use of nutrition in practice pre- and post-elective. Participants also completed elective evaluations following the course. Changes in mean outcome scores were measured pre- and post-elective using signed Wilcoxon tests. Alpha was set at .05. Frequencies of responses were calculated to determine which course components were ranked highest in their efficacy. Nutrition knowledge and self-efficacy increased significantly from pre- to post-elective (p < .0001 and p < .0001, respectively). Students valued the hands-on and culinary components of the course most. Results indicate that a brief culinary medicine curriculum can effectively improve medical students’ knowledge and self-efficacy of nutrition counseling and that students prefer hands-on and applied learning when learning about nutrition.
Keywords: Culinary medicine, Medical students, Nutrition, Experiential learning, Culinary nutrition
Introduction
It is essential for physicians to have an adequate knowledge of nutrition as healthy dietary habits and interventions can decrease mortality, disease morbidity, and medical costs [1]. Physicians in various specialties acknowledge the important role that nutrition plays in patient health, yet admit that providing those individuals with the necessary information relevant to their goals is not common in practice settings [2]. A possible lack of nutritional advice offered is linked to poor confidence of physicians, as one survey showed that only 14% reported that they felt adequately trained to advise individuals on proper nutrition [3]. This spans across all divisions of medicine, for example, gastroenterologists practicing in Canada reported that only 50% of residents received a formal nutrition rotation that was mandatory 36% of the time, and as a result reported a low self-confidence in their nutrition knowledge [4].
The poor nutrition knowledge reported by practicing physicians may be a result of the lack of attention focused on nutrition during medical school and residency. The AAMC reports that often medical schools implement nutrition education in preclinical years with less nutrition education made available during the clerkship years, likely resulting in the low rate of nutrition counseling occurring in clinical settings [5]. Medical schools are required to teach a minimum of 25 h of nutrition education; however, a survey sent to 133 US medical schools revealed that 71% of programs fall short [6]. There are several reported barriers on the lack of nutritional education including minimal faculty expertise, funding, and little to no time to fit nutrition into the medical curriculum [7]. Students reported that when in a nutrition rotation, the application of nutrition science in a practical manner was not clear to them, and there was an evident poor collaboration with nutrition professors, and rather, curriculum was taught by medical doctors [1]. Another identified barrier on the lack of attention to nutrition during medical school is the time constraints during appointments with individuals upon practicing medicine and the accessible information via the internet available to patients [2]. However, when nutrition is included into medical school, students report that experiential learning courses are the most effective in increasing their cooking competency as well as confidence in advising patients [8, 9]. Furthermore, recent literature has found that the most successful nutrition education interventions emphasize practical skill development instead of solely knowledge acquisition [10]. Overall, medical students agree that nutrition is relevant in their future practice and that they would like to have additional nutritional education [11, 12].
Chronic diseases remain a great concern in the twenty-first century, highlighting the need for physicians to develop a proficient skill in advocating for a healthy lifestyle where diet is an essential component for individuals who come to seek help for their chronic disease [13]. Recognition of the lacking nutrition knowledge of physicians and the continual high prevalence of chronic diseases has contributed to the development of the field of culinary medicine, which blends the art of cooking with the science of medicine [14]. Culinary medicine programs have consistently shown to be successful in increasing practitioner knowledge and skills in providing nutrition advice, likely due to the use of hands-on teaching, interprofessional collaboration, and a centralized approach [15]. Various research has been conducted on the importance of experiential learning such as Miller’s framework. Miller’s framework focuses on assessing clinical competency by matching learning objectives to individual pyramidal staged ranging from written exams to ultimately participating in daily patient care to advance practitioners’ knowledge [16]. Because of the time constraints faced by medical students, strategies to provide them with brief but effective nutrition education need to be investigated. Therefore, the aim of this preliminary study was to determine how a 2-week experiential learning culinary medicine course impacts medical students’ nutrition knowledge, attitudes towards giving nutrition advice in practice, and self-efficacy in providing nutrition advice. In addition, this study aimed to determine which components of the elective students found to be most helpful. This preliminary work aims to begin to develop a brief, effective curriculum that can adapt to the busy schedules of faculty and students.
Methods
Ethics Approval
This study was approved by West Virginia University’s Institutional Review Board (#1,611,355,436). Consent was given by all subjects before their participation.
Participants and Procedures
Researchers used a pre-post intervention design to investigate a convenience sample of fourth-year medical students attending a medical school in Appalachia. Participants had to be currently enrolled in year 4 at the School of Medicine during their rotations and at least 18 years of age to be eligible. Students attending a medical school in Appalachia during spring 2019 were invited to participate in a 2-week culinary medicine elective as part of their rotation experiences during their final year of medical school. There were approximately 100 students enrolled in their fourth year of medical school who were eligible to participate. Fourth-year medical students are permitted to choose some of their rotations, and this elective was offered as one of their options. Participants then completed the rotation with the Lifestyle Intervention Research Lab (LIRL) for 2 weeks and completed a variety of learning activities, outlined below. The rotation occurred in the LIRL, which is equipped with a kitchen and a space for lectures and activities. Before and after the elective, participants completed a survey measuring their nutrition knowledge, attitudes towards giving nutrition advice in practice, and self-efficacy in providing nutrition advice. The class was offered to 4 to 8 students at a time over a span of 2 months. The majority (56.3%) of participants were female and most (96.9%) were not first-generation college students. Students had very limited prior nutrition exposure, most often briefly covered in one of their medical school courses.
Curricula Content
Curricula content was developed by experts in the field of nutrition (PhD/RDNs) with previous experience developing curriculum [17–23]. The format of each day varied, but generally, students listened to a lecture on a topic, followed by an activity related to and reinforcing that topic. Students participated in experiential learning rotation activities for an average of 5 h each day, with an average of 3 h additionally each day during which they worked on assignments remotely. In total, participants completed about 80 h during this rotation. Objectives for the elective are outlined in Table 1.
Table 1.
Learning objectives of culinary medicine elective
| Objectives |
|---|
| 1. Discuss diet with patients and offer advice regarding healthy food choices and preparation of meals |
| 2. Evaluate emerging research on culinary medicine and provide critical review |
| 3. Maintain a safe culinary environment using appropriate food safety and culinary techniques |
| 4. Identify the role of macronutrients in health and disease progression and how to make dietary and lifestyle changes to prevent the development and progression of chronic diseases |
| 5. Complete a budget and meal plan to make recommendations that ensure the patients’ success in following the new diet and extending the scope of their conversation with patients to address potential barriers to success |
| 6. Evaluate patient diets and demonstrate effective counseling skills through the Transtheoretical Model of Behavior and Motivational Interviewing |
| 7. Display cultural sensitivity and how to address different patient populations. Specifically, an understanding of the West Virginia population, allowing a more personalized approach in providing care |
| 8. Use culinary skills to prepare healthy meals, with the goal of modeling this behavior in their own lives |
Lecture Topics
(1) Behavior Change Theories, (2) Food Groups Introduction, (3) Food Safety and Culinary Techniques, (4) Carbohydrates and Health, (5) Proteins and Health, (6) Lipids and Health, (7) Mediterranean Diet, (8) Mental Health, (9) Cooking Healthy on a Budget, (10) Nutrition Counseling and Common Patient Questions, and (11) Culinary Competency.
Activities
Researchers sought to demonstrate concepts discussed in the lectures and reinforce learning through hands-on experience in the following activities. These included (1) beginner knife skills practice, (2) ranking healthiness of breads, (3) preparing and tasting plant-based proteins, (4) substituting fats, (5) exploring nutrition.gov resources, (6) creating 1-day meal plan on a budget, (7) grocery store visit to cook meal on a budget, (8) mock counseling sessions, and (9) final projects.
For their final project, students chose a nutrition-related disease state, completed a literature review on nutrition therapy for their chosen disease, prepared a presentation on what nutrition advice they would give to a patient with that disease, and prepared a meal that followed their nutrition advice. Students chose a range of topics for their final projects, including Microbiome’s Relationship with Mental Health, Ketogenic Diet Effects on Cardiovascular Health, Treatments for Eating Disorders, and Low FODMAP Diets for IBS. Student final projects were assessed based off the quality of their summary of the current literature, their application of the scientific evidence to a real-life scenario, and appropriateness of their meal to prescribe for their chosen disease state or condition. Lecture topics and activities are summarized in Table 2.
Table 2.
Schedule of elective’s lectures and activities
| Day | Lecture topic | Content | Activities |
|---|---|---|---|
| 1 | Introduction | Review course requirements and assignments |
Pre-test Assign final project topic |
| 2 | Theory and Research Design, Introduction to Culinary Medicine and Nutrition |
Behavior Change Theories Food Groups Introduction |
Begin literature review for final project |
| 3 | Food Safety | Food Safety and Culinary Techniques |
Kitchen tour Beginner knife skills practice |
| 4 |
Carbohydrates and Health Proteins and Health |
Dietary Sugars Diseases Impacted by Carbs Complete Proteins Vegetarian Proteins |
Ranking healthiness of breads Preparing and tasting plant-based proteins |
| 5 |
Lipids and Health Mediterranean Diet Mental Health |
Dietary Fats Cholesterol Diseases Impacted by Lipids Mediterranean Diet Nutrition Needs for Mental Health and Recovery |
Substituting fats in recipes |
| 6 | Cooking Healthy on a Budget |
Making More with Less Nutrition Assistance Programs |
Explore nutrition.gov resources Create 1-day meal plan on a budget Grocery store visit to prepare meal on a budget |
| 7 | Nutrition Counseling and Addressing Common Patient Questions |
Making Patient the Focus Fad vs. Evidence-Based Diets Dietary Supplements |
Mock counseling sessions |
| 8 | Culinary Competency |
Religious and cultural differences Pregnancy Allergies |
Mock counseling Case studies |
| 9 | Final Projects | Student Presentation | Student prepared meals and review |
| 10 | Final Projects | Student Presentation |
Student prepared meals and review Wrap-up Post-test and evaluations |
Measures and Data Collection Procedures
This 67-item survey was developed through a compilation of validated tools from literature as well as researcher-generated questions. The survey gathered information on student demographics as well as their nutrition knowledge, self-efficacy, and attitudes.
Nutrition Knowledge
The nutrition knowledge of students was measured by participants completing 22 questions created by the research team of nutrition experts (PhDs/RDNs) who implemented this study. Questions included items such as “Which is a source of insoluble fiber?” and “Which of the following are complementary proteins?” Responses were scored as correct (1) or incorrect (0) and summed for a total number of correct answers out of 22 for both pre- and post-surveys.
Self-efficacy
Self-efficacy in providing nutrition advice was measured through 22 questions asking students about their perceived level of proficiency on a scale of 1–4. Questions were adapted from a previously used tool [24] in order to match the topics of the current curriculum. Participants were asked to rank their proficiency (Totally proficient (4), Somewhat proficient (3), Not proficient (2), or Not applicable (1)) in instructing individuals on topics such as “Role of omega-3 and omega-6 fatty acids in heart health” and “Recommended dietary patterns for type 2 diabetes mellitus.” Responses were scored and summed out of a possible 88, with high scores indicating higher self-efficacy in providing nutrition advice.
Attitudes
Attitudes towards giving nutrition advice in practice were measured by 23 questions adapted from the Nutrition in Patient Care Survey (NIPS) [25] in order to match the curriculum of this rotation. Participants were asked to rate their agreement on a 5-point Likert scale (strongly agree (5), agree (4), neither agree nor disagree (3), disagree (2), strongly disagree (1)) to statements such as “Nutrition counseling should be a part of routine care by all physicians, regardless of specialty” and “I have an obligation to improve the health of my patients including discussing nutrition with them.” Responses are summed out of a possible 115, with higher scores indicating more positive attitudes.
Elective Evaluations
Students completed a short evaluation containing 20 questions at the end of the rotation that asked them to rank the helpfulness of the lectures and activities and about their overall experience. Elective evaluation questions were a compilation of open-ended questions and scales of “Not at all helpful,” “Slightly helpful,” “Moderately helpful,” “Very helpful,” and “Extremely helpful” for participants to rank the helpfulness of activities and lectures.
Analysis
All data were analyzed using JMP Pro Version 14.0. Signed Wilcoxon tests were used to determine mean changes in nutrition knowledge, self-efficacy, and attitudes from pre- to post-elective. Open-ended responses to elective evaluations were not thematically analyzed and instead were reported verbatim.
Results
A total of 16 students enrolled in the elective, representing about 16% of the eligible student population at this institution. All students completed the entire elective and the pre- and post-assessments. Participants had a mean baseline nutrition knowledge score of 14.06 ± 2.21 (out of a possible 22). The mean baseline nutrition self-efficacy score was 60.76 ± 8.06 (out of a possible 84). The mean attitudes towards providing nutrition advice were 86.82 ± 4.48 (out of a possible 115). Participants displayed significant increases in nutrition knowledge pre- to post (18.38 ± 1.63 at post) (p < 0.001) and nutrition self-efficacy (79.4 ± 7.69 at post) (p < 0.001). There was no significant difference in pre- and post-attitudes towards providing nutrition advice (92.4 ± 6.99 at post) (p = 0.073) (Table 3).
Table 3.
Pre- and post-elective nutrition knowledge, self-efficacy, and attitudes
| Variable | Mean ± SD [95% CI] | P-value | |
|---|---|---|---|
| Pre-elective | Post-elective | ||
| Nutrition knowledge | 14.06 ± 2.21 [12.88, 15.23] | 18.38 ± 1.63 [17.51, 19.24] | < 0.001* |
| Self-efficacy in providing nutrition advice | 60.76 ± 8.06 [56.62 + 64.91] | 79.4 ± 7.69 [75.14, 83.66] | < 0.001* |
| Attitudes towards providing nutrition advice | 86.82 ± 4.48 [84.52, 89.12] | 92.4 ± 6.99 [88.53, 96.27] | 0.073 |
Means, standard deviations, and 95% confidence intervals are displayed. Results of signed Wilcoxon tests are indicated by p-values
In the elective evaluations, students ranked the Nutrition Needs for Mental Health, Making Carbs, Proteins, Lipids, and the Fad vs. Evidence-Based Diets as the most helpful, as indicated by the high percentage of “extremely helpful” responses for these lectures. The lectures on Making Patient the Focus, Making More with Less, and Culinary Competency were next in number of students ranking them as extremely helpful. Behavior Change Theories and Food Safety and Culinary Techniques had the lowest ratings (Table 4). For activities, students ranked cooking vegetarian proteins, ranking healthfulness of breads, grocery store visit, substituting fats, cooking meal for their disease state, and meal planning and budgeting as the most helpful. Next were mock counseling with the 24-h recall, and preparing their final presentation. Beginner culinary and knife skills and mock counseling with the Mediterranean Diet Score were ranked the lowest (Table 5).
Table 4.
Elective evaluations of lecture topics
| Lecture topic | Not at all helpful | Slightly helpful | Moderately helpful | Very helpful | Extremely helpful |
|---|---|---|---|---|---|
| Behavior Change Theories | 2 (12.5%) | 1 (6.3%) | 5 (31.3%) | 5 (31.3%) | 3 (18.8%) |
| Food Safety and Culinary Techniques | 0 | 0 | 3 (18.8%) | 8 (50.0%) | 5 (31.3%) |
| Carbohydrates and Health | 0 | 1 (6.3%) | 2 (12.5%) | 3 (18.8%) | 10 (62.5%) |
| Proteins and Health | 0 | 1 (6.3%) | 1 (6.3%) | 4 (25.0%) | 10 (62.5%) |
| Lipids and Health | 0 | 0 | 1 (6.3%) | 5 (31.3%) | 10 (62.5%) |
| Fad vs. Evidence-Based Diets | 0 | 0 | 1 (6.3%) | 5 (31.3%) | 10 (62.5%) |
| Making More With Less | 0 | 0 | 5 (18.8%) | 5 (31.3%) | 8 (50.0%) |
| Nutrition Needs for Mental Health | 0 | 0 | 2 (12.5%) | 3 (18.8%) | 11 (68.8%) |
| Making Patient the Focus | 0 | 0 | 3 (18.8%) | 6 (37.5%) | 7 (43.8%) |
| Culinary Competency | 0 | 0 | 1 (6.3%) | 8 (50.0%) | 7 (43.8%) |
Table 5.
Elective evaluations of activities
| Activity | Not at all helpful | Slightly helpful | Moderately helpful | Very helpful | Extremely helpful |
|---|---|---|---|---|---|
| Beginner culinary and knife skills | 1 (6.3%) | 3 (18.8%) | 5 (31.3%) | 3 (18.8%) | 4 (25.0%) |
| Ranking bread | 0 | 1 (6.3%) | 1 (6.3%) | 2 (12.5%) | 12 (75.0%) |
| Preparing vegetarian proteins | 0 | 0 | 1 (6.3%) | 2 (12.5%) | 13 (81.3%) |
| Substituting fats | 0 | 1 (6.3%) | 1 (6.3%) | 3 (18.8%) | 11 (68.8%) |
| Meal planning and budgeting | 0 | 0 | 2 (12.5%) | 3 (18.8%) | 11 (68.8%) |
| Grocery store visit | 0 | 0 | 2 (12.5%) | 3 (18.8%) | 11 (68.8%) |
| Mock counseling with 24-h recall | 0 | 1 (6.3%) | 5 (31.3%) | 2 (12.5%) | 8 (50.0%) |
| Mock counseling with Mediterranean Diet Score | 0 | 1 (6.3%) | 5 (31.3%) | 4 (25.0%) | 6 (37.5%) |
| Preparing Final Presentation | 0 | 0 | 1 (6.3%) | 5 (31.3%) | 10 (62.5%) |
| Cooking meal for disease state final project | 0 | 0 | 1 (6.3%) | 4 (25.0%) | 11 (68.8%) |
In the open-ended feedback questions, students had positive comments regarding their experience. Participants noted that the course provides education that they do not receive in medical school and valued the hands-on cooking experiences that solidified lecture content (Table 6).
Table 6.
Responses to open-ended elective evaluation questions
| Topic | Example answers |
|---|---|
| Would you recommend this elective to your peers? |
“Yes, you learn a lot about food as it relates to medicine that you don’t get in other medical school courses.” “Yes, I really enjoyed this class. It is important to focus on aspects of health and disease management other than medication.” “Yes, I though this course was a great complement to our clinical experience.” |
| What aspects of the course did you find to be most effective in your learning? |
“The hands-on cooking sessions and presentations at the end of the course were most helpful.” “Hands-on mixed with the lectures, and the willingness of presenters to answers questions that we had.” “The lectures were very helpful and reinforced by cooking.” |
| What is your overall opinion on this course? |
“It has been a great experience and I would definitely recommend it to any medical student.” “I thought it was an excellent course with much need and importance for future physicians.” “I loved this course. I learned so much about nutrition that I have already started to implement in my daily life.” |
Discussion
The aims of this study were to determine how a brief, 2-week culinary medicine elective impacted medical students’ nutrition knowledge, attitudes towards providing nutrition advice in practice, and self-efficacy in providing nutrition advice and to determine which components of the elective were most beneficial according to the students. Participants displayed lower nutrition knowledge prior to the elective, with a significant increase in knowledge following the elective. The same pattern was seen with self-efficacy in providing nutrition advice pre- and post-elective. The mean attitude score did increase, but not significantly. Other studies examining how the implementation of a culinary medicine course impacts medical students’ nutrition knowledge and confidence have found overall positive results. Pang et al. implemented a 6-week culinary medicine course to second-year medical students and found a significant increase in student’s nutrition knowledge and self-efficacy in providing nutrition advice [8]. This curriculum was of a longer duration compared to ours, yet our study was also found to be effective, as indicated by the significant increases in nutrition knowledge and self-efficacy and positive feedback from participants. Coppoolse et al. implemented a brief curriculum, consisting of a total of 25 h, and did find improvements in nutrition knowledge and self-efficacy, but not as much as other studies [11]. This was attributed to the lack of hands-on education. Although our curriculum was brief, we incorporated daily hands-on and interactive lessons, which may be the reason why we were able to be effective using a short-duration curriculum.
The attitudes towards providing nutrition advice in practice did not significantly increase in this study. In previous studies using this modified tool, there have been similar results [26, 27] and it was hypothesized that it was due to the already high attitudes displayed by participants at baseline. Coppoolse et al. also found this when measuring participant attitudes towards nutrition following a culinary medicine program [11] and this was also attributed to the high baseline attitudes. Research on this topic consistently shows high attitudes but low knowledge and confidence in nutrition counseling pre-intervention [10, 15].
The most helpful lecture topics were Nutrition Needs for Mental Health, Making More with Less, and the Fad vs. Evidence-Based Diets, and the lectures on Making Patients the Focus, Carbohydrates, Proteins, and Lipids were also ranked positively. We believe that Nutrition Needs for Mental Health and Fad vs. Evidence-Based Diets were ranked highly because of their relevance to contemporary nutrition topics. Making More with Less was relevant to this study population because we are in a low-income area with limited access to healthy foods. The positive ratings of macronutrient lectures could be due to the content of these lectures being focused on application in practice, rather than metabolic pathways that participants likely learned about in previous education. As this curriculum evolves and adapts, these lectures will remain and the lectures that did not receive as much positive feedback, Behavior Change Theories, Food Safety and Culinary Techniques, and Culinary Competency, will be re-examined to make improvements. Of the activities, cooking vegetarian proteins, ranking breads, cooking meal for their disease state, and meal planning and budgeting received the most positive evaluations. Substituting fats, grocery store visit, mock counseling with the 24-h recall, and preparing their final presentation were also positively rated, albeit not as highly as the other activities, while beginner culinary and knife skills and mock counseling with the Mediterranean Diet Score did not receive many positive ratings. The beginner culinary and knife skills was incorporated to ensure all students had a baseline level of culinary safety and will likely continue to be implemented in the future in order to ensure safety, but modifications may be made to make it more interactive and engaging. The mock counseling with the Mediterranean Diet Score was incorporated after discussion of the Mediterranean diet to demonstrate how they could screen someone using that tool, but participants preferred the 24-h recall method. In the future, the Mediterranean Diet Score might be discussed but mock counseling sessions might not use this tool.
Participants had positive feedback regarding the course overall, with many expressing that they received education and skills they had not been exposed to during medical school and feeling it was important for them to learn in order to complement their clinical knowledge. They also stated they would recommend the course to their peers and that they enjoyed the hands-on approach that solidified their learning. In order for other programs to implement this curriculum, minimal resources are required. First, the brief duration allows for flexibility with faculty or researcher schedules. The focus on cost-effective meals also kept the budget to a minimum. The curriculum could be implemented by one individual, but a team of 3 to 4 experts is most effective.
While results of culinary medicine electives have been overall positive, there are different approaches among studies. For example, some have the culinary component implemented by chefs [8, 28], while ours had the dietetics researchers and dietitians implement both the lectures and the culinary components. Some studies investigated courses created by medical students [8, 28], whereas our curriculum was created by PhD/RDNs. Some have focused on medical students, while others have implemented a curriculum for pre-medical undergraduates [29] or physician assistant students [30]. Studies have also focused on different outcomes. For example, a study by Jaroudi et al. [28] focused more on the culinary skills outcomes. They implemented an elective consisting of 4 didactic lessons and 4 cooking labs and found an increase in culinary skills, knowledge of ingredients, knowledge of cooking techniques, and ability to use kitchen supplies. Our study focused on the nutrition knowledge and self-efficacy as it applied to counseling and educating individuals about culinary techniques. Although each of these approaches have found positive results, moving forward, the culinary medicine field could benefit from standardization of implementation methods and how best to measure outcomes.
There are several limitations to this study. First, it was conducted at one university and results cannot be generalized to other medical students. Second, the sample size was small, but this was due to space limitations of the teaching kitchen. Third, participants chose to enroll in the elective, which may suggest they had positive attitudes towards nutrition in medicine before participating, but this could also be due to other reasons, such as expecting this elective to be more fun or easy than other electives offered to them. Fourth, the survey consisted of original and modified tools, which was done to suit the content of the curriculum, but the lack of validated tools may impact results. Fifth, there was no comparison group so results cannot be definitively attributed to the elective. Finally, no long-term follow-up of participants was conducted.
This study also has several strengths. The implementation of content and activities being facilitated by PhD/RDNs and dietetic researchers helped to ensure that questions by students could be answered by nutrition experts. To our knowledge, we implemented the only culinary medicine course of brief duration reported in the literature that included both knowledge-building lectures and skill-building activities, and this was integral to enhancing outcomes and was received positively by students. The positive impact after a brief intervention may be due to the use of Miller’s pyramid for teaching higher level skills: assessment of student knowledge through the pre-test (“knows”), application via activities and case studies (“knows how”), and demonstration of learning through culinary activities and student presentations (“shows”) [15, 16]. Another strength of the curriculum was its brief duration that allowed for more ease of accommodation of schedules without sacrificing positive effects on nutrition knowledge and self-efficacy. Results of this preliminary study will be used to improve upon the curriculum as researchers plan to continually implement it with each cohort of fourth-year medical students in a continual process of refining the program.
This preliminary study demonstrates that a 2-week, hands-on culinary medicine elective can be effective in improving medical students’ short-term nutrition knowledge and self-efficacy towards providing nutrition advice. In addition, course components that were beneficial to participants were evaluated and can be used to inform future curriculum development. The brief design of this curriculum allows for flexibility in implementation to accommodate the busy schedules of students and faculty. This study shows that a brief intervention has potential to be implemented and show positive outcomes on future physicians’ knowledge and self-efficacy in providing nutrition advice, but more work is needed to continually refine and validate a curriculum that can have a wider impact and reach.
Acknowledgements
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is Scientific Article No. 3434 supported by the West Virginia Agricultural and Forestry Experiment Station (#WVA00689, WVA00721).
Author Contribution
Conceptualization: Rachel A. Wattick and Melissa D. Olfert; methodology: Rachel A. Wattick and Emily G. Saurborn; formal analysis and investigation: Rachel A. Wattick; writing — original draft preparation: Rachel A. Wattick and Emily G. Saurborn; writing — review and editing: Rachel A. Wattick, Emily G. Saurborn, and Melissa D. Olfert; funding acquisition: Melissa D. Olfert; resources: Melissa D. Olfert; supervision: Melissa D. Olfert.
Declarations
Ethics Approval
This study was approved by West Virginia University’s Institutional Review Board (#1611355436).
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Conflict of Interest
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Rachel A. Wattick, Email: rawattick@mix.wvu.edu
Emily G. Saurborn, Email: es0071@mix.wvu.edu
Melissa D. Olfert, Email: Melissa.olfert@mail.wvu.edu
References
- 1.Mogre V, Stevens FCJ, Aryee PA, Amalba A, Scherpbier A. Why nutrition education is inadequate in the medical curriculum: a qualitative study of students’ perspectives on barriers and strategies. BMC Med Educ. 2018;18(1):26. doi: 10.1186/s12909-018-1130-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Adamski M, Gibson S, Leech M, Truby H. Are doctors nutritionists? What is the role of doctors in providing nutrition advice? Nutr Bull. 2018;43(2):147–152. doi: 10.1111/nbu.12320. [DOI] [Google Scholar]
- 3.Leslie FC, Thomas S. Competent to care. Are all doctors competent in nutrition? Proc Nutrit Soc. 2009;68(3):296–9. doi: 10.1017/S0029665109001293. [DOI] [PubMed] [Google Scholar]
- 4.Hu J, Raman M, Gramlich L. Current status of and recommendations for nutrition education in gastroenterology fellowship training in Canada. Nutr Clin Pract. 2018;33(2):191–197. doi: 10.1177/0884533617700852. [DOI] [PubMed] [Google Scholar]
- 5.AAMC. Curriculum topics in required and elective courses at medical school programs. https://www.aamc.org/data-reports/curriculum-reports/interactive-data/curriculum-topics-required-and-elective-courses-medical-school-programs. Accessed 5 May 2022.
- 6.Adams K, Butsch WS, Kolmeier M. The state of nutrition education at US medical schools. J Biomed Educ. 2015;7:1. doi: 10.1155/2015/357627. [DOI] [Google Scholar]
- 7.Bassin SR, Al-Nimr RI, Allen K, Ogrinc G. The state of nutrition in medical education in the United States. Nutr Rev. 2020;78(9):764–780. doi: 10.1093/nutrit/nuz100. [DOI] [PubMed] [Google Scholar]
- 8.Pang B, Memel Z, Diamant C, Clarke E, Chou S, Gregory H. Culinary medicine and community partnership: hands-on culinary skills training to empower medical students to provide patient-centered nutrition education. Med Educ Online. 2019;24(1):1630238. doi: 10.1080/10872981.2019.1630238. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lang RD, Jennings MC, Lam C, Yeh HC, Zhu C, Kumra T. Community culinary workshops as a nutrition curriculum in a preventive medicine residency program. MedEdPORTAL : the journal of teaching and learning resources. 2019;15:10859. doi: 10.15766/mep_2374-8265.10859. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Wood NI, Gleit RD, Levine DL. Culinary nutrition course equips future physicians to educate patients on a healthy diet: an interventional pilot study. BMC Med Educ. 2021;21(1):280. doi: 10.1186/s12909-021-02702-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Coppoolse HL, Seidell JC, Dijkstra SC. Impact of nutrition education on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students: an intervention study. BMJ Open. 2020;10(4):1–8. doi: 10.1136/bmjopen-2019-034377. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Nyenhuis J. P209 culinary medicine program improves physician resident’s nutrition knowledge and communication skills. J Nutr Educ Behav. 2019;51(7 Supplement):S126–S7. doi: 10.1016/j.jneb.2019.05.585. [DOI] [Google Scholar]
- 13.Kushner RF, Van Horn L, Rock CL, Edwards MS, Bales CW, Kohlmeier M, et al. Nutrition education in medical school: a time of opportunity. Am J Clin Nutr. 2014;99(5 Suppl):1167S–S1173. doi: 10.3945/ajcn.113.073510. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Puma J. Culinary medicine and nature: foods that work together. Am J Lifestyle Med. 2020;14(2):143–146. doi: 10.1177/1559827619895149. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Magallanes E, Sen A, Siler M, Albin J. Nutrition from the kitchen: culinary medicine impacts students’ counseling confidence. BMC Med Educ. 2021;21(1):88. doi: 10.1186/s12909-021-02512-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9 Suppl):S63–S67. doi: 10.1097/00001888-199009000-00045. [DOI] [PubMed] [Google Scholar]
- 17.Kattelmann KK, White AA, Greene GW, Byrd-Bredbenner C, Hoerr SL, Horacek TM, et al. Development of Young Adults Eating and Active for Health (YEAH) internet-based intervention via a community-based participatory research model. J Nutr Educ Behav. 2014;46(2):S10–25. doi: 10.1016/j.jneb.2013.11.006. [DOI] [PubMed] [Google Scholar]
- 18.Meade R, Colby S, Donaldson A, Franzen-Castle L, Plaggemeyer A, Kattelmann K, Kabala C, Mathews D, White J, Olfert M, White A. Influencers of family meal experience: iCook 4-H. J Nutr Educ Behav. 2014;46:S102. doi: 10.1016/j.jneb.2014.04.020. [DOI] [Google Scholar]
- 19.White AA, Colby S, Franzen-Castle L, Kattelmann K, Olfert M. iCook: A 4-H program to promote culinary skills and family meals for obesity prevention. J Nutr Educ Behav. 2013;45(-):S91. doi: 10.1016/j.jneb.2013.04.255. [DOI] [Google Scholar]
- 20.Hanson AJ, Kattelmann KK, McCormack LA, Zhou W, Brown ON, Horacek TM, et al. Cooking and meal planning as predictors of fruit and vegetable intake and BMI in first-year college students. Int J Environ Res Public Health. 2019;16(14):2462. doi: 10.3390/ijerph16142462. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Hagedorn RL, Baker K, DeJarnett SE, Hendricks T, McGowan M, Joseph L, et al. Katalyst pilot study: using interactive activities in anatomy and physiology to teach children the scientific foundation of healthy lifestyles. Children. 2018;5(12):1. doi: 10.3390/children5120162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Mathews AT, Famodu OA, Olfert MD, Murray PJ, Cuff CF, Downes MT, et al. Efficacy of nutritional interventions to lower circulating ceramides in young adults: FRUVEDomic pilot study. Physiol Rep. 2017;5(13):1. doi: 10.14814/phy2.13329. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.White JA, Hagedorn RL, Waterland NL, Barr ML, Famodu OA, Root AE, et al. Development of iGrow: a curriculum for youth/adult dyads to increase gardening skills, culinary competence, and family meal time for youths and their adult caregivers. Int J Environ Res Public Health. 2018;15(7):1. doi: 10.3390/ijerph15071401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Mihalynuk TV, Scott CS, Coombs JB. Self-reported nutrition proficiency is positively correlated with the perceived quality of nutrition training of family physicians in Washington State. Am J Clin Nutr. 2003;77(5):1330–1336. doi: 10.1093/ajcn/77.5.1330. [DOI] [PubMed] [Google Scholar]
- 25.McGaghie WC, Van Horn L, Fitzgibbon M, Telser A, Thompson JA, Kushner RF, et al. Development of a measure of attitude toward nutrition in patient care. Am J Prev Med. 2001;20(1):15–20. doi: 10.1016/S0749-3797(00)00264-6. [DOI] [PubMed] [Google Scholar]
- 26.Santella ME, Hagedorn RL, Wattick RA, Barr ML, Horacek TM, Olfert MD. Learn first, practice second approach to increase health professionals’ nutrition-related knowledge, attitudes and self-efficacy. Int J Food Sci Nutr. 2020;71(3):370–377. doi: 10.1080/09637486.2019.1661977. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Olfert MD, Wattick RA, Hagedorn RL. Experiential application of a culinary medicine cultural immersion program for health professionals. Journal of medical education and curricular development. 2020;7:2382120520927396. doi: 10.1177/2382120520927396. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Jaroudi SS, Sessions WS, 2nd, Wang VS, Shriver JL, Helekar AS, Santucci M, et al. Impact of culinary medicine elective on medical students’ culinary knowledge and skills. Proc (Baylor Univ Med Cent) 2018;31(4):439–442. doi: 10.1080/08998280.2018.1473742. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Hauser ME. A novel culinary medicine course for undergraduate medical education. Am J Lifestyle Med. 2019;13(3):262–264. doi: 10.1177/1559827619825553. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Wetherill MS, Davis GC, Kezbers K, Carter V, Wells E, Williams MB, et al. Development and evaluation of a nutrition-centered lifestyle medicine curriculum for physician assistant students. Medical science educator. 2018;29(1):163–172. doi: 10.1007/s40670-018-00655-4. [DOI] [PMC free article] [PubMed] [Google Scholar]