Medical schools teach students about diet-related diseases such as scurvy and rickets -- conditions most physicians aren't likely to see in everyday practice -- but what are we teaching the next generation of doctors about nutrition itself? At a time when more than one-third of U.S. adults are obese,(www.cdc.gov) less than one-third of U.S. medical schools(www.hindawi.com) actually provide students the minimum recommended 25 hours of nutrition instruction.
The West Virginia University School of Medicine's Medical Curriculum in Health, Exercise and Food Science -- MedCHEFS -- program teaches students to talk with patients about healthy eating.
Although chronic disease practice guidelines uniformly call for lifestyle change as first-line therapy, fewer than one in four physicians feels adequately trained(bipartisanpolicy.org) to counsel patients about making such changes.
This is especially alarming in light of the World Health Organization's prediction that by 2020, two-thirds of all disease worldwide will be the result of lifestyle choices. Lifestyle factors -- including nutrition, physical activity and stress -- are critical determinants of health and, when poorly managed, can cause a veritable pandemic of chronic disease and unsustainable health care costs. Yet despite overwhelming connections between lifestyle factors and disease, most medical schools lack a cohesive approach to helping students translate their basic science education into practical patient advice and care.
In West Virginia, which ranks among the most obese states in the nation,(www.cdc.gov) we've decided to do something about it.
We developed a program called MedCHEFS(wvuhealth.hsc.wvu.edu) -- Medical Curriculum in Health, Exercise and Food Science -- that teaches students to talk with patients about healthy eating. And those conversations are based, at least in part, on the students' own experiences in the kitchen rather than on learning that is limited to lectures or readings. Dietitians teach students how to shop for healthy foods, and professional chefs show them how to use those foods -- fruits, vegetables, herbs and spices -- to create meals that are good, quick, healthy and affordable.
When the students become practicing physicians, they can teach patients to fit food as medicine into their lives. Is spinach too expensive this week? Our students learn how to identify and use money-saving substitutions. Does little Susie turn up her nose at veggies? Slip them into something she loves.
In the MedCHEFS program, third-year medical students have four cooking classes in a teaching kitchen. Chefs also work with the students in the classroom setting.
"I can suggest adding them to muffins because we made zucchini muffins last week," one student told us. "I know it was easy to do and tasted good."
Imagine the benefits of more physicians being able to deliver practical advice to engaged patients. This needs to happen, and family physicians can lead the way.(www.npr.org)
So how did we do it? How did we put our program together? West Virginia University's Eastern Division was awarded a dean’s grant for innovative curriculum (based on a proposal written by four family doctors and a pediatrician) to teach nutrition, culinary science and exercise as medicine to all of the third-year medical students on our regional campus. Having a longitudinal, integrated curriculum allows some flexibility in scheduling, which gave us a bit of leeway in the initial delivery of the curriculum during the 2012-13 academic year.
However, the dean challenged us to find a way to incorporate this education at our school's two other campuses, which use traditional block clerkship scheduling. Starting this summer, we are bringing some components of our curriculum to the third-year students at those campuses.
The field of nutrition science is continuing to evolve, and there are conflicting recommendations as to what constitutes a healthy plate. Using the plethora of information on the Web and AAFP published guidelines(9 page PDF) for resident nutrition education, we developed a practical course.
Our goal was to create a thought-provoking experience for the students that would inspire them to stay tuned in to ongoing nutrition conversations, as well as those in the exercise as medicine movement, while at the same time guiding them toward decisions about how to discuss these topics with their patients.
Components of our MedCHEFS curriculum(www.fmdrl.org) include
- instruction on the didactics of a healthy plate, plus specifics about each food group;
- patient simulation exercises that include motivational interviewing, lectures, readings and experience with a standardized patient;
- a workshop about safe walking and running and exercise as medicine;
- experience in a teaching kitchen;
- an introduction to nutrition-related public policy, including attending lunch at a public school;
- clinical teaching cases in six specialty areas;
- classes with local chefs and nutritionists, as well as faculty, to cover shopping and meal planning for different family needs and using spices and herbs for health as well as taste;
- instruction on the psychology of eating, as well discussions on bias in medicine toward people who are obese; and
- a student-led, communitywide teaching session on the latest in nutrition and exercise.
General principles we teach involve eating whole foods (locally produced, if possible), limiting foods with many additives, preservatives and sugars, and drinking plenty of water.
Students were surveyed before and after the course, and statistically significant gains were seen in their understanding of the importance of discussing nutrition and exercise with patients, their knowledge of nutrition principles, and their confidence in their ability to talk with patients about it. Students also indicated they would be more likely to bring up the issue of nutrition in conversations with patients.
A study published recently(journals.lww.com) in Academic Medicine offered nine recommendations to expand the culture and content of medical education, including the ways we eat, move, think, sleep and relate to one another in our global village. Training medical students in these topics throughout all four years of undergraduate medical education will create a new generation of physicians with the knowledge, skills and tools to improve and sustain their own health behaviors and those of their patients.
The faculty from MedCHEFS has recently joined the Society of Teachers of Family Medicine's revived Nutrition Education group(www.stfm.org) to continue to explore ways all medical schools can provide this type of education in clinical years.
Family doctors can lead the way. Please join us.
Rosemarie Cannarella Lorenzetti, M.D., M.P.H., and Konrad Nau, M.D., are professors of family medicine at West Virginia University and serve as co-directors of the school's MedCHEFS program. Cannarella Lorenzetti also is associate dean for student services and academic achievement. Nau also is associate vice president for health sciences and dean of the School of Medicine's Eastern Division.