ABSTRACT
The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.
Introduction
The American College of Lifestyle Medicine outlines six pillars of lifestyle medicine to combat chronic disease: nutrition, physical activity, stress management, restorative sleep, social connection, and avoidance of risky substances [Citation1]. Despite the burden of chronic disease, U.S. medical students often lack education in preventive medicine and skills for counseling on healthy lifestyle modifications [Citation2,Citation3]. To address these deficits, there has been a call for innovative medical school curricula to teach basic lifestyle medicine tenets for wellness, as well as practical ways to mitigate risk factors, providing students with the tools to effectively counsel patients and implement personalized treatment plans [Citation2–5]. The Culinary and Lifestyle Medicine Track (CLMT) was developed and implemented at West Virginia University School of Medicine (WVUSoM) to supplement the existing medical school curriculum in the critical areas of nutrition, physical activity, sleep hygiene and stress management.
The deficiencies in these areas have been noted in the literature. For example, findings from medical schools surveyed by Association of American Medical Colleges identified that only 29% of medical schools provided the basic 25 h of nutrition instruction, and a majority of students and instructors perceived that nutrition education was lacking [Citation6]. As recently as 2023, only 34 culinary medicine programs have been identified that offer medical student focused culinary nutrition education [Citation2]. When surveyed, less than 20% of medical schools offered courses pertaining to physical activity [Citation7]. Moreover, primary care physicians have cited a lack of knowledge or training as a barrier to counseling patients on physical activity [Citation8]. Sleep disorders often go unrecognized in the clinic setting, and lack of sleep education in medical school is cited as a potential contributing factor [Citation9]. Sleep education represents less than 3 hours of didactic lectures in medical school [Citation10,Citation11]. Despite rising concerns of the effects of chronic stress in our society, most medical schools do not adequately prepare medical students to interview and counsel patients to improve mental health [Citation4].
To date, the majority of initiatives to improve delivery of these concepts to medical students include brief courses, workshops, and learning sessions within the traditional curriculum [Citation2,Citation3,Citation12–14]. The University of South Carolina School of Medicine Greenville is an example of a medical school that has taken a more comprehensive approach when integrating lifestyle medicine into the traditional medical school curriculum [Citation15]. However, there is a paucity of longitudinal tracks that integrate culinary and lifestyle medicine throughout both the preclinical and clinical years of students’ medical education [Citation2].
To address the shortage of longitudinal lifestyle medicine training in medical education, the Culinary and Lifestyle Medicine Track (CLMT) was created in 2018 to teach four foundational concepts of wellness: healthy nutrition, physical activity, stress management, and restorative sleep. Education on these topics is incorporated across 4 years of the medical school as a specialized track for students that are competitively selected in an interview process prior to starting medical school. The track incorporates both online and in-person activities that enrich the traditional curriculum including an orientation, hands-on Teaching Kitchens, online journal clubs, enriched Clinical Learning Group (CLG) sessions, a Summer Externship, an online and experiential clinical elective, a capstone project, and an optional certification exam in Culinary Medicine. Here we present the development, implementation, and initial findings of the CLMT curriculum.
Methods
Development
The CLMT is a collaborative program spanning all three campuses of the West Virginia University School of Medicine (WVUSoM) and all 4 years of the curriculum. It was built upon the core of the Medical Curriculum in Health Exercise and Food Sciences (MedCHEFS) program [Citation16], which is a curriculum of nutrition, culinary education, and physical activity offered to third-year medical students on the Eastern Campus of the WVUSoM since 2013. MedCHEFS was expanded to offer one Teaching Kitchen to every third-year student at WVUSoM in 2016. Based on positive feedback from students, the Dean of WVUSoM acknowledged the need to offer lifestyle medicine education to all interested medical students across all three campuses. Thus, a comprehensive culinary and lifestyle medicine program was developed with the support of WVUSoM leadership to better address the burden of chronic disease experienced within our state.
The co-directors and core CLMT faculty are composed of three family medicine physicians who are Certified Culinary Medicine Specialists (CCMS), including one physician who is board-certified with the American College of Lifestyle Medicine. The 60 credit-hour CCMS curriculum was created at Tulane School of Medicine by registered dieticians and physicians. The core faculty lead the majority of educational activities in the track. The core faculty are supported by two board-certified American Board of Obesity Medicine physicians (one internal medicine and one psychiatrist), two cardiologists (one of whom is CCMS certified), a pediatrician, an endocrinologist, an exercise physiologist, and an embedded behavioral medicine psychologist. The supporting faculty assist with didactic lectures and precepting during the Summer Externship and clinical rotations. A local chef with experience in healthy locally sourced food is also part of the faculty team and assists in creating menus for cooking classes and teaching culinary skills. CLMT students and faculty are located on the three campuses of West Virginia University: Morgantown, Charleston, and Martinsburg (Eastern Division Campus).
Curriculum materials pertaining to the four foundational concepts of wellness were identified and vetted by track faculty (Supplemental Table S1). The faculty utilize evidence-based resources from nationally recognized expert leaders within the fields of nutrition, physical activity, sleep, and stress management such as ACLM, American College of Cardiology/American Heart Association, American College of Sports Medicine, CCMS, and National Sleep Foundation. The Health meets Food (HmF) online culinary medicine curriculum teaches learners evidenced-based culinary and nutrition principles pertinent to multiple medical conditions and dietary components, for example Food Allergy and Carbohydrates, respectively [Citation17]. The HmF curriculum is the foundation of the CCMS course and exam, therefore the track faculty that are CCMS certified are intimately familiar with the HmF material. Attention was focused on creating educational experiences that address socioeconomic challenges, dietary and cultural preferences, and age-specific topics. A Curriculum Map was then developed spanning the 4 years of medical school (). The curriculum includes activities that are delivered in parallel to the preclinical and clinical years, like Teaching Kitchens, Journal Clubs, Externships, the online/experiential fourth year clinical rotation, and capstone project. There is deliberate scheduling of the track activities around required medical school work to optimize time management. There is also integration of some CLMT material into the traditional curriculum by enrichment of the Clinical Learning Group (CLG) Sessions (). This track was designed in Spring 2017 and received approval by LCME in October 2017. The initial class was accepted in spring 2018. Funding for track activities was obtained through institutional support, the West Virginia University Foundation Fund and the Rural Health Initiative (RHI) grant in collaboration with the WVU Institute for Community and Rural Health.
Table 1. Culinary and lifestyle medicine track curriculum map.
Implementation
In 2018, first-year students from the Class of 2021 were invited to apply for the track and eight students were selected. The application process has become increasingly competitive and selective and, due to increasing demand, acceptances have ranged from eight-sixteen per class. Prior to the start of their first year of medical school, students are given an in-person two-day orientation session for the track, where they meet the faculty, cook together, and learn about future activities. This is an opportunity for the students to meet like-minded classmates prior to commencement of classes. Expectations are clearly defined and the students are given an outline of how the educational activities integrate into their class schedules. During orientation, several research faculty members meet the students to introduce themselves and their research areas. Students are paired with research mentors throughout the 4 years of medical school as the students discover their interests.
During the fall and spring semesters of the first 2 years of medical school, the curriculum includes Clinical Learning Group sessions, Teaching Kitchens, and Journal Club sessions related to CLMT topics (). Clinical Learning Groups (CLGs) are small group case driven discussions outlining anatomy, physiology, medical terminology, and clinical skills in patient interviewing and physical exam techniques related to each body system (i.e., cardiovascular, neurologic, respiratory). While all medical students have 2 h CLGs as part of their Physical Diagnosis and Clinical Integration course, CLMT students are all placed in the same group led by CLMT faculty to enable the application of clinically relevant principles pertaining to healthy nutrition, physical activity, stress management, and restorative sleep to patient cases presented in each session. Teaching Kitchens consist of 4 h hands-on cooking classes where students complete an online Health meets Food clinical module on a specific topic before class (i.e., congestive heart failure), then come together and cook healthy recipes related to that topic. Each lesson consists of a 30 to 45 min video PowerPoint lecture covering pertinent physiology of a dietary component or medical condition. The nutritional impact of certain foods is discussed, and ideas for implementation of the dietary strategies are explored. There are also several required readings and a quiz to assess knowledge. The modules take approximately 2 to 3 h to complete. CLMT faculty (physicians and chef) and WVU Dietetic Interns are present to lead the cooking class and offer students guidance on cooking techniques and offer practical clinical pearls to share with patients. Menus for the classes include recipes that are tailored to culturally diverse cuisine and different dietary preferences, for example, vegan and vegetarian diets and lower carbohydrate diets. Dietary challenges across the lifespan are also addressed, including childhood, pregnancy, and geriatrics. After cooking, students and faculty eat together and discuss patient cases related to the module. During the COVID-19 pandemic, CLMT faculty adapted Teaching Kitchens to be delivered virtually using video conferencing with students and faculty participating from home. When constraints regarding COVID were relaxed, a return to in-person kitchens was accomplished.
The Summer Externship, which takes place between the first and second year of medical school, is a cornerstone of the CLMT, allowing students to come together for a paid, immersive, 2-week experience in culinary and lifestyle medicine. Students live together in housing obtained with track funding for at least 1 week of the externship to experience planning and cooking healthy meals for themselves as a group. They have three Teaching Kitchens and participate in community service activities including planning and executing a community cooking demonstration and participating in a community walk. Students are tasked with creating low-cost menus for the community cooking demonstration to address patient differences in socioeconomic status. There are didactic lectures from core and adjunct CLMT faculty from across the state with topics related to taking a lifestyle medicine history, sleep apnea, eating disorders, pediatric diet, food safety, and writing an exercise prescription. They also have the opportunity to use culinary and lifestyle medicine interviewing skills with patients in a variety of clinical settings and precept with clinical faculty. During the summer externship, students with expressed research interests are typically paired with faculty members with similar interests.
Third-year students are assigned one HmF module per clerkship that complements their clinical work (i.e., “The Pediatric Diet’’ on the Pediatric Clerkship, ‘Congestive Heart Failure’ on the Internal Medicine Clerkship, and ‘Food and Neurocognition’ on the Neurology Clerkship). In the fourth year, all CLMT students take a 4-week elective rotation in culinary and lifestyle medicine. Two weeks of the rotation are an online class entitled Lifestyle Solutions for Common Chronic Medical Diseases, which was developed by a CLMT faculty member and WVU SoM student and is available to CLMT students and all fourth-year medical students at WVU School of Medicine. The online class includes HmF modules and additional modules created by CLMT faculty and faculty from the Exercise Physiology department. The remaining 2 weeks are hands-on in the clinic, allowing them to precept with identified clinical faculty and to utilize their Lifestyle Medicine clinical skills. These clinical faculty have a personal interest in culinary, lifestyle or obesity medicine, and include both primary care and specialty physicians.
Through participation in the CMLT, students can choose whether they want to pursue Culinary Medicine Certification by sitting for the CCMS exam. The Culinary Medicine Certification Board (now called the American College of Culinary Medicine) offers the opportunity to take the exam if students complete the sixty credit hour curriculum that consists of all of the HmF online modules, additional required readings, and completion of required teaching kitchens. The exam does incur a cost to the student. In the first 2 years, the CLMT provided 25% of the funds to cover the cost of the CCMS exam. The cost of the exam was prohibitive for some of the students, therefore the financial support was increased to cover 75% of the costs for subsequent classes.
With the geographic distance between the three WVU School of Medicine campuses, video conferences are held periodically to connect with all CLMT students for Journal Clubs, discussion of winter break assignments, and discussion of student progress in the track and CCMS exam requirements. Development of the skills to critically appraise the medical literature and practice evidence-based medicine are central tenets of the track. Journal Clubs are held in-person during orientation and the summer externship, and virtually in the fall and spring semesters to review evidence-based journal articles and patient cases related to healthy nutrition, physical activity, stress management, and restorative sleep ().
Track requirements for graduation
Students who achieve the following requirements graduate with a certificate of completion from the WVU SoM CLMT:
Attend Orientation
Attend the Summer Externship
Attend a least four Teaching Kitchens
Attend at least four Journal Club sessions
Complete four Winter Break Assignments
Complete at least twenty HmF nutrition modules
Complete the 4-week elective in culinary and lifestyle medicine during their fourth year
Complete at least one capstone scholarly activity/project pertaining to any of the four foundational concepts of culinary and lifestyle medicine.
It is encouraged that the students present their research at a conference of their choice, but not required. It is also encouraged that they take the CCMS exam, however not required for graduation.
Curriculum evaluation
Several key measures are tracked to evaluate the curriculum including student feedback surveys, the number of applications and acceptances each year, the specialties students choose, the type of community service and research projects completed, and the number of students that have taken and passed the CCMS certification exam. Initially, the program was evaluated using a voluntary quantitative and qualitative pre- and post-survey of the first graduating CLMT Class of 2021, however due to low response rate on the optional pre-survey, the evaluation transitioned to an exit survey given to each graduating class commencing with the Class of 2022. The exit survey is voluntary and is electronically distributed to students using Qualtrics software. The exit survey gathers feedback on each component of the track: orientation, Journal Club sessions, Teaching Kitchens, Summer Externship, 4-week culinary and lifestyle medicine elective, their capstone project, and the CCMS exam. Feedback is also gathered on the organization, administration and communications of the track. The exit surveys were collected and analyzed in Qualtrics. Student responses were grouped into dominant themes for each component of the track based on the frequency they occurred in the free text responses. The survey results were then reviewed by the core track faculty each year. Prominent themes were evaluated and several were chosen to improve upon the curriculum the following year.
Challenges
There were several challenges in developing and implementing the CLMT. After gaining approval from the Dean of WVU SoM, the track had to be approved by the Curriculum Committee at WVUSoM. After approval with the Curriculum Committee, the formal outline of the curriculum for the track and goals and objectives had to be submitted to the Liaison Committee for Medical Education (LCME). The outline had to include how the track goals and objectives aligned with WVUSoM’s mission and objections. The writing of the curriculum and approval process took 9 to 12 months.
Funding was also a challenge and was obtained through Dean funds, Chair funds, private donors, and grants. Funding was required for the following: ten percent protected time for each of the three core faculty members, ten percent protected time for the local chef, thirty percent protected time for a Program Coordinator, stipends for the students’ Summer Externship, housing for the Summer Externships, food for the Teaching Kitchens, CCMS exam fees, and teaching supplies like reference books.
Securing kitchen space for the Teaching Kitchens can be challenging and required interdepartmental collaboration with the Dietetics Department at WVU in Morgantown and the Health Science Center in Martinsburg. Finding preceptors for the Summer Externship and fourth year experiential clinical rotation in lifestyle medicine was also a challenge due to the limited number of faculty with expertise in lifestyle medicine and the growing number of track students. Core faculty found champions on all three campuses by networking with faculty at meetings which helped to facilitate scheduling rotations with interested faculty on all three campuses.
Results
Initially, it was anticipated that four students may apply to the CLMT. Eight students applied, prompting CLMT faculty to seek approval to accept all eight students. The number of applications have increased over the last 4 years (). Due to the quality and increased quantity of applicants, the ability to deliver curriculum materials online without increasing administrative costs, and the availability of grant funding to cover Summer Externship housing, acceptances for the Class of 2025 were expanded to 16. After that class, acceptances were again capped at 10 per class due to limitations in preceptor availability during the Summer Externship and fourth-year online and experiential elective rotation.
Table 2. CLMT applicants and acceptances into the CLMT, number of graduates, CCMS** pass rate, and student residency choices.
Since its inception, 73 students have been accepted into the track. Forty students have graduated from the track. Residency interests represent a wide range of medical specialties, both surgical and nonsurgical. The first four graduating classes of the CLMT students were selected to enter a wide variety of residences. These residencies include Dermatology (1), Emergency Medicine (1), Emergency Medicine/Internal Medicine (1), Family Medicine (6), Internal Medicine (8), Neurology (1), Neurosurgery (2), Obstetrics and Gynecology (4), Orthopedics (2), Pathology (1), Pediatrics (4), Physical Medicine & Rehabilitation (1), Psychiatry (6), and research (2). Twelve of the forty students that have graduated from the CLMT have taken the CCMS exam and they have had a 100% pass rate (). Class size fluctuated slightly from year to year because of student academic remediation, early graduation in our Mountaineer Accelerated Track To Enter Residency (MATTER) programs, or students taking an additional year to attend fellowships and/or do research. Unfortunately, there have been two students who have withdrawn from medical school prior to their clerkship years.
While only one scholarly activity was required to graduate from the track, the first three graduating classes of 29 students have completed at least 31 scholarly activities including research projects, quality improvement endeavors, community outreach projects, and medical education and interdisciplinary initiatives (). Many students have presented their work as oral and poster presentations at both local and national conferences. Current classes have continued that trend, including involvement in NIH-funded research related to lifestyle medicine.
Table 3. Scholarly, community, and interdisciplinary activities.
Results that informed the continued refinement and improvement of the track came from exit survey responses from the Class of 2022 and 2023. These surveys highlighted elicited benefits and provided constructive feedback related to each component of the track (). Students indicated benefits obtained from being involved in track activities that included: meeting and bonding with classmates prior to commencement of medical school, relieving stress by participating in Teaching Kitchens, learning new cooking techniques, participating in research, learning patient-oriented communication skills in the externship and in-person lifestyle medicine clinical rotations, and gaining talking points for residency interviews. Feedback on potential improvements were grouped into themes: delineating expectations and time commitments of the track more clearly at orientation; improving Journal Club by keeping journal club to 45 min and having students choose and lead the journal club discussion with faculty supervision; scheduling the Summer Externship so that it does not interfere with other externships; creating clear expectations for clinical faculty for the externship and fourth year in-person lifestyle medicine rotation; engaging third- and fourth-year students more closely in track activities; increasing funding for the CCMS exam and creating more robust study materials for the CCMS exam. Based on this feedback, students in the second CLMT class created more study materials for the CCMS exam, utilized by subsequent classes for CCMS exam preparation. More funding was obtained to cover students’ CCMS exam costs, which led to an increase in students taking the CCMS exam this year. Track expectations are more clearly outlined during orientation. Journal clubs were shortened and driven by students in selecting the journal club theme/article and in leading the discussion. The Summer Externship was scheduled earlier in the summer to accommodate other externships. There is now more communication with faculty preceptors regarding expectations and objectives for their Summer Externship and fourth year experiential electives. Faculty meet with third and fourth year students by video conferencing to make sure they are more engaged in the track and complete required assignments.
Table 4. Exit survey responses from class of 2022 and 2023 (n = 24) (number of students).
Students’ written responses in the exit survey indicated the value of the track experience to their residency interviews, as demonstrated in the following student quotation: ‘An interviewer said the CLMT was one of the most unique [and] interesting things he’s seen on a resume in a long time. I got asked about CLMT over and over in my interviews.’ Written responses also included comments on the versatility of track application to both surgical and nonsurgical specialties as demonstrated in another student response. As one student reflected, ‘I plan on going into [orthopedics] so although my day-to-day may not directly be related to health/wellness, I think I can use many of these skills in both pre and post operative patients. I found that many patients with [musculoskeletal] related issues could benefit from lifestyle modifications in addition to interventions. In addition, I will continue to use the skills for my own personal wellbeing.’
The vast majority of students noted the positive impacts of the CLMT on their personal wellbeing and how CLMT positively impacted their clinical skills in counseling patients effectively in lifestyle changes. Seventeen of the twenty-four respondents noted the positive impact that the track had on their personal wellbeing. One student commented, ‘This track has [provided] me with a wealth of information that can be translated into improving my own dietary habits, sleeping habits, social/stress management habits, and physical fitness habits.’ Another student reflected, ‘Participating in this track caused me to reflect on my own diet and lifestyle choices. I am still a picky eater – but I have started trying new foods that fit into the Mediterranean diet. I eat more seafood, nuts, and fruits/vegetables than I did prior to starting medical school.’ Another student stated, ‘Learned lots of mechanisms to de-stress, eat healthy, and sleep better. Honestly helped me be a better student by learning how to take care of myself. If we are going to teach this information to our patients, it is helpful if we walk the walk too.’ Sixteen of the twenty-four student respondents had positive comments regarding practical skills that they learned in the CLMT. One student reflected, ‘I plan on using what I learned to counsel my patients on making diet/lifestyle changes. I think it is so easy to tell a patient that they need to eat better, but actually being able to sit down with a patient and set specific/attainable goals will be a big part of my future practice.’ Another student wrote, ‘I want to work in preventative medicine. I want to continue counseling patients on their SMART goals and finding ways to help them overcome any obstacles. I think it is so important to take time to sit down and think of specific goals with my patients to improve their lifestyle. I want to write prescriptions for nutrition and physical activity.’ Another stated what skills they may use in their future practice based on what they learned in the CLMT, ‘Being able to speak with patients about their health through food, exercise, and sleep. I feel confident in my ability to speak on these topics, so I will be more likely to incorporate them into my practice.’
Students who chose to take the CCMS exam commented on the significance of obtaining the certification and how it would impact their future career. One student commented, ‘I think it is a great way to reflect the work put into this course. In addition, I think it is great to have a certification to show that we learned the material.’ Another student reflected, ‘I want to be certified so I can educate my patients and continue culinary and lifestyle medicine.’ One student reflected on the importance of the CCMS exam in their education to ‘force [them] to internalize modules and apply them in case scenarios.’
Discussion
The West Virginia University School of Medicine Culinary and Lifestyle Medicine Track is a comprehensive, longitudinal track focusing on healthy nutrition, physical activity, stress management, and restorative sleep that offers approximately 300 h of lifestyle medicine education over 4 years of medical school, addressing known deficiencies in education [Citation6,Citation7,Citation9,Citation10]. This curriculum was implemented in a land grant university across multiple satellite campuses in a predominantly rural state facing some of the highest chronic disease and obesity burden in the country. As indicated by Newman et al. 2023, it is imperative to identify elements of success in culinary and lifestyle medical school educational programs to share best practices in order to inform and standardize future programs [Citation2]. Based on our experience in development and administration of the track, this paper has presented the methods and lessons learned. The longitudinal delivery over 4 years allows breadth of lifestyle topics covered by the curriculum and flexible delivery both online and in-person, continued interest in the track by medical students, and increasing number of students taking and passing the CCMS exam are all key outcomes of the track to date. Students note how this comprehensive educational experience has positively affected their medical education in their exit survey responses. Funding has been cited as a barrier to implementing these types of educational programs [Citation2], however with increased donor and grant support, this program has remained financially sustainable since 2018. The findings presented here will contribute to the development of best practices to inform and standardize future programs.
Successful components intentionally built into our approach were the longitudinal structure of the program; diversity of the topics covered including nutrition, physical activity, stress management, and restorative sleep; and, delivery of individual components of the track (orientation, Teaching Kitchens, Summer Externship, Journal Club sessions, fourth year online and experiential elective rotation, and scholarly activity). Previous studies have indicated the success of nutrition and culinary medicine educational programs; however, they entailed at minimum one learning session/Teaching Kitchen up to culinary education delivered over two semesters in medical school [Citation2]. No programs noted in the scoping review of nutrition education in medical school spanned up to 4 years and included education on physical activity, sleep and stress management [Citation2]. Several unanticipated benefits of the track were the degree of interest among students who entered into a broad range of specialties, both surgical and nonsurgical, and the value of the track to students’ residency interviews. It is expected that students interested in primary care residencies may be interested in lifestyle medicine, however those students choosing procedural/surgical residencies also recognize the importance of lifestyle medicine in their chosen specialty and the population they would serve.
Another unexpected benefit of the track was the interdisciplinary collaborative efforts in curricular development, community engagement, and scholarly activity. CLMT faculty have engaged clinical faculty that span a range of specialties and embrace lifestyle medicine concepts of teaching to make the best use of student and faculty time together during the Summer Externship as well as their fourth year elective rotation. A reciprocal relationship was developed with faculty of the Agriculture-Science Division giving the track access to their teaching kitchen paired with having dietetic graduate students participate in the Teaching Kitchens and come to the Eastern Division campus for rotations with our faculty to get more clinical experience. Efforts were also made by the CLMT core faculty to improve communication with collaborating medical faculty members to ensure clear expectations for their clinical rotations with CLMT students. With the support of an exercise physiologist, core faculty and track students created three new online physical activity modules for the fourth year elective online course Lifestyle Solutions for Common Chronic Medical Diseases. Students in the CLMT have developed community engagement activities and research activities in collaboration with a vascular surgeon, medical weight loss specialists, an endocrinologist, pediatricians, and obstetrics and gynecology resident physicians.
The collaborative efforts also achieved considerable scholarly activity that far outpaced the requirement of one project per student. The caliber of scholarly activity with NIH-funded projects and students presenting nationally was also beyond expectation. One project in particular, ‘Walk with a Future Doc’ which was started by three CLMT students in 2020, has shown sustainability and is ongoing today. Walk with a Doc is a national organization promoting physical activity with medical presentations, and the CLMT students started a local chapter at the school. The program consists of 1 h walks every other week on Saturday mornings and includes an invited guest that speaks on a specific lifestyle medicine topic followed by a question answer session. This program is maintained by the CLMT students, but invites others to join as well.
The Summer Externship was found to be a key component of the program. The Culinary and Lifestyle Medicine Track faculty found that having the students live together for at least 1 week of the externship has been a key element in encouraging student wellness, sharing of skills and knowledge, and creating a team-like atmosphere. During the externship, community teaching demonstrations are an essential part of the experience. Exit survey findings indicated that when the medical students returned to their second year of their curriculum, they were excited to continue community outreach activities introduced to them as first-year medical students and this was reflected in their scholarly activity production.
Several limitations were identified during the implementation of the track. These include class size constraints and evaluation of the track processes and outcomes. The necessity of limiting class size became apparent with the simultaneous enrollment of our third class and recruitment of preceptors for both the Summer Externship and fourth year elective in Culinary and Lifestyle Medicine. The number of preceptors with the needed expertise in lifestyle medicine is limited, and this can place a strain on preceptor availability. Ultimately, this resulted in acceptances being capped at 10 students per class to ensure stability and continuity of a core CLMT preceptor team. Since the initiation of the track, a central focus has been on the continual assessment and revision of the curriculum and educational activities based on informal and formal student and faculty feedback. As has been experienced by other implemented lifestyle medicine curricula [Citation18], objective evaluation of the track has been limited due to the low response rates of voluntary surveys. While exit surveys to date have been essential to making constructive changes, a more complete evaluation is needed to fully assess and revise over time. Similarly, measurement of track impact on student and patient outcomes has been hampered by the use of voluntary surveys alone. We plan to address this moving forward with an incentivized survey assessing student attitudes, beliefs, behaviors and competencies at baseline and upon completion of the track. The baseline and exit survey will also include track focused evaluation measures regarding the organization, delivery, and administration of the track and will be coupled with yearly interval surveys to allow for refinement of track activities. Now that three classes of CLMT graduates are in residency training, it is also an opportune time to create surveys assessing graduates’ use of culinary and lifestyle medicine in their own practices. We will begin the development of those surveys for distribution upon their graduation from residency training. Due to the nature of medical school training and the lack of continuity, measuring patient outcomes related to patient interaction with track students is difficult to assess. Measuring patient outcomes may be a feasible goal if such a track was implemented in a residency program where resident physicians have continuity clinics; however, this concept is more difficult to achieve in the medical school clinical years. We are currently working with our family medicine residencies at two WVU SoM sites to develop residency tracks in culinary and lifestyle medicine.
Since the track’s inception, the value of lifestyle medicine has garnered increased recognition from our medical school faculty and administration. There is now a medical nutrition therapy lecture discussing lifestyle change and carbohydrate reduction as part of the pharmacology curriculum to treat insulin resistance and diabetes, led by one of the CLMT faculty. All third-year students in the school receive a nutrition lecture in their orientation week, as well as a physical activity and sleep lecture during their ‘wellness week’. All third-year students also participate in one Teaching Kitchen about nutrition for patients with congestive heart failure. An online fourth year nutrition elective was created by a student-CLMT faculty team, and approximately half of the fourth-year class has enrolled for the last several years. Independent of track requirements, our students have sparked a ripple effect among their peers by leading a Culinary (now Lifestyle Medicine) interest group, participating in community health research, leading cooking classes for the community, and creating an online lifestyle medicine repository for their peers to reference for personal wellness and professional use.
It is our hope that the curricula and activities created from the track will be adopted and refined by other medical schools and allied health programs across the country to further build a foundation of capacity to fully address and ease the chronic disease burden of patients and communities. The versatility of the virtual or in-person delivery of this track’s curricular materials and the variety of smaller track components that could be adopted individually make it a viable option for implementation at schools with varying levels of available resources.
Supplemental Material
Download MS Word (16.5 KB)Acknowledgments
The authors would like to thank the CLMT Faculty: Dr Jonathan Deiches, Dr Sarah Moerschel, Dr Laura Davisson, Dr Sarah Rinehart, Dr Annette Freshour, and Chef Scott Anderson. We would like to thank the CLMT coordinator, Michelle Alder. Thank you to Carla Toolan, Research Coordinator, for her efforts in helping to write this manuscript. Thank you to the West Virginia University Foundation Fund for its support of our program. In addition, thanks to April Vestal, Director of the WVU Institute for Community and Rural Health for including us in their RHI grant funding. A special thanks to Dr. Konrad Nau who was the author of the original MedCHEFS grant that made all of this possible.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/10872981.2024.2372919.
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References
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