Seven of the top ten causes of death globally are attributable to non-communicable causes, including cardiovascular disease (CVD), stroke, chronic obstructive pulmonary disease, cancers attributable to smoking, dementia-producing diseases, diabetes mellitus, and kidney disease . Non-communicable diseases are particularly prevalent in high-income countries, where most communicable diseases have been successfully controlled. For example, in the USA, heart disease, stroke, and diabetes are in the top seven causes of death .
Treatment and prevention of non-communicable diseases is therefore an important topic for health care professionals, yet the most effective interventions are often overlooked in medical education. The CDC estimates that the elimination of three key risk factors: poor nutrition, inactivity, and smoking, would prevent 80% of heart disease, stroke, and type 2 diabetes. Of the three, nutrition is the most critical component to preventing premature CVD deaths [3, 4] as well as helping manage or prevent other non-communicable diseases. For example, heart disease, stroke, and diabetes are often preceded by elevated blood pressure, raised blood glucose and cholesterol levels, and excess body weight, all of which may be addressed by a healthier diet. Diet has been identified as the single most significant risk factor for disability and premature death in the USA .
Coverage of nutrition and its influence on health issues in the medical education curriculum is not in alignment with the prevalence and seriousness of the diseases stemming from a poor diet. There is an abundance of research indicating nutrition is a key component in preventing or managing important and common diseases, and the poor coverage within the medical school curriculum has been recognized for over 30 years. The National Academy of Science recommended in 1985 that medical schools include a minimum of 25 hours dedicated to nutrition . However, in 2015, a study which included 121 allopathic medical schools in the USA found that only 29% met or exceeded the recommended hours of instruction . A separate study of 26 osteopathic medical schools revealed that only 15% met the recommended hours of nutrition instruction .
The sub-optimal level of nutrition education is particularly surprising in osteopathic medical schools. Osteopathic medicine was founded by A.T. Still, who asserted that environmental, cultural, social, mental, and behavioral factors should be addressed by any management plan produced by a health care provider , indicating a whole-person, patient-centered philosophy for treating disease. Schools that produce osteopathic doctors (DOs) are primarily responsible for training primary care providers. In 2019, 56.5% of osteopathic physicians identified their specialty as primary care . By virtue of their guiding philosophy and the primary care focus of their students, osteopathic medical education should be at the forefront of preventative medicine .
It is important that primary care providers (PCP) be equipped to recognize, coordinate, and manage diet-related problems and health conditions because they are the members of the health care team who make initial contact with a patient and decide on who else should be involved in the patient’s care . Although it is true that registered dieticians and nurse practitioners may be the members of the health care team who have proven effectiveness for patients in the area of nutrition counseling , the PCP must first recognize that nutrition is a component of a patient’s problem and involve the necessary personnel. If a PCP has knowledge of nutrition, he or she is more likely to think about nutrition counseling as a component of care to prevent, reverse, or improve outcomes in non-communicable disease. If a PCP personally practices the tenets of good nutrition, even greater gains may be realized.
Poor coverage of nutrition in the medical school curriculum prevents physicians from taking their rightful place as nutrition advisors and lifestyle role models to prevent or manage nutrition related diseases. A majority of patients (61%) consider doctors to be “very credible” sources of nutritional information , and some of the credibility is based on perception of the physician as a role model. For example, patients who watched a video of physicians disclosing their own healthy habits regarding both exercise and diet found the physicians to be significantly more believable and motivating when counseling individuals on nutrition and a healthy lifestyle . There is ample evidence that physicians who practice healthy nutrition habits are more likely to counsel their patients on healthy habits [13, 14]. The current reality is that primary care providers report difficulty in counseling patients about behaviors that they themselves struggle with and do not practice . In a recent study, only 14% of resident physicians believed themselves adequately trained to provide nutritional counseling .
Therefore, there is a significant need for medical schools to offer a strong nutrition education curriculum with an emphasis on managing special diets, not only for patients but also for future physicians. This curriculum should also include guidance on how to counsel patients in a sensitive and professional manner as improving nutrition can require major lifestyle changes, and counseling is more effective when the person recommending a change exemplifies the desired behavior in his or her own life. Most nutrition education takes place during the preclinical years, with very little instruction received during clinical training , so it is during undergraduate medical education (UME) that the problem should be addressed. The UME curriculum is crowded with requirements associated with accreditation and standardized examinations, so solving the problem associated with delivering an adequate nutrition education calls for a creative approach, such as offering a nutrition education elective with an active learning component.
Nutrition education is ideally suited for experiential learning because the purpose of nutrition education is not only to provide accurate information about the updated practices in the subject matter, but also to influence future physicians to adopt healthier nutritional behaviors. Mauriello and Artz reported on the burden of chronic diseases on health care costs and the need for focusing more of health care on lifestyle and nutrition to reduce these costs . They indicate that training future physicians using a hands-on approach called “culinary medicine” is the ideal method to alleviate the burdens associated with nutrition-related chronic disease . La Puma defined culinary medicine as “a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine” . He adds that “culinary medicine is aimed at helping people reach good personal medical decisions about accessing and eating high-quality meals that help prevent and treat disease and restore well-being” . It gives participants the opportunity to learn not only the pathophysiology behind nutrition-linked diseases and which foods to use for specific conditions, but also teaches how to transform ingredients into tasty meals. The goal of culinary medicine is to impart knowledge that physicians can then use to improve their own diets in addition to advising patients in practical ways. Medical students trained in culinary medicine, as opposed to traditional education, report an improved fruit and vegetable diet and better attitudes and competencies in the area of nutrition .
The purpose of this descriptive study was to explore an alternative way to provide nutrition education without adding hours to the formal curriculum by (1) surveying student perceptions regarding current nutrition education, (2) surveying student interest in attending a nutrition elective, (3) selecting how the elective could best be delivered, and finally (4) running and assessing participants’ reactions to a short experimental version of the elective. The overarching goal was to provide future physicians with relevant and actionable nutrition education through a focused clinical nutrition elective with a culinary medicine component.