Culinary Medicine: Needs and Strategies for Incorporating Nutrition into Medical Education in the United States.

In the past decade, medical education has increasingly incorporated evidence-based lifestyle interventions as primary strategies for preventing and managing noncommunicable diseases. This shift embraces the growing recognition of the significant impact of lifestyle on health outcomes, driving diseases including obesity, diabetes, heart disease, and cancer. Now deemed "food is medicine" (FIM), diet-related interventions witnessed integration into healthcare systems and recognition in the United States' White House Conference on Hunger, Nutrition, and Health in 2023. As FIM gains traction, investigating optimal strategies for team-based education becomes essential. Healthcare teams need the necessary knowledge and tools to effectively administer FIM services and collaborate across disciplines, ultimately enhancing disease prevention, chronic disease management, health quality, value, and overall wellness. Culinary medicine (CM), a vital component of FIM, bridges nutrition education, pragmatic culinary skills, and conventional strategies to improve chronic disease management. CM involves experiential learning, imparts practical skills, and encourages behavior change by addressing food-related determinants of health and promoting equitable access. Teaching kitchens serve as physical or virtual learning spaces and as a didactic and experiential method (skills lab), playing a crucial role by integrating culinary, lifestyle, integrative, and conventional medicine. A growing number of medical schools in the United States and globally offer CM education via diverse methods including interest groups, electives, and specialty tracks, encompassing didactic sessions, hands-on kitchen education, and virtual teaching methods. Given the rising demand for CM programs, this article aims to describe, map, and compare existing CM education types in medical education. It provides actionable recommendations for medical schools to establish and expand CM programs by fostering service-learning partnerships, clinical innovation, and interdisciplinary research. As FIM gains prominence, cultivating a robust foundation of educational strategies is vital to ensure seamless integration into both medical education and collaborative medical practice.

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education.

Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.

Assessing the Impact of Nutrition Training Among Medical Students.

Introduction: Nutrition education remains inadequate in American medical schools, and physicians often cite lack of nutrition knowledge as a barrier to counseling patients. The goal of this study was to evaluate the impact of additional nutrition curriculum on first-year medical students. Methods: We created a 1-hour nutrition lecture, delivered to first-year medical students. Using pre-, post-, and 3-month follow-up surveys, we assessed the following: (1) change in student knowledge; (2) confidence in counseling patients; (3) motivation to change their personal dietary behaviors; and (4) satisfaction with the curriculum. We assessed objectives using multiple choice questions and 10-point Likert scale questions. Results: Of the 142 students who attended the live lecture, 105 (73.9%) completed both pre- and postsurveys, and 65 (45.8%) completed the 3-month follow-up survey. Students' knowledge of the material increased from 37% to 82%, but retention dropped to 65% at the 3-month mark (P<.001). Comfort in assessing and counseling patients improved across the three survey iterations, from 3.53 to 5.90 to 8.00 (P<.001). Motivation to change personal behaviors was high overall at 8.04, 8.36 and 8.25 [P<.05]). Moreover, students were satisfied with the lecture, with a rating of 8.58/10. Conclusions: This study supports the value of additional medical student nutrition education. This curriculum significantly increases student knowledge, comfort with the material, and confidence in counseling their future patients. A longitudinal curriculum that reinforces concepts over time will help improve long-term retention.

An 8-Year Review of Match Outcomes From a Primary Care Pipeline Program.

BACKGROUND AND OBJECTIVES: Primary care supports the global health care system. With an increased need for primary care physicians, medical schools must provide resources, role models, and opportunities to increase the number of medical students matching into primary care residencies. Some medical schools have developed primary care pipeline programs for students. The outcomes of one such program-the Primary Care Program (PCP)-at the Keck School of Medicine (KSOM) of the University of Southern California (USC), an urban and private academic medical training center, are evaluated here. METHODS: We reviewed PCP student outcome data for students who graduated between 2015 and 2022. Data were gathered through surveys, residency match lists, and graduation records. RESULTS: Among PCP matriculates (n=134), 70% were female and 39% were underrepresented in medicine. Thirteen percent (n=16) of PCP graduates (n=122) completed a master of public health (MPH) degree. Among PCP graduates, 70% matched into primary care residencies compared to 36% of non-PCP graduates (P<.001). The most common residencies that PCP graduates matched into were family medicine (n=45, 37%), internal medicine (n=20, 16%), pediatrics (n=12, 10%), surgery (n=10, 8%), and psychiatry (n=9, 7%). A higher percentage of KSOM students matched into primary care residencies in the 8 graduation years after PCP was instituted (39%) than in the 8 graduation years before PCP was instituted (33%, P=.003). CONCLUSIONS: The PCP data demonstrate the program's success at increasing the number of KSOM graduates matching into primary care residencies. The program provides a replicable training model.

Geriatrics Education: Phone Calls With Older Adults and Medical Students.

BACKGROUND AND OBJECTIVES: The rapid increase in the older adult population necessitates an increase in physicians who are adept at caring for the various medical comorbidities that accompany aging. To fill the gap in geriatric medical education and overcome barriers to medical student interest in geriatrics, we developed a friendly caller program that links medical students to older adults through multiple weekly phone calls. This study examines the impact of this program on geriatric care competency, a foundational skill for primary care physicians, in first-year medical students. METHODS: We used a mixed-methods design to measure how medical students' self-assessed geriatric knowledge was impacted by their longitudinal interactions with seniors. We compared pre- and postsurvey data using a Mann-Whitney test. We used deductive qualitative analysis to examine themes that emerged from narrative feedback. RESULTS: Our results demonstrated that students (n=29) showed a statistically significant increase in components of their self-assessed geriatric care competency. Qualitative analysis of student responses revealed five common themes: transformation of preconceived notions regarding older adults, relationship building, greater understanding of older adults, communication skills, and self-compassion. CONCLUSIONS: Given the shortage of physicians competent in geriatric care amid a rapidly growing older adult population, this study highlights a novel, older adult service-learning program that positively impacts geriatric knowledge in medical students.

Implementation of an online and in-person addiction medicine course and its impact on medical students' knowledge on substance use disorders.

BACKGROUND: Substance use is a public health crisis that requires improved education on substance use disorders (SUDs) in medical school curriculum to ensure that the future generation of physicians is prepared to care for this growing patient population. OBJECTIVES: This study evaluates how the implementation of an online and in-person addiction medicine course impacted medical students' knowledge on SUD and caring for patients with SUD. METHODS: 86 third-year and fourth-year medical students participated in either an online or in-person elective course on addiction medicine. Students learned about SUDs through various modalities, such as online SUD modules, clinical encounters, movies, books, participation in support group meetings and learning evidence-based tools to screen or treat patients. To assess the impact of the course curriculum on students' knowledge in treating SUDs, a pre and post survey was administered and analyzed. RESULTS: After completing the SUD course, students showed significant improvement (P < 0.01) in caring for SUD patients. Specifically, they improved in the areas of: assessing a patient with SUD, comfort and knowledge in using motivational interviewing to affect behavior change in a patient with a SUD, and knowledge of community resources related to SUD. Students also showed a significant improvement (P < 0.01) in the number of unique SUDs (such as opioids or alcohol) they felt knowledgeable about and in the number of treatment modalities for unique SUDs. CONCLUSIONS: Implementation of an addiction medicine course that utilizes various teaching modalities can significantly improve medical students' fundamental knowledge on SUD.

Tattoo Removal in People of Color Who Were Formerly Incarcerated or Were Gang Members: Complications and Best Practices.

There are limited data about the tattoo removal process in formerly gang-involved and incarcerated people of color. This single center retrospective study was conducted on patients treated at Homeboy Industries' Ya'Stuvo Tattoo Removal Clinic between January 2016-December 2018. It reviewed data on 2,118 tattoos, and a representative sample of 502 patients was used to conduct our analysis. Treatment on 118 of the tattoos (5.57%) resulted in at least one complication (hypo-or hyper-pigmentation, keloids, or scarring). Patients who experienced tattoo removal complications (7.3%) were less likely to return to complete the removal process. More complications were experienced with higher fluences of energy, on tattoos placed by professional artists, on colored tattoos, and tattoos on clients who had a greater number of treatments. The study highlights complications and best practices in tattoo removal in people of color, a process critical to the reintegration and gang disengagement of this vulnerable population.

Impact of an Interprofessional Health Student Education Program on Older Adult Participants.

Training health professional students to work with older adults will improve future workforce capacity to meet growing needs. Additionally, older adults may benefit from health education and interactions with health professional students. We analyzed survey responses from older adults who had participated in an interprofessional health student education program regarding their experiences. Qualitative data were summed and averaged, and quantitative survey data were analyzed with Fisher's Exact Test. At least 60% of participants reported receiving information for health needs or making changes to physical activity, dental care, or diet. The most significant differences in lifestyle modifications were noted among racial and ethnic minorities and among speakers of different primary languages. 64% of the qualitative responses reflected positive affirmation of the program. Our data suggest that interactions with health students are meaningful experiences for older adults, are associated with healthy habit changes, and reflect demographic differences in response to health education.

A Descriptive Analysis of the Epidemiology and Motivations for Laser Tattoo Removal in an Underserved Population.

Tattoos of formerly gang-involved and incarcerated individuals can negatively impact their ability to reintegrate into society. Laser tattoo removal is essential to helping individuals obtain employment, re-cultivate positive relationships, and disengage from gangs. The objective of this study is to describe the demographics and motivations for laser tattoo removal at a large nonprofit clinic. This was a single center retrospective study conducted on patients presenting to Ya'stuvo Tattoo Removal between January 2016-December 2018 and had at least three laser tattoo removal sessions. Data was recorded on patient demographics, geographic location of residence (e.g. zipcode), comorbidities, probation/parole status, referral source, transportation mode, and motivations for receiving and removing tattoos. A representative sample of 862 patients was used to conduct our analysis. Average age at first visit was 30. 16% (n = 134) were on probation, 8% (n = 66) were on parole, and 63% (n = 544) did not report their probation/parole status. Reasons for receiving a tattoo included gangs (46%, n = 368), a current or ex-relationship (28%, n = 223), and decoration (20%, n = 159). The most common reasons for tattoo removal were employment (66%, n = 546), readiness to change life (47%, n = 392), maturity (47%, n = 392), family (43%, n = 356), and negative attention from tattoos (37%, n = 303). The current study highlights the importance of laser tattoo removal in reintegration and gang disengagement. Expanding cost efficient laser tattoo removal is paramount to meet the safety and socioeconomic needs of this population.

Describing the Breadth and Scope of Keck Medical Student Primary Care Research Projects.

Introduction: Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project. Methods: To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ2 analysis determined significance at P<.05. Results: We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P<.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%). Conclusions: Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship.

Qualitative Analysis of an Inter-Professional, In-Home, Community Geriatric Educational Training Program.

This study describes and provides qualitative analysis of an innovative, inter-professional (IP) geriatrics curriculum focused on team-based care with healthy older adults in a home-based community setting. The curriculum consisted of five, four-hour didactic and experiential sessions over one academic year. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams led by IP faculty from each health professional school. Teams met with a community-dwelling older adult three times. At the program's conclusion, students responded to the reflective question "What is the most important learning experience you expect to take away from the geriatric inter-professional training? A qualitative analysis of student responses revealed four common themes from all five professions aligning with curricular goals: (1) health professional roles/scope of practice, (2) geriatric care and health outcomes, (3) team communication/collaboration, and (4) advocating for one's own profession. As sites for institutional clinical training become scarcer for health professions' trainees, this study offers both a novel, IP, geriatrics curriculum with didactic/experiential learning through community partnerships in a home-based setting and a reflective evaluation.

Dual MD-MPH Degree Students in the United States: Moving the Medical Workforce Toward Population Health.

OBJECTIVE: A growing need exists to train physicians in population health to meet the increasing need and demand for physicians with leadership, health data management/metrics, and epidemiology skills to better serve the health of the community. This study examines current trends in students pursuing a dual doctor of medicine (MD)-master of public health (MPH) degree (MD-MPH) in the United States. METHODS: We conducted an extensive literature review of existing MD-MPH databases to determine characteristics (eg, sex, race/ethnicity, MPH area of study) of this student cohort in 2019. We examined a trend in the MD community to pursue an MPH career, adding additional public health and health care policy training to the MD workforce. We conducted targeted telephone interviews with 20 admissions personnel and faculty at schools offering MD-MPH degrees in the United States with the highest number of matriculants and graduates. Interviews focused on curricula trends in medical schools that offer an MD-MPH degree. RESULTS: No literature describes the US MD-MPH cohort, and available MD-MPH databases are limited and incomplete. We found a 434% increase in the number of students pursuing an MD-MPH degree from 2010 to 2018. The rate of growth was greater than the increase in either the number of medical students (16%) or the number of MPH students (65%) alone. Moreover, MD-MPH students as a percentage of total MPH students more than tripled, from 1.1% in 2010 to 3.6% in 2018. CONCLUSIONS: As more MD students pursue public health training, the impact of an MPH degree on medical school curricula, MD-MPH graduates, and MD-MPH career pursuits should be studied using accurate and comprehensive databases.

Interprofessional, older adult, team-based home visits: A 6-year prospective analysis.

This 6-year prospective study describes the impact on student attitudes of an innovative, interprofessional geriatrics curriculum (IPGC) focused on team-based care with older adults in a home-based community setting. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams each led by faculty members from all of the professions. The curriculum consisted of five, four-hour sessions over one academic year. Teams met with a community-dwelling older adult three times. Students completed the Geriatric Assessment Scale (GAS) before and after the IPGC experience. At the conclusion, improvements in attitudes toward older adults in the GAS and its four domains - social value, medical care, compassion, and societal resources-were observed across a wide spectrum of students. Students with the lowest initial attitudes improved the most, as did the scores of the youngest students. Older students improved more than younger students in the social value domain (i.e., the perceived social value of older adults). Among disciplines, occupational therapy and social work students improved the most in the social value domain. This study demonstrates improvement in attitudes toward older adults from student involvement in IPGC that combines didactic and experiential learning through community partnerships in a home-based setting.

"Storytelling as a vehicle of healing": Johanna Shapiro, PhD, professor, psychologist, poet, medical humanities scholar.

This commentary reflects the professional life story of a respected editor, poet, and champion of medical humanities, Johanna Shapiro. A psychologist by training, Johanna's work in medical humanities is well known and respected by health professionals in multiple venues. It is within family medicine that Johanna found her professional home. Her work has focused on the value of storytelling as a vehicle of healing, helping health professionals at all levels of training better understand their patients' experiences of illness and healing. The understanding helps patients more deeply connect to their illness and wellness. This commentary offers a tribute to Johanna's professional life and her contributions to family and narrative medicine. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Postmortem Chikungunya Diagnosis: A Case Report and Literature Review.

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.

An Educational Intervention to Improve the Sleep Behavior and Well-Being of High School Students.

OBJECTIVE: The objective of this study was to determine whether a sleep education intervention improves knowledge of sleep, sleep behaviors, and depression in high school freshmen. METHODS: We recruited student volunteers at a single magnet high school in Los Angeles, California through their health class. Twenty-four freshmen participated and 18 students (17 female, 1 male) completed pre- and postsurveys. Curriculum consisted of 4 hours of after-school interactive lectures emphasizing sleep physiology, benefits of sleep, what impacts sleep, and methods to improve sleep, followed by a 9-week sleep behavior change journal. Pre- and postsurveys measuring both sleep behaviors and knowledge, and a Patient Health Questionnaire-9 depression screening were administered to participants prior to and after the intervention. We used t tests and χ 2 tests to analyze knowledge and behavior change. RESULTS: Subjects improved in average sleep hours per night (preintervention 6.9 hours to postintervention 7.8 hours, P=.0134), and average weekend night bedtime (11:36 pm to 10:54 pm, P=.0307). CONCLUSIONS: This school sleep behavior intervention demonstrated students' average sleep hours per night and weekend bedtime improved after the lecture and sleep journal intervention. This suggests a sleep education intervention may benefit this population. Further studies are needed to demonstrate effectiveness of this education over time, across sexes, and in high-risk students.

The "in-between writer": Howard Stein, PhD, professor emeritus, psycho-analytic anthropologist, poet, educator, transdisciplinary scholar.

This commentary reflects the professional life story of a prolific and well-published poet, Howard Stein. An anthropologist by training, Howard's poetry is well known and well respected by family physicians. It is within family medicine that Howard found his professional home, and in his 45-plus-year career he has shared the value of "patient story"; the value of the doctor-patient relationship; and the art of listening deeply to self, colleagues, and patients. This commentary offers a tribute to Howard's professional life and his contributions to family and narrative medicine. (PsycINFO Database Record