Cooking up change in American medical schools
It’s a stormy Friday night in Chicago and traffic is a mess. But, one by one, a group of damp medical students comes filing into a classroom at Chicago’s Kendall College. They could be out drinking tonight or hunkered down with their anatomy books. But instead they’ve traveled miles from the University of Chicago's campus to attend a voluntary 3-hour class that they’re not even getting credit for.
The course is Culinary Medicine, which explores the intersection of food, science, medicine and nutrition. The idea is to learn how to help prevent and control some of our most pervasive chronic health conditions.
“We don’t get a lot of devoted curriculum to this issue,” says Erik Kulenkamp. He’s a first-year med student at University of Chicago’s Pritzker Medical School. “And I feel like it’s one of the things patients are most curious about and have the most questions about — lifestyle changes and things they can do to prevent things from happening to them rather than treating them once they occur.”
Where’s the nutrition training for doctors?
Only about 30 institutions around the country teach culinary medicine. And according to a 2010 survey, only about 27 percent of all American medical schools teach the 25 hours of nutrition coursework recommended by the National Academy of Science.
This comes at a time when a recent Journal of the American Medical Association study found that dietary quality is the single biggest risk factor for death and disability in the country.
This seems crazy to folks like Stephen Devries, who runs Chicago’s Gaples Institute. It’s trying to expand more nutritional training in the medical field. When he spells out for people the current requirements for nutrition training among medical professions, “they are shocked.”
Last year, Devries wrote a commentary in The American Journal of Medicine decrying the current lack of nutrition education among doctors. He noted that a recent study showed only 14 percent of physicians feel trained to provide nutritional counseling and yet 61 percent of patients turn to their doctors as “very credible” sources of nutrition information.
Dr. Geeta Maker Clark is a clinical instructor at the University of Chicago; she also runs an integrative family practice in the North Shore University Health system. She pursued culinary medicine studies after medical school, and has used them in her integrative practice as well as a class for non-med students that she teaches with a chef in Evanston.
But a couple of years ago she was approached by University of Illinois at Chicago doctoral student Sabira Taher with an idea to expand that teaching to future doctors. Things moved slowly. But last month, working with U of C's Dr. Sonia Oyola (who co-teaches the class) and Kendall's chef instructor Renee Zonka, they finally launched this pilot class. The pilot is funded by a grant from the U of C Women’s Board, but the university stresses it will not give students credit for taking it.
At this point the University says, "Instructors are just starting to review data that was collected on the nutritional medicine project to help them assess the class and make refinements if it’s offered again. It’s possible some iteration will be incorporated into the formal curriculum in the future, but it’s too early to say.”
This is not the case at Tulane University, where med students are required to study culinary medicine. Maker Clark is using teaching modules from the Tulane program in the 4-week course that meets for three hours a session. Each class begin with case studies and clinical lectures. But for the second part of the class they put down the pens and pull on the chef hats.
Breakfast tacos as medical care
During a recent class, the University of Chicago medical students cooked up spinach and feta frittatas, quick granola, banana nut muffins and breakfast tacos.
“It’s one of the only opportunities we have at Pritzker to combine treating with pills and things that are directly in the patient’s control,” says first-year student Maggie Montoya. “Also, it will help me with my cooking skills because I can’t cook for beans.”
This is a common refrain among med students who said they were eating a lot of take-out and processed food before they took the class. They see it as a way to improve their own health and become examples to their patients.
That’s a huge part of this kind of training, says Dr. David Eisenberg of the Samueli Institute and the Harvard School of Public Health. For nearly a decade he’s been leading a 4-day culinary medicine class for health professionals at the Culinary Institute of America in California.
Surveys from doctors who've taken the class have convinced him that such personal experience is key to translating the information to a patient. He cites studies showing that doctors who exercise or have given up smoking are much better at counseling patients on the issues.
In a recent article for Academic Medicine, Eisenberg lamented that so few medical schools prepare their students to dispense dietary guidance, “and more importantly there are really few if any requirements on the part of graduating medical students to be knowledgeable about nutrition and its translation into practical advice for patients,” he said. “And those competencies don’t exist on the certification exams to become a licensed physician.”
The accreditation body that decides standards for 4-year medical school training is called the Liaison Committee for Medical Education. Its co-chair, Dan Hunt, says that after four years of medical school, he might expect graduates to "identify nutritional disorders, but I wouldn’t expect them to be able to treat those disorders because they’re going to get the management of the illness in the next set of [specialized residency] training."
But that's not really how it works. In fact, in its 34- and 35-page accreditation documents for doctors of internal medicine or cardiology, the Accreditation Council for Graduate Medical Education never once mentions a need for any nutrition knowledge. When WBEZ contacted Dr. Mary Lieh-Lai, at the ACGME to ask her why, she initially said that she doubted this was true. Lieh-Lai is the senior vice president of medical accreditation at ACGME and she asked for time to go over the documents herself, and then speak to us.
When we called 30 minutes later she conceded that nutrition is never mentioned in the documents, but added, “We don’t dictate the detailed requirements. We leave that up to the programs and the programs make those detailed requirements at the local level because it depends on the local needs and things of that nature.”
Asked if ACGME might ever consider including nutrition knowledge as a requirement for accreditation, Lieh-Lai said, “No.”
“Tsunami of obesity and diabetes”
Still, Eisenberg blames the current situation less on negligence by the accreditors than a slow response to the “tsunami of obesity and diabetes” that’s hit this country.
“I don’t think we could have predicted that health care professionals would need to know so much more about nutrition and its translation into shopping for and preparing healthy delicious foods,” he says. “Nor did we expect that we would need to know more about movement and exercise or being mindful in the way we live our lives and eat or how to change behaviors. I think these are relatively new areas of expertise that (we) really must grapple with for the next generation of health professionals.”
Back in the Kendall College kitchen Maker Clark aims to give her students some of that expertise. In just the last two hours her students have mastered 12 healthy dishes that they will be able to pass on to future patients.
Today, this class is just a small grant-funded pilot, but Maker Clark envisions a day when it’s standard fare in local med schools.
“That would be absolutely fantastic,” she says. “If we can get it to the point where they are getting credit for it and then incorporated into the curriculum, that is a goal.”
A more immediate goal is for students to share what they’ve learned with others. Later this month, they’ll be expected to teach healthy cooking workshops in underserved Chicago communities as their final project.
WBEZ will check that out and report back on it here.
Monica Eng is a WBEZ producer and co-host of the Chewing The Fat podcast. Follow her at @monicaeng or write to her at firstname.lastname@example.org