Culinary Medicine Improves Trainee Nutrition Education

Yale School of Medicine (YSM) researchers led the first-ever randomized controlled trial of a culinary medicine curriculum for medical trainees, which found that hands-on cooking is an effective approach to increasing nutrition knowledge for resident physicians. The paper was published in the Journal of General Internal Medicine on June 25.

The study aimed to compare the efficacy of hands-on culinary medicine with didactics-only pedagogy.

“We want trainees to learn about the benefits that certain foods have on cardiovascular disease, how to better manage patients’ health using nutrition, and to appreciate the importance and impact of dietitian referrals,” says Nate Wood, MD, MHS, assistant professor of medicine (general medicine), director of culinary medicine at YSM, and first author of the study.

Culinary medicine is a multidisciplinary field that combines medical education, nutrition science, and the culinary arts to promote wellness through lessons in meal preparation and hands-on cooking. Today, only 26% of residency programs provide formal education in nutrition.

"Given that so many of our patients have at least one diet-related condition—type 2 diabetes, dementia, high blood pressure, high cholesterol, heart attack, stroke, obesity, kidney disease, fatty liver disease, etc.—this three-year curriculum on diet and disease is important for our residents, especially in how it could translate to better care for our patients."

-Donna Windish, MD, MPH

Wood and colleagues developed a longitudinal, three-year curriculum on diet and disease for residents in the Yale Primary Care Residency Program. The first year focuses on cardiovascular disease. The second prioritizes weight and obesity, and the third is dedicated to diabetes.

“Given that so many of our patients have at least one diet-related condition—type 2 diabetes, dementia, high blood pressure, high cholesterol, heart attack, stroke, obesity, kidney disease, fatty liver disease, etc.—this three-year curriculum on diet and disease is important for our residents, especially in how it could translate to better care for our patients,” says Donna Windish, MD, MPH, professor of medicine (general medicine) and senior author on the study.

To evaluate the curriculum, the researchers divided residents into two groups: the control group watched video-based lectures, and the intervention group participated in hands-on cooking classes.

Increased Confidence and Behavior Change

The researchers examined several outcomes, including how much nutrition knowledge trainees gained. Surveys on attitudes, knowledge, confidence, and behavior were distributed before the sessions, immediately after, and eight weeks later.

The surveys showed that 83% of residents felt their training in nutrition to date had not been sufficient in preparing them to provide dietary counseling to patients, while 94% said additional training would allow for better clinical care for patients with diet-related diseases.

There were some differences between the two groups. The study found that the group that participated in hands-on cooking classes reported feeling confident in all five domains of dietary counseling that were assessed, whereas the control group noted increased confidence in only two.

"Our findings show how hands-on classes aren’t just changing knowledge or attitudes. They are changing behavior."

-Nate Wood, MD, MHS

Residents who receive hands-on training are more likely to talk to their patients about nutrition, according to Wood. “They are also more likely to refer patients to dietitians, because they understand how important nutrition is, and they can help their patients find ways to eat affordable, accessible, healthy, delicious foods,” he says.

Overall, the researchers noted that nutrition knowledge in both groups was greater than before the course. Residents were more confident in educating patients on a heart-healthy diet and providing evidence-based information about heart disease.

“Our findings show how hands-on classes aren’t just changing knowledge or attitudes,” Wood says. “They are changing behavior.”

Other authors of the paper included: Maya Fussell, RD; Erica Benghiat, MPH, RD; Lora Silver, RDN; Max Goldstein; Amy Ralph, RD; Lisa Mastroianni, RD; Erica Spatz, MD, MHS; Dana Small, PhD; and Rosemarie Fisher, MD.

General Internal Medicine, one of 10 sections in the Yale Department of Internal Medicine, is committed to the core missions of patient care, research, education, and community health from the “generalist” perspective. To learn more, visit General Internal Medicine.