Culinary Medicine: Teaching the importance of nutrition in medical school
By Jade Kelly Solovey
During future physicians’ four years in medical school, they expect to be exposed to many different environments. They become acquainted with the emergency room, operating room, delivery room and every other room in between. Instructors at Penn State College of Medicine hope to help their students become familiar with one more room-the kitchen.
Fourth year medical students at the College now have an opportunity to participate in a Culinary Medicine course to learn cooking and nutrition basics, which they can then pass on to patients. Culinary Medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine.
“In the United States, the traditional medical approach has been to focus on treatment rather than prevention of disease and illness,” said Tomi Dreibelbis, Culinary Medicine course co-director and senior director of educational affairs and instructor of public health sciences. “For the past 100 years, the standard medical school curriculum has required spending only a few days in four years discussing how nutrition affects wellness and the risk of progression of disease. Diet and nutrition will take us either on the path to wellness or on the path to disease.”
Dreibelbis has a background as a public health nutritionist and a graduate degree in health education. She was inspired by the Culinary Medicine program at Tulane University School of Medicine and its teaching kitchen where students are required to take nutrition courses throughout their four years of medical school. She visited Tulane in July 2016 and worked with her counterparts there to bring the program to Penn State. The first class launched in September 2016.
“Dietary intervention can positively impact health outcomes across the lifespan. Optimal nutrition throughout all phases of life, especially for the population groups that are at high risk for health disparities, must be the primary focus of health promotion and disease prevention,” she said.
Nine students have completed the course this semester, which is currently offered as an elective.
The course is held at the Mohler Senior Center, which is located on the edge of the College of Medicine and Penn State Health Milton S. Hershey Medical Center campus. Use of its kitchen adds an additional dynamic to the course, as members of the senior center participate in the course alongside the students.
“This is a wonderful opportunity for students to apply the nutritional knowledge they are gaining in an intergenerational environment,” Dreibelbis said. “The seniors bring years of experience of already cooking on their own in the kitchen; plus, the life knowledge that they have to share with the students brings the course to the next level.”
Each session begins by reviewing the role of nutrition in certain disease processes and small group case discussions on evidence-based nutritive literature. The students, paired with Mohler Senior Center members in the center’s kitchen, learn food preparation skills relevant to the day’s focus and cook healthy recipes that illustrate nutrition health concepts. At the end of each session, the seniors, students and instructors gather to practice mindful eating.
“Beyond sautéing and chopping, the course teaches flavor building without relying on salt and fat, shopping skills and building a healthy pantry. A doctor who understands the difference between taste, perceived only by the tongue, and flavor, a multi-sensory, emotional experience perceived by the tongue, nose, and brain, empathizes with a patient struggling to lose weight more easily,” Dreibelbis said.
Shannon Kelleher, associate professor of nutritional sciences, cellular and molecular physiology, and surgery, is Dreibelbis’ co-director and brings the nutritional biochemistry components to the course.
“As a culinary medicine course, it’s really important that they not only know what foods to eat but why you should be eating those foods and what they’re doing internally so they can better prescribe and advise their patients as they move forward,” Kelleher said. “Better educating our up-and-coming physicians to be able to diagnose and treat and help to prevent disease from a nutritional based perspective is really important.”
Kelleher said that the experience offers the students more perspective that they’ll keep in mind when they advise patients to change their lifestyle.
“When they’re advising a patient, and say ‘your sodium is too high, we need to reduce the sodium in your diet,’ I think they now get a better understanding of how difficult it is to advise some of these nutritional changes that have been shown to be good for your health,” she said.
Rounding out the educational team is Dave Gurdus, an executive chef in a health system.
“My role is to deliver a culinary perspective on everything that we are doing in class to really solidify the techniques that we go over in the lesson plans and to also give tips and pointers that are sometimes unrelated to what we’re going over,” he said.
During class, Gurdus has a constant running dialog with students that allows him to provide teaching moments beyond the curriculum. He has taught knife skills, provided impromptu gravy tutorials and demonstrated how to make chiffonade (julienned leafy vegetables.)
Two small groups of students have taken the course to date. Among them were future surgeons, anesthesiologists, obstetricians and pediatricians. All specialties are welcome because nutrition is important to patient care across every setting.
Katie Greco, for example, plans to go into anesthesiology.
“We learn a lot about heart disease and a lot of other diseases that can be improved with diet or prevented completely, but we don’t always learn the prevention part,” Greco said. “We learn how to treat with medication but prevention education is something all of our patients need. We should be able to counsel them a little, not just refer them to a dietitian.”
Lia Miceli who plans to go into obstetrics/gynecology participated to be able to better counsel pregnant patients. After all, a healthy diet makes a healthy baby.
“There is a big dietary component with OBGYNs because there are a lot of diabetic patients and also people who just have problems growing babies, so there’s a lot of nutritional counseling,” she said. “I also love to cook.”
Megan Gray plans to be a plastic surgeon.
“I’m a very pro-nutrition person so I think it’s incredibly important that everyone knows about it,” she said. “I’m not going to counsel patients on nutrition typically but I still think it’s important.”
Gray added that there are certain procedures that require patients to be of a certain weight, and often surgeons verify that they are nutritionally optimized before they will proceed.
Mena Abdelmalak plans to be an anesthesiologist and will counsel patients prior to procedures.
There are certain restrictions from an anesthesia point of view; things you can’t eat, restrictions with medications and interactions with the foods that you’re eating,” he said.
He also strives to practice what he preaches.
“Being a med student, diet sometimes takes a back seat to working and studying and I think for us as students it should be something that’s more emphasized and more supported,” he said. “Personally, I love the whole concept of cooking for yourself and trusting in the foods that you make and knowing what goes into your food.”
Amanda Bryson plans to be a pediatrician.
“A lot of what I will be doing during well child checkups is talking about nutrition and making healthy choices,” she said. “I think that’s important especially in the pediatric population they start to develop their habits. So I think it will be important for me to be able to affectively counsel them on what are healthy choices and what aren’t.”
Dreibelbis would like to see nutrition become a required course for all medical students to help develop well-rounded physicians who can care for patients holistically. Plans are currently in place to expand the course to include other health professional students and Penn State Health surgery residents.