Abstract
Just as lifestyle medicine is the necessary foundation for true health care reform, lifestyle medicine competencies should be the foundation for health education. Although lifestyle medicine education may benefit a health professional at any stage in their education or career, evidence-based undergraduate lifestyle medicine education for future health professionals shifts the perspective of health and health care delivery. Educating health preprofessionals in associate, bachelor’s, master’s, and other preprofessional healthcare training programs is of paramount importance due to the interdisciplinary nature of lifestyle medicine. To accomplish this, American College of Lifestyle Medicine (ACLM) members can work collaboratively through committees, projects, and working groups—becoming leadership champions of change. An ACLM Pre-Professional Member Interest Group (LMPP) was created in 2018. LMPP has been working to build a national collaborative effort to amass, create, and distribute resources for educators in this pre-professional arena. Educating college students planning to become professionals outside the medical sphere, for example, lawyers, business people, artists, and engineers, will also benefit the field by introducing the power of nutrition, exercise, sleep, social connection, and stress resiliency during this formative state of career development. Pre-professional educational programs provide learners the opportunity to personally experience the power of lifestyle medicine.
‘Since lifestyle medicine is interdisciplinary, it is important to teach the foundations of the field to health pre-professionals . . .’
When is the optimal time to begin teaching a formalized curriculum in lifestyle medicine? Medical School? Residency? Many have sought to address this question within the American College of Lifestyle Medicine (ACLM) through committees, projects, and working groups. One way to conceptualize the potential target population of lifestyle medicine educational programs is represented as a mountain in Figure 1. When training starts early, many more health care providers and people working in health-related fields reach the top of the mountain and can utilize lifestyle medicine knowledge to help others (patients, family, friends) climb up a mountain, too.
The mountain of target learners for lifestyle medicine educational initiatives.
Lifestyle medicine education may benefit a health professional at any stage in their education or career, but educating future health professionals at the undergraduate level with evidence-based lifestyle medicine may shift their perspective of health and health care delivery. Since lifestyle medicine is interdisciplinary, it is important to teach the foundations of the field to health pre-professionals at the associate, bachelor’s, master’s, and other preprofessional educational levels. To address these educational needs, develop best practices, and create a community of ACLM members, the Lifestyle Medicine Pre-Professional (LMPP) Member Interest Group was created in June 2018 by cochairs Beth Frates and Michelle Tollefson. The mission, goals, and objectives of the member interest group are summarized in Figure 2.
Mission, goals, and objectives of ACLM’s Lifestyle Medicine Pre-Professional Education Member Interest Group. ACLM, American College of Lifestyle Medicine.
The LMPP has been working to build a national collaborative effort to amass, create, and distribute resources for educators in this preprofessional arena. Educating college students who are going into careers outside the medical sphere, such as law, business, creative and performing arts, and engineering may benefit the field by introducing the power of nutrition, exercise, sleep, social connection, and stress resiliency at a young age, making them more likely to seek services from lifestyle medicine health care providers when needed. Educating preprofessional students on undergraduate campuses provides an opportunity for them to develop a foundational knowledge base as well as experience lifestyle as medicine personally and experientially through opportunities to enhance the power of lifestyle as medicine for their future patients. The potential impact of lifestyle medicine preprofessional educational curricula includes approximately 19.9 million students (13.9 million in 4-year institutions and 6.0 million in 2-year institutions) who attend colleges and universities in the United States, using data from 2019 (Table 1).
Examples of Target Populations for Lifestyle Medicine Educational Initiatives.
Abbreviations: GME, graduate medical education; UME, undergraduate medical education.
Since its inception in the summer of 2018, LMPP has expanded to include 8 subcommittees and 89 members. The LMPP Member Interest Group meets quarterly while the subcommittees meet monthly. The subcommittees are listed in Table 2.
LMPP Member Interest Group Sub-Committees.
Through the work of LMPP, over 1000 lifestyle medicine curricula are being taught around the globe. While those in healthcare often focus only on undergraduate medical education (UME) and graduate medical education (GME) learners, the numbers of educational institutions at the pre-professional level is exponentially larger.
The main purpose of this article is to provide examples and demonstrate the educational diversity in pre-professional lifestyle medicine education that currently exists with the hope that it may lead to more programs at other institutions. Most of the programs that are highlighted have a stand-alone lifestyle curriculum. One school had lifestyle medicine concepts embedded into a medical professionalism course for premedical students at Rice University in Houston. Another course that is highlighted in this article, spans from kindergarten to community college. The highlighted programs include both private and public colleges as well as universities with majors and minors in lifestyle medicine in the undergraduate schools.
MCPHS University in Boston, MA offers a wide spectrum of health care programs and professional degrees. At the pre-professional level, students may be introduced to lifestyle medicine through interprofessional behavioral science courses, a Nutrition minor, and/or participation in a student-run Lifestyle Medicine Interest Group. The undergraduate major, Health Psychology, provides the most extensive exposure to lifestyle medicine through several courses.
A classroom-based 3-credit (14 week) introductory course, Lifestyle Medicine, has been offered for the past 10 years at MCPHS. The course exposes students to the 4 of 6 pillars of this field, with a focus on health behavior change and motivation. The course is divided into 3 modules, with each module building upon previously learned material. Thus, exams and other requirements assess cumulative knowledge and skills. An instructor-generated course pack and online resources activate learning both in and outside the classroom.
The initial 5-week module introduces students to the rationale for lifestyle medicine and the evidence-based recommendations in nutrition, physical activity, sleep, and stress management. Students complete assignments to gain an understanding of these pillars of lifestyle medicine, for example, a personal nutrition assessment and a nutritional analysis of various packaged food products.
The second 6-week module addresses health behavior change principles, which stem from research in psychological frameworks, for example, the transtheoretical model, social-cognitive theory, behavior modification, and self-determination theory. During this module, each student implements a self-modification plan related to one of the pillars studied during the first module. It is a progressive project, in which students apply what they are learning to their own self-modification plan over the course of several weeks. They complete 6 graded online assignments during this time, and instructor feedback to each assignment offers prompts for plan adjustments and fosters understanding of the challenges of changing one’s health habits.
During the final 3-week module, students learn about patient-centered counseling and motivational interviewing. They apply these principles and what they have learned throughout the course to a theoretical health coaching scenario. After selecting a chronic health condition, student triads create a hypothetical client with this condition who could benefit from health behavior change(s). Then, utilizing the 5 As framework (Assess, Advise, Agree, Assist, Arrange), each group writes and enacts a 5-minute motivational interview, in which a lifestyle medicine provider coaches the client. Follow-up class time video sharing and discussion reinforces course learning objectives.
Lifestyle Medicine’s postcourse student evaluations over the past 10 years have consistently been very positive, as measured by Likert-type surveys and open-ended questions. Students often comment that the self-modification project was the most influential aspect of the course. Their feedback suggests that this project often promotes healthier lifestyles, especially related to stress management. These students often state that stress is a major obstacle to developing a healthy lifestyle. Several studies have supported this observation, noting that health sciences students face increasing rates of stress beyond those generally experienced among university students. 7 However, they also state that the knowledge and skills learned in this course related to stress management have been helpful in laying a foundation toward the adoption and maintenance of other health behaviors.
Metropolitan State University of Denver (MSU Denver) offers the first bachelor’s level Lifestyle Medicine minor and major in the country. Over the past 8 years, what started as a single course in lifestyle medicine has become a campus-wide movement, inspiring students to change personal health behaviors and advocate change for others. MSU Denver is a large, urban, public university with affordable degree programs, located in downtown Denver. With almost 45% of the student body being composed of students of color and the Hispanic Serving Institution designation, MSU Denver has a commitment to underserved and diverse students and the communities they will eventually serve. The students in the Lifestyle Medicine Program have often experienced or seen health disparities in their communities and are passionate about addressing these issues through lifestyle medicine.
At MSU Denver, the Lifestyle Medicine major is part of their Health Institute, which encompasses the ten health related departments on campus. Through coursework from departments such as Health Professions, Nutrition, Human Performance and Sport, and Psychology, the resulting curriculum is stronger than what any one department could have provided alone. The interdepartmental nature of the program strategically positions graduates to enter a variety of health care graduate programs and to be prepared to collaborate as members of interprofessional teams. Additionally, students are encouraged to become involved in lifestyle medicine–related service, research, and leadership opportunities, early in their academic journey.
The Lifestyle Medicine minor has 9 required credits and 9 elective credits. The required courses are Lifestyle Medicine, Lifestyle Medicine across Gender and Lifespan, and Community Health Education and Lifestyle Medicine. Students can choose from a long list of lifestyle medicine related electives that span the 6 pillars of lifestyle medicine. Students from a variety of health-related majors have declared this minor as well as students in nonhealth-related majors who want to learn more about lifestyle medicine to improve their personal health habits.
The Lifestyle Medicine major at MSU Denver was developed in conjunction with the Colorado Department of Public Health and the Environment. Colorado has a need for health (patient) navigators across the state, but especially in rural Colorado. Wellness coaching competencies were determined integral for health navigators and other allied health professionals. Thus, there was both the need and the support to develop a Lifestyle Medicine major where students would receive a foundational knowledge of lifestyle medicine, wellness coaching, and health navigation. Students completing the program are eligible to sit for the National Board for Health and Wellness Coaches examination. Many students have progressed to a variety of health-related graduate programs, while others have entered directly into the workforce in positions such as health navigators, wellness coaches, and health educators.
The Lifestyle Medicine Program at MSU Denver has grown organically, catalyzed by student interest. After taking the introductory lifestyle medicine course, students expressed interest in a service-learning course where they could apply what they had learned and work directly with a community partner. The Community Health Education and Lifestyle Medicine course was developed to guide students through the process of planning, implementing, and evaluating a health education workshop for their particular community partner on a lifestyle medicine–related topic. A new course, Lifestyle Medicine across Gender and Lifespan, was also created after students expressed interest in wanting to learn more about how lifestyle medicine applied to women’s health, men’s health, pediatric health, whole health aging, and LGBTQ (lesbian, gay, bisexual, transgender, queer) populations.
Passionate student leaders also started the Lifestyle Medicine Student Interest Group/ACLM Trainees Group on campus. This group has organized a Distracted Driving initiative with the Colorado Department of Transportation, worked with a local grow house to offer produce boxes which can be picked up directly on campus, initiated a “Walk with a Future Doc” chapter, and has hosted several health profession webinars and documentary screenings. Their desire to be interdepartmental, break down university and health specialization silos, and to address the root cause of disease has been inspirational to their fellow students, faculty, administration, and community members. The Lifestyle Medicine major, minor, and interest group at MSU Denver has allowed students interested in health careers and beyond learn the value of a healthy lifestyle, both personally and professionally.
In 2014, Harvard Extension School offered the first full semester lifestyle medicine course at Harvard University, Introduction to Lifestyle Medicine. The course was offered as an undergraduate and master’s level course in the Department of Psychology. Approximately 100 students enrolled in the class, a mixture of premedical students, psychology majors, students from a variety of undergraduate majors, physicians, lawyers, nurses, laypeople, and engineers from ages 18 to 65 years old. As a hybrid offering, some of the students were in the classroom at the extension school while others were watching class livestream. If students worked during the day when the course was offered, they were able to watch a recording of the class. The course was 14 weeks in length, and each week, the class focused on a different pillar of lifestyle medicine or other essential topics as listed in Table 3.
Harvard Extension School Lifestyle Medicine Course Topics.
As part of the course requirements, the students answered weekly discussions questions, completed weekly quizzes, reported on eight case studies, and wrote a final project about their own behavior change process during the semester. The course received perfect evaluation scores (5 out of 5), and was offered 3 more years with the same format.
At Rice University, the components of lifestyle medicine are a core part of a for credit elective course that was developed by Dr Gia Merlo, the founding director of the medical professionalism program and Associate Dean of Health Professions. In 2014, Dr Merlo, through surveys and meetings with students, conducted a needs assessment of students’ curricular and experiential needs. On admission to Rice University, over 40% of students report wanting to pursue a career in medicine. Historically, about 20% of the Rice graduates matriculate into medical school with a limited number choosing other health professions (veterinary, dental, pharmacy, nursing, etc). Analysis of the data collected from the students over the next year showed that the students reported wanting more exposure to physicians, with a greater understanding of the nuisances of their chosen fields, and a more formalized means to decide if they are a right fit for the medical profession. The university began offering a medical professionalism course in 2015 with a focused curriculum coupling clinical shadowing with a 3-credit, 14-week (semester) program in medical professionalism. The basis of the course curriculum came from medical professionalism literature 8 and supports professional identity formation of undergraduate premedical students in a number of ways, including the following:
(1) decision making to ascertain if the profession is a “good fit”;
(2) learning the core competencies and foundational knowledge of medical professionalism;
(3) identifying strategies to avoid future lapses in medical professionalism;
(4) improving wellbeing and resilience; and
(5) developing coping skills.
Institutional review board approval was obtained, students volunteered to participate in questionnaires and surveys, completing a number of different instruments related to health and wellness over the course of the semester.
The course has been offered every semester for 5 years and has been revised each semester based on student feedback. In spring 2019, the course included small group discussions, large group discussions, written assignments/activities, didactic foundational knowledge, a group enrichment project, weekly reflective writing essays, and weekly 4-hour blocks shadowing a physician at an area hospital. The course has been well-received by students and consistently receives excellent student reviews. A blog showcasing a sample of student reflective writings can be accessed at www.merlomd.com.
In 2015, Creighton University in Omaha, NE began offering academic programs in the area of lifestyle medicine at both the undergraduate and graduate levels. The programs were based on the established methods of an existing employee health program, The Lifestyle Medicine Clinic, at Creighton University. At the undergraduate level, a Bachelor of Arts degree is offered in Healthy Lifestyle Management as both a traditional program in the College of Arts and Sciences and a fully online program in the College of Professional Studies. At the graduate level, a Master of Science degree is offered in Integrative Health and Wellness in addition to a Graduate Certificate in Lifestyle Medicine. Both graduate programs are offered in a fully online format.
The Bachelor of Arts degree in Healthy Lifestyle Management (HLM) at Creighton is described as the study of theory and practice of whole person health. It is fostered through the beliefs and actions of the care of others and self by building relationships, refining practices springing from reflection, and appreciating the interconnectedness of all things. At Creighton, the program is interdisciplinary and combines the theory of social sciences with the application of natural sciences to promote the fullest sense of personal well-being. Students learn to work one-on-one with others with a purpose of fostering the creation of heath so that each individual can optimally thrive in the community in which they live, work, and spend their time.
The foundational philosophy of HLM consists of four parts, each of which works synergistically toward student development:
Whole Person Health: Many interconnected factors affect the health of individuals and communities. The philosophy of whole person health defines health broadly and addresses health according to the uniqueness of each individual and is rooted in the Ignatian-Jesuit value, cura personalis, and care for the whole person.
Tinkering: The philosophy of tinkering is not a quest for perfection, but rather the continual refinement of personal and relational care practices based on individual uniqueness and reflection.
Relational Care: Relational care is fostered through a consistent presence and engagement with another individual over a period of time. In doing so, relational care supports the individual’s unique hopes, dreams, and aspirations.
Self-Care: Self-care is a manner in which each individual possesses the knowledge, skills, and values to recognize, create, and care for self and others in a way that leads to the fullest sense of well-being. Self-care should not be linked with self-centeredness as self-care becomes more fully developed through an understanding of the importance of the connections with others and with the community.
The HLM program partners with the Departments of Social and Cultural Studies, Communication Studies, and Psychological Studies to offer students an interdisciplinary education. The core courses in the program consist of: Biology, Introduction to Healthy Lifestyle Management, Introduction to Anthropology, Introductory Psychology, Determinants of Health, Healthy Eating and Whole Person Health, Physical Activity and Whole Person Health, Lifestyle Medicine, Health and Wellness Coaching, Community Health, and Capstone in Healthy Lifestyle Management. Students also select 9 credits from a list of upper level courses within partner departments as well as an additional 6 upper level elective credits. Experiential and research-based courses can also be taken by HLM majors at The Creighton Lifestyle Medicine Clinic as well as a Creighton community-based health and wellness center that was started by the HLM program. In addition, the Lifestyle Medicine Students Association on campus provides a resource for students interested in lifestyle medicine to become involved in various activities regardless of their area of study.
The Master of Science in Integrative Health and Wellness and Graduate Certificate in Lifestyle Medicine are philosophical extensions of the HLM program with a more intensive integration of evidence-based lifestyle medicine. The 36-credit degree and 15-credit graduate certificate programs consist of the same 5 core courses. These include: Advanced Lifestyle Medicine, Health Behavior Modification, Nutrition for Chronic Disease, Exercise for Chronic Disease, and Stress and Sleep Management. Additional courses include Advanced Health and Wellness Coaching, Personal Development for the Health and Wellness Coach, Research Methods and Program Design, and Capstone in Integrative Health and Wellness. Students also choose 9 elective credits from graduate programs in Public Health, Organizational Leadership, Medical Ethics, Nursing, and Negotiation and Conflict Resolution. As with the HLM program, students can obtain experiential and research credits via The Creighton Lifestyle Medicine Clinic and the Creighton community-based health and wellness center.
Since the inception of the programs, lifestyle medicine has continued to provide the backbone structure of the courses. As the programs have evolved, curricular changes have taken place within both the bachelor’s and master’s programs to achieve the correct balance between didactic and experiential courses as well as natural science and social science courses. New areas of emphasis that continue to be developed include programming in spirituality and well-being as well as leadership in well-being.
Founded in 2016, the Healthy Living Campus at Kalamazoo Valley Community College (KVCC) is an interprofessional undergraduate learning center that explores the connections between food, health, and sustainability. Located in Kalamazoo, Michigan, the campus is a partnership between KVCC, Bronson Healthcare, and Integrated Services of Kalamazoo (formerly Kalamazoo Community Mental Health and Substance Abuse Services). The campus includes a culinary and allied health center, an urban farm and food hub, and a community mental health clinic. Offering undergraduate education in disciplines from nursing, to culinary arts, to sustainable agriculture, the Healthy Living Campus at KVCC seeks to promote urban revitalization, drive workforce development, and improve community health. These goals align with the college’s strategic plan, which commits to provide programming to foster job preparation, health improvement, and life skills for a productive and rewarding existence.
The Department of Community Culinary and Nutrition at KVCC’s Healthy Living Campus offers hands-on cooking classes that empower students and the public to prepare delicious, nutritious, and inexpensive meals at home. Programs meet students and community where they are—cognizant of their socioeconomic environment, barriers to healthy eating/cooking, and key health concerns. Guided by the principle of food as medicine, classes offer an innovative collaboration of physicians, dietitians, chefs, and subject matter experts. Programs are delivered to all populations, including primary (K-8), secondary, postsecondary, and adult life-long learners.
Education in primary population centers on culinary, nutrition, food systems, and physical fitness fundamentals. Culinary and nutrition content includes introductory knife skills and kitchen safety, product and produce identification and tasting, hands-on cooking, healthy hydration, and an emphasis on increased fruit and vegetable intake. Students explore food systems at the urban farm, where they learn where food comes from, how it is cultivated, and how the choices they make impact their health and the environment. Finally, students engage in activities promoting active movement and physical fitness. Sessions are delivered in partnership with community youth organizations as well as area schools.
The college also partners with Western Michigan University Homer Stryker MD School of Medicine (WMed) to deliver both secondary and post-secondary culinary medicine education. Sessions at these levels teach methods to remove common barriers to home cooking and promote disease prevention and wellness. Topics include culinary fundamentals, food safety, healthy eating on a budget, meal planning and preparation, motivating behavior change, and understanding social determinates that effect health and health equity.
Secondary culinary medicine education is a module in the WMed Early Introduction to Health Careers 2 Pipeline Program (EIH 2). The EIH 2 program provides learning opportunities for underrepresented youth (8th and 10th grade students) in area public schools. Mentored by medical students, secondary school students are engaged in exploring health careers, including learning the impact food, and food systems, have on human health. Sessions include team-based learning, root cause analysis, culinary education, and hands-on cooking. Student feedback demonstrates the sessions provide increased culinary confidence and a better understanding of food’s role in preventing and managing disease.
In postsecondary sessions, culinary medicine education is delivered to all second-year medical students at Western Michigan University School of Medicine. Sessions include didactic lecture and experiential learning. The program aims to increase culinary confidence, expand knowledge of common barriers to healthy eating, and a review of foods role in preventing and managing acute and chronic disease. Statements from medical students indicate sessions serve to bolster empathy for patients and generate an increased awareness of the barriers they face.
Innovative, demand driven, and relevant, culinary medicine programs continue to grow and develop across the nation, and at KVCC. The global burden of preventable disease continues to rise, and culinary and nutrition education plays a key role in prevention, treatment, and reversal. A benefit to all, from life-long learners to community youth, KVCC kitchens and classrooms are open to learn about nutrition and healthy cooking.
Next Steps and Resources
As LMPP continues to develop resources and model programs for the membership of ACLM, we encourage others to join our mission. Our LMPP Member Interest Group is open for all members to join. Figure 3 summarizes a few resources and ways to join our working groups and subcommittees. In addition, ACLM members have access to purchase teaching slides to accompany the book The Lifestyle Medicine Handbook, An Introduction to the Power of Healthy Habits by Beth Frates, MD.
Resources for American College of Lifestyle Medicine (ACLM) members.
The programs highlighted in this article are just a few examples of successful approaches in expanding lifestyle medicine education beyond traditional medical education. Figure 4 provides links and additional information for these initiatives and other Champions of Change in Lifestyle Medicine Pre-Professional Education. We invite you to explore all the resources in Figure 4. May you be inspired by these innovations, creatively apply what is here to your unique educational vision, and collaborate with others through ACLM. Together, through broad educational efforts, we can work to eradicate the root cause of chronic disease.
Champions of Change in Lifestyle Medicine Pre-Professional Education.
Footnotes
Acknowledgements
The authors would like to thank Alexandra Kees, BS, Shannon Worthman, BS, and Brittany Plaven, PhD, CHES.
Authors’ Note
Presentation at ACLM 2019 Annual Conference, Orlando, FL, on October 29, 2019 from 10 to 11
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
Not applicable, because this article does not contain any studies with human or animal subjects.
Informed Consent
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Trial Registration
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