Lifestyle Medicine Education: Medical School to Residency

Abstract

This narrative work follows my experience as a medical school student and then Family Medicine resident trying to pursue education and training in the field of Lifestyle Medicine. As a newer specialty, it can be difficult for trainees to find mentors and opportunities to advance their education. In this essay, I hope not only to provide an example of my own experience but also to highlight the multitude of resources trainees can and should utilize from the Donald A. Pegg Student Leadership Award to the Walk with a Future Doc community to the Lifestyle Medicine Handbook and Lifestyle Medicine 101 Curriculum slides. I have seen first-hand the impact incorporating these resources has on medical school and residency training and I believe that by sharing our stories trainees can light the path for the next generation of graduates.

Education, Trainees, Resources, Residency

I first learned about Lifestyle Medicine from my step-mom Maggie, although she didn’t call it that. She simply lived in a way that brought her joy—practicing yoga every day, eating a whole food plant based diet, spending time tending an herb garden with friends, and making sure to be in bed by 10 p.m. She taught my sisters and I skills like how to make home-made oat milk and trim a sage bush, but more importantly she taught us how to question our health—what was actually in that #5 from the local McDonalds, and how did it make us feel when we scarfed it down immediately before a three hour soccer practice?

Maggie taught me the principles of Lifestyle Medicine without ever putting a label on them. With time, I came to regard them as simply the fundamentals of health. Thus, when I started medical school at the Warren Alpert Medical School at Brown University, I figured we would start with the basics of how to encourage patients to live a healthy lifestyle through their own behavior by maximizing sleep, nutrition, exercise, and human connection. I was quite disappointed when I found out our “nutrition” curriculum was actually a four week unit on the Krebs cycle, and that lack of social connectivity was synonymous with a diagnosis of depression and prescription for an SSRI.

I expressed some of these frustrations to my mentor, Dr Mark Paulos who happened to be at the forefront of Lifestyle Medicine in Rhode Island. Dr Paulos suggested I apply for the Donald A. Pegg Student Leadership Award, which subsidizes registration and travel to the ACLM Conference and also provides seed funding to start a Lifestyle Medicine Interest Group. With much thanks to Dr Paulos’ support and guidance, six months later, we were at the ACLM conference seed funding in hand—and with that, Brown’s Lifestyle Medicine Interest Group was begun!

The group grew quickly and with force. We held noon conferences on nutrition while serving whole food plant based lunches sponsored by ACLM trainee grants. We started partnering with local restaurants and hospitals and were able to bring names like Dr Caldwell Esselstyn, Dr Saray Stancic, and Dr Michael Greger to the Providence community. Dr Paulos and I started Walk with a Doc and Walk with a (Future) Doc groups which allowed our Lifestyle Medicine community to spread like wildfire. We also developed and implemented a Lifestyle Medicine Curriculum for fourth year medical students so that all interested graduates would at the very least have an introduction to the principles so foundational to human health.

By the time I graduated, I was actually quite sad to leave Brown because the students, faculty, and staff had really gotten behind the LMIG and I felt like we were making substantial change. But some changes you can’t postpone, and I was at that wonderfully terrifying moment of transitioning from fourth year of medical school to first year of residency. I was lucky enough to match at my top choice, St. Mark’s Family Medicine Residency in Salt Lake City, UT. The program is a trailblazer in the “Clinic Every Day” model and advertised their commitment to adult learning style and resident driven innovation. It seemed like a great fit—I only hoped they would be receptive to innovating towards Lifestyle Medicine.

One of the first things I did when I moved into my residency desk was print off the patient handouts on the ALCM website and organize them in my filing drawer. I let my co-residents know they were welcome to use these resources when counseling patients on behavior change. My co-residents seemed interested, but weren’t quite sure how they would use these resources on a daily basis. So I suggested a noon conference to introduce the principles of Lifestyle Medicine to the residency. I wanted this introduction to go well and spent hours re-reading Dr Frates’ Lifestyle Medicine Handbook, outlining research papers, and trying my best to put together arguments to convince my program this field was worth a serious learning investment. My co-residents and faculty saw the facts and were quickly convinced—Lifestyle Medicine is the most fundamental way we can change our patient’s health and also our healthcare system from the ground up. They asked for more. More lectures, more resources, more training. I will admit I was beyond thrilled to be surrounded by such support, but also a little overwhelmed as I was also trying to learn this material alongside my peers.

I turned to the Lifestyle Medicine Handbook co-authored by Beth Frates, MD, Jonathan Bonnet, MD, Richard Joseph, MD, and James Peterson PhD in collaboration with American College of Lifestyle Medicine and the LM 101 Curriculum slides available to download free of charge on the ACLM website for guidance. Putting it into practice was a pinch! I was allotted one Noon Conference per month to teach Lifestyle Medicine. One week before each talk, I would download the free powerpoint, re-read the accompanying chapter, and provide my co-residents with any pertinent pre-work. It was incredibly simple, and provided a thorough and thoughtful introduction to Lifestyle Medicine. The slides were a huge hit, and noon conferences were stretched to the last minute with lively discussion and suggestions about how to implement these principles when seeing our patients that afternoon.

In fact, these slides were so impactful and by the end of the year, we had so many residents interested in continuing their education in the field of Lifestyle Medicine that my residency program applied to implement the official Lifestyle Medicine Residency Curriculum, which we are starting this year. At the moment, every resident as well as several faculty members at St Mark’s are planning on becoming Lifestyle Medicine certified. But more than provider certification, I see every day how Lifestyle Medicine is improving our patient care. We discuss the benefits of a whole food plant based diet, we share tips and tricks on motivational interviewing, and have recently started using Park Rx as an outdoor exercise prescription. I see our program and our residents leaning into Lifestyle Medicine and I feel the life-changing outcome that has for our patients and our community.

I could not be more thankful for the support and guidance of my mentors Maggie, Dr Mark Paulos and Dr Beth Frates who sparked my passion, guided my interest, and showed me how to make this tough and not always seamless transition from medical school to residency while still embracing my zeal for Lifestyle Medicine. In particular, I would also like to highlight Lifestyle Medicine Syllabus co-created by Dr Beth Frates and ACLM available online through the ACLM website which provided my residency program with a warm welcome into the world of Lifestyle Medicine and have set the groundwork for what I am sure will be the next healthcare revolution.