Planting the Seeds of Lifestyle Medicine for Physician Associate Students

“Integrating the cooking video content into the coursework offered a break from the standard PowerPoint content.” ∼ PA Student

Despite marathoning and healthy eating, “Joel” suffered an unexpected myocardial infarction in his early 40s. None of it made any sense, neither the stent nor statins, because he thought he was fit and doing everything he could to stay healthy. When asking his provider how long he’d need to stay on the meds, he was again surprised to hear the answer, “forever.” Because that answer really didn’t make any sense to him, he started a journey to explore alternatives, and thankfully, he discovered a whole new path with lifestyle medicine. Joel found new information on a whole food, plant-based dietary pattern. His hope was to not need any more metal stents and to possibly, eventually reduce or eliminate his need for statin medication.

Within a few months, Joel’s cholesterol and other labs were markedly improved, and today just a few years later, these same markers indicate that he has all but fully-reversed his heart disease and could discontinue most of the medications first prescribed. More importantly, today he feels great, and happy he chose to seek new answers. Joel’s journey stands out as an inspiration for educating all patients, and especially providers, about the benefits of a whole food plant-based diet and the specialty of Lifestyle Medicine (LM).

Founded in 2004, The American College of Lifestyle Medicine (ACLM) is “the medical professional society providing quality education and certification to those dedicated to clinical and worksite practice of lifestyle medicine as the foundation of a transformed and sustainable health care system.” ¹ This specialty society provides education to those few providers who are dedicated to the clinical practice of lifestyle medicine and aims to provide this education broadly across many different professions and provider groups. Over the last 2 decades, the value of Lifestyle Medicine has been well established in the literature and by the College and numerous colleagues, however, integrating this into early medical education remains to be seen. It is no wonder that a whole food plant-based diet was never a part of Joel’s care plan.

As a key member of the health care team, Physician Associates (PAs) work in a variety of clinical settings. Throughout the career of a PA, they can move across a variety of settings from the primary care office to the intensive care unit. As such, PAs are extremely well-suited for planting the seeds of lifestyle medicine with the many patients they will encounter across the lifespan of their long careers. However, as is the case in the medical education of physicians, PA education on lifestyle medicine interventions for chronic diseases remains scant with only a few PA educators having started to incorporate this content into the existing curriculum as Sarah Keyes and Aimee Gardner have published on this topic. ²

In a bold and innovative move during the winter of 2022, Northeastern University’s Bouvé College of Health Sciences Physician Assistant Program, began to incorporate an introduction to Lifestyle Medicine into their already rigorous curriculum. Looking at their curriculum, there were already several components of Lifestyle Medicine hidden within the existing coursework, and the following summer, a pilot was initiated to provide a more comprehensive overview of Lifestyle Medicine. New modules were added to the curriculum to specifically focus on “The Power of Connection,” “Stress and Resilience,” and “Improving Health through Exercise.”

Thanks to favorable feedback from the first cohort of students in 2022, further steps were taken in 2023 to formalize education around the pillars of lifestyle medicine by utilizing the ACLM free resource of the Lifestyle Medicine 101 Curriculum providing educational content made available through an ACLM membership. This provided more than enough content which was delivered in 8 lectures spanning the 6 pillars of Lifestyle Medicine. The value of utilizing the ACLM materials included the opportunity to leverage standardized information as well as having content already well-curated.

Additionally, Northeastern faculty and lecturers saw another potential benefit of an expansion of its curriculum. PA education includes an extraordinary amount of complex material in an abridged timeframe, so students are often “stressed” at baseline. Thus, while teaching future providers how to help patients manage stress, students were encouraged to utilize the same strategies themselves. It also made sense to teach concepts of stress management in a way that would not add to that stress. To ease the load, a variety of additional video resources were added to provide humor and levity while driving home the following pillars of lifestyle medicine:

• When learning about the Whole Food Plant-Based Diet, the delightful early videos of Jane and Anne Esselstyn ³ sharing their Plant Perfect guidelines for Preventing and Reversing Heart Disease were shown. Integrating their cooking videos into the coursework offered students a break from the standard PowerPoint content.

• When learning about Stress Management, students watched humorous comedy skits that poked fun at the stresses of our American life, and then spent time practicing meditation together as a class with an 8 minute long, facilitator led breath awareness meditation ⁴ where everyone in the class closed their laptops and engaged for that brief timeframe.

• When learning about “Improving Health through Exercise,” the students discussed Exercise Prescriptions and shared content from health.gov ⁵ with the Physical Activity Guidelines for future reference in clinicial work.

These are just 3 examples of making the Pillars of LM more concrete for students who will soon be sharing what it means to eat a whole food plant-based diet with patients, guiding their patients through a stressful time, or encouraging more physical activity. Future considerations could include utilizing additional tools from ACLM such as the Lifestyle Medicine Handbook, Taste of Lifestyle Medicine grants, reimbursement and clinical toolboxes, assessment tools, and handouts. A lifestyle medicine student interest group could also be formed. Providing didactic content is foundational. Adding real-world examples in an enjoyable and memorable manner can make a lasting impression on future clinicians early in their careers—for the care of their patients as well as themselves.

While Joel’s early providers never talked to him about the pillars of LM before his myocardial infarction as a means of prevention, nor after as a means of preventing subsequent infarctions, as a college, we can do better by educating the next wave of providers. We never know who will plant the “seed” of the benefits of a whole food plant-based diet. PAs are uniquely positioned to plant these seeds whether they work in primary care, surgery, an emergency room or an urgent care setting. They might see a patient only once and for only 15 minutes, but that could make the difference in changing someone’s perspective or helping them to take a new path towards controlling their health, just like Joel.