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Abstract

Background and Objectives

Food insecurity (FI) in the United States is 13.5% and is increasing. FI impacts a person's ability to manage their chronic diseases and overall health. Limited studies explore the impacts of FI teaching interventions on medical students. This study examines a FI educational intervention on preclerkship medical students at the Keck School of Medicine (KSOM) of USC and its impact on learner knowledge of FI resources and screening questions, comfort in FI counseling, and FI attitudes.

Methods

First- and second-year KSOM medical students participated in a service-learning activity in August 2024 and August 2025. They received a 30-min lecture on FI and a case. Students then participated in a 3.5-h service-learning experience at the Los Angeles Foodbank preparing food boxes. Students were surveyed immediately before the lecture/case, immediately post, and 1.5 months afterwards.

Results

Findings showed that medical students increased their knowledge of FI resources, screening tools, and confidence in assessing patients for FI both immediately after the session and 1.5 months afterwards. Students were most commonly able to recall SNAP/Food Stamps/Cal Fresh/EBT (45%) and WIC (21%) when asked about FI patient resources. Students’ attitudes towards FI also changed from baseline.

Conclusions

Training medical students to assess patients for FI and gain FI resources to help patients is critical to supporting the health and well-being of patients. This intervention showed promising results for increasing students’ FI knowledge and confidence and can be used as a replicable model.

Keywords

food insecurity medical students service-learning case study lecture

Introduction

Food insecurity (FI) impacts patients’ abilities to take their medications properly, their chronic disease management and prevention, and overall health.^1,2 FI is defined as an insufficient access to sufficient food for healthy living due to inadequate money and other resources.³ This includes people being worried that their food would run out before they had money to buy more, not being able to afford a balanced meal, skipping meals multiple times a day because there was not enough, and having food run out as there was not enough.³ While FI focuses on having a consistent access to enough food, nutrition insecurity focuses on having consistent access to nutrient-dense food to sustain health.⁴ Addressing both FI and nutrition insecurity is crucial for addressing hunger.

Adequate food and nutrition security is critical to overall disease burden. Consuming sufficient and nutritious food impacts disease prevention and chronic disease management (i.e., the ability of diabetic patients to manage the glycemic index of the foods they eat). Studies demonstrate that food-insecure individuals and families have higher rates of chronic disease,⁵ increased rates of obesity,⁶ have more illnesses, poorer academic performance, challenges in development, and poorer mental health.⁷ Further, there are multiple neighborhood and racial and ethnic disparities in FI in the United States, with urban underserved neighborhood food deserts, rural neighborhoods far from access to grocery stores,^8,9 and underrepresented minorities facing higher rates of FI than non-Hispanic white communities.¹⁰

FI is estimated to be 13.7% in the United States.¹¹ In California, 22% of households are food insecure and in Los Angeles County, the rate is 21%.¹² Los Angeles County faces dual challenge: FI and nutrition insecurity.¹³ In the Boyle Heights area surrounding Keck School of Medicine (KSOM) of University of Southern California (USC), FI rates are 38%,¹⁴ which underscores the importance of educating our medical students about FI to prepare them to address this need in their patients and community. During the COVID pandemic, overall United States FI increased, especially within lower-income communities, and has still not recovered to prepandemic rates.^11,15

While there are increased rates of FI and it has a significant impact on health, standard FI screening in the health care system is limited,¹⁶ and it is not systematically taught within medical schools or in postgraduate training. There is an imperative to teach medical students about nutrition and nutrition competencies.¹⁷ FI is a standard within these competencies,¹⁸ yet few studies examine the impact of teaching about FI to medical students, their ability to assess and identify FI, and their ability to better care for their future patients with increased FI knowledge and training.¹⁹ Further, curricular models to best address how to teach FI in medical education are limited.^20–22 The Liaison Committee on Medical Education (LCME) recommends incorporating experiential learning into medical student education to reinforce classroom learning,²³ and teaching about FI lends itself to this learning through service-based learning.

There are limited studies looking at outcomes of medical schools that have implemented FI educational interventions, but those that have implemented interventions have shown promising outcomes at increasing medical student knowledge and comfort discussing FI with patients.^19,20,24 These interventions have varied in format, from a lecture-based format to a multi-year intervention. This study is unique in its format from other studies with its use of a combined lecture, case, and service-learning activity in a half-day format. This quasi-experimental study examines an FI educational intervention among first- and second-year medical students at the KSOM of USC and the impact of an intervention on learner knowledge of FI, comfort in counseling patients about FI, attitudes towards FI, and knowledge about the health resources for food insecure individuals.

Methods

Participants

The FI training was delivered to the KSOM students in their first and second year as part of the Primary Care Program (PCP) standard curricula,²⁵ during a service retreat in August of 2024 and 2025 at the Los Angeles Foodbank, and was required. Medical students apply to the PCP prior to matriculation based on their interest in primary care and are selected through an application process. PCP students comprise between 20–25% of their medical school class. In 2024, there were 24 first year students (MS1s) and 32-second year students (MS2s) in the PCP. In 2025, there were 32 first-year students and 24-second year students (these second-year students were the same as the 24 first-year students in 2024, so they received the curriculum twice). Approximately five students each in 2024 and 2025 were not present at the retreat to receive the curriculum. They were invited to complete the 1.5-month postsurvey because the link was sent out to all PCP students for that year.

Curriculum

Over a half day, students received a 30-min lecture on FI and then participated in a 3.5-h service-learning experience at the Los Angeles Foodbank, preparing food boxes for delivery in the local community (Figure 1). Students did not deliver the food boxes. In 2025, students also participated in a case study after the lecture and before the service-learning experience to role play with peer colleagues (Supplemental File A). In addition, in 2025, students were given a laminated FI resource card with 10 standardized FI questions adopted from a few FI instruments,^26–28 and a state and national FI resource list to use in the case activity and to take with them as a future clinical resource (Supplemental File B).

Figure 1.

Curriculum flowchart food insecurity retreat.

Evaluation Tools

In 2024 (version 1), a pre‒posttest survey was administered immediately before and after a FI lecture. The five-item FI survey tool assessed learner knowledge about FI and FI resources. The students were reevaluated 1.5 months post the service-learning event. We re-evaluated the students after only 1.5 months to minimize the other possible confounding experiences and/or education that students might have received during their preclerkship time that may have influenced their responses.

In 2025 (version 2), a longer, modified pre‒posttest survey was administered immediately before and after a FI lecture and case study, allowing students the opportunity to immediately practice their new knowledge in pairs. The 14 item FI survey tool assessed learner knowledge about FI and FI resources. This included the addition of an eight-item true/false section to assess student attitudes and biases towards FI that was adapted from another study on FI.²² The students were re-evaluated 1.5 months post the service-learning event.

The first year medical students who were surveyed in 2024 (version 1) were surveyed for a second time when they were in their second year in 2025 (version 2) after participating in the Food Bank service activity and presentation for a second year. Identifiers were not collected to be able to link together the surveys that were completed by the same person over the two years.

Analysis

Data were collected through Qualtrics and descriptive analysis was conducted via Excel. A chi-square calculator was utilized to calculate statistical significance with p < .05. The study was deemed exempt by the USC's IRB (UP-20-01459). The reporting of this study conforms to the DoCTRINE statement (Supplemental File C).

Results

Medical Students’ Year of Training

In 2024, 43 (23 MS1, 20 MS2) students completed the presurvey, 48 (23 MS1, 25 MS2) completed the postsurvey, and 22 (13 MS1, 9 MS2) completed the 1.5-month postsurvey (Table 1). In 2025, 50 (31 MS1, 19 MS2) students completed the presurvey, 51 (31 MS1, 20 MS2) completed the postsurvey, and 54 (32 MS1, 22 MS2) completed the 1.5-month postsurvey.

Table 1.

Year of training among medical student participants.

Year	2024			2025
Year	Pre	Post	1.5 Post	Pre	Post	1.5 Post
MS1	23	23	13	31	31	32
MS2	20	25	9	19	20	22
Total	43	48	22	50	51	54

FI Knowledge, Confidence, Attitudes

When students were asked whether they were familiar with a standardized set of questions to assess for FI (Table 2), there was a statistically significant increase from the presurvey to postsurvey to 1.5 months post in both 2024 and 2025 (19%, 92%, 82% in 2024 and 30%, 92%, 89% in 2025). When looking at the students’ confidence assessing a patient for food security, there was a statistically significant increase from the presurvey to postsurvey to 1.5 months post in both 2024 and 2025 (2.51, 3.69, 3.55 in 2024 and 2.22, 3.86, 3.44 in 2025). Similarly, when looking at students’ confidence in counseling patients on the state and federal resources for food security, there was also a statistically significant difference from baseline among the surveys in both 2024 and 2025 (2.09, 3.60, 3.45 in 2024 and 1.88, 3.61, 3.33 in 2025). When participants were asked to name 2 state and/or federal resources that help support a patient that is food secure, there was a statistically significant increase from baseline among the surveys in both 2024 and 2025 (49%, 96%, 82% in 2024 and 54%, 100%, 78% in 2025).

Table 2.

Knowledge and confidence questions among student participants.

Questions	Group	2024			2025
Questions	Group	Pre	Post	1.5 Post	Pre	Post	1.5 Post
Are you familiar with a standardized set of questions to assess for food insecurity (for example, the AAP screening tool)?	MS1	1/23^a,b (4%)	21/23^a (91%)	12/13^b (92%)	2/31^c,d (6%)	28/31^c (90%)	27/32^d (84%)
	MS2	7/20^a (35%)	23/25^a (92%)	6/9 (67%)	13/19^c,d (68%)	19/20^c (95%)	21/22^d (95%)
	Total	8/43^a,b (19%)	44/48^a (92%)	18/22^b (82%)	15/50^c,d (30%)	47/51^c (92%)	48/54^d (89%)
How confident are you in assessing a patient for food insecurity?	MS1	2.17^a,b	3.48^a	3.62^b	1.71^c,d	3.68^c	3.44^d
	MS2	2.90^a	3.88^a	3.44	3.05^c,d	4.15^c,e	3.45^d,e
	Total	2.51^a,b	3.69^a	3.55^b	2.22^c,d	3.86^c,e	3.44^d,e
How confident do you feel in counseling patients on the state and federal resources for food security?	MS1	1.70^a,b	3.30^a	3.38^b	1.39^c,d	3.29^c	3.25^d
	MS2	2.55^a,b	3.88^a	3.56^b	2.68^c,e	4.10^c,d	3.45^d,e
	Total	2.09^a,b	3.60^a	3.45^b	1.88^c,d	3.61^c	3.33^d
Number of respondents who could name 2 state and/or federal resources that help support a patient that is food insecure.	MS1	8/23^a,b (35%)	23/23^a (100%)	11/13^b (85%)	14/31^c (45%)	31/31^c,d (100%)	22/32^d (69%)
	MS2	13/20^a (65%)	23/25^a (92%)	7/9 (78%)	13/19^c (68%)	20/20^c (100%)	20/22 (91%)
	Total	21/43^a,b (49%)	46/48^a (96%)	18/22^b (82%)	27/50^c,d (54%)	51/51^c,e (100%)	42/54^d,e (78%)

Note. Not confident = 1, slightly confident = 2, somewhat confident = 3, mostly confident = 4, extremely confident = 5. Superscript letters (^a,b,c,d,e) indicate statistical significance at p < .05 within a row and within the year.

Interestingly, there was a statistically significant difference in participants answering “yes” that they were familiar with a standardized set of questions to assess for FI between respondents in 2024 who were MS2s (35%) and respondents in 2025 who were MS2s (68%) (p<0.05). Those MS2s in 2025 had already received the curriculum previously in 2024 and so this was their second time being exposed to the curriculum.

The most common federal and/or state resources that help support a food insecure patient that students could recall were SNAP/Food Stamps/Cal Fresh/EBT with 45% of all responses, WIC with 21% of all responses, followed by food banks with 9% of all responses. 16% of the respondents could not name at least one resource (Table 3).

Table 3.

Knowledge of Federal/State Food Insecurity Resources Among Student Participants.

State/federal resources	2024			2025			Total
State/federal resources	Pre	Post	1.5 months post	Pre	Post	1.5 months post	Total
SNAP/food stamps, Cal fresh/EBT	31	44	19	45	49	54	242 (45%)
WIC	8	29	11	11	30	23	112 (21%)
Food bank	13	4	2	9	8	12	48 (9%)
School lunch	2	5	2	1	3	1	14 (3%)
Meals on wheels	0	7	2	2	8	1	20 (4%)
Other resources	2	5	2	1	3	0	13 (2%)
Didn’t know	30	2	6	31	1	17	87 (16%)
Total	86	96	44	100	102	108	536

Students were also asked about whether eight statements were true or false to assess attitudes towards FI (Table 4). There was a statistically significant change (p<0.05) in the total responses for four of the statements, including a lower agreement with the following statements: patients will be reluctant to discuss access to food; patients will not answer accurately about access to food; and not everyone on the patient care team will appreciate the value of screening for FI. There was a statistically significant higher agreement (p<0.05) with the following statement: patients will appreciate being asked about their access to food. There was no statistically significant change in respondents level of agreement with the following statements: people will be upset by my asking about access to food; I am concerned that there is insufficient time to address the presence of FI in a patient care plan; addressing FI is best done in an outpatient setting; and addressing FI is always appropriate even in an acute care setting.

Table 4.

Attitudes Toward Food Insecurity Among Student Participants.

Statements	Pre-2025 “True”	Post-2025 “True”	1.5 Months post-2025 “True”
Patients will be reluctant to discuss access to food.	24/50^a (48%)	16/51 (31%)	13/54^a (24%)
Patients will be upset by my asking about access to food.	6/50 (12%)	0/51 (0%)	2/54 (4%)
Patients will not answer accurately about access to food.	12/50^a (24%)	4/49^a (8%)	6/54 (11%)
Patients will appreciate being asked about their access to food.	43/50^a (86%)	51/51^a (100%)	51/54 (94%)
Not everyone on the patient care team will appreciate the value of screening for food insecurity.	41/50^a,b (82%)	33/51^a (65%)	25/54^b (46%)
I am concerned that there is insufficient time to address the presence of food insecurity in a patient care plan.	32/50 (64%)	26/50 (52%)	36/54 (67%)
Addressing food insecurity is best done in an outpatient setting.	22/50 (44%)	24/51 (47%)	28/54 (52%)
Addressing food insecurity is always appropriate even in an acute care setting.	45/50 (90%)	48/51 (94%)	49/54 (91%)

Note. Superscript letters (^a,b) indicate statistical significance at p < .05 within a row.

Discussion

While FI impacts patient's ability to prevent illness, manage chronic illness, and worsens mental health, it is increasing nationwide.^1,2,7,11 Despite the fact that FI is a core undergraduate and graduate medical nutrition competency,¹⁸ and that there are validated FI tools to engage with patients,^16,19 FI is not well taught nor assessed in medical schools and residencies. This study examined the impact of a lecture, role playing, take home laminated FI resource list sheets, and community service learning at a local food bank on medical student's knowledge of FI, comfort in counseling about FI, and knowledge about the health resources for food insecure individuals.

Our experience is that service-based learning is an ideal modality to teach the social determinants of health (SDOH). Not surprisingly, while multiple FI teaching modalities can be used, learners were most able to retain knowledge when they had multiple repetitions and when they had an opportunity to use the knowledge (i.e., practice with a case). This was made evident with the statistically significant difference in the MS2s who were more familiar with the FI questions when they had already received the curriculum a year earlier. This FI knowledge needs to be reinforced longitudinally, as noted in the small drop off in comfort, knowledge, and confidence in FI knowledge from the day of the intervention to 1.5 months postintervention. This intervention is a replicable model for other institutions looking to teach medical students about FI. This is encouraging because this intervention is designed to only take a half a day and uses minimal resources to be implemented.

It is well known that physicians do not often ask SDOH questions, such as questions about FI, if they do not have knowledge of or access to resources to give a patient.²⁹ All students at baseline had little knowledge about state/federal food resources and were not able to name resources. With an educational intervention, they were able to learn these resources and their knowledge was sustained in almost 80% of students 1.5 months after the intervention. Teaching medical students about FI and FI resources can have downstream positive effects once these students are in clinical practice. Further studies would need to determine if this knowledge is sustained over time and what happens to the students once they are in clinical practice to see if they are utilizing these resources and partnering with social workers, discharge planners, etc. to support their patients FI needs. Of note, 2/3 of students persistently were not sure that a medical visit gave the time to ask about FI, perhaps reinforcing the importance of an interprofessional (IP) team to support optimal patient care. Further, FI education also may have made an impact on decreasing student's hesitance to ask patients about FI because respondents were statistically less likely to feel that patients would not want to discuss FI, patients would be upset by a health provider asking about FI, the patient team would appreciate the value of screening for FI, and patients would not report their FI accurately. This reinforces the importance of having active and dynamic conversations with patients and IP health care teams about the impact of FI on chronic disease management, children's academic learning and performance, and overall health.

Teaching about basic local and national food service resources can empower medical learners to ask FI questions, direct their patients to social workers and food agencies, giving them agency to support their patients.²⁰ Adding FI tools into electronic health records, smart phrases, previsit FI screening tools may also facilitate standardization and consistency of physician FI screening.³⁰ An IP approach to teaching with RD and MD support physician's role to contextualize FI for the dieticians and best understand what is needed to enhance patient health.³¹ Utilizing lifestyle medicine residency curriculum, may also be another source of teaching FI curriculum and identifying best strategies to address FI.

This study did have some limitations. The smaller sample size of this FI study may limit its impact. In 2024, there was a large decrease in respondents who completed the 1.5-month postsurvey and improvements were made so an increased response rate was achieved in 2025. In addition, the question that asked about whether students were familiar with FI questions was a “yes”/“no” response and did not assess their recall of the actual questions. Further, assessing the sustainability of FI knowledge over a longer period would be important to assure that the impact of learning is sustained. Future studies should consider the sustainability of respondent's knowledge and behavior change as a result of this intervention and look at referral rates to social work and RD colleagues, knowledge of FI resources, and utilization of FI tools in the clinic. It would be important for future studies to also follow these students into residency and beyond to look at their practice habits and patient referrals as it relates to FI. The PCP students who participated in this study also may already be more motivated to want to address FI with their patients due to their interest in primary care and these results may not represent the general medical school class. In addition, identifiers were not collected so we could not link responses from the same person, which may have provided more insight when analyzing the data.

In conclusion, adequate food and nutrition security is critical to overall disease burden. Consuming sufficient and nutritious food impacts disease prevention such as obesity and it also impacts chronic disease management. Training medical students to assess their patients for FI, gain resources to help patients access sufficient food, and access IP support teams is critical to supporting the health, chronic disease management, and well-being of our patients and communities.

Supplemental Material

sj-docx-1-mde-10.1177_23821205261445209 - Supplemental material for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project

Supplemental material, sj-docx-1-mde-10.1177_23821205261445209 for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project by Jo Marie Reilly and Ilana Simon Greenberg in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-2-mde-10.1177_23821205261445209 - Supplemental material for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project

Supplemental material, sj-docx-2-mde-10.1177_23821205261445209 for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project by Jo Marie Reilly and Ilana Simon Greenberg in Journal of Medical Education and Curricular Development

Supplemental Material

sj-docx-3-mde-10.1177_23821205261445209 - Supplemental material for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project

Supplemental material, sj-docx-3-mde-10.1177_23821205261445209 for Preparing Medical Students to Address Food Insecurity in Their Patients Through a Service-Learning and Community Engagement Project by Jo Marie Reilly and Ilana Simon Greenberg in Journal of Medical Education and Curricular Development

Footnotes

Acknowledgments

We would like to thank the Los Angeles Foodbank for partnering with our program for the past 4 years and allowing this service-learning and community engagement work. We would like to thank Bryan Ayala-Rivera for his work in coordinating the service-learning opportunity. We would also like to acknowledge PCP Assistant Director, Dr. Isabel Edge.

ORCID iDs

Jo Marie Reilly

Ilana Simon Greenberg

Ethical Considerations

The study was deemed exempt by USC's IRB (UP-20-01459).

Consent to Participate

Participants were provided with a study information sheet that described the purpose of the study, and that participation was voluntary prior to completing the study. Per the KSOM IRB, because this was considered an exempt study, no written or verbal consent was required aside from including the information sheet prior to the start of the survey.

Consent for Publication

Not applicable.

Author's Contribution

Dr. Jo Marie Reilly developed the food insecurity service retreat. Survey instrument was developed by all authors. Data analysis was conducted by Ilana Simon Greenberg. All authors contributed to the writing and editing of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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