This past winter quarter at Stanford University School of Medicine we had a window of opportunity to test out a teaching kitchen elective course with the medical students. And…drumroll, please…it was a hit!
Let me back up a moment and set the stage. With everything that medical students are expected to learn, why you ask, would they want to learn to cook? Well, think about this for a moment–imagine you are a physician and 2/3 of the patients you see will have overweight or obesity. The patients look to you for solutions and you offer the oft repeated mantra to “eat healthy and exercise.” But, if someone is serious about losing weight, they will ask their physician questions like, “what do you mean by healthy?” and “what diet should I be eating?”. At this point, the majority of physicians may offer some generic advice to eat more fruits and vegetables, and eat less fast food. However, nutrition education in medical school is so limited, that most physicians have no further evidence-based details or practical, individualized advice to offer.
This is not the physicians’ fault. Nutrition education in medical school represents a missed opportunity. Traditionally, there has been a heavy focus on micronutrients and biochemistry (things one almost never talks about with patients), delivered through standard lecture format or online content that is often outdated. This comprises, on average, 19 hours of educational time over the entire 4 years of medical school. The vast majority of medical school curricula offer no instruction on how to operationalize healthy eating in either the students’ or their patients’ lives. This is particularly troubling since diet has been identified as the single most significant risk factor for morbidity and mortality in the U.S.
With the teaching kitchen course, we shift the focus to food, how the students can eat healthy on a limited budget while strapped for time, and how to counsel patients to make healthy eating a practical part of their daily routines. Think of this as the laboratory for a nutrition course–you’ve know the basics, now it’s time to test out what you’ve learned via hand-on experiments with professional guides.
In our course, the guides* include a chef, 2 chef-MDs, 2 foodie MDs, and 1 nutrition scientist. Additionally, other volunteer physicians, medical school faculty and chef educators join each session to show their support, make connections between the kitchen and other courses/content in the medical school curriculum (think an Edible Schoolyard for med school), and sometimes they jump right in to learn alongside the students.
For the pilot quarter of this course, 12 medical students attended weekly classes for 8 weeks. During this time they learned all the basics that they would need to prepare quick, healthy meals on a budget and practiced counseling skills that they could use to guide their patients to do the same. The course culminated in a final “exam” (aka. potluck) where the students created a dish of their choosing that was meaningful to them in some way and exemplified what they had learned in the course (i.e., it had to healthy AND tasty). These final potluck recipes, along with all of the other recipes from the course, were collated into a pdf cookbook that they could use for themselves and their patients well into the future.
Since the curriculum was created from scratch for this pilot course, we wanted to make sure to measure whether the course had any effect on the students’ attitudes, knowledge and behaviors around healthy cooking and eating. So, before the start of the course we allowed twice as many students as could fit into the teaching kitchen to register their interest in taking the course. Then, we randomly assigned the students to either get into the course or be added to the waitlist (aka. “waitlisted controls”). All students and waitlisted controls were given a survey to measure their attitudes, knowledge and behaviors around healthy cooking and eating before and after the course. On preliminary analysis, the students showed highly significant overall improvement (p <0.00001) compared with the waitlisted controls at the end of the course. When the final analyses are complete, they will be published in an academic journal.
More impressive than the p-values and statistical tests are the stories that students shared with us about the impacts the course has had on them. Here are a couple responses that are representative of the sentiments shared by the group of students that took the course:
1. How do you think participating in a teaching kitchen elective will help you with your current or future patients?
“I now feel more comfortable making delicious, healthy, and easy food with the constraints of time, budget, and resources. I can use my personal experience to talk to patients about how they can similarly enjoy home-cooked healthy food and overcome whatever barriers they face.”
2. How do you think participating in this teaching kitchen elective will impact your personal health?
“This teaching kitchen elective has completely changed the way I eat. Before, only 25% of my meals were home cooked (generally ramen with a few vegetables thrown in). I now cook 90% of my meals and have almost eliminated ramen. I’m also much more efficient in the kitchen and have been able to actually save time because I don’t spend time ordering and waiting in line at a restaurant. I’ve noticed that when I go to the grocery store, I fill my basket with fresh vegetables and whole grains rather than processed foods. I’m not purposefully making healthier decisions, but find myself drawn to fresher selections and am excited about how I can experiment with them. If I can retain these habits, I think this course will have completely shifted my personal health trajectory.”
When we started the course with a small amount of funding to rent out the kitchen and donated faculty time to write the curriculum, write recipes, organize volunteers, and reach out to student to collect surveys, we had no guarantee that we’d be able to offer the class a second time. We are excited to announce that thanks to the generous support of Dr. Jeanne Rosner of SOUL Food Salon we will be able to continue to offer the course! The next session starts fall quarter 2017!
*Our core Teaching Kitchen and Nutrition Task Force Team:
- Chef Michelle Hauser, MD, MS, MPA, FACLM; Course Director and Postdoctoral Research Fellow in Cardiovascular Disease (Stanford Prevention Research Center)
- Chef Julia Nordgren, MD; Pediatric Lipidologist (Palo Alto Medical Foundation), and Founder of the excellent culinary medicine website, Dr. Julia Cooks
- Chef David Iott; Culinary Educator, Teaching Kitchen @ Stanford Residential Dining & Enterprises
- Maya Adam, MD; Instructor in Pediatrics (Department of Pediatrics, Stanford)
- Tracy Rydel, MD; Clinical Assistant Professor of Medicine (Family Medicine, Department of Primary Care & Population Health, Stanford)
- Christopher Gardner, PhD; Rehnborg Farquhar Professor of Medicine (Stanford Prevention Research Center)
Special thanks to Jackson Gardner for filming and editing the Teaching Kitchen video.