Research Letter

Medical Student–Led CommunityCooking ClassesA Novel Preventive Medicine Model That’sEasy to Swallow

IntroductionThe obesity epidemic and increasing rates of associatedchronic diseases highlight the need for physician compe-tency in clinical nutrition. The importance of this issuenotwithstanding, only 19% of graduating U.S. medicalstudents report readiness to offer adequate nutritionaleducation to patients despite its demonstrated efficacy.1,2

Tulane University School of Medicine created The Goldr-ing Center for Culinary Medicine as the world’s firstknown medical school–based teaching kitchen led by aphysician and trained chef with a dedicated associatedresearch team for monitoring outcomes. The Centerproduced an integrated nutrition curriculum withhands-on application via medical student–led communitycooking and nutrition classes. Medical students whoparticipated in the first- and second-year Goldring electivelearning modules helped lead community cooking classes.In addition, we developed a 4-hour community servicetraining series for students unable to take the electivecourse. All students may attend third-year disease-specificnutrition seminars and fourth-year away rotation at theCollege of Culinary Arts in Johnson & Wales University.3

MethodsThe Center trained 125 first- and second-year medical studentsthis past year in an elective 2-hour nutrition and cooking skillsclass, and then the students directed a six-class series as commu-nity service. The students collectively accumulated 1200 servicehours leading structured culinary classes combined with chronicdisease management education for underserved urban commu-nities in New Orleans. Outreach cooking classes were taught at avariety of locations, including The Goldring Center, health clinics,community centers, health fairs, and schools. Community parti-cipants were provided curricular materials and recipes to reviewprior to each class that were designed around a single theme,including healthy breakfasts, low-salt diet adherence, and strategicmeal planning. Medical students delivered a 10-minute presenta-tion, ran a cooking lesson, and guided a dinner discussion. At theconclusion of the class, participants and students discussed thenew techniques and information they learned over freshly pre-pared food and considered how to incorporate these lessons intotheir daily lives.

& 2014 American Journal of Preventive Medicine. All rights reserved.

ResultsGoldring implemented an aggressive curriculum qualityimprovement plan with annual schoolwide surveys thattracked changes in students’ clinical self-reported compe-tencies, attitudes, and health habits, in addition to theirdegree of participation in Goldring’s curriculum through-out their medical education and residencies. Prior to theCenter’s curriculum implementation, the 2012 fall survey of422 students (83.41% completion rate, n¼352) was per-formed with univariate analysis and multivariate logisticregression models (Stata 12.0). Results suggest that thiselective curriculum with its service learning application iscritical to student competency in providing nutritioneducation for their patients during clerkships and extendinginto their residencies. This finding is especially pronouncedamong third- and fourth-year medical students, with thoseparticipating in the nutrition modules reporting greatercompetency in patient nutrition counseling compared withtheir peers who did not engage in education through theCenter for Culinary Medicine. After controlling for race,gender, intent to enter a primary care field, and dietaryhabits, students with past nutrition education (prior to theGoldring curriculum) were more likely to report totalproficiency in educating obese patients about nutrition foroptimal weight loss (OR¼2.38, 95%CI¼1.14, 4.96, p¼0.021);antioxidants in health (OR¼2.06, 95% CI¼1.17, 3.60,p¼0.012); aerobic exercise (OR¼2.34, 95% CI¼1.40, 3.91,p¼0.001); and hydration (OR¼1.96, 95% CI¼1.19, 3.24,p¼0.008) compared to students without such education. It isparticularly striking that third- and fourth-year medicalstudents who completed clinical clerkships did not reportsignificant proficiency in these areas whereas students withnutritional education did. These findings indicate that thestudents’ nutrition education prior to medical school (evenwith varying degrees of exposure via academic degrees and/orresearch) may better prepare them to provide nutritioneducation to patients compared to students with clinicaltraining as third- and fourth-year students during clerkships.

DiscussionWorldwide increases in obesity rates and associatedchronic diseases highlight the need for improved pre-ventive medicine strategies. Baseline medical studentsurvey results suggest that these students are receivinginadequate nutrition education training in their currentcurriculum; Tulane’s courses are consistent with thenational model of restricting such education to mostlypreclinical year lectures. A promising alternative isGoldring’s interactive translation of nutrition information

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from first- and second-year team-based modules toservice learning in the community, which then buildsinto third-year disease-centric seminars, and culminatesin fourth-year rotations with a leading culinary instituteand hospital. Ongoing program monitoring will enableevaluation and optimization of Goldring’s evidence-basedcurriculum and establish it as a preventive medicinemodel for medical schools nationally, in service to theircommunities locally.

Andrew G. Birkhead, BA, Sarah Foote, BS,Dominique J. Monlezun, BA, Jacob Loyd, BS,Esther Joo, BS, Benjamin Leong, MS, MPH,

Leah Sarris, BS,Timothy S. Harlan, MD

Goldring Center for Culinary Medicine, TulaneUniversity, New Orleans, Louisiana

E-mail: tharlan@tulane.edu. (T.S. Harlan)

Dominique J. Monlezun, BASchool of Public Health & Tropical Medicine, Tulane

University, New Orleans, Louisianahttp://dx.doi.org/10.1016/j.amepre.2013.11.006

No financial disclosures were reported by the authors ofthis paper.

References1. Spencer EH, Frank E, Elon LK, Hertzburg VS, Serdula MK, Galuska DA.

Predictors of nutrition counseling behaviors and attitudes in US medicalstudents. Am J Clin Nutr 2006;84(3):655–62.

2. Castry DC, Samuels M, Harman AE. Growing Healthy Kids: acommunity garden–based obesity prevention program. Am J PrevMed 2013;44(3S3):S193–S199.

3. Kay D, Abu-Shamat L, Leong B, Monlezun DJ, Sarris L, Harlan T.Improving medical student nutritional counseling competency. J InvestMed 2013;61(2):511.

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