Medical Schools Embrace a Push for Lifestyle Medicine

From a Wall Street Journal story by Laura Landro headlined “Medical Schools Embrace a Push for Lifestyle Medicine”:

An ounce of prevention may be worth a pound of cure, but medical schools have traditionally given little weight to instruction on how to help patients live healthier lives.

The future could look different as schools and residency training programs have begun to embrace a field known as lifestyle medicine, weaving teaching on nutrition, exercise and other healthy behaviors into the core curriculum of medical education. This new push aims to provide doctors with tools to tackle chronic but often preventable conditions such as heart disease, stroke and diabetes that affect six in ten adults in the U.S.

“Incorporating lifestyle medicine into medical-school curricula can resolve the inadequacies that exist in preparing physicians for the growing challenge of chronic disease,” says Jennifer Trilk, professor of biomedical sciences and director of lifestyle-medicine programs at the University of South Carolina School of Medicine Greenville, which in 2017 became the first medical school in the U.S. to incorporate more than 80 hours of lifestyle-medicine training over four years of undergraduate education.

A number of U.S. medical schools have begun to adopt lifestyle medicine or embed some of it in their programs. Among them are those of Brown University, Harvard University, Stanford University, the University of Oklahoma, historically Black colleges and universities including Morehouse School of Medicine, and schools of osteopathic medicine.

The approach is part of a broader movement to improve health and close gaps on racial disparities in healthcare, as research points to the benefits of healthy behaviors in preventing, treating and even reversing common chronic diseases. A study published in the Journal of the American College of Cardiology last year projected an increasing prevalence of heart disease and diabetes by the year 2060 among Black and Hispanic populations, which have historically had poor access to quality care. The Centers for Disease Control and Prevention cites chronic diseases as leading drivers of the nation’s $4.1 trillion in healthcare costs. And while the U.S. healthcare system has traditionally paid doctors to treat disease rather than prevent it, the opportunity to reduce costs is spurring new reimbursement models from Medicare, private insurers and employer health plans that offer clinicians incentives to prevent disease.

A new generation of medical students is helping fuel the change. Research has shown that even though many students come in to medical school believing lifestyle factors are important, they later feel ill-prepared to engage on the topic with patients. Now, student-led lifestyle-medicine interest groups are active at more than 100 campuses across the country, and more than 200 residency programs include lifestyle-medicine curriculum, according to the American College of Lifestyle Medicine, a society founded in 2004 by a group of physicians that is funded by dues of about 9,900 members and certifies certain health professionals.

The society promotes six “pillars of care”: a plant-dominant diet that limits processed foods and added sugar and salt; exercise; restorative sleep; stress management; avoidance of risky substances; and positive social connections. “We think lifestyle medicine will be the wave of the future, and we hope every medical student and every doctor regardless of specialty would understand the power of these six pillars,” says Dr. Beth Frates, an assistant clinical professor at Harvard Medical School and president of the society.

Changes in medical education may face significant hurdles. Undergraduate medical programs are of necessity already jam-packed with the basic building blocks of biomedical science, organ systems, pharmacology, anatomy, immunology and other requirements students must master to pass licensing exams.

A spokesperson for the National Board of Medical Examiners says the exams evolve with the field of medicine and must cover a broad array of competencies while maintaining a reasonable length. The exams have included lifestyle and preventive-care items since the 1990s, and nutrition content was added in 2013.

Federal agencies and medical organizations have been calling for enhancing lifestyle and preventive-medicine curricula for more than a decade. There is also new pressure to educate medical students about avoiding bias, addressing healthcare inequities and providing culturally responsive care. Critics contend that all the added instruction would come at the expense of rigorous training.

But the Covid-19 pandemic and social-justice movement have put medical education at an “inflection point,” says Catherine R. Lucey, executive vice chancellor and provost of the University of California San Francisco, and co-author of a proposed 10-year plan to transform medical education published last year in the journal Academic Medicine. “Our social obligation is to make the world better for patients and families, and when designing medical school curriculum we have to start from that position: What is necessary to prepare doctors for medicine in the 21st century?” Dr. Lucey says.

There may be room for adjustments to fit more into curricula, since much of what used to require memorization is now accessible to doctors on mobile devices, says Dr. Richard Safeer, chief medical director of employee health at Johns Hopkins Medicine and an assistant professor at the university’s medical school and its Bloomberg School of Public Health. “The skills clinicians need to help patients learn how to breathe to lower stress or optimize the likelihood of getting a good night’s sleep require time in medical education, but knowing the side-effects of a drug is now a tap on your cellphone screen.”

At the University of South Carolina School of Medicine Greenville, courses on the musculoskeletal system can include instruction on how a sedentary lifestyle leads to muscle loss during aging. The study of cancer can cover the role obesity and associated inflammation play in risks for breast and colon cancer. Electives include nutrition education with cooking classes in a test kitchen co-taught by a chef.

Michelle Troup, a second-year medical student at Greenville, recently completed her dermatology, musculoskeletal and rheumatology exam. In addition to basic science and diagnostic material, it covered such issues as how to counsel patients about the role of core strength and physical therapy in treating back pain and the importance of strength training for women concerned about bone loss. “We learn these lifestyle medicine interventions alongside pharmacology, pathology and physiology,” she says. “The art of medicine is having a human interaction about what we can do to get you to your healthiest state based on the goals you have for yourself.”

The clinics and direct patient care that come with later medical-school years and residency training are key parts of lifestyle-medicine education. Students at Greenville participate in a community program called Exercise is Medicine Greenville–a partnership among the university, a local healthcare provider and the YMCA of Greenville–that gives patients with obesity, high blood pressure and diabetes access to an exercise program.

At Morehouse School of Medicine, a fourth-year preventive-medicine elective includes a two-week rotation in Morehouse Health’s Optimal Health and Wellness Clinic, which provides services to a predominantly Black patient population in Atlanta. Preventive-medicine residents do an eight-week rotation. The experiences show them how to guide patients towards dietary, exercise and other lifestyle changes that improve health, says Dr. Jennifer Rooke, assistant professor in the department of community health and preventive medicine. “When students see patients begin to reverse their diabetes, it’s an eye-opener.”

At Howard University, David Bowman, a pediatrician and board member at the American College of Lifestyle Medicine, teaches medical students about food as medicine. Dr. Bowman is pursuing a masters in nutritional sciences at Howard to deepen his own knowledge and created an annual wellness day for new residents at Howard University Hospital to help them focus on their own health, “so they are better able to counsel people to transform theirs.”

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