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Launching a revolutionary new program in culinary medicine [debrief and future plans]

From inspiration to execution – reflecting on the joys and challenges involved with creating a culinary medicine program from scratch, getting it accredited, and being pioneers chartering new territory. 


AL-HS.jpgAngel Luk, BSc, RD is a registered dietitian with the College of Dietitians of BC and a member of Dietitians of Canada and SportMedBC. She has been working as a clinical dietitian within Vancouver Coastal Health since 2012 in a variety of settings. Angel is the author of You Can't Out-Train a Bad Diet - The Simplest Guidebook in Performance Nutrition for Every Athlete, due to be published in 2016. Since joining the Richmond Olympic Oval in 2014, Angel has worked with athletes at the community, provincial, and national level. While Angel specializes in sport nutrition, she has simultaneously pursued her passion for preventative health by co-creating a hands-on course: The Physician in the Kitchen. The goal of the course is to assist physicians and allied health professionals to provide earlier and evidence based nutrition interventions. Connect with Angel on Twitter @FoodMysteries or LinkedIn.

  

Allow me to start by extending my heartfelt gratitude for the overwhelming support the dietitian community extended after my first Practice Blog post. I feel so incredibly proud to be part of a profession that prides itself in collaboration and innovation. Your encouraging messages and support in spreading the word about The Physician in the Kitchen program has no doubt contributed to its success.
 
The inspiration for Physician in the Kitchen
 
These two quotes recap the motivation for developing this program well:
 
Early evidence is emerging that “cooking demonstrations and participatory hands-on cooking workshops, combined with more traditional didactic, nutrition-related presentations, would result in positive changes in behaviour among participants’ personal habits and their perceived ability to advise" (p.471).1

"Other than being a primary care practitioner, practicing a healthful behavior oneself was the most consistent and powerful predictor of physicians counselling patients about related prevention issues" (p.637).2


angel-in-action-1.JPG
 
Recapping the program’s objectives:
 
  • Improve health care providers’ nutrition related self-behavior
  • Improve health care providers’ ability to discuss culinary skills (shopping, food storage, meal prep) and nutritional knowledge with patients
  • Boost  health care providers’ attitudes about the importance of their patients’ nutrition and culinary behaviours
  • Provide practical tools for patients to help them improve their nutritional and culinary behaviours (e.g. patient handouts)
 
Facing challenges
 
We faced many challenges when developing this program.
 
It was hard to find an affordable teaching venue and identify chefs with compatible attitudes regarding evidence-based nutrition practice. We also had to figure out how to effectively teach the program considering the likelihood of participants coming from different disciplines and having varied nutritional knowledge and culinary skills.  Developing an evaluation strategy was another hurdle.   
 
However, the most difficult hurdle was getting the program accredited by the College of Family Physicians of Canada, including the BC Chapter.
 
An anonymous reviewer’s initial comments: “The Mainpro system is designed to accredit education that benefits one’s profession vs education that benefits one's self; for example, teaching about the health benefits of yoga can be accredited, doing yoga cannot. As such the cooking time cannot be included as educational time.”
 
Therefore, for the pilot sessions, the program was accredited for up to 2.25 Mainpro-M1 credits, instead of 3.0.

PITK-food-shot.JPG
 
Overcoming accreditation challenges
 
Our subsequent argument to accredit the hands-on cooking time was this:

Firstly, circulating training chefs supervise and coach the attendees during the hands-on cooking time. It is therefore an educational activity. The attendees are learning new skills and are not simply executing previously well-established cooking techniques that they have already mastered.

Secondly, although it’s clear the hands-on cooking time is associated with a personal benefit, we believe strongly it also benefits one’s profession.
 
As Frank2 has emphasized, a physician who practices a healthful behaviour (such as cooking and eating in a healthful manner) is a powerful predictor of the physician who counsels patients about these same behaviours (p. 637).
 
Further, there is emerging evidence that those physicians who are knowledgeable and skilled in the kitchen will be better able to effectively communicate such principles to their patients, thereby benefitting their professional practice.
 
Thirdly, the physicians are cooking in pairs and in close proximity with other physicians in the working kitchens. The collegial discussions that emerge related to cooking and nutrition in these small groups are powerful learning interactions. 
 
Fourthly, the annual Healthy Kitchens, Healthy Lives conference sponsored by the Harvard School of Public Health integrates hands-on teaching workshops into its program. We have confirmed with the conference that these sessions are deemed eligible as AMA PRA Category 1 credits™
 
After submitting this argument, the program was accredited by the College of Family Physicians of Canada and the BC Chapter for up to 3.0 Mainpro-M1 credits!
 
How did the pilot workshops go and who attended?
 
In November 2015, we launched our first two Introduction to Culinary Medicine workshops!  We had a great turnout of a mixed audience in both sessions. We almost reached maximum capacity of 32 people per session!
 
The audience was predominantly physicians working in family practice (which is what we anticipated), but we also attracted a few dietitians, allied health professionals, students, and residents.
 
To our surprise, there were also couples in attendance. It turns out that our program was perceived as not only an educational evening, but also a fun and creative one. This led to spouses (usually not in the health care field) to attend as well.
 
Evaluating our efforts
 
PITK-team-shot.JPG

With this impressive mix of participants coming from varied educational and professional backgrounds, we weren’t quite sure what their response would be. After the completion of the evening program, each attendant was encouraged to fill out a formal evaluation.
 
Here is a snapshot of the results:
 
  • Overall rating: 4.42 (1=unsatisfactory, 3=satisfactory, 5=exceptional)
  • Will you be recommending this workshop? Of those that responded to this question (17), 100% said yes!
  • How would you rate your degree of proficiency in the kitchen BEFORE attending this workshop? Average: 5.53 (1-lowest 10-highest)
  • How would you rate your degree of proficiency in the kitchen AFTER attending this workshop? Average: 7.06
  • How would you rate your degree of nutritional knowledge BEFORE attending this workshop? Average: 6.24
  • How would you rate your degree of nutritional knowledge AFTER attending this workshop? Average: 7.12
 
We are very encouraged by the improvement in scores in both kitchen and nutritional knowledge proficiency and the overall rating of the program! I strongly believe that it was the intentional and creative collaboration within our team (physician, dietitian, chef) that led to these results.
 
Future plans
 
We have two more introductory workshops scheduled for April 2 and May 21. We are excited to continue offering more health care professionals and students a taste of culinary medicine. Thereafter, our plan is to create speciality workshops for specific health conditions and launch them later this year!

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Editor’s note: Angel’s argument to get the hands-on cooking time accredited had me saying, “Yes, yes, yes!” Great points. It is so important to teach behaviours and skills, in addition to nutrition knowledge. Way to go Angel and team!

Please leave your comments or questions for Angel below. 

 
References
  1. Eisenberg, D.M., Myrdal, M.A., McManus, K., Burgess, J., & Bernstein, A.M. (2013). Enhancing medical education to address obesity: “See one. Taste one. Cook one. Teach one.” Journal of the American Medical Association, 73, 470-472. 
  2. Frank, E. (2004). Physician health and patient care. Journal of the American Medical Association, 291(5), 637.
 
    Angel Luk
    @Jessica Begg - THANK YOU! *fingers crossed* I hope our program will continue to go strong.

    @Jon Leung - Thank you!!

    @Johanna F.M. - Thank you! Our advertising is primarily word of mouth, so any help we can get with spreading the word would be amazing!

    @Patricia Chuey - Thank you so much! Your supportive words mean so much to me. I attribute my work ethic and boldness to mentors like yourself! (And yes, I have reached out to Michele.)

    @Susanne Couture - Thank you! And great idea - I'm not sure I'm at the point of pitching to CTV or Food Network yet...but then again, why not? Haha, if I do, you can rest assured you put the bug in my ear.
    2016-03-02 1:59:53 AM
    Susanne Couture
    Great Stuff! I can't help but think that it would be amazing to have a healthy Master Chef Canada show...I tell my kids that it is easy to make good tasting food if you add salt, fat and sugar...but the real test of a good cook is one who makes healthy food taste great....all the time. Maybe there is a group of RDs out there who would pitch that to CBC!
    2016-02-29 1:01:02 PM
    Patricia Chuey
    Congratulations on your excellent program Angel! You are doing fantastic work! Keep up the great job! (PS Have you teamed with anyone at VGH? Michele Blanchet in Cardiac rehab there may be a great connection (they run cooking programs) if you aren't already connected.
    2016-02-29 11:29:23 AM
    Johanna Fralick McLeod
    Your team must have been very pleased to see the evaluation results. Hopefully the word will start getting passed around the GP community about this great program, and move outward from there! Love the idea of ones tailored to specific health conditions, so many avenues from there - celiac, diabetes friendly, prenatal....All the best with your future endeavors!
    2016-02-29 7:48:54 AM
    Jessica Begg
    What a fabulous and innovative program to get all health care providers on board with our messages!
    2016-02-27 11:36:18 AM
    Jon Leung
    Wow, what a great idea. Congratulations, Angel! Thanks for sharing.
    2016-02-27 5:16:10 AM
    Angel Luk
    @Jane Jensen - Thank you so much!!!

    @Nola Cook - Yes we have! It was a source of inspiration during our research for sure :)

    @Helen Yeung - Your support as a colleague means a lot. Thank you!!
    2016-02-26 2:25:05 PM
    Jane Jensen
    Great idea!
    2016-02-26 11:58:16 AM
    NOLACook
    Have you heard about The Goldring Center for Culinary Medicine at Tulane University?
    2016-02-26 8:56:22 AM
    Helen Yeung
    Congratulations on your creative and courageous approach to nutrition education for physicians! Innovative in strategies, audiences reached, learning through all five senses, effecting change... Thanks for writing about your experience.
    2016-02-25 5:32:20 PM

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