As future physicians make their way through medical school, they build their clinical knowledge and develop their patient care skills in settings ranging from labs and clinics, to emergency, delivery, and operating rooms. For students at the Perelman School Medicine at the University of Pennsylvania, there are also opportunities to learn in more unconventional classrooms — including the kitchen.
For eight weeks, students who take the culinary medicine elective — the first of its kind at Penn, which was presented at the AAMC’s Northeast Group on Educational Affairs earlier this month — trade in clinical rounds for a cooking class, white coats for white aprons, and stethoscopes for spice blends. Though the course is undoubtedly fun and gives them a chance to flex their Top Chef: Med School muscles, they also learn how nutritious eating can treat and prevent disease and provide a pathway to healthier living, both for themselves and for their patients.
Culinary medicine is an emerging evidence-based field that mixes together the practice of cooking, the science of medicine, and the preventative power of good nutrition. By learning to create meals from start to finish, clinicians are better equipped to provide effective nutrition counseling, make personalized suggestions that take into account patients’ ability, budget, and dietary restrictions, and confidently help them adopt sustainable lifestyle changes that complement their regular prescriptions and treatments.
The brainchild of fourth-year medical student Joshua (“Yoshi”) Rothman, Penn’s culinary medicine course is not only a student-favorite, but it also addresses a curriculum gap Rothman recognized when pursuing his MA in Nutrition.
“I remember learning that only 25 percent of medical schools actually teach nutrition. That was pretty alarming,” Rothman said. “When I started at Penn, I knew I wanted to immerse myself in that work and apply it to my patients. Several medical schools were trying out new programs, and culinary medicine was slowly becoming more popular, so in my third year, I approached the administration with the idea for a new course.” Creating an entirely new elective from scratch was challenging, but Rothman found the general response to his suggestion was, “Finally! We’ve been waiting for something like this.”
In seemingly no time, he gained the enthusiastic support of William Duffy, MD, a physician in Internal Medicine, Horace M. Delisser, MD, an associate professor of Medicine in Pulmonary, Allergy, and Critical Care, and Suzanne Rose, MD, MSEd, senior vice dean for Medical Education, as well as Maria Mascarenhas, MBBS, a nutrition pediatrician in Gastroenterology, Hepatology, and Nutrition at CHOP. Duffy and Mascarenhas serve as co-facilitators for the course. Rothman also reached out to CHOP’s Healthy Weight Kitchen to secure a location, partnered with the Vetri Community Partnership (VCP), and developed course outlines with the input of Melissa Bailey, MS, RD, CNSC, LDN, a clinical dietician at the Hospital at the University of Pennsylvania.
“This really is a collaborative and interdisciplinary project. All these people who have come together to make this a possibility… It just shows that we’re already building community across disciplines,” Rothman said. “Then there’s the fact that half of the participating students are specializing in primary-care-based fields, and the other half are pursuing everything from surgery to anesthesia. This a topic so many students can apply to their own patient populations.”
The course begins with a review of cooking concepts and safe food handling; as Duffy puts it, “Knife skills are life skills!” Each subsequent week is themed around a specific patient population, such as patients with diabetes, celiac disease, or coronary heart disease, or patients who are obese, pregnant, or lactating. After discussing patient cases, dietary recommendations, and the science of why certain foods can be beneficial, the students channel their inner Bobby Flay and apply their knowledge during a cooking hour led by an instructor from VCP. (Marc Vetri actually popped in during a session one week, which definitely proved to be a highlight.)
During “Hypertension Week,” for example, the menu called for a pita, tzatziki, and falafel dish, and the discussion centered on how a Mediterranean diet can prevent and aid in the treatment of high blood pressure. In addition to talking about the cooking method, nutrition, and taste, students also discuss the cost of the ingredients and barriers patients might encounter when trying to recreate the meal. Integrating cultural competency into the class highlights the reality that many patients may struggle with food insecurity or live in food deserts, and encourages students to realize how a patient’s background and accessibility might affect the food choices they make.
“All of us have the same goal of teaching children and families about healthy living through good nutrition. Teaching medical students allows us to extend this education further to patients. Given the increasing evidence of the role nutrition plays in health and treating disease, it is very important that we teach the next generation of physicians about the power of food,” Mascarenhas said.
The feedback has been outstanding. Post-course surveys show that students not only feel confident that can effectively counsel patients on a wide range of nutrition topics, but that they also feel counseling can really make a difference. Rothman recalls that his roommate shared the recipes with his family over the holidays, and others reported that they started eating more fruits after taking the class — which is a start! One student also told Rothman that it was the best class he’d ever taken, and he believes every medical student should have to take the course. And they’re trying to.
“The course has grown almost too quickly for its own good! But I’m not surprised by the enthusiasm and momentum,” Duffy said. “I see it as a foundational course; not only does it teach students about nutrition science that’s applicable in a clinical setting, but it also teaches them skills they can use at home on a daily basis. It has the capacity to change their lives and the lives of those around them. From my experience, I know that we are creating both better physicians and better people. I don’t know that there could be a better mission that that.”
With two years of success under its belt, the course will only continue to grow. The Culinary Medicine Board is led by medical students from every class, ensuring that students will continue to run the course with a level of continuity. The short-term goal is to keep filling up the ten available spots each semester, continue collecting data to assess what students are taking away from the course, and to eventually establish a culinary medicine certificate program comprised of a foundational nutrition class for first- and second-year students, the current course, and an extension that would send two fourth-year students into the community to lead cooking and nutrition sessions.
Looking ahead, Rothman also hopes Penn will be able to establish a teaching kitchen on campus. Not only will this allow students to spend more time in the space, but it will also make the course accessible to any student, resident, or staff member who is interested. “And why stop there? Providers could prescribe this course to patients. Studies show that immersive cooking and nutrition classes can not only improve health, but also save patients money — fewer medications, fewer hospital visits — so, bringing this class to the community? That’s the dream,” he said.
And Rothman plans to continue playing a key role in realizing these dreams; only a few short weeks ago, he learned that he’ll continue his journey as a resident in Pediatrics at CHOP, placing him in the perfect position to maintain involvement.
“From infancy all the way to the last years of life, nutrition and diet can really dictate a person’s quality of life. Helping patients learn to prevent and treat diseases and restore their sense of well-being — and being part of the process for medical students learning to initiate those conversations — is so rewarding,” Rothman said. “And at the end of the day, if all we have are students, physicians, dietitians, and a chef sitting together eating a meal and building a community — that’s fine with me too.”