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Table 2 Study Summaries

From: Exploring culinary medicine as a promising method of nutritional education in medical school: a scoping review

Authors Outcome measures Notable Findings
Monlezun et al. (2015) Quantitative: Student diet and attitudes and competencies counseling patients on nutrition were compared using conditional multivariate logistic regression, as well as propensity score-weighted, and longitudinal panel analyses using 4 sets of the same 59 question survey After fully adjusted conditional multivariate logistic regression, Tulane University’s CHOP significantly increased the pooled odds of total proficiency in overall competencies by 72% when compared to traditional clinical education (OR = 1·72, 95% CI: 1·54–1·92, p < 0·001)
Dreibelbis & George (2017) Qualitative: Observations by researchers evaluating the interactions and experiences of students and elders, post-intervention written self-reflections by students and elders participating in the course Participants shared the perception that elders had been able to successfully impart their lived experience and developed an understanding of the logistical and economic challenges patients face while making nutritional choices
Jaroudi et al. (2018) Quantitative: Pre- and post-course Likert-scale surveys of culinary skill, knowledge of ingredients, knowledge of cooking techniques and ability to use kitchen supplies. Analysed using Mann–Whitney U test. A second pre- and post- course Likert scale survey and open-ended questions to assess nutrition knowledge and confidence, cooking habits, and factors that contribute to success of physician in promoting lifestyle changes. Analysed using Mann–Whitney U test
Qualitative: A set of 3 open-ended questions were asked in the post-course survey about participant experience
A significant increase in students’ confidence in overall culinary skill level, knowledge of ingredients, knowledge of cooking techniques, and ability to use kitchen supplies (P = 0·002, 0·002, 0·0004, and 0·003, respectively). Nine participants reported improvement in their knife skills and eight students reported an improvement in their knowledge of dietary restrictions
Monlezun et al. (2018) Quantitative: Propensity score-adjusted multilevel mixed effects multivariable regression showing medical students' improved competencies across 25 topics: All results are reported as fully adjusted Odds-Ratios. Analysed using two-tailed P value Report of multi-site CHOP trial shows highest power study on culinary medicine program efficacy currently, with 4026 completed surveys across more than 45 medical schools indicating good generalisability. Significant improvements were seen for participants in all aspects of nutritional counseling competency and attitudes towards positive impact of nutritional counseling in clinical practice
Hauser et al. (2019) Qualitative: Pre- and post-course surveys evaluating attitudes, knowledge and behaviours about healthy cooking, eating, motivational interviewing of patients focusing on making dietary behaviour changes, and general course feedback. Data and analysis not reported Survey data and analysis were not presented in article. Authors suggest that preliminary findings indicate practical instruction of nutritional education is superior to traditional methods for teaching nutritional counseling
Lawrence et al. (2019) Quantitative: Pre- and post-course surveys including team performance scale (TPS) (evaluating quality of team interactions) and 6-point Likert scale to rate frequency of participants engagement in each team-building process. Analysed using paired t test Despite high pre-course TPS scores, post-course TPS scores for the entire group, medical students and residents, and nutrition students were significantly higher (t = -4·79, P < 0·001; t = -4·15, P = 0·001; and t = -2·71, P = 0·02, respectively)
Pang et al. (2019) Quantitative: Pre- and post- survey assessing students' knowledge in nutrition, ability to identify various foods by visual inspection, and confidence in cooking and nutritional counseling
Qualitative: Additionally, students provided course feedback on ways to improve the course and rated overall satisfaction with the class. Wilcoxon Signed Rank test used to analyse survey results
Among the three cohorts, all students self-perceived nutrition knowledge and confidence scores increased significantly. Students self-perceived food identification scores increased significantly in 2017 and 2018 only. Students rated overall course satisfaction at 4·87/5, 5/5 and 5/5 for 2016, 2017 and 2018 intakes, respectively
Ring et al. (2019) Quantitative: Pre- and post-course survey on self-perceived competency in nutritional counseling using Conner and colleagues, Perceived Competency in Obesity Counseling Scale (PCOC), attitudes toward nutrition in patient care using Nutrition in Patient Care Survey (NIPS), cooking confidence using "The Cooking with the Chef Evaluation Instrument" (Cohort 1), and Cooking and Food Skills Measure (Cohort 1), and personal dietary habits using PrimeScreen Dietary Screening Tool. Post-course only, survey on likelihood of course recommendation. Analysed using ANOVA and Bonferroni corrections, calculations of mean, standard deviation, confidence interval and P-value of changes over time
Qualitative: Open ended questions with prompts
Across two pilot cohorts, retention rates and attendance rates were more than 89% and 96% respectively, with mean recommendation scores of 6·25 and 6·67 out of 7, indicating good feasibility and acceptability. Notable methodologies include use of peer-reviewed competency scales for participants self-evaluations. Significant improvements in students’ counseling competencies in nutrition and obesity reported. No significant or mixed results reported for attitudes to nutrition counseling, culinary techniques and personal dietary habits
Hennrikus et al. (2020) Qualitative: Post-course evaluation of strengths and weaknesses of individual classes and the course, using open-ended, free text, voluntary responses. Thematic analysis of qualitative data using grounded theory: data managed using ATLAS.ti 8.0 software Qualitative results described three major themes: increased relevance of basic science to real life, increased empathy towards complying with dietary restrictions, and increased student group cohesiveness
Patnaik et al. (2020) Quantitative: Validated Likert scale-based, voluntary survey, assessing competency of medical students in 25 nutrition topics, their own dietary consumption habits (including food groups, diets and a validated Med-diet score), and beliefs regarding value of nutrition counseling. Analysed using propensity score–weighted logistic regression models with reported odds ratios and two-tailed p-values Within the multi-site trial using CHOP, University of Texas Health Sciences Center students were significantly more likely to strongly agree nutrition assessment should be routine clinical practice and that providers can improve patients’ health with nutrition education but displayed non-significant results in 12 of the 25 nutrition competency topics
Razavi et al. (2020) Quantitative: Validated Likert scale-based, voluntary survey assessing the competency of medical students in 25 nutrition topics, students' dietary consumption habits (including food groups, diets and a validated Med-diet score), and beliefs regarding the value of nutrition counseling. Analysed using propensity score–weighted logistic regression models with reported odds ratios and two-tailed p-values CHOP participants were at least twice as likely to adhere to Med-diet guidelines involving monounsaturated fats (P = 0·009), fruit (P = 0·019), vegetables (P < 0·001) and legumes (P < 0·001), and six times as likely to master Mediterranean diet principles competency
Rothman et al. (2020) Quantitative: Pre- and post-course surveys of students’ self-perceived nutrition knowledge, confidence in counseling patients in management of diet-associated disease, and personal dietary/food choices. Analysed using calculations of means, standard deviations and two-tailed paired t-tests
Qualitative: Open-ended questions for feedback about the course
The culinary medicine course for final year students, significantly improved competencies in all aspects of nutrition counseling. No significant improvements found in self-perceived value of nutrition counseling and mixed results reported for personal dietary habits
Lieffers et al. (2021) Qualitative: open ended, post- workshop survey focused on workshop evaluation, and reflection on learning Students enjoyed the workshops for several reasons including the topic itself, cooking, free food, and the chance for interprofessional networking and socialization. Many students self-reported increased knowledge in the workshop topics
Magallanes et al. (2021) Quantitative: pre- and post- intervention Likert scale surveys of confidence in patient nutritional counseling, familiarity with the Mediterranean diet, knowledge of a dietician's role on a care team, personal beliefs on how physicians' nutrition can impact patient outcomes, cooking skills, and perception of the importance of nutritional education in medical programs; chi-squared analysis and calculated odds ratios reported with Yates correction At baseline most students (92%) strongly agreed or agreed that counseling patients on food choices is essential, but only 29% felt confident in their ability to counsel patients about food choice. and just over half (54%) were familiar with the Mediterranean diet. Post intervention 92% of students felt comfortable discussing nutrition with patients (OR = 26·8), 97% felt familiar with the Mediterranean diet (OR = 25·59) and 93% were confident they understood the role of a dietitian (OR = 23·3). Post intervention, there was a significant increase in the number of students feeling confident in the kitchen (OR = 32·6), and a significant decrease in students who believed healthy eating is expensive or time consuming (OR = 0·43). reporting to think healthy eating is expensive. At baseline students also reported poor understanding of the role of a registered dietician and only 54% of students were familiar with the Mediterranean diet. After the intervention, 92% of students reported feeling confident in counseling patients on nutrition and 93% of students reported to understand the role of a registered dietician. After the intervention, there was a significant increase in the number of students feeling confident in kitchen skills, and a significant decrease in students reporting to think healthy eating is expensive
Asano et al. (2021) Quantitative: Pre- and post-course surveys including Likert scales Qualitative: one open-ended response Compared to the pre-course survey, students who responded “strongly agree” in questions related to nutrition counseling in the post-course survey were 26·5 to 31·3% higher (p < 0·05)In the post-course survey (n = 34), 33 students responded to either “strongly agree” (n = 25, 73·5%) or “agree” (n = 8, 23·5%) that the course increased their knowledge of nutrition
Leggett et al. 2021 Quantitative: post-intervention survey; questions assessed participants’ confidence in preparing meals, satisfaction with organization and process of the short experimental course, likelihood of participating or recommending proposed elective to a friend Almost all participants gave positive ratings to the workshop for improving cooking skills and the quality of the sessions. Most importantly, participants were willing to take the elective if offered, and were overall very likely to recommend the elective to other students. Participants were less certain about the applicability of the elective towards counseling future patients
Poulton & Antono (2021) Qualitative: Pre- and post- surveys of self-perceived confidence in lifestyle medicine topics and on the course itself In the pre-course survey only 29% of students agreed that they were comfortable counseling patients on nutrition. In the post course survey, 95% of students felt comfortable counseling patients on nutrition
Hashimi et al. (2020) Quantitative: Students completed an anonymous postexperience survey utilizing a Likert‑type rating scale followed by
Qualitative: free‑text response questions
Most students (91·3%) who completed the post-experience survey, “strongly agreed” or “agreed” they would recommend the experience to other medical students. Most students (60·5%) reported learning something about nutrition and 42·2% reported learning something about cooking. Of the third-year participants (n = 19), 94·7% of them reported learning something about nutrition education, and 84.2% of them reported learning something about the social determinants of health. A common theme from the free text responses was the need for more robust education in nutrition science in the initial year of the program
Vanderpool et al. (2020) Quantitative: The "Cooking with a Chef" survey was utilized which consists of 8 sections including 1 index, 6 scales, and 1 knowledge test. A "Culinary medicine curriculum delivery observation checklist" was utilized to measure student engagement, and a "Culinary Medicine Curriculum Delivery Participant Feedback Questionnaire" was utilized for feedback
Qualitative: An open ended "curriculum focus group" was held post-course
Students demonstrated significant improvements (P < ·05) in all assessment measures. Significant improvements identified in cooking confidence and self-efficacy from pre-course survey to post-course survey
D'adamo et al. (2021) Quantitative: Pre-/post session questionnaires assessed nutrition knowledge, skills, and attitudes as well as nutritional counseling confidence scored on a 5-point Likert-type scale. Paired t-tests estimated mean differences in outcomes pre- and post-training
Qualitative: open-ended qualitative questions were administered to all participants and data were subjected to thematic analysis. Two additional survey questions reflecting on the applicability of the culinary medicine training to patient care and self-care, with open-ended options to elaborate, were asked (only at) in the post training assessment
Participants were asked: "How will you offer practical nutrition
advice to your future patients?3 key themes emerged: (1) addressing barriers to healthy eating, (2) personalizing dietary recommendations, and (3) providing evidence-based information for different ways of healthy eating. When participants were asked: " “How do you think you will utilize the information you have learned in the culinary medicine session in your own life?” 3 key themes emerged: (1) implementing cost and time efficiency strategies, (2) trying different evidence-based diets, and (3) making practical dietary changes to support personal health
Kaye et al. (2018) Qualitative: Students provided anonymous feedback on the curriculum. Questionnaire specifics not elaborated The introductory 3 sessions were well received and repeated in subsequent years, with Grocery Shopping on a Budget being the favorite. The experiential nature of the learning, particularly cooking activities and those that provided a patient-level experience, and a focus on health habits were the favorite aspects of the program. Many commented that they enjoyed activities and spending time with their peers outside of the medical classroom. Overall, the curriculum was well received with students desiring to continue activities beyond the first year
Flynn et al. (2019) Quantitative: pre- and post- assessments including a nutrition quiz designed to assess simple nutrition themes that could be useful in providing patients dietary advice, and a 1-page questionnaire assessing current eating behaviours Participants significantly increased (P < 0·000) knowledge of nutrition, assessed by the 100-point nutrition quiz from pre-course to post-course. At the 2-month follow-up, one-third of participants reported spending less on groceries and an overwhelming number of participants reported to still use the recipes learned in the program
Kumra et al. (2021) Quantitative: Participants completed a voluntary questionnaire which included a 5-point Likert scale (pre-course 23-items with 3 demographic questions; post- course included an additional19 follow-up questions) addressing participants’ attitudes and confidence in providing nutritional counseling to patients and the impact of nutritional counseling and culinary education on patient health outcomes Significant improvements were reported in self-reported understanding of the principles of motivational interviewing (P = 0·002), confidence in ability to use motivational interviewing (P < ·001), and intention to use motivational interviewing in their practice (P = 0·03). A significant increase (P = ·008) was also reported in confidence in ability to come up with nutrition related changes to improve health ( and intention to discuss nutrition related changes with patients (P = 0·006)
Musick et al. (2020) Quantitative: faculty assessed each student’s attendance, preparation and level of participation in all required activities, with students earning 0 points (absent or disruptive group behavior), 1 point (no, minimal or inappropriate participation) or 2 points (effective participation). Students also submitted reflective essays (between 400 and 500 words) that were graded by a "Team Action Group" composed of 7 faculty members with students earning from 0 to 3 points for their essays. Students from all 3 disciplines used a Likert-type scale to provide feedback for the course, ranking items that reflected how the course prepared them for interprofessional learning and patient interactions surrounding nutritional counseling While generally received positively by students, this new curricular track was very labor- intensive and not particularly impactful in terms of orienting students to the demands of clinical patient care teams. Students rated their experiences in learning about nutrition favorably (3·78 on a five-point Likert scale) and many students expressed appreciation for this content anecdotally
  1. CHOP Cooking Through Health Optimisation, OR Odds ratio, CI Confidence interval, P = P value, t = T-test value, Med-diet Mediterranean diet, PBL Problem-based learning, RI Rhode Island