The ACGME requires experiences in lifestyle medicine and our program has many components that fulfill this requirement. Fellows will participate in numerous activities that help develop skills in sharing lifestyle medicine content. They will have opportunities to work with patients individually, in groups and in both clinical and non-clinical settings.
Since there is still suboptimal nutrition education provided for medical learners, and both poor diet and obesity have been identified as important risk factors for morbidity and mortality in the United States, we have cultivated training opportunities in Culinary Medicine. Culinary Medicine is an interactive, evidence-based field that brings together nutrition, culinary skills, and knowledge to maintain health and work towards health promotion and disease prevention. It can be an impactful tool to increase confidence of medical learners in nutrition counseling.
Health Meets Food
The material in the Health Meets Food curriculum develops basic and advanced culinary skills, while integrating clinically relevant nutrition education in a case-based format. Additional key skills and material covered includes food insecurity screening, motivational interviewing techniques and nutrition label reading. We have incorporated in a multidisciplinary approach with a chef from Southern Maine Community College helping with the culinary skills teaching and guest dieticians from the institution.
Health Meets Food at MaineHealth Maine Medical Center (MHMMC)
At MHMMC we have incorporated in the Health Meets Food Curriculum to teach medical students and residents and faculty. We incorporated a fully annotated online curriculum that utilizes lectures, quizzes, recipes, and case-based teaching with local expertise of chefs, clinicians, and dietary professionals. In initial experiences, we focused on second year medical students beginning clinical skills training. We have run virtual sessions this past year with students, second year Family Medicine Residents, Preventive Medicine Fellows, and Internal Medicine Residents in the Primary Care Track.
Food for Health and Healing
Food for Health and Healing is a comprehensive approach to provide support and education to educate patients, and clinical staff and learners, on the importance of food as an integral component for health and healing, as well as provide services and resources to support food supply, access to fresh vegetables, and culinary skills.
This program encompasses Culinary Medicine education and training for patients, students and providers; system wide engagement around the importance of healthy food distribution in inpatient and outpatient settings; establishing environmental policies which recognize the impact of use of food for improving health; and the development of effective tools for healthy food access in local practices.
Leadership in Preventive Medicine fellows will have opportunities to work with the Group Medical Visit (GMV) team to provide an innovative clinical setting for learning about lifestyle and wellness in the setting of allopathic medical clinic. The MHMMC department of family medicine has been conducting GMVs since the early 2010s, and has the expertise and tools to effectively share key lifestyle medicine content with patients.
What are Group Medical Visits?
Group medical visits (GMV) are like a regular doctor's appointment but instead of meeting one-on-one, you'll join a group of people with similar medical conditions for education, discussion and support. Often, the GMV is facilitated by more than one provider so the group benefits from multiple areas of expertise. GMVs are covered by most insurers and have been shown to improve health outcomes, the patient experience and provider efficiencies.
Lifestyle and Wellness Group Medical Visits
MaineHealth offers lifestyle and wellness group medical visits for people who have, or are at risk for developing, chronic illnesses such as diabetes, chronic pain, high blood pressure, high cholesterol, depression, anxiety, heart disease and cancer.
Participants learn how to make healthy choices, work towards behavior change and set goals that can prevent, treat, or better manage chronic disease. Discussions may include:
- Nutrition
- Exercise
- Stress
- Sleep
- Symptom/pain management
- Thoughts and emotions
- Relationships with others
- Mindfulness techniques
What to Expect
- Weekly, virtual visits with a physician and health coach over the course of 4 weeks
- A focus on lifestyle habits with goal setting for slow, sustainable changes that are monitored by providers and supported by the curriculum and other participants
- Guest sessions with experts in psychology, physical therapy, cooking and more
- Remote patient monitoring tools including a personal Bluetooth scale and blood pressure cuff
- A tablet to help you track your goals, communicate with your health coach and access recommended educational resources
- Expert curriculum, materials and resources accessible to all group participants
- Weekly sessions billed to your health insurance as an office visit (you may be responsible for co-payments)
- Additional sessions available as extensions to the initial 4-week program, including maintenance groups
- An option to repeat the initial 4-week session for a total of 8 weeks per year
Common features of group medical visits include:
- A group of patients who meet in one location for 60 to 120 minutes
- Facilitation by an interdisciplinary team of providers
- Established ground rules, such as confidentiality, for group interactions
- Interactive learning activities
- Education and discussion on shared health topics
- Opportunities for socializing and community-building within the group
- Health assessments
- Goal setting
Who leads GMVs?
Group medical visits are led by primary care physicians, medical specialists, health coaches and/or behavioral health providers.
Are GMVs covered by my insurance?
Group Medical Visits are billed to your health insurance provider. You may be responsible for a co-payment at each visit. A referral from your primary care provider (PCP) is required to participate. Please talk to your doctor about joining a MaineHealth GMV.
Referral Process for Lifestyle and Wellness GMV
- Email: cdpw@mmc.org
- Portland Phone: 207-874-2466
- Falmouth Phone: 207-781-1500
- Patient self-referral: Please contact Amy Pearl, RN, MA at amy.pearl@mainehealth.org
- Provider referrals: MaineHealth providers may refer through EPIC: ref 8070, Amb ref Lifestyle and Wellness Group Medical Visit
- Referred patients will be contacted by our health coach with further details about the group.
MHMMC’s Preventive Medicine Enhancement for Maine program partnered with Good Shepard Food Bank to help support the expansion of Cooking Matters® classes into health care settings. Patients joined or were referred to this program who had obesity and/or other chronic illnesses that were related to obesity, as well as patients who needed more education on the importance of eating a healthy and varied diet (especially for those picky eaters).
This 6-week family class was offered several times a year to pediatric patients and their families to teach nutrition education, skills in how to cook healthy meals, and how to stretch their food budget. Throughout the course, participants learned how to: Cook healthy, tasty, and low-cost meals, Shop on a budget, use nutrition information to make healthy choices, try new foods and recipes, dice an onion, prep a mango, use a knife safely, and many more helpful kitchen skills.
Each week, participants received a shopping list and a Hannaford gift card so they could buy the ingredients needed to make the meals. During the class, kids and families joined an MHMMC dietitian and other families to talk about the meal and learned some new information and techniques.
What is Physical Literacy?
The motivation, confidence, physical competence, knowledge and understanding that individuals develop in order to maintain physical activity at an appropriate level throughout life.
Why screen for it?
From heart disease and obesity to depression and anxiety, we are increasingly aware of how physical activity helps support a healthy lifestyle. As language literacy helps children learn to read and write, physical literacy provides the building blocks that allow children to participate in healthy levels of physical activity. Physical literacy screening aims to identify children who may benefit from additional support to develop these essential skills.
Who should be screened?
Validated screening tools have been developed for children 8-12 years of age.
Much of the research to date in the area of physical literacy and screening has been done by the Canadian Assessment of Physical Literacy (CAPL) group. They have created a comprehensive assessment that has been shown to accurately and reliably assess a broad spectrum of skills and abilities that help define the participant’s physical literacy in this age range. We have modified their program to allow for a quick screen in the health care provider’s office and created a program of secondary assessment and intervention that can be implemented in a variety of settings upon referral from the physician.
Providers: How to introduce screening
When a child is referred to you from the provider’s office:
- “Your doctor suggested we do a movement screen today to see if we can help your body move better. We will answer some questions and do some fun activities to see how things are going. After, we can decide what activities might help you have more fun with activity and get stronger.”
- Relate to injury:
- “Some people move a lot, but there are sometimes some things we can do to help their bodies move better. This can make them better at sports, enjoy moving their bodies more and help prevent injuries when being active.
Our screen does not yet have specific tips of how to be inclusive of children with special health care needs.
- As an ongoing process, we hope to add more videos/resources in the future with more specific ways to be inclusive and provider tips/alternative and adapted strategies. In the meantime…
- We encourage you to adapt the current methods as needed to be as inclusive as possible, ensuring focus on motivation and confidence building rather than specific motor skills.
- We want to emphasize FUN and make this feel enjoyable rather than feel like a “TEST” – remembering that motivation and confidence are key drivers to physical activity!!
Providers: How to get further information
- Part 1: Physical Literacy and Physical Activity: The Connection and the Importance of Both: An overview on physical activity recommendations and counseling and an introduction to the concept of physical literacy. Recorded as a supplemental CME module for the Let’s Go Obesity Project ECHO.
- Part 2: Physical Literacy Screening in Health Care Settings: Specific guidance for health care providers on how to perform a 2-step, office-based screen for physical literacy. This includes scripting for clinicians, and reviews approaches/resources for children at risk for low physical literacy. This video was funded through PrevME’s HRSA grant.
- PLAY ME primary screen manual (pdf)
- PLAY ME secondary screen manual(pdf)
Food for Health and Healing is a comprehensive approach to provide support and education to educate patients, and clinical staff and learners, on the importance of food as an integral component for health and healing, as well as provide services and resources to support food supply, access to fresh vegetables, and culinary skills.
This program encompasses Culinary Medicine education and training for patients, students and providers; system wide engagement around the importance of healthy food distribution in inpatient and outpatient settings; establishing environmental policies which recognize the impact of use of food for improving health; and the development of effective tools for healthy food access in local practices.
Food for Health and Healing focuses on four main components:
- Access
- Food Security
- Medically Tailored Food Programs
- Hospital Food Service
- Education
- Marketing & Communication
- Medical Education
- Teaching Kitchens
- Dietician Services
- Environment & Policy
- Healthy Places
- Employee Wellness Programs
- Research & Evaluation
Program Vision
- Comprehensive approach to provide support and education around the role that food plays in health and healing throughout the patient and learner experience
- Building a culture of recognizing Food as integral to Health and Healing
- Educational for med students, residents/fellows, physician and APP
- Community engagement with education and services for patients and service providers
- Clinical expertise and improved clinical care
- Improved community resource support re: food supply, fresh vegetables, skill building, etc.
- Addressing Social Determinants of Health in role as Anchor Institution for our community
Tools and Resources
- Evidence-Based Culinary Medicine modules (Goldring Curriculum) for patients, students and providers (knowledge)
- Collection of baseline data of system practices in inpatient and outpatient settings (practice)
- Advocacy for MMC/environmental policies which recognize the impact of use of food for improving health (attitudes and policy)
- Plan for local practice implementation of effective tools for healthy food access (access)
The Need
Overwhelming amounts of health care dollars are spent treating disease that would be amenable to cultural changes in dietary habits. Poor eating causes nearly 1,000 deaths in the United States/day (heart disease, diabetes, stroke) and the costs of chronic diseases related to obesity were 1.72 trillion dollars in 2016.
Currently, health care providers do not have sufficient training in nutrition and culinary skills to help facilitate behavioral changes in their patients. Over 50 medical training programs across the country are implementing the Tulane Medical School Culinary Program as a method to bridge this knowledge gap.
Successful implementation of the Tulane modules in other parts of the country has often partnered schools of nutrition, culinary programs and health care learners. We propose the creation of a partnership between SMCC schools of nutrition and culinary science, MHMMC’s residency programs and the Tufts School of Medicine’s Maine Track in an effort to better prepare all our learners to care for the communities of our future.