Innovative elective subject at Göttingen University Medical School for the first time in the clinical section of medical studies
From the summer semester 2020, the Institute for Nutrition and Psychology, headed by PD Dr. med. Thomas Ellrott, will start the teaching format and research project "Culinary Medicine" in cooperation with Culinary Medicine Deutschland e.V. at the University Medical Center of the Georg August University Göttingen.
Durch die großzügige Forschungsförderung der Rut- und Klaus-Bahlsen-Stiftung besteht für die Medizinerausbildung in Deutschland die große und einzigartige Chance, ein solches Modellprojekt als wesentliche Innovation für den Bereich Ernährungsbildung in das zukünftige Curriculum des Medizinstudium zu verankern.
Nutrition-associated diseases are one of the greatest challenges major challenges in industrialised societies. The direct costs for therapy, but also indirect costs due to loss of work, etc. are immense. are immense. In addition, there are restrictions and suffering for those affected. There is no doubt that dietary behaviour plays a central - though not the sole - role in the genesis of such diseases. the sole - significance for the genesis of such diseases. Therefore solutions need to be developed to counteract diet-related diseases and to and to strengthen health-promoting behaviour. Physicians are doctors are important multipliers for this. Nevertheless, the theory and practice of nutrition theory and practice in the curriculum of medical training. comparatively little space in the curriculum of medical training. In practice, the treatment of existing existing diseases. Preventive possibilities are still hardly used.
In principle, there are two options to better prepare physicians better prepared for the practice of nutritional medicine: Firstly, a Firstly, a corresponding teaching programme can be implemented in medical studies. Alternatively, it is possible to obtain an additional qualification parallel to the practice of the medical profession within the framework of a structured curricula. profession within the framework of a structured curricular training programme. acquire.
For continuing education and training after licensure, the in cooperation with the specialist societies DGEM, DGE and DAEM. DAEM, the Federal Medical Association has published a structured curricular (last update 2015), on which a number of courses have since been based throughout Germany. courses offered throughout Germany (Biesalski, Bischoff, & Puchstein, 2010).
In comparison, the situation in medical studies is still unsatisfactory. still unsatisfactory. Nutritional medicine topics are indeed part of the content of various lectures in the preclinical and clinical phases, e.g. biochemistry, physiology, general medicine, internal medicine, immunology, gastroenterology, psychosomatics, psychiatry and psychotherapy. However however, there is a complete lack of practice in their practical application during the course of study. It is sufficient to provide patients with information on the correct nutritional nutrient composition and the adequate energy content of the diet. energy content of the diet. The translation of such nutritional guidelines into practical into practical action cannot be achieved by the patient (Pudel & Westenhöfer, 2003). This is a major cause of the so-called Knowledge-Behaviour-Gap. Knowledge and information hardly determine the hardly determine the eating behaviour of the patient in practice. Much more decisive are the motives of enjoyment and taste, convenience, habits, practical skills and price, habits, practical skills and price. Advice for nutritional behaviour must therefore be given on the food and recipe level and recipe level, but not at the nutritional level, in order to be practically implemented by the patients. practical implementation by patients (Ellrott, 2012, 2013). In the best case scenario, medical students would have to learn already during their studies how to these aspects and apply them in practice. This gap is filled by the subject of Culinary Medicine.
Innovation through Culinary Medicine
Since the term nutritional medicine does not adequately reflect the practical aspects, the term was recently coined in the Anglo-Saxon world (La Puma, 2016). Culinary Medicine (La Puma, 2016). Culinary Medicine is a special combination of nutritional science and medicine with practical culinary science, so that future doctors learn the basics of learn the basics of clinical nutrition, but at the same time learn how to learn how to care for their patients based on natural foods, practical cooking natural foods, practical cooking and attractive recipes to motivate their patients to motivate their patients to lead healthier lives. Future doctors are predestined for this predestined to do so, as they are seen by patients as the most trusted source of health information about health. In addition, doctors have a significant role in doctors have a significant impact on the success of their patients' behavioural change of their patients' behaviour change (Rieder et al., 2018; Rose, Heller, & Roberto, 2019).
Culinary Medicine is not about following strict rules and practising renunciation. Rather, it is important to find a healthy balance and to strengthen awareness and self-efficacy for one's own diet in the sense of Antonovsky's salutogenesis approach (Wulfhorst & Hurrelmann, 2009) - then healthy eating can become a feasible, pleasure-friendly life principle. In Culinary Medicine, enjoyment and health are explicitly understood synergistically and not as a contradiction. In addition to health, Culinary Medicine also includes various aspects of sustainability and social community as goals (cf. UN Sustainable Development Goals (United Nations [UN], 2016)) and WHO Social Determinants of Health (World Health Organization Regional Office for Europe, 2003)). This coincides perfectly with the main topics of the Ruth and Klaus Bahlsen Foundation: healthy nutrition, organic medicine/naturopathy, organic farming as well as their application and dissemination, here by doctors as highly influential multipliers. Through additional piloting at other medical faculties - currently the Brandenburg Medical School and the University Hospital of the Justus Liebig University of Giessen - the formative evaluation of the Culinary Medicine elective is constantly being expanded. Other interested universities can join the evaluation project at any time.
Development of a Culinary Medicine Curriculum for Germany
In the United In the United States, Culinary Medicine the Goldring Center for Culinary Medicine at Tulane University, culinary medicine is already taught at more than 50 medical schools as part of the medical curriculum. medical schools as part of the medical school curriculum (Chae, Ansa, & Smith, 2017; Monlezun et al, 2015; Nicosia, R. Lanzoni, L. & Eisenberg, 2017; Polak et al., 2016; Vanderpool, 2019), including at Ivy League universities.
At the University Medical Center Göttingen, a curriculum for a course in Culinary Medicine with 28 teaching hours (LVS) is being developed together with students in a co-creation approach and tested directly in practice (professional introductions, recipes, time sequences, etc.). This will be done taking into account the US experience at Tulane University in order to be able to develop the best possible curriculum specifically for Germany. Current international contributions to the concept of Culinary Medicine will be taken into account (Hirsch et al., 2019; Mauriello & Artz, 2019). The structure of the curriculum will be based on the guideline "Nutrition Therapy in Clinic and Practice" (LEKuP), which is to be published in a new version at the end of 2019. The guideline Nutrition Therapy in Clinic and Practice is published jointly by several medical societies. The consideration of the LEKuP in the Curriculum Culinary Medicine ensures both a high degree of topicality as well as a broad approval of the concept by nutritional medical societies.
The CookUOS portfolio, which was conceived in 2010 in the field of health, nutrition and sustainability education for student teachers at the Institute for Health Research and Education at the University of Osnabrück and has been successfully implemented since winter semester 2011/2012, also serves as a methodological approach. It is under the guiding principle "Kitchen - Cooking - Competence" and is internationally visible in teaching and research (Lewis & O'Neil, 2018), (Joyce et al., 2018), (Neumann, 2018; Neumann, Gillen, & Behrens, 2016). The evaluated interdisciplinary and interprofessional method is scalable and can be adapted for education and training in the medical teaching and practice field with the same learning theory reference.
Existing modules with problem-oriented and interdisciplinary learning (POL) or qualification lines and interdisciplinary learning (POL) or qualification lines such as those listed in the module descriptions of the the module descriptions of the model degree programme in human medicine, an. Examples are the modules "Doctor, Patient, Society" and "New Media, Communication and Didactics". media, communication and didactics" (Charité - Universitätsmedizin Universitätsmedizin Berlin, 2013; RWTH Aachen, 2018) can be mentioned as examples.
Piloting and evaluation at the University Medical Centre Göttingen
The newly developed Curriculum Culinary Medicine will be offered at the University Medical Center Göttingen (UMG) two semesters two semesters in a row (SS 2020 and WS 2020/21) in the clinical part of the medical of medical studies as an elective and evaluated in parallel. The aim is to conditions for success and possible indicators for the successful implementation of a implementation of a sustainable and health-promoting diet. will be identified.
The overall scientific management and responsibility for the model project lies with the scientific director of the Institute for Nutrition & Psychology at the Georg-August-University Göttingen Medical Center (at the same time scientific director of Culinary Medicine Deutschland e.V.) PD Dr. med. Thomas Ellrott and the chairman of the board of the association Culinary Medicine Deutschland e.V. Uwe Neumann.
Project teams are formed for the implementation which consist of two student and two research assistants from the Dr. Rainer Wild of the Dr. Rainer Wild Foundation for Healthy Nutrition, as well as a specially cook and one lecturer each for the introductory interdisciplinary lectures. lectures. On the course days, there is first a short theoretical introduction to the topic by the lecturer. introduction to the topic by the lecturer, followed by practical cooking in the teaching kitchen. practical cooking in the teaching kitchen. The contents of the practical part are always the theoretical introduction of the course days. The course also includes one excursion or one action day per semester. Within the framework of an excursion, e.g. research institutes, organic farms, caterers, company restaurants or media caterers, company restaurants or the media that deal with relevant health and sustainability topics. Alternatively, at the end of each semester at the end of each semester, which serves to communicate and network the project locally. of the project. The curriculum is accompanied by an extensive teaching evaluation during the pilot project. comprehensive teaching evaluation (cf. Jaroudi et al., 2018). For the US curriculum, an improvement in the nutritional knowledge of the students knowledge, a higher confidence in their own counselling skills in the case of lifestyle diseases, as well as an improvement in culinary skills (Pang et al. have recently been confirmed (Pang et al., 2019).
Better practical cooking skills are typically typically go hand in hand with a healthier diet, as was also shown by the NVS II (Nutrition Report, 2012). Thus, the participating students also benefit directly from the project. project. This is associated with a higher motivation to also advise patients on their health behaviour (Frank, 2004). health behaviour (Frank, 2004). Participation in nutrition education courses increases doctors' confidence in their counselling skills. doctors in their counselling competence. They subsequently address patients patients about nutritional topics much more frequently (Kaplan et al., 2013). Culinary Medicine thus synergistically benefits both the trainee physicians both the trainee doctors and their patients.
The following shows an overview of the structure of the Culinary Medicine course. The teaching formats lecture, seminar, exercise and implementation are integrated into the curriculum.
Indication-related modules of Culinary Medicine (Göttingen Model)
The practical cooking courses in the form of a "Teaching Kitchen" are directly related to the indication groups and dietary forms published in the evidence-based guideline Nutrition Therapy in Clinic and Practice (LEKuP) and are supplemented by appropriate case studies.
- Whole foods/healthy nutrition (incl. prevention)
- Malnutrition
- Nutrition therapy for metabolism and cardiovascular diseases I
- Nutrition therapy for metabolism and cardiovascular diseases II
- Nutrition therapy for gastroenterological diseases
- Nutritional therapy for kidney disease and urinary stones
- Nutritional therapy for inflammatory rheumatic, orthopaedic and neurological diseases
Es wird eine komplette Dokumentation des Curriculums Culinary Medicine inkl. Videoanleitungen erstellt und kosten- bzw. lizenzfrei für andere Universitäten zur Verfügung gestellt. Dieses ist ausdrücklich von der Rut und-Klaus-Bahlsen-Stiftung erwünscht und Konsens des Projektteams. Es ist zudem Voraussetzung für eine nachfolgende breite Anwendung von Culinary Medicine an deutschsprachigen Universitäten.