Hospital Expands Lifestyle Medicine Curriculum to All Resident Doctors

HCA Houston Healthcare-Kingwood is providing about 65 residents access to the curriculum that prepares residents to make evidence-based lifestyle behavior interventions and become certified in lifestyle medicine upon residency completion.

A Houston-area hospital has embraced the value of lifestyle medicine in health care by making the Lifestyle Medicine Residency Curriculum (LMRC) available to all of its resident physicians..

HCA Houston Healthcare-Kingwood, a full-service, 457-bed acute care hospital and Level III Trauma Center, is providing about 65 residents access to the comprehensive, applicable, and flexible curriculum that prepares residents to make evidence-based, lifestyle behavior interventions and become certified in lifestyle medicine by the American Board of Lifestyle Medicine upon residency completion.

Additionally, the residency program is working with two faculty members from the Fertitta Family University of Houston College of Medicine who are board-certified to practice lifestyle medicine, secured funding to provide more plant-based meals at the hospital, and have integrated lifestyle medicine experts into the rotation of grand rounds guest speakers who meet with the resident doctors.

Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions  including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions. Applying the six pillars of lifestyle medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections—also provides effective prevention for these conditions.

“In our patient population, we see a lot of chronic disease. We can keep adding new medications and upping doses, or we can use the practice of evidence-based lifestyle medicine to treat the root causes of those chronic diseases,” said Rajeev Raghavan, MD, FASN, program director for the hospital’s internal medicine residency program. “The Lifestyle Medicine Residency Curriculum is an unbelievable learning resource to equip physicians with the knowledge and skills to practice this growing medical specialty early in their medical careers. I believe not providing this information is a disservice to the next generation of physicians and their patients.”

HCA Houston Healthcare-Kingwood resident Reuben Plasencia, MD, was instrumental in bringing the LMRC to the hospital. Dr. Plasencia graduated from Montemorelos University School of Medicine in Mexico and then took a year to do research at Loma Linda University in California, where six faculty members were among the first class of physicians to become board certified in lifestyle medicine in 2017. He discovered the LMRC while researching the specialty on ACLM’s website.

The LMRC has significantly expanded since it was piloted in 2018. The curriculum is being implemented in 207 residency programs across more than 100 sites, with 5,560 enrollees. Residents were included in every aspect of the creation of the LMRC, which is designed to be deliverable by residents to their peers. The educational component includes 40 hours of in-person didactic material along with 60 hours of asynchronous application with application activities to be presented and completed over an 18 month to three-year time period. Upon completion of both the educational and practicum components, residents are qualified to sit for the American Board of Lifestyle Medicine (ABLM) certification exam.

“Knowing that there was a curriculum specifically for residents, I had to introduce this to our residency program,” Dr. Plasencia said. “Most medical schools don’t prepare physicians to practice lifestyle medicine despite the scientific evidence that supports it. I surveyed the other residents in my hospital and found that about 80% to 90% didn’t know what lifestyle medicine was but their perception was that learning it would be very beneficial to their medical practice.”

Many faculty members, including Dr. Raghavan, were not familiar with lifestyle medicine when Dr. Plasencia proposed incorporating it into the residency program. But as Dr. Raghavan reviewed the evidence and resources available from ACLM, he became convinced it would not only enhance the residency program but his own practice. He is in the process of obtaining his certification from the American Board of Lifestyle Medicine and has brought the certification opportunity to HCA residents, including Dr. Plasencia, through the LMRC as well.

Although physicians are generally lifelong learners, introducing the pillars of lifestyle medicine early in their medical careers is ideal, he said. Practicing physicians often navigate hectic schedules and time constraints that make it hard to spend adequate time with patients, much less learn new specialties and study for additional board exams.

“Also, because residents are still in training, they have more time to spend with patients,” Dr. Raghavan said. “In our clinic, we may have three patients scheduled for a half a day with residents. If you are a typical internal medicine or family medicine physician, you are seeing patients every 15 minutes and have less time for patient education. That’s why I think a resident clinic is an ideal place to incorporate lifestyle medicine.”

As interest in lifestyle medicine grows, more new doctors like Dr. Plasencia may seek out residency programs that offer comprehensive lifestyle medicine training and certification opportunities.

During interviews of 200 prospective residents for the HCA Kingwood incoming class starting in July 2023, at least one in five interviewees expressed a specific interest in lifestyle medicine upon learning about the LMRC.

During his residency rotations, Dr. Plasencia gained insight into one way a lifestyle medicine clinic runs by training with Drs. Bandana and Munish Chawla, who are both board-certified in lifestyle medicine. Their clinic hosts group medical appointments, potlucks, and cooking classes to help patients connect with and inspire others to develop healthy lifestyle habits.

“Our vision is to establish a clinic where a multi-disciplinary team of health professionals has the time, attitude, knowledge, and skills to educate and empower patients on lifestyle behavior change,” Dr. Plasencia said. “I’m grateful to be in a residency program that believes in lifestyle medicine and its proven ability to treat, prevent and even reverse chronic disease. It will make us all better doctors.”