By the end of this course (7 days), you will be able to:

• Introduce metabolic signaling, enzymes, and co-factors
• Learn intermediary metabolism and its regulation at the organ, tissue, cellular and biochemical level
• Stress the importance of each aspect of metabolism to the regulation homeostasis under various physiological conditions, with an emphasis on fed, fasted, prolonged fasted, and starved states
• Outline current thoughts on how disruptions of various aspects of metabolism contribute to various pathological conditions including cancers
• Give a coherent understanding of the inter-relationships involved in regulating general metabolism
• Lipid metabolism and how can be influenced through diet

Assessments: medical knowledge quizzes and exam, small group case-based problems

By the end of this course (3 days), students will be able to:

• Describe normal nutritional changes over the life course and the impact of lifestyle change on patients’ health and quality of life
• Obtain a thorough patient history on lifestyle behaviors
• Describe the role of evidence-based counseling and the multidisciplinary care team care in facilitating lifestyle behavior change
• Discuss how social determinants of health may impact a patient’s ability to engage in lifestyle behavior change
• Identify aspects of their personal experiences with lifestyle behavior change that can be applied to patient care as well as physician self-care

Additionally, during this TIME course, all students complete the Gaples Institute Nutrition Course for Health Professionals consisting of 4 modules covering 25 competencies (4-8 hours), which are mapped to the recommendations in the JAMA article: Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement by by Eisenberg et al. (2024). Modules and materials are updated annually by the institute.

• Module 1: Why Does Nutrition Matter to You and Your Patients?
• Module 2: Dietary Fats and Patient Health
• Module 3: Carbohydrates and Protein
• Module 4: Counseling Your Patients About Nutrition

Assessments: Medical knowledge quizzes, case study assignments, standardized patients, small group clinical problems, reflections, self-assessment

By the end of this course (4 days), students will be able to:

• Reintroduce students to the fundamentals of human metabolism.
• Examine facets of human metabolism that are particularly relevant to human health, well-being, and disease
• Explore the influence of sedentariness, activity, and exercise.
• Explore therapeutic options for obesity.
• Gain an appreciation for the emerging relationships between metabolism, aging, and neuronal function.

In small groups with faculty guidance, students explore cutting edge topics in the basic science and clinical medicine literature related to:

• Mitochondrial bioenergetics, structure, and disease
• Genetics of obesity and thinness
• GLP-1 receptor agonists
• Exercise metabolism
• Mechano-transduction and sedentariness
• Microbiome and metabolism

Assessments: Journal club and small group oral presentations and participation

TIME: Disparities and Inequities in Health and Health Care (Year 1)

• Introduces access to healthy foods in social determinants of health
• Assessments: Small group participation and reflection, private individual implicit bias tests related to patient-related domains, successful completion of group assignment related to service learning

TIME Pain (Year 1)

• Understand how food impacts the central nervous system response to pain
• Understand why changes in diet often relieve physical pain and psychiatric symptoms
• Learn the chronic diseases that can benefit from a dietary approach
• Learn and understand the role of glutamate in pain processing
• Assessments:Daily reflections with prompts

Foundations in Public Health: Epidemiology, Ethics and Health Care System

• Epidemiology of obesity is introduced in small group activity
• Epidemiology of food source contamination and disease outbreak
• Assessments: written exam, small group participation

Longitudinal Ambulatory Clinic (Year 1-2)

• Applying motivational counseling related to nutritional habits
• Preventative medicine – obesity
• Care of patients with hyperlipidemia
• Care of patients with gastrointestinal or liver disease
• Behavioral change counseling
• Assessments: oral presentations, standardized patient encounters, patient encounter notes, direct observation of entrustable professional activities

Integrative Medicine (Year 1)

• Nutrition related to a wellness plan
• Culinary and botanical medicine
• Evidence-based diets
• Recognize the importance of Cultures and Community in food choices.
• Nutrition concepts related to primary preventive care and management of chronic disease
• Assessments:Menu design, case write-up, reflection, medical knowledge quizzes

Organ System Foundations of Medicine (OSFM) (Year 1-2)

Assessments for OSFM: Standardized patients, small group clinical problems and concept maps, medical knowledges quizzes and exams

OSFM Immunology

• Immunologic mechanisms related to food allergy

OSFM Hematology

• Iron Deficiency
• Folate and B12 metabolism and deficiency

OSFM Neurosciences

• Neurological disorders related to vitamin deficiencies and toxicities

OSFM Brain, Mind, Behavior

• Motivated behaviors using hunger cues as an example
• Eating disorders and nutritional deficiencies

OSFM Infectious Disease/Microbiology

• Food borne illnesses
• Microbiomes

OSFM Cardiology

• Nutrition and exercise related to cardiac health
• Metabolic syndrome

OSFM Renal

• Nutritional management of chronic disease

OSFM Endocrinology

• Nutrition related to diabetes, lipid metabolism, bone health
• Pharmacologic therapies for diabetes, lipid metabolism, bone health
• Define obesity & understand why it is a problem
• Know the different hormonal signals that affect appetite and energy expenditure
• Understand that the hypothalamus and brainstem integrate numerous hormone signals to affect feeding behavior and energy expenditure
• Understand factors that make maintenance of weight loss difficult
• Review the normal function of oxytocin in lactation

OSFM Gastrointestinal/Liver

• Mediterranean diet in context of fatty liver disease
• Know the main segments of the small intestine and be familiar with their absorptive roles
• Understand the mechanistic basis for absorption of lipids, carbohydrates, and protein
• Understand the importance of calories and nutrition in the human body
• Differentiate marasmus vs. kwashiorkor
• Have a general understanding of assessing a patients' nutritional status
• Understand the importance of maintaining the gut barrier
• Be familiar with indications for enteral and parenteral nutrition
• Understand the gastrointestinal conditions that cause malabsorption of micronutrients
• Be cognizant of manifestations of micronutrient and mineral deficiencies
• Recognize the signs of toxicity from excessive micronutrient supplementation
• Mechanisms of malabsorption and chronic diarrhea and related diagnostic laboratory studies
• Role of pancreas in glucose homeostasis
• Nutritional mechanisms related to therapeutic approaches to irritable bowel syndrome
• Definitions and classification of obesity
• Review the growing epidemic of obesity in the US
• Medical and financial impact of obesity
• Surgical and endoscopic obesity treatment options, including patient selection and outcomes

OSFM Musculoskeletal

• Musculoskeletal disorders related to vitamin deficiencies

OSFM Reproductive

• Review how nutrition and behavioral interventions can affect menstrual disorders
• Dietary management of gestational diabetes
• Normal lactation physiology

General

• Students are provided with links to documents from the Gaples Institute modules both as reference and for use in patient education (all students originally completed these modules in Year 1)
  • Module 1: Why Does Nutrition Matter to You and Your Patients?
  • Module 2: Dietary Fats and Patient Health
  • Module 3: Carbohydrates and Protein
  • Module 4: Counseling Your Patients About Nutrition
• Primary Care Leadership Guide to Social Determinants of Health – Food Insecurity – developed and updated annually by our students in the Primary Care Leadership Track and their faculty mentors
  • Provides guide to asking the right questions when taking a history
  • Provides local resources to assist and advocate for patients’ needs.

Transition to the Wards (Year 2)

• Non-physician healthcare disciplines in delivery of care in the hospital – Nutrition and Dietetics
• Assessment: active participation in allied health care experience

Core Clerkship in Obstetrics and Gynecology (Year 2-3)

• Half-day experience working with a lactation consultant educating new parents on lactation and newborn nutrition
• myLearning module “Wellstart Lactation Management” with a focus on the nutritional value of breast-feeding and newborn nutrition
• Targeted nutrition topics are covered along with preconception, antepartum and postpartum care, and in management of gestational and pregestational diabetes
• Assessments: Standardized patients, clinical performance assessment, oral presentations, case write-ups and medical encounter documentation, medical knowledge exam, direct observation of entrustable professional activities

Core Clerkship in Pediatrics (Year 2-3)

• Demonstrate an ability to perform an age-appropriate history regarding diet/nutritional history, including ability to assess and communicate nutritional goals
• Describe the advantages of breastfeeding and describe common prepared formulas for normal, premature and food allergic infants.
• Growth and development module
• Food insecurity - strategies for addressing limited access to healthy foods among socially disadvantaged populations.
• Essential principles of breastfeeding
• Growth and development - understanding of the nationally accepted parameters for "overweight" and "obesity" in children.
• Assessments: Clinical performance assessment, oral presentations, case write-ups and medical encounter documentation, medical knowledge exam, direct observation of entrustable professional activities

Core Clerkship in Surgery (Year 2-3)

• Fluids, Electrolytes, and Surgical Nutrition
• Assessments: Standardized patients, clinical performance assessment, oral presentations, case write-ups and medical encounter documentation, medical knowledge exam, direct observation of entrustable professional activities

Advanced Clerkship in Critical Care (Year 4)

• ICU nutrition
• Assessments: Simulations, clinical performance assessment, oral presentations, case write-ups and medical encounter documentation, medical knowledge exam, direct observation of entrustable professional activities

Advanced Ambulatory Clerkship (Year 4)

• Physician Education and Assessment Center (PEAC) modules on diabetes management, obesity and overweight management, nutrition related to chronic hypertension, nutrition and preventative medicine
• Refresher using updated Gaples Institute modules
• Behavioral change counseling
• Home care visits during which nutrition of patient is assessed
• Assessments: Clinical performance assessment, oral presentations, medical encounter documentation, weekly structured reflection, health advocacy assignment, direct observation of entrustable professional activities