Where is the lifestyle medicine in the Canadian undergraduate medical education curricula? A content analysis
DOI:
https://doi.org/10.36834/cmej.81526Abstract
Background: Lifestyle Medicine (LM) focuses on preventing and managing non-communicable diseases (NCDs) through evidence-based behavioural and therapeutic interventions. Despite the established efficacy of LM, its integration into Canadian undergraduate medical education (UGME) remains largely unexamined.
Methods: We employed a deductive and inductive summative content analysis methodology. We collected publicly available course and program descriptions for each UGME program across Canada. Further, we contacted deans/curriculum leads for additional curriculum documentation. Documents were coded according to references to various domains of LM as defined by the American College of LM and British Society of LM.
Results: The sample comprised 13 UGME programs, with 1327 documents included for the final review. Notable variability across institutions was noted with reference to LM integration. LM topics were more frequently included in pre-clerkship and required courses compared to clerkship and electives. Notably, nutrition, mental wellbeing, and physical activity were most frequently referenced, while sleep health and social connectedness were less represented.
Conclusions: To our knowledge, this study is the first to formally map the current practices of LM integration in Canadian UGME. Although there were some study limitations (e.g., exclusion of 25% of Canadian UGME programs), this mapping is integral to identify the current state of the curricula and inform future educational initiatives to enhance medical trainees’ LM-related knowledge and skills. This in turn, may potentially help address modifiable risk factors for NCDs and improve population health outcomes.
Downloads
References
1. Public Health Agency of Canada. At-a-glance how healthy are Canadians? A brief update. HPCDP J. 2018;38(10):385. https://doi.org/10.24095/hpcdp.38.10.05
2. Institute for Health Metrics and Evaluation. Global burden of disease 2021: findings from the GBD 2021 study. Available from https://www.healthdata.org/research-analysis/library/global-burden-disease-2021-findings-gbd-2021-study [Accessed Nov 9, 2024]
3. Budreviciute A, Damiati S, Sabir DK, et al. Management and prevention strategies for non-communicable diseases (ncds) and their risk factors. Front Pub Health. 2020;8:574111. https://doi.org/10.3389/fpubh.2020.574111
4. Statistics Canada. Health outcomes. Sept 13, 2023. Available from https://www150.statcan.gc.ca/n1/pub/82-570-x/2023001/section1-eng.htm#a3 [Accessed Oct 4, 2024].
5. Flexner N, Bernstein JT, Weippert MV, et al. How many diet-related non-communicable disease deaths could be averted or delayed if Canadians reduced their consumption of calories derived from free sugars intake? a macrosimulation modeling study. Nutrients. 2023;15(8):1835. https://doi.org/10.3390/nu15081835
6. Noncommunicable Disease Alliance. Financing NCDs. NCD Alliance. Mar 2, 2015. Available from https://ncdalliance.org/why-ncds/financing-ncds [Accessed Feb 29, 2024].
7. World Health Organization. Noncommunicable diseases country profiles 2018. World Health Organization; 2018. Available from https://iris.who.int/handle/10665/274512 [Accessed Mar 18, 2024].
8. Public Health Agency of Canada. Evaluation of the healthy living and chronic disease prevention – multi-sectoral partnerships (MSP) program. Available from https://www.canada.ca/en/public-health/corporate/transparency/corporate-management-reporting/evaluation/healthy-living-chronic-disease-prevention-multi-sectoral-partnerships-program-2014-2019.html#a3.0 [Accessed Oct 4, 2024].
9. Andersen K, Gudnason V. [Chronic non-communicable diseases: a global epidemic of the 21st century]. Laeknabladid. 2012;98(11):591-595. https://doi.org/10.17992/lbl.2012.11.462
10. O’Neil A, Jacka FN, Quirk SE, et al. A shared framework for the common mental disorders and non-communicable disease: key considerations for disease prevention and control. BMC Psychiat. 2015;15(1):15. https://doi.org/10.1186/s12888-015-0394-0
11. Pikula A, Gulati M, Bonnet JP, et al. Promise of lifestyle medicine for heart disease, diabetes mellitus, and cerebrovascular diseases Mayo Clin Proc Innov Qual Outcomes. 2024;8(2):151-165. https://doi.org/10.1016/j.mayocpiqo.2023.11.005
12. Rippe JM. Lifestyle medicine: the health promoting power of daily habits and practices. Am J Lifestyle Med. 2018;12(6):499-512. https://doi.org/10.1177/1559827618785554
13. British Society of Lifestyle Medicine. Transforming healthcare through lifestyle medicine. British Society of Lifestyle Medicine. Available from https://bslm.org.uk/ [Accessed Feb 20, 2024]
14. American College of Lifestyle Medicine. Overview. American College of Lifestyle Medicine. Available from https://lifestylemedicine.org/overview/ [Accessed Oct 4, 2024].
15. Lippman D, Stump M, Veazey E, et al. Foundations of lifestyle medicine and its evolution. Mayo Clin Proc Innov Qual Outcomes. 2024;8(1):97-111. https://doi.org/10.1016/j.mayocpiqo.2023.11.004
16. Rutten-Jacobs LC, Larsson SC, Malik R, et al. Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: cohort study of 306 473 UK Biobank participants. BMJ. 2018;363:k4168. https://doi.org/10.1136/bmj.k4168
17. Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, et al. 10-year follow-up of diabetes incidence and weight loss in the diabetes prevention program outcomes Study. Lancet. 2009;374(9702):1677-1686. https://doi.org/10.1016/S0140-6736(09)61457-4
18. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-2007. https://doi.org/10.1001/jama.280.23.2001
19. Bharati R, Kovach KA, Bonnet JP, et al. incorporating lifestyle medicine into primary care practice: perceptions and practices of family physicians. Am J Lifestyle Med. 2022;17(5):704-716. https://doi.org/10.1177/15598276211072506
20. Lee JS, Xierali IM, Jaini PA, Jetpuri Z, Papa F. Medical student perception of lifestyle medicine and willingness to engage in lifestyle counseling: a pilot study of allopathic and osteopathic medical students. Am J Lifestyle Med. 2021;17(2):280-289. https://doi.org/10.1177/15598276211004449
21. Lessans S, Pasarica M, Kay D. Do medical students appreciate lifestyle medicine and are they confident in their skills? PRiMER. 2022;6:15. https://doi.org/10.22454/PRiMER.2022.968910
22. Gramlich LM, Olstad DL, Nasser R, et al. Medical students’ perceptions of nutrition education in Canadian universities. Appl Physiol Nutr Metab. 2010;35(3):336-343. https://doi.org/10.1139/H10-016
23. McFadden T, Fortier M, Sweet SN, Tomasone JR, McGinn R, Levac BM. Canadian medical students’ perceived motivation, confidence and frequency recommending physical activity. Prevent Med Rep. 2019;15:100898. https://doi.org/10.1016/j.pmedr.2019.100898
24. Persaud N, Sabir A, Woods H, et al. Preventive care recommendations to promote health equity. CMAJ. 2023;195(37):E1250-E1273. https://doi.org/10.1503/cmaj.230237
25. Frates B, Ortega HA, Freeman KJ, Co JPT, Bernstein M. Lifestyle medicine in medical education: maximizing impact. Mayo Clin Proc Innov Qual Outcomes.2024;8(5):451-474. https://doi.org/10.1016/j.mayocpiqo.2024.07.003
26. American College of Lifestyle Medicine. Lifestyle medicine interest group directory. Available from https://connect.lifestylemedicine.org/lmig-directory [Accessed Oct 31, 2024]
27. Rea B, Wilson A. Creating a lifestyle medicine specialist fellowship: a replicable and sustainable model. Amer J Lifestyle Med. 2020;14(3):278-281. https://doi.org/10.1177/1559827620907552
28. American College of Lifestyle Medicine. Curriculum. American College of Lifestyle Medicine. Available from https://lifestylemedicine.org/curriculum/ [Accessed Oct 5, 2024].
29. Anderson NN, Gagliardi AR. Medical student exposure to women’s health concepts and practices: a content analysis of curriculum at Canadian medical schools. BMC Med Educ. 2021;21(1):435. https://doi.org/10.1186/s12909-021-02873-8
30. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
31. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. https://doi.org/10.1177/1049732305276687
32. Ibrahim S, Donelle L, Regan S, Sidani S. A qualitative content analysis of nurses’ comfort and employment of workarounds with electronic documentation systems in home care practice. Can J Nurs Res. 2020;52(1):31-44. https://doi.org/10.1177/0844562119855509
33. Vears DF, Gillam L. Inductive content analysis: a guide for beginning qualitative researchers. FoHPE. 2022;23(1):111-127. https://doi.org/10.3316/informit.455663644555599
34. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245. https://doi.org/10.1097/ACM.0000000000000388
35. The R Foundation. R: The R Project for statistical computing. Available from https://www.r-project.org/ [Accessed Apr 26, 2025].
36. NVivo Team. NVivo: leading qualitative data analysis software. Lumivero. Available from https://lumivero.com/products/nvivo/ Accessed April 26, 2025.
37. Association of Faculties of Medicine in Canada. Home. AFMC. Available from https://www.afmc.ca/ [Accessed Oct 31, 2024].
38. Vij V. Integration of lifestyle medicine into the medical undergraduate curriculum. J Adv Med Educ Prof. 2022;10(2):133-134. https://doi.org/10.30476/JAMP.2022.93916.1559
39. Pasarica M, Boring M, Lessans S. Current practices in the instruction of lifestyle medicine in medical curricula. Patient Educ Counsel. 2022;105(2):339-345. https://doi.org/10.1016/j.pec.2021.05.042
40. Canadian Resident Matching Service. R-1 Data and reports. CaRMS. Available from https://www.carms.ca/data-reports/r1-data-reports/ [Accessed Oct 1, 2024].
41. Medical Council of Canada. Periodic health encounter/preventive health advice. July 26, 2023. Available from https://mcc.ca/objectives/medical-expert/periodic-health-encounter-preventive-health-advice/ [Accessed Apr 11, 2025].
42. Medical Council of Canada. Substance use or addictive disorders. July 26, 2023. https://mcc.ca/objectives/medical-expert/substance-use-or-addictive-disorders/ [Accessed Apr 11, 2025].
43. Medical Council of Canada. Cerebrovascular accident and transient ischemic attack (stroke). July 26, 2023. Available from https://mcc.ca/objectives/medical-expert/cerebrovascular-accident-and-transient-ischemic-attack-stroke/ [Accessed Apr 11, 2025].
44. Lianov LS, Adamson K, Kelly JH, Matthews S, Palma M, Rea BL. Lifestyle medicine core competencies: 2022 update. Am J Lifestyle Med. 2022;16(6):734-739. https://doi.org/10.1177/15598276221121580
45. Lianov L, Johnson M. Physician competencies for prescribing lifestyle medicine. JAMA. 2010;304(2):202-203. https://doi.org/10.1001/jama.2010.903
46. Eisenberg DM, Cole A, Maile EJ, et al. Proposed nutrition competencies for medical students and physician trainees: a consensus statement. JAMA Network Open. 2024;7(9):e2435425. https://doi.org/10.1001/jamanetworkopen.2024.35425
47. Strings S. Fearing the black body: the racial origins of fat phobia. Social Forces. 2020;99(1):e3. https://doi.org/10.1093/sf/soz161
48. Grega ML, Shalz JT, Rosenfeld RM, et al. American college of lifestyle medicine expert consensus statement: lifestyle medicine for optimal outcomes in primary care. Am J Lifestyle Med. 2023;18(2):269-293. https://doi.org/10.1177/15598276231202970
49. Harden RM. AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Med Teach. 2001;23(2):123-137. https://doi.org/10.1080/01421590120036547
50. Hart J. Lifestyle as medicine: institute of lifestyle medicine, Harvard Medical School. Alt Compl Therapies. 2017;23(2):72-75. https://doi.org/10.1089/act.2017.29104.pro
51. Temerty Faculty of Medicine. Food Basics for Future Doctors: ‘Culinary Medicine’ at U of T. Available from https://temertymedicine.utoronto.ca/news/food-basics-future-doctors-culinary-medicine-u-t [Accessed Dec 17, 2024].
52. Hivert MF, Arena R, Forman DE, et al. Medical training to achieve competency in lifestyle counseling: an essential foundation for prevention and treatment of cardiovascular diseases and other chronic medical conditions: a scientific statement from the American Heart Association. Circulation. 2016;134(15):e308-e327. https://doi.org/10.1161/CIR.0000000000000442
53. de Meyrick J. The Delphi method and health research. Health Educ. 2003;103(1):7-16. https://doi.org/10.1108/09654280310459112
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 David Vaz, Sarah Ibrahim, Aleksandra Pikula

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.


