Lifestyle Medicine Track

Since 2012, UC San Diego PMR has offered Exercise is Medicine, a curriculum published in the American Journal of Preventive Medicine, and includes exposure to didactic and experiential training.The modules included energetics, exercise and cardiorespiratory health, bone health, obesity and sarcopenia, balance and fall prevention, and behavior change and the use of technologies. UC San Diego is a certified Exercise is Medicine campus with Gold Level status by the American College of Sport Medicine.

EIM Faculty:

• Jeanne Nichols, PhD
• David Wing, MS
• Ryan Moran, MD, MPH
• Job Godino, PhD

UC San Diego/San Diego State University PMR has collaborated with Steve Cole MD, MA, the creator of Brief Action Planning, and UC San Diego Psychiatry faculty to offer a comprehensive behavior change curriculum. PMR residents are able to participate in a basic or “Expert” track in Motivational Interviewing, described below. This curriculum is appealing to residents interested in addiction, lifestyle medicine, obesity medicine and behavior change. After participation in the curriculum, residents gain comfort with patient counseling for behavior change using motivational interviewing. 

Basic Track: Basic track residents go through a course on Brief Action Planning, a modality of behavior change that provides residents a method of engaging patients with brief counseling that can be utilized in a short clinic visit. They also receive a lecture on the basics of motivational interviewing, and later, coded feedback from this expert faculty while being observed in a patient encounter after BAP training, and then at the end of residency. Finally, they participate in facilitating shared medical appointment visits in a structured shared medical appointment program that provides intensive lifestyle change treatment for obesity. 

Expert Track: Expert track residents go through the basic track, but also receive access to online modules that teach motivational interviewing principles. This allows them to gain understanding and proficiency in incorporating stylistic principles and “Spirit” of MI in their counseling. Following this, they become certified in Brief Action Planning by one of the residency BAP faculty, and then are able to participate in BAP Faculty Development Group meetings, where they are able to network with nationally renowned behavior change experts and receive feedback on their counseling. They then teach BAP to the incoming PGY-2 residents in the summer curriculum. Finally, residents participate in a four-week virtual Lifestyle Medicine clinic rotation embedded within the Linda Vista Healthcare Center. After completion of the Expert Track, residents become comfortable with providing behavior change counseling in a variety of practice settings.  

List RACE-MI Curriculum faculty:

• Deepa Sannidhi, MD, DipABLM, DipABOM
• Camila Romero, MD
• Steve Cole, PhD
• Igor Koutsenok, MD

The Lifestyle Medicine Residency Curriculum is a collaborative effort of the American College of Lifestyle Medicine and Loma Linda University. Completion of the curriculum makes residents eligible to sit for the American Board of Lifestyle Medicine Certification exam. Passing the exam confers a “Diplomate of the American Board of  Lifestyle Medicine” status. The curriculum covers all 6 pillars of lifestyle medicine, including diet, physical activity, sleep, stress, risky substance avoidance and personal connection/spirituality. Residents receive 40 hours of didactic instruction, meet a required number of clinical encounters, and are exposed to an intensive therapeutic lifestyle change program. They also complete 60 hours of independent application activities which include a variety of self-directed activities intended to increase resident exposure to lifestyle services and positive health behaviors. This curriculum has provided UC San Diego/San Diego State University PMR the opportunity to expand its clinical lifestyle medicine and cardiometabolic offerings, as described in detail below. 

Supervised Lifestyle and Integrative Medicine (SLIM) Program (required):  UC San Diego/San Diego State University PM residents rotate through a virtual shared medical appointment program for the treatment of obesity designed to provide intensive lifestyle treatment in addition to standard obesity care. Residents gain practice in behavior change skills by facilitating small groups within the virtual appointment, and become more comfortable with patient education focused on lifestyle principles. This is part of the LMRC.

Virtual Lifestyle Medicine Rotation: Residents rotate in clinic once a week for 4 weeks to follow patients in an Federally Qualified Health Center setting that need behavior change counseling for a variety of reasons. This rotation is part of the RACE-MI behavior change curriculum Expert Track (See above under RACE-MI curriculum for details). 

Cardiometabolic Rotation: 

Cardiac Rehab: Residents have the opportunity to shadow nutritionists, exercise physiologists, and a preventive cardiologist/lipidologist at Cardiac rehab. Residents are exposed to intensive lifestyle change with the Pritikin program. Residents follow patients, write notes and participate in counseling. 

Obesity Medicine: Residents rotate once weekly with UC San Diego PMR faculty and faculty at UC San Diego Weight Management clinic. 

Comprehensive Lifestyle Medicine Intakes for SLIM Program: Residents rotate with UC San Diego PMR faculty doing comprehensive lifestyle medicine intakes and follow ups prior to patient participation in virtual shared medical appointment program 

Residents who express interest are also able to gain exposure to intensive therapeutic lifestyle change programs such as Ornish and CHIP if they express interest. 

Skinny Gene Diabetes Prevention Program: Diabetes Prevention Program (DPP) is an intensive lifestyle change program that has been shown in a large multicenter randomized controlled trial to decrease the likelihood of progression to diabetes by 58% (Diabetes Prevention Program Research Group 2002), which was superior to metformin. Residents rotate with the Skinny Gene project, a local non-profit provider and umbrella organization specializing in the implementation of the Diabetes Prevention Program. They are able to participate in quality improvement projects and counseling with Skinny Gene DPP participants. (To learn more about DPP go to the AMA Diabetes Prevention website and the CDC Diabetes Prevention website).

Faculty:

• Camila Romero MD, MPH 
• Deepa Sannidhi, MD, DipABLM, DipABOM
• Eduardo Grunvald, MD, FACP
• Pam Taub MD, FACC, FASPC

At this time, residents are exposed to lectures from nationally recognized faculty in culinary medicine. They are also exposed to a ½ day culinary medicine workshop conducted at a local teaching kitchen. Residents who are interested in pursuing more are able to work with culinary medicine certified faculty locally in San Diego pursuing projects focused in this area. 

Culinary Medicine Faculty:

• Sabrina Falquier Montgrain, MD 
• Rani Polak, MD, MBA

UC San Diego PMR participated in the University of Arizona Center for Integrative Medicine in Residency (IMR) Curriculum. We coordinate with our sister programs at UC San Diego that participate in the IMR including UC San Diego Family Medicine Residency and UC San Diego Internal Medicine. The IMR offers residents the opportunity to be exposed to integrative medicine principals and practice in addition to lifestyle medicine, which is one modality within the larger field of Integrative Medicine, which includes botanicals, acupuncture, manipulation treatments, traditional medicinal systems such as ayurveda and traditional chinese medicine, mind-body medicine and functional medicine. Patients are often interested in understanding how Integrative Modalities may be useful to them, and have questions on alternative treatments. They may also have many questions on the use of diets outside of the scientific mainstream. The IMR provides residents an opportunity to gain a little bit of exposure to these modalities, and arms them with a basic understanding of how and when to apply these tools. The IMR aso does a deep-dive into mind-body practices and a self-care module. Finally, the IMR curriculum also provides information on the evidence for and against a variety of diets outside the mainstream, so that residents can have informed conversations with patients who inquire about them. 

All preventive medicine residents are required to complete 160 hours in public health. Residents are able to find mentorship to do public health work at the county of San Diego Health and Human Services (HHSA), where many residency graduates sit in leadership positions. San Diego HHSA has jurisdiction over the border communities of South-East San Diego, rural communities in the mountains, urban communities in Central San Diego, and suburban and semi-rural and rural populations in the Northern part of the county. Residents are also able to work at the Imperial County department of health, providing exposure to rural public health where residents gain exposure to addressing public health needs in under-resourced settings in one of the poorest and most medically under-served counties in the country. San Diego county is home to the nationally renowned Live Well San Diego program, an initiative that aligns the efforts of individuals, organizations and government to help San Diegans reach goals of wellness rather than simply the prevention of disease by addressing healthy choices, social determinants of health and improving community connections.