A Comprehensive Clinical Lifestyle Medicine Specialty Fellowship Program: What Intensive Lifestyle Treatment Can Do

Lifestyle medicine (LM) is recognized as an essential component of evidence-based medical treatment, particularly for chronic diseases. Multiple studies have shown that intensive therapeutic lifestyle change can arrest and reverse disease, including heart disease, type 2 diabetes, essential hypertension, metabolic syndrome, and autoimmune and inflammatory conditions. While more modest lifestyle changes can slow the onset or prevent disease, studies reveal that intensive therapeutic changes are required to arrest and reverse disease. As increasing numbers of clinicians have learned about the powerful treatment effects of intensive lifestyle interventions, interest in LM has greatly increased. This, in turn, has led to the need for evidence-based clinical LM training in how to effectively provide intensive LM interventions that can arrest and reverse disease. As with all clinical training, such training must include actual patient care guided by knowledgeable expert LM clinicians. The purpose of this article is to (1) describe the need for and function of clinical LM specialists, (2) describe the key components in the training of clinical LM specialists to treat and reverse chronic disease, and (3) describe the steps/components in establishing and implementing a clinical LM specialty-training program.

Transition from Chief Residency to Specialty Training: Issues and Solutions

Three fourths of chief residents in general surgery receive further specialty training. The end to start-of-year transition can create administrative conflicts between the residency and the specialty training program. An Internet-based questionnaire surveyed general surgery and surgical specialty program directors to define issues and possible solutions associated with end to start-of-year transitions using a Likert scale. There was an overall response rate of 17.5 per cent, 19.6 per cent among general surgery directors, and 15.8 per cent among specialty directors. Program directors in general surgery felt strongly that the transition is an administrative problem ( P < 0.001). They opposed extra days off at the end of the chief resident year or ending in mid-June, which specialty directors favored ( P < 0.001). Directors of specialty programs opposed starting the year 1 or 2 weeks after July 1, a solution that general surgery directors favored ( P < 0.001). More agreement was reached on whether chief residents should take vacation week(s) at the end of the academic year, having all general surgery levels start in mid-June, and orientation programs in July for specialty trainees. Program directors acknowledge that year-end scheduling transitions create administrative and patient care problems. Advancing the start of the training year in mid-June for all general surgery levels is a potential solution.