Even prior to the Covid-19 pandemic, there was an increasing attentional shift to medical student, resident physician, and attending surgeon wellness. Departmental and hospital-based resources included coaching, gym passes, and group cohesion exercises. However, one important aspect of physician wellness is largely absent from the surgical literature and includes nutritional support and healthy eating habits. Despite anecdotal evidence of lack of food options during night-time shifts, unwanted weight gain during residency, and the development of food binging/hoarding habits as an attending, healthy nutrition education and access are largely seen as Liaison Committee of Medical Education (LCME) or Accreditation Council for Graduate Medical Education (ACGME) regulatory issues by surgical leadership.
Clinical medical students may have difficulty balancing their workload and adherence to a healthy diet. The critical importance of nutrition for cognitive function, emotional well-being, and overall physical health is well-documented, highlighting a significant issue when access to nutritious food becomes limited for medical students.1, 2 This lack of access is often due to time or financial constraints and is especially apparent during the surgery clerkship, where increased hours, stress, and physical demands can strain a student’s opportunity to consume regular and healthy meals.3 If these challenges are not explicitly addressed by the clerkship leadership, medical students may develop the misperceptions that their health and learning environment is not a priority thus decreasing their overall satisfaction with their clerkship and possibly even negatively change their attitudes towards surgeons and a surgical career.
These issues are not unique to medical students and are well-documented among resident physicians and surgical fellows as well.4-6 In general, the literature reflects a common neglect of self-care practices, including lack of adequate nutrition among medical trainees, primarily due to the pressures of clinical responsibilities and a culture that undervalues personal well-being in the face of professional obligations,7, 8 The resultant irregular eating patterns and potential nutritional deficits may negatively impact trainees’ learning, performance, and overall wellness, suggesting a clear need for targeted interventions.3 While the challenge of maintaining adequate nutrition amidst the demands of medical training is not a novel concept, there are limited examples of structured programs specifically designed to address this issue within the context of medical education. Some institutions have introduced wellness initiatives that encompass a range of health-promoting activities, including nutritional education, though these programs vary widely in scope, implementation, and success.9-13 However, there is a lack of literature describing dedicated nutritional support programs tailored to the unique needs of medical trainees, particularly those in surgery.
Ultimately, poor self-care and nutritional habits accumulated during medical school and residency can lead to compromised health as attending physicians. Among attending surgeons, one institution reported a 50% rate of major health issues by 50 years of age, which may ultimately decrease the number of years that those individuals are able to safely practice and their patient care skills.14 In fact, a physician’s personal health habits, including alcohol use, exercise, and tobacco use, may affect the care that they provide to patients.15, 16 This pattern has also been shown to apply to the extent physicians are up to date on their own personal recommended medical screenings.17, 18 Therefore, improving healthy eating habit resources may positively affect patient care by improving surgeon wellness.
Possible Resources
As illustrated in Table 1, multiple sources offer resident physicians general advice regarding eating habits,4, 5 but implementation of initiatives to improve nutritional access or eating habits within surgical training has not been documented to our knowledge. This lack of research may provide a subtle indicator of the difficulties associated with balancing the demands of surgical training with maintaining positive nutritional habits. For example, practices such as limiting caloric consumption overnight, avoiding “junk food” with high sugar content, increasing protein consumption, and creating protected eating time for resident physicians4, 5 do not seem congruent with resident physician workflows and the realities of food access in hospitals.
For medical students, there are even fewer available resources and suggestions. The American Medical Association recommends that medical students do not skip meals, they avoid drinking their calories and instead choose water, they plan ahead and consider scheduling meals and exercise over a four week period, and they add another fruit or vegetable to their meal19 (Table 1). Again, more concrete suggestions are likely needed for medical students to operationalize these tips into their daily surgical clerkship workflows.
Next Steps
For medical students, we suggest that nutritional education be incorporated into the existing surgical clerkship orientation with specific guidance on what healthy eating should be and where healthy food options can be found logistically with their other clinical demands. For resident physicians, improved nutritional education could inform their clinical practice.20-23 While critically ill surgical patients and highly active surgical trainees have inherently different dietary needs, increasing emphasis on trainee nutrition may foster an improved understanding of nutritional principles more broadly. For example, the optimal nutrition strategies to minimize muscle atrophy and preserve a patient’s functionality after major surgery may be applied to a resident’s own lifestyle needs which could have a positive impact on patient care as well as trainee wellness.24
To address the need for improved surgical trainee nutritional access and education, we propose the implementation of targeted initiatives by individual institutions. Ideally, this would provide the opportunity to pilot interdisciplinary educational projects that leverage insights from nutritional science, medical education, and wellness programming to directly address the challenge of nutritional access during medical school clinical rotations, surgical residency, and surgical fellowships. For example, our institution created a snack locker filled with snacks for medical students. We collaborated with a lifestyle medicine (LM) physician and a registered dietitian (RD) to select healthy options. The LM physician and RD also created a handout that explained the reasoning for the different types of snacks in the snack locker. This helped to address two gaps: 1) the lack of snacks for medical students on the surgical rotation, and 2) the lack of knowledge about what makes a snack healthy.
For attending surgeons, wellness coaching may help break negative nutritional habits and promote healthier lifestyles. At our institution, we have mentored and coached 60% of the mid-career and senior attending surgeons on this topic and over 95% have expressed satisfaction with their behavioral changes and reversing poor nutritional habits from residency.
In summary, nutritional education and promotion of healthy eating habits is an often neglected but very important component of overall physician wellness. Formally assessing the impact of targeted nutrition projects and documenting their strengths and weaknesses in the literature may help to provide a template for other medical schools and training programs interested in similarly addressing this unmet educational need. Barriers to implementation may include securing adequate funding, administrative coordination between medical schools and surgical training programs, and establishing sufficient logistical support for food distribution. Overcoming these challenges requires buy-in from both surgical educators and dedicated surgical trainees willing to provide constructive feedback and have open conversations about this important topic.
