Implementing a National Lifestyle Medicine Residency Curriculum: A Mixed-Methods Evaluation of Learning, Behavior Change, and Clinical Integration.

Abstract

Purpose: To evaluate the impact of a national lifestyle medicine residency curriculum (LMRC) on resident knowledge, confidence, and clinical behaviors, and to examine factors influencing implementation in real-world training environments. Methods: A convergent mixed-methods design was used. Quantitative analyses included pre- and post-curriculum survey data from 148 residents across multiple specialties, analyzed using Wilcoxon signed-rank tests. Qualitative data were collected through semi-structured interviews with 15 residents and analyzed using reflexive thematic analysis. Findings were integrated using a side-by-side comparison approach guided by Kirkpatrick's evaluation model. Results: Residents demonstrated significant improvements in lifestyle medicine knowledge, confidence, and frequency of counseling behaviors across all domains (P < .001), with moderate to large effect sizes. Qualitative findings revealed that residents integrated lifestyle medicine into clinical practice through brief counseling strategies, goal-setting techniques, and the use of practical tools such as electronic health record prompts and patient education resources. Reported facilitators included faculty support and workflow integration, while barriers included time constraints, documentation burden, and variability in local resources. Residents also described early patient-level improvements, including enhanced engagement and clinical indicators. Conclusions: A structured lifestyle medicine curriculum was associated with meaningful improvements in resident competencies and clinical practice behaviors. Successful implementation depended on integration into clinical workflows and supportive training environments. These findings provide actionable insights for scaling lifestyle medicine education across graduate medical education.