The research question that guided this scoping review was: What is the current state of the nature, impact, facilitators, and barriers of culinary medicine experiences for medical students and resident physicians? The purpose of this review is to provide a foundation of knowledge for stakeholders interested in implementing culinary medicine experiences for medical trainees.

We identified evidence for this scoping study through searching four electronic databases: (1) PubMed, (2) Scopus, (3) CINAHL, and (4) Global Health. University library services assisted with the search strategy. We initially performed a limited search with two databases, PubMed and CINAHL, and included additional terms after review of titles, abstracts, and key words. We completed the initial full literature search on February 1, 2022, and an updated search on August 28, 2023. Boolean operators “OR” and “AND” were used to expand and narrow our search to capture all relevant articles that fit the inclusion criteria (Table 1). We adapted the search strategy for each database to index relevant articles, such as Medical Subject Headings (MeSH).

We defined the study selection process and inclusion criteria a priori and published an abstract of our protocol.⁴³ We included publications describing the nature, impact, or barriers/facilitators of culinary medicine experiences, which we defined as nutrition learning experiences that incorporate food preparation/cooking, for medical students or residents. We limited experience location to the U.S. and Canada given shared Liaison Committee on Medical Education (LCME) accreditation standards. We included allopathic and osteopathic programs and publications in English with human subjects. We limited our search time frame to beginning in 2002 as this was the publication year of the first article found documenting a culinary medicine experience.⁴⁴ In the updated search we modified our protocol to exclude literature reviews.

To facilitate the process of screening articles and extracting data, we used the web-based software platform, Covidence.⁴⁵ After the retrieval of publications and removal of duplicates from the search, two reviewers (JL, MP) independently reviewed the remaining titles and available abstracts for relevance. A third reviewer (CH) resolved conflicts. During the full-text review, two reviewers (MC, JL, KL, MP, or AT) conducted independent reviews of the articles. Due to feasibility challenges, we modified our original protocol from resolving conflicts by consensus as a team to resolving conflicts by a third reviewer (CH) or by consensus of three reviewers (CH, JL, MP, or AT) if needed. We identified one publication⁴⁶ with 51 abstracts and a senior reviewer (CH) reviewed each of the 51 abstracts for relevance, and we counted each included abstract as an independent publication for ease of reference. For 10 publications, we emailed authors clarification questions, and we received eight responses. While we did not formally include a review of references in our protocol, during the review of full-text articles, two referenced publications potentially meeting inclusion criteria were discovered, reviewed, and added for data extraction after consensus was reached by three reviewers (CH, MP, and AT). In our updated search, we reviewed the articles included in literature reviews for relevance to our review. If they were not already included in our review, we added those meeting our criteria, including two publications after consensus was reached by three reviewers (CH, JL, and AT). Our study selection flow is shown in Figure 1.

To extract and synthesize the data, we reviewed the literature based on the following broad categories: (1) nature of culinary medicine experiences, (2) impact of the experiences, and (3) facilitators and barriers to implementation of experiences. The study team charted extracted data using Excel to collate information based on the three categories of interest. We charted data initially by publication and subsequently by institutions and individual culinary medicine experiences. We identified common themes within the categories as they became evident during the data extraction and synthesis process.

We retrieved 1,706 titles, and, after the removal of duplicates and review of titles/abstracts, we reviewed 186 full-text articles. We excluded 98 publications and added 4 articles from references. In one publication⁴⁶ that contained 51 peer-reviewed abstracts from a research day, we extracted data from nine abstracts that met eligibility criteria and counted each abstract as a distinct publication. A total of 20 abstracts were included in the review.^47–66 We extracted data from 100 publications. From the included publications we identified 49 program/curriculum/intervention evaluations that reported on some level of impact of the experience,^{34,35,47,48,51,52,55–58,60,63,65,67–102} 10 program descriptions,^{59,61,62,66,103–108} six review articles,^109–114 six feature/magazine/news articles,^44,115–119 six reports,^120–125 four program evaluation protocols,^49,50,53,64 four commentary/opinion articles,^1,126–128 one science advisory,²⁵ one research letter,¹²⁹ one interview,¹³⁰ and one book chapter.¹³¹ The remaining 11 publications were other research studies: three multisite surveys,^54,132,133 one website content analysis,¹³⁴ two comparative effectiveness research studies,^135,136 and five multisite cohort studies,^137–141 one of which included a meta-analysis.¹³⁷ Thirty-seven percent of publications described pilot culinary medicine experiences.

The 100 publications covered 116 unique culinary medicine experiences from 70 medical training institutions, eight of which were schools of osteopathic medicine.^{65,73,83,109,111,112,123,132,133} Seven of the identified experiences described plans for an experience not yet implemented.^{49,50,58,69,112,125,126} Three publications described experiences in Canada.^60,95,97 The majority (n = 83/100) of the manuscripts were published in 2018 or later. The earliest article was published in 2002, describing “Whole Heartedly: Cooking Classes for Healthy Living,” a culinary and nutrition course for medical students at the University of Maryland School of Medicine (SOM) taught by a dual chef and nutrition counselor and supported by participation in the Nutrition Academic Award Program.⁴⁴ In a small portion of experiences (n = 19/116), medical trainees provided culinary medicine instruction to patients or community members after or while gaining knowledge and skills in culinary medicine.^{25,34,51,78,88,91,96,99,105,107,108,111–113,116,119,124,129,131,141} Some culinary medicine experiences (n = 33/116) integrated interprofessional education (IPE) with medical students and/or residents engaging with trainees from other disciplines.^{25,47,55,60,62,63,65,69,71,72,79,81,84,86,88,94,95,97,101–103,121,124,131,132} Over half (n = 54/100) of the publications reported medical trainee outcomes following participation in a culinary medicine experience.

The publications demonstrate a variety of ways that medical training institutions are offering culinary medicine experiences, as shown in Table 2 which reports characteristics by institution.

Medical students (n = 96/116) were primarily the trainees identified, with 28 experiences identified for preclinical students,^{25,34,35,49–52,59,63–65,67,69,76,77,80–82,85,86,88,89,93,95,99,108,111,113,129,133} 24 experiences identified for clinical students,^{1,58,63,69,74,75,90,91,98,100,105,111–113,116,119,121,129,132} nine experiences identified for both preclinical and clinical students,^{48,69,73,78,79,83,92,103,111,131} and the remaining unspecified. Twenty-four experiences reflected opportunities for residents.^{56,57,61,68,70,71,94,96,106,121,122,125,126,130–132} Residency program types included the following: family medicine,^{61,68,94,96,122,130–132} internal medicine,^121,122,126 pediatrics,^56,121,132 preventive medicine,^{70,106,131,132} and physical medicine and rehabilitation.¹³² As shown in Table 2, some institutions (n = 12/70) offered experiences for medical students and residents.^{34,56,57,68,70,71,74,75,80,82,96,111,113,115,116,122,125,126,128,131,132} Table 3 describes examples of various offerings.

Nearly 70% (n = 80/116) of experiences reflected elective or extracurricular activities, 17% (n = 20/116) required experiences, and the remaining unspecified. Of the required experiences, nine were specified for residents,^{50,57,61,68,106,121,130,132} six for preclinical medical students,^{69,80,81,88,108,111} two for clinical medical students,^111,112 and one for combined preclinical and clinical students.¹¹¹ Extracurricular offerings of culinary medicine included activities hosted by student organizations such as interest groups, which were most commonly lifestyle medicine interest groups.^{107,109,119,120,123–125,132} Six experiences were offered through pathways/tracks, longitudinal experiences for trainees that commonly have a special focus such as lifestyle medicine or community medicine.^{99,103,111,112,131} Two experiences were integrated into a retreat.^47,68 Table 2 summarizes offerings by institution and Table 3 outlines examples of a variety of culinary medicine offerings.

While most culinary medicine experiences were offered through a trainee’s institution, this review also identified opportunities offered outside of a trainee’s institution. Residents can attend the Healthy Kitchens, Healthy Lives conference through Harvard University.¹³² CHEF (Culinary Healthcare Education Fundamental) Coaching is an online program that applies health coaching to culinary instruction.¹¹⁷ Free online resources identified include the open-source Culinary Medicine Curriculum¹⁰⁴ or culinary medicine activities included in the Foundations of Lifestyle Medicine for Medical Students curriculum.¹¹³ A pilot elective at the University of North Carolina SOM used free courses offered through online platforms Coursera and NextGenU.⁹⁰

The number of trainees in each culinary medicine experience ranged from small groups to entire medical school classes. For example, at Penn State College of Medicine, four clinical medical students participated in an elective culinary medicine experience while the entire class participated in a separate required experience for preclinical medical students.^74,75,80 The preclinical required experience used existing problem-based learning groups to divide the class of 140 students into 20 small groups of 7 students each for a culinary challenge applying knowledge learned in the basic science curriculum.⁸⁰ After a positively-received pilot elective taken by 12 preclinical and clinical medical students, the University of Maryland SOM engaged the entire first-year medical student class of 125 students in a culinary medicine experience during the Introduction to Clinical Medicine course.⁶⁹ Working with the available teaching kitchen space, they divided the students into five classes, which were further divided into small groups of five students who cooked together.⁶⁹ A virtual clinical medical student elective at the University of Southern California Keck SOM enrolled eight students at a time to allow for individualized attention.⁹⁸ In a four-week elective piloted through the University of Colorado Pediatric Residency Program, seven residents participated,⁵⁶ and the Johns Hopkins Preventive Medicine Residency Program invited 16 residents to participate in a 3-workshop culinary medicine series with workshop attendance ranging from 8–11 residents at a given workshop.⁷⁰

Amount of culinary medicine instruction varied from brief, one-time offerings to longitudinal programs. Medical students at the University of Cincinnati SOM had the opportunity to attend a 6-h interprofessional wellness retreat at a farm that included a farm tour, “Food as Medicine” instruction, and two hours of hands-on cooking.⁴⁷ Twenty-five family medicine residents at East Carolina University Brody SOM and local culinary arts high school students were divided into nine teams practicing culinary skills during a 4-h workshop experience.⁹⁴ At Brown University, a registered dietitian (RD) led a weekly 30-minute class with preclinical medical students for four weeks, meeting either at lunch or after class.^76,77 The instructor set up a pop-up teaching kitchen in the student lounge using an electric skillet and presented nutrition topics while students tasted the recipes.^76,77 Keck SOM designed a clinical student elective to meet the 40-h/week requirement with a mix of live virtual sessions and independent study.⁹⁸ Tulane’s culinary medicine programming provides a longitudinal elective experience for medical students, beginning with an 8-week preclinical elective meeting weekly for 28 h total and covering the Mediterranean diet and dietary counseling.¹³⁵ During the third year of medical school, Tulane offers culinary medicine programming that is disease-specific while fourth-year medical students may elect to complete an away rotation at Johnson & Wales University in Rhode Island for four weeks.¹³⁵ A.T. Still University – School of Osteopathic Medicine integrates culinary medicine through its longitudinal lifestyle medicine curriculum.¹¹¹ The University of South Carolina SOM Greenville also integrates a longitudinal lifestyle medicine curriculum while also offering a longitudinal culinary medicine elective that spans the first three years of medical school, totaling over 100 h, and students have the option to take an additional 4-week elective during their fourth year.¹¹¹

The locations of the culinary instruction, listed in Table 4, varied by access to teaching kitchen space, from institutions with a dedicated teaching kitchen at the medical school¹¹⁵ to using an electric skillet in the medical school lounge⁷⁶ to virtually cooking together using personal kitchens.^{90,96,98,102,130,136} A survey of 32 organizations with teaching kitchens found the most common spaces were built-in, borrowed, or mobile/pop-up.⁵⁴ The Tulane medical school-based Goldring Center teaching kitchen is the first teaching kitchen housed at a medical school, and the Goldring Center not only offers space for medical trainees and health professionals to engage in hands-on cooking workshops but also makes their kitchen accessible to the community through community culinary medicine courses.^115,132,135 Many institutions located kitchen space through partnerships with culinary schools or community organizations while others used cooking spaces housed in nutrition/dietetics departments. An RD-led longitudinal pathway for medical students at Case Western used the food sciences lab housed in the Nutrition Department,¹⁰³ and RDs and dietetic interns in the Department of Dietetics at Marshall University taught medical students in their teaching kitchen.⁶³ Personal kitchens were also commonly used, whether meeting in person or virtually. A medical student-led lifestyle medicine interest group at the University of Utah used a student’s home for kitchen space,¹²⁴ and two programs used medical school faculty home kitchens.¹³²

During the COVID-19 pandemic, UNC SOM and Keck SOM virtually offered clinical medical students electives that integrated culinary and nutrition instruction over Zoom, allowing students to learn culinary skills using the equipment accessible to them in their home.^90,98 The University of Maryland, Northwestern, California Health Sciences University, and the Health meets Food program likewise shifted their culinary medicine experiences to online or virtual opportunities during the pandemic.^{65,69,102,130,136} CHEF Coaching, used by Harvard Physical Medicine and Rehabilitation residents and Yale Preventive Medicine residents, was designed as a remote culinary training experience to supplement nutrition curricula.^117,132 The Foundations of Lifestyle Medicine for Medical Students’ open-source curriculum can be taught in person or virtually,¹¹³ and Keck SOM demonstrated a virtual adaptation of the open-source Culinary Medicine Curriculum.^98,104 Some experiences integrated culinary instructional videos,^{79,94,102,132} and some trainees were assigned recipes to prepare at home outside of class meetings.^76,77

Instructors of the culinary medicine experiences varied, from medical students to teams of interprofessional faculty (Table 5). Several experiences included a chef instructor and some featured a dually trained chef-physician or chef-RD. Some experiences engaged community members for cooking instruction, including high school culinary teachers,⁹⁴ community health personnel,¹⁰² and collective kitchen facilitators.⁹⁷ Culinary medicine experiences commonly included dietitians/nutrition faculty and physicians/residency/medical school faculty as facilitators, and multiple experiences used an interprofessional team of a chef, dietitian, and physician/medical faculty member to teach culinary medicine to trainees.^{47,52,62,71,89,91,113,115,132} A certified culinary medicine specialist (CCMS) also led culinary training. Administered as part of Health meets Food programming, the CCMS certification is a 60-h continuing education opportunity with an examination requirement for various health professionals to acquire cooking and nutrition knowledge and skills.¹¹⁷ Some experiences integrated trainees in dietetics/nutrition and culinary arts in the facilitation of the culinary medicine experience. Other specialized instructors included a librarian who instructed on identifying credible nutrition resources,⁸⁴ an Elder who shared about indigenous culture,⁹⁷ a community organization representative speaking on food access/security,⁹⁷ other health professional faculty for an IPE training,^88,101,102 a health coach covering mindfulness,¹¹³ and a gardener for an experience that integrated growing food.¹³² Some electives invited guest speakers.^88,97,98,131 The Culinary Medicine Curriculum recommends one of the following options for culinary medicine course facilitators: (1) an instructor trained in culinary arts, nutrition, and the health profession of the trainees, (2) a clinician-educator with nutrition and cooking proficiency, or (3) a team of instructors to meet the culinary, nutrition, and clinical training needs of the course.¹⁰⁴

Most of the culinary medicine curricula used to implement the learning experiences were homegrown curricula,^{34,35,47,48,50,51,53,56,57,59–61,65,67,69,70,72,76,77,79–83,85,88,89,91,92,94,96,100,102,103,105,107,108,111,112,115,116,122,124,125,131,132,135} while others licensed existing curricula^{68,71,73–75,84,86,93,112,113,121,131,132,139} or utilized free resources.^90,98 Some experiences used a combination of existing and homegrown curricula.^{73–75,84,98} Multiple institutions included a culinary medicine experience as part of a broader lifestyle medicine curriculum or interest group,^{105,106,108,111,113,124,125,128,131} and the American College of Lifestyle Medicine collaborated with Stanford University to provide free access to the Culinary Medicine Curriculum, an evidence-based and comprehensive guide to implementing culinary medicine learning experiences based on Stanford University SOM’s culinary medicine elective, “The Doctor is In (the Kitchen).”^79,104 Keck SOM demonstrated adaptation of the Culinary Medicine Curriculum for a clinical medical student virtual elective.⁹⁸ The Foundations of Lifestyle Medicine for Medical Students curriculum, also a free curriculum, includes culinary medicine activities to complement lifestyle medicine content.¹¹³ East Carolina University offers free access to the facilitator guide for a culinary workshop developed for their Family Medicine residency program.⁹⁴ Health meets Food is a culinary medicine courseware that programs can license annually.¹¹⁷ CHEF Coaching is an 18-h evidence-based training available online.¹¹⁷ Examples of curricula are outlined in Table 6.

Nutrition content in culinary medicine experiences was covered in a variety of ways, such as didactics, reading assignments, online modules, problem-based learning, and case-based learning, and was covered separately or concurrently with culinary instruction. In some experiences, trainees completed assignments, such as watching videos or reading articles, prior to a class meeting.^{34,79,91,94,96,98,102,110,113} Curricula commonly focused on the Mediterranean diet and plant-based diets. For instance, the Health meets Food courseware is based on the Mediterranean diet and the Culinary Medicine Curriculum features whole-food, plant-based nutrition.^104,110 Other common topics included low-sodium/Dietary Approaches to Stop Hypertension (DASH) diets, fad diets, and “Food as Medicine” or dietary management for chronic diseases.

Some experiences were designed to complement the preclinical curriculum. For example, Penn State College of Medicine introduced a hands-on cooking experience as part of problem-based learning of metabolism disorders during the basic science curriculum for first-year medical students.⁸⁰ Students applied basic science knowledge through preparation of food meeting dietary restrictions associated with an assigned disorder, such as Maple Syrup Urine Disease or Phenylketonuria.⁸⁰ This experience required students to consider the challenges faced by patients with dietary restrictions.⁸⁰ The University of Rochester integrated a required experiential culinary laboratory into the first-year curriculum to help medical students connect concepts in biochemistry to practical nutrition.⁸¹ Faculty who teach biochemistry, nutrition, and clinical skills collaborated to write the cases, and dietetic interns from Cornell University facilitated the lab.⁸¹ Preclinical medical students at California Health Sciences University College of Osteopathic Medicine could view “Salt-free Seasonings,” 1 of 6 brief nutrition-focused videos created by dietetic interns, during their Renal System course.⁶⁵

Recognizing a void in nutrition training for clinical medical students, faculty at West Virginia University SOM designed a brief, flexible culinary medicine elective for fourth-year medical students that focused on increasing knowledge and self-efficacy in dietary counseling skill development before they transition to residency.¹⁰⁰ The elective emphasized experiential learning of applied nutrition topics, such as “Nutrition Counseling and Common Patient Questions” and various macronutrients and health, as opposed to focusing on learning biochemical pathways alone.¹⁰⁰ Faculty at the University of Maryland created an IPE-focused culinary medicine curriculum tailored to the participating professions, and medical students received instruction in food access (Social Work), food/medicine interactions (Pharmacy), the relationship between oral health and nutrition (Dentistry), and nutrition policy (Law) while engaging with other professional students.¹⁰²

Assessment of trainees was infrequently mentioned, with quizzes being the most common form of assessment.^{53,71,88,93,121,135} Another method of assessment was written reflections.^74,75,88,112 Preclinical students at Virginia Tech were assessed through a quiz, reflective essay, and small group participation and received a pass/fail grade after completing a culinary medicine IPE track.⁸⁸ Students taking a clinical elective offered at Keck SOM also received a pass/fail grade, which was based on attendance, participation, and assignment completion.⁹⁸ At West Virginia University SOM, students were assessed based on a final project that entailed conducting a literature review, giving a presentation, and making a meal tailored to dietary guidance they would give for a specific condition of their choice.¹⁰⁰ The University of South Carolina SOM Greenville extensively assesses its broader lifestyle medicine curriculum through exams, objective structured clinical examinations (OSCEs), reflections, and cases.¹¹² While a traditional assessment of trainee competencies was infrequently mentioned, multiple programs evaluated the impact of their culinary medicine experience on medical trainees’ knowledge and skills through survey questionnaires (see Impact of Culinary Medicine Experiences, below).

The offering of many culinary medicine experiences was influenced by trainee advocacy and interest,^{35,52,59,67,69,83,89,94,97,107,108,120,121,124} commonly to increase nutrition training opportunities in medical training.^{67,89,108,121,124} Some of these efforts were through student organization activities, such as student interest groups^{107,109,119,120,123–125,132} or the medical student-coordinated TEACH kitchen program at the Medical College of Georgia that provides cooking and nutrition classes to patients.¹⁰⁷ Trainee advocacy was instrumental in starting some elective or required culinary medicine experiences,^{35,59,67,69,83,89,97,121} and some trainees were involved in curriculum development.^{35,53,59,85,89,107,108,131} For example, students at Wake Forest SOM engaged a faculty advisor to introduce more lifestyle medicine learning experiences in the curriculum which led to integrating a required food shopping and preparation activity during the first-year medical student wellness-focused orientation.¹⁰⁸ The students and faculty advisor also collaborated to design a year-long pilot lifestyle medicine elective for 16 students that included meal preparation activities.¹⁰⁸

Several culinary medicine experiences were tailored to focus on specific learning goals. Common themes of tailored experiences included: community engagement and service-based learning, interprofessional education (IPE), social determinants of health/food insecurity and food affordability, and trainee well-being. Another less common theme in publications was cultural considerations in culinary medicine.

Over half of the publications (n = 54/100) reported evaluation outcomes, including 50 publications reporting on evaluations of 45 individual experiences/interventions (summarized in the Supplemental Appendix). Seven publications reported preliminary results/evidence,^{34,48,51,65,79,81,131} and five publications were multisite studies.^136–140 Most evaluations were conducted through surveys, and a minority of publications reported findings from trainee written reflections or course evaluations. We identified several ( n = 28/45) pilot program evaluations.^{34,35,51,52,55,56,58,60,67–77,83,85,89–93,96,98,100,101,108} Most evaluations were of medical student experiences, while seven evaluations included resident experiences.^{56,57,68,70,71,94,96} Evaluations frequently assessed outcomes relevant to food, nutrition, and clinical practice, such as the impact of the experiences on attitudes, nutrition knowledge and skills, culinary knowledge and skills, confidence, personal dietary behaviors, and clinical practice behaviors. Several experiences noted improved attitudes regarding nutrition in clinical practice,^{34,51,72,73,82,85,91,98,101,135} nutrition knowledge,^{34,48,52,55,57,60,63,65,67–69,73,76,81,86,91,92,96–98,100,102} and confidence in dietary counseling skills.^{34,51,52,55,68,69,82,90,91,94,96,98,101,102} Many experiences reported changes in dietary behaviors of trainees,^{34,47,76,85,91,93,131,135} for example improvements in fruit and/or vegetable intake.^{34,76,91,131,135} Other studies included outcomes related to the tailored focus of the elective, such as improving food insecurity scores of medical students⁷⁷ or improving attitudes or knowledge regarding interprofessional team care.^72,97,102 Multiple evaluations reported trainee feedback about the experience, which was generally positive, with feedback such as helpful content,^{47,83,86,93,94,100,108} trainees indicating they would recommend the experience,^{47,78,83,86,90,93,98,100,101} and an appreciation of the opportunity to engage with their peers through the experience.^80,92,93,108 Several experiences reported plans to continue the culinary medicine experience, often due to positive feedback from and positive impact on participants.^{52,58,67,69,78,80,85,89,92,93,97,98,100,112}

Our review included publications from the large, multisite Cooking for Health Optimization with Patients (CHOP) study that tracks medical trainee attitudes, dietary behaviors, and counseling practices, and these studies demonstrated improvements in trainee diet scores^{136–138,140} and dietary counseling competencies^136,138,140 after participating in the Goldring Center for Culinary Medicine, later referred to as Health meets Food, hands-on cooking and nutrition education curriculum when compared to standard medical education, including when offered virtually.^{136–138,140}

Three publications reported outcomes of community or patient classes that medical students led or assisted in leading.^87,99,141 The first study evaluated a program for patients with type 2 diabetes in which medical students assisted in teaching after receiving culinary medicine training.⁸⁷ The pilot randomized controlled trial resulted in lowered HbA1c, blood pressure, and cholesterol in participants.⁸⁷ The second study evaluated community classes led by medical students who received culinary medicine training through online modules and were required to pass corresponding quizzes before leading the classes.¹⁴¹ These student-led classes resulted in improved dietary behaviors and a decreased belief that “cooking takes excessive time” among the 1,381 community participants.¹⁴¹ In the third experience, preclinical medical students in a primary care track received four hours of training prior to leading virtual, bilingual (English/Spanish) community classes focusing on nutrition/cooking and exercise to predominantly low-income participants.⁹⁹ The majority of participants reported high satisfaction with classes and an intent to make dietary improvements.⁹⁹

Publications cited barriers and facilitators to implementing a culinary medicine experience, with some overlap (Figure 2). A common barrier described was the costs associated with a culinary medicine experience and the need to secure and maintain funding.^{56,60,69,77,79,89,93,94,98,102,104,108,111,112,114,117,121,132} Some of the costs related to culinary medicine experiences cited included food/cooking expenditures,^{59,69,70,74,75,86,94,98,102,103,121,123} curriculum licensing,^74,121 staff/instructor time,^{102,103,113,121} and teaching kitchens.^{54,102,121,132} Addressing the cost of food, some programs focused on preparing low-cost recipes or purchasing in bulk.^{69,76–78,100,102} Licensing an existing curriculum such as the Health meets Food courseware, which programs cited as costing $1,200–$3,000, can add to cost;^74,121 however, other publications listed free resources available to facilitate culinary medicine training.^{84,90,98,104,113} Startup expenditures associated with starting teaching kitchens are costly and can range from $10,000 to more than $500,000,^54,132 a barrier overcome by some institutions accessing kitchen space through a culinary institute,¹³² community setting,^70,74,75,102 a campus facility,¹⁰³ or faculty/trainee homes, including through virtual/online offerings.^{90,102,114,117,132} The Teaching Kitchen Collaborative offers free guidance on establishing teaching kitchens through a seminar.¹¹⁷ Accessing adequate kitchen space, such as the size of the kitchen limiting class capacity, was also a barrier.^{60,67,69,75,79,91,100,136} For several experiences, funding or donations helped facilitate the cooking and nutrition training.^{44,54,59,70,74,75,81,84,86,94,98,102,106–108,111,113,115,121,123–125}

Instructors and institutional support were identified as facilitators and barriers. Some experiences cited faculty as helpful advocates, advisors, and experts for culinary medicine experiences.^{69,72,94,97,98,100,102,105,107,108,111,112,119,125,127} However, securing faculty with the necessary expertise can be a challenge,^91,105,114 and faculty may need to volunteer their time, a potential barrier given demanding schedules.^91,119,121 Institutional support was another factor cited as both a barrier and a facilitator, particularly through the availability of funds and support from the administration, such as providing time for a culinary medicine experience during medical school orientation.^{86,91,93,94,98,103,105,106,108,112,121,132}

Finding time for a culinary medicine experience in an already packed curriculum was another common barrier cited.^{60,70,83,88,94,105,108,111,112,119,121,134,136} Even when culinary medicine is implemented as an elective or extracurricular activity, trainees face barriers of competing demands on their schedule and may not receive academic credit for participation in a culinary medicine experience.^{70,78,102,108,111,121} Scheduling culinary medicine classes amidst packed curricula and competing demands was a barrier¹⁰⁸ that was overcome by one elective offering brief sessions with flexible meeting times based on student schedules⁷⁶ and another elective designed as a brief, 2-week clinical elective for flexibility.¹⁰⁰ Access to online modules and videos was also a facilitator that offered flexibility.^{65,69,83,94,132} Integration of a culinary medicine experience into the existing curriculum was a facilitator for other experiences, such as introducing a culinary medicine-focused track for a required IPE curriculum,⁸⁸ adding a hands-on cooking experience to orientation or a retreat,^68,108 or introducing an experiential hands-on cooking activity to problem-based learning of basic sciences.⁸⁰ Another barrier to introducing more nutrition in medical training curricula was the lack of emphasis on assessment of practical nutrition competencies on licensing examinations.¹²⁶

Additional facilitating factors cited include collaboratives and partnerships. Some institutions joined or formed collaboratives, such as the Teaching Kitchen Collaborative, Lifestyle Medicine Education Collaborative, and Ohio-based “Health Meets Food Collaborative”, which can facilitate shared learning and resources.^{89,112,121,127} Community partnerships also helped facilitate culinary medicine experiences, at times helping overcome barriers such as locating kitchen space or identifying/funding qualified instructors.^{74,89,102,113,121} Three Ohio-based training programs partnered with a local nonprofit that provided access to a kitchen space and a chef instructor and as a result of their shared community partnership formed the “Health Meets Food Collaborative.”¹²¹ A partnership with a nonprofit helped Northwestern facilitate curriculum development and service-based learning opportunities.^34,118 Interprofessional collaborations with dietetics and culinary arts were commonly mentioned facilitators that improved access to nutrition and culinary expertise.^{60,65,68,69,74,81,83,86,102,103,107,116,119,126} A final common facilitator of culinary medicine experiences was trainee interest and advocacy. As previously described, multiple programs were trainee-driven, often due to a desire for more nutrition training.