The Food as Medicine Project

Podcast Transcript

Jeremy Lipman:

Hello, and welcome to MedEd Thread, the Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise. Hi, and welcome to today's episode of MedEd Thread, Cleveland Clinic Education Institute podcast. I'm your host Jeremy Lipman, I'm a colorectal surgeon, the DIAO and director of Graduate Medical Education here at Cleveland Clinic. And today, I'm really pleased to be joined by Peris Kibera. She's a resident physician at Cleveland Clinic's Akron General Hospital, and is going to be speaking with us a bit about her work with The Food as Medicine project as part of the scholarship she's doing during her residency training. So, Peris, thanks so much for being here.

Peris Kibera:

Thank you, Dr. Lipman. It's my pleasure to be here.

Jeremy Lipman:

So, tell us a little bit about yourself.

Peris Kibera:

Well, I grew up in Kenya and have lived in the United States for the past 20 years. I have lived in Northeast Ohio for the majority of that time. So Northeast Ohio is like second home to me. I live in the Cleveland area in one of the West Side suburbs. And I have a nine-year-old son who just started fourth grade.

Jeremy Lipman:

That's great. So, the listeners will see on the, uh, notations here, you have a lot of letters after your name, I counted, you have more letters after your name than in your name. So, talk to us a little bit about your pathway through all these different degrees.

Peris Kibera:

So, all my training in career pursuits have been in the helping professions. I originally trained as a social worker, I have a bachelor's and master's degree in social work. And a couple of years after I attained my Master of Social Work, I embarked on doctoral studies in social welfare at the University of Washington in Seattle. Along the way, I ended up enrolling in the master of public health program there in global health.

And, the common thread in all my prior training is that I focused on health. I was very invested in health and worked on areas of health such as mental health, maternal health, HIV, AIDS, healthcare, delivery and global health, as I mentioned. So, I was already very deeply entrenched in the field of health, when I decided to pursue a career as a physician, and I wanted to be a central part of the movement that was happening in medicine. In the last decade or so, there's been an increased focus on social determinants of health in health disparities, all areas which I felt aligned very well with my prior training in the social sciences and in public health. So, I was very excited to pursue a career as a physician.

Jeremy Lipman:

And so, Peris, you joined the clinic through the Transformative Care Continuum, which allows you to begin your training in medical school with the goal of going through into your family practice residency. Tell me about that process and how you got into that?

Peris Kibera:

Yes. So, TCC: Transformative Care Continuum is a partnership between Ohio University and Cleveland Clinic. I was part of the inaugural TCC class, the Ohio University's Cleveland Campus, which is located at Cleveland Clinic, South Pointe Hospital. So TCC is a fast track combined medical school and family medicine residency program. Students in the program, they are 18 each cohort, complete three instead of four years of medical school, and are pretty much one of the family medicine residency programs through the Cleveland Clinic.

One of the programs is Akron General, which is where I'm located, and the second program is Lakewood Family Health Center. So, a core part of the TCC curriculum is population health, which means that the program train students to develop a knowledge base and skill sets to keep communities healthy by addressing the root causes of diseases that are highly prevalent, that account for a high morbidity and mortality, and also contribute to a high burden on the health system and society. So chronic diseases such as obesity, type 2 diabetes, hypertension, and heart disease.

Jeremy Lipman:

So, you basically were matched into your residency program without even starting medical school.

Peris Kibera:

Correct. That's how the TCC program works by design. And the beauty of that is that you become familiar with your future residency site or home and can even begin to forge relationships with faculty there with other senior residents there who in the future will become your colleagues.

Jeremy Lipman:

Yeah, so that must really have allowed you to become enmeshed in that environment and develop a very deep understanding of the kind of work that you hope to do.

Peris Kibera:

Yes, absolutely. I was able to delve into the Akron area communities and do some research as part of my training, medical school training and as part of the TCC curriculum on some of the problems and issues that were prevalent in the communities, as well as diseases that community members and health system, Akron General in particular, was trying to address.

Jeremy Lipman:

Now, as part of that, this led you into The Food as Medicine project, if I understand correctly?

Peris Kibera:

Correct.

Jeremy Lipman:

So, talk to us a little bit about that. What is The Food as Medicine project and what is your role been in developing this?

Peris Kibera:

So, I developed The Food as Medicine project with a vision of trying to promote healthy eating and possibly impact chronic disease markers, among patients with chronic diseases that we see at Akron General Center for Family Medicine. I applied for a Cleveland Clinic caregivers catalyst grant to fund the project and received 88 thousand in funding. The idea of the project is to provide healthy food items to 70 patients, for a period of 15 weeks. Those food items come from community vendors, and they ship those food items to participants home, which makes it really convenient for participants. Half of those participants are randomized to receive a weekly produce box. The other half are randomized to receive daily pre-made ready to eat and serve meals.

Patients recruited into the project have a BMI of 30 and above, they also have to have pre-diabetes or diabetes, and or hypertension. Patients come in for a baseline visit where they complete surveys on food insecurity, depression, dietary practices and self-efficacy for healthy eating, healthy weight and chronic disease management, we also get a baseline height, weight, and take their blood pressure as well as their A1C. Then they return for a follow-up visit approximately 16 weeks after their baseline visit. At that visit, they complete the same service they did at the baseline visit, and we recheck their weight blood pressure.

But very importantly, participants take part in nutritional counseling and education with a dietician that is provided by the University of Akron Nutrition Center, the Center for Family Medicine at Akron General has a long-standing relationship with the University of Akron Nutrition Center. We in fact, do refer patients there if they need dietary counseling and education. So, participants in this project are getting individualized counseling on modifications they can make to improve their nutrition to support healthy weight, and better blood glucose and blood pressure control.

And the University of Akron also very neatly developed for us for videos that our participants are watching. Those videos are on their aforementioned chronic diseases, obesity, diabetes, and blood pressure, high blood pressure. And they get to also keep those videos as a resource that they can reference in the future beyond the tenure of this project.

Jeremy Lipman:

That's outstanding. I mean, what a phenomenal undertaking. Can you talk a little bit about the barriers that you encountered in setting up such a large scale and high impact project?

Peris Kibera:

Yes, so the biggest barrier that I can state is time. Time, because I was a medical student that had just finished medical school when I started intensely working on this project. And I was getting ready to begin my first year of residency, the intern year, which, as you know, is perhaps the most intense year of graduate medical training. So, while I was refining my project and getting ready to launch it, I was also juggling all my other program requirements as an intern.

The other barrier was that Cleveland Clinic is a very extensive health system, and because of the various components of the program, or the project, I had to be in contact with a variety of people in different parts of the system to get everything aligned, and everybody on the same page, and that required ongoing communication with just various entities.

Jeremy Lipman:

Yeah, I could see that raising a lot of issues to get it all organized. I imagine you had mentors supporting you with this. How did you identify mentors and faculty to support you and engage with you on this?

Peris Kibera:

I think the biggest lesson about this project Dr. Lipman, and its success has been the invaluable mentorship that I received from medical school and residency faculty, right from the project's conception to its execution. I got support for my idea as a medical student and worked closely with a TCC program faculty as well as faculty in the family medicine program at Akron General. They all helped me so much in bringing this idea to life. So, I identified people who were readily available to me and who were willing mentors.

When I talked with potential mentors, one thing that I found useful was to communicate with them specifics about what I was looking to do, as well as specific requests or asks of them. Medical school and residency faculty are busy people. So, I was very conscientious about getting things done in a timely manner, gathering as much information as I could on any particular issue related to the project, and just providing ample time for them to be able to provide feedback on my ideas.

Jeremy Lipman:

Now, without naming names, we know that sometimes the mentors get too busy and get distracted, and, you know, they don't have the same vision that you do. So, can you provide people with some guidance on how to get your mentors reengaged, try to get them back on track without abandoning you?

Peris Kibera:

Yes, that's a great point that you bring up, Dr. Lipman. And one of the things that I realized very early into my project is that I needed to set or establish dates for project meetings, to help everybody come together and have a forum to discuss the project, where we're at, you know, troubleshoot any issues that we were having. So, one of the very first things that I did was establish project meetings every other Wednesday, and put them on a calendar, send that as an invite to my mentors' calendar, so that they would be able to have that on their radar, and engage with me and the project that way.

Jeremy Lipman:

Yeah, that's good advice. You know, you put in a ton of time, and, you know, it sounds like your background and experience in social work and other domains of social research helped you to be well prepared and well situated to take on such a big project like that. What about somebody who doesn't have that type of experience, someone who's looking to do perhaps a smaller scale project, during their training period? What advice do you have for them on getting something meaningful off the ground?

Peris Kibera:

So, I think far from my background, having a goal and really being invested in it and putting in the work is what matters in the end. It helps a lot, if the goal is one that fits within one's vision of their career trajectory. I want to work in population health myself and do research as part of my career. So, I took on this opportunity as a launching pad. I think additionally, identifying and engaging mentors, as we've talked about, is, uh, a key part of that process. And, um, we are fortunate here at Cleveland Clinic, that the health system has enormous resources, and opportunities, and almost always trainees can take advantage of these resources and opportunities.

One of the things that kept me going as I was working on this project, despite the time constraints was just the goal that many trainees have to improve their patients' health, was always the focus of my work, and that kept me engaged and kept me motivated throughout this project. I think that there are always opportunities also to improve many of the processes of healthcare delivery, and they have a trainee can identify something that they think could make their work better or easier or more fulfilling than, you know, it is always kind of a nice idea to take on such a challenge.

So, the last point that I want to make is that most residency programs do have a requirement for residents to undertake a scholarly activity at Akron General, that is part of the requirements for residency. So, uh, that can be an opportunity for residents or trainees to pursue an activity or a project of their interest, and have that fulfill the goal of meeting scholarly activity requirements.

Jeremy Lipman:

I feel like with our research, though, there's sort of the excitement at the beginning, and then there's the excitement at the end, and then there's this valley in the middle, where it seems like it's never gonna work, and maybe this is a bad idea. And so how do you push through that middle part? How do you keep yourself focused, especially with such an ambitious project?

Peris Kibera:

That's such an on point observation, because I felt like the last few months I have been living in that valley. We are literally recruiting our last participant, the 70 of participants today. So, the past few months have been living and trying to kind of push ourselves through that valley of just doing the work and getting to the end. And I think as I mentioned earlier on, having meetings where people come back together and talk about highs and lows has been an opportunity to kind of get everybody staying with the project and staying with the larger vision. And I think celebrating every little milestone, when we got to our 35th patient halfway through the project, halfway through recruitment, we all celebrated that milestone, and just reminding ourselves why we're doing this, and just finding opportunities to walk through the process and get the work done.

Jeremy Lipman:

Yeah. That's great advice. I think celebrating what may seem like small accomplishments along the way, but in reality, are major milestones towards completing it. Do you have any results so far of the project, or if you're at any feedback from the participants?

Peris Kibera:

So, we have had feedback from participants, we haven't really delved into that data to try to get any type of preliminary findings or results from our work. But, uh, some of the informal feedback we have gotten from patients has been that they have been excited about being able to work with a dietitian to receive more information about proper nutrition, healthy eating, and to utilize their skills that they are learning as part of that process to help them better manage their chronic diseases.

Other feedback that we have gotten from some of the patients is just how useful it's been for them to have healthy food items shipped right to their doorstep, when a part of the challenges that they face is being able to either access healthy food items because of transportation challenges, or just the time to make it to the grocery store and buy healthy food items. We also have identified a few participants who have done really tremendously well. Just this last week, I was informed about a patient who give the feedback that, since starting the program, or the project that they have lost about 18 pounds, which is amazing.

They are one partway through the project, and just because of the information that they have gotten from working with the dietician, and the food items that they have received, and being able to utilize the food items as they have been recommended by their dietician, they have lost so much weight in such a short amount of time. So, such wonderful news to hear.

Jeremy Lipman:

Yeah, that's fantastic. What a rewarding experience, and congratulations again on getting number 70.

Peris Kibera:

Yes. Today's a big day. So, celebrating that milestone.

Jeremy Lipman:

Yeah. Any advice, uh, you might provide for other students and other learners moving through this, thinking about how to identify a project that is of reasonable scope, you know, this is something that you've undertaken, that's of a really very large importance, but also, you know, an incredible amount of work and it takes the resources that you've been able to identify through your catalyst grant, through your mentors, through the Cleveland Clinic. So, helping people that want to do something impactful, but maybe don't have the same access, what might you recommend to them?

Peris Kibera:

I think the most immediate way to identify a problem or an issue that one can tackle by way of research or a project that they might pursue as part of their residency program is just using daily clinical interactions to identify what's working, what's not working, what are patients, uh, communicating to the provider, as their needs that are not being met, or could be improved in a certain way. I think clinical interactions just makes for a great ground to be able to identify an issue that one could pursue as a scholarly project.

Jeremy Lipman:

That's great advice, listen to your patients.

Peris Kibera:

Correct.

Jeremy Lipman: 

Hear their problems, and work to address them. I think we've heard that other places in our training probably.

Peris Kibera:

Yes, absolutely. The patients almost always have, um you know, as we always say almost always have answers and the most insightful feedback and comments about what can be done to or they can do to improve their own health, but also about what's not working for them as far as care goes, our healthcare delivery goes.

Jeremy Lipman:

So, what's next? You've got patient 70. Write it up really quick, move on, what's next for you?

Peris Kibera:

So next as far as this project goes, we just submitted an abstract in the residency and fellow's category, the North American Primary Care Group Research meeting that happens every year. It's taking place in November in Arizona. So, we are hopeful that our abstract will be accepted and we will try to attend that. Colleague of mine in my, cohort, the PGY2 class is, working with me on this project as well.

Then we are also working on write ups for the project. Our goal is to try to get out publication based on our protocol prior to completing the follow-up visits that we have to do with our patients. Beyond that, we have as part of this project, we have been interested in looking at six-month follow-up data as well as 12-month follow-up data and see whether our patients are sustaining some of their, or will be sustaining some of the changes that they might make in that short period between the time that they start receiving food items to the time that they complete receiving food items. So, all those things are in the works. And beyond that, just more of the daily grind and training.

Jeremy Lipman:

That's great. Well, uh, our podcast is called MedEd Thread. So why don't you help us to take all these threads and tie them together? Any summary point you'd like to make for people that are listening?

Peris Kibera:

Yes. So, summary points, I'd say one, there's always opportunities to do more as part of training. Training is a very intense period of time. But I think trying to identify a passion project and pursuing it can help make training fulfilling despite the hustle and bustle of their daily grind. And I think the other key point I want to make is that there are mentors all around, mentors are busy people for sure, but are often energized by trainees who are coming in with ideas and want to pursue a project. Those things I have had from my mentors, keep them energized, remind them of why they chose to do our practice within our own academic center.

Jeremy Lipman:

Fantastic. Well, congratulations on everything you've accomplished, and the very bright future that certainly lies ahead for you. This has been a terrific conversation, appreciate your being here. And for our listeners, we thank you very much for being here, and I look forward to speaking with you next time.

Peris Kibera:

Thank you very much for having me.

Jeremy Lipman:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.