Transformative Education Sparks Bold Research on Nutrition and Chronic Disease

Peris Kibera, DO, PhD, MPH, MSW, is a first-year resident in the Transformative Care Continuum (TCC) who is working to advance research on healthy nutrition and disease. The American Association of Colleges of Osteopathic Medicine (AACOM) spoke with Dr. Kibera about what attracted her to osteopathic family medicine, the TCC’s unique approach to education and training, and her transformative research project being funding by the Cleveland Clinic.

The TCC is a partnership between the Ohio University Heritage College of Osteopathic Medicine and the Cleveland Clinic to educate and train family medicine physicians with an emphasis on community health.

The answers below have been edited for brevity and clarity.

Q: As a first-year resident looking back on your undergraduate medical education, what was your medical school experience like as a TCC student?

Dr. Kibera: As an undergraduate TCC medical student, you get immersed into clinical care right away. This makes the TCC program unique from the traditional medical education pathway. On my very first Monday of medical school, I was at my clinical site—Akron General—working with a preceptor. TCC undergraduates spend two half days a week, on Mondays and Fridays, at clinical sites. One half day is dedicated to doing clinical work—following a preceptor, working with them and seeing the patients they see in clinic. The second half day is spent working on health system science issues pertaining to family medicine. The U.S. health system is complex. It is confusing to patients and even physicians. My undergraduate medical experience was very rich and nuanced in terms of clinical, hands-on patient care as well as health system science work, which can be even more impactful in shaping patient outcomes.

Q: How has your first year of residency been so far and how would you describe your transition from undergraduate to graduate medical education?

Dr. Kibera: So far, so great! I’m getting into my sixth month of residency and one of the benefits of being in the TCC program is that I was already familiar with my residency setting. Often, students will match to programs that they briefly worked at during their clinical years, or sometimes not at all, but for us as TCC students, we've been immersed in our residency setting for three years before residency begins. That familiarity comes with a lot of advantages. I know the people in my family medicine department and within the larger Akron General and Cleveland Clinic health system. I’m also familiar with the electronic medical system, which is huge because a lot of patient care happens through electronic medical records. This made for such a smooth transition. Being familiar with issues and language that most medical students may not have been exposed to as new residents was such a huge blessing in terms of making me feel like I was already settled in, even though I was entering a very different role. I can’t speak highly enough of being familiar with a site, with how care happens and with the patient population. I have patients who I see now who I first encountered as a medical student. Even back then I used to tell them, you know, I’m going to be here for the next six years so I will likely see you again, and that made for very rich interactions. One of the things patients seek most from their physicians is continuity of care. The knowledge that they would see me repeatedly made them more appreciative that they were coming to a practice that would ensure that continuity.

Q: Did you always know that you wanted to become an osteopathic family physician? What makes you passionate about this field?

Dr. Kibera: I always knew that I wanted to practice primary care and as I researched what branch of primary care to pursue, family medicine stood out as a natural fit. I love working with people of different ages. I love being able to tap into public health tools that we know are so good for our patients. I also knew that I wanted to do research as part of my training and my work as a physician. I knew that I wanted to be involved with transforming the health system. All those things are what make family medicine unique. I was drawn to family medicine right away. As I was deciding which medical schools to apply to, I became familiar with osteopathic medicine, and everything about it spoke to me, from the holistic approach to patient care to applying treatment based on the body’s ability to heal itself. When I learned about the TCC program and how it was developed and designed not only to improve health outcomes at the individual level but also at the population level, I knew right away that this was what I wanted to do.

Q: You received an $88,000 grant to investigate the effect of healthy foods on select chronic disease markers. What inspired this project, how did the TCC program support it and what do you hope to achieve through it?

Dr. Kibera: A curricular component of the TCC program inspired this project. As third-year medical students, we spend the entire year working on community projects. These projects can take any form, but they need to address some need in the community and involve community partners. My project was designed to look at food access issues and nutrition, and how they contribute to or shape chronic disease. In this country, chronic disease causes a lot of morbidity and mortality for middle aged patients, and increasingly, younger adults, people in their 30s, are struggling with heart disease. When we do root cause analysis, we can trace heart conditions back to lifestyle issues—the kind of food we eat and the ways we live our lives. I worked with a food bank and a community organization that rescues fruits and vegetables that would otherwise end up as waste—food that does not look great aesthetically but is just as nutritious and fresh—and with a community organization that has a commercial kitchen. With these partners, we created videos about what foods are healthy and how food contributes to disease. Out of that project I came up with the idea of doing a research study to investigate whether we could provide healthy food to community members or patients we see in our clinic and track and monitor their chronic disease markers. I got a lot of support from the TCC program, from Dr. Chrisman-Khawam and from my mentors at Akron General. Dr. Davidson, medical director of the Center for Family Medicine at Cleveland Clinic Akron General, was also very supportive. In fact, he's the principal investigator on the project and decided to apply for a grant because this is compelling work. It's work that could give us some insights about how providing people with healthy food helps shape chronic disease markers. Fortunately, there is a grant that the Cleveland Clinic runs on a yearly or semi-yearly basis that funded my work. They were looking for bold ideas and people who are willing to bring them to life—people who are willing to try to make a change not only at the institutional level but also in the community, and who will champion work that will have long-term effects. We launched the project in January and will be recruiting 70 patients from our practice, providing them with healthy foods and tracking and monitoring their chronic disease markers. We will also be providing some nutritional counseling and education. So, it's not only about providing healthy foods, which we know people need, but we are also going to have them work directly with a dietitian and provide them with long-term information about using foods to manage their chronic diseases.

Q: How do you see your TCC experience and your work to research food and disease, and its potential community impact, as contributing to your leadership and that of the osteopathic profession?

Dr. Kibera: There is a lot of opportunity to take this work to the next level by addressing the social determinants of health through long-lasting interventions. Moving this work forward will require leadership and the development of practical guidelines that health systems can adopt and study. For example, with my food as medicine project, seeing what works, taking the lessons and insights we learn and building from there can help shape what do in the future. If we truly want to change the health outcomes of our patients then we need to be able to work with others who have similar goals. I had rich conversations with community partners about how meaningful our project was and how they were delighted to see the healthcare system reaching out and inviting them to be part of the solution. They’d long dealt with some of these challenges by themselves and were pleasantly surprised to see the health system recognize the social needs that our patients face.

 Q: What are your long-term goals and what do you hope to accomplish as you advance through residency to become a practicing osteopathic family physician?

Dr. Kibera: I’ve never been able to look at health only from the narrow lens of addressing disease. I’ve always taken a larger view of community health because we know that health starts from the community. I want to continue working at the population level, both through practice and research, to address health disparities and social determinants of health. I want community-based health research to remain a big component of my career and I want to always maintain direct patient care because it's very rewarding and nourishing. I love family medicine because it allows me to do all those things. I also want to continue using my osteopathic manipulative treatment (OMT) skills. Pain is one of the chronic conditions that many of our patients face and OMT works wonders for them.

Q: Do you think the curriculum offered by the TCC has the power to transform medical education? Why or why not?

Dr. Kibera: Absolutely! It has the power not only to transform medical education but also to educate and train physicians who can do complex work inside the health system and beyond. This program is very transformative—it’s perfectly named! I mean, I’m here today talking to you because of some of the work that I was able to accomplish as a student and now as a resident in training. I don't know that I could have ever done the project I’m doing now as a resident if I had not been in the TCC program. The tools, skills and knowledge that we learn stay with us. We are often called upon to educate or share knowledge about quality improvement projects or initiating, developing and maintaining relationships with community partners. Those are not skills I would have gained in a traditional medical school.

Q: What has been the best thing about your TCC experience?

Dr. Kibera: Two things: one has been the knowledge and skills that I learned as part of the TCC program. Not many interns, let alone residents, are able to do research like my food as medicine project during residency. What a gift that I was able to take a challenge and be able to come up with an idea and develop it. I think that is the legacy and big take away from the TCC program. The other is the idea of having a family residency program that is very responsive and invested in training physicians with an outlook not only toward the patients we see in the clinic and the social needs they have but also teaches us how to reach out to communities and work with them to address even bigger problems. For me, that has been the biggest gift. It’s not often that medical schools give you permission to cultivate relationships with community partners and invite them to work with you.

For more information about the TCC program, please read AACOM’s interviews with Dr. Chrisman-Khawam published on December 2, 2021 and with Dr. Snyder published on June 10, 2021 or  view this webinar presented on October 30, 2020.