The magazine of the Joe R. & Teresa Lozano Long School of Medicine at UT Health San Antonio

Students Share Nutrition Knowledge with Fourth-Graders

A Walzem Elementary student wears a vest that medical students Emily Sendukas (center) and Laura Zabalgoitia fill with bags of sugar representing extra calories students may consume throughout the day.

Fourth-graders learn how to make fun, healthy snacks such as these colorful fruit kabobs.

By Catherine Duncan

During their first year of medical school, Emily Sendukas and Laura Zabalgoitia decided to take a new elective—“Introduction to Culinary Medicine”—taught by Tisha N. Lunsford, M.D., AGAF, FACG, associate professor of medicine in the Division of Gastroenterology and Human Nutrition, and Chef Charlotte Samuel, M.S., H-E-B culinary nutritionist and adjunct instructor in the Department of Epidemiology and Biostatistics.
For the course, Dr. Lunsford partnered with H-E-B which hosted the cooking part of the course at the H-E-B Culinary Academy and Kitchen Theater in the heart of downtown San Antonio. Each week the students cooked a meal geared to a specific type of patient, such as a newly diagnosed diabetic.
Dr. Lunsford said according to the Journal of the American Medical Association “Report on the State of U.S. Health,” when it comes to premature death and disease, food choice is the single most important factor.
Zabalgoitia, a third-year student at the Long School of Medicine, said in addition to learning about nutrition and cooking meals for specific types of patients, they were taught how to talk to patients about making healthy eating and cooking choices.
“After we took the class, Emily and I talked about our nutritional education while growing up, and it was scarce,” Zabalgoitia said. “We decided we wanted to see if medical students could teach younger students the basics of nutrition. We wanted to take what we had learned in the course and share it in the community.”
Dr. Lunsford said, “Emily and Laura not only embraced and excelled in mastering nutritional principles in my course, they took it to the next level with inspiring innovation and teaching techniques that translated into an amazing adaptation of unpacking basic nutritional principles to an elementary school curriculum.”
Dr. Lunsford asked Dana Dalke, M.Ed., a fourth-grade teacher at Walzem Elementary in San Antonio, if the two medical students could teach a 12-week “Elementary Nutrition” course to her students. Sendukas and Zabalgoitia taught the course for one hour each week, with half the time devoted to teaching the basics of nutrition and the other half for hands-on food activities.
“We decided to concentrate on children. Obesity is such a problem now; maybe we can prevent it instead of treating its consequences when we are doctors,” Sendukas said.
Sendukas said they coincidentally received an email around that time from UT Health San Antonio’s Center for Medical Humanities & Ethics, inviting applications from students for grants to perform such community service learning projects.
Writing the grant helped the medical students determine their goals and methods to implement the curriculum. The medical students researched the fourth-grade learning level to be able to create the best content for the 12 weeks.
The center awarded them a Community Service Learning Midi Grant that paid for printing, supplies and mileage reimbursement costs. With funds provided by H-E-B, the students purchased food at an H-E-B grocery store near the elementary school. This allowed the medical students to use food that families could purchase locally.
During the first 30 minutes of each class, the basics of nutrition and reading food labels were taught to the fourth-graders. The next 30 minutes included a food activity with the total costs explained to the children.
Zabalgoitia said one week when they were teaching about carbohydrates, fiber and protein, the students made peanut butter banana rollups with a whole wheat tortilla. “We were able to show the students they can eat a healthy snack for less than one dollar,” she said.
On another day, the students made rainbow kabobs with different fruits on wooden skewers. Sendukas said the students were learning they can have fun preparing food, and it is good to have a variety of colors in their food.
“We really felt it was important to do this course in our community where obesity is prevalent. We wanted to make sure and show it was affordable and doable,” she said. “We wanted them to understand there are ways to eat healthy even if money is a problem.”
In order to measure the effectiveness of the curriculum, the two medical students administered a pre-program quiz to assess the youngsters’ baseline nutritional knowledge. An identical quiz was given after the 12 sessions to evaluate whether objectives were met and to assess the fourth-graders’ nutritional awareness.
Zabalgoitia said overall every student improved on the test. “Part of the test was giving them a blank sheet of paper and asking them to draw My Plate, which is the USDA’s modern food pyramid. They drew the plate and noted the five food groups,” she said.
In the pre-program quiz, the students answered 32.1 percent of the questions correctly. After they completed the curriculum, they answered 66.1 percent of the questions correctly.
Sendukas said because of the success of this program, Principal John Hinds asked them to adapt the curriculum for an after-school program for all fourth- and fifth-graders. “We knew we couldn’t teach the after-school program because as third-year students, we will spend most of our time at the hospital,” she explained. “We are modifying the curriculum for a different format.”
The medical students went back to Dr. Lunsford and asked her to talk to her current students about teaching the course. “We are so happy that rising second-year medical students will be teaching the curriculum next year,” Sendukas said.
“Being able to communicate the information we learn about nutrition and healthy eating is a great skill for any doctor. We need to practice this so we can be good at communicating with our future patients,” she said. “I think this is a great experience for medical students.”
Sendukas said it had not occurred to her or Zabalgoitia that their course might be the first time some children had communicated with health care professionals.
“On the last day, the teacher had the students give us letters. A few said they hope to be doctors one day. Not only did they learn, but maybe they have new ideas about what they want to do with their lives. Maybe we made a difference. That is a really beautiful thought,” she added.
Dr. Lunsford said she is very proud of these clever and compassionate young clinicians. “Not only were the children engaged, they learned healthy cooking and eating is within their reach.
“These young educators unpacked each benefit and balance of macro- and micronutrients in a meaningful way that impacts not just the children but their families as well,” she said. “Their enthusiasm is infectious; their heart for these children is priceless.”

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