Life's Essential 8™ - Medical Students Program

Seminar Series: Life's Essential 8™ Deep Dive

8 interactive seminars (2 hours each) - one per metric

Seminar 1: Introduction & Diet Quality

• Session overview: LE8 framework, CV disease epidemiology (global burden, trends, disparities), prevention potential
• Diet Quality:
  • Nutritional epidemiology: Mediterranean diet, DASH, plant-based patterns
  • Evidence: PREDIMED trial, dietary trials meta-analyses
  • Practical counseling: 24-hour recall, food frequency questionnaire, setting dietary goals
  • Challenges: Cost, time, cultural preferences, food deserts
• Activity: Small group - analyze sample patient diet, develop SMART goals for improvement

Seminar 2: Physical Activity

• Exercise physiology basics: Acute and chronic adaptations, dose-response relationship
• Evidence: Exercise and CV outcomes, all-cause mortality, quality of life
• AHA/WHO guidelines: 150 min/week moderate aerobic + strength training
• Barriers and solutions: Time, motivation, injuries, disabilities
• Prescribing exercise: FITT principle (Frequency, Intensity, Time, Type), individualization
• Activity: Students create personalized exercise plan for themselves, share barriers/solutions

Seminar 3: Nicotine Exposure

• Tobacco and CV disease: Mechanisms (endothelial dysfunction, thrombosis, atherosclerosis), quantifying risk
• E-cigarettes: Youth epidemic, cardiovascular effects, harm reduction debate
• Cessation strategies: 5 A's framework, motivational interviewing, pharmacotherapy (NRT, varenicline, bupropion)
• Evidence: Benefits of cessation (timeline), cessation trials efficacy
• Activity: Role-play - one student plays smoker, another counsels using 5 A's, class feedback

Seminar 4: Sleep Health

• Sleep physiology: Architecture, circadian rhythms, functions
• Insufficient sleep and CV disease: HTN, obesity, diabetes, inflammation, mortality
• Sleep disorders: Obstructive sleep apnea (prevalence, consequences, diagnosis, treatment), insomnia
• Sleep hygiene: Evidence-based recommendations, addressing barriers
• Activity: Sleep diary analysis - students track own sleep 1 week prior, identify issues, set improvement goals

Seminar 5: Body Weight

• Obesity epidemic: Prevalence, trends, disparities, economic costs
• Pathophysiology: Energy balance, adipose tissue biology, insulin resistance, inflammation
• CV consequences: HTN, diabetes, dyslipidemia, atherosclerosis, HF, AFib
• Management: Lifestyle (diet + exercise + behavior), pharmacotherapy (GLP-1 agonists), bariatric surgery
• Communication: Weight stigma, person-first language, compassionate approach
• Activity: Case discussion - patient with obesity, multiple comorbidities; how to approach sensitively and effectively

Seminar 6: Blood Lipids

• Lipoproteins and atherosclerosis: LDL, HDL, triglycerides - structure, function, atherogenicity
• Lipid guidelines: 2018 ACC/AHA, risk-based approach, treatment thresholds
• Statins: Mechanism, efficacy (CTT meta-analysis - 1 mmol/L LDL ↓ = 22% event ↓), safety (myalgias, diabetes risk)
• Non-statin therapies: Ezetimibe, PCSK9 inhibitors - when to use
• Activity: Calculate ASCVD risk for sample patients, determine treatment recommendations per guidelines

Seminar 7: Blood Glucose

• Diabetes epidemiology: Prevalence explosion, prediabetes (96 million US adults), complications
• Pathophysiology: Insulin resistance, β-cell failure, glucotoxicity
• Prevention: Diabetes Prevention Program (lifestyle 58% ↓, metformin 31% ↓), implementation
• Management: Glycemic targets, CV-beneficial medications (GLP-1, SGLT2i), comprehensive diabetes care
• Activity: Prediabetes case - develop lifestyle intervention plan using DPP principles

Seminar 8: Blood Pressure

• Hypertension fundamentals: Definition, prevalence, pathophysiology, target organ damage
• Measurement: Proper technique (common errors, office vs home vs ambulatory), white coat/masked HTN
• Lifestyle management: DASH diet, sodium reduction, weight loss, exercise - magnitude of effects
• Pharmacotherapy: First-line agents (thiazides, ACE-I, ARBs, CCBs), combination therapy, resistant HTN
• Activity: BP measurement workshop - students practice on each other with feedback, identify technique errors

Personal Health Assessment Project

Students assess own cardiovascular health using LE8 framework

Components

1. Self-assessment:
   • Diet: 3-day food diary, evaluate against Mediterranean/DASH principles
   • Physical activity: Track 1 week (pedometer, activity log), compare to 150 min/week goal
   • Nicotine: Current use? Exposure to secondhand smoke?
   • Sleep: Sleep diary 1 week (duration, quality, issues)
   • BMI: Calculate from height/weight, assess waist circumference
   • Lipids: Optional fasting lipid panel (if available through student health)
   • Glucose: Optional fasting glucose or HbA1c
   • BP: Measure properly (trained in seminar 8), average of 3 readings
2. Calculate LE8 score: Score each metric 0-100 per LE8 criteria, average for overall score
3. Reflection paper (3-5 pages):
   • Current CV health status: Strengths and areas for improvement
   • Barriers to optimal health: Time constraints, stress, environment, habits
   • Action plan: SMART goals for 2-3 metrics to improve over next 6 months
   • Physician health reflection: How will your own health impact ability to counsel patients? Importance of modeling healthy behaviors.
4. Follow-up: Reassess at end of Year 2 - did you achieve goals? What did you learn about behavior change?

Educational Value

• Personal relevance: Students realize CV prevention applies to them (young, often think they're invincible)
• Empathy: Experiencing difficulty changing own behavior → understanding patient challenges
• Modeling: Physicians with healthy behaviors more credible when counseling patients (studies show patients more likely to follow advice from "healthy-appearing" doctors)
• Longitudinal: Tracking over 4 years - reinforces importance, allows seeing own change

Workshops

Nutrition Workshop (4 hours)

• Faculty: Registered dietitian + cardiologist
• Content:
  • Macronutrients and CV health: Fats (saturated, unsaturated, trans), carbohydrates (refined vs complex, glycemic index), protein
  • Micronutrients: Sodium, potassium, fiber, antioxidants
  • Reading nutrition labels: Serving sizes, % daily values, ingredient lists, health claims
  • Meal planning: Sample menus (Mediterranean, DASH), grocery shopping strategies, cooking demos (if kitchen available)
  • Counseling practice: Students counsel each other on dietary change, receive feedback
• Deliverable: Each student creates 1-week meal plan for hypothetical patient (given clinical scenario - e.g., post-MI, diabetic, hypertensive)

Physical Activity Workshop (4 hours)

• Faculty: Exercise physiologist + sports medicine physician
• Content:
  • Exercise prescription: FITT principle applied to various populations
  • Pre-participation screening: PAR-Q, AHA/ACSM algorithm, when to refer for cardiac stress test
  • Exercise demonstrations: Aerobic (walking, jogging), resistance (body weight, bands), flexibility
  • Adaptations for special populations: Obesity, arthritis, cardiac disease, elderly
  • Motivational strategies: Goal-setting, self-monitoring, relapse prevention
• Activity: Students develop exercise prescription for sample patients, present to group for feedback

Integration into Organ Systems Courses

Prevention content embedded in existing curriculum (cardiovascular, endocrine, renal blocks)

Cardiovascular System Block

• Atherosclerosis lecture: Risk factors (LDL, HTN, smoking, diabetes), pathogenesis, prevention strategies
• Hypertension lecture: Epidemiology, pathophysiology, lifestyle management, pharmacotherapy (mechanisms of antihypertensives)
• Heart failure lecture: Include prevention (treating HTN, CAD, diabetes to prevent HF)
• Pharmacology: Statins, antihypertensives, antiplatelet agents - mechanisms, efficacy, side effects

Endocrine System Block

• Diabetes lectures: Type 2 diabetes prevention (DPP trial), glycemic management, CV complications
• Obesity lecture: Pathophysiology, treatment options (lifestyle, pharmacotherapy, surgery), CV consequences
• Metabolic syndrome: Definition, prevalence, management

Renal System Block

• Hypertension: Renal mechanisms (RAAS, sodium handling), secondary HTN (renal artery stenosis, CKD)
• Diabetic nephropathy: Prevention (glycemic control, BP control, ACE-I/ARB), progression

Case-Based Learning Sessions

4 small-group case discussions (2 hours each) throughout Year 2

Case 1: Primary Prevention - Low Risk

• Scenario: 35-year-old woman, healthy, BMI 26, BP 128/82, LDL 145 mg/dL, non-smoker, sedentary
• Questions: Calculate 10-year ASCVD risk. What LE8 metrics are suboptimal? Develop comprehensive prevention plan (lifestyle recommendations, follow-up). Does she need statin? Why or why not?
• Learning points: Risk assessment, lifestyle as first-line, appropriate use (and non-use) of medications in low-risk patients

Case 2: Primary Prevention - High Risk

• Scenario: 62-year-old man, type 2 diabetes (HbA1c 7.8%), BP 142/88 on lisinopril, LDL 160 mg/dL, current smoker (1 ppd), BMI 32
• Questions: Calculate ASCVD risk (high). Prioritize interventions - what to address first? Statin indicated? BP control adequate? Smoking cessation approach? Diabetes management optimization?
• Learning points: Comprehensive risk factor management, medication indications in high-risk patients, addressing multiple issues simultaneously vs sequentially

Case 3: Secondary Prevention - Post-MI

• Scenario: 58-year-old woman, 6 weeks post-MI (stent placed), currently on aspirin, ticagrelor, metoprolol, lisinopril, atorvastatin 40 mg (LDL now 95 mg/dL), BP 135/85, still smoking, sedentary, depressed
• Questions: Is LDL at goal? (No - should be <70 post-MI). How to intensify lipid management? Smoking cessation critical - approach? Cardiac rehabilitation referral? Depression screening/management? BP optimization?
• Learning points: Aggressive secondary prevention, LDL goals post-ACS, cardiac rehab benefits, psychosocial factors post-MI

Case 4: Resistant Hypertension

• Scenario: 55-year-old man, BP 155/95 despite amlodipine 10 mg, lisinopril 40 mg, HCTZ 25 mg. Obese (BMI 35), high sodium diet, OSA (untreated - refuses CPAP), taking ibuprofen daily for back pain.
• Questions: Define resistant HTN. Is this true resistance or pseudoresistance? (Pseudoresistance - multiple contributing factors). What changes to recommend? (Dietary sodium reduction, weight loss, CPAP adherence, stop NSAIDs). If still resistant after addressing these - next medication? (Spironolactone)
• Learning points: Resistant HTN evaluation, lifestyle/medication factors contributing, importance addressing secondary causes and adherence before adding more medications

Standardized Patient Encounters

2 encounters during Year 2 (each 15 minutes + 10 min feedback)

Encounter 1: Diet Counseling

• Scenario: Patient with newly diagnosed hypertension (BP 145/92), overweight (BMI 29), diet high in processed foods, sodium. Asked to counsel on DASH diet.
• Skills assessed:
  • Elicits current dietary patterns (24-hour recall)
  • Explains rationale for dietary change (BP reduction)
  • Provides specific DASH recommendations
  • Uses motivational interviewing (open-ended questions, reflective listening, elicits patient's own motivations)
  • Sets collaborative goals (SMART)
  • Assesses barriers, problem-solves
• Feedback: Standardized patient completes checklist, provides qualitative feedback. Faculty reviews video (if recorded), gives written feedback.

Encounter 2: Smoking Cessation

• Scenario: Patient post-MI, still smoking (wants to quit but anxious about withdrawal, past failed attempts). Asked to counsel using 5 A's.
• Skills assessed:
  • Assesses smoking history (pack-years, prior quit attempts, triggers, readiness to quit)
  • Advises to quit (clear, personalized message linking to recent MI)
  • Assesses willingness to set quit date
  • Assists: Discusses behavioral strategies + pharmacotherapy (NRT, varenicline, bupropion options)
  • Arranges follow-up
  • Empathy, non-judgmental tone
• Feedback: Similar to above - checklist + qualitative feedback from SP and faculty

Integration into Core Clerkships

Internal Medicine Rotation (8-12 weeks)

Prevention teaching integrated into daily rounds, didactics

• Daily teaching:
  • Attending/resident teaching rounds: Highlight prevention opportunities in every patient (e.g., patient admitted with pneumonia - also has HTN, not on statin despite diabetes → discuss ASCVD risk, initiate statin at discharge)
  • Discharge planning: Students identify prevention gaps, recommend interventions (medication optimization, referrals to cardiac rehab, smoking cessation, nutrition counseling)
• Supervised counseling: Students counsel ≥2 patients during rotation on lifestyle modification (under supervision, with feedback)
• Noon conference: 1-2 didactic sessions on prevention topics (e.g., "Outpatient lipid management," "Diabetic cardiovascular risk reduction")
• Case presentation: Each student presents 1 case emphasizing prevention during rotation (e.g., "55-year-old man with pneumonia - also has prediabetes, overweight, sedentary. Prevention plan: weight loss, exercise, metformin, follow-up HbA1c.")

Family Medicine Rotation (4-6 weeks)

Ideal setting for prevention - longitudinal outpatient care

• Clinic sessions: Students see patients independently (with attending supervision), focus on prevention:
  • Annual physicals: Comprehensive CV risk assessment, LE8 scoring, prevention planning
  • Chronic disease visits: HTN, diabetes, dyslipidemia management - medication titration, lifestyle reinforcement
  • Acute visits: Opportunistic prevention (e.g., patient with URI - also note BP 140/90, discuss HTN evaluation)
• Continuity: If rotation structure allows, students follow same patients over 4-6 weeks - see impact of interventions, build relationships
• Interdisciplinary exposure: Shadow dietitian, diabetes educator, pharmacist - understand team-based care

Pediatrics Rotation (6-8 weeks)

Prevention focus: Childhood obesity, healthy habits formation

• Well-child visits: Growth chart monitoring (BMI percentiles), dietary counseling (families), physical activity promotion, screen time limits
• Anticipatory guidance: Emphasize establishing healthy habits early (prevents adult obesity, CVD)
• Adolescent care: Tobacco/vaping prevention, mental health, sexual health, sports physicals

Optional: 2-Week Preventive Cardiology Elective

Immersive clinical experience for interested students

Structure

• Clinic sessions: 4 half-days/week in preventive cardiology clinic
  • See patients under supervision (new consults, follow-ups)
  • Present to attending cardiologist
  • Participate in management decisions
  • Patient panel: Primary prevention (risk assessment), secondary prevention (post-MI, post-stroke), familial hypercholesterolemia, resistant hypertension, women's cardiology
• Procedures/diagnostics: Observe/participate in lipid apheresis (if available), carotid ultrasounds, arterial stiffness testing, coronary calcium scoring (interpretation)
• Didactics: 2-3 dedicated teaching sessions (e.g., "Advanced lipidology," "PCSK9 inhibitors," "Hypertension controversies")
• Cardiac rehabilitation: Attend 1-2 sessions, understand structure, benefits, patient engagement

Deliverables

• Case log: Document ≥10 patient encounters with detailed notes (history, assessment, plan)
• Reflection paper: What did you learn? How will this influence your future practice (regardless of specialty)?
• Presentation: Present 1 interesting case to peer students (grand rounds style)

Elective Opportunities

Multiple 2-4 week electives available (students choose based on interest):

• Preventive Cardiology Clinic (described above in Year 3)
• Lipid Disorders Clinic: Focus on familial hypercholesterolemia, severe hypertriglyceridemia, statin intolerance, PCSK9i therapy
• Cardiac Rehabilitation: Exercise prescription, patient education, psychosocial support, multidisciplinary teamwork
• Nutrition & Culinary Medicine: Intensive dietary counseling, cooking classes (teaching kitchen if available), food as medicine
• Tobacco Treatment: Smoking cessation clinic, intensive counseling, pharmacotherapy management
• Women's Cardiovascular Health: Pregnancy-related risks (gestational diabetes, preeclampsia), hormonal influences, gender disparities
• Community Health: Public health department, community-based prevention programs, health screenings, policy work

Community Health Project

Capstone requirement - students design and implement (or participate in) community-based CV prevention initiative

Examples

• Health screening event: Organize community screening (BP, lipids, glucose, BMI) at underserved location (church, community center, workplace). Provide education, referrals.
• School-based intervention: Develop nutrition/physical activity curriculum for elementary school, deliver to classes, assess pre/post knowledge.
• Worksite wellness: Partner with local employer to implement wellness program (healthy cafeteria options, walking groups, BP checks).
• Patient education materials: Create culturally-appropriate, low-literacy materials (videos, pamphlets) on LE8 metrics in multiple languages. Disseminate at clinics.
• Policy advocacy: Work with local government on tobacco-free ordinances, menu labeling laws, built environment improvements (sidewalks, parks).

Requirements

• Needs assessment: Identify community need (data, stakeholder input)
• Planning: Develop logic model, set objectives, design intervention
• Implementation: Execute project (with faculty mentorship)
• Evaluation: Assess reach, effectiveness, lessons learned
• Dissemination: Present at medical school symposium, write report

Learning Objectives

• Understand social determinants of health (poverty, education, food access, built environment)
• Recognize health disparities, work toward health equity
• Develop skills in community engagement, program planning, evaluation
• Appreciate population health perspective (complement individual patient care)
• Experience interprofessional collaboration

Capstone Presentation

End of Year 4: Students present synthesis of 4-year learning

Format

• 15-minute presentation + 5 min Q&A
• Audience: Faculty, peers, invited guests
• Content:
  • Personal LE8 journey: Year 1 baseline → Year 4 current. What changed? What was hard? What helped?
  • Clinical application: 2-3 patient cases where you applied prevention principles during clerkships/electives. What was impact? What did you learn?
  • Community project: Summary with photos, data, reflections
  • Future commitment: How will you integrate prevention into your future specialty (whatever it is)? Specific strategies, goals.

Assessment

• Rubric: Content (depth, accuracy), presentation skills (organization, clarity, engagement), reflection (insight, self-awareness), commitment (concrete prevention integration plan)
• Pass/Honors/Fail