Campus Location
Dallas Campus (Online)
Date of Award
10-2025
ORCID
https://orcid.org/0009-0007-1005-7974
Document Type
Dissertation
Department
Organizational Leadership
Degree Name
Doctor of Education
Committee Chair or Primary Advisor
Lawrence Santiago
Second Committee Member or Secondary Advisor
Raquel Ellis
Third Committee Member or Committee Reader
Joseph Cardot
Abstract
This dissertation examined how a U.S. national lifestyle medicine residency curriculum influenced resident learning and practice using a program evaluation paradigm with a convergent mixed methods design guided by Kirkpatrick’s four-level evaluation model. The problem addressed was the persistent gap between evidence for lifestyle interventions and the limited preparation residents receive to deliver lifestyle counseling in routine care. The purpose of the study was to evaluate changes in residents’ reactions, learning, and clinical behaviors and to identify early patient-level signals and the implementation conditions that enabled or constrained behavior change. Quantitative methods analyzed archived pre- and posttraining surveys from 148 residents across multiple specialties and sites. Data collection included item-level reaction, knowledge, confidence, and behavior ratings; procedures included data cleaning, descriptive statistics, paired nonparametric tests appropriate for ordinal outcomes, and effect size estimation, with valid denominators reported per item. Qualitative methods included semistructured interviews with 15 residents, conducted via videoconference, transcribed verbatim, member checked, and analyzed using reflexive thematic analysis. Integration used joint displays to connect quantitative movement with qualitative explanations of mechanisms. Quantitative results indicated statistically significant, practically meaningful improvements in knowledge, confidence, and frequency of lifestyle counseling behaviors. Qualitative findings showed that residents incorporated lifestyle practices into daily visits by using brief openers, specific and time-bound goal setting, simple prescriptions, and quick referrals, supported by microworkflows, electronic health record tools, and one-page patient handouts. Reported early patient-level signals included medication reduction, improved clinical measures, and enhanced patient engagement; these signals were self-reported and noncausal. Barriers included time pressure, documentation burden, variable faculty modeling, and inconsistent local resources. Conclusions were that the curriculum was associated with positive movement across Levels 1 to 3 and with plausible early indicators at Level 4 when key drivers were present, such as faculty exemplars, embedded tools, and streamlined workflows. Recommendations included institutionalizing these drivers, expanding faculty development, and conducting follow-on studies that link resident behaviors to electronic health record outcomes using stronger comparative designs.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Recommended Citation
Mello, Shanna, "Advancing Medical Education With Lifestyle Medicine: A Comprehensive Program Evaluation Using the Kirkpatrick Framework" (2025). Digital Commons @ ACU, Electronic Theses and Dissertations. Paper 963.
https://digitalcommons.acu.edu/etd/963