Practitioner health and advocacy practice questions for the lifestyle medicine boards

Answer: E. 27% of schools met the 25-hour minimum

A (incorrect): Incorrect. Medical students received an average of 19.6 contact hours (range 0 to 70). B (incorrect): Incorrect. Just 26 of 105 schools (25%) required a dedicated nutrition course. C (incorrect): Incorrect. Average hours fell from 22.3 in 2004 to 19.6, and the share meeting 25 hours fell from 38% to 27%. D (incorrect): Incorrect. Most schools (103 of 109) required some form of nutrition education; the problem was the amount. E (correct): Correct. Just 28 of 105 schools (27%) met the minimum 25 required hours set by the National Academy of Sciences, down from 38% in 2004; students averaged 19.6 contact hours.

Source: Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542. Abstract Results (103/109 required some nutrition education; 26 of 105 (25%) required a dedicated course vs 30% in 2004; mean 19.6 contact hours vs 22.3 in 2004; 28 of 105 (27%) met the 25-hour National Academy of Sciences minimum vs 38% in 2004) and Conclusions. https://pmc.ncbi.nlm.nih.gov/articles/PMC4042309/

Answer: A. Publish tagged, text-based versions and test them with screen-reader users

A (correct): Information presented as images of text cannot be adapted or read by assistive technology; WCAG 2.2 Success Criterion 1.4.5 asks authors to use real text instead. NICE NG197 recommendation 1.2.4 asks that information take account of accessibility, and 1.2.5 that resources be offered in the person's preferred format. Properly structured text versions, checked with the users who reported the problem, address both. B (incorrect): OCR can make some text readable, but automated layers often lack reading order, headings, and text descriptions of graphics such as icon arrays, and the clinic still would not know whether the aids are usable. C (incorrect): A read-aloud service is a useful accommodation, but decision aids are meant to be reviewed at the person's own pace before a discussion. Staff reading on request is a weaker substitute than accessible materials. D (incorrect): Larger, higher-contrast images may help some low-vision readers, but a screen reader still cannot read an image of text. E (incorrect): A request process puts the burden on each patient and delays access. It does not fix the format that is failing.

Source: NICE. Shared decision making (NG197), 2021. NICE NG197 recommendations 1.2.4 (take account of accessibility) and 1.2.5 (resources in preferred format); W3C Understanding WCAG 2.2 Success Criterion 1.4.5 Images of Text, Intent section, https://www.w3.org/WAI/WCAG22/Understanding/images-of-text.html. https://www.nice.org.uk/guidance/ng197/chapter/Recommendations

Answer: A. Offer routine validated screening at preventive visits, sooner when indicated

The AAP policy recommends a validated two-question screen at scheduled health-maintenance visits, or sooner when indicated, and calls for universal screening. Food insecurity can occur outside visibly deprived neighborhoods and without growth faltering or public-assistance enrollment. A (correct): Routine screening of all families at preventive visits, with earlier screening when indicated. B (incorrect): Event-triggered screening misses families whose food insecurity has not been disclosed through a known income change. C (incorrect): Growth faltering is a late and insensitive marker; many food-insecure children grow normally. D (incorrect): Enrollment-based screening misses eligible but unenrolled households and those above program thresholds. E (incorrect): Area-based targeting misses food-insecure families in less deprived neighborhoods, as in this case. A positive screen should prompt sensitive assessment and connection to resources. This verifies the original 2015 recommendation; it does not assert a later reaffirmation date.

Source: AAP Council on Community Pediatrics and Committee on Nutrition. Promoting food security for all children. Pediatrics. 2015;136:e1431-e1438. https://publications.aap.org/pediatrics/article/136/5/e1431/33896/Promoting-Food-Security-for-All-Children [p. e1435: practice-level screening discussion and the validated 2-question screening tool; p. e1436: Recommendations, 2-question screen at scheduled health-maintenance visits or sooner, and universal screening]

Answer: B. Name an accountable leader with a language-access budget and tracked goals

A (incorrect): Training is CLAS Standard 4, which the clinic already addresses in part. More training does not supply interpreter funding, measures, or anyone accountable for acting on results. B (correct): The review found missing resources, measures, and accountability. CLAS Standard 2 calls for governance and leadership that promote CLAS through policy, practices and allocated resources; Standard 9 calls for goals, policies and management accountability; Standard 10 calls for integrating CLAS measures into quality improvement. A responsible leader with funding and tracked goals addresses all three gaps. C (incorrect): Translated materials meet Standard 8 and are worthwhile, but they do not fund interpreters for clinical conversations, create measures, or assign accountability. D (incorrect): Standard 7 says the competence of people providing language assistance should be ensured and that untrained individuals should be avoided as interpreters. Ad hoc bilingual staff also leave the budget and accountability gaps unaddressed. E (incorrect): A survey adds one source of data, but without a responsible leader and resources there is no mechanism to act on it, and it does not fund language assistance.

Source: US HHS Office of Minority Health. National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care, revised June 2025. National CLAS Standards (revised June 2025), Standards 2, 4, 7, 8, 9 and 10. https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards_Revised_June2025.pdf