Consensus views on competencies and teaching methods for an interprofessional curriculum on complementary and integrative medicine: A Delphi study

A pre- and post-course survey of an elective Chinese medicine curriculum among junior Western medical students in Taiwan

BACKGROUND

Demonstrating a positive impact of educational programs on clinical care outcomes is challenging. We assess students' knowledge, attitudes, and behaviors as short-term outcomes of integrating a structured Traditional Chinese Medicine course within a Western medical school.

METHODS

A prospective questionnaire survey was conducted among first-year and second-year undergraduate medical students who participated in the "Introduction to Chinese Medicine" course in 2020. The survey assessed their knowledge, attitudes, and behaviors before and after completing the 32-hour course.

RESULTS

In total, 89 participants who completed both pre- and post-course questionnaires exhibited significantly higher scores in Chinese medicine knowledge after the course (3.82 ± 0.67 vs. 4.05 ± 0.73, p = 0.002). The majority of medical students displayed positive attitudes towards traditional Chinese medicine (80.9% vs. 83.3%, p = 0.392), particularly regarding the statement, "Traditional Chinese medicine emphasizes holistic considerations and whole person health to a greater extent than Western medicine does" (75.3% vs. 88.8%, p = 0.017). Additionally, most medical students reported proactive behaviors related to integrative care with Chinese medicine, including inquiring about Chinese medicine therapy history (76.4%), the concurrent use of Western and Chinese medications (78.7%) and participating in academic exchanges with Chinese medicine physicians (78.7%) after the course. More medical students expressed an intention to proactively learn more about Chinese medicine after the course (40.4% vs. 51.7%, p = 0.031).

CONCLUSIONS

The elective "Introduction to Chinese Medicine" course enhanced Taiwanese Western medical students' knowledge of Chinese medicine, fostered positive attitudes towards integrative healthcare involving Chinese medicine, and increased their willingness to learn more about Chinese medicine for future clinical practice.

TRIAL REGISTRATION

Registration prior to patient enrollment was not applicable because participants were not assigned to treatment groups in this study.

Instruments for Evaluating Undergraduate Medical Education in Complementary and Integrative Medicine: A Systematic Review

Objectives: The provision of courses in complementary and integrative medicine (CIM) varies widely between medical schools. To effectively improve CIM education, it is essential to use robust evaluation instruments that measure the impact of different educational interventions. This review aimed to identify and critically appraise qualitative and quantitative instruments used to evaluate CIM courses in undergraduate medical education. Methods: A systematic review was conducted in PubMed/MEDLINE, LIVIVO, CINAHL/EBSCO, Scopus, Web of Science, and Ovid/Embase in January 2023. Eligible studies included complete evaluation instruments for medical students and reported learning outcomes. Data extraction included information on the study design, the educational intervention, the evaluation instrument, and the outcome measure (e.g., Kirkpatrick levels: 1 reaction, 2a attitudes, 2b knowledge/skills, 3 behavioral change, 4 results). Instruments were categorized as validated, nonvalidated, or qualitative and analyzed using descriptive statistics. Validated instruments were assessed for quality using standardized criteria. Results: Of the 1909 records identified, 263 were subjected to a full-text review and 100 studies met the inclusion criteria. Twenty-seven studies reported on 14 validated instruments, 7 studies reported on qualitative, and 66 reported on nonvalidated instruments. Most were conducted in the United States (31) and Europe (28), 51 were cross-sectional studies, and 42 were intervention studies. Most of the instruments were self-administered (50), addressed general aspects of CIM (53), and assessed student attitudes (74). None of the validated instruments covered Kirkpatrick level 1, one covered level 3. Measurement of levels 2b and 3 was usually based on subjective self-assessment. Qualitative instruments covered the widest range of outcomes overall. Validated instruments often had good content validity and internal consistency, but lacked reliability and responsiveness. Revalidation of translated or modified instruments was mostly inadequate. Discussion: This structured and comprehensive set of existing instruments provides a starting point for the further development of CIM course evaluation in undergraduate medical education. Future studies should prioritize the measurement of higher-level learning outcomes, such as behavioral change and impact on patient care. Comparative intervention studies between medical schools or with pre-post designs and follow-up evaluations are needed to assess the effectiveness of different teaching approaches. Regular revalidation of both existing and newly developed instruments is essential to ensure their applicability to different audiences and settings. Their structured and standardized use would promote evidence-based CIM training and understanding of its impact on student competencies and patient outcomes.

How Delphi studies in the health sciences find consensus: a scoping review

BACKGROUND

Delphi studies are primarily used in the health sciences to find consensus. They inform clinical practice and influence structures, processes, and framework conditions of healthcare. The practical research-how Delphi studies are conducted-has seldom been discussed methodologically or documented systematically. The aim of this scoping review is to fill this research gap and to identify shortcomings in the methodological presentation in the literature. On the basis of the analysis, we derive recommendations for the quality-assured implementation of Delphi studies.

METHODS

Forming the basis of this scoping review are publications on consensus Delphi studies in the health sciences between January 1, 2018, and April 21, 2021, in the databases Scopus, MEDLINE via PubMed, CINAHL, and Epistemonikos. Included were publications in German and English containing the words "Delphi" in the title and "health" and "consensus" in the title or abstract. The practical research was analyzed for the qualitative content of the publications according to three deductive main categories, to which an influence on the result of Delphi studies can be imputed (expert panel, questionnaire design, process and feedback design).

RESULTS

A total of 287 consensus Delphi studies were included in the review, whereby 43% reported having carried out a modified Delphi. In most cases, heterogeneous expert groups from research, clinical practice, health economics, and health policy were surveyed. In about a quarter of the Delphi studies, affected parties, such as patients, were part of the expert panel. In the Delphi questionnaires it was most common for standardized Likert scales to be combined with open-ended questions. Which method was used to analyze the open-ended responses was not reported in 62% of the Delphi studies. Consensus is largely (81%) defined as percentage agreement.

CONCLUSIONS

The results show considerable differences in how Delphi studies are carried out, making assessments and comparisons between them difficult. Sometimes an approach points to unintended effects, or biases in the individual judgments of the respondents and, thus, in the overall results of Delphi studies. For this reason, we extrapolate suggestions for how certain comparability and quality assurance can be achieved for Delphi studies.

Screening and evaluation of key technologies for non-bioartificial liver care: an empirical study

Introduction

To identify key technologies within non-bioartificial liver (NBAL, an extracorporeal support system that temporarily replaces some of the liver's functions) nursing to offer guidance for clinical practice. In the context of NBAL nursing, key technologies are crucial for successful implementation of artificial liver treatment, ensuring patient safety, and enhancing nursing quality. A review of both domestic and foreign literature revealed that studies on NBAL nursing technology are lacking and that the key technologies for NBAL nursing have not been clearly identified.

Methods

Using empirical research methods to collect and analyze data. First, the on-site survey method and literature research method were used to create a preliminary screening list of key technologies for NBAL care. Next, the focus group discussion method was used to establish the screening principles and evaluation indicators for these key technologies. Then, a two-round Delphi study via e-mail correspondence was used to screen and determine the key technologies for NBAL care. Finally, the analytic hierarchy process (AHP) and the technique for order preference by similarity to ideal solution (TOPSIS) comprehensive evaluation method were applied to evaluate these key technologies for NBAL care.

Results

Seventeen key technologies for NBAL care were identified. These include three basic nursing technologies, seven operating techniques, three items for treatment process monitoring technology, two items for health education, and two items for complication prevention and treatment technology.

Conclusion

This study identified key NBAL nursing technologies, offering a systematic guide to enhance clinical practice. These technologies improve treatment safety, efficacy, and nursing standards, laying a foundation for NBAL care advancement.

Interprofessional education in traditional and complementary medicine: a scoping review

Interprofessional education (IPE) is a teaching method that improves collaboration and communication across health professions. There are consistent reports of poor interprofessional collaboration and communication between conventional health professionals and traditional and complementary medicine (TCM) professions. The application of IPE within courses that provide training in TCM requires close examination. This research aimed to identify the state of the art in IPE in TCM teaching. A scoping review was conducted. Thirteen databases were searched to identify citations up to March 2021. Thirty articles were selected after filtering for relevance against the inclusion criteria. The included articles were categorized into four a priori categories: Knowledge and Attitudes of students and professionals about TCM and IPE; Competencies of IPE in TCM; Teaching about TCM using IPE and Challenges and Opportunities for IPE in TCM. Nineteen of the included articles reported empirical research and primarily presented the evaluation of IPE activities within TCM courses or workshops; six studies consisted of texts with propositions and theoretical analyses; and five were case/experiential reports of IPE and TCM interventions, with or without evaluation of results. The studies report all health science students (undergraduate and graduate) exposed to IPE demonstrate a decrease in prejudice and an increase in knowledge about TCM. A sense of partnership developed through the collaborative competencies common to IPE and TCM and integrated care of patients. IPE in the context of TCM has been used for fostering integrative health care through the collaborative work of professional teams. Implementing IPE in TCM teaching requires inclusion in the curriculum, primarily undergraduate and research training.

Naturopathy, complementary and integrative medicine in medical education - position paper by the GMA Committee Integrative Medicine and Perspective Pluralism

Background

A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process.

Objective

The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training.

Method

The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine.

Results

First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice.

Conclusion

Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.