Medical students' attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study

Integrative medicine and health in undergraduate and postgraduate medical education

Background and objective: Integrative Medicine and Health (IMH) is a theory-based paradigm shift for health, disease and health care, which can probably only be achieved by supplementing medical roles and competences. Definition of IMH: The definitions of the Academic Consortium for Integrative Medicineand Health 2015 and the so-called Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally are used. The basic features of evidence-based Integrative Medicine and Health (EB-IMH) are based on the recommendations on EBM by David L. Sackett. Global State of Undergraduate and Postgraduate Medical Education (UG-PGME) for IMH: The USA and Canada are most advanced in the development of IMH regarding practice, teaching and research worldwide. Despite socio-cultural peculiarities, they can provide guidance for Europe and especially for Germany. Of interest here are competences for UG-PGME in IMH in primary care and in some specialist disciplines (e.g. internal medicine, gynecology, pediatrics, geriatrics, oncology, palliative care). For these specialties, the need for an interprofessional UG-PGME for IMH was shown in the early stages of development. UG-PGME for IMH in Germany: In the course of the development of the new Medical Licensure Act in Germany (ÄApprO), based on a revision of the National Competence-based Catalogue of Learning Objectives for Medicine (NKLM 2.0) and new regulations for Postgraduate Medical Education in Germany, suggestions for an extension of UG-PGME are particularly topical. To some extent there are already approaches to IMH. Old and new regulations are set out and are partly compared. As a result, some essential elements of IMH are mapped in the new ÄApprO. The new regulations for Postgraduate Medical Education do not mention IMH. Conclusion: The development of medical competences for IMH in the continuum of the UG-PGME could be supported by the coordinated introduction of appropriate entrustable professional activities (EPA) and IMH sub-competences combined with appropriate assessment.

Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

Correlation of Personal Experience and Acquired Knowledge With Intent to Recommend Adjunctive Osteopathic Manipulative Treatment or Yoga for Patients With Chronic Low Back Pain

Context

Osteopathic manipulative treatment (OMT) and yoga are both recommended by systematic reviews in the evidence-based research literature for low back pain management. It is unknown, to the authors' knowledge, what the effect of personal experience with OMT or yoga, reading research articles on OMT or yoga, or both will have on medical students' recommendations for these treatment options to future patients with chronic low back pain.

Objective

To evaluate the likelihood of osteopathic medical students recommending OMT or yoga to treat patients with chronic low back pain based on their personal experience or reading research articles that recommend OMT or yoga for patients with chronic low back pain.

Methods

In this prospective cohort study, researchers administered an anonymous 18-question online survey for osteopathic medical students. The survey included a patient vignette, 2 evidence-based articles, and multiple choice, yes/no, and Likert-type questions. Participants were recruited via email from all 4 years of medical school. Between-group differences in proportions were assessed with descriptive statistics and χ2 tests; differences within groups were assessed with the McNemar test; and Fischer exact tests were used when expected cell counts were less than 5.

Results

A total of 180 participants (100 male, 80 female) completed the study. Personal experience increased the likelihood of osteopathic medical students recommending OMT (P<.018) or yoga (P<.001) to a future patient or to a patient in a case vignette (P<.05) with chronic low back pain. Students who read research articles were more likely to recommend OMT to the case patient and future patients before and after reading the intervention article regardless of their experience (P<.001).

Conclusion

Personal experience and reading evidence-based research may increase the likelihood that osteopathic medical students will recommend OMT to future patients with chronic low back pain.

Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study

OBJECTIVE

Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person. We implemented a longitudinal IM short-course curriculum into our medical school education. This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.

METHODS

A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies. Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school. Paired data analysis was done, and only students who completed surveys at both time points were included in final analyses.

RESULTS

Of 52 students in each class, 17 (33%) in the class of 2015 and 22 (42%) in the class of 2016 completed both surveys. After the IM curriculum, students' knowledge of and comfort with several IM therapies-biofeedback, mindfulness, and the use of St. John's wort-improved significantly. Students' personal health practices also improved, including better sleep, exercise, and stress management for the class of 2015. Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.

CONCLUSION

It is feasible to incorporate IM education into undergraduate medical education, and this is associated with improvement in students' knowledge of IM and personal health practices.

Using longitudinal mixed methods to study the development of professional behaviours during pharmacy work-based training

Recent longitudinal investigations of professional socialisation and development of professional behaviours during work-based training are lacking. Using longitudinal mixed methods, this study aimed to explore the development of professional behaviours during a year of intensive work-based (pre-registration) training in pharmacy. Twenty trainee pharmacists and their tutors completed semi-structured interview and professional behaviour questionnaires at four time points during 2011/2012: months 1, 4 and 9 during training and 4 months after registration; tutors participated in months 1 and 9. Interviews were analysed thematically using template analysis, and questionnaires were analysed using ANOVA and t-tests. Self-assessed (trainee) and tutor ratings of all elements of professional behaviours measured in questionnaires (appearance, interpersonal/social skills, responsibility, communication skills) increased significantly from the start of pre-registration training to post-registration. Some elements, for example, communication skills, showed more change over time compared with others, such as appearance, and continued to improve post-registration. Qualitative findings highlighted the changing roles of trainees and learning experiences that appeared to facilitate the development of professional behaviours. Trainees' colleagues, and particularly tutors, played an essential part in trainees' development through offering support and role modelling. Trainees noted that they would have benefited from more responsibilities during training to ease the transition into practising as a responsible pharmacist. Longitudinal mixed methods can unpack the way in which professional behaviours develop during work-based training and allow researchers to examine changes in the demonstration of professional behaviours and how they occur. Identifying areas less prone to change allows for more focus to be given to supporting trainees in areas where there is a development need, such as communication skills and holding increasing responsibility.

Addressing holistic healthcare needs of oncology patients: Implementation and evaluation of a complementary and alternative medicine (CAM) course within an elective module designed for healthcare professionals

BACKGROUND

Patients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it.

OBJECTIVE

This paper reports on the implementation and evaluation of a newly designed module "Complementary and Alternative Medicine in oncological healthcare" in the bachelor degree program Interprofessional Health Care (B.Sc.).

DESIGN

The study applied a developed evaluation questionnaire to capture students' perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit.

SETTING

Interprofessional medical education, University Hospital Heidelberg, Germany.

RESULTS

The integration of the CAM elective module was possible and was met by positive response. Students' interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students' expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met.

CONCLUSIONS

Evaluation results indicate that the module content was in line with the students' expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today's healthcare professionals for patient-oriented healthcare delivery.

Development and evaluation of the R-I-CAM-Q as a brief summative measure of CAM utilisation

OBJECTIVE

This study evaluates a revised version of the I-CAM-Q, the R-I-CAM-Q, which is a shorter scale, and suitable for use as a brief, summative measure of CAM utilisation.

DESIGN

Online survey with an Australian sample (n=2697).

ANALYSIS

The psychometric properties of the I-CAM-Q were analysed using Mokken Scaling Analysis and Structural Equation Modelling.

RESULTS

A subset of items were identified as having an adequate uni-dimensional structure that can be aggregated to yield a scalar measure of CAM utilisation. Certain items, including prayer for health purposes, and chiropractic, were not indicative of general CAM use.

CONCLUSIONS

The R-I-CAM-Q provides a unitary, aggregate measure of CAM utilisation that provides scope for replicable research into the determinants of CAM use. It is the first quantitative and summative measure of general CAM use, developed and tested using modern psychometric methods.

Complementary and alternative medicine education for medical profession: systematic review

Purpose. To help integrate traditional, complementary and alternative medicine (TCAM) into health systems, efforts are being made to educate biomedical doctors (BMD) and medical students on TCAM. We systematically evaluated the effect of TCAM education on BMD and medical students' attitude, knowledge, and behavior towards TCAM utilization and integration with biomedical medicine. Methods. Evaluative studies were identified from four databases. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Study outcomes were classified using Kirkpatrick's hierarchy. Results. 3122 studies were identified and 12 studies of mediocre quality met inclusion criteria. Qualitative synthesis showed usage of diverse approaches including didactic, experiential learning, varying length, teacher background and intensity of exposure. More positive attitudes and improved knowledge after intervention were noted especially when teachers were BM trained. However, few studies assessed behavior change objectively. Finally, longer-term objective outcomes such as impact on patient care were not assessed. Conclusions. Lack of use of objective and reliable instruments preclude firm conclusion on the effect of TCAM education on study participants. However, positive changes, although mostly subjectively reported, were noted in most studies. Future evaluation should use validated or objective outcome assessments, and the value of using dual trained instructors.

Pakistani pharmacy students' perception about complementary and alternative medicine

OBJECTIVES

To assess Pakistani pharmacy students' perceptions of complementary and alternative medicine (CAM), the frequency with which they use CAM, and barriers to use of CAM.

METHOD

A CAM health belief questionnaire was administered to 595 students enrolled in a 5-year doctor of pharmacy program (PharmD) in Pakistan.

RESULTS

Attitudes of students towards CAM were positive. Lack of evidence supporting CAM practices was considered to be the major barrier toward more students using CAM. A majority of students (79%) agreed that clinical care should integrate conventional medicine and CAM practices. Many CAM-based therapies, such as dietary supplements, massage, herbal medicines, and homoeopathic medicines were used by the students. Significant gender differences in attitude were observed, with male students having more conservative attitudes toward CAM use. A high percentage of students desired more training in CAM.

CONCLUSIONS

Pakistani students exhibited positive attitudes about the value of CAM and most felt that CAM should be included in the PharmD curriculum.

Attitudes towards complementary and alternative medicine among medical and psychology students

The use of complementary and alternative medicine (CAM) is increasing in Europe as well as in the USA, but CAM courses are infrequently integrated into medical curricula. In Europe, but also especially in the USA and in Canada, the attitudes of medical students and health science professionals in various disciplines towards CAM have been the subject of investigation. Most studies report positive attitudes. The main aim of this study was to compare the attitudes towards CAM of medical and psychology students in Germany. An additional set of questions concerned how CAM utilisation and emotional and physical condition affect CAM-related attitudes. Two hundred thirty-three medical students and 55 psychology students were questioned concerning their attitudes towards CAM using the Questionnaire on Attitudes Towards Complementary Medical Treatment (QACAM). Both medical students and psychology students were sceptical about the diagnostic and the therapeutic proficiency of doctors and practitioners of CAM. Students' attitudes towards CAM correlated neither with their experiences as CAM patients nor with their emotional and physical condition. It can be assumed that German medical and psychology students will be reluctant to use or recommend CAM in their professional careers. Further studies should examine more closely the correlation between attitudes towards CAM and the students' worldview as well as their existing knowledge of the effectiveness of CAM.

Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.

Medical Students and Acupuncture: A Short Sharp Placement Experience!

Background

Acupuncture and other complementary therapies (CTs) have become increasingly popular, with patients calling for more integrated care. It is questionable whether doctors know enough about these therapies to provide balanced and informed advice to patients and, given that most will come across patients accessing CTs, this is an area of concern.

Method

This was an exploratory study of 40 students attending a placement at a CT service within an acute hospital trust in the UK. A questionnaire was given at the start of placement to record their scepticism towards CTs on a 0–10 scale and again, on placement completion.

Result

Of the students attending, 73% (n=29) completed the questionnaire. There was a statistically significant reduction in scepticism scores assessed before and after placement (p<0.001). Of the respondents, 90% (n=26) were shown or attempted acupuncture. 76% of students reported that the placement would definitely influence the rate of CT referrals in their future practice.

Conclusion

The placement experience provided students an opportunity to reconsider their attitudes towards CTs. The study was limited to one site and students independently elected to participate in the experience. Similar exposure could be of value to the wider medical student population, ultimately leading to more informed advice available to patients. Future research should include greater numbers, which could include a multi-site study.