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Cutshall SM, Khalsa TK, Chon TY, Vitek SM, Clark SD, Blomberg DL, Mustafa R, Bhagra A. Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center. Glob Adv Health Med 2019; 8:2164956119837489. [PMID: 30967973 PMCID: PMC6444766 DOI: 10.1177/2164956119837489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Susanne M Cutshall
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tejinder K Khalsa
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sairey M Vitek
- Quality Management Services, Mayo Clinic, Rochester, Minnesota
| | - Stephanie D Clark
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Debra L Blomberg
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rafid Mustafa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Mahapatra S, Bhagra A, Fekadu B, Li Z, Bauer BA, Wahner-Roedler DL. Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 15:442-449. [PMID: 29103413 DOI: 10.1016/s2095-4964(17)60367-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Saswati Mahapatra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Bisrat Fekadu
- Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota 55905, USA
| | - Zhuo Li
- Biostatistics Unit, Mayo Clinic, Jacksonville, Florida 32224, USA
| | - Brent A Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Enioutina EY, Salis ER, Job KM, Gubarev MI, Krepkova LV, Sherwin CMT. Herbal Medicines: challenges in the modern world. Part 5. status and current directions of complementary and alternative herbal medicine worldwide. Expert Rev Clin Pharmacol 2016; 10:327-338. [PMID: 27923318 DOI: 10.1080/17512433.2017.1268917] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Herbal medicine (HM) use is growing worldwide. Single herb preparations, ethnic and modern HM formulations are widely used as adjunct therapies or to improve consumer wellbeing. Areas covered: This final part in the publication series summarizes common tendencies in HM use as adjunct or alternative medicine, education of healthcare professionals and consumers, current and proposed guidelines regulating of production. We discuss potential HM-HM and HM-drug interactions that could lead to severe adverse events in situations where HMs are taken without proper medical professional oversight. Expert commentary: A number of serious problems have arisen with the steady global increase in HM use. HM interaction with conventional drugs (CD) may result in inadequate dosing of CD or adverse reactions; HM-HM interaction within herbal supplements could lead to toxicity of formulations. Inadequate education of clinicians and patients regarding medicinal properties of HMs must be addressed regionally and globally to ensure consumer safety.
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Affiliation(s)
- Elena Yu Enioutina
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA.,b Division of Microbiology and Immunology, the Department of Pathology , University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Emma R Salis
- c New Zealand School of Pharmacy , University of Otago , Dunedin , New Zealand
| | - Kathleen M Job
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA
| | | | - Lubov V Krepkova
- e Division of Toxicology, Center of Medicine , All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR) , Moscow , Russia
| | - Catherine M T Sherwin
- a Division of Clinical Pharmacology, the Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA.,f Department of Pharmacology and Toxicology , University of Utah , Salt Lake City , UT , USA
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Memon MA, Shmalberg J, Adair HS, Allweiler S, Bryan JN, Cantwell S, Carr E, Chrisman C, Egger CM, Greene S, Haussler KK, Hershey B, Holyoak GR, Johnson M, Jeune SL, Looney A, McConnico RS, Medina C, Morton AJ, Munsterman A, Nie GJ, Park N, Parsons-Doherty M, Perdrizet JA, Peyton JL, Raditic D, Ramirez HP, Saik J, Robertson S, Sleeper M, Dyke JV, Wakshlag J. Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges. Open Vet J 2016; 6:44-56. [PMID: 27200270 PMCID: PMC4824037 DOI: 10.4314/ovj.v6i1.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/04/2016] [Indexed: 12/13/2022] Open
Abstract
Integrative veterinary medicine (IVM) describes the combination of complementary and
alternative therapies with conventional care and is guided by the best available
evidence. Veterinarians frequently encounter questions about complementary and
alternative veterinary medicine (CAVM) in practice, and the general public has
demonstrated increased interest in these areas for both human and animal health.
Consequently, veterinary students should receive adequate exposure to the principles,
theories, and current knowledge supporting or refuting such techniques. A proposed
curriculum guideline would broadly introduce students to the objective evaluation of
new veterinary treatments while increasing their preparation for responding to
questions about IVM in clinical practice. Such a course should be evidence-based,
unbiased, and unaffiliated with any particular CAVM advocacy or training group. All
IVM courses require routine updating as new information becomes available.
Controversies regarding IVM and CAVM must be addressed within the course and
throughout the entire curriculum. Instructional honesty regarding the uncertainties
in this emerging field is critical. Increased training of future veterinary
professionals in IVM may produce an openness to new ideas that characterizes the
scientific method and a willingness to pursue and incorporate evidence-based medicine
in clinical practice with all therapies, including those presently regarded as
integrative, complementary, or alternative.
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Affiliation(s)
- M A Memon
- Department of Clinical Science, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - J Shmalberg
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - H S Adair
- Department of Small Animal Clinical Sciences (Egger) and Department of Large Animal Clinical Sciences (Adair), College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - S Allweiler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - J N Bryan
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - S Cantwell
- Medicine Wheel Veterinary Services, Ocala, FL, USA
| | - E Carr
- Department of Small Animal Clinical Sciences (Robertson) and Department of Large Animal Clinical Sciences (Carr), College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - C Chrisman
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - C M Egger
- Department of Small Animal Clinical Sciences (Egger) and Department of Large Animal Clinical Sciences (Adair), College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - S Greene
- Department of Clinical Science, College of Veterinary Medicine, Washington State University, Pullman, WA, USA
| | - K K Haussler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - B Hershey
- Integrative Veterinary Oncology, Phoenix, AZ, USA
| | - G R Holyoak
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - M Johnson
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - S Le Jeune
- Veterinary Medical Teaching Hospital (Peyton) and Department of Surgical and Radiological Sciences (Le Jeune), School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - R S McConnico
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - C Medina
- Coral Springs Animal Hospital, Coral Springs, FL, USA
| | - A J Morton
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - A Munsterman
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - G J Nie
- Angel Animal Hospital, Springfield, MO, USA
| | - N Park
- Integrative Ophthalmology for Pets, Los Angeles, CA, USA
| | | | | | - J L Peyton
- Veterinary Medical Teaching Hospital (Peyton) and Department of Surgical and Radiological Sciences (Le Jeune), School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - H P Ramirez
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - J Saik
- Winterville Animal Clinic, Winterville, GA, USA
| | - S Robertson
- Department of Small Animal Clinical Sciences (Robertson) and Department of Large Animal Clinical Sciences (Carr), College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - M Sleeper
- Departments of Small Animal Clinical Sciences (Shmalberg, Chrisman, Johnson, Sleeper), Large Animal Clinical Sciences (Morton), and Biomedical Sciences (Ramirez), College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - J Van Dyke
- Canine Rehabilitation Institute, Wellington, FL, USA
| | - J Wakshlag
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Kidd IJ. A pluralist challenge to "integrative medicine": Feyerabend and Popper on the cognitive value of alternative medicine. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2013; 44:392-400. [PMID: 23859834 DOI: 10.1016/j.shpsc.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/20/2013] [Indexed: 06/02/2023]
Abstract
This paper is a critique of 'integrative medicine' as an ideal of medical progress on the grounds that it fails to realise the cognitive value of alternative medicine. After a brief account of the cognitive value of alternative medicine, I outline the form of 'integrative medicine' defended by the late Stephen Straus, former director of the US National Centre for Complementary and Alternative Medicine. Straus' account is then considered in the light of Zuzana Parusnikova's recent criticism of 'integrative medicine' and her distinction between 'cognitive' and 'opportunistic' engagement with alternative medicine. Parusnikova warns that the medical establishment is guilty of 'dogmatism' and proposes that one can usefully invoke Karl Popper's 'critical rationalism' as an antidote. Using the example of Straus, I argue that an appeal to Popper is insufficient, on the grounds that 'integrative medicine' can class as a form of cognitively-productive, critical engagement. I suggest that Parusnikova's appeal to Popper should be augmented with Paul Feyerabend's emphasis upon the role of 'radical alternatives' in maximising criticism. 'Integrative medicine' fails to maximise criticism because it 'translates' alternative medicine into the theories and terminology of allopathic medicine and so erodes its capacity to provide cognitively-valuable 'radical alternatives'. These claims are then illustrated with a discussion of 'traditional' and 'medical' acupuncture. I conclude that 'integrative medicine' fails to exploit the cognitive value of alternative medicine and so should be rejected as an ideal of medical progress.
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Affiliation(s)
- Ian James Kidd
- Department of Philosophy, Durham University, 50 Old Elvet, Durham DH1 3HN, United Kingdom.
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Scheffer C, Tauschel D, Neumann M, Lutz G, Cysarz D, Heusser P, Edelhäuser F. Integrative medical education: educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM). PATIENT EDUCATION AND COUNSELING 2012; 89:447-454. [PMID: 22738823 DOI: 10.1016/j.pec.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/20/2012] [Accepted: 04/15/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES the development and preliminary evaluation of a new medical program aimed at educating students in patient-centered integrative care and developing appropriate educational strategies. METHODS The Integrated Curriculum for Anthroposophic Medicine (ICURAM) was developed with modules on anthroposophic medicine integrated into the full 6 years of the regular medical curriculum. The educational strategy is the ESPRI(2)T approach, combining Exploratory learning, Supported participation, Patient-based learning, Reflective practice, Integrated learning, an Integrative approach and Team-based learning. The student participation, assessed based on the number of credit points earned per year (ctp/year) through the ICURAM (1 ctp=30 h workload), served as a preliminary indicator of student interest. RESULTS Of the 412 55%medical students participated in the program: 16% full participation (≥ 4 ctp/year), 18% partial participation (1-3.99 ctp/year) and 22% occasional participation (0.25-0.99 ctp/year). The amount of additional workload taken on by students was between 7.8h/year for occasional participants, 33 h/year for partial participants and 84 h/year for full participants. CONCLUSION More than half of medical students were willing to invest a significant amount of additional time in the optional program. PRACTICE IMPLICATIONS An integrative medical curriculum with a student-centered educational strategy seems to be of interest to most medical students.
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Affiliation(s)
- Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine, Theory of Medicine, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Germany.
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Ys Lee A, Foong YC, C Le H. Complementary and alternative medicine and medical students in Australia:Where do we stand? Australas Med J 2012; 5:144-9. [PMID: 22905057 PMCID: PMC3413933 DOI: 10.4066/amj.20121183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Adrian Ys Lee
- Tasmanian School of Medicine, University of Tasmania, Tasmania, Australia
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Abbott RB, Hui KK, Hays RD, Mandel J, Goldstein M, Winegarden B, Glaser D, Brunton L. Medical Student Attitudes toward Complementary, Alternative and Integrative Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:985243. [PMID: 21826186 PMCID: PMC3147138 DOI: 10.1093/ecam/nep195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 10/26/2009] [Indexed: 11/14/2022]
Abstract
While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students' attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007. Factor analysis of the CAIMAQ revealed five distinct attitudinal domains: desirability of CAIM therapies, progressive patient/physician health care roles, mind-body-spirit connection, principles of allostasis and a holistic understanding of disease. The students held the most positive attitude for the "mind-body-spirit connection" and the least positive for the "desirability of CAIM therapies". This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable.
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Affiliation(s)
- Ryan B Abbott
- Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Nicolao M, Täuber MG, Heusser P. How should complementary and alternative medicine be taught to medical students in Switzerland? A survey of medical experts and students. MEDICAL TEACHER 2010; 32:50-55. [PMID: 20095775 DOI: 10.3109/01421590902825123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In Switzerland and in the whole western world, the growing popularity of CAM is calling for its implementation in the undergraduate medical curriculum. AIMS To determine whether medical experts and medical students are favorable to complementary and alternative medicine (CAM) education at Swiss medical schools and to investigate their opinion about its form, content and goals. METHODS Experts in the fields of conventional medicine (COM, n = 106), CAM experts (n = 29) and senior medical students (n = 640) were surveyed by an online questionnaire. RESULTS 48.7% of the COM experts, 100% of the CAM experts, and 72.6% of the students are favorable to CAM education at Swiss medical schools. The most requested disciplines are acupuncture, phytotherapy, and homeopathy; the most recommended characteristics of CAM education are elective courses, during the clinical years, in the format of seminars and lectures. For the CAM experts, the priority is to improve the students' knowledge of CAM, whereas for the COM experts and the students, the priority is to analyze efficiency, security, interactions, and secondary effects of CAM. CONCLUSIONS CAM courses should be informative, giving the students sufficient knowledge to provide a critical analysis of efficiency and security of different CAM modalities.
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Marcus DM, McCullough L. An evaluation of the evidence in "evidence-based" integrative medicine programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1229-1234. [PMID: 19707062 DOI: 10.1097/acm.0b013e3181b185f4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Alternative therapies are popular, and information about them should be included in the curricula of health profession schools. During 2000 to 2003, the National Institutes of Health National Center for Complementary and Alternative Medicine awarded five-year education grants to 14 health professions schools in the United States and to the American Medical Students Association Foundation. The purpose of the grants was to integrate evidence-based information about complementary and alternative medicine (CAM) into the curriculum. The authors reviewed the educational material concerning four popular CAM therapies-herbal remedies, chiropractic, acupuncture, and homeopathy-posted on the integrative medicine Web sites of the grant recipients and compared it with the best evidence available. The curricula on the integrative medicine sites were strongly biased in favor of CAM, many of the references were to poor-quality clinical trials, and they were five to six years out of date. These "evidence-based CAM" curricula, which are used all over the country, fail to meet the generally accepted standards of evidence-based medicine. By tolerating this situation, health professions schools are not meeting their educational and ethical obligations to learners, patients, or society. Because integrative medicine programs have failed to uphold educational standards, medical and nursing schools need to assume responsibility for their oversight. The authors suggest (1) appointing faculty committees to review the educational materials and therapies provided by integrative medicine programs, (2) holding integrative medicine programs' education about CAM to the same standard of evidence used for conventional treatments, and (3) providing ongoing oversight of integrative medicine education programs.
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Affiliation(s)
- Donald M Marcus
- Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA.
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Sierpina VS, Schneeweiss R, Frenkel MA, Bulik R, Maypole J. Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:946-50. [PMID: 17895653 DOI: 10.1097/acm.0b013e31814a5092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Fifteen U.S. academic programs were the recipients of a National Center for Complementary and Alternative Medicine R25 Education Grant Program to introduce curricular changes in complementary and alternative medicine (CAM) in their institutions. The authors describe the lessons learned during the implementation of these CAM education initiatives. Principal investigators identified these lessons along with discovered barriers and strategies, both those traditionally related to medical and nursing education and those unique to CAM education. Many lessons, barriers, and strategies were common across multiple institutions. Most significant among the barriers were issues such as the resistance by faculty; the curriculum being perceived as too full; presenting CAM content in an evidence-based and even-handed way; providing useful, reliable resources; and developing teaching and assessment tools. Strategies included integration into existing curriculum; creating increased visibility of the curriculum; placing efforts into faculty development; cultivating and nurturing leadership at all levels in the organization, including among students, faculty, and administration; providing access to CAM-related databases through libraries; and fostering efforts to maintain sustainability of newly established CAM curricular elements through institutionalization and embedment into overall educational activities. These lessons, along with some detail on barriers and strategies, are reported and summarized here with the goal that they will be of practical use to other institutions embarking on new CAM education initiatives.
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Ernst E, Pittler MH, Wider B, Boddy K. Acupuncture: its evidence-base is changing. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2007; 35:21-5. [PMID: 17265547 DOI: 10.1142/s0192415x07004588] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effectiveness of acupuncture remains a controversial issue. The aim of this article is to evaluate trends over time in the development of the evidence-base of acupuncture. A comparison of two series of systematic reviews was conducted. The first related to the evidence-base in 2000, the second related to 2005. Both employed virtually the same methodology and criteria for evaluation. The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.
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Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, UK.
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Frenkel M, Frye A, Heliker D, Finkle T, Yzaguirre D, Bulik R, Sierpina V. Lessons learned from complementary and integrative medicine curriculum change in a medical school. MEDICAL EDUCATION 2007; 41:205-13. [PMID: 17269955 DOI: 10.1111/j.1365-2929.2006.02654.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum. METHODS A qualitative approach was selected as a first step in evaluating the phenomenological experience of introducing the CAM Educational Project in 2000-05. In 2005, semi-structured interviews were conducted with faculty staff and graduating students who had participated in all 4 years of the CAM Project. Qualitative content was analysed focusing on linguistic data and contextual meaning. RESULTS The overall response to the integration of CAM curricular elements into the medical school curriculum was positive among all faculty and graduating medical students. Participant experiences were often dependent on the perceived rigour of alternative approaches to a presenting patient problem, along with the importance attributed to openness to patient perspectives as part of evidence-based practices. There was an appreciation of the importance of developing increased awareness and utilisation of CAM in medical practice, as well as a recognition of resistance by some medical school faculty to CAM approaches. CONCLUSIONS This evaluation of a specific CAM educational project suggests potentially transferable findings to other medical schools. Integrating CAM into the medical school curriculum requires a dedicated team if it is to result in a significant change. This change requires that CAM practices are visible to both students and faculty, that there is a co-operative climate, accessible resources, and institutional support, and that CAM content is embedded into the existing curriculum. All these factors combined can lead to sustainable integration of CAM content issues into the medical school curriculum.
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Affiliation(s)
- Moshe Frenkel
- Complementary and Alternative Medicine (CAM) Education Project, Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
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Busse JW, Heaton G, Wu P, Wilson KR, Mills EJ. Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees. Mayo Clin Proc 2005; 80:616-23. [PMID: 15887429 DOI: 10.4065/80.5.616] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine factors that predict disclosure of natural product use by patients to their primary care physicians. METHODS An 18-item survey about health care use and communication was distributed to patients who presented to the Canadian College of Naturopathic Medicine in March 2003. We examined correlations between responses and created a multivariable logistic regression model to explore which factors were associated with patients' discussion of natural product use with their primary care physicians. RESULTS The survey was given to 198 patients, 174 of whom responded (response rate, 87.9%). Most respondents (161 [92.5%] of 174) made use of natural products, and many (61 [41.5%] of 147) reported that they did not discuss natural product use with their primary care physician. The most significant factor predictive of patients having discussed natural product use with their primary care physician was having their primary care physician ask about natural product use (odds ratio, 18.77; 95% confidence interval, 5.06-69.62). Most respondents (107 [69.9%] of 153) indicated that their primary care physician did not ask about natural product use. CONCLUSIONS An important number of patients who visit a naturopathic clinic do not disclose natural product use to their primary care physicians. Our findings suggest that disclosure rates could be improved by physicians taking a more active role in asking their patients about natural product use.
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Affiliation(s)
- Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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15
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Teixeira MZ, Lin CA, Martins MDA. Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates' attitudes. SAO PAULO MED J 2005; 123:77-82. [PMID: 15947835 DOI: 10.1590/s1516-31802005000200009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Homeopathy and acupuncture, although recognized as medical specializations in Brazil, are not taught in most medical schools. The objective was to evaluate undergraduate attitudes towards them following their inclusion as optional disciplines at Faculdade de Medicina da Universidade de São Paulo (FMUSP) in 2002. DESIGN AND SETTING Questionnaire, at FMUSP. METHODS 484 students answered a self-administered questionnaire on these therapies, regarding their interest in learning, the teaching methods, their knowledge/experience (or that of someone close to them) and how it was acquired, the main indicators and general effectiveness of these therapies, and the possibilities for offering and integrating them within public healthcare units. RESULTS Over 85% of the students considered that homeopathy and acupuncture should be included in curricula, as options (72%) or compulsorily (19%); 56% showed great interest in learning about them. Although 76% had little or no knowledge, 67% believed that these therapies had some effectiveness, and that chronic diseases (37%) or even chronic and acute diseases (29%) would be the main indicators for their use. Around 35% were receptive towards offering public primary care using both therapies, while 34% thought these treatments should also be available in hospitals and 60% believed they could be integrated with conventional medical practices. CONCLUSION The medical students were interested in learning the principles of homeopathy and acupuncture, were able to observe and report on the effectiveness of these treatments and defended the use of these medical specializations within public healthcare.
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Frenkel M, Ben-Arye E, Hermoni D. An approach to educating family practice residents and family physicians about complementary and alternative medicine. Complement Ther Med 2005; 12:118-25. [PMID: 15561521 DOI: 10.1016/j.ctim.2004.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Complementary and alternative medicine (CAM) in the context of medical education is a controversial topic among the medical community. With the increased popularity of complementary and alternative medicine, medical educators are faced with the need of educating physicians so they would become competent to communicate with patients about CAM. As academic medicine shows more interest in CAM, it is critical to develop initiatives to overcome physicians' attitudinal barriers toward CAM and develop an instruction strategy that can address these needs. An approach to educate family practice residents and family physicians about CAM is described in this article. This patient-centered teaching approach hinges on the belief that CAM and family medicine are closely related. It espouses utilizing critical thinking and basing decisions on evidence-based material. The course covered four main topics in CAM: herbal medicine, traditional Chinese medicine (TCM), homeopathy and complementary nutrition. The course had limited objectives of exposing physicians to the common methods in CAM and providing sufficient information, so physicians could provide their patients with an informed, safe and balanced advice. The instructions emphasized the importance of improving physician-patient relationship and enriching the participant both professionally and personally. Results of our study revealed that after the course physicians' referral to CAM became more selective, at the same time, their personal use of CAM also increased. This reflects the increased value of CAM in the physicians' own healthcare, as well as their improved knowledge of appropriate referral patterns. Most importantly, the course increased the physicians' awareness of the psychosocial aspect of clinical problems encountered in family practice and, through the close observation of CAM in practice, gave them an additional viewpoint to better understand the patient-doctor relationship.
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Affiliation(s)
- Moshe Frenkel
- CAM Education Project, Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
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17
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Abstract
BACKGROUND Despite family practitioners frequently being requested to assist their patients with advice on or referrals to complementary-alternative medicine (CAM), there is an absence both of evidence about the efficacy of nearly all specific treatments or modalities and of guidelines to assist with the integration of conventional and CAM therapies. OBJECTIVE The aim of this article is to suggest a comprehensive and rational, best-evidence strategy for integrating CAM by primary care practitioners into primary care, within the context of the limitations of the current knowledge base and the local milieu. METHODS The suggested approach was developed by a combination of literature review, key informant interviews, focus groups, educational presentations for family practice residents and practitioners, and field testing. An iterative model was utilized whereby more refined drafts of the suggested approach were subjected to later discussants and groups, as well as further field testing. Drafts of the strategy were utilized in consultations of patients requesting advice on alternative medicine in a primary care setting and in a CAM clinic. RESULTS Both family physicians and CAM practitioners provided useful comments and recommendations throughout the process. These can be categorized in terms of knowledge, attitudes and skills. Our strategy suggests that patients requesting advice on the use and integration of CAM modalities as part of their health care should be evaluated initially by their primary care physician. The physician's responsibilities are to evaluate the appropriateness of that use, and to maintain contact, monitoring outcomes. Advice on referrals should be based on the safety of the method in question, current knowledge on indications and contraindications of that modality, and familiarity and an open dialogue with the specific therapist. CONCLUSIONS Given patients' demands and utilization of CAM therapies, despite the lack of evidence, there is an increasing need to address how CAM therapies can be integrated into conventional medical systems. These suggestions should respond to patient's expectations and needs, but at the same time maintain accepted standards of medical and scientific principles of practice.
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Affiliation(s)
- Moshe A Frenkel
- Department of Family Practice, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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18
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Barrett B. Alternative, complementary, and conventional medicine: is integration upon us? J Altern Complement Med 2003; 9:417-27. [PMID: 12816630 DOI: 10.1089/107555303765551642] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will use a complementary and alternative medicine (CAM) therapy this year. CAM therapies vary widely, with acupuncture, chiropractic, herbal medicine, and homeopathy among the more prominent modalities. CAM therapies are used in addition to and/or instead of the more conventional forms of medical care available in U.S. hospitals or licensed physicians' offices. A rapidly increasing interest in CAM has led to a nascent movement aimed at integrating various CAM therapies with the conventional health care system. In Washington State, for example, health insurance coverage for CAM therapies has been mandated, and a number of "integrated" delivery systems have been born. Although the political and economic forces leading to adoption and integration of CAM therapies vary widely by geographic locale, it is likely that some degree of integration will occur throughout much of the United States. Similar processes are occurring in Canada, Europe, and Australia, and indeed within middle and upper level socioeconomic strata worldwide. This paper identifies potential barriers and facilitators to potential integration, of medical disciplines and argues for an accessible, multidisciplinary and evidence-based, yet humanistic and patient-oriented approach.
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Affiliation(s)
- Bruce Barrett
- Department of Family Medicine, University of Wisconsin Medical School, Madison, WI 53715, USA.
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Bodeker G, Kronenberg F. A public health agenda for traditional, complementary, and alternative medicine. Am J Public Health 2002; 92:1582-91. [PMID: 12356597 PMCID: PMC3221447 DOI: 10.2105/ajph.92.10.1582] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2002] [Indexed: 11/04/2022]
Abstract
Traditional medicine (a term used here to denote the indigenous health traditions of the world) and complementary and alternative medicine (T/CAM) have, in the past 10 years, claimed an increasing share of the public's awareness and the agenda of medical researchers. Studies have documented that about half the population of many industrialized countries now use T/CAM, and the proportion is as high as 80% in many developing countries. Most research has focused on clinical and experimental medicine (safety, efficacy, and mechanism of action) and regulatory issues, to the general neglect of public health dimensions. Public health research must consider social, cultural, political, and economic contexts to maximize the contribution of T/CAM to health care systems globally.
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Affiliation(s)
- Gerard Bodeker
- Green College, University of Oxford Medical School, Oxford OX2 6HG, England.
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20
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Park CM. Diversity, the individual, and proof of efficacy: complementary and alternative medicine in medical education. Am J Public Health 2002; 92:1568-72. [PMID: 12356593 PMCID: PMC1447280 DOI: 10.2105/ajph.92.10.1568] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2002] [Indexed: 11/04/2022]
Abstract
Patients will always have access to a variety of possibly effective, but unproved, therapies directed at maintaining health or treating illness. And there will always be complex, potentially therapeutic regimens that cannot be adequately tested for financial, ethical, or methodological reasons. Furthermore, even after adequate study of a given regimen, there will always be the fundamental uncertainty of medical practice: the fact that epidemiological research produces probabilistic results that cannot predict with certainty the best treatment for the single unique patient before us. The exploration of complementary and alternative medicine topics in the medical school curriculum helps to elucidate the complex and uncertain nature of medical practice, sharpens skills for clinical decisionmaking, increases cultural sensitivity, and provides ideas for future research.
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Affiliation(s)
- Constance M Park
- Department of Medicine, Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, Columbia University College of Physicians and Surgeons, Box 75, 630 W 168th Street, New York, NY 10032, USA.
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Hui KK, Zylowska L, Hui EK, Yu JL, Li JJ. Introducing integrative East-West medicine to medical students and residents. J Altern Complement Med 2002; 8:507-15. [PMID: 12230912 DOI: 10.1089/107555302760253711] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over the last several years, many medical schools and residencies have introduced complementary and alternative medicine (CAM) into their curricula, prompting a discussion as to how CAM should be taught. In this paper, we share our experiences teaching medical trainees integrative East-West medicine, an approach to health and disease that brings together modern Western and Chinese medicine. A 2-week clinical rotation that is intimately tied to our busy clinical program is described in detail as we explore some of the challenges and opportunities involved in teaching a CAM-related field to medical trainees. We also demonstrate how such a clinical experience offers an opportunity to impart on our students a broad view of medicine and to discuss novel approaches to clinical problem-solving.
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Affiliation(s)
- Ka-Kit Hui
- UCLA Center for East-West Medicine, Santa Monica, and Department of Medicine, School of Medicine, University of California, Los Angeles, CA, USA.
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Mills EJ, Hollyer T, Guyatt G, Ross CP, Saranchuk R, Wilson K. Teaching evidence-based complementary and alternative medicine: 1. A learning structure for clinical decision changes. J Altern Complement Med 2002; 8:207-14. [PMID: 12006129 DOI: 10.1089/107555302317371514] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complementary and alternative medicine (CAM) education is at a crossroads and has been an area of increasing debate. Public use of CAM has risen dramatically since 1997, with initial reports ranging from 30% to a possible 60% in the United States. Much attention has been directed to the education of the public regarding CAM, with respect to efficacy, potential harm, and integration. Far less attention has been paid to the education of CAM practitioners. In the current climate of integrative health settings, CAM practitioners should be trained to interact with conventional physicians, the public, and policy makers in an evidence-based format. In order to create communication effectively, an evidence-based approach may provide the common ground required for all schools of thought.
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Affiliation(s)
- Edward J Mills
- Department of Research, The Canadian College of Naturopathic Medicine, North York, Ontario.
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Marcus DM. Alternative medicine and The Arthritis Foundation. ARTHRITIS AND RHEUMATISM 2002; 47:5-7. [PMID: 11932871 DOI: 10.1002/art1.10223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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