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Valentini J, Flum E, Schwill S, Krug K, Szecsenyi J, Joos S. Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung. Complement Med Res 2018; 25:233-239. [PMID: 30056453 DOI: 10.1159/000485319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hintergrund: Inhalte aus den Bereichen der klassischen Naturheilverfahren und Komplementärmedizin sind im Rahmen der ärztlichen Approbationsordnung curricular verankert. Im Gegensatz dazu werden in den Weiterbildungsordnungen zum Facharzt für Allgemeinmedizin keine komplementärmedizinischen Inhalte abgebildet. Bisher ist nicht bekannt, ob Ärzte in Weiterbildung (ÄiW) zum Facharzt für Allgemeinmedizin innerhalb ihrer Weiterbildung mit komplementärmedizinischen Verfahren in Kontakt kommen und ob sie solche erlernen bzw. erlernen möchten. Das Ziel der vorliegenden Studie war die Erhebung der Einstellung zum und des Weiterbildungsbedarfs im Bereich Komplementärmedizin bei ÄiW zum Facharzt für Allgemeinmedizin. Methoden: In Rahmen einer Querschnittsstudie erfolgte eine Fragebogen-gestützte Umfrage unter ÄiW zum Facharzt für Allgemeinmedizin innerhalb des Weiterbildungsprogramms «Verbundweiterbildungplus Baden-Württemberg». Diese wurde onlinebasiert initiiert und durch eine papierbasierte Umfrage komplettiert. Ergebnisse: Insgesamt nahmen 138 Teilnehmer der Verbundweiterbildungplus Baden-Württemberg an der Umfrage teil. Der Gesamtrücklauf betrug damit 28%. Dabei zeigte sich, dass die Teilnehmenden ein hohes Interesse an Komplementärmedizin hatten. Gleichzeitig gaben sie an, Unsicherheiten sowohl inhaltlicher als auch formaler Art wahrzunehmen (z.B. Evidenz der einzelnen Methoden und Kostenübernahme durch gesetzliche Krankenkassen). Die große Mehrheit der befragten Ärzte befürwortete, dass in der Weiterbildung zum Facharzt Allgemeinmedizin Kompetenzen aus dem Bereich Komplementärmedizin vermittelt werden. Schlussfolgerungen: Vor dem Hintergrund der weiten Verbreitung komplementärmedizinischer Methoden im hausärztlichen Alltag muss diskutiert werden, ob im Rahmen der Weiterbildung zum Facharzt für Allgemeinmedizin Basiskompetenzen für diesen Bereich definiert werden sollten. Diese könnten beispielsweise in das «Kompetenzbasierte Curriculum Allgemeinmedizin» der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) einfließen.
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Koithan M, Bell IR, Caspi O, Ferro L, Brown V. Patients' Experiences and Perceptions of a Consultative Model Integrative Medicine Clinic: A Qualitative Study. Integr Cancer Ther 2016; 6:174-84. [PMID: 17548796 DOI: 10.1177/1534735407301992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: A common theme in integrative medicine (IM) is patient-centered partnering in care between patients and providers. Despite the stated ideals, few studies have assessed patients' perspectives on their actual experience in the context of a specific care model. The purpose of the present study was to retrospectively explore and compare experiences of cancer and noncancer patients under care in a consultative IM outpatient teaching clinic in the south-western United States. Design: Qualitative study using inductive content analysis of focus group interview transcripts (2 groups of adult patients with cancers of various types and 1 group of chronically ill noncancer patients with mixed diagnoses). Method: Participants were recruited by random selection from a pool of eligible patients. Groups were conducted with patients who had completed their initial conventional cancer treatment and were at least 6 months postconsultation with an IM clinic physician. Transcripts of the audiotaped focus groups were analyzed. Results: Cancer patients (n = 15) and noncancer patients (n = 6) (mean age, 60 years; 77% women) expressed overall satisfaction with IM, emphasizing (1) expansion of treatment options with lower perceived toxicity than conventional therapies, (2) positive experiences of the IM physician as caring and taking time to listen, and (3) improved self-care skills and sense of empowerment. Cancer patients noted positive relationships with their conventional MDs more than did noncancer patients, although both groups appreciated the IM physicians' communication styles. Conclusion: Patients experience a consultative integrative clinic model overall as favorable. The impact on outcomes, costs, and long-term quality of life requires additional study.
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Affiliation(s)
- Mary Koithan
- Department of Medicine (Program in Integrative Medicine) at The University of Arizona Health Sciences Center, Tucson, AZ 85724-5153, USA.
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Liu MA, Nguyen J, Nguyen A, Kilgore DB. Longitudinal survey on integrative medicine education at an underserved health centre. EDUCATION FOR PRIMARY CARE 2015; 26:404-9. [DOI: 10.1080/14739879.2015.1101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chaudry SS, McGuire MJ, Lam C, Hatef E, Wright SM, Alexander MH. Teaching Integrative Medicine to Residents: A Focus on Populations Rather Than Individual Patients. Am J Prev Med 2015; 49:S285-9. [PMID: 26477905 DOI: 10.1016/j.amepre.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Integrative medicine (IM) is by its very definition patient centric: "It reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches." Best methods for teaching IM in residency have not been well described. METHODS An IM curriculum for preventive medicine (PM) residents was thoughtfully developed and iteratively revised using Kern's six-step approach. The centerpiece of this curriculum was to have learners work collaboratively within teams on projects that would facilitate IM-focused care within primary care practices. Before embarking on specific IM-related projects, residents immersed themselves within the practices to understand the needs of the community. RESULTS Forty-eight PM residents have participated in the curriculum in the last 3 years, and 27 unique physician preceptors served as mentors for the projects. Both residents and preceptors enjoyed working on the projects, and both groups considered the work to be a valuable educational pursuit. Common IM content areas covered by the projects dealt with interprofessional collaboration, health promotion, and population-based prevention. Although there were challenges associated with implementation of the projects, overcoming these enhanced the PM residents' confidence and ability to serve as agents of change. CONCLUSIONS An IM curriculum was successfully incorporated into a PM residency program. The focus on serving the community, or a population health approach, may not be the most common approach in IM, but it worked effectively to enhance the IM knowledge and skills of PM residents.
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Affiliation(s)
- Sajida S Chaudry
- General Preventive Medicine Residency Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland.
| | - Maura J McGuire
- Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland
| | - Clarence Lam
- General Preventive Medicine Residency Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elham Hatef
- General Preventive Medicine Residency Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Scott M Wright
- Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland
| | - Miriam H Alexander
- General Preventive Medicine Residency Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Maizes V, Horwitz R, Lebensohn P, McClafferty H, Dalen J, Weil A. The evolution of integrative medical education: the influence of the University of Arizona Center for Integrative Medicine. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2015; 13:356-62. [DOI: 10.1016/s2095-4964(15)60209-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Two new scales for integrative medical education and research: confidence in providing calm, compassionate care scale (CCCS) and self-efficacy in providing non-drug therapies (SEND) to relieve common symptoms. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2014.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jung B, Shimmell L, Stewart D, Gatti L, Venasse K, Plaisant L, Ledgerd R, Baptiste S. Competency-based education: A survey study of international occupational therapy educational programmes. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2015. [DOI: 10.1179/1447382815z.0000000009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kemper KJ, Mo X, Lynn J. Preaching to the choir: comparing health professionals who enroll in mind-body skills versus herbs and dietary supplements training? J Evid Based Complementary Altern Med 2014; 20:98-103. [PMID: 25516529 DOI: 10.1177/2156587214561328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Observational studies evaluating elective training programs may be biased if learners who enroll differ from nonenrollees. To assess self-selection bias, we compared participants who enrolled in 2 different online courses in complementary and alternative medical therapies. METHODS Participants were recruited from entering classes in medicine, nursing, social work, and dietetics, and residencies in family medicine and pediatrics. The 2 electives were (a) herbs and dietary supplements and (b) mind-body skills training. Participants completed standardized questionnaires before training. RESULTS The 218 participants had an average age of 28 years; 76% were trainees. There were no significant differences between enrollees in mind-body skills and herbs and dietary supplements with regard to age, gender, stress levels, mind-body training or practice, mindfulness, empathy, compassion, or resilience. CONCLUSIONS Those who enroll in mind-body skills are not measurably different than those who enroll in herbs and dietary supplements. There is no evidence of self-selection bias or "preaching to the choir."
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Affiliation(s)
| | - Xiaokui Mo
- The Ohio State University, Columbus, OH, USA
| | - Joanne Lynn
- The Ohio State University, Columbus, OH, USA
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Barros NFD, Fiuza AR. Evidence-based medicine and prejudice-based medicine: the case of homeopathy. CAD SAUDE PUBLICA 2014; 30:2368-2376. [DOI: 10.1590/0102-311x00183513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/12/2014] [Indexed: 11/22/2022] Open
Abstract
In recent decades an important social movement related to Complementary and Alternative Medicine has been identified worldwide. In Brazil, although homeopathy was recognized as a specialist medical area in 1980, few medical schools offer courses related to it. In a previous study, 176 resident doctors at the University of Campinas Medical School were interviewed and 86 (49%) rejected homeopathy as a subject in the core medical curriculum. Thus, this qualitative study was conducted to understand their reasons for refusing. 20 residents from 15 different specialist areas were interviewed. Very few of them admitted to a lack of knowledge for making a judgment about homeopathy; none of them made a conscientious objection to it; and the majority demonstrated prejudice, affirming that there is not enough scientific evidence to support homeopathy, defending their position based on personal opinion, limited clinical practice and on information circulated in the mass media. Finally, resident doctors’ prejudices against homeopathy can be extended to practices other than allopathic medicine.
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Ring M, Brodsky M, Low Dog T, Sierpina V, Bailey M, Locke A, Kogan M, Rindfleisch JA, Saper R. Developing and implementing core competencies for integrative medicine fellowships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:421-428. [PMID: 24448047 DOI: 10.1097/acm.0000000000000148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.
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Affiliation(s)
- Melinda Ring
- Dr. Ring is assistant professor of clinical medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Brodsky is assistant clinical professor of medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. Dr. Low Dog is clinical associate professor of medicine, Department of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona. Dr. Sierpina is professor of family medicine, Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas. Dr. Bailey is instructor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina. Dr. Locke is assistant professor of family medicine, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan. Dr. Kogan is assistant professor of medicine, Division of Geriatrics and Palliative Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC. Dr. Rindfleisch is associate professor, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Dr. Saper is associate professor of family medicine, Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts
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Okoro CA, Zhao G, Li C, Balluz LS. Has the use of complementary and alternative medicine therapies by U.S. adults with chronic disease-related functional limitations changed from 2002 to 2007? J Altern Complement Med 2012; 19:217-23. [PMID: 23072266 DOI: 10.1089/acm.2012.0009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined changes in the use of complementary and alternative medicine (CAM) therapies by U.S. adults aged 18 years or older with chronic disease-related functional limitations between 2002 and 2007. DESIGN The study was a cross-sectional survey. SETTING/LOCATION The study was conducted in the United States. SUBJECTS The study comprised adults aged 18 years or older with chronic disease-related functional limitations. METHODS Data were obtained from the 2002 and 2007 U.S. National Health Interview Survey to compare the use of 22 CAM therapies (n=9313 and n=7014, respectively). Estimates were age adjusted to the year 2000 U.S. standard population. RESULTS The unadjusted and age-standardized prevalence of overall CAM use (22 therapies comparable between both survey years) was higher in 2007 than in 2002 (30.6% versus 26.9%, p<0.001 and 34.4% versus 30.6%, p<0.001, respectively). Adults with functional limitations that included changing and maintaining body position experienced a significant increase in CAM use between 2002 and 2007 (31.1%-35.0%, p<0.01). The use of deep breathing exercises was the most prevalent CAM therapy in both 2002 and 2007 and increased significantly during this period (from 17.9% to 19.9%, p<0.05). The use of meditation, massage, and yoga also increased significantly from 2002 and 2007 (11.0%-13.5%, p<0.01; 7.0%-10.9%, p<0.0001; and 5.1% to 6.6%, p<0.05, respectively), while the use of the Atkins diet decreased (2.2%- 1.4%, p<0.01). CONCLUSIONS Among U.S. adults with chronic disease-related functional limitations, the overall increase in CAM use from 2002 to 2007 was significant, particularly among those with changing and maintaining body position limitations.
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Affiliation(s)
- Catherine A Okoro
- Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Public Health Surveillance and Informatics Program Office, Division of Behavioral Surveillance, Atlanta, GA 30333, USA.
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Vohra S, Surette S, Mittra D, Rosen LD, Gardiner P, Kemper KJ. Pediatric integrative medicine: pediatrics' newest subspecialty? BMC Pediatr 2012; 12:123. [PMID: 22894682 PMCID: PMC3470978 DOI: 10.1186/1471-2431-12-123] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 08/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children's hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. METHODS Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. RESULTS Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income. CONCLUSIONS Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.
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Affiliation(s)
- Sunita Vohra
- CARE Program for Integrative Health & Healing, Department of Pediatrics, Faculty of Medicine and School of Public Health, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada.
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Lebensohn P, Kligler B, Dodds S, Schneider C, Sroka S, Benn R, Cook P, Guerrera M, Low Dog T, Sierpina V, Teets R, Waxman D, Woytowicz J, Weil A, Maizes V. Integrative medicine in residency education: developing competency through online curriculum training. J Grad Med Educ 2012; 4:76-82. [PMID: 23451312 PMCID: PMC3312539 DOI: 10.4300/jgme-04-01-30] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/05/2011] [Accepted: 10/04/2011] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education. INTERVENTION The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings. EVALUATION TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments. RESULTS The class of 2011 (n = 61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses. CONCLUSIONS The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.
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Shannon S, Weil A, Kaplan BJ. Medical Decision Making in Integrative Medicine: Safety, Efficacy, and Patient Preference. ACTA ACUST UNITED AC 2011. [DOI: 10.1089/act.2011.17210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Scott Shannon
- Psychiatry at the University of Colorado, in Denver, Colorado
| | - Andrew Weil
- The Program in Integrative Medicine, a professor of medicine and public health, and the Jones-Lovell endowed chair in integrative rheumatology at the University of Arizona, in Tucson, Arizona
| | - Bonnie J. Kaplan
- The department of paediatrics and community health sciences at the University of Calgary, in Calgary, Alberta, Canada
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Joos S, Musselmann B, Szecsenyi J. Integration of complementary and alternative medicine into family practices in Germany: results of a national survey. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:495813. [PMID: 19293252 PMCID: PMC3140199 DOI: 10.1093/ecam/nep019] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 02/12/2009] [Indexed: 12/17/2022]
Abstract
More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners ("Heilpraktiker"). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.
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Affiliation(s)
- Stefanie Joos
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
| | - Berthold Musselmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
- Practice of Family Medicine, Academic Teaching Practice, University of Heidelberg, Hauptstrasse 120, 69168 Wiesloch, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Voßstrasse 2, 69115 Heidelberg, Germany
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Systematic review of integrative health care research: randomized control trials, clinical controlled trials, and meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2010; 2011. [PMID: 20953383 PMCID: PMC2952316 DOI: 10.1155/2011/636134] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/18/2010] [Indexed: 01/22/2023]
Abstract
A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe.
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Kreitzer MJ, Kligler B, Meeker WC. Health Professions Education and Integrative Healthcare. Explore (NY) 2009; 5:212-27. [DOI: 10.1016/j.explore.2009.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Guerrera MP, Goetz J. Incorporating Acupuncture Into Medical School Curriculum: An Innovative, Successful Model. Med Acupunct 2007. [DOI: 10.1089/acu.2007.0558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
| | - Jordan Goetz
- University of Connecticut School of Medicine, Farmington, CT
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Sierpina V, Levine R, Astin J, Tan A. Use of mind-body therapies in psychiatry and family medicine faculty and residents: attitudes, barriers, and gender differences. Explore (NY) 2007; 3:129-35. [PMID: 17362848 DOI: 10.1016/j.explore.2006.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mind-body medicine (MBM) approaches to many health problems have been well documented in the literature, including through multiple meta-analyses. Efficacy has been well demonstrated in conditions such as headache, irritable bowel syndrome, anxiety, fibromyalgia, hypertension, low back pain, depression, cancer symptoms, and postmyocardial infarction. However, an apparent disconnect (ie, translational block) prevents more widespread adoption of such therapies into practice. Biofeedback, relaxation therapy, hypnosis, guided imagery, cognitive behavioral therapy, and psychoeducational approaches are the domain of MBM we examined in assessing physician attitudes, beliefs, and practices. METHODS Using a Web-based survey, we obtained responses from 74 faculty and resident physicians in the Department of Family Medicine and the Department of Psychiatry. Our response rate was 69%. We conducted descriptive statistics, bivariate analysis, and multivariate analysis using a logistic regression model. Various statistics were chosen depending on the nature of analyzed variables. Synoptic tables are presented. RESULTS Comparing these cohorts, we found little difference between physicians in the two specialties, but substantial reports that barriers to the use of MBM were largely based on lack of training, inadequate expertise, and insufficient clinic time. Lack of expertise and insufficient clinic time were higher among family physicians than among psychiatrists. There was a high interest in both groups in learning relaxation techniques and meditation and lower interest in biofeedback and hypnosis. Female physicians were significantly more likely to use MBM, both with patients and for their own self-care, and were less likely to be concerned that recommending these therapies would make patients feel that their symptoms were being discounted. Female physicians also had significantly higher beliefs about the benefits of MBM on health disorders in several of the conditions examined, with a consistent though nonsignificant trend in others.
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Affiliation(s)
- Victor Sierpina
- University of Texas Medical Branch, Galveston, TX 77555-1123, USA.
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Kligler B, Koithan M, Maizes V, Hayes M, Schneider C, Lebensohn P, Hadley S. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study. BMC MEDICAL EDUCATION 2007; 7:7. [PMID: 17442108 PMCID: PMC1855050 DOI: 10.1186/1472-6920-7-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 04/18/2007] [Indexed: 05/14/2023]
Abstract
BACKGROUND As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs) developed for the program. METHODS The direct observation (DO) and treatment plan (TP) evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP). The OSCE I was implemented first in 2005 (n = 6), revised and then implemented with a second class of IFM participants in 2006 (n = 7). OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6). Data from the initial implementation of these tools are described using descriptive statistics. RESULTS Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. CONCLUSION As these tools are refined further they will be of value both in improving our teaching in the IFM program and as competency-based evaluation resources for the expanding number of family medicine residency programs incorporating integrative medicine into their curriculum. The next stages of work on these instruments will involve establishing inter-rater reliability and defining more clearly the specific behaviors which we believe establish competency in the integrative medicine skills defined for the program.
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Affiliation(s)
- Benjamin Kligler
- Albert Einstein College of Medicine, Bronx, NY/University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Mary Koithan
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Victoria Maizes
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Meg Hayes
- Oregon Health Sciences University, Portland, OR, USA
| | | | - Patricia Lebensohn
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Susan Hadley
- Middlesex Hospital/University of Connecticut, Middlesex, CT, USA
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Kemper KJ, Dirkse D, Eadie D, Pennington M. What do clinicians want? Interest in integrative health services at a North Carolina academic medical center. Altern Ther Health Med 2007; 7:5. [PMID: 17291340 PMCID: PMC1802091 DOI: 10.1186/1472-6882-7-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 02/09/2007] [Indexed: 12/03/2022]
Abstract
Background Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. Methods We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendations in the past year and interest in therapies or services if they were to be provided at the medical center in the future. Results Responses were received from 173 clinicians in 26 different departments, programs and centers. There was strong interest in offering several specific therapies: therapeutic exercise (77%), expert consultation about herbs and dietary supplements (69%), and massage (66%); there was even stronger interest in offering comprehensive treatment programs such as multidisciplinary pain management (84%), comprehensive nutritional assessment and advice (84%), obesity/healthy lifestyle promotion (80%), fit for life (exercise and lifestyle program, 76%), diabetes healthy lifestyle promotion (73%); and comprehensive psychological services for stress management, including hypnosis and biofeedback (73%). Conclusion There is strong interest among medical staff at an academic health center in comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness, nutrition and stress management. Future studies will need to assess the cost-effectiveness of such services, as well as their financial sustainability and impact on patient satisfaction, health and quality of life.
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Affiliation(s)
- Kathi J Kemper
- Department of Pediatrics, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Deborah Dirkse
- Department of Pediatrics, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Dee Eadie
- Department of Nursing, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
| | - Melissa Pennington
- Department of Strategic Planning, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA
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