Collaborations between allopathic and complementary and alternative medicine health professionals: four initiatives.

An effort to increase the understanding of complementary and alternative medicine (CAM) by health care professionals requires an interdisciplinary and collaborative approach. Between 2000 and 2002, National Institutes of Health National Center for Complementary and Alternative Medicine funded 15 educational institutions to develop curricular models for educating allopathic medical and nursing learners in CAM literacy. Four of these 15 programs, Tufts University School of Medicine, University of California at San Francisco School of Medicine, Oregon Health & Sciences University School of Medicine, and University of Washington School of Nursing, formed collaborative partnerships with nearby academic institutions that train CAM practitioners.This article focuses on these four examples of institutional collaboration, summarizing the challenges faced and the positive outcomes achieved for learners, faculty, and institutions. As collaborations between such institutions increase, future potential directions for consideration include credentialing of CAM practitioners teaching within allopathic health professional institutions, faculty development within existing allopathic health professional schools on incorporating evidence-based CAM content into their standard allopathic education, and viewing CAM as an aspect of cultural sensitivity.     

The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview.

The authors provide a historical context and overview of the experience of education projects at 14 health professions schools in the United States and the American Medical Students Association that were funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health in cohorts of five per year in 2000, 2001, and 2002-2003. These 15 projects were designed to incorporate CAM information into the curricula of conventional health professions schools. A longer-term goal was to accelerate the integration of CAM and conventional medicine.The overall program started in 2000 at a time when discussions about the definition, goals, and value of integrative medicine were already well underway. The efforts specific to each project, as well as the shared challenges, accomplishments, and collaborative efforts of all 15 projects, can provide guidance for the education of conventional health care providers about CAM in an integrative medicine environment.Challenging issues that must be faced include (1) the need to develop successful strategies to incorporate information about CAM into already dense health professions school curricula, (2) the need for conventional health professionals to have authoritative resources to provide their patients information about risks and benefits of CAM practices, and (3) the need to identify appropriate roles for CAM practitioners in educating conventional health professionals about CAM therapies. The authors discuss these issues and others and present some recommendations.     

Evaluating CAM education in health professions programs.

As medical, nursing, and allied health programs integrate complementary and alternative medicine (CAM) content into existing curricula, they face many of the same challenges to assessment and evaluation as do more traditional aspects of health professions education, namely, (1) specifying measurable objectives, (2) identifying valid indicators, and (3) evaluating the attainment of desired outcomes.Based on the experiences of 14 National Center for Complementary and Alternative Medicine (NCCAM) education grant recipients funded between 2000 and 2003, the authors cite selected examples to illustrate strengths and deficits to "mainstreaming" CAM content into established health professions curricula, including subjecting it to rigorous, systematic evaluation.In addition to offering recommendations for more strenuously evaluating key CAM-related educational outcomes, the authors discuss related attitudes, knowledge, and skills and how these, like other aspects of health professions training, may result in enhanced patient care through modifications in clinical (provider) behaviors.     

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey

ABSTRACT: OBJECTIVE: This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM). METHOD: S: A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools. FINDINGS: The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2%), acupuncture (80.8%), hypnosis (78.8%), body-based practices including massage (77%) and meditation (65.2%), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p<0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p=0.001), and this knowledge would be helpful in their future professional lives (p=0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased. CONCLUSION: Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.     

Development and validation of the CAM Health Belief Questionnaire (CHBQ) and CAM use and attitudes amongst medical students

Background  

The need for Complementary and Alternative Medicine (CAM) and holistic approaches in allopathic medical school curricula has been well articulated. Despite increased CAM instruction, feasible and validated instruments for measuring learner outcomes in this content area do not widely exist. In addition, baseline attitudes or beliefs of medical students towards CAM, and the factors that may have formed them, including use of CAM itself, remain unreported.     

Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives.

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.     

Rationales for CAM Education in Health Professions Training Programs.

The authors review the use of complementary and alternative medicine (CAM) in the United States. They then present and discuss the rationales used by the 15 National Center for Complementary and Alternative Medicine CAM educational grantees in their original proposals for incorporating CAM content into conventional health professions training programs. Fourteen of the grantees were from major U.S. medical and nursing schools, and one was from a medical student foundation. Awards were for five-year periods (with the exception of one three-year grant) from 2000 to 2008. Rationales for developing educational programs about CAM for conventional health professionals included (1) the prevalence and growth of CAM in the United States, (2) response to governmental, legislative, and other mandates, (3) need for enhanced communication between conventional providers and patients using CAM, (4) need to enhance safety of CAM use and interactions with conventional care, (5) CAM education's positive impact on broadening core competencies for conventional health care professionals, (6) positive impact on enhancing cultural competency, (7) need for better communication between conventional and CAM providers, (8) potential for improving health care coordination, (9) potential impact on increasing CAM research quality and capacity, and (10) potential for enhancing quality of care through informed CAM use. Integration of CAM with conventional health care requires educational venues that prepare conventionally trained caregivers with a sufficient knowledge base for assessing beneficial and detrimental interactions between CAM and conventional care approaches; development of criteria for making informed referrals to CAM practitioners; and enhanced research capacity.     

What should students learn about complementary and alternative medicine?

With thousands of complementary and alternative medicine (CAM) treatments currently being used in the United States today, it is challenging to design a concise body of CAM content which will fit into already overly full curricula for health care students. The purpose of this article is to outline key principles which 15 National Center for Complementary and Alternative Medicine-funded education programs found useful when developing CAM course-work and selecting CAM content. Three key guiding principles are discussed: teach foundational CAM competencies to give students a framework for learning about CAM; choose specific content on the basis of evidence, demographics and condition (what conditions are most appropriate for CAM therapies?); and finally, provide students with skills for future learning, including where to find reliable information about CAM and how to search the scientific literature and assess the results of CAM research. Most of the programs developed evidence-based guides to help students find reliable CAM resources. The cumulative experiences of the 15 programs have been compiled, and an annotated table outlining the most highly recommended resources about CAM is presented.     

Comparative survey of Complementary and Alternative Medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty

Background  

There is significant and growing national interest for introducing Complementary and Alternative Medicine (CAM) instruction into allopathic medical education. We measured CAM attitudes, use, and information-seeking behaviors as a baseline to evaluate future planned CAM instruction.     

The challenge of educating physicians about complementary and alternative medicine.

The rapid growth of complementary/alternative medicine (CAM) predated both the 1992 establishment of the Office of Alternative Medicine at the National Institutes of Health and the release of Dr. David Eisenberg's 1993 groundbreaking article on the widespread use of CAM. Since these two watershed events, the use of nontraditional medical modalities has seen exponential expansion. Most physicians are not prepared to respond knowledgeably about CAM modalities, and, indeed, sorting out the viable CAM modalities can be a difficult task. Additional factors are poor and inadequate dialogue between physicians and CAM practitioners, doubts about CAM practitioners' competence, a lack of readily identifiable and recognizable qualifications of such practitioners, and the risk of offering unrealistic hope of a cure. All these factors place the patient in a sometimes perilously uncertain position. Incorporating systematic presentation of CAM information into the curricula of medical schools would provide future physicians the necessary tools and knowledge to enable their patients to use CAM modalities appropriately, with limited risks.     

Using complementary and alternative medicine curricular elements to foster medical student self-awareness.

PURPOSE: To determine the value that the National Center for Complementary and Alternative Medicine (NCCAM)-funded Education Project leaders placed on self-awareness objectives among their curricular activities, to identify projects' rationales for inclusion of self-awareness activities, and to describe curricular elements used to teach self-awareness. METHOD: A survey was distributed to the NCCAM Education Project grantees in October 2006. Survey items sought to identify project directors' perceived importance of self-awareness activities in complementary and alternative medicine (CAM) curricula, rationales for inclusion of self-awareness activities, and activities to foster self-awareness. Invited reports described in more depth the specific activities in three of the projects. RESULTS: Fourteen of 15 reporting NCCAM educational projects rated activities to promote self-awareness as highly or very highly valued components, and all projects incorporated numerous strategies to enhance self-awareness. Learning objectives ranged from basic knowledge about mind-body relationships and psychoneuroimmunology, to evidence and indications for mind-body interventions, to training in self-application, to training for intervention with patients. Specific strategies that increase students' self-awareness included evidence-based CAM activities to help students recognize personal biases that may impair critical thinking; personal health experiences to expand definition of health beliefs; and mind-body medicine skills groups to personally integrate the use of mind-body techniques for wellness and stress management. CONCLUSIONS: Incorporating some of these CAM curricular activities, didactically or experientially, may be a unique way to foster student self-awareness and personal growth.     

Complementary and alternative medicine use among adults in Enugu,Nigeria

Background  

Attention and interest in the use of Complementary and Alternative Medicine (CAM) has been reawakened globally. Evidence from studies carried out in different parts of the world has established that CAM use is very common and varies among populations. This study investigated the use of CAM among adults in Enugu urban, irrespective of their health status. It provided information on the prevalence of CAM use, forms of CAM remedies used and reasons for utilizing them     

Cochrane CAM reviews commentary: is there more to quality than the research method itself?

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 520 W. Lombard St., Baltimore, MD 21201. For more information, contact Eric Manheimer at: emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by Grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM, or the National Institutes of Health.     

Commentary on the Cochrane Review of Chinese herbal medicine for dysmenorrhea

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207-6697. For more information, contact Eric Manheimer at emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM or the National Institutes of Health.     

Health care utilization among complementary and alternative medicine users in a large military cohort

Background  

Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.     

Beyond borders: building global health programs at McGill University Faculty of Medicine.

Globalization has irrevocably altered the determinants of health as well as the delivery of health care. Although these changes have been increasingly recognized by governments and funding agencies, and despite the large and growing interest in global health topics among faculty and students, many medical educational programs lack courses or programs in this important area. At McGill University Faculty of Medicine, the Global Health Programs (GHP) were established to build research and training capacity in global health locally and internationally, to stimulate individuals to work in related fields and topics, and to facilitate partnerships with institutions around the world. These goals are addressed through programs that foster communication among interested faculty and students; provide resources such as project databases and easily accessed, centrally located reference materials; and provide both financial and consultative support for faculty and student initiatives. Important lessons learned in building GHP at McGill include (1) the need for a dedicated senior faculty member to lead the program while promoting activities and initiatives, (2) the need for resources to begin new projects, and (3) a willingness to work with others to achieve common goals. Most medical schools already have faculty engaged in and students interested in global health activities. By bringing interested individuals together with a modest infusion of additional resources and creativity, it is possible to develop programs that provide exciting global health educational opportunities for the medical school community and beyond.     

Enhancing behavioral science education at the Ohio State University College of Medicine.

The social and behavioral sciences play key roles in patient health outcomes. Given this reality, successful development of social and behavioral science curricula in medical education is critically important to the quality of patients' lives and the effectiveness of health care delivery systems. The Institute of Medicine, in a recent report, recommended that medical schools enhance their curricula in these areas and identified four institutions as "exemplars" of social and behavioral science education. The authors describe an ongoing curriculum development and improvement process that produced one such exemplary program at The Ohio State University College of Medicine.The authors provide a historical perspective on behavioral science education, discuss issues that led to curricular change, and describe the principles and processes used to implement reform. Critical factors underlying positive change are addressed: increase active learning, recruit a core group of small-group facilitators who are primary care physicians, diversify teaching methods, support student-directed educational initiatives, enhance student-teacher relationships, centralize course administration, obtain funding, implement a faculty development program, and apply curriculum quality improvement methods. Outcome data from evaluations completed by both students and small-group physician faculty are presented, and future directions regarding further revision are outlined. The authors believe that the strategies they describe can be applied at other institutions and assist behavioral science educators who may experience the challenges typically encountered in this important field of medical education.     

The need for educational reform in teaching about alternative therapies.

Advocacy and non-critical assessment are the approaches currently taken by most U.S. medical schools in their courses covering what is commonly called "complementary and alternative medicine" (CAM). CAM therapies are anomalous practices for which claims of efficacy are either unproved or disproved. The author's research indicates that most medical schools do not present CAM material in a form that encourages critiques and analyses of these claims. He presents the reasons for the unwarranted acceptance of CAM. These include the CAM movement's attempt to alter standards of evaluating therapies. A survey of CAM curricula in U.S. medical schools in 1995-1997 showed that of 56 course offerings related to CAM, only four were oriented to criticism. The author's course at Stanford University School of Medicine approaches CAM with the skepticism and critical thinking appropriate for unproven therapies. The author concludes by calling on all medical schools to include in their curricula methods to analyze and assess critically the content validity of CAM claims.     

Reflexions about the curricula at the faculty of medicine in the XXI century

In this paper we review the main medical programs from the Universidad Nacional Autonoma de Mexico (UNAM) faculty of medicine in the first seventy-five years of twentieth century. We have selected those instances that are representative of special moments in the development of Mexican medical knowledge, and also corresponding to the need to prepare medical students in view of social demands. The first programs are those of Ignacio Chavez in 1934, concerned mainly with the introduction into the curricula of medical specialties such as cardiology or neurology. After those, the 1956 and 1960 programs are mentioned and briefly analyzed; both were founded on the concern to develop a clinical reasoning in the student. Finally, the 1974 Integral General Medicine Program directed its interest to social and environmental themes.     

Pediatricians' attitudes,experience and referral patterns regarding complementary/alternative medicine: a national survey

Background  

To assess pediatricians' attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies.