AN INTEGRATIVE CURRICULUM MODEL:

Incorporating CAM Within an Allopathic Curriculum

Rita K. Benn, Ph.D., Sara L. Warber, M.D.University of Michigan

Complementary & Alternative Medicine Research Center

Department of Family Medicine

Rationale

• Increased patient use of CAM without disclosing such information to physicians

• Physicians have limited knowledge base of CAM

• Physician and medical students attitudes towards CAM correlate with educational exposure

USF Survey Results

Most students agreed that traditional medicine could benefit from CAM but

• only 1/4 students would refer for CAM

• 2/3 students understood principles of only 4/10 CAM modalities

• 40% would dissuade their patients from using chiropractic care.

CAM in Medical Schools

• 75/125 offer some form of CAM training

• 83% of courses are electives

• 31% incorporate CAM into other courses

GOALS

Knowledge• To expand physician base of information on

theory and practice of CAM

• To provide research based evidence for efficacy and safety of CAM

Professional Behaviors

• To instill an attitude of openness & respect for CAM

• To develop skills for:– communicating information about CAM to

patients– coordinating health care with CAM

practitioners– use CAM for personal self-care

Plans for UM Medical Curriculum

• New curricular units within existing courses and clerkships

• New web case-based modules

• New clinical electives

• New clinical assessment stations

• Faculty development in CAM

Introductory CAM Module in M1Goals:

• To identify common forms of CAM

• To become aware of reasons for patient use of CAM

• To experience/observe the clinical practice of a CAM modality

• To observe and reflect on differences among CAM practices and between CAM and conventional medicine.

CAM Unit: First Semester M1

• Lecture — An overview of CAM modalities and evidence surrounding its efficacy

• Readings — Several general articles on CAM and specific modality-related to their field visit

• Field Visit — Students observe/or experience the practice of a CAM modality

• Small Groups — Students reflect on their experiences and discuss the readings.

Evaluation of CAM Unit

Student Opinions of CAM After CAM Unit

0 10 20 30 40 50 60 70 80 90 100

I Now Understand Why It's ImportantFor A Physician To Understand CAM

I See the Value of Introducing This UnitAs A MI Student

As A Result of This Unit, I Would Liketo Expand My Knowledge of CAM

Percent In Agreement

CAM Selective Courses - M1

• Mind-Body Medicine for Care of Self and Patient

• Understandings of Health and Disease in the Classic Medical Systems of Asia

• The Role of Spirituality in Medicine

• Nutrition and Chronic Disease

Evaluation of SelectivesMean Ratings(1-low, 5-high) Mind-

BodyMedicine

Spiritualityin Medicine

OrientalMedicine

Nutrition& ChronicMedical

Care

AllSelectivesDisease

Increased my interest inthis topic.

4.53 4.36 4.18 4.40 4.26

I have a broaderunderstanding of thistopic.

4.46 3.92 4.18 4.60 4.31

Increased myunderstanding of therelationship betweenmedicine and society.

4.23 4.36 3.94 4.40 4.19

Overall the quality ofteaching during thiscourse was

4.38 3.67 3.71 4.40 4.19

Overall, this course was 4.38 3.83 3.65 4.20 4.01I would recommendhaving this course

4.54 4.46 3.82 4.60 4.31

Future First Year Plans

• An Overview Lecture in Four Required Courses:– Pharmacology– Immunology– Host Defense– Anatomy

• Two Panel Case Based Presentations Focused on Herbs and Nutrition

Second Year Curriculum Integration Plans

• CAM and Nutrition Content in all Courses

• Case Based Presentations

• Integrative Case for Standardized Patient Interview

• Practice-based Modules in Alternative Medicine and Spiritual History Taking

Web-Based Materials and Consultation: Third year

• Standard Integrative Case Materials in all Clerkships

• Case Consultation On-line with CAM Faculty

• Packets of Readings

Fourth Year Electives

• Clinical Electives

-Complementary Medicine

-Specialized Topic Area Electives

• Science in the Clinic Research Elective

Faculty Development:CAM Faculty Scholars Program

Three components:

• One day a month of CAM Content

• Individual Mentoring by CAM affiliate faculty

• Educational Project

Medical Curriculum Evaluation

• Student Performance in Courses

• Course Evaluations

• Pre-Post Learner Attitudes and Knowledge

• Fourth Year Clinical Competence

• Qualitative Study of Physician Growth

Related Program Initiative Interdisciplinary Graduate

Certificate Program• Enrolled in Masters/Doctoral Program in

Schools of Pharmacy, Social Work, Nursing and Public Health

• Three additional core courses

-Clinical Complementary Therapies (Nursing School)

Challenges

• Building Relationships with Faculty Course Directors

• Shifting Academic Faculty Attitudes about CAM• Expanding Academic Faculty CAM Knowledge• Engaging Faculty in Interdisciplinary

Collaboration• Cultivating value in students for

self-reflection/self-care• Developing Capacity for Clinical CAM Electives

Facilitating Factors• Medical Education Administration Support

• NIH, Foundation, and Donor Funds

• CAM Research Center Grant

• Quality Courses and Positive Student Evaluation

• Expansive Community Network of Reputable CAM Providers

Conclusions

• Model program

• Curricular innovations

• Benchmarking quality education

• Preparation of health care professionals and researchers of the future