Complementary and Alternative Medicine Curriculum: Who Needs It?

Educational Challenges and StrategiesVictor S. Sierpina, MD

W.D. and Laura Nell Nicholson Family Professor of Integrative

Medicine

UTMB

Concerns

• Evidence

• Biological plausibility

• Advocacy

• Safety

• Product quality

• Placebo

Challenges

• Communication

• Content

• Critical thinking

• Consider public safety issues

NCCAM Domains of Alternative Therapies

• Biological therapies: herbs, supplements, special diets

• Mind-body therapies: meditation, biofeedback, relaxation, yoga, tai chi

• Manual therapies: chiropractic, massage, osteopathy

• Biofield therapies: magnets, healing touch, therapeutic touch, Reiki

• Alternative systems: traditional Chinese medicine, Ayurveda, naturopathy, homeopathy

Key questions

1)    Given the wide public use of CAM, how do health professionals learn to communicate with patients about such therapies and

2) How do they assess such therapies for safety and efficacy?

IOM CAM Committee Recommendations

• 1)     Health profession schools must include sufficient content on CAM so that graduates can competently advise their patients

• 2)     That funding be provided to train research training for CAM practitioners

• 3)     That training standards and practice guidelines be established by CAM practitioners

• 4)     That competency guidelines be defined for both CAM and conventional practitioners regarding scope of practice, referral patterns, and integration of conventional and CAM therapies.

•  

Resources

• IOM Report: Complementary and Alternative Medicine in the United States, http://www.nap.edu/openbook/0309092701/html/1.html#pagetop

• White House Commission on Complementary and Alternative Medicine Policy http://www.whccamp.hhs.gov/finalreport.html

• National Education Dialogue (handout for member list and mission)

WHHCAMP Recommendations

• “The education and training of CAM and conventional practitioners should be designed to ensure public safety, improve health, and increase the availability of qualified and knowledgeable CAM and conventional practitioners and enhance the collaboration among them."

WHHCAMP recommendations

• “Conventional health professional schools, postgraduate training programs, and continuing education programs should develop core curricula of knowledge about CAM that will prepare conventional health professionals to discuss CAM with their patients and clients and help them make informed choices about the use of CAM.”

Resources

• National Center for Complementary and Alternative Medicine http://nccam.nih.gov/

• Progress Notes Series on Curricular Initiatives http://cam.utmb.edu/cam_education_series.asp

R 25 Grantees

2000Boston Children’s Hospital/ Harvard

Medical SchoolRush Presbyterian St. Luke’s School of

NursingUniversity of MinnesotaUniversity of North CarolinaUniversity of Texas Medical Branch

R 25 Grantees

2001

Maine Family Medicine Residency

Georgetown Medical School

Tufts Medical School

University of Michigan

University of Washington Medical School

2002

American Medical Student Association

Oregon Health Sciences University

University of Kentucky

University of California at San Francisco

University of Washington School of Nursing

Consortium of Academic Health Centers for Integrative Medicine

• http://www.imconsortium.org• 27 US and Canadian Medical Schools

• “Our mission is to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems.”

What is Integrative Medicine

Definition: “Integrative Medicine is 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 to achieve optimal health and healing.” –CAHCIM definition

Elements of Successful Curricular Change

• Leadership• Cooperative Climate• Politics• Participation by Organizational Members• Human Resource Development• Evaluation

Bland et al. Academic Medicine, 2000;75(6):575-594

Proposed Consensus of CAM Education Goals for Medical Schools

      Provide basic knowledge of the language and domains of CAM

      Teach critical thinking skills in assessing evidence regarding CAM practices

      Make known essentials about safety, efficacy, risks of CAM, as well as potential for interaction of CAM practices with conventional medical treatment

Sierpina, V. Alt Therapies Health & Med 2002; 8(6): 102-104

      Encourage communication skills in advising patients about CAM practices

      Promote cultural competency regarding CAM practices

      Provide knowledge about the role of interdisciplinary health care teams including referral processes to CAM practitioners in the present health care system

 

 Core Goals of UTMB’s CAM Curriculum

• 1) Communicate effectively with patients about CAM use.

• 2) Access and interpret the evidence for safety, efficacy, and clinical appropriateness of CAM therapies.

• 3) Develop a therapeutic relationship that is patient-centered and includes respect for a pluralism of cultural and religious values.

• 4) Develop positive personal perspectives on the construct of wellness and of illness.

Longitudinal CAM Curriculum

• Summary (hand out)

• Design Model (hand out)