Complementary and Alternative Medicine in the United States (2005) / Chapter Skim
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8 Educational Programs in CAM
8 Educational Programs in CAM
Pages 226-252
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From page 226... ...
Park (2002) writes, "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 decision-making, increases cultural sensitivity, and provides ideas for future research." In 1995 the Alternative Medicine Interest Group of the Society of Teachers of Family Medicine surveyed U.S.
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From page 227... ...
Chiropractic 16 (34.8) Massage therapy 16 (34.8)
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From page 228... ...
report Health Professions Education: A Bridge to Quality (IOM, 2003) proposed the following vision for health professional education: "All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics." To meet the challenges facing health professional education, the IOM report (2003)
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From page 229... ...
suggest that because CAM is used prominently in health care, "education of nursing staff about the therapies and their indications for use is essential." Park (2002) presents four additional arguments for teaching CAM in conventional health professions education: 1.
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From page 230... ...
The White House Commission on Complementary and Alternative Medicine Policy (2002) recommended, "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."
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From page 231... ...
reported on a set of guidelines for the inclusion of CAM in family practice residencies developed by the Society of Teachers of Family Medicine Group on Alternative Medicine. The guidelines include understanding and respect for different health beliefs and choices, the underlying theory of different CAM modalities indications and potential adverse effects of these treatments, and evidence of the efficacy and the cost-effectiveness of the therapies.
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From page 232... ...
The authors of the consortium guidelines emphasize that each school must develop its own specific content of courses needed to achieve competency in these areas, and they urge the development of innovative educational approaches that go beyond the teaching of scientific facts. These approaches include · experiential approaches to facilitate an understanding of CAM, · education of medical students in self-care and reflection, and · faculty development programs to produce educators who both have knowledge and skills in integrative medicine and recognize the importance of self-care and reflection in medical education and practice.
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From page 233... ...
The following section discusses approaches to education on CAM taken by different conventional health professions schools. Approaches to Curriculum Development Health professional schools have taken a variety of approaches to providing education about CAM therapies.
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From page 234... ...
. of these projects is to design new educational approaches to the incorporation of information about CAM into the curricula of medical, dental, nursing, and allied health professional schools as well as in residency training programs and continuing education courses.
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From page 235... ...
Several changes were made in the medical school curriculum, including the addition of seven 2-hour sessions in one course related to designing integrated systems of care, traditional chinese medicine, manual therapies, and spirituality. Another course includes information on interviewing and assessing CAM therapies; a pharmacology course includes information on botanical therapies; self-care is included in a required surgery clerkship; and the 3-week clinical elective in integrative medicine was expanded.
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From page 236... ...
The Oregon Health and Science University is part of a CAM consortium that has designed the Oregon CAM Course, the mission of which is to develop CAM literacy and cognitive flexibility in conventional health professional students. The other members of the Consortium are the Oregon College of Oriental Medicine, National College of Naturopathic Medicine, and the Western States Chiropractic College.
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From page 237... ...
Endocrine Although the preceding discussion has briefly described a few of the approaches being taken to teach CAM what is actually included in a CAM program depends on the goals and objectives of the individual educational institutions. The committee believes that it is important that the schools of health professions include information about CAM in their required curricula so that health care practitioners will be able to inquire about their patients' use of CAM in a way that is nonjudgmental and that allows health care practitioners to advise their patients about the use or avoidance of CAM therapies on the basis of the available evidence.
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From page 238... ...
that health practitioners should engage in such care. Although a great deal of research has evaluated patient interactions with conventional medical providers, little research that has examined practitioner-patient interaction or the delivery of patientcentered care has been conducted for most CAM therapies, including the five therapies in which practitioners are licensed.
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From page 239... ...
Two major potential sources of trained scientists exist: academic health centers and CAM institutions. Training in research was not a part of CAM clinical training, nor for the most part have careers in CAM been dependent on publishing research findings.
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From page 240... ...
The program trains students to analyze current research critically using traditional methods of scientific inquiry, provides practice in designing research studies, and teaches students to identify areas requiring further research. In another effort, ten massage therapy schools have formed the Massage Therapy Research Consortium with the aim of enhancing each member school's research capacity and activity, as well as to advance massage therapy education and practice generally.
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From page 241... ...
The clinical research component teaches classes that include such topics as grant writing, study administration, and writing for publication. The proposal development process acts as a vehicle for instruction and practice in electronic literature search es articulating specific aims; matching research design to research ques tions; exploring research methodologies appropriate to CAM and how and when qualitative and quantitative techniques should be applied; se lecting outcome measures, options for data analysis, and issues related to the protection of human participants in research studies.
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From page 242... ...
LESSONS FROM OTHER FIELDS The development of a cadre of scientists trained to perform research on CAM therapies will occur only as part of the overall development of CAM science and education, especially in academic health centers, but also in CAM institutions. Two other fields have gone through processes that are relevant to the challenges faced by CAM in attempting to develop qualified researchers and a research infrastructure: geriatrics and HIV/AIDS.
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From page 243... ...
Today geriatrics is firmly established as a separate area of study in academic health centers. It is taught as part of the curricula of nearly all medical schools, and clinical training in geriatrics is required as part of residencies in internal medicine, family practice, obstetrics and gynecology, and psychiatry.
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From page 244... ...
Over the subsequent 10 to 15 years, the field attracted many seasoned scientists and trained new ones, with the result that, today, a well-developed research workforce operates at all levels of HIV/AIDS-related science. The development of scientists trained to conduct behavioral research in HIV/AIDS provides an excellent case illustration with many relevant applications to the development of CAM research.
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From page 245... ...
The 27-month program includes funding for small grants, a structured summer program to which the participants return for three summers, individualized long-term research collaboration in which program faculty serve as mentors throughout the year, and access to relevant scientific expertise. Although such programs require a large investment of resources, the participants emerge with preliminary data and fundable research proposals.
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From page 246... ...
Many CAM practitioners argue that their therapies are individualized to meet the specific needs of each patient and that variation is good. Conventional medical practitioners also tailor therapies to individual patients, and when practice guidelines were first proposed, many were concerned about the negative effects of those guidelines on "clinical autonomy, health care costs, and satisfaction with clinical practice" (Tunis et al., 1994)
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From page 247... ...
In conventional medicine evidence consists of that obtained by Western-scientific type evaluations. Mills et al.
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From page 248... ...
Some programs include experiential learning, fellowship, and residency programs. Although the individual content and organization of an educational program on CAM vary from institution to institution on the basis of the goals and objectives of each program, the committee believes that it is essential to provide health professionals of today with information sufficient to enable them to competently advise their patients.
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From page 249... ...
Furthermore, both research and quality would be fostered by the development of practice guidelines for CAM therapies. Practice guidelines are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (IOM, 1992)
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From page 250... ...
2003. Complementary and alternative medicine: Core competencies for family nurse practitioners.
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From page 251... ...
2001. Alternative medicine: The importance of evidence in medicine and in medical education.
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From page 252... ...
:191196. White House Commission on Complementary and Alternative Medicine Policy.
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