why integrative medicine is essential for medical education aviad haramati, phd professor of...
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Why Integrative Medicine is Essential for Medical Education
Aviad Haramati, PhDProfessor of Physiology & Biophysics and Medicine
Georgetown University School of MedicineWashington, DC USA
Dir. Academic Programs, Institute for Integrative HealthBaltimore, MD, USA
NVMO – Dutch Association on Medical EducationEgmond Ann Zee, Netherlands November 12, 2010
Complementary, Alternative, and Integrative Medicine
Medical and health care practices that are: - Outside the realm of
conventional medicine
- Much yet to be validated using scientific methods
Complementary: with conventional practices
Alternative: in place of conventional practices Integrative: embraces best of conventional & complementary as well as whole person care
Integrative Medicine
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, healthcare professionals and disciplines to achieve optimal health and healing
Consortium Academic Health Centers for Integrative Medicine, 2004
CAM Domains
Source: http://nccam.nih.gov
Outline
Rationale for including Complementary/Integrative Medicine (CAM/IM) in the Medical Curriculum
Using CAM/IM in the Learning of Science
Using CAM/IM to Foster Professionalism
Why is CAM/IM Important for the Training of
Physicians?
Widespread public usage
CAM Use in the United States
Barnes et al., CDC NHS # 12 2008
Why Patients Use Complementary/Integrative
Medicine
Value whole person emphasis
Conventional treatment did not work
Adverse effects of orthodox medicine
Seek active participation in treatment
Poor doctor communication Vincent J Why patients turn to
complementary medicine. An empirical study. Brit J Clinical
Psychology 35:37-48 1996
But The Real Problem is…
<40% of therapies used were disclosed to the physician
(Eisenberg DM et al Trends in Alternative Medicine use in the United States:
1990-1997; results of a follow-up national survey, JAMA, 1998)
Why is CAM/IM Important for the Training of
Physicians?
Widespread public usage
Growing awareness/desire by students and faculty to include CAM/IM in medical training
CAM practices should be included in my school's curriculum.
1.83.6
5.4
11.7
29.7
25.222.5
0.62.6 1.9
5.28.4
17.4
31.6 32.3
0
10
20
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50
60
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100
No Answer StronglyDisagree
Disagree Somewhat
Disagree
Neutral Somewhat
Agree
Agree Strongly
Agree
Per
cen
tag
e (n
=26
6)
First YearsSecond Years
Chaterji et al Alt Ther Health Med 2007
Desire for Future CAM Training First and Second Year Students
0 10 20 30 40 50 60 70 80 90 100
Acupuncture
Aromatherapy
Bioelectromagnetic Therapies
Biofeedback
Chiropractic
Herbal Medicine
Homeopathy
Hypnosis/Guided Imagery
Massage
Music
Nutritional Supplements
Prayer/Spiritual Healing
Meditation
Rolfing (Structural Reintegration)
Therapeutic/Healing Touch
Response (%)
Sufficient to PersonallyProvide
Sufficient to Advise PatientsAbout Use
None
No Answer
Chaterji et al Alt Ther Health Med 2007
Desire for Future Training
>50% of the students would like enough knowledge to
personally provide their patients: Nutritional supplements
advise their patients on: Acupuncture Herbal medicine Chiropractic Massage
Chaterji et al Alt Ther Health Med 2007
National Efforts Addressing CAM Integration in Education
15 NIH-Funded (R25 Grants) for CAM Curricular Initiatives (2000-2003)
NCCAM R25 Grant Institutions
Children’s Hospital – Boston Rush College of Nursing University of Minnesota University of North Carolina University of Texas -
Galveston Georgetown University Maine Medical Center Tufts University University of Michigan University of Washington Oregon Health Sciences
University U California - San Francisco
University of Kentucky University of Washington
School of Nursing American Medical Student
Association U California - Irvine U Connecticut U Massachusetts Kansas City University Louisiana State University University of Texas at San
Antonio
Special Series for Academic Medicine October 2007Education in Complementary and Alternative Medicine
Editorial Group: Aviad Haramati, PhD, Chair, William Elder, PhD, Margaret Heitkemper, RN, PhD, Nancy Pearson, PhD, Sara
Warber, MD
• Preface: Insights from Educational Initiatives in CAM
• The CAM Education Program from NCCAM: An Overview
• Rationales for CAM Education in Health Professions Training Programs
• What Should Students Learn about CAM?
• Incorporation of CAM into Health Professions Education: Organizational and Instructional Strategies
• Barriers, Strategies, and Lessons Learned from CAM Curricular Initiatives
• Using CAM Curricular Elements to Foster Medical Student Self-awareness
• Evaluating CAM Education in Health Professions Programs
• Collaboration Between Allopathic and CAM Health Professionals: Four Initiatives
National Efforts Addressing CAM Integration in Education
15 NIH-Funded (R25 Grants) for CAM Curricular Initiatives (2000-2003)
Consortium of Academic Health Centers for Integrative Medicine (est. 2002)
University of California, San Francisco
Duke University
University of Maryland
University of Massachusetts
University of Arizona
Harvard University
1999: 8 Institutions
Stanford University
University of Minnesota
Albert Einstein/Yeshiva UniversityBoston UniversityColumbia UniversityDuke UniversityGeorgetown UniversityGeorge Washington UniversityHarvard Medical SchoolJohns Hopkins UniversityLaval University, QuebecMayo ClinicMcMaster University,
OntarioNorthwestern UniversityOhio State UniversityOregon Health &
Science UniversityStanford UniversityThomas Jefferson UniversityUniversity of AlbertaUniversity of ArizonaUniversity of Calgary
University of Kansas
University of Maryland
University of Massachusetts
University of Medicine &Dentistry of New Jersey
University of Michigan
University of Minnesota
University of New Mexico
University of North
Carolina, Chapel Hill
University of Cincinnati
University of Pennsylvania
University of Pittsburgh
University of Texas
University of Vermont
University of Washington
University of Wisconsin
Vanderbilt University
Wake Forest University
Yale University
University of Colorado
University of Connecticut
University of Hawaii
University of Illinois
University of California, Irvine University of California, Los AngelesUniversity of California, San DiegoUniversity of California, San FranciscoUniversity of Chicago
2010: 46 Members
Academic Consortium’s Educational Projects in Medical Curricula
Kligler, B et al Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal Academic Med 79:521-531, 2004
A Guide for Medical Educators: Curriculum in Integrative Medicine - Sample Modules www.imconsortium.org
National Efforts Addressing CAM Integration in Education
NIH-Funded Institutions (R25 Grants) Undertaking Curricular Initiatives (15)
Consortium of Academic Health Centers for Integrative Medicine (30) (est. 2002)
Policy Initiatives: White House Commission on CAM Policy (2002) National Policy Dialogue Report (2002) IOM Committee on CAM (Jan 2005) National Education Dialogue (June 2005) IOM: Integrative Medicine and Health (2009)
IOM Study on CAMRecommendation on Education
“The committee recommends that health profession schools (e.g. schools of medicine, nursing, pharmacy, and allied health) incorporate sufficient information about CAM into the standard curriculum…to enable licensed professionals to competently advise their patients about CAM.”
Report Issued: January 12, 2005
Canada: CAM in UME Task Force
All 17 Medical Schools Participating Task Force convened 2000 Goal: To develop a guide for
implementing CAM integration in UME Consensus regarding core
competencies Digital repository of curricular
materialswww.caminume.ca
THE SCOTTISH DOCTOR Learning Outcomes
3rd Edition – April 2008
The doctor as a
professional
How the doctor approaches their practice
What the doctor is able to do - Technical Skills
Clinical Skills
Practical Procedures
Patient Investigation
Patient ManagementCommunication Skills
Health promotion and Disease Prevention
Medical Informatics
1. Appreciation of what is available in the form of complementary therapies and the evidence-base for them
2. Outline of what is involved in most commonly practised therapies;
how alternative and conventional therapies might be combined
3. Keeping an open mind and remaining non-judgmental regarding the use of complementary therapies
Learning Outcomes for Patient Management – Complementary Therapies
Educational Initiative in CAM at Georgetown U School of Medicine
Broad objective
By the end of the project period, all graduates of Georgetown University School of Medicine will have an improved level of awareness about CAM information and practices, so that they will be able to understand and follow advances in CAM, as well as advise and communicate more effectively with their patients
Educational Initiative in CAM at Georgetown U School of Medicine
Goals for Implementation Knowledge about CAM
Skills and Attitudes about CAM
Enhancing the Research Environment in CAM
Why is CAM/IM Relevant to the Training of Physicians?
Widespread public usage
Growing awareness/desire by students and faculty to include CAM in medical training
Incorporation of CAM-relevant material can help address several desired goals in the medical curriculum
Using CAM to Advance…
Knowledge – Understanding the scientific basis for various CAM therapies; interactions (herb-drug)
Educational Initiative in CAM at Georgetown U School of Medicine
Examples of Basic Science Integration
Gross Anatomy:anatomy of acupuncture, massage Human Physiology: biofeedback, neuromuscular
manipulation Human Endocrinology:Stress reduction: imagery,
meditation, breathing Neuroscience: mechanisms of acupuncture action Immunology: psychoneuroimmunology Pharmacology: botanicals, dietary supplements,
herb-drug interactions
Using CAM to Advance…
Knowledge – Understanding the scientific basis for various CAM therapies; interactions (herb-drug)
Skills – Analytic Skills: Rules of Evidence, Stress Management Skills, Self-Awareness with Mind-Body Medicine Skills, Clinical Skills: OSCE Station
Attitudes – Improvements in patient-doctor communication, open-mindedness
Values – Emphasis on relationship-centered care, respect for CAM disciplines/practitioners
Hierarchy of Evidence
Basic biological understanding
Rigorous human studies
Systematic reviews
Guidelines
Courtesy of Dr. Josie Briggs, NCCAM
*Number of CAM RCTs Indexed on MEDLINE, 1982-2008. We used the following search strategy to obtain counts for each year: CAM [subset] AND randomized-controlled-trial [subset] AND year [Publication Date]. Searches were run on Oct. 22, 2009.
Number of CAM RCTs Indexed on MEDLINE, 1982-2008*
0
500
1000
1500
2000
2500
3000
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008 yr
Courtesy of Eric Manheimer
CAM Field of Cochrane Collaboration: Databases of Controlled Trials and Systematic Reviews Over 21,000 controlled clinical trials of
complementary therapies have been identified and published in The Cochrane Library (as of Issue 3, 2008)
300 CAM-related Cochrane reviews have been completed and are published in The Cochrane Library (as of Issue 3, 2008)
201 CAM-related Cochrane review protocols are published in The Cochrane Library (as of Issue 3, 2008)
Courtesy of Eric Manheimer
Number of CAM Systematic Reviews Indexed on MEDLINE, 1982-2008*
0
200
400
600
800
1000
1200
1400
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008 yr
*Number of CAM SRs Indexed on MEDLINE, 1982-2008. We used the following search strategy to obtain counts for each year: CAM [subset] AND systematic [subset] AND year [Pulication Date]. Searches were run on Oct. 22, 2009.
Courtesy of Eric Manheimer
RCT
Journal of Manipulative and Physiological TherapeuticsJournal of Manipulative and Physiological Therapeutics
Systematic Review
Practice
Guidelines
Courtesy of Dr. Josie Briggs, NCCAM
At the 2009 Conference in Minneapolis, MN (May 12-15,
2009)
Goal: To highlight recent research and state-of-science across
disciplines
6 keynote speakers
33 scientific sessions (symposia, featured discussions,
workshops)
57 oral abstracts (top 15% of all abstracts)
>250 posters (basic science, clinical, health services, methodology, and
education)
Research Resource sessions for trainees/new investigators
Over 800 registrants and 26 Participating Organizations
Graduate Studies in CAM at Georgetown University
DirectorsHakima Amri, PhD, Assistant Professor
Aviad Haramati, PhD, Professor
Program CoordinatorAureller Cabiness, MA
M.S. in Physiology
Mission
• To educate open-minded health care providers and scientists eager to explore the state of the evidence in areas of complementary and integrative medicine with objectivity and rigor.
Goals of the Program
• Core Foundation in Science– Systems Physiology, Cell and Molecular Physiology– Physiology of Mind-Body Medicine– Human Nutrition, Herbs, Supplements– Pathophysiology and Mechanisms of Disease– Research Methodology, Biostatistics
• Broad Exposure to CAM (Complementary, Alternative, Integrative)– Survey of CAM Disciplines, Philosophies and Therapeutic Approach
• Competence in Assessment of Evidence– Research literacy– Objectivity and Rigor in Evaluating Data
• Safety and Efficacy of CAM Therapies• Understanding bias
Tai Chi for Fibromyalgia
Courtesy of Dr. Josie Briggs, NCCAM
“But what is the active element of a complex, multi-component therapy such as tai chi? Is it rhythmic
exercise, deliberate and deep breathing, contemplative concentration, group support, relaxing imagery, a
charismatic teacher, or some synergistic combination of these elements?”
Gloria Y. Yeh, M.D., M.P.H., Ted J. Kaptchuk, and Robert H. Shmerling, M.D. Prescribing Tai Chi for Fibromyalgia — Are We There Yet? N Engl J Med 2010; 363:783-784
Courtesy of Dr. Josie Briggs, NCCAM
“If so, would the matched control include awkward movements, halted breathing, participant isolation, unpleasant imagery, or a tepid teacher? Would the
resulting sham intervention be credible, valid, or even genuinely inactive?”
Outline
Rationale for including Complementary/Integrative Medicine (CAM/IM) in the Medical Curriculum
Using CAM/IM in the learning of Science
Using CAM/IM to Foster Professionalism
Georgetown University School of Medicine
Mission Statement
Guided by the Jesuit tradition of cura personalis, of caring for the whole person, Georgetown University School of Medicine will educate, in an integrated way, knowledgeable, skillful, ethical, and compassionate physicians and biomedical scientists dedicated to the care of others and the health needs of our society.
Decline in Empathy in Medical School
Newton et al Academic Med 83:244-249, 2008
Women
Men
Competency-Based Medical Education
1. Effective Communication2. Basic Clinical Skills
3. Using Basic Science in the Practice of Medicine
4. Diagnosis, Management and Prevention
5. Life-long Learning
6. Self-Awareness, Self-Care, and Personal Growth
7. Social/Community Contexts of Healthcare
8. Moral Reasoning and Clinical Ethics
9. Problem-solving
The doctor as a professional
THE SCOTTISH DOCTOR Learning Outcomes
How the doctor approaches their practice
Basic, Social, Clinical Sciences, Underlying Principles
Attitudes, Ethics, Legal Responsibilities
Decision Making Skills , Clinical Reasoning, Judgment
What the doctor is able to do - Technical Skills
Clinical Skills
Practical Procedures
Patient Investigation
Patient Management
Communication Skills
Health promotion and Disease Prevention
Medical Informatics
Personal Development
Self-awareness, Self-care, Commitment
Role of the Doctor within the Health Service
Educational Initiative in CAM at Georgetown U School of Medicine
Specific Aim
To increase student understanding of self-awareness and self-care by providing a unique experiential and didactic introduction to Mind-Body Medicine
Educational Initiative in CAM at Georgetown U School of Medicine
Goal of Mind-Body Medicine Skills Program Mind-Body approaches are not only effective in
helping to reduce stress and anxiety, but also teach the power of self-awareness and self-care.
In order for students to understand the potential and applicability of mind-body approaches in healthcare, we believe it is important for them to experience these techniques and gain insight about themselves.
Mind-Body Medicine Programat Georgetown U School of Medicine
To increase self-awareness of emotional, physical, mental, social and spiritual aspects of one’s life
To increase personal self-care through guided experiences and daily practice.
To foster non-judgmental, supportive collegial relationships
Objectives
Mind-Body Medicine Programat Georgetown U School of Medicine
Format of groups: 10-11 students and 2 faculty facilitators per group Participants (voluntarily sign up for the course) meet
once a week for 2 hours for 11 weeks per semester for this “journey of self-discovery”
Structure of Each Session A safe environment must be created that adheres to
certain guidelines confidentiality, respect, compassionate listening, non-judgment
Check-in (sharing of new reflections and insights) Introduction of a new mind-body medicine skill Process the experiential exercise (sharing insights)
Mind-Body Medicine Programat Georgetown U School of Medicine
Skills and Experiences
Meditation (mindfulness/awareness, concentrative) Guided Imagery (several types) Autogenic training/biofeedback Art (emphasis on non-cognitive approaches) Music (used in meditation and imagery sessions) Movement (shaking, dancing, exercise) Writing (journals, dialogues, service commitment) Group support
Mind-Body Medicine Skills Groups
Evaluation and assessment:
21-item Attitudinal Mind-Body Skills Scale (MBSS) Georgetown University School of Medicine
10-item Perceived Stress Scale (PSS)J Health Soc Behav 24:385-396, 1983.
15-item Mindful Awareness Attention Scale (MAAS)J Pers Soc Psychol.84:822-48, 2003.
Written responses to open-ended questions
I have an appreciation for my classmates' concerns and struggles.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1-AbsolutelyDisagree
2-StronglyDiagree
3-DiagreeSomewhat
4-Neither Agreeor Disagree
5-AgreeSomewhat
6-StronglyAgree
7-AbsolutelyAgree
Response
Pre
Post
I understand what self-awareness means.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1-AbsolutelyDisagree
2-StronglyDiagree
3-DiagreeSomewhat
4-Neither Agreeor Disagree
5-AgreeSomewhat
6-StronglyAgree
7-AbsolutelyAgree
Response
Pre
Post
I have a high degree of self-awareness.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1-AbsolutelyDisagree
2-StronglyDiagree
3-DiagreeSomewhat
4-Neither Agreeor Disagree
5-AgreeSomewhat
6-StronglyAgree
7-AbsolutelyAgree
Response
Pre
Post
Perceived Stress Scale
N Score Std Error
Pre-Course 102 16.4 0.6
Post-Course 102 13.1 0.6
Mean paired difference: -3.2 (95% CI: -2.1 to -4.2: P < 0.001)
SUMMARY
Mindful Awareness Attention Scale
Mean paired difference: 6.5 (95% CI: 9.00 to 3.44:P < 0.001)
N Score Std Error
Pre-Course 69 54.8 1.4
Post-Course 69 61.3 1.4
SUMMARY
Educational Initiative in CAM at Georgetown U School of Medicine
Survey Questions & Responses
1 What did this course mean to you?
2 How has it helped you as a medical student and as a person, if at all?
3 How will it contribute to your work as a physician, if at all?
4 How has it changed your attitude toward medicine and healthcare, if at all?
5 How has it changed your attitude toward medical school, if at all?
6 Has it changed your relationship with your classmates, if so, how?
Analysis of Student Responses to Six Open-ended Questions
Five central themes 1) Connections2) Self-discovery3) Learning4) Stress Management Skills5) Medical Education
Problems in health care Awareness of CAM Attitudes towards medical school
Saunders et al Medical Teacher 29:778-784, 2007
Theme 1: Connections
Students’ appreciation of the opportunity provided by the MBS group to meet others and make meaningful connections.
Students’ isolation at medical school
Examples – Connections “It also provided an outlet to discuss my
feelings, which is so important to working out issues and resolving them. It has made me more aware and mindful in all aspects of my life.”
“I have realized that I'm not alone in my fears to succeed in med school, and the insecurities and self-doubts that have plagued me on and off this first year. I realize everyone faces these issues as they come up. We are never really alone, and this is a fact that we as a society need to become more aware of.”
Theme 2: Self Discovery Students’ process of self discovery
stemming from their experience in the MBS group.
They discover important things about themselves and their abilities to be better people and better medical students.
The group helps students become more aware of their own priorities and limitations.
Examples – Self Discovery
“I feel that I have reached new levels of understanding myself, and in that vein I am painfully aware of the giant disconnect between my intentions and feelings and my actions. So, in that way, I can see more clearly what I need to do in my life.”
“Encouraged me to make my physical and mental health priorities.”
Theme 3: Learning
Learning Mind-Body medicine skills
Learning and academic improvement
Examples - Learning Learning M-B skills
“Yes! I listen to my body more, I'm more attentive to my state of mind. I feel that I have more control over myself.”
“This course was helpful in that I learned skills, practiced them, and have a better appreciation for mind-body practices, as well as how I might utilize them in my future practice.
Examples - Learning
Learning and Academic improvement “As a medical student, this course taught
me ways to relax and focus. I actually have improved on my tests while reducing study time. Whether I have become more efficient at studying, a better test-taker, or simply more focused I am not sure. I like to think it is because I am more self-aware and relaxed-which is more important for my everyday existence as a person.”
Theme 5: Medical Education
Students were aware that the MBS group is a unique experience in medical education. “It has made me more cognizant of the
fact that med school as an environment does not foster healthy emotional life/human emotion weakness as normal qualities. It has also made clear to me that I am responsible for my own relaxation during these years.”
Specific Theme
Attitudes – In response to Question 5 – “Has it (this course) changed your attitude toward medical school? If so, how”
“It has changed my attitude toward Georgetown since they are willing to offer this course to their students.”
“It has changed my attitude in the sense of knowing that there are people who care about my well-being as a student. And because I have received, I also want to give back.”
Emotional IntelligenceEmotional Intelligence
Defined as: a type of social intelligence that involves the ability to monitor one’s own and others’ emotions, to discriminate among them, and to use the information to guide one’s thinking and actions.*
*Stratton T, Elam C, Murphy-Spencer A, Quinlivan S. Emotional Intelligence and Clinical Skills: Preliminary Results from a Comprehensive Clinical Performance Exam. Powerpoint Presentation at the Research in Medical Education (RIME) Conference, Washington DC. Office of Medical Education: University of Kentucky College of Medicine. 2005 Nov 8.
Assessing Elements of EIAssessing Elements of EI
Intrapersonal Capacities: Attention to feelings Mood repair Clarity of feelings
Emotional Intelligence Survey (EI) – 51 items Stratton et al Academic Med. 80:10:S34-S37, 2005.
Trait Meta-Mood ScaleDavis’ Interpersonal Reactivity Index
Interpersonal Capacities: Perspective taking Empathetic concern Personal distress in response to distress of others
Emotional Intelligence Subscales
Assessing Elements of EIAssessing Elements of EI 66 first year medical students
participated in the study: MBS group n = 30
Students who took the surveys and self-selected to participate in MBS course
Control group n = 36 Students who took the surveys but did not
participate in MBS course
Interpersonal CapacityPersonal Distress
p ≤ .01
Emotional Intelligence Scale Results
January 2006 May 2006
Time of Survey
Emotional Intelligence Scale Results Intrapersonal Capacity
Attention to Feelings
p ≤ .05
January 2006 May 2006
Time of Survey
Emotional Intelligence Scale Results Interpersonal Capacity
Empathetic Concern
p ≤ .05
January 2006 May 2006
Time of Survey
Implementation and Scope of the Mind-Body Medicine Skills Program
Over 8 years
>60 trained faculty facilitators (clinicians, scientists, educators)
>800 medical students participated ~180 graduate students (MS and PhD) ~90 nursing students >60 faculty participants (including from curriculum
committee)Over 130 groups and over 1300 participants
Embraced by the School of Medicine as essential for a core competency (self-awareness and self-care)
Summary
Rationale for including Complementary/Integrative Medicine (CAM/IM) in the medical curriculumResponsibility, advance knowledge, skills and
attitudes
Using CAM/IM in the learning of ScienceMechanisms, EBM—rules of evidence, research path
Using CAM/IM to Foster Professionalism Enhancing self-awareness, self-care, empathy
Why Incorporate Integrative Medicine into Medical
Education?
Good for Medicine!
Contributing Faculty and Contributing Faculty and StudentsStudents
Hakima Amri, PhD Mary Ann Dutton, PhDKristi Graves, PhD Claire Gross, M’13Aviad Haramati, PhD Nancy Harazduk, MSW, MEdMichael Lumpkin, PhD Kevin Motz, M’13
Meredith Riddle, MS ’09 Pamela Saunders, PhD
Supported by grants from NCCAM and the Institute for Integrative Health
InterventionAn intensive phase (8 wk 2.5 hr)
All day (7 hr) session (6-7 wks)
A maintenance phase (10 monthly)
15 min didactic material (weekly)
(awareness, burnout, self-care)
Formal mindfulness meditation
Body scan
Sitting meditation
Walking meditation
Mindful movement
Narrative/Appreciative Inquiry Exercises
US Medical Schools with CAM topics in either a required or elective course
Source: Liaison Commission on Medical Education
82
102 107 109 116 118 119
0
20
40
60
80
100
120
140
Graduation Questionnaire Data
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
1999 2000 2001 2002 2003 2004
Inadequate Appropriate
Do you believe that the time devoted to your instruction in complementary and alternative medicine was inadequate, appropriate or excessive?
Theme 2: Self Discovery Students’ process of self discovery
stemming from their experience in the MBS group.
They discover important things about themselves and their abilities to be better people and better medical students.
The group helps students become more aware of their own priorities and limitations.
Examples – Self Discovery
“I feel that I have reached new levels of understanding myself, and in that vein I am painfully aware of the giant disconnect between my intentions and feelings and my actions. So, in that way, I can see more clearly what I need to do in my life.”
“Encouraged me to make my physical and mental health priorities.”
Theme 4: Stress Relief Students felt the MBS group gave them
relief from the stress of medical school. “This course has been about self-
awareness for me. I have learned to better recognize what is going on for me physically and emotionally. I have also learned a new set of tools for dealing with the stresses in life.”
“This course means health and relaxation and exploring. A way to take care of yourself and to be proactive.”
Specific Themes Problems in the health care system –
In response to Question 4 – “Has it (this course) changed your attitude toward medicine and healthcare? If so, how?” “I more strongly feel that there needs to be a
large change in what is considered standard practice.”
“I fully see, now, how lacking medicine (and especially healthcare) is in the whole person approach to well-being. I also feel like more of these things could help prevent more progression of serious disease in the world.”
Specific Theme
Awareness of MB medicine and CAM Also response to Question 4 – Has it (this course) changed your attitude toward medicine and healthcare? If so, how?
“I am definitely more of a believer in mind-body techniques and their effectiveness.”
“It has enabled me to think about healthcare more holistically and as a partnership between the physician and the patient.”
Specific Themes Problems in the health care system –
In response to Question 4 – “Has it (this course) changed your attitude toward medicine and healthcare? If so, how?” “I more strongly feel that there needs to be a
large change in what is considered standard practice.”
“I fully see, now, how lacking medicine (and especially healthcare) is in the whole person approach to well-being. I also feel like more of these things could help prevent more progression of serious disease in the world.”
Recommendations for Incorporating CAM/IM in
Medical Education
Teach One Medicine Practice Open-Minded Skepticism Focus on Required Curriculum Involve CAM Practitioners/Schools and
Create Opportunities for Interdisciplinary Activities
Don’t Forget Faculty Development Include “Experiential” Components Use CAM to Teach “Rules of Evidence”