Committee on the Use of Complementary and Alternative Medicine by the American Public Board on Health Promotion and Disease Prevention

Complementary and Alternative Medicine
IN THE UNITED STATES

Committee on the Use of Complementary and Alternative Medicine by the American Public

Board on Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

8
Educational Programs in CAM

CAM IN HEALTH PROFESSIONS EDUCATION

Along with the growth in the integration of CAM and conventional medicine in health care institutions and individual practices, the number of health professional education programs that are teaching CAM is also growing. 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. medical school departments of family medicine and all family medicine residency programs to determine the extent to which CAM was being taught in medical schools. The results showed that in 1995 CAM was taught in 34 percent of U.S. medical schools and 28 percent of family practice residency programs. The number of medical schools offering courses on CAM-related topics rose from 45 of 125 schools in the 1996–1997 academic year to 75 schools in 1998 (Wetzel et al., 2003) and 98 medical schools in the 2002–2003 academic year (Barzansky and Etzel, 2003).

To gather information about the specific topics being taught and the objectives behind the instruction, Brokaw et al. (2002) surveyed 123 CAM course directors at 74 U.S. medical schools.

They found that the most typical course was an elective and that most of the courses (78.1 percent)

were taught by CAM practitioners or by those who prescribe CAM therapies.

Burman (2003), in a survey of family nurse practitioner program directors, found that 98.5 percent of the 141 respondents reported that their programs included CAM-related content and that most of these (80.3 percent) integrated the CAM content into existing courses. A survey of 627 medical school, school of nursing, and college of pharmacy faculty and students at the University of Minnesota found that 88 percent of the faculty respondents and 84 percent of the students believed that CAM should be included in their schools’ curricula (Kreitzer et al., 2002). Biofeedback, massage, and meditation were the therapies most likely to be used by the faculty from all schools.

A study of schools of pharmacy conducted by Dutta et al. (2003) found that 73 percent (46 out of 64 respondents) of schools were offering instruction in CAM, although courses on CAM were not yet mandated by the schools. The most frequently taught content area was herbals (45 schools). Table 8-1 shows the number of schools teaching various modalities. The National Association of Boards of Pharmacy, in a memorandum to all pharmacy school deans, stated that herbal products and nutraceuticals would be included in the North American Pharmacist Licensure Examination (NAPLEX).

These data indicate that much CAM-related education is being taught in the schools of the conventional health professions; however, the specifics of that training and a good understanding of the total extent of the training in CAM remain unknown.

Why Teach CAM?

At present, integrative medicine is largely market-driven and spans the spectrum from evidence-based practices that benefit patients and carry little risk to outright quackery, sometimes with significant risk. Without involvement on the part of our profession, we leave patients uninformed and without medical guidance. (Gaudet and Snyderman, 2002)

The Institute of Medicine (IOM) 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) proposed a set of core competencies that all health clinicians should possess. The first of these is the ability to provide patient-centered care. To provide patient-centered care, the report states, health professionals must share power and responsibility with caregivers; communicate with patients in a shared and fully open manner; take into account patients’ individuality, emotional needs, values, and life issues; implement strategies for reaching those who do not present for care on their own, including health care strategies that support the broader community; and enhance prevention and health promotion. Although that IOM report was referring to conventional medicine, the same competencies apply to CAM.

Given that CAM is widely used by the U.S. population, health care professionals need to be informed about CAM and knowledgeable enough to discuss the CAM therapies that the patient is using or thinking of using to more effectively communicate with their patients. Consistent with this view, a report of the American Association of Medical Colleges emphasized the importance of physicians being “sufficiently knowledgeable about both traditional and non-traditional modes of care to provide intelligent guidance to their patients” (AAMC, 1998). Gaudet (1998) maintains that to achieve the best medicine possible, physicians need to know both the CAM practices that have the potential to harm or be ineffective and knowledge of which CAM practices that, “when critically and intelligently integrated into health care, could be of benefit to patients.”

An article by Marcus (2001), in which the author took issue with some

of the criticisms of conventional medical education (e.g., that physicians ignore mind-body interactions and disease prevention), concludes that medical students should receive evidence-based education about CAM, stating,

Without additional education about alternative medicine, physicians cannot obtain accurate information from patients about their use of alternative modalities, or provide information and guidance … physicians must assist patients in making informed choices about health care, and they should be receptive to discussing alternative medicine with patients who request information. Physicians should be especially sensitive to the needs of patients with intractable medical conditions, such as cancer, chronic pain, and degenerative neurologic diseases, who seek relief and hope in alternative therapies.

As mentioned above, the IOM report on health professions education (IOM, 2003) described taking “into account patients’ individuality, emotional needs, values, and life issues” as one aspect of patient-centered care. To meet this goal, both conventional health care professionals and CAM practitioners need to learn about the CAM therapies that are in use among the many cultures and ethnic groups that make up the U.S. population. Konefal (2002) writes that “understanding the cultural and political as well as the medical relevance of CAM modalities will allow the physician to respond more appropriately to his or her individual patients.” Although much of the preceding discussion relates to physicians, it can be applied equally to several health professions, including nursing, pharmacy, and dentistry.

Disch and Kreitzer (2003) 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. Medical schools are defining the mission of health care in progressively broader terms that are conceptually similar to those embraced by the integrative medicine movement. (See Chapter 7 for a discussion of an ecological approach to health.)
2. Clinical decision making requires the ability to deal with uncertainty, and the same skills are needed to assess all therapies whether they are identified as conventional medicine or CAM.
3. There is growing societal interest in diversity, and training in CAM increases cultural competence.
4. As the boundaries of the medical sciences grow and more knowledge is accrued, the exploration of therapies currently identified as CAM will help direct productive biomedical, psychological, and sociomedical research agendas.
   Few today would argue against the fact that health professionals must be knowledgeable about CAM in order to best serve the interests of their patients. The difficulty comes in attempting to decide what should be taught and how to fit such teachings into already crowded health professional educational curricula. The next section explores ideas about what should be taught about CAM to conventional medical practitioners.
   
   
   http://www.nap.edu/openbook.php?record_id=11182&page=230