Why Integrative Medicine is Essential for Medical Education

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

30

40

50

60

70

80

90

100

No Answer StronglyDisagree

Disagree SomewhatDisagree

Neutral SomewhatAgree

Agree StronglyAgree

Perc

enta

ge (n

=266

)

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 PersonallyProvideSufficient to Advise PatientsAbout UseNone

No Answer


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


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 KansasUniversity of MarylandUniversity of MassachusettsUniversity of Medicine &

Dentistry of New JerseyUniversity of MichiganUniversity of MinnesotaUniversity of New MexicoUniversity of North Carolina, Chapel Hill University of CincinnatiUniversity of PennsylvaniaUniversity of PittsburghUniversity of Texas University of VermontUniversity of WashingtonUniversity of WisconsinVanderbilt UniversityWake Forest UniversityYale University

University of ColoradoUniversity of ConnecticutUniversity of HawaiiUniversity 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 SkillsPractical ProceduresPatient Investigation

Patient ManagementCommunication Skills Health promotion and Disease PreventionMedical 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 combined3. 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 objectiveBy 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


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)


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

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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)


Number of CAM Systematic Reviews Indexed on MEDLINE, 1982-2008*

0200400600800

100012001400

1982

1984

1986

1988

1990

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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.


RCT

Journal of Manipulative and Physiological TherapeuticsJournal of Manipulative and Physiological Therapeutics

Systematic Review

Practice

Guidelines


At the 2009 Conference in Minneapolis, MN (May 12-15, 2009)Goal: To highlight recent research and state-of-science across disciplines6 keynote speakers33 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


“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


“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 StatementGuided 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 Skills3. Using Basic Science in

the Practice of Medicine4. Diagnosis, Management

and Prevention5. 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 SkillsPractical Procedures

Patient InvestigationPatient Management

Communication Skills Health promotion and Disease Prevention

Medical Informatics

Personal DevelopmentSelf-awareness, Self-care, Commitment

Role of the Doctor within the Health Service


Specific Aim To increase student understanding

of self-awareness and self-care by providing a unique experiential and didactic introduction to Mind-Body 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


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)


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%

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1-AbsolutelyDisagree

2-StronglyDiagree

3-DiagreeSomewhat

4-Neither Agreeor Disagree

5-AgreeSomewhat

6-StronglyAgree

7-AbsolutelyAgree

Response

PrePost

I understand what self-awareness means.

0%

10%

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30%

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2-StronglyDiagree

3-DiagreeSomewhat


5-AgreeSomewhat

6-StronglyAgree

7-AbsolutelyAgree

Response

PrePost

I have a high degree of self-awareness.

0%

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2-StronglyDiagree

3-DiagreeSomewhat


5-AgreeSomewhat

6-StronglyAgree

7-AbsolutelyAgree

Response

PrePost

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


Survey Questions & Responses1 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


Time of Survey

Emotional Intelligence Scale Results Interpersonal Capacity

Empathetic Concern

p ≤ .05


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 Science

Mechanisms, 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 ’09Pamela 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

82102 107 109 116 118 119

020406080

100120140

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”

Why Integrative Medicine is Essential for Medical Education

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