Complementary and Alternative Medicine Issues in Undergraduate Medical Education
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About the Project


Background

    Rationale

Many factors underlie the rationale for greater attention to CAM in undergraduate medical education (UME), including:
  1. the widespread use of CAM by patients1 and the projected increase over the next decades.2
  2. the majority of CAM users also continue to use conventional medicine creating potential safety risks due to interaction effects.3
  3. only a minority of patients reportedly disclose CAM use to their physician.4
  4. patients report wanting to receive information about CAM from their physician.5
  5. a growing evidence base for selected CAM therapies.6
Currently, many physicians are unprepared to engage in informed discussions about CAM with their patients. Although a greater number of schools recognize CAM as a relevant area to physician training, most programs suffer from a serious lack of curricular time for additional topics. In Canada, as in other countries, attention to CAM in UME is limited, varies across each of the 17 medical schools, and depends on several local factors such as the availability of faculty members who have the skills, interests, and credibility to 'champion' its inclusion. In many medical schools, CAM curriculum is hidden (e.g., 5 minutes on chiropractic in a lecture) and is elective based.

These factors together initiated the start of the Canadian Complementary and Alternative Medicine in Undergraduate Medical Education Project, or CAM in UME Project, chaired by Dr. Marja Verhoef at the University of Calgary.

     A Multifaceted Project

The CAM in UME Project has been multifaceted. In 2001, Health Canada and the Association of Medical Colleges of Canada (ACMC, now called the Association of Faculties of Medicine of Canada (AFMC)), sponsored a half-day session on CAM at their annual meeting. In preparation for this session, Health Canada funded a survey of medical educators to assess their opinions about the need to include CAM in UME.7 This event fueled a series of studies and workshops that focused on the role and nature of CAM education in Canadian medical schools, including but not limited to:

The two workshops, the 2002 Associate Deans Workshop and the 2003 Saskatoon Invitational Workshop, were groundbreaking in clearly demonstrating a national interest and effort to collectively develop a CAM curriculum suitable for UME programs. Subsequent meetings and workshops (see documents) refined details on structure and content.

    Guiding Principles

The general guiding principles of the CAM in UME Project are:

  • to make students aware of relevant CAM-related issues in a Canadian context; and
  • to provide students with the knowledge, skills, and attitudes to discuss CAM with patients in an informed and non-judgmental manner.
Our intent is not to present a wholesale endorsement of CAM in general or of any specific CAM products and practices, nor is our intent to teach medical students how to practice any specific therapies.

Given the variability in UME programs across Canada and the role that CAM education plays, it is impractical to produce a standardized CAM curriculum package for schools to integrate. As such, our focus is to:

  1. provide teaching materials and teaching resources that instructors could use to either modify their existing curriculum or to develop their own curriculum;
  2. pay particular attention to foundational concepts such as wellness, evidence, safety and physician-patient communication to develop a basis and a context for CAM teaching; and
  3. provide a guide to help faculty begin introducing and/or integrating CAM education in UME.

Content

Three components comprise our curriculum framework.

    1. CAM Competencies/Learning Objectives for UME

Competency-based, outcomes-oriented education is a priority in the push for medical schools to be socially accountable.8 In other words, what do physicians need to be able to do to effectively practice medicine? In the context of this project, what do physicians need to know and do with regard to CAM to be better physicians?

Initially, the 16 Associate Deans Undergraduate Medical Education (2002) drafted a set of CAM learning objectives under the headings knowledge, skills, and attitudes.9 During the first national CAM capacity building workshop in 2003 these were re-worded as competencies - i.e., observable and measurable abilities to which knowledge of CAM contributes. The competencies have undergone several modifications in an effort to achieve relative consensus. The most recent version can be accessed here with the proviso that revisions may occur in the future. As we recognize the value that the College of Physicians and Surgeons of Canada's CanMEDS Physician Competency Framework 10 plays in medical education, we have identified in each CAMpod the physician roles that the CAM topic may help enhance.

    2. CAMpods

The CAMpods are executive summaries on a priority set of CAM topics relevant to undergraduate teaching. They are to help instructors "quick start" curriculum development and/or amendment by providing foundational information. CAMpods are peer reviewed for comprehensiveness and accuracy; each each POD is comprised of three sections: Purpose, Overview, and Discussion. CAMpods are categorized into one of three overarching sections:

  1. Foundations for CAM. This is further categorized into two subgroups:

    1. Foundational Themes—topics that are not necessarily CAM, but can provide an excellent basis for CAM discussion or teaching, such as Beliefs, Culture, Evidence-Based Medicine, and Stress.
    2. CAM Basics—topics that provide fundamental information about CAM such as its description, reasons for CAM use, and regulations.

  2. CAM Practices and Products. Overviews of the more prominent CAM practices such as chiropractic and massage as well as of natural health products (NHPs).


  3. CAM in Clinical Practice. topics that will foster and support physicians in their discussions of CAM with patients such as, Patient- Physician Communication and Obtaining Clinical Information about CAM. We also would like to develop CAMpods on CAM for specific medical conditions.

The full CAMpod list can be accessed from the Digital Resource Repository. *Selected CAMpods in sections 2 and 3 are in the process of development and are not yet available in the repository. In addition, we are seeking experts to volunteer to write or review a number of CAMpods, particularly on CAM use for specific clinical conditions. If you are interested in contributing to the CAMpod development, please e-mail us at caminume@ucalgary.ca.

    3. Teaching/Learning Resources (TLRs)

Teaching/Learning Resources, or TLRs, are CAM-related materials that have been used in Canada. A TLR can be a slide presentation, an assignment, an instructor's notes, a student handout, a case presentation, etc. The TLR collection also includes external sources of CAM information (e.g., books and Web sites). To date, we have collected and indexed over 80 CAM TLRs and external Web sites (e.g., CAMline and NCCAM). Approximately 80 educators have been contacted for potential resources. TLR collection is ongoing. If you have TLRs that you would like to add to our Digital Resource Repository in order to share them with other educators, please submit your TLRs via our TLR submissions page or e-mail us directly.

Delivery & Implementation

The CAM in UME Project is national in scope. However, we do not intend to impose or mandate a standardized CAM curriculum upon Canadian medical schools. We expect individual instructors to select and adapt components of the CAM curriculum that best fit their schools strategies, priorities, and structure. In order to allow instructors to easily download as well as share existing teaching materials and resources (i.e., CAMpods and TLRs), we developed an online, dynamic, searchable repository. We officially launched the CAM in UME Digital Resource Repository on May 23, 2007.

Although medical schools in Canada are increasingly incorporating CAM content into their programs, most are still challenged with issues surrounding implementation. Based on the deliberations of a national workshop on CAM implementation held in December 2006, we developed a guide to help medical school faculty to continue to integrate CAM education into UME programs. The guide, called A Guide for the Development, Implementation, and Sustainability of Curriculum about CAM in UME Programs: A synthesis of a national workshop, can be accessed here. A more comprehensive report of the workshop also will be written.


1. The most recent survey on Americans' use of CAM indicates that 36% of adults are using some form of CAM. When metavitamin therapy and prayer used specifically for health reasons are included, this percent rises to 62. [Cited from: Barnes PM, Powell-Griner E, McGann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Advance Data May, 2004:343:1-120. Available at: http://nccam.nih.gov/news/report.pdf]. In Canada, the 2003 Canadian Community Health Survey (CCHS) reported that 20% of Canadians aged 12 and older reported consulting with an alternative care provider in the past year (this does not include non-practitioner based therapy). [cited from: Park J. Use of alternative health care. Health Reports 2005; 16(2), 39-41.] Health Canada reports that 70% of Canadians use Natural Health Products. Available at: http://www.hc-sc.gc.ca/dhp-mps/pubs/natur/eng_cons_survey_e.html.]
2. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb; 11(1):42-9.
3. Eisenberg DM, Davis RB, Ettner SL, Appel S et al. Trends in alternative medicine use in the United States, 1990-1997. Results of a follow-up national survey. JAMA 1998; 280(18):1569-75; Eisenberg DM, Kessler RC, Van Rompay MI et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001; 135:344-51.
4. Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Comp Ther in Med. 2004; 12:90-98.
5. In a recent study of cancer patients, 79% indicated that they would prefer to receive CAM information from their physicians. Trojan, L., Verhoef, M., Carlson, L, Hilsden, R. (2005). Cancer Information Services: What are callers complementary therapy needs?. "CAM Research in Canada: Sharing Successes and Challenges - Abstracts from the 2nd Annual IN-CAM Symposium, November 12&13, 2005, Toronto, Canada", Journal of Complementary and Integrative Medicine: Vol. 2 : Iss. 1, Article 12. Available at: http://www.bepress.com/jcim/vol2/iss1/12.
6. Cochrane Reviews. Available from: http://www.cochrane.org/.
7. Verhoef, M, Best A, and Boon H. Role of complementary medicine in medical education: opinions of medical educators. Annals RCPSC. 2002;35(3):166-170.
8. Health Canada. Social Accountabilty: A Vision for Canadian Medical Schools. Her Magesty the Queen in Right of Canada, Minister of Public Works and Government Services Canada, 2001. Available from: http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-social-vision-med/2001-social-vision-med_e.pdf.
9. Verhoef MJ, Boon HS, Jones A. Complementary and Alternative Medicine in Undergraduate Medical Education: Workshop for the Associate Deans UME. 59th Annual Meeting of the Association of Canadian Medical Colleges, Calgary, Canada, April 2002. [Health Canada report - English version. Available from: http://www.caminume.ca/documents/associatedeansenglish.pdf.
10. Frank, JR (Ed). 2005. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada. Available from: http://rcpsc.medical.org/canmeds/CanMEDS2005.
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