Why Integrative Medicine is Essential
for Medical Education
Aviad Haramati, PhD
Professor of Physiology & Biophysics and Medicine
Georgetown University School of Medicine
Washington, DC USA
Dir. Academic Programs, Institute for Integrative Health
Baltimore, MD, USA
NVMO – Dutch Association on Medical Education
Egmond 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.
100
90
80
Percentage (n=266)
70
60
First Years
Second Years
50
40
32.3
31.6
29.7
30
25.2
22.5
17.4
20
11.7
8.4
10
0.6
1.8 2.6
3.6
5.4 5.2
1.9
0
No Answer
Strongly
Disagree
Disagree
Somewhat
Disagree
Neutral
Somewhat
Agree
Agree
Chaterji et al Alt Ther Health Med 2007
Strongly
Agree
Desire for Future CAM Training
First and Second Year Students
Sufficient to Personally
Provide
Sufficient to Advise Patients
About Use
None
Therapeutic/Healing Touch
Rolfing (Structural Reintegration)
Meditation
No Answer
Prayer/Spiritual Healing
Nutritional Supplements
Music
Massage
Hypnosis/Guided Imagery
Homeopathy
Herbal Medicine
Chiropractic
Biofeedback
Bioelectromagnetic Therapies
Aromatherapy
Acupuncture
0
10
20
30
40
50
60
Response (%)
Chaterji et al Alt Ther Health Med 2007
70
80
90
100
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 2007
Education 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)
1999: 8 Institutions
University of Minnesota
University of California,
San Francisco
University of
Massachusetts
Harvard University
Stanford University
University of Maryland
Duke University
University of Arizona
2010: 46 Members
Albert Einstein/Yeshiva University
Boston University
Columbia University
Duke University
Georgetown University
George Washington University
Harvard Medical School
Johns Hopkins University
Laval University, Quebec
Mayo Clinic
McMaster University,
Ontario
Northwestern University
Ohio State University
Oregon Health &
Science University
Stanford University
Thomas Jefferson University
University of Alberta
University of Arizona
University of Calgary
University of California, Irvine
University of California, Los Angeles
University of California, San Diego
University of California, San Francisco
University of Chicago

University of Colorado
University of Connecticut
University of Hawaii
University of Illinois
 
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
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 CAM
Recommendation 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 materials
www.caminume.ca
THE SCOTTISH DOCTOR Learning Outcomes
3rd Edition – April 2008
Clinical Skills
Practical Procedures
Patient Investigation
Patient Management
Communication Skills
Health promotion and Disease Prevention
What the doctor is able to
do - Technical Skills
How the doctor
approaches their practice
The doctor as a
professional
Medical Informatics
Learning Outcomes for Patient Management – Complementary Therapies
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
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 MindBody 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
Guidelines
Systematic
reviews
Rigorous human studies
Basic biological understanding
Courtesy of Dr. Josie Briggs, NCCAM
Number of CAM RCTs Indexed on MEDLINE, 1982-2008*
3000
2500
2000
1500
1000
500
20
08
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
0
yr
*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.
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*
1400
1200
1000
800
600
400
200
08
20
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
19
82
0
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
Practice
Guidelines
Journal of Manipulative and Physiological Therapeutics
Systematic
Review
RCT
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
M.S. in Physiology
Directors
Hakima Amri, PhD, Assistant Professor
Aviad Haramati, PhD, Professor
Program Coordinator
Aureller Cabiness, MA
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, multicomponent 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?”
“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?”
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
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
Women
Men
Newton et al Academic Med 83:244-249, 2008
Competency-Based Medical Education
1. Effective Communication 6. Self-Awareness,
Self-Care, and
2. Basic Clinical Skills
Personal Growth
3. Using Basic Science in
7. Social/Community
the Practice of Medicine
Contexts of Healthcare
4. Diagnosis, Management
8. Moral Reasoning
and Prevention
and Clinical Ethics
5. Life-long Learning
9. Problem-solving
THE SCOTTISH DOCTOR Learning Outcomes
What the doctor is able to do - Technical Skills
How the doctor approaches their practice
The doctor as a professional
Clinical Skills
Practical Procedures
Patient Investigation
Basic, Social, Clinical Sciences, Underlying Principles
Attitudes, Ethics, Legal Responsibilities
Decision Making Skills , Clinical Reasoning, Judgment
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 Program
at Georgetown U School of Medicine
Objectives



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
Mind-Body Medicine Program
at 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 Program
at 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)

15-item Mindful Awareness Attention Scale (MAAS)

Written responses to open-ended questions
J Health Soc Behav 24:385-396, 1983.
J Pers Soc Psychol.84:822-48, 2003.
Perceived Stress Scale
SUMMARY
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)
Mindful Awareness Attention Scale
SUMMARY
N
Score
Std Error
Pre-Course
69
54.8
1.4
Post-Course
69
61.3
1.4
Mean paired difference: 6.5 (95% CI: 9.00 to 3.44:P < 0.001)
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)
2)
3)
4)
5)
Connections
Self-discovery
Learning
Stress Management Skills
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 relaxedwhich 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 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 EI
Emotional Intelligence Survey (EI) – 51 items
Stratton et al Academic Med. 80:10:S34-S37, 2005.
Trait Meta-Mood Scale
Davis’ Interpersonal Reactivity Index
Emotional Intelligence Subscales
Interpersonal Capacities:
Perspective taking
Empathetic concern
Personal distress in response to distress of others
Intrapersonal Capacities:
Attention to feelings
Mood repair
Clarity of feelings
Assessing 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
Emotional Intelligence Scale Results
Interpersonal Capacity
Personal Distress
p ≤ .01
January 2006
May 2006
Time of Survey
Emotional Intelligence Scale Results
Intrapersonal Capacity
Attention to Feelings
56
Average Scores
54
52
50
MBS Group
48
Control
Group
p ≤ .05
46
44
January 2006
May 2006
Time of Survey
Emotional Intelligence Scale Results
Interpersonal Capacity
Empathetic Concern
Average Scores
29.5
29
28.5
MBS Group
28
Control Group
p ≤ .05
27.5
27
26.5
January 2006
May 2006
Time of Survey
Interpersonal Reactivity Index
Empathetic Concern
25
20
15
10
18.5
20.6
22.6
19.9
5
0
Pre-MBM
Males (n=24)
Post-MBM
Females (n=47)
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 curriculum
Responsibility, 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 Students
Hakima Amri, PhD
Kristi Graves, PhD
Aviad Haramati, PhD
Michael Lumpkin, PhD
Mary Ann Dutton, PhD
Claire Gross, M’13
Nancy Harazduk, MSW, MEd
Kevin Motz, M’13
Meredith Riddle, MS ’09
Pamela Saunders, PhD
Supported by grants from NCCAM and the Institute for Integrative Health
Intervention
An 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
140
120
109
102 107
100
80
116 118 119
82
60
40
20
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
0
Source: Liaison Commission on Medical Education
Graduation Questionnaire Data
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
1999
2000
2001
Inadequate
2002
2003
2004
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 mindbody 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”