Developing a National Vision for Complementary and Alternative Medicine in Undergraduate Medical Education: a workshop report

1
Developing a National Vision for Complementary
and Alternative Medicine in Undergraduate Medical
Education a workshop report
Marja Verhoef, Michael Epstein, Michel Boivin,
Rebecca Brundin-Mather
Background

1. Curriculum Content

Several, but not all, medical schools in Canada
are taking steps to introduce education regarding
complementary and alternative medicine (CAM) into
their undergraduate medical education (UME)
curriculum. However, development has been slow.
To accelerate this process, a multi-phased
project called CAM in UME was initiated in
January 2002.1 Largely funded by Health Canada,
the series of small independent projects were all
aimed at collecting as much information as
possible about the potential role of CAM in
Canadian UME programs.
A topic-based approach was used to organize the
proposed CAM content. CAM topics were organized
under two primary, but not mutually exclusive
headings, CAM in General and CAM Products and
Practices.
Many participants stressed adding First Nations
Health Systems as a practice area, particularly
given the demographic composition and existing
partnerships in some regions.
In general, participants favoured giving more
time and more detailed consideration in the
curriculum to CAM modalities that are
CAM in General
Participants agreed that the following seven
general CAM topics should be considered for
inclusion in a curriculum, with varying degrees
of emphasis

• Widely used (variation by region or cultural
  demographics)
• Relatively easy to include in the curriculum
  (i.e., fits biomedical model)
• Supported by an evidence-base and
• Established in terms of education, training, and
  regulation.

The results of these projects clearly pointed to
the need for representatives from all Canadian
medical schools to get together to not only share
their schools experiences and ideas about CAM in
UME, but also to begin collaborating on the
development of a CAM curriculum.

1. Curriculum Implementation

The Saskatoon Workshop
CAM Products and Practices
The overarching challenge is how to implement CAM
education into existing undergraduate programs.
During the workshop, participants reiterated
previous findings that medical schools can bring
CAM into UME through (1) a stand-alone course
(2) adding or integrating CAM into existing
curriculum or (3) a mixed model that combines
strategies one and two.
As an initial step in this national effort, a
2-day invitational workshop was held in September
2003 in Saskatoon, SK. The 26 participants
included faculty from 14 of the 16 Canadian
medical schools, a representative from the
Canadian Federation of Medical Students, a second
medical student, two CAM practitioners, and
representatives of the funding organizations.
Table 1 presents participant ratings of the
importance of teaching nine proposed
product/practice areas in UME. Natural Health
Products (NHPs) was the highest rated category
with 19 of 20 participants rating it a five.
Expressive Therapies had the lowest mean rating,
with almost half the participants rating it a one
or a two.
Within the context of these approaches, some of
the more salient participant comments included
Three areas were addressed during the workshop
(1) a rationale for introducing CAM education
into UME programs (2) potential curriculum
content and (3) potential strategies to
facilitate implementing CAM education.
Table 1 Frequency of participant ratings of the
importance of teaching selected CAM practices or
products in a UME program.

• Recognize barriers to CAM integration (e.g.,
  faculty buy in, valid teaching resources,
  curriculum time, expert instructors, etc.)
• Find a champion with access to opinion leaders or
  decision makers
• Tailor CAM material to host courses in curriculum
• Work with individual faculty to develop
  appropriate curricula
• Become involved in the overall development of UME
  curriculum
• Obtain support from medical students

1 (not impt) 2 3 4 5 (impt)
NHP (20) 1 19 4.95
Trad. Chinese Med. (20) 1 2 3 14 4.50
Chiropractic (20) 3 5 12 4.45
Naturopathy (19) 4 4 11 4.37
Homeopathy (20) 2 2 6 10 4.20
Mind-Body (19) 1 1 3 6 7 3.94
Therapeutic Bodywork (20) 1 1 4 7 7 3.90
Energy Therapies (16) 2 2 6 6 3.87
Expressive Therapies (18) 3 5 6 2 2 2.72

1. Rationale

Participants drafted a statement of rationale for
CAM in UME that reflects the current emphasis on
patient-centred health care and interdisciplinary
health care.
Conclusion
To prepare physicians to practice health care in
an environment where CAM is used by their
patients and where there is a potential for
interactions among therapies.
National efforts to develop a CAM curriculum that
is appropriate for introduction into Canadian
medical schools continues to progress. The
proposed curriculum will address CAM-related
issues of greatest significance to physicians
practicing in Canada, and will be sufficiently
flexible to accommodate the differing needs and
circumstances of individual medical schools.
Phase 1 Program scan of faculty and medical
students at Universities of Calgary,
Saskatchewan, and Manitoba interviews with
Associate Deans UME ½ day workshop with
Associate Deans UME at the 2002 ACMC meeting.
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University of Calgary University of
Saskatchewan Université de Montréal
Phase 2 Review of international literature on
CAM in medical education Review of Canadian
medical licensing polices addressing CAM
comparative profiles of current CAM education in
Canadian medical schools (through interviews with
faculty and medical students in each school)
National 2-day invitational workshop (bound
report available from Dr. Marja Verhoef at
mverhoef_at_ucalgary.ca)