Alternative Medicine. Should it be required in. Medical School Curriculum? Lawrence G. Smith, M.D. introduction to clinical medicine. Two week vacation or …
Complementary and Alternative Medicine
Should it be required in Medical School Curriculum? Lawrence G Smith, MD Dean for Medical Education Mount Sinai School of Medicine
What is CAM?
Alternative therapies that are neither taught widely in US medical schools nor generally available in US hospitals
Common Areas of CAM
Touch/massage Relaxation/mediation mind/body medicine Prayer Herbal remedies Acupuncture other cultural healing systems Diet/nutrition Homeopathy, naturopathy
Why now?
Large patient use Billion dollar industry Public empowerment as patients NCCAM Unintentional Validation Developing evidence based data
Integrative medicine Rising number of patients with chronic disease Dissatisfaction with traditional medicine Third party reimbursement
Are CAM Therapies Becoming Mainstream?
Massage Acupuncture Herbals Chiropractic Podiatry Meditation/Relaxation
Have Some CAM Always Been Mainstream?
Diet/nutrition Exercise Prayer/meditation Stress reduction
Micronutrients/vitamins
Are There Evidence-Based Categories of Therapy?
Proven effective Unproven with strong biological rationale or strong observational evidence Unproven, no biological rationale, only anecdotes Unproven, untestable, requires belief Proven ineffective Proven harmful
Why The Intense Emotion and Acrimony in the Debate?
Physicians CAM practitioners are frauds with worthless or dangerous treatments pushed on the vulnerable, ill-informed and desperately ill CAM Practitioner Doctors only treat diseases, not people, with painful therapies, harmful drugs and regimens and never go to the root causes
Patients Perception of CAM
Patient centered Safe Natural Focus on prevention and Health Worth trying when conventional treatments fail
Medical School Curriculum Gridlock
Overfilled — no time for any new material every Course Directors wants more time Cannot teach the core science of medicine Shorter, more superficial curriculum rotations Every good idea or politically
correct topic becomes mandatory For every new topic something must be removed
New Curriculum Initiatives
Active learning Patient/case centered Concept focused Varied pedagogy EBM Problems in context [patient, culture, society, etc] Life Long Learning
Year One Courses
Intro to Emergency Medicine
Embryology
The Art and Science of Medicine I Molecules and Cells Gross Anatomy Histology Physiology Pathology PMHD
BENCH TO BEDSIDE SELECTIVE: CLINICAL OR RESEARCH
Medical Epidemiology
Aug 2003
Sept
Oct
Nov
Dec
Jan
Feb
March
April
May
June 2004
Year Two Courses
The Art and Science of Medicine II Pharmacology
Brain Behavior / Psychopathology Systems Based Pathophysiology Genetics Musculoskeletal Cardiovascular
Dermatology
ASM II CSA - COMPASS I
Blood Liver-GI
Endocrine Gyn-Breast
Pulmonary Renal-GU
Sept 2003
Oct
Nov
Dec
Jan
Feb
March
April
May 2004
Third Year Modules
12 weeks per module
A B C D
Pediatrics In-Pt Med In-Pt Med OB/GYN Out-Pt Geri Psych Elective
Fam Med
Surgery Neuro/Anes
Third Year Schedule
Module Period Module Period 2 1 Module Period 3 Module Period 4
One week introduction to clinical medicine Two week vacation or elective One week intersession
Year Four Individually Designed
Emergency Medicine Subinternship-Medicine or Pediatrics Critical Care/Physiology Surgical Specialties Medical Specialties Radiology/Anatomy Travel-Interviews and experiences Electives-here, there and everywhere
Great New Ideas That Must Be Taught Learned?
New biology molecular medicine diagnostics Genetics Geriatrics Nutrition Cultural competency EBM Substance Abuse
Great New Ideas That Must Be Taught Learned?
Gender specific medicine Family violence CAM Medical practice Health financing Law and Medicine Personal finance management Transplantation medicine
Great New Ideas That Must Be Taught Learned?
Emerging infections Disaster medicine Global Health Professionalism Bedside ultrasound Bariatrics Physical therapy
Areas Inadequacy
Taught No Time
Orthopedics Ophthalmology, otolaryngology Muscle physiology/exercise Drug therapies Molecular/Cancer genetics Neurology, Pediatrics
Areas Inadequacy Taught No Time
Nutrition Law and Medicine Dermatology Advanced physical diagnosis Rehabilitation medicine Population medicine
From The Perspective of the Person In-charge of the Curriculum
Should CAM be required in medical school curriculum? How much? What depth? Compared with what else? What should be eliminated? Where in the curriculum? In what context? Taught by whom? Why required vs elective?
Positive of Required CAM
Patient focused care Culturally respectful/competent Integrative Medicine Focus Understand patient perspective of illness Enhanced history taking/patient rapport skills Understand effective CAM therapies
Positive of Required CAM
Integrative Medicine Perspective
Avoid harm to patients Understand other core beliefs of health Regional variations of CAM Better understand patients needs Extend core
science to explain or hypothesize mechanisms of CAM effects
Positive of Required CAM
Integrative Medicine Perspective
Use EBM skills Incorporate proven therapies into medical practice Enhance intellectual curiosity Participate in the research/clinical possibilities with increased funding Target for philanthropy
Negatives of Required CAM
Grant unintended credibility to CAM May conflict with scientific/evidence-based approach to teaching Hostile faculty Lack of good teachers Preaching not teaching Curricular time constraints
Final Recommendations
Should be both required and elective Taught in the context of the patient, illness, and culture Learn to use resources on issues of CAM Should not be given unintentional scientific validity Taught with respect and inquisitiveness Open minded, yet rigorous approach
Final Recommendations
Integrative medicine should not evoke negative emotions Respectfulness is a key professional attitude Open dialogue benefits all Being non-judgmental is
fundamental to effective doctoring It is all about the best care of the patient
Source:iom.edu
