Medical schools adapting to reality and accounting for alternative medicine
According to a study conducted by the U.S. Center for Disease Control and Prevention (CDC) in 2007, more than 38% of Americans currently use some form of complementary or alternative medicine. But what exactly is complementary/alternative medicine (CAM), and what does that mean for traditional health care providers?
The National Institutes of Health (NIH) has defined complementary and alternative medicine as “a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional medicine.” Examples of complementary and alternative medicine can include things like chiropractic treatments, massage therapy, naturopathic therapies, acupuncture, Chinese herbal medicine, spiritual and wellness counseling, even art therapy. While traditional medicine has historically been resistant to alternative and complementary medicine treatments, there currently is a growing movement among conventional physicians called "integrative medicine" (IM). The goal of integrative medicine is to incorporate CAM more fully into conventional medicine practice, and also to build more cooperation among providers in an increasingly team-based health care delivery system.
“The increased recognition of the role CAM is playing in today’s health care system, and perhaps the dissatisfaction of both patients and health care providers with the current system, has led to growing interest in the concept of integrative medicine,” says Adam Perlman, MD, MPH, FACP and chair of the Institute for Complementary and Alternative Medicine at the University of Medicine and Dentistry of New Jersey’s School of Health-Related Professions.
While Dr. Perlman has been instrumental in helping to spread integrative medicine and CAM curricula across American medical schools (he also serves as Chair of the Consortium of Academic Health Centers for Integrative Medicine), he also emphasizes the importance of raising awareness of IM and CAM across all allied health care disciplines. “Medical schools are taking an interest in teaching integrative medicine and CAM, but it should be of interest to all health professions, not just MDs,” he says. “If you’re part of a health care team, whether you’re a nurse, a physical therapist, a counselor or clinician, then it’s relevant to your work to know about CAM. It’s also hard to have a dialogue with your fellow health care providers and patients about CAM without a basic understanding of which alternative treatments are effective, versus which are harmful.”
The University of Medicine and Dentistry of New Jersey offers a number of different CAM-related course options, including courses on mind-body medicine, integrative treatments for chronic conditions and a CAM survey course. Dr. Perlman emphasizes that integrative medicine can also include aspects of the doctor-patient relationship, such as cultural competency.
Karen L. Lawson, MD, is Director of Health Coaching at University of Minnesota’s Center for Spirituality and Healing, part of the Academic Health Center which also contains the university’s medical school. “Since 2002, I have worked with the leadership in the medical school to integrate information into the medical curriculum, both in required and elective formats,” says Dr. Lawson. “Required lectures have included the areas of Spirituality and Medicine; Comparative Systems of Medicine (including traditional Chinese and Ayurvedic medicine); Manual Therapies (including Chiropractic, Osteopathic medicine and massage therapy); homeopathy and energetic therapies; and the evidence base for integrative medicine.” The Center for Spirituality is also one of over 70 U.S. schools to offer medical students a 15-hour elective course for first- and second-year medical students called "The Healer’s Art," which focuses on the meaning of medicine as well as the student’s emotional and spiritual experience of medical training and practice.
Why should issues of spirituality be of interest to medical students? “I believe and hope that someday we won’t have to use words like 'integrated' or 'holistic' when we speak of medicine, because these modifiers will describe ALL good health care,” Dr. Lawson says.
Other medical schools are including integrative and alternative medicine disciplines into their program offerings in unique ways. For example, the Eastern Virginia Medical School in Norfolk, Va. is currently the only medical school in the United States to house a graduate art therapy and counseling program under its roof.
“Art therapy is a relatively new clinical specialty,” says Abby Calisch, PsyD, LPC, ATR-BC, director and professor of Eastern Virginia Medical School’s graduate art therapy and counseling program. “We were not officially designated as a degreed clinical specialty until 1968, and the specialty was not well-known until quite recently,” says Dr. Calisch. “But in recent years, there has been quite a bit of research that quantitatively measures the medical and psychological benefits of art therapy. The arts stimulate many parts of the brain simultaneously, and that can have wide-reaching effects on a variety of health conditions.”
Dr. Calisch explains that while art therapy can trace its origins to the mental health sphere, you can now find art therapists working with patients in all areas of the hospital and community. “Back when I was on staff at Michael Reese Hospital in Chicago, a typical day would have me working with kids who were in for routine tonsillectomies, to psychiatric patients, to terminally ill patients,” she says. While Dr. Calisch’s own students are studying to become master’s-level art therapists, and not medical students, they do work alongside medical students and physicians during their studies. “Our art therapy program students have been fully integrated into the medical students’ psychiatric rotations, as well as the psychiatric internship and residency programs at our affiliate hospitals,” says Dr. Calisch. “They do rounds, charting, present cases and participate in treatment recommendations with the medical students and physicians-in-training.”
While medical schools are increasingly open to including CAM and IM in their curricula, medical education does not stop with medical school. Physicians and other allied health clinicians in all 50 states are required to complete a certain number of continuing medical education (CME) hours each year in order to maintain their licensing and board certifications, and CME course offerings are also incorporating more CAM and IM-related content. Dr. Richard Freishtat, PhD, oversees educational programming and faculty matters at the Institute for Integrative Medicine, a company that offers certification programs and CME courses relating to integrative medicine. “We offer courses and certificate programs to physicians and a number of allied health specialties,” says Dr. Freishtat. “Our students include MDs and DOs as well as chiropractors, dieticians, nurses, naturopaths and many others. One of our core principles is the integration of multiple clinical specialties, so that they can all understand and see the value of one another.”
Dr. Freishtat emphasizes that all the CME content his company offers is scientifically rigorous. “All of our content is evidence-based, and embedded into conventional medicine subject areas, such as functional neurology, infectious disease, primary care, etc.,” he says. “And our existence is really consumer-driven. The American public is gravitating towards complementary and alternative medicine in a big way, and conventional medicine needs to be educated about it if it’s going to respond and become fully integrated with the alternative providers.”
