Haramati, Aviad PhD; Elder, William PhD; Heitkemper, Margaret RN, PhD; Warber, Sara MD
Dr. Haramati is professor of physiology and medicine, Georgetown University School of Medicine, Washington, D.C. He also served as the guest editor for the articles about CAM education that appear in this issue of Academic Medicine.
Dr. Elder is associate professor, Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.
Dr. Heitkemper is professor of nursing, University of Washington School of Nursing, Seattle, Washington.
Dr. Warber is assistant professor, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Disclaimer: The conclusions and opinions expressed are those of the authors and do not represent the positions or policies of NCCAM, the NIH, or the Department of Health and Human Services.
In the June 2000 issue of Academic Medicine, the late Stephen E. Straus, MD, first director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), discussed the challenges and opportunities for academic medicine with regard to complementary and alternative medicine (CAM).1 Specifically, he called for a strategic partnership between NCCAM and academic medicine to develop health education curricula that respect the art of healing from various traditions, while emphasizing the need to base treatment decisions upon rigorous evidence. In the accompanying editorial, Jordan J. Cohen, MD, then president of the Association of American Medical Colleges (AAMC), agreed that students
must have sufficient knowledge of the commonly employed alternative remedies to counsel patients about those that are harmful, those that might interact adversely with prescribed medications, those that are harmless and can be used with impunity, and those that have been shown to be beneficial.2
Dr. Straus bolstered his call to action by having NCCAM release a program announcement (for R25 grants) entitled “Complementary and Alternative Medicine (CAM) Education Project Grant,” which had as its goal to support the incorporation of CAM information into allopathic health professions schools’ curricula at the undergraduate, graduate, and continuing education levels. Between the years 2000–2003, NCCAM funded 15 grants to medical and nursing schools and the American Medical Student Association. Fourteen of the grants were funded for five years, and one grant was funded for three years.
Since the funding began, the principal investigators and their key colleagues have met yearly in Bethesda, Maryland, to report on the progress of the projects and share both successes and challenges. There were lessons to be learned regarding the best ways to determine what CAM information ought to be taught and how best to incorporate the material into the various curricula. The project directors also began to understand first-hand the importance of “experiential learning” and how this initiative in CAM could actually advance broader goals in medical and nursing education, such as enhanced evidenced-based practice, improved patient–provider communication, and heightened student and faculty self-awareness and self-care.
In discussing how best to disseminate and publish the insights gained from these projects, the principal investigators decided not to focus on each institution or project independently, but, instead, to look for central themes that affected more than one institution or project. Individuals involved in the various programs were invited to join in writing the articles, and the authors of this Preface, along with Dr. Nancy Pearson, the NCCAM Program Officer for this CAM Education Program, were selected by the principal investigators to serve as the editorial group to coordinate and review the submissions to Academic Medicine.
In the following series of articles, various aspects of the CAM education projects are described and analyzed. In the first article, Pearson and Chesney provide the historical context for NCCAM’s program announcement and outline the intended goals of the program—some of which were exceeded—as well as challenges that lie ahead. Gaylord and Mann address the question “Why educate health professionals about CAM?” and outline a number of rationales for developing such educational programs in conventional curricula.
One of the major challenges facing the project leaders was to determine what students should learn about CAM and how to find high-quality information about this field. To that end, Barak and colleagues summarize a number of key principles used by the NCCAM-funded educational programs to select appropriate CAM content and develop CAM coursework that form the basis for achieving CAM competencies.
Turning to the processes by which these programs were implemented, Lee and colleagues discuss the range of organizational and instructional strategies that were used at the NCCAM-funded institutions. Successful programs relied on the engagement of key faculty leaders and provided a range of faculty development activities. The most effective strategies for integration addressed a core curriculum need and used some form of an evidence-based framework. Sierpina and colleagues extend that discussion by reflecting on some of the lessons learned about how to create significant curricular change and by discussing the challenges and barriers to CAM education initiatives.
One of the more interesting outcomes from these initiatives has been the recognition that certain aspects of the “CAM curriculum” could be used to advance a medical education competency or goal. Perhaps the best example of this is reported by Elder and colleagues, who describe how student self-awareness and self-care can be fostered through different CAM curricular activities, didactic or experiential, that address personal biases in clinical interactions, personal health and wellness, or training in mind–body interventions.
The CAM educational projects faced many of the same challenges in assessment and evaluation as do those of the more conventional aspects of health professions education, such as specifying measurable objectives, identifying valid indicators, and evaluating the attainment of desired outcomes. In addition, there is a desire to ascertain to what extent these curricular initiatives result in changed behaviors on the part of health professionals and, more important, improved patient care. Stratton and colleagues address the evaluation aspect of the projects by identifying strengths and weaknesses of efforts to define and assess key learning outcomes in CAM, and by describing specific approaches that were used for the acquisition of CAM-related clinical skills. The authors also offer recommendations for more rigorous evaluation of CAM-relevant educational outcomes.
An important long-term goal of the NCCAM program was to accelerate the integration of CAM and conventional health care practices in an effort to improve patient care. This will often require collaboration and communication between health care professionals across disciplines. In the final article of the series, Nedrow and colleagues describe four examples of interdisciplinary collaborations between educators, schools, and practitioners that led to real benefits for all parties—most of all, the learners.
In reflecting on the CAM education projects, we see how several innovative models of education have been created through the investment of the NIH. Much has been learned, but, more important, the nature of the training of health professionals has been changed and improved by these projects. Our hope in compiling this collection of articles is that their descriptions of the types of approaches and strategies employed and the experiences gained will provide important lessons to all institutions and educational leaders contemplating similar initiatives.