Purpose: The number of U.S. medical schools offering courses in complementary and alternative medicine (CAM) has risen sharply in recent years. This study gauged the current state of CAM instruction by gathering details about the specific topics being taught and the objectives behind the instruction.
Method: Data were collected from questionnaires mailed to 123 CAM course directors at 74 U.S. medical schools.
Results: Questionnaires were returned by 73 course directors at 53 schools. The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). The amounts of instructional time devoted to individual CAM topics varied widely, but most received about two contact hours. The typical CAM course was sponsored by a clinical department as an elective, was most likely to be taught in the first or fourth year of medical school, and had fewer than 20 contact hours of instruction. Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribes of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness.
Conclusion: A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.
Complementary and alternative medicine (CAM) encompasses a bewildering array of healing philosophies, beliefs, and practices with little in common except for their unorthodox nature. The National Center for Complementary and Alternative Medicine at the National Institutes of Health (NIH) defines CAM as those treatments and healthcare practices not widely taught in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.1 Some CAM practices are consonant with accepted biomedical theory and have demonstrated therapeutic value under controlled testing procedures (e.g., certain herbal remedies),2 whereas others have a more dubious theoretical basis whose healing benefits have been called into question (e.g., therapeutic touch).3
The public's embrace of these unconventional therapies is shown by recent studies of health care utilization patterns.4,5,6 Eisenberg et al.5 estimated that 42% of Americans used some form of unconventional therapy in 1997, for which they were willing to pay $27 billion in out-of-pocket expenses. From 1990 to 1997, the number of visits to CAM practitioners increased from 427 million to 629 million, which exceeded the total number of visits to all primary care physicians in the United States.5 Those who seek unconventional therapies appear to do so because they find them more in line with their own values, beliefs, and philosophical orientations toward health and disease.6 Clearly, CAM is offering something that many patients want but are not getting from conventional medical services.
The growing popularity of CAM is beginning to have an impact on medical education. In their 1997-1998 survey of all 125 U.S. medical schools, Wetzel et al.7 found that 64% of the 117 responding schools were teaching CAM topics either as stand-alone elective courses or as part of required courses. This is almost twice the number of institutions found offering CAM instruction in a 1995 survey (34% of 97 responding schools),8 which underscores the rapid acceptance of unconventional therapies in U.S. medical schools. Canadian medical schools have likewise incorporated CAM into their curricula-as of 1998, 81% were teaching CAM topics.9
Collectively, these surveys indicate that CAM has established a significant presence in the undergraduate medical curriculum. However, they provide few details about what is being taught, the amount of time devoted to specific topics, or the intent of such training (i.e., general background information versus application of specific therapies). Of particular interest is whether CAM topics are being presented in the context of uncritical advocacy or scientific evidence of therapeutic value.
We assessed the current state of CAM instruction in U.S. medical schools, with a particular emphasis on the issues raised above. To do so, we contacted individuals from a published listing of CAM course directors affiliated with medical schools accredited by the Liaison Committee on Medical Education (LCME)10 and requested information about the courses they taught. This enabled us to obtain more detailed information about course specifics than was reported in previous surveys.7,8