During a beautiful warm and sunny week of May, the first-year class of the University of Minnesota School of Medicine took its spring finals. Most of us got maybe ten hours of sleep during the week, as we studied for exams in physiology and microbiology, subjects deemed necessary to become "good physicians."
It's important, of course, to learn about human physiology, but I'm afraid many medical students finish medical school more tired than inspired. They go into medicine with a desire to heal and help others, but the demands of the curriculum are so overwhelming that they lose sight of their sense of calling. They become part of the dominant biomedical model--a system good at identifying and curing physiological pathologies but less adept at seeing the whole person. To truly heal and help others, medical students need a more wholistic kind of training.
Thankfully, students in approximately 42 schools around the country have the option to learn about complementary and alternative medical approaches, according to Mark Wenneker, the American Medical Student Association's Liaison to the Office of Alternative Medicine (OAM) at the National Institutes of Health (NIH). Classes taught in medical schools like Georgetown and Harvard offer unique perspectives to not only patient health care but also to students' self-care.
But should medical students be taught about complementary practices? And what should they be taught? These questions and many more were addressed at the National Conference on Medical and Nursing Education in Complementary Medicine held by the OAM and the Uniformed Services University of the Health Sciences (USUHS), June 5-7.
The conference established a blue ribbon panel which was charged with answering questions regarding complementary and alternative medicine (CAM) in medical and nursing education. The panel, chaired by Alan Neims, dean of the University of South Florida School of Medicine, included deans of several medical and nursing schools, representatives of the American Medical Association and the Association of American Medical Colleges, and experts in medical and nursing education as well as medical and nursing students. In addition to the panel, the conference was attended by about 150 participants and another 20 presenters.
As the presenters revealed, integration of complementary medicine varies widely, from teaching about CAM in survey courses to integrating the principles and philosophy of complementary and alternative medicine into all four years of medical training. Education models from different countries, including Australia, Korea, China, Germany and the UK, demonstrated how far ahead of the U.S. some countries are in integrating alternative practices: in Germany, for example, medical students must complete courses in herbalism and homeopathy in order to graduate.
Presenters and participants entered into a lively debate on the difference between presenting alternative techniques and presenting the philosophy behind the techniques to students. This segued into a discussion about shifting the paradigms of education from a biomedical approach to a holistic healing approach.
With the information from presenters, participants went into networking sessions which led to the development of key points which were given to the blue-ribbon panel to direct their recommendations. The networking sessions gave participants a chance to see what other schools around the country were facing and set up networks for curriculum and information exchange. The Center for Mind-Body Medicine's Director James S. Gordon, M.D., who over fourteen years has developed a comprehensive program of mind-body medicine at Georgetown University Medical School, co-chaired one such networking session with Pali Delavitt, an educator at . Dr. Gordon shared the process by which courses on alternative medicine were incorporated into the curriculum at Georgetown.
"It was enormously exciting for teachers and students to have an opportunity to make medical students aware of these approaches," said Dr. Gordon. "We shared strategies on making scientific studies available--through grand rounds, guest lectures, scientific symposia, etc. And we explained the need to make the mind-body approach a living part of each student's experience--through self-awareness, meditation, exercise and nutritious meals--as well as academic input."
On the final morning, the blue ribbon panel made these recommendations:
(1) Medical and nursing education should include information about complementary practices. The panel proposed a number of instructional formats including didactic and experiential learning opportunities, continuing education courses, faculty development programs, self-learning through enhanced access to electronic and print resources, and comprehensive databases.
(2) Medical and nursing education about each complementary practice should include information about the discipline's philosophical/spiritual paradigm, scientific foundation, educational preparation, practice, and evidence of efficacy and safety.
(3) National centers of excellence should continue to be developed to foster collaboration among complementary practitioners, nurses, and physicians and to promote synergy among education, research, and clinical practice.
The recommendations ended with a statement that the goals of the proposed educational programs should be the cultivation of open-mindedness, increased awareness, and respectful communication among physicians, nurses, patients, and complementary practitioners. According to Wayne Jonas, director of the OAM, these recommendations will be forwarded to organizations which affect curriculum and curriculum guidelines at educational institutions. A number of medical students in attendance suggested that the recommendations also be sent to the deans of medical schools.
The impact of these recommendations may not be seen at universities this year. Laura Vovan, national co-coordinator of the American Medical Student Association's holistic health task force, said she was disappointed that more deans from medical schools were not present. However, Mark Wenneker, who sat on the blue ribbon panel, said the impact will be felt over generations of medical students.
During the final hours of the conference, a discussion shifted to whether changes in curriculum would be evolutionary or revolutionary. As I start my final six weeks of my first year of medical school I feel a need for revolutionary change. The University of Minnesota School of Medicine offers no courses which step outside the biomedical paradigm. Even so, I believe it will take an evolutionary process to integrate CAM into medical education. The conference and the blue ribbon panel's recommendations are the first step in such a process. When this integration occurs, medical students will be better equipped to help and heal patients--and themselves.
Retu Saxeria is a first year medical student at the University of Minnesota School of Medicine and co-chair of the Student Committee on Holistic Health.