Integrative Medicine in Residency Education: Developing Competency Through Online Curriculum Training

Journal of graduate medical education 03/2012; 4(1):76-82. DOI: 10.4300/JGME-04-01-30
Source: PubMed


The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education.
The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings.
TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments.
The class of 2011 (n = 61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses.
The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.

Download full-text


Available from: Tieraona Low Dog, Feb 03, 2014
  • Source
    • "Based on the growing use of complementary and alternative medical (CAM) therapies by the American public, a growing number of academic health centers have developed training programs in integrative medicine [1] [2] [3]. Specific competencies for physicians practicing integrative medicine have been identified [4] [5] [6] [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Training in integrative medicine aims to promote compassionate, patient-centered care, including non-pharmaceutical therapies to reduce common symptoms. Although specific competencies have been identified, few tools are available to assess clinician confidence in providing integrative care. We evaluated two instruments to address this gap. Methods: We assessed face validity with focus groups. We assessed internal reliability (Cronbach's alpha) and convergent validity in a survey of 213 health professionals, correlating the new instruments to each other and to standard measures of mindfulness, compassion, empathy, training, and practice. Results: The two measures each had 10 items with scores ranging from 0 to 100, and had good face validity. Cronbach's alpha was 0.87 for the calm, compassionate care scale (CCCS) and 0.95 for self-efficacy in providing non-drug therapies to relieve common symptoms (SEND). Scores for CCCS were significantly correlated with measures of mindfulness, compassion, empathic concern, and perspective-taking as well as training and practice (. p<. 0.05 for each). Scores for SEND were similarly correlated with CCCS, compassion, empathic concern, and perspective-taking as well as training and practice (. p<. 0.05 for each). Conclusion: These two new tools, CCCS and SEND, have good psychometric properties and may be useful to educators and researchers evaluating clinicians' confidence in providing calm, compassionate care and self-efficacy in using non-drug therapies to relieve common symptoms.
    European Journal of Integrative Medicine 10/2014; 7(4). DOI:10.1016/j.eujim.2014.10.010 · 0.78 Impact Factor
  • Source
    • "In the field of postgraduate medical training (PGMT) an increasing need is articulated to include some forms of IM [17], but so far little has been done to evaluate PGMT in IM except for an internet-based on-line IM training program implemented in family residency programs in the United States [18]. In Germany and Switzerland some CON hospitals offer forms of CAM [19,20] and some of these take part in PGMT. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. Methods An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05. Results Return rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach’s alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. Conclusion The lower quality of PGMT in German hospitals can be attributed to larger departments, more difficult working conditions, and less favorable structural features for PGMT in AM, possibly also in relation to increased financial pressure.
    BMC Complementary and Alternative Medicine 06/2014; 14(1):191. DOI:10.1186/1472-6882-14-191 · 2.02 Impact Factor
  • Source
    • "Successful implementation of interdisciplinary education and training programs will require a high level of collaboration between relevant academic centers, professional societies and clinicians from a range of disciplines. The successful implementation of an Integrative Medicine in Residency program demonstrates that it is possible to develop a rigorous training program in integrative medicine and import it into traditional residency curricula on a large scale [35]. Aside from university-based education, web-based education is an emerging application that may provide global education of IMH. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mental illness accounts for about one-third of adult disability globally, reflecting marked societal and personal suffering, and social and economic costs. This calls for change in the paradigm and practices of mental healthcare, including fundamental reforms in education, clinician-training, and research priorities. This White Paper outlines current challenges in mental healthcare, and characterizes the emerging field of integrative mental health (IMH), a critical element in the large-scale changes needed to transform mental healthcare in the 21st century. Strategic recommendations for advancing IMH are outlined including increasing research in key areas, improving clinician training and education, and promoting a public health agenda. The field of IMH adopts the bio-psycho-socio-spiritual model, utilizing evidence-based & evidence-guided treatments from both traditional healing and modern scientific practices. IMH incorporates mainstream interventions including the judicious use of psychopharmacology, psychosocial therapies, evidence-based complementary and alternative (CAM) medicines and therapies, meditation, in addition to health-promoting lifestyle changes. The clinical application of IMH takes into account the range of socio-cultural, economic and spiritual considerations affecting mental healthcare in different countries. To meet the challenges facing mental healthcare, the International Network of Integrative Mental Health (INIMH: ) was established in 2010 with the objective of creating an international organization consisting of clinicians, researchers, and public health advocates. INIMH was created to advance a global agenda for research, education and the clinical practice of evidence-based integrative mental healthcare. In authoring this White Paper the board of INIMH is inviting global dialog on critical issues surrounding mental health care in the hope of achieving integrated, compassionate, individualized, person-centered mental healthcare.
Show more