Complementary medicine courses in Swiss medical schools: actual status and students' experience.

Abstract

In line with growing public popularity of complementary and alternative medicine (CAM), courses in CAM have been implemented in Medical Schools internationally, but as yet in an uncoordinated and heterogeneous way. In Switzerland, comprehensive data about CAM education at Medical Faculties are lacking.
To survey courses at Swiss Medical Schools, document medical students' attitude toward and knowledge of CAM and their experience of CAM courses at medical schools. The aim was to determine the relationship between the presence/absence of CAM courses at each medical school and students' attitude toward, knowledge of, and motivation to learn about CAM.
Data about current courses in CAM were collected from the websites of the five Swiss Medical Schools and from an online questionnaire addressed to the CAM teachers (n = 13). All Swiss senior medical students (n = 640) were surveyed by an anonymous online questionnaire.
There are two chairs for CAM in Bern and Zürich, CAM familiarisation courses are provided by external teachers in Basel and Lausanne, and there was no CAM education in Geneva. 38.3% of the senior medical students replied to the survey. 80.0% of the students who visited CAM courses stated that they have improved their knowledge of CAM. There was no relationship between the presence of CAM education and a significant elevation of the self-assessed knowledge of CAM of the students. CAM education has no significant influence on students' opinions about CAM, nor does it significantly motivate them to deepen their study of CAM. Form, frequency and content of CAM courses are similarly as heterogeneous as in other countries.
There is no coordination or standard for CAM courses in Swiss Medical Schools. Our results suggest an overall positive attitude toward and positive personal experiences with CAM of Swiss medical students', but a relationship between the absence or presence of CAM courses and students attitudes and knowledge could not be found. A coordinated policy towards the integration of CAM in medical curricula is strongly recommended.

Full text

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Peer reviewed article
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Original article
SWISS MED WKLY 2010;140(3–4):44–51 · www.smw.ch
Complementary medicine courses
in Swiss medical schools: actual status
and students’ experiences
Marie Nicolaoa, Martin G. Täuberb, Florica Mariana, Peter Heusserc
aInstitute of Complementary Medicine KIKOM, Faculty of Medicine, University of Bern, Switzerland
bInstitute of Infectious Diseases, Faculty of Medicine, University of Bern, Switzerland
cChair for Theory of Medicine, Integrative and Anthroposophic Medicine, Faculty of Medicine,
University of Witten/Herdecke, Germany
Summary
Background: In line with growing public popu-
larity of complementary and alternative medicine
(CAM), courses in CAM have been implemented
in Medical Schools internationally,but as yet in an
uncoordinated and heterogeneous way. In Swit-
zerland, comprehensive data about CAM educa-
tion at Medical Faculties are lacking.
Objectives: To survey courses at Swiss Medical
Schools, document medical students’ attitude to-
ward and knowledge of CAM and their experience
of CAM courses at medical schools. The aim was
to determine the relationship between the pres-
ence/absence of CAM courses at each medical
school and students’ attitude toward, knowledge
of, and motivation to learn about CAM.
Methods: Data about current courses in CAM
were collected from the websites of the five Swiss
Medical Schools and from an online questionnaire
addressed to the CAM teachers (n = 13).All Swiss
senior medical students (n = 640) were surveyed by
an anonymous online questionnaire.
Results:There are two chairs for CAM in Bern
and Zürich, CAM familiarisation courses are pro-
vided by external teachers in Basel and Lausanne,
and there was no CAM education in Geneva.
38.3% of the senior medical students replied to
the survey. 80.0% of the students who visited
CAM courses stated that they have improved their
knowledge of CAM. There was no relationship
between the presence of CAM education and a
significant elevation of the self-assessed knowl-
edge of CAM of the students.CAM education has
no significant influence on students’ opinions
about CAM, nor does it significantly motivate
them to deepen their study of CAM. Form, fre-
quency and content of CAM courses are similarly
as heterogeneous as in other countries.
Conclusions: There is no coordination or stan-
dard for CAM courses in Swiss Medical Schools.
Our results suggest an overall positive attitude
toward and positive personal experiences with
CAM of Swiss medical students’, but a relation-
ship between the absence or presence of CAM
courses and students attitudes and knowledge
could not be found.A coordinated policy towards
the integration of CAM in medical curricula is
strongly recommended.
Key words: medical education; undergraduate
medical curriculum; complementary and alternative
medicine
No external funding
was provided.
Introduction
Complementary and alternative medicine
(CAM) consists of a mixture of various methods,
whose mode of action and effectiveness are, in
part, still a matter of intensive debate [1–4]. This
situation, as well as growing popularity and in-
creasing use of CAM in many countries, makes it
necessary for physicians to be knowledgeable
about CAM.This has led to a gradual integration
of CAM courses into medical school curricula [5].
By 2003, 83% of US primary care medical school
faculties had offered CAM courses within primary
care curricula [6].At least 40% of European Med-
ical Schools offer courses involving CAM [7, 8].
Most medical schools in the UK offer CAM famil-
iarisation courses [9]. In Germany, CAM has be-
come a required subject for all medical schools
since 2003 [10].CAM is also very popular in Swit-
zerland. Two chairs for CAM were created upon
popular demand at the Universities of Zürich
(1994) and Bern (1995). In May 2009, a public

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SWISS MED WKLY 2010;140(3–4):44–51 · www.smw.ch
vote was held in which 67% of the national popu-
lation voted for the formal consideration of CAM
in the national constitution.
Surveys assessing the status, prevalence, and
diversity of CAM education in medical schools are
available for the US, Canada, Australia, Japan, Is-
rael, UK, Germany, and other countries. Collec-
tively, these surveys indicate that CAM has estab-
lished a significant presence in undergraduate
medical curricula [7, 8, 10–15]. Surveys gauging
students’ attitudes toward, knowledge of and in-
terest in learning more about CAM in several
countries unanimously show positive attitudes to-
wards, and a high level of desire to learn about,
CAM in medical schools [16–24]. In Switzerland,
such data as well as a meaningful educational pol-
icy in this respect are completely lacking on a na-
tional level. Only one survey by the University of
Geneva exists, showing that 64% of medical stu-
dents wanted to have CAM training at medical
school [25].For this reason,we decided to conduct
a national survey with the aim to investigate
whether and how CAM is integrated into the
medical curricula in Switzerland and to document
medical students’ attitudes toward, experiences
with, knowledge of, and desire to learn about
CAM.
Methods
Current CAM education at Swiss Medical Schools
Information on CAM teachers and courses in the
curricula was collected from the websites of the five Swiss
Medical Schools between October 2006 and January
2007. Then, an online questionnaire gathering details
about the specific CAM disciplines being taught and the
format of the courses was developed and submitted to
CAM teachers of the Swiss Medical Schools (n = 13).
These teachers where found through the websites of the
medical faculties and information obtained from the
deans, who were directly contacted by mail.The purpose
of this questionnaire was to complete the data collected
from the websites, with the aim to obtain a full and reli-
able description of CAM education in Switzerland. The
results were discussed in a descriptive analysis and inter-
preted with a qualitative approach.
Medical students’ survey
We chose sixth year students to ensure,in the univer-
sities with CAM options, that students had completed
CAM courses before answering the questionnaire. After
referring to a possible previous personal use, the ques-
tionnaire encompassed five questions which were sampled
and adopted from earlier studies [16, 17, 19–21, 24]. The
following question and answer formats were used: Ques-
tion 1: “How was your personal experience with the fol-
lowing CAM disciplines?”, click “positive”, “indifferent”,
“negative”, or “no experience” for these disciplines: acu-
puncture and Traditional Chinese Medicine (TCM), an-
throposophy, ayurveda, homeopathy, naturopathy and
phytotherapy (these disciplines figured on the websites of
the Swiss universities offering CAM courses and are the
most frequently applied CAM disciplines by physicians in
Switzerland). Question 2: “What is your opinion about
the effectiveness of the following disciplines?”, click “ef-
fective”, “rather effective”, “rather ineffective”, or “inef-
fective”for disciplines as in question 1.Question 3:“How
is your self-assessed knowledge of the following CAM
disciplines?”,click“could practise”,“could advise”,“heard
about”, or “don’t know” for disciplines as in question 1.
Question 4: “What is your opinion about the following
assertions?”, assertions as stated in table 8, click “strongly
agree”, “agree”, “disagree”, or “strongly disagree”. Ques-
tion 5 investigated exposure to CAM, prior to learning at
medical school with the question and answer format indi-
cated in table 9. As the questionnaire was designed to be
accepted by the server even if it was not complete, the
number of respondents (n) could vary in the same group
for the different items of one question.Therefore the re-
sults are presented in relative frequency tables (percent-
ages). For each question, the n-range (nmin–max) figures in
brackets under the header of each group of respondents.
The responses of the questionnaire were entered and an-
alysed using OpenEpi Version 2 open source calculator.
Absolute frequencies of responses to each item of each
question were tabulated separately and compared be-
tween the different groups of respondents in R by C ta-
bles. Chi squares, degrees of freedom, and p-values were
calculated to identify statistically significant differences
between the groups of students.
The survey among CAM teachers and students was
performed from February to June 2007 with permission
from the five medical faculties. The teachers received a
letter,and the students an e-mail,that explained the study
together with a request for them to participate by com-
pleting the online questionnaires. As the questionnaires
were anonymous, we sent two follow-up e-mails to all
respondents providing the updated status and the re-
sponse rate of our study and asking those who had not yet
answered to do so.
Results
CAM teachers and courses at Swiss Medical
Schools
On the websites, we found that CAM courses
were offered at the medical schools in Bern,
Lausanne and Zürich. Basel and Geneva did not
mention CAM or any CAM discipline. We then
contacted all 13 CAM teachers with formal CAM
teachingassignments,whowerefoundbytheinter-
net or who were mentioned by deans: four in Bern,
three in Zürich and six in Lausanne. Replies were
received from 10 (76.9%) teachers. The qualifica-
tions of the CAM teachers reported are depicted in
table 1, and the structure, content and form of
CAM courses are depicted in tables 2 and 3.

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Complementary medicine in Swiss medical schools
Table 1
Qualifications of CAM teachers.
Qualifications of CAM teachersBern ZürichLausanne
yesno yesno yesno
Physicians practicing CAM402030
Physicians practicing conventional medicine221130
Representatives of societies of physicians using CAM401102
Non-medical health professionals practicing CAM041111
Researchers in the field of CAM402011
Researchers in the field of conventional medicine222002
Physicians practicing CAM and conventional physicians
in a debate
Others
221120
131120
Table 3
Content and form of CAM education at Swiss Medical Schools*.
ContentBern
Acupuncture/TCM° Yes
Anthroposophy Yes
Ayurveda No
Homeopathy Yes
NaturopathyNo
Neural therapy Yes
Phytotherapy No
OthersNo
Zürich
yes
yes
no
no
yes
no
yes
no
Lausanne
yes
yes
yes
yes
no
no
no
popular medicine,
osteopathy, healing
Lausanne
no
yes
no
yes
no
yes
yes
no
yes
no
no
yes
no
Basel
no
yes
no
no
no
no
no
no
Form
Required
Elective
Preclinical years
Clinical years
ECTS-credits
Faculty lectures
Seminars
Problem-based
Patient presentation
Clerkship
With examination
CAM thesis
Public lectures
Bern
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Zürich
no
yes
yes
yes
no
yes
yes
yes
no
yes
no
yes
yes
Basel
no
yes
yes
yes
in project
in project
in project
no
in project
no
no
no
no
* There is no CAM education at Medical School of Geneva.
° TCM: Traditional Chinese Medicine.
At the Medical School of Bern, all four CAM
teachers responded to the questionnaire. The In-
stitute of Complementary Medicine (KIKOM:
Kollegiale Instanz für Komplementärmedizin) is
responsible for CAM education for the under-
graduate medical curriculum. Four disciplines are
covered: TCM and acupuncture, anthroposophic
medicine, homeopathy, and neural therapy. Most
courses are electives and most of these are credit-
rewarded.The teaching formats are lectures,sem-
inars, problem-based learning and patient presen-
tations.
At the Medical School of Zürich, two out of
three CAM teachers filled in the questionnaire.
The Institute of Naturopathy (Institut für Natur-
heilkunde), which is affiliated to the Department
of Internal Medicine, offers CAM courses during
Table 2
Structure of CAM courses at Swiss Medical Schools* in hours per year.
Medical
curriculum
1st year
BernZürichLausanne Basel
20 hours electives with 2 half-day practices110 hours lectures (also
for students of other
faculties who choose the
topic Naturopathy)
–4 hours lectures
2nd year
20 hours electives with 2 half-day practices
–
3rd year
20 hours elective with 2 half-day practices
4th year48 hours seminars (for students of all years) 12 hours lectures (familiarisation courses)In project: 72 hours courses
(elective,“learning with the
patient”)
5th year 8 hours lectures24 hours lectures; 16 hours seminars (also
for students of other faculties who choose
the topic TCM°)
6th year Clerkship 1 monthClerkship
* There is no CAM education at the Medical School of Geneva.
° TCM: Traditional Chinese Medicine.
the undergraduate medical curriculum.The disci-
plines are: TCM/acupuncture, anthroposophic
medicine, naturopathy and phytotherapy, taught
by lectures,problem-based learning and seminars.
All courses are electives and none of them are
credit-rewarded.
At the Medical School of Lausanne, four of the
six CAM teachers returned the questionnaire.Two
departments organise CAM courses: the Depart-
ment of Pharmacology andToxicology offers elec-
tive, non-credit-rewarded familiarisation courses
(lectures and patient presentations) in acupunc-
ture, anthroposophic medicine, homeopathy, ay-
urveda,osteopathy,healing and popular medicine,
and the Institute of History of Medicine and Pub-
lic Health gives elective,non-credit-rewarded lec-
tures and seminars on TCM.
Although the website of the Medical School of
Basel does not mention CAM, some CAM courses
are offered, as one of the Bern CAM teachers is
regularly invited to lecture in Basel.A compulsory
CAM lecture and a credit-rewarded elective
within a program called “learning with the pa-
tient” were offered.
Medical students’ survey
We contacted all 640 sixth year medical stu-
dents in Switzerland; 245 (38.3%) of them replied
to the survey. Of the respondents, 136 (55.5%)
were women and 109 (44.5%) were men. The re-

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sponse rates of the students of different medical
schools did not vary to a statistically significant ex-
tent (table 4).
Students’ personal experience with CAM (table 5)
Only homeopathy had been experienced by
more than half of the total students (61.8%).
Naturopathy had been experienced significantly
more by students from Zürich (37.0%) than by
any of the other groups of students.The personal
experience with CAM was rather positive for the
majority of students (mean value 74.3%). Home-
opathy was the only discipline to show a statisti-
cally significant disparity: 75.9% of the students in
Lausanne versus 29.3% in Bern stated it had been
a rather positive experience.
Students’ perceived effectiveness of CAM (table 6)
Acupuncture/TCM and phytotherapy were
rated as the most effective, whilst ayurvedic and
anthroposophic medicine and homeopathy were
rated lowest. The results for homeopathy were,
again, not homogeneous: in Zürich, Lausanne,
Geneva, and Basel the perceived effectiveness of
homeopathy was more than 50.0%, versus 25.0%
in Bern.
Table 4
Response rates of the
students’ survey.
Bern Zürich Lausanne Geneva Basel Total
Contacted
students
148186100 84 122640
Responding
students
65 5747 32 44245
Response
rate (%)
43.930.647.038.136.138.3
For this table p = 0.03954: the difference between the response
rates is not significant.
Table 5
Students’ personal
experience with
CAM.
Experienced CAM discipline (% yes)
Bern
(n = 57–63)
Zürich
(n = 46–55)
Lausanne
(n = 38–46)
Geneva
(n = 26–30)
Basel
(n = 38–44)
Total
(n = 205–238)
Acupuncture/TCM*33.351.926.736.734.1 36.9
Anthroposophy19.0 13.07.06.94.511.2
Ayurveda6.59.413.6 27.66.8 11.2
Homeopathy63.5 65.5 60.966.752.361.8
Naturopathy17.537.0 20.513.813.6
21.4 ≠
Neural therapy 9.55.7013.8 9.17.3
Phytotherapy23.828.332.644.829.530.2
Other CAM 7.013.018.426.910.513.7
If yes, % positive personal experience with CAM:
Experienced CAM discipline
(% positive experience)
Bern
(n = 5–41)
Zürich
(n = 3–33)
Lausanne
(n = 0–29)
Geneva
(n = 3–21)
Basel
(n = 3–23)
Total
(n = 18–147)
Acupuncture/TCM* 70.881.584.6 81.885.7 79.8
Anthroposophy 50.057.1100 66.766.7 60.7
Ayurveda60.0 83.3 66.7100 66.7 78.6
Homeopathy 29.357.6 75.957.1 69.6
55.1 ≠
Naturopathy83.3 75.0 77.880.0 83.378.8
Neural therapy 10066.7–66.775.0 83.3
Phytotherapy83.3 73.3 10061.5 63.677.8
Other CAM 50.066.788.9 100 10080.6
* TCM: Traditional Chinese Medicine.
≠ p <0.05: there is a statistically significant difference between the responding groups for these disciplines:
p = 0.0261 for Naturopathy in Zürich vs. all in all other universities;
p = 0.0011 for Homeopathy in Bern vs. in Lausanne.
Table 6
Students’ subjec-
tively perceived
effectiveness of CAM.
CAM discipline
(% effective + rather effective)
Bern
(n = 55–64)
Zürich
(n = 40–55)
Lausanne
(n = 28–46)
Geneva
(n = 21–31)
Basel
(n = 36–43)
Total
(n = 186–237)
Acupuncture/TCM* 92.289.176.1 90.390.788.6
Anthroposophy 46.832.0 42.033.342.140.2
Ayurveda 27.331.859.5 45.543.2
39.5 ≠
Homeopathy25.0 52.8 57.151.752.4
45.5 ≠
Naturopathy44.863.2 38.5 63.661.5 53.1
Neural therapy 68.830.0 28.628.669.4
50.0 ≠
Phytotherapy61.6 71.8 65.073.1 71.1 67.6
* TCM: Traditional Chinese Medicine.
≠ p <0.05: there is a statistically significant difference between the responding groups for these disciplines:
p = 0.0240 for Ayurveda in Lausanne vs. in Bern and Zürich;
p = 0.0037 for Homeopathy in Bern vs. all other universities;
p = 0.000006 for Neural therapy in Bern and Basel vs. in Zürich, Lausanne and Geneva.

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Complementary medicine in Swiss medical schools
Students’ self-assessed knowledge of CAM (table 7)
The best known disciplines were homeopathy
and acupuncture/TCM. The two disciplines
which nobody could practise were ayurveda and
neural therapy,and these two disciplines have also
the highest percentages of the answer “don’t
know”. The calculated Chi squares do not meet
Cochrane’s recommendations in the data in this
table, therefore the calculation of the statistical
relevance of these results is unreliable.
Students’ attitude toward CAM (table 8)
More than three quarters of all students
agreed with the following three statements: (1)
CAM is a useful supplement to conventional med-
icine; (2) CAM includes ideas and methods from
which conventional medicine could benefit; and
(3) practitioners should be able to advise their pa-
tients about commonly used CAM topics. There
was little agreement with the statement: CAM is a
threat to public health (11.7%).The individual re-
sults for each school of medicine are relatively
similar for this section.
Students’ experience of CAM courses at medical school
(table 9)
Of the respondents, 67.7% from Bern, 53.2%
from Lausanne,15.8% from Zürich and zero from
Basel and Geneva have attended CAM courses at
their medical school. 80.0% of all students state
that the CAM courses have improved their knowl-
edge of CAM. 64.0% of the students at Lausanne
have felt motivated to deepen their study of CAM,
versus 33.3% in Zürich and 19.0% in Bern. The
Table 7
Students’ self-
assessed knowledge
of CAM (%).
CAM discipline Bern
(n = 62–63)
Zürich
(n = 55–56)
Lausanne
(n = 47)
Geneva
(n = 29–31)
Basel
(n = 43–44)
Total
(n = 238–241)
Acupuncture/TCM*
Don’t know1.600 6.52.3 1.7
Heard about60.355.470.251.670.5 61.8
Could advise36.542.925.541.925.034.4
Could practise 1.61.84.302.32.1
Anthroposophy
Don’t know 15.932.757.465.525.035.7
Heard about76.260.031.934.568.257.1
Could advise6.37.38.50 6.86.3
Could practise1.60 2.1000.8
Ayurveda
Don’t know56.550.929.823.336.442.0
Heard about40.345.566.056.761.452.5
Could advise 3.23.64.320.02.3 5.5
Could practise000000
Homeopathy
Don’t know000000
Heard about44.4 48.259.664.559.153.5
Could advise54.0 48.231.9 32.338.642.7
Could practise1.6 3.6 8.53.22.3 3.7
Naturopathy
Don’t know30.2 12.7 23.423.329.523.8
Heard about58.774.5 61.7 63.352.362.3
Could advise9.512.712.813.3 13.6 12.1
Could practise 1.60 2.10 4.51.7
Neural therapy
Don’t know17.572.7 83.063.337.252.5
Heard about 61.923.617.0 36.753.539.5
Could advise20.6 3.600 9.3 8.0
Could practise000000
Phytotherapy
Don’t know25.4 29.18.513.318.220.1
Heard about55.656.4 66.0 80.065.962.8
Could advise14.310.9 23.46.713.614.2
Could practise4.83.62.102.3 2.9
* TCM: Traditional Chinese Medicine.