Interest in Integrative Medicine and complementary and alternative modalities is growing. As general internists, we are often the first point of contact when medical questions arise. Along with the standard questions about the spot on their skin or the racing heart they notice here and there, we may be the first to field questions about dietary supplements, manual modalities, and the mind-body connection. “I read about an herb that can be helpful for depression, is it OK to take it along with my Lexapro?” “Do I need to stop taking fish oil before my wisdom teeth are pulled next week?” “Can acupuncture help with my migraines?” While these questions, in the absence of adequate training to field them, can be unnerving, it is even more disconcerting to consider that many of our patients aren’t even asking them.
Based on National Health Information Survey data, 34% of patients are using complementary and alternative medicine (CAM), and, of those patients, nearly half did not disclose their CAM use to their primary care physician.1 Commonly cited reasons for this nondisclosure included failure of the PCP to ask about unconventional therapies, as well as the perception that their physician lacked the appropriate knowledge. This is not only a quality-of-care issue but also a patient safety issue. To provide our patients high quality, comprehensive primary care, we should have at least enough knowledge about the complementary modalities our patients are using to engage them in dialogue, answer basic questions, and identify safety concerns. As many educational interventions do, this starts at the medical school level.
At the University of Florida College of Medicine, we are implementing a longitudinal Integrative Medicine curriculum throughout the four years of medical student education. We are weaving this into the existing curriculum in an effort to both emphasize synergy in content areas and conserve space in an otherwise full didactic program. We are utilizing a combination of Integrative Medicine corollary slides added to existing presentations, stand-alone lectures given during key content blocks, interactive workshops, team-based learning activities, patient/practitioner panels, and electives.
To study the curriculum’s effectiveness, we plan to survey outgoing fourth year medical students to assess impact on attitudes and perceived competence surrounding Integrative Medicine. Baseline data shows that students not exposed to the curriculum had generally positive attitudes toward Integrative Medicine but low perceived competence in counseling patients about herbs and dietary supplements, manual modalities, and mind-body therapies. We expect that students who complete this curriculum will demonstrate increased perceived competence in these areas.
With an increasing demand for treatments that fall outside the realm of conventional medicine, it is important that we prepare our medical students to field questions, identify safety issues and interactions, and utilize complementary therapies in an evidence-based manner. We should strive to weave training on this into the existing curriculum in a way that emphasizes coactive content and utility at the bedside.