Philosophy for Integrative Medicine Education

Several overlapping subcultures are active in the ongoing journey to keep conventional medicine current to the public and improve morale for the physician today. All of these stand alone in their own merit, yet perhaps could gain synergy from combining energy.

As we complete the Oregon CAM Course, the R25 NIH grant from the National Center for Complementary and Alternative Medicine, we needed to ask ourselves, "How have we enhanced our education for learners at Oregon Health & Science University?"

If we limited ourselves to CAM literacy, we determined we not only did not communicate the philosophy of why this has caught the time and attention of our public, but we also had missed what may be the gifts practitioners in these fields offer patients that we do not. Therefore, we have tried in this diagram to outline the elements of medical education that the grant will focus on enhancing and supplementing in the developing curriculum.

The six petals are elements essential to medicine and patient satisfaction:
Wellness refers to the emphasis we place on self-care for the patient in their treatment plan. Areas of nutrition, exercise, relaxation training, and smoking cessation skills are examples of self-care of patients that can be enhanced in the current curriculum.

Mind-body Medicine is a well known, but perhaps an underutilized tool for enhancing healing in patients. Are we active in teaching OHSU learners how to involve the power of the mind in their approach to patients? How can we take advantage of this powerful technique?

Basic Science is the foundation for all we teach, and the groundwork for clinical decision making when evidence based medicine is lacking or not available. We also need to integrate some of the philosophical differences in basic science understanding between other health systems and conventional medicine. The emerging interest in a bioenergetic model of the body, versus biomechanical is an example.

CAM Literacy is the ability to demonstrate knowledge and understanding of the nature and the extent of the modalities that constitute complementary and alternative medicine (CAM) in order 1) to evaluate the effectiveness of CAM, 2) to advise patients, who are interested in CAM modalities, 3) to appropriately refer patients to CAM providers and 4) to recognize the potential benefits and/or risks existing at the interface between CAM and allopathic medicine.

Patient Centered Care communicates the need for OHSU graduates to maintain the highest levels of professionalism and service. This learned profession is faced with significant challenges, where many regret the decision to be in medicine. At OHSU, we are initiating a medical elective, Healer's Art, in January 2003 to attempt to help students retain their humanity and mission for service.

Cultural Sensitivity is critical to much of the success of what we try to do with patients. If we do not understand why they would be conflicted with compliance with our instructions, we have failed. As we are an increasing diverse population, this challenge increases, often through language difficulties and financial restraints.

Evidence Based Medicine as the core of the flower is what we attain to provide for patients. Yet we know that much of what we do is steeped in tradition. Training our students to critically appraise the medical literature and understand the strength of the evidence, and then apply that is essential. The ability to create lifelong learners with those skills will be mandatory in the information explosion.

Yet, the center is only that. It is central, yet not complete. Much of the art of medicine is what can be taught, but may have been neglected with our fascination of science and technology. Our view of integrative medicine is that the graduate will express all of these qualities in balance. Both the art and science of medicine will be evident in their care of patients, with a large dose of continual curiousity.

Anne Nedrow, M.D.
Medical Director, Women's Primary Care/Integrative Medicine
Center for Women's Health, OHSU

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