Strategies for Integrating EIP into the AOM Curriculum Belinda (Beau) Anderson, PhD, LAc Academic Dean, Pacific College of Oriental Medicine (NY) Assistant Professor, Albert Einstein College of Medicine Acupuncturist and Chinese Herbalist, New York University Fertility Center

Pacific College of Oriental Medicine (PCOM)  Largest Chinese medicine college in US (~1400 students)  3 campuses – San Diego, New York City, Chicago  Regionally accredited – WASC  Programs  AOM – Masters and doctoral degrees  Massage therapy – Associates degree  Holistic Nursing – Bachelor completion program

Impetus for EIP at PCOM  NIH K07 grant ( ) ‘Evidence Informed Practice: Faculty and Curriculum Development’  Modeled on NWHSU EIP NIH R25 project  AOM First Professional Doctorate  New EIP competency

Cover today…  Baseline EIP knowledge and attitudes of PCOM-NY faculty and students (survey outcomes)  Needs of faculty and institution for implementation of EIP faculty training and curriculum (survey outcomes)  AOM specific EIP issues  Approach to infusing EIP into the PCOM AOM programs

Baseline EIP Knowledge and Attitudes of PCOM-NY Faculty and Students Anderson et al J Altern Complement Med 20(9):705-12

Survey FacultyStudents # Close-ended Qs*1418 Response Rate89% (102/115)42% (176/420) Prior Research Ed.51%40% Prior Res. Ed. Grad Level 41%34% * Close-ended questions with 5-point Likert answers (Strongly agree; Agree; Neutral; Disagree; Strongly disagree). Results expressed as %Agree + Strongly agree

Research Literacy FacultyStudents * I am comfortable searching the web for relevant scientific literature I am comfortable critically appraising scientific literature I read journal articles weekly57.8n/a * 4 th year students who had taken the introductory research course

Faculty: Support for Research Funding and Training Faculty It is important that PCOM develop a research agenda and apply for external research funding 89.2 CAM practitioners will benefit from having a strong foundation of training in research methodology and outcomes 78.8 AOM professionals, if appropriately trained, can make a significant contribution to CAM research 95.1

Faculty: Participation in Research Training and EBM Implementation Faculty I would be interested in receiving research training75.5 I would be interested in being on an committee working to introduce research curriculum into the Master’s degree 68.7 I would be interested in incorporating research focused material into the courses and clinics that I instruct 74.5

Value of EBM Faculty4 th Year Students Critical evaluation of biomedical research methodology and outcomes is necessary to be able to assess the value and application of biomedical research to the practice of CAM Evidence from well-designed biomedical research clinical trails, where the acupuncture intervention appears appropriate, is useful to an acupuncturist’s clinical practice Defining what successful outcomes look and feel like with patients allows practitioners and patients to agree on what ‘successful’ treatment is, and facilitates patient retention and satisfaction The quality of patient care is improved when practitioners seek out evidence about effective approaches to treating patients The quality of patient care is improved when practitioners assess the outcomes of their treatments and use this knowledge to decide on further treatment strategies

Student Survey Assessing trends as students progress through the 4-year Masters program

Students: Research Value Q# 1Biomedical research investigating acupuncture and Chinese herbal medicine is important for patient referral from biomedical practitioners 2This research is important for the development of greater insurance coverage for acupuncture 3This research has a positive influence on the public's perception of the profession

Students: Science & Chinese Medicine Q# 1 I believe acupuncture and Chinese herbal medicine are more of a science than an art** 2I believe that the scientific method (gathering empirical and measurable evidence) is compatible with the basic principles of Acupuncture and Oriental Medicine* ** P for trend = * P for trend = 0.01

Students: Future Research Interest Q# 1I am interested in engaging in acupuncture and/or Chinese herbal medicine research (either full-time or part-time) after I graduate 2I am interested in doing the Doctoral Program in Acupuncture and Oriental Medicine after I graduate

4 th Year Students: Desire for Further Research Training 4 th Year Students I would have liked to have additional research training as part of my Master’s degree 36.7 I would have preferred a greater amount of research material and or assignments in the other courses (biomedical and Oriental medicine) in my Master’s degree 30

Faculty Needs Assessment

Degree of Agreeability HighLow  EIP skill importance  Compatible with current perspective  Complexity is manageable  Involvement  Consistent with institutional values  Institutional support, timing, obligation  Low resistance  Advantageous  Currently in courses  Institutional ability

Themes from open-ended questions

Support Faculty and students  Research is important to the profession

Concerns Faculty and Students  Biomedical research paradigms are not compatible with Chinese medicine Faculty  Chinese medicine could get co-opted by biomedicine  Research isn't relevant to the practice of Chinese medicine Students  Biomedical research paradigms cannot account for practitioner intention

AOM Specific EIP Issues

 Not based on biomedical model (physiology and pathology)  Significant paradigm differences  Acupuncture RCTs – often not useful to clinical practice  Specific issues of the acupuncture RCTs  Placebo control  Fixed protocol bias  Dosage  Pragmatic acupuncture trial is most clinically relevant

Infusion of EIP into AOM Programs

Strategy  Train faculty first  NWHSU modules  Doctoral upgrade program (3-credit FEIP course)  Faculty driven EIP curriculum development  Start clinic implementation early  Outcome measures (MYMOP)

Entry-level Doctoral Degree 189 credits, 3495 hours, 11 trimesters  2 research courses  Foundations of EIP (3 credits/45 hours, trimester 3)  Clinical Research Design and Statistics (2 credits/30 hours, trimester 7) Course CategoryProportion with EIP content Biomedicine100% Integrated biomed/TCM100% Acupuncture55% Herbal medicine65% Clinical courses & shifts100% Overall average65%

Important takeaways…  “Discipline that is 100s of years old (modern science) telling a discipline that is 1000s of years old (Chinese medicine) how to practice”  To what extent is evidence already being used?  What are we really trying to promote?  Critical thinking  What are the other ways that EIP benefits AOM clinicians?  Practice building $$  Need to assist faculty in incorporating EIP into their courses  Adult and active learning

Thank you Belinda (Beau) Anderson, PhD, LAc