1. Developing a National Vision for Complementary and Alternative Medicine in Undergraduate Medical Education: a workshop report Marja Verhoef *, Michael Epstein †, Michel Boivin ‡, Rebecca Brundin-Mather * * University of Calgary † University of Saskatchewan ‡ Université de Montréal Background Several, but not all, medical schools in Canada are taking steps to introduce education regarding complementary and alternative medicine (CAM) into their undergraduate medical education (UME) curriculum. However, development has been slow. To accelerate this process, a multi-phased project called “CAM in UME” was initiated in January 2002. 1 Largely funded by Health Canada, the series of small independent projects were all aimed at collecting as much information as possible about the potential role of CAM in Canadian UME programs. The Saskatoon Workshop The results of these projects clearly pointed to the need for representatives from all Canadian medical schools to get together to not only share their schools’ experiences and ideas about CAM in UME, but also to begin collaborating on the development of a CAM curriculum. As an initial step in this national effort, a 2-day invitational workshop was held in September 2003 in Saskatoon, SK. The 26 participants included faculty from 14 of the 16 Canadian medical schools, a representative from the Canadian Federation of Medical Students, a second medical student, two CAM practitioners, and representatives of the funding organizations. Table 1 presents participant ratings of the importance of teaching nine proposed product/practice areas in UME. Natural Health Products (NHPs) was the highest rated category with 19 of 20 participants rating it a five. Expressive Therapies had the lowest mean rating, with almost half the participants rating it a one or a two. Table 1:Frequency of participant ratings of the importance of teaching selected CAM practices or products in a UME program. 1.Rationale Participants drafted a statement of rationale for CAM in UME that reflects the current emphasis on patient-centred health care and interdisciplinary health care. To prepare physicians to practice health care in an environment where CAM is used by their patients and where there is a potential for interactions among therapies. 2.Curriculum Content A topic-based approach was used to organize the proposed CAM content. CAM topics were organized under two primary, but not mutually exclusive headings, CAM in General and CAM Products and Practices. CAM in General Participants agreed that the following seven general CAM topics should be considered for inclusion in a curriculum, with varying degrees of emphasis: Definitions of CAM Classifications of CAM Utilization of CAM Reasons for using CAM Evidence Implications for Practice Bridging Paradigms CAM Products and Practices Widely used (variation by region or cultural demographics); Relatively easy to include in the curriculum (i.e., fits biomedical model); Supported by an evidence-base; and Established in terms of education, training, and regulation. In general, participants favoured giving more time and more detailed consideration in the curriculum to CAM modalities that are: Many participants stressed adding First Nations Health Systems as a practice area, particularly given the demographic composition and existing partnerships in some regions. 3.Curriculum Implementation The overarching challenge is how to implement CAM education into existing undergraduate programs. During the workshop, participants reiterated previous findings that medical schools can bring CAM into UME through (1) a stand-alone course; (2) adding or integrating CAM into existing curriculum; or (3) a mixed model that combines strategies one and two. Three areas were addressed during the workshop: (1) a rationale for introducing CAM education into UME programs; (2) potential curriculum content; and (3) potential strategies to facilitate implementing CAM education. Within the context of these approaches, some of the more salient participant comments included: Recognize barriers to CAM integration (e.g., faculty “buy in”, valid teaching resources, curriculum time, expert instructors, etc.) Find a champion with access to opinion leaders or decision makers Tailor CAM material to host courses in curriculum Work with individual faculty to develop appropriate curricula Become involved in the overall development of UME curriculum Obtain support from medical students Conclusion National efforts to develop a CAM curriculum that is appropriate for introduction into Canadian medical schools continues to progress. The proposed curriculum will address CAM-related issues of greatest significance to physicians practicing in Canada, and will be sufficiently flexible to accommodate the differing needs and circumstances of individual medical schools. Phase 2:Review of international literature on CAM in medical education; Review of Canadian medical licensing polices addressing CAM; comparative profiles of current CAM education in Canadian medical schools (through interviews with faculty and medical students in each school); National 2-day invitational workshop (bound report available from Dr. Marja Verhoef at mverhoef@ucalgary.ca) Phase 1: Program scan of faculty and medical students at Universities of Calgary, Saskatchewan, and Manitoba; interviews with Associate Deans UME; ½ day workshop with Associate Deans UME at the 2002 ACMC meeting. 1 1 (not impt) 2345 (impt) NHP (20)1194.95 Trad. Chinese Med. (20) 12 3144.50 Chiropractic (20) 3 5124.45 Naturopathy (19) 4 4114.37 Homeopathy (20) 22 6104.20 Mind-Body (19)113673.94 Therapeutic Bodywork (20)114773.90 Energy Therapies (16)22663.87 Expressive Therapies (18)356222.72