By Alexandra Bernstein (www.acunpunturetoday.com)
From May 31 to June 3, 2005, a historical dialogue took place among conventional medical and complementary and alternative medicine (CAM) educators and the leaders in the movement towards integrated health care. The dialogue, formally denominated the National Education Dialogue (NED)to Advance Integrated Health Care: Creating Common Ground, was held at Georgetown University in Washington, D.C.
For the first time, experienced educators and practitioners from conventional academic medicine met with representatives of councils of colleges and accrediting bodies of the principal CAM fields to explore shared interests in improving health care education.
Over 70 educators participated in the NED, coming from all over the United States and from as far away as Australia. Catherine Niemiec, JD, LAc, attended as the representative of the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM).
The primary focus of the NED was on strategies for creating an integrated educational experience in conventional medical schools and in those CAM disciplines that have an accrediting agency recognized by the U.S.
Department of Education – acupuncture and Oriental medicine, chiropractic, naturopathic medicine, massage therapy, and direct-entry midwifery. Also discussed were the disciplines of nutrition, holistic nursing, public health, and holistic medicine, each of which play a vital role in present-day health care, as well as considerations for an integrated system in the future.
While meetings of those who shape both Eastern and Western medical education policy may be routine in a few years, this first dialogue was a pioneering venture to see how CAM and conventional medicine educators could jointly address such initiatives.
Examples of crossover activity came from several conventional medical schools, including: meditation before examinations; a mind/body skills elective to second-year medical students; expanded CAM content integrated into required medical courses; clinical collaborations; and joint research projects overseen by cross-disciplinary faculty.
Topics covered at the meeting included a discussion of common values, current models of inter-institutional relationships, educational contracts between conventional and CAM institutions, collaborative development of educational and curriculum resources (including a model outline for educational resources to enhance delivery of collaborative health care produced by Elizabeth Goldblatt, PhD, and Daniel Seitz, JD), and workshops in developing skills as leaders for change.
Attendees addressed concerns about how to do a better job of teaching about each other’s disciplines, and how to create common ground with conventional medical educators, holistic nurses, and public health.
The first morning of the conference was used to look at ways to advance integration and develop plans for the coming year. Dr. Dale W. Lick of Florida State University , a noted specialist in transformational leadership, change creation and strategic planning, gave a moving talk on how to become an agent for change within an institution.
He reminded attendees that learning must precede change, and that rather than focussing on behavioral change to attain goals, leaders must first change assumptions and beliefs.
Participants were optimistic about the effect the NED may have on academic policy because of the participation of people who are directly involved in its development.
College presidents and deans, as well as representatives of their accrediting agencies, took part in presentations about collaborative education, educational leadership, and developing shared language. Catherine Niemiec, CCAOM’s representative, was effusive in describing the passionate mood of NED discussions.
“I was fascinated to see so many policy-makers and agents of change open to discover, discuss and collaborate,” said Niemiec. “Everyone was respectful, creative, and optimistic. Moving medical education in the direction of integration is historic and monumental.”
Niemiec also noted that the attendees struggled at times to agree on common terms and values. “General terms such as therapy, discipline and system mean different things to different academicians,” she said. “And the overlapping competencies and scopes of practice within CAM proved to be unsettling sometimes to the Western-trained physicians.”
The NED was a significant step in addressing recommendations made in the report of the White House Commission on Complementary and Alternative Medicine Policy (2002) and the report of The National Academies’ Institute of Medicine (IOM), Use of Complementary and Alternative Medicine by the American Public (January 2005).
The IOM investigation found that “[m]ore than a third of American adults reports using some form of CAM, with total visits to CAM providers each year now exceeding those to primary-care physicians. An estimated 15 million adults take herbal remedies or high-dose vitamins along with prescription drugs.
It all adds up to annual out-of-pocket costs for CAM that are estimated to exceed $27 billion.” (For an executive summary of the report, go to www.nap.edu/execsumm_pdf/11182.pdf.)
The IOM findings included recommendations that conventional health professions schools incorporate sufficient information about CAM into their required curriculum to enable licensed professionals to competently advise their patients about CAM.
They also recommended that the national professional organizations for all CAM disciplines ensure the presence of training standards and develop practice guidelines.
Further, it was suggested that health care professional licensing boards and accrediting and certifying agencies (for both CAM and conventional medicine) should set competency standards in the appropriate use of both conventional and CAM therapies.
The report emphasized the development of models in research training for CAM practitioners in order to enable full and equal participation in CAM research, and for strategic partnerships between CAM institutions, NIH, and health sciences universities to create the research infrastructure to develop appropriate educational models for improved care.
NED is a project of the Education Task Force of the Integrated Healthcare Policy Consortium (IHPC), a nonprofit group now in its fourth year of work on an ambitious agenda of advancing the nation’s development of an integrated, effective health care system.
The NED was co-organized by the Academic Consortium of Complementary and Alternative Health Care (ACCAHC), of which the CCAOM, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) and the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) are members (along with representatives from other CAM modalities), and the Consortium of Health Centers for Integrative Medicine (CAHCIM), representing conventional health sciences institutions involved in CAM.
The National Education Dialogue meeting was planned over a 15-month period and was preceded by two retreats and two research projects, both of which were reported at the meeting.
NED participants envision a multi-year process, in which participants will work to further these objectives. Sustaining funding is being sought for this unique and innovative project.
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