March 2, 2001
White House Panel Discusses Complementary and Alternative Medicine Education, Credentialing Issues
The White House Commission on Complementary and Alternative Medicine met Feb. 22 to discuss education/training and credentialing/licensure issues related to complementary and alternative medicine (CAM). The commission also began developing preliminary recommendations on a number of CAM topics. Commission Chair James S. Gordon, M.D., requested that commissioners generate as many recommendations as possible and that altering or deleting them would be done in the future.
The first session focused on establishing CAM educational programs. Jennifer Engstrom, third-year medical student, Case Western University, and member of the American Medical Student Association, said CAM training should be better integrated into current medical school course curriculum and also should be offered as electives. She supported her views by citing the 1999 AAMC Graduation Questionnaire (GQ) Survey question indicating that 68 percent of all medical student graduates feel CAM training is inadequate. However, she did indicate that the medical establishment was beginning to incorporate CAM training by quoting principles/recommendations from both the AAMC Medical School Objectives Project (MSOP) Report and the ACGME Core Curriculum Requirements with respect to CAM education.
Deborah Danoff, M.D., assistant vice president, AAMC Division of Medical Education, also cited these documents during her testimony as evidence to how academic medicine has recognized and is addressing the evolving curriculum in medical education to meet the needs of the nation's patient population. Dr. Danoff listed a number of educational objectives as well as initiatives relevant to CAM education and training. She also noted data from the 1999 LCME school report indicating that more than 75 of the 128 medical schools provide CAM education.
Peter V. Scoles, M.D., vice president, Assessment Programs, the National Board of Medical Examiners (NBME), provided an update of the current status of CAM in the USMLE, the only pathway to licensure for practice of medicine in the United States. Although the USMLE does not dedicate a set of questions to CAM treatments, the NBME incorporates testing of CAM education in the evaluation of communication skills, side-effect reactions of medicines, and critical evaluation of medical literature.
Alfred P. Fishman, M.D., senior associate dean, University of Pennsylvania School of Medicine, stressed the training of CAM therapies to promote communication and healing. He also stressed the need for more research in this area, which would result in greater accountability and legitimacy. He reminded the commission that each academic institution probably has very different approaches to CAM education and that homogenization is not an easy task, and possibly, not a desirable one either. Geraldine Bednash, Ph.D., R.N., executive director, American Association of Colleges of Nursing, stressed the need for CAM training in schools of nursing because consumers are self-selecting CAM therapies, and nurses must be able to have the skills, knowledge, and resources to assess the usefulness or danger of these CAM therapies, which are often used in conjunction with conventional therapy. Dr. Bednash did not advocate a separate or specific required course for all schools of nursing on CAM therapies; however, she does believe that nurses need to be made aware of such therapies.
Neil Sampson, deputy associate administrator, Bureau of Health Professions, Health Resources Services Administration, expressed HRSA's support for CAM education to be incorporated in the training of all health professions. However, he noted HRSA currently only financially supports CAM research and not CAM education because the lack of information on the structure, roles, and properties of the CAM workforce has prevented HRSA from developing strategies to assess the impact of CAM healthcare or healthcare delivery.
Sara Collins, senior policy analyst, National Breast Cancer Coalition, provided a patient perspective on having CAM as a healthcare option. She focused the need to integrate CAM education into the training of all healthcare professionals to ensure quality healthcare in the United States.
During the session on education and training, the commissioners focused on why CAM education was not integrated more directly, more often, and sooner in medical training. For the most part, the respondents indicated that training, in general, should be evidence-based, which are developed from proven, ethical medical practices. Commissioners also raised questions on possible funding mechanisms for CAM educational programs.
The second session focused on continuing CAM education and training. This panel consisted of CAM educators and a member of the Accreditation Council of Continuing Education (ACCME). The third and final session focused on CAM credentialing and licensure. During this session, a variety of individuals spoke on establishing standards for CAM treatment. Some advocated strongly in support of national licensing; others vehemently opposed it. A number of CAM practitioners spoke, as well as a representative of an insurance company and a member from the Federation of State Medical Boards.
Information: Andrew Quon, AAMC Division of Biomedical and Health Sciences Research, 202-828-0485.
