Consortium of Academic Health Centers for Integrative Medicine

1. Consortium of Academic Health Centers forIntegrative Medicine Resources for Developing & Integrating Innovative Curricula in Complementary & Alternative / Integrative Medicine AAMC Regional GEA Meetings April 2008

2. Goals • Emergence of field • National Reports & Initiatives • NIH sponsored Research & Education • Consortium’s Mission & Network • Serve Academic Leadership & Collaborative needs • Resources for Education • Exemplars from 2-3 Consortium Schools

3. Clarification of Terms • Conventional Medicine = that practiced by MDs or DOs & other allied health professionals • Complementary = used together with conventional medicine • Alternative = used in place of conventional medicine • Complementary & Alternative Med (CAM) Practices: • Include biologic, mind-body, manipulative, energy therapies & whole systems of care • Some have a strong historical, clinical or experimental evidence base for efficacy & others may not

4. What is Integrative Medicine? • Integrative Medicine ~ the practice of medicine that reaffirms the importance of the relationship between practitioner & patient, focuses on the whole person, is informed by evidence, & makes use of all appropriate therapeutic approaches, healthcare professionals & disciplines to achieve optimal health & healing. (CAHCIM 2005)

5. A Wake-up Call for Physician Education • 1997 Survey revealed: • 40% used unconventional therapy • 629 million visits (385 primary care visits) • 60% did notinform their physicians • 80% used with conventional medicine (JAMA 1998:279:1548-1553)

6. Committee on the use of CAM by the American Public Board on Health Promotion and Disease Prevention (IOM) “Medical practitioners are ethically & legally obligated to disclose & discuss reasonable treatment alternatives, along with risks & benefits of each option, so patients can make adequately informed healthcare decisions and give valid consent to treatment.” (Ernst & Cohen, 2001)

7. Patient Use of CAM % Adults who used CAM, prior 12 mos or ever

8. National Interest in CAM • NIH OAM 1992  NCCAM 1998 • White House Commission on CAM Policy 2002 • 10 guiding principles • IOM Report on CAM in the U.S. 2005 • Recom for Education, Research, Clinical • NCCAM 5 yr strategic plan 2005-2009 • Priority setting, Call for New Research, Innovation

9. Institute of Medicine (IOM)2005 Report on CAM in the U.S. • Education for Improved Care • “…the committee recommends that health profession schools (e.g., schools of medicine, nursing, pharmacy, and allied health) incorporate sufficient information about CAM into the standard curriculum at the undergraduate, graduate, and postgraduate levels to enable licensed professionals to competently advise their patients about CAM.”

10. Implication for Medical Education • Physicians must communicate with patients about CAM • Ask patients about their use • Explain risks and benefits with patients • “Natural” ≠ safe • Potential for herb-drug & herb-herb interactions • Use of non-pharmaceutical therapies (i.e. massage, mindfulness may  risks of poly-pharmacy & drug side-effects • Help patients identify reliable sources on the Internet • Discuss options openly & respectfully

11. American Medical Association (AMA) • AMA resolution #306 statement that CAM education should be included in med school education: • “Promote awareness of CAM among medical students & physicians of the wide use of CAM, including its risks, benefits, & evidence of efficacy or lack thereof.” • Adopted June 2006, AMA House of Delegates

12. CAM Use by Adults in Canada 2003 Canadian Community Health Survey 20% of Canadians > 12 y/o (5.4 million people) consulted a CAM provider 1997 National Survey 73% had used at least one CAM therapy in their lives 50% reported using at least one CAM therapy in the previous 12 months (this included non-practitioner based therapies such as taking Natural Health Products)

13. NIH NCCAM R25 Initiative • 2000-2002, over 20 million K awarded to 14 academic institutions & AMSA • Varied focus (primarily UGME) & approaches to infusing CAM into academic curriculum • Evidenced-based, required curricula & experiential electives • Academic faculty development critical • Community based CAM practitioners as teachers/preceptors • Academic Medicine, October 2007

14. Canadian CAM in UME Initiative Developing curricular materials addressing CAM topics appropriate for introduction into Canadian UME programs A Digital Repository has been developed: www.caminume.ca/drr/ All 17 Canadian Medical Schools represented Health Canada has been one of the primary funders of the CAM in UME Project

15. Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) • Birth: 1999 – Eight (8) ACHs meet • Mission: Expand & Develop Field • “To help transform medicine & healthcare through rigorous scientific studies, new models of clinical care & innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing & the rich diversity of therapeutic systems.” • Growth: 8 (1999)  41 (2008)

16. Membership History 1999 - Duke Univ, Harvard Univ, Stanford Univ, UCSF, Univ Arizona, Univ Maryland, Univ Mass, Univ Minnesota. 2000 - Albert Einstein/Yeshiva Univ, Georgetown, Thomas Jefferson Univ. 2002 - UTMB, Univ Pittsburgh, Univ Washington, Univ Pennsylvania, Univ Hawaii, UMDNJ, Univ Michigan, Columbia. 2003 - UCLA, OHSU, Univ Calgary (Canada), George Washington Univ. 2004 - Univ Connecticut, Univ New Mexico, UCI, Wake Forest, Univ Alberta (Canada). 2005 - Laval Univ (Canada), UNC-Chapel Hill, Univ Wisconsin. 2006 - Univ Colorado, Univ Kansas, Univ Vermont, Mayo Clinic Stanford, Yale. 2007 - Vanderbilt, McMaster (Canada), Johns Hopkins. 2008 - Boston Univ, Northwestern Univ.

17. Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) Member Schools, April 2008

18. Consortium Accomplishments • UGME Integrative Medicine Competencies • Curriculum Activities Guidebook • LCME 2008 • ED modifications (17-19-21) proposed by Consortium passes 1st cmt, next cmt June 2008 • National Research Conference in Complementary, Alternative and Integrative Medicine • First one: April 2006, next one: May 2009

19. Join us! • Education Research Clinical Policy • Networking • Support • Collaborative Initiatives

20. Resources • www.imconsortium.org • Consortium Contacts & Fact Sheets • CAM Education ‘Primer’ • Academic Medicine • Oct 2007 & Competencies Article June 2004 • MedEdPORTAL • www.aamc.org/mededportal • AMSA EDCAM & LTP • www.amsa.org/humed/CAM/resources.cfm

21. SGEA: Presenting Schools/Contacts • Vanderbilt Univ (Host) • Roy Elam, MD • roy.elam@vanderbilt.edu • Duke Univ • Michelle Bailey, MD • baile010@mc.ducke.edu • Univ of NC, Chapel Hill • Susan Gaylord, PhD • gaylords@med.unc.edu

22. NEGEA: Presenting Schools/Contacts • Univ of Vermont (Host) • Tania Berch, MD • tania.bertsch@vtmednet.org • Albert Einstein College of Medicine of Yeshiva Univ • Ben Kliger, MD, MPH • bkligler@chpnet.org • McMaster Univ • Esther Konigsberg MD,CCFP • infin8health@hotmail.com • Univ of Connecticut • Mary P. Guerrera, MD • mguerrer2@stfranciscare.org

23. WGEA: Presenting Schools/Contacts • UCLA (Host) • Ka-Kit Hui, MD • khui@mednet.ucla.edu • UCSF • Susan Folkman, PhD • Folkman@ocim.ucsf.edu • OHSU • Anne Nedrow, MD • nedrowa@ohsu.edu