Attitudes of medical students toward the practice and teaching of integrative medicine

The effectiveness of teaching complementary and alternative medicine based on the components of theory of planned behavior on nutrition students: multicenter research study

OBJECTIVE

Safe and beneficial use of complementary and alternative medicine (CAM) modalities results from integrating CAM education into curricula and increasing CAM knowledge. We sought how much teaching CAM procedures in a virtual environment can influence the components of the theory of planned behavior (TPB), including knowledge, attitude, behavioral intention, and behavior of nutrition students.

METHODS

This cross-sectional descriptive-analytic study was conducted on 162 undergraduate nutrition students were selected through convenience sampling based on inclusion criteria in 2021-2022. Data were collected through a validated researcher-made CAM questionnaire that was designed based on TPB questionnaire that consisted of four constructs (knowledge, attitude, behavioral intention, and behavior). The content validity index and content validity ratio of the questionnaire were evaluated.

RESULTS

Our results revealed that students who significantly scored the highest scores in attitude, behavioral intention, and behavior constructs were the students who claimed that "teaching two credits of CAM for nutrition students is not enough" (p. value =  < 0.001, < 0.001, and 0.005, respectively). In addition, these students used treatment methods of CAM for themselves, suggested treatment methods of CAM to others, and followed the recommendations of the CAM specialists (for three pairwise comparisons: p. value =  < 0.001, < 0.001, and < 0.001, respectively). The attitude could predict 70% of behavioral intention. However, attitude and behavioral intention could predict 90% of behavior.

CONCLUSION

Attitude was the most critical determinant influencing behavioral intention and behavior. CAM teaching using evidence-based CAM-ITM principles with a succinct, concerted, and collaborative curriculum, integration of CAM into continuing education, and integration of educational CAM programs continuously for several years into the academic curriculum in the actual setting influence the success of the educational CAM program.

Indications of medical plants: what do medical students in Germany know? A cross-sectional study

Background

Patients use phytotherapy in addition to cancer therapy. Aiming to equip students with the knowledge necessary for a holistic treatment approach, the (German) national competence-based catalogue of educational objectives in medicine advises to include phytotherapy as part of the curriculum. Here, we evaluate if medical students know the official indication of herbal products as stated by the German Federal Institute for Drugs and Medical Devices (BfArM) for treating oral and abdominal discomfort.

Methods

In an online survey, students were asked to write down indications they associated with 25 plants used for treating either oral or abdominal discomfort. Students’ indications were then sorted according to symptom complexes (oral discomfort, abdominal discomfort, skin care, others) and compared with the official indications stated by the BfArM.

Results

Of 168 participating students, 113 wrote down indications for 22 of the 25 plants surveyed. 70.80% of the students knew the correct indication for Matricaria recutita, 41.59% for Salvia officinalis, 37.17% for Foeniculum vulgare Mill. and 36.28% for Mentha piperita. Those were the highest rates of correct answers. Looking at symptom complexes (e.g., oral/ abdominal discomfort) instead of single symptoms, ≥ 10% of the students stated an indication that fell into the same symptom complex as the BfArM’s indication for 10 out of 25 plants surveyed. The most well-known plants and indications were Matricaria recutita, Salvia officinalis and Mentha x piperita.

Conclusion

Only a small minority of participating students know the official indications for specific phytotherapeutic drugs. Our study demonstrates that phytotherapy needs to be incorporated into the medical teaching curriculum.

Integration of traditional and complementary medicine into medical school curricula: a survey among medical students in Makerere University, Uganda

OBJECTIVE

To describe the disposition and sociodemographic characteristics of medical students associated with inclusion of traditional and complementary medicine in medical school curricula in Uganda.

DESIGN

A cross-sectional study conducted during May 2017. A pretested questionnaire was used to collect data. Disposition to include principles of traditional and complementary medicine into medical school curricula was determined as proportion and associated factors determined through multivariate logistic regression.

PARTICIPANTS AND SETTING

Medical students in their second to fifth years at the College of Health Sciences, Makerere University, Uganda. Makerere University is the oldest public university in the East African region.

RESULTS

393 of 395 participants responded. About 60% (192/325) of participants recommended inclusion of traditional and complementary medicine principles into medical school curricula in Uganda. The disposition to include traditional and complementary medicine into medical school curricula was not associated with sex, age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI 0.16 to 0.93) year students were significantly less likely to recommend inclusion of traditional and complementary medicine into the medical school curricula. Participants who hold positive attributes and believe in effectiveness of traditional and complementary medicine were statistically significantly more likely to recommend inclusion into the medical school curricula in Uganda.

CONCLUSIONS

Inclusion of principles of traditional and complementary medicine into medical school curricula to increase knowledge, inform practice and research, and moderate attitudes of physicians towards traditional medicine practice is acceptable by medical students at Makerere University. These findings can inform review of medical schools' curricula in Uganda.

Representações sociais de doença, usos e significados atribuídos às Práticas Integrativas e Complementares por universitários

RESUMO O objetivo deste estudo foi apreender as representações sociais de estudantes universitários sobre a doença e analisar os usos e significados conferidos por eles às Práticas Integrativas e Complementares. Para isso, realizou-se uma pesquisa qualitativa apoiada na Teoria das Representações Sociais, utilizando um questionário semiestruturado para a coleta dos dados, que incluiu, em sua estrutura, o Teste de Associação Livre de Palavras. A maior parte dos estudantes declarou estar no primeiro semestre do curso, na faixa etária de 18 a 24 anos e possuir religião. Para eles, a doença esteve mais associada ao desequilíbrio, sendo a massagem a prática mais adotada. Esses estudantes relacionaram as práticas integrativas à produção de benefícios à vida, à saúde e à manutenção ou alcance da qualidade de vida individual. Nesse sentido, as respostas sugerem que os discentes acreditam na eficácia das práticas integrativas, considerando-as como ligadas à promoção, prevenção e recuperação da saúde. Eles mostram-se abertos a outras racionalidades médicas, ainda que também estejam ligados ao modelo biomédico. Compreender como estudantes pensam a doença e a utilização de práticas integrativas colabora para atribuir sentidos aos projetos terapêuticos organizados no sistema de saúde, dirigindo-se a atenção para a construção da integralidade do cuidado.

Use and acceptance of complementary and alternative medicine among medical students: a cross sectional study from Palestine

BACKGROUND

Teaching Complementary and alternative medicine (CAM) in medical schools is becoming prevalent worldwide. Few studies have been conducted to evaluate medical students' knowledge and attitude toward CAM. Therefore, this study was designed to assess CAM knowledge, attitudes, and beliefs among Palestinian medical students.

METHODS

This study was developed in a cross-sectional design. It targeted medical students at An-Najah National University, between January and April of 2018. We gathered the data from students using a questionnaire printed as a hard copy. Medical students of both sexes in their 4th, 5th, or 6th year of studies were included in the survey. The questionnaire consisted of 3 sections: demographic characteristics and detailed practices of the participants, their attitude and held beliefs towards CAM, and their knowledge on CAM. Mann-Whitney U Test and Kruskal-Wallis Test were used to test if there were differences between knowledge about CAM and the characteristics of the participants.

RESULTS

Of the 300 medical students who were offered the questionnaire, 251 students (43.8% male and 56.2% female) were included in the final analysis. Out of a maximum of 8 points, the mean knowledge score of the participants was 2.0 ± 1.6. The Kruskal-Wallis test showed a statistically significant difference in overall knowledge score among students of different year groups, with students at lower levels obtaining higher scores (P < 0.001). Additionally, the highest knowledge scores were found in students with low income, and students who came from the Palestinian refugee camps (P < 0.001). Students frequently recommended CAM modalities, with herbal medicine being the most recognized and used CAM modality and Ayurvedic medicine being the least recognized and recommended one. Social media was the most popular source of information about CAM, cited by 72.9% of the participants. Participants generally had a good attitude towards CAM but held varying beliefs about it.

CONCLUSIONS

In the current study, a knowledge gap regarding CAM was found among medical students in our sample, despite their good attitude towards the subject. Also, there was a general acceptance to include materials on CAM within the curriculum of medical students.

Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

Complementary alternative medicine practices and beliefs in spinal cord injury and non-spinal cord injured individuals

CONTEXT/OBJECTIVE

To compare the beliefs and practices of individuals with spinal cord injury (SCI), their friends and family members (F&F SCI), and healthcare professionals (HCP) regarding complementary alternative medicine (CAM).

DESIGN

A questionnaire regarding CAM practices and beliefs was administered to participants on paper or online.

SETTING

An academic rehabilitation hospital.

PARTICIPANTS

Ninety-six individuals voluntarily participated in the study. Participants included 28 patients with SCI, 36 F&F SCI, and 32 HCP.

INTERVENTIONS

Not applicable Outcome Measures: The questionnaire assessed participants' prior or current use of 14 CAM modalities, their willingness to use CAM in the future or recommend its use, and their beliefs and opinions of CAM.

RESULTS

Participants with SCI and their family and friends, were more likely than HCP to have used CAM (P ≤ 0.01 and P ≤ 0.03, respectively) and recommend its use (P ≤ 0.04 and P ≤ 0.03, respectively). All three groups showed statistical significance in their willingness to ever use certain CAM modalities (P ≤ 0.03 for SCI, P ≤ 0.04 for F&F SCI, and P ≤ 0.02 for HCP). SCI, F&F SCI, and HCP groups had similar beliefs and opinions regarding CAM.

CONCLUSION

Patients with SCI as well as their friends and family, have significantly more experience with CAM and are more likely to recommend its use than HCP, suggesting that they are interested and find benefit in alternative healthcare. This warrants further investigation of the integration of CAM into general health practices for those with SCI.

Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study

OBJECTIVE

Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person. We implemented a longitudinal IM short-course curriculum into our medical school education. This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.

METHODS

A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies. Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school. Paired data analysis was done, and only students who completed surveys at both time points were included in final analyses.

RESULTS

Of 52 students in each class, 17 (33%) in the class of 2015 and 22 (42%) in the class of 2016 completed both surveys. After the IM curriculum, students' knowledge of and comfort with several IM therapies-biofeedback, mindfulness, and the use of St. John's wort-improved significantly. Students' personal health practices also improved, including better sleep, exercise, and stress management for the class of 2015. Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.

CONCLUSION

It is feasible to incorporate IM education into undergraduate medical education, and this is associated with improvement in students' knowledge of IM and personal health practices.

New candidates for treatment and management of carpal tunnel syndrome based on the Persian Canon of Medicine

Carpal tunnel syndrome (CTS) is defined as a compressing median mononeuropathy. CTS is one of the major costly debilitating diseases of the hand. Although CTS is a relatively recent concept in current medicine, some evidences show that medieval physicians in Persian medicine (PM) such as Avicenna were familiar with it. The PM textbook written by Avicenna, the Canon of Medicine, defines the anatomy of carpal tunnel and median nerve, as well as mononeuropathy; it also offers suggestions for the prevention and treatment of carpal tunnel syndrome (called as Vaja al-asab and Khadar) in the chapter of nerve diseases. The book describes not only symptoms including pain, paresthesia, hypoesthesia, tingling, and numbness, but also its etiology such as nerve compression (entrapment neuropathy); nonphysical reasons such as disturbed balance among the four body humors; alteration in the nerve's temperament (Mizaj) that prevents the transmission of nerve impulses; and the others such as nutrition, mental condition, sleep, weather condition, body movements, and proper disposal of body waste. Furthermore, the book suggests a lifestyle modification method based on six factors and 10 prescriptions composed with 85 natural products that are not actively used for CTS treatment in modern times. The medicinal suggestions for CTS in the Canon of Medicine will be good candidates for discovering new treatments besides providing historical significance to the various insights considered 1000 years ago.