An approach to teaching primary care physicians how to integrate complementary medicine into their daily practices: a pilot study

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BACKGROUND

In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education.

METHODS

This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.

RESULTS

Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.

CONCLUSIONS

Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Integrative Medicine in General Practice in Australia: A Mixed-Methods Study Exploring Education Pathways and Training Needs

Background

Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice.

Objective

This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners’ IM Specific Interest Network, which is a group of GPs with interest in IM.

Methods

We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined.

Results

Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM.

Conclusion

Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.

Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

BACKGROUND

The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare.

OBJECTIVE

The main objective was to gather primary care providers' perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs.

METHODS

We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities.

RESULTS

218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality.

CONCLUSION

Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

Canadian ophthalmologists' opinions concerning complementary and alternative medicine (CAM) use in glaucoma

PURPOSE

Our goal is to investigate the opinion and practice pattern of Canadian ophthalmologists regarding the use of and recommendations for complementary and alternative medicine (CAM) for their glaucoma patients.

METHODS

Institutional review board approval for this prospective, cross-sectional survey was obtained from the Research Ethics Board of Sunnybrook Health Sciences Centre. The survey was sent to all ophthalmologists in Canada electronically through the e-mail lists of 4 ophthalmology associations.

RESULTS

A total of 241 ophthalmologists representing all provinces in Canada responded to the questionnaire. Twenty-two percent felt that CAM does have a role in glaucoma therapy with specialists being more likely to believe there is a role (P<0.05). Of the total respondents, 26% ask their patients if they use CAM with those in practice for <20 years more likely to encourage use (P<0.05). Of the respondents, 9% recommend CAM and if an ophthalmologist was in practice for <20 years he/she was significantly more likely to recommend CAM (P<0.01). Respondents (62%) in general do not discourage CAM with younger ophthalmologists (younger than 50 y, P<0.02) and ophthalmologists in practice for <20 years (P<0.05) being less likely to discourage CAM use. Respondents (41%) believe that CAM rarely ever affects compliance with ophthalmologists from an urban practice (P<0.01) and academic practice (P<0.05) more likely to deny effect on compliance. Respondents believe that CAM sometimes (46%) results in patient morbidity with ophthalmologists being in practice for <20 years believing that morbidity is less likely (P<0.05).

CONCLUSION

A substantial minority of respondents believe that CAM has a role in glaucoma therapy, recommend its use, and ask their patients if they use CAM. Younger doctors are more likely to encourage alternatives; those in practice for <20 years are more likely to ask about alternative medicine use, recommend its use, and believe that morbidity usually does not result from the use of alternative treatments.

Integrating family medicine and complementary medicine in cancer care: a cross-cultural perspective

In this paper, we describe the case study of a 27 year-old Arab female patient receiving palliative care for advanced breast cancer who was referred to complementary medicine (CM) consultation provided within a conventional oncology department. We explore the impact of the integrative CM practitioners' team of three family physicians and one Chinese medicine practitioner on the patient's well-being and specifically on the alleviation of her debilitating hot flashes and insomnia. This quality of life improvement is also affirmed by comparing the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Well-being (MYCAW) questionnaires administered at the initial and follow-up assessment sessions. In conclusion, we suggest that family physicians trained in evidence-based complementary medicine are optimal integrators of holistic patient-centered supportive care. The inclusion of trained CM practitioners in a multi-disciplinary integrative team may enhance the bio-psycho-social-spiritual perspective, and provide additional practical therapies that improve the quality of life of patients confronting cancer.

Complementary and alternative medicine education for medical profession: systematic review

Purpose. To help integrate traditional, complementary and alternative medicine (TCAM) into health systems, efforts are being made to educate biomedical doctors (BMD) and medical students on TCAM. We systematically evaluated the effect of TCAM education on BMD and medical students' attitude, knowledge, and behavior towards TCAM utilization and integration with biomedical medicine. Methods. Evaluative studies were identified from four databases. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Study outcomes were classified using Kirkpatrick's hierarchy. Results. 3122 studies were identified and 12 studies of mediocre quality met inclusion criteria. Qualitative synthesis showed usage of diverse approaches including didactic, experiential learning, varying length, teacher background and intensity of exposure. More positive attitudes and improved knowledge after intervention were noted especially when teachers were BM trained. However, few studies assessed behavior change objectively. Finally, longer-term objective outcomes such as impact on patient care were not assessed. Conclusions. Lack of use of objective and reliable instruments preclude firm conclusion on the effect of TCAM education on study participants. However, positive changes, although mostly subjectively reported, were noted in most studies. Future evaluation should use validated or objective outcome assessments, and the value of using dual trained instructors.

Referring to complementary and alternative medicine--a possible tool for implementation

BACKGROUND

Patients' extensive use of complementary and alternative medicine (CAM) can affect doctor-patient communication. Substantial numbers of patients expect their primary care physician to be able to refer them to CAM practitioners. However, a simple and practical referral CAM process is lacking.

RESEARCH DESIGN AND METHODS

We developed an 11-item questionnaire that addresses issues a physician should consider in determining whether to refer a patient for CAM treatment, including biopsychosocial and communication concerns and the safety and effectiveness of modalities. The tool was administered via questionnaires posted and e-mailed to primary care physicians and CAM practitioners.

RESULTS

Our CAM referral tool was found to be considerably useful in a primary care setting. High reliability and validity of the tool were found among the primary care physicians (Cronbach's alpha score of 0.867, spearman rho correlation 0.2-0.67) and moderate reliability among CAM practitioners (0.745).

CONCLUSIONS

We hope that our CAM referral tool will help advance the integration of CAM and conventional medicine.