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Yuan NP, Brooks AJ, Burke MK, Crocker R, Stoner GM, Cook P, Chen MK, Bautista J, Petralba P, Whitewater S, Maizes V. My Wellness Coach: evaluation of a mobile app designed to promote integrative health among underserved populations. Transl Behav Med 2022; 12:752-760. [PMID: 35661225 DOI: 10.1093/tbm/ibac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Underserved populations, including those from racial and ethnic groups and with low socioeconomic status, often lack access to mobile apps aimed at reducing health risk factors. This study evaluated the feasibility, acceptability, and preliminary effectiveness of the mobile app, My Wellness Coach (MWC), designed to promote behavior change in seven core areas of integrative health among underserved populations. Patients and staff were recruited from clinic and other settings. Some participants used MWC in a weekly group setting (n = 5); others on their own with support from a coordinator (n = 36). Health outcomes were assessed at baseline and 3 months. Mobile app ratings were collected at 5 weeks and 3 months. Goal setting data were analyzed at 3 months. Most participants (76%) set at least one goal, 71% created action steps for goals, and 29% completed a goal. Patients in the group setting had the highest rate of goal completion (60%) compared to patients (20%) and staff (27%) using the app on their own. Significant (p < .05) changes in pre- and post-test scores were documented for overall wellbeing, global physical health, BMI, vigorous physical activity, and eHealth literacy. Most participants (75%-91%) gave MWC high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge, and awareness. This study documented preliminary evidence of the potential benefits of MWC among underserved communities. Future evaluations of Spanish and Android versions and comparisons between group and individual administration will inform implementation strategies for scaling MWC-based interventions to reach underserved communities nationally.
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Affiliation(s)
- Nicole P Yuan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, the University of Arizona, Tucson, AZ 85724, USA
| | - Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Molly K Burke
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Robert Crocker
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Gates Matthew Stoner
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Paula Cook
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Mei-Kuang Chen
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
| | - Juan Bautista
- El Rio Community Health Center, Tucson, AZ 85745, USA
| | | | - Shannon Whitewater
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, the University of Arizona, Tucson, AZ 85724, USA
| | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, the University of Arizona, Tucson, AZ 85724, USA
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Win H, Russell S, Wertheim BC, Maizes V, Crocker R, Brooks AJ, Mesa R, Huberty J, Geyer H, Eckert R, Larsen A, Gowin K. Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e33581. [PMID: 35357315 PMCID: PMC9015738 DOI: 10.2196/33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.
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Affiliation(s)
- Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Samantha Russell
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Robert Crocker
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Ruben Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Jennifer Huberty
- Department of Hematology, University of Arizona, Tucson, AZ, United States
| | - Holly Geyer
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ashley Larsen
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, United States
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Ricker M, Maizes V, Brooks AJ, Lindberg C, Cook P, Lebensohn P. A Longitudinal Study of Burnout and Well-being in Family Medicine Resident Physicians. Fam Med 2021; 52:716-723. [PMID: 33151531 DOI: 10.22454/fammed.2020.179585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) core competencies for residency learning and work environment standards acknowledge high levels of burnout and depression in resident physicians and the critical importance of physician well-being to patient care and effective education. The objective of this study was to follow family medicine resident physicians' well-being throughout residency. METHODS Family medicine resident physicians from 12 programs completed validated assessments (burnout, depression, perceived stress, satisfaction with life, positive and negative affect, emotional intelligence, mindfulness, gratitude) at residency start, second year start, and graduation. Resident physicians were from the 2011, 2012, and 2013 graduating classes (N=158). RESULTS Two indicators of burnout (emotional exhaustion, depersonalization) increased between the start of residency and the start of the second year, remaining elevated at graduation. Emotional intelligence was lower at graduation than at the start of residency. In contrast, other measures of well-being (stress, life satisfaction, affect) improved during the second and third years. Depression, mindfulness, and gratitude remained stable. Increased levels of burnout risk at graduation were negatively associated with emotional intelligence, mindfulness, and gratitude. CONCLUSIONS While the stressful impact of residency is transitory for some measures of well-being, that is not the case for burnout or emotional intelligence. Burnout levels peak after the first year of residency and remain high through graduation. Targeted interventions to identify and address burnout in residency need to be evaluated in future studies.
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Affiliation(s)
- Mari Ricker
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Victoria Maizes
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Audrey J Brooks
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Coya Lindberg
- Cascades East Family Medicine Residency, Oregon Health and Science University, Klamath Falls, OR
| | - Paula Cook
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ
| | - Patricia Lebensohn
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
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Ricker M, Brooks AJ, Bodine S, Lebensohn P, Maizes V. Well-being in Residency: Impact of an Online Physician Well-being Course on Resiliency and Burnout in Incoming Residents. Fam Med 2021; 53:123-128. [PMID: 33566347 DOI: 10.22454/fammed.2021.314886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Wellness in residency has come to the forefront of national graduate medical education initiatives. Exponential growth in knowledge and skill development occurs under immense pressures, with physical, mental, and emotional stressors putting residents at burnout risk. The Accreditation Council for Graduate Medical Education requires programs to attend to resident wellness, providing the structure, environment, and resources to address burnout. This study's purpose was to evaluate the Andrew Weil Center for Integrative Medicine online Physician Well-being Course (PWC) with incoming postgraduate year-1 (PGY-1) residents in multiple residencies across a single health care system. The PWC teaches the learner strategies for building resilience, managing stress, identifying signs of burnout, and mindfulness practices including a self-selected daily 10-minute resiliency activity (meditation, gratitude journaling, and finding meaning journaling) for 14 days. METHODS Incoming PGY-1 residents were enrolled in PWC 1 month prior to 2018 orientation. Validated measures of resiliency, burnout and gratitude were completed pre- and postcourse. We assessed pre/postcourse changes with paired t tests. We asked participants whether they incorporated any wellness behavior changes postcourse. RESULTS Almost two-thirds of the incoming trainees completed the course (n=53/87, 61%). We found significant improvements (P<.05) for resiliency and burnout (emotional exhaustion, depersonalization). Gratitude did not change. The personal accomplishment burnout scale declined. The most frequently reported wellness behaviors were in the area of sleep, exercise, and diet. CONCLUSIONS Resiliency, emotional exhaustion, and depersonalization improved, personal accomplishment declined, while gratitude remained the same. This project demonstrates an accessible and scalable approach to teaching well-being to incoming residents.
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Affiliation(s)
- Mari Ricker
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ
| | - Audrey J Brooks
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Sarah Bodine
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ
| | - Patricia Lebensohn
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Victoria Maizes
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
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5
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Affiliation(s)
- Randy Horwitz
- University of Arizona College of Medicine, Andrew Weil Center for Integrative Medicine at the University of Arizona, Tucson.
| | - Victoria Maizes
- University of Arizona College of Medicine, Andrew Weil Center for Integrative Medicine at the University of Arizona, Tucson
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Alschuler L, Chiasson AM, Horwitz R, Sternberg E, Crocker R, Weil A, Maizes V. Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease. Explore (NY) 2020; 18:140-148. [PMID: 33358750 PMCID: PMC7756157 DOI: 10.1016/j.explore.2020.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 12/13/2022]
Abstract
The majority of individuals infected with SARS-CoV-2 have mild-to-moderate COVID-19 disease. Convalescence from mild-to-moderate (MtoM) COVID-19 disease may be supported by integrative medicine strategies. Integrative Medicine (IM) is defined as healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. Integrative medicine strategies that may support recovery from MtoM COVID-19 are proposed given their clinically studied effects in related conditions. Adoption of an anti-inflammatory diet, supplementation with vitamin D, glutathione, melatonin, Cordyceps, Astragalus and garlic have potential utility. Osteopathic manipulation, Qigong, breathing exercises and aerobic exercise may support pulmonary recovery. Stress reduction, environmental optimization, creative expression and aromatherapy can provide healing support and minimize enduring trauma. These modalities would benefit from clinical trials in people recovering from COVID-19 infection.
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Affiliation(s)
- Lise Alschuler
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States.
| | - Ann Marie Chiasson
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Randy Horwitz
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Esther Sternberg
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Robert Crocker
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Andrew Weil
- Andrew Weil Center for Integrative Medicine, United States; University of Arizona, United States
| | - Victoria Maizes
- University of Arizona, College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
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Vodovotz Y, Barnard N, Hu FB, Jakicic J, Lianov L, Loveland D, Buysse D, Szigethy E, Finkel T, Sowa G, Verschure P, Williams K, Sanchez E, Dysinger W, Maizes V, Junker C, Phillips E, Katz D, Drant S, Jackson RJ, Trasande L, Woolf S, Salive M, South-Paul J, States SL, Roth L, Fraser G, Stout R, Parkinson MD. Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit. Front Med (Lausanne) 2020; 7:585744. [PMID: 33415115 PMCID: PMC7783318 DOI: 10.3389/fmed.2020.585744] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4–5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt “whole-person health and performance” models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.
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Affiliation(s)
- Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Neal Barnard
- Department of Medicine, George Washington University School of Medicine, Washington, DC, United States
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - John Jakicic
- School of Education, University of Pittsburgh, Pittsburgh, PA, United States
| | - Liana Lianov
- American College of Lifestyle Medicine, Chesterfield, MO, United States
| | | | - Daniel Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Toren Finkel
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendolyn Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Paul Verschure
- Institute for Bioengineering of Catalunya, Barcelona Institute of Science and Technology, Catalan Institute of Advanced Studies, Barcelona, Spain
| | - Kim Williams
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | | | | | - Victoria Maizes
- Department of Internal Medicine, University of Arizona, Tucson, AZ, United States
| | - Caesar Junker
- United States Air Force, Washington, DC, United States
| | - Edward Phillips
- Department of Physical Medicine and Rehabilitation, Veterans Administration Boston Healthcare System, Boston, MA, United States
| | - David Katz
- True Health Initiative, Derby, CT, United States
| | - Stacey Drant
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richard J Jackson
- Department of Environmental Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Leonardo Trasande
- Department of Pediatrics and Environmental Medicine, New York University, New York, NY, United States
| | - Steven Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Marcel Salive
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, MD, United States
| | - Jeannette South-Paul
- Department of Family Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah L States
- Phipps Conservatory and Botanical Gardens, Pittsburgh, PA, United States
| | - Loren Roth
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gary Fraser
- Department of Medicine, Preventive Medicine and Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Ron Stout
- Ardmore Institute of Health, Ardmore, OK, United States
| | - Michael D Parkinson
- University of Pittsburgh Medical Center Health Plan/WorkPartners, Pittsburgh, PA, United States
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Alschuler L, Weil A, Horwitz R, Stamets P, Chiasson AM, Crocker R, Maizes V. Integrative considerations during the COVID-19 pandemic. Explore (NY) 2020; 16:354-356. [PMID: 32229082 PMCID: PMC7270871 DOI: 10.1016/j.explore.2020.03.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Lise Alschuler
- University of Arizona College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States.
| | - Andrew Weil
- Andrew Weil Center for Integrative Medicine, United States; University of Arizona, United States
| | - Randy Horwitz
- University of Arizona College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | | | - Ann Marie Chiasson
- University of Arizona College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Robert Crocker
- University of Arizona College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
| | - Victoria Maizes
- University of Arizona College of Medicine, United States; Andrew Weil Center for Integrative Medicine, United States
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Chiasson AM, Brooks AJ, Ricker M, Lebensohn P, Chen MK, Maizes V. Educating Physicians in Family Medicine Residencies About Nonpharmacologic Approaches to Pain:. Fam Med 2020; 52:189-197. [DOI: 10.22454/fammed.2020.865003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: Opioid misuse is at an all-time crisis level, and nationally enhanced resident and clinician education on chronic pain management is in demand. To date, broad-reaching, scalable, integrative pain management educational interventions have not been evaluated for effectiveness on learner knowledge or attitudes toward chronic pain management.
Methods: An 11-hour integrative pain management (IPM) online course was evaluated for effect on resident and faculty attitudes toward and knowledge about chronic pain. Participants were recruited from family medicine residencies participating in the integrative medicine in residency program. Twenty-two residencies participated, with 11 receiving the course and 11 serving as a control group. Evaluation included pre/post medical knowledge and validated measures of attitude toward pain patients, self-efficacy for nondrug therapies, burnout, and compassion.
Results: Forty-three participants (34.4%) completed the course. The intervention group (n=50), who received the course, improved significantly (P<.05) in medical knowledge, attitude toward pain patients, and self-efficacy to prescribe nondrug therapies while the control group (n=54) showed no improvement. There was no effect on burnout or compassion for either group. The course was positively evaluated, with 83%-94% rating the course content and delivery very high. All participants responded that they would incorporate course information into practice, and almost all thought what they learned in the course would improve patient care (98%).
Conclusions: Our findings demonstrate the feasibility of an online IPM course as an effective and scalable intervention for residents and primary care providers in response to the current opioid crisis and need for better management of chronic pain. Future directions include testing scalability in formats that lead to improved completion rates, implementation in nonacademic settings, and evaluation of clinical outcomes such as decreased opioid prescribing.
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Affiliation(s)
- Ann Marie Chiasson
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Audrey J. Brooks
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Mari Ricker
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Patricia Lebensohn
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Mei-Kuang Chen
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
| | - Victoria Maizes
- University of Arizona Andrew Weil Center for Integrative Medicine, Tucson, AZ
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Brooks AJ, Maizes V, Billimek J, Blair J, Chen MK, Goldblatt E, Kilgore D, Klatt M, Kligler B, Koithan MS, Kreitzer MJ, Lee JK, Lopez AM, Taren D, Lebensohn P. Professional development in integrative health through an interprofessional online course in clinical settings. Explore (NY) 2020; 17:505-512. [PMID: 32229083 DOI: 10.1016/j.explore.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although there is mounting clinical and cost-effectiveness evidence supporting integrative healthcare (IH), a significant knowledge gap hinders widespread adoption by health professionals. INTERVENTION Foundations in Integrative Health (FIH), a 32-h online competency-based interprofessional course to address this knowledge gap. METHODS The course was pilot-tested by an interprofessional sample of providers in various clinical settings as professional and staff development. OUTCOME MEASURES Prior to and following the course, participants completed an IH knowledge test, an IH self-efficacy self-assessment, and validated measures of burnout, wellness behaviors, and attitudes toward IH, interprofessional teams, and patient involvement. Evaluation surveys were administered following each unit and the course. RESULTS Thirty-one percent of the participants (n = 214/690) completed the course. Pre/post course improvements were found in IH knowledge, IH self-efficacy, attitudes towards IH and interprofessional teams, and several wellness behaviors. The course was positively evaluated with 81% of the participants indicating interest in applying IH principles in their practice and 92% reported that the course enhanced their clinical experience. CONCLUSION This study demonstrates the outcomes of a multi-site, online IH curriculum offered to a diverse group of health professionals in various clinical settings. This course may allow clinical settings to offer an interprofessional, IH curriculum even with limited on-site faculty expertise.
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Affiliation(s)
- Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States.
| | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States; Department of Family and Community Medicine, University of Arizona, 655N Alvernon Way, Ste 228 Tucson, AZ 85711, United States; Mel and Enid Zuckerman College of Public Health, University of Arizona, PO Box 245163, Tucson, AZ 85724-5163, United States.
| | - John Billimek
- Department of Family Medicine and Health Policy Research Institute, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA 92617, United States.
| | - Jennifer Blair
- Penny George Institute for Health and Healing, Allina Health, Mail Route 15115, 2833 Chicago Avenue, Minneapolis, MN 55407-3799, United States.
| | - Mei-Kuang Chen
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States.
| | - Elizabeth Goldblatt
- Academic Collaborative of Integrative Health, 700 S Flower St., Ste 1000, Los Angeles, CA 90017, United States; American College of Traditional Chinese Medicine, 455 Arkansas St, San Francisco, CA 94107, United States.
| | - David Kilgore
- UC Irvine Department of Family Medicine, 200 S. Manchester Ave, Suite 835, Orange, CA 92868, United States.
| | - Maryanna Klatt
- Department of Family Medicine, The Ohio State University College of Medicine, 2231N High St., Ste 261 Columbus, OH 43201, United States.
| | - Benjamin Kligler
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029-5674, United States.
| | - Mary S Koithan
- College of Nursing, University of Arizona, PO Box 210203, Tucson, AZ 85721-0203, United States.
| | - Mary Jo Kreitzer
- Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, C510 Mayo Memorial Building, MMC 505, 420 Delaware St SE, Minneapolis, MN 55455, United States.
| | - Jeannie K Lee
- Pharmacy Practice & Science, College of Pharmacy, University of Arizona, PO Box 210202, Tucson, AZ 85721-0202, United States.
| | - Ana Maria Lopez
- School of Medicine, University of Utah, HSEB 5515, 26 South 2000 East, Salt Lake City, UT 84112, United States.
| | - Douglas Taren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, PO Box 245163, Tucson, AZ 85724-5163, United States.
| | - Patricia Lebensohn
- Andrew Weil Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724-5153, United States; Department of Family and Community Medicine, University of Arizona, 655N Alvernon Way, Ste 228 Tucson, AZ 85711, United States.
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Ranjbar N, Villagomez A, Brooks AJ, Ricker M, Lebensohn P, Maizes V. Assessing Integrative Psychiatry Curriculum Needs. Glob Adv Health Med 2019; 8:2164956118821585. [PMID: 30643670 PMCID: PMC6322096 DOI: 10.1177/2164956118821585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/23/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Research on incorporating integrative medicine (IM) into medical training is increasing. Programs and organizations around IM have been established, but there has not previously been a needs assessment focused on integrating IM into psychiatry training. OBJECTIVES The results of a needs assessment of training directors and faculty, focused on interest and priorities for developing an IM curriculum for psychiatry training programs, are described. METHODS Psychiatry Training Directors and faculty were invited to participate in a detailed electronic survey. Areas of inquiry included (a) IM content areas to include in training; (b) IM approaches to specific medical conditions; (c) existing IM content; (d) importance, interest, and strategies for IM training; and (e) availability of wellness programs for trainees. RESULTS Thirty-six respondents from psychiatry training programs completed the survey. Of the training programs represented by the respondents, 50% indicated that they currently had IM content in their curriculum; only 11.8% of them rated their programs' existing IM content as sufficient. Content areas rated most highly for inclusion in a psychiatry IM curriculum included sleep health, motivational interviewing, and self-care. Respondents indicated incorporating IM into the psychiatry training curriculum (47%) or as an elective (44%) as the desired implementation strategy, with experiential onsite activities demonstrating IM topics (67%) and online modules supplemented by local faculty (58%) as the 2 most desirable learning formats. Significant barriers identified were time constraints, lack of faculty expertise in IM, current lack of curricular requirements for IM competencies, and budgetary limitations. CONCLUSION Responses to the survey suggest that faculty need support and additional education in implementing IM training. A standardized, online curriculum could help meet that need. Our results also indicate that wellness programs for residents are currently inadequate; bolstering them could help address burnout and increase the knowledge psychiatrists have of IM modalities. The types of institutions represented by faculty interested in further developing IM offerings vary considerably, as do their current efforts to integrate IM into training programs.
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Affiliation(s)
- Noshene Ranjbar
- Department of Psychiatry, University of Arizona, Tucson, Arizona
| | | | - Audrey J Brooks
- The Center for Integrative Medicine, University of Arizona, Tucson, Arizona
| | - Mari Ricker
- The Center for Integrative Medicine, University of Arizona, Tucson, Arizona
| | - Patricia Lebensohn
- The Center for Integrative Medicine, University of Arizona, Tucson, Arizona
| | - Victoria Maizes
- The Center for Integrative Medicine, University of Arizona, Tucson, Arizona
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Herman P, Crocker R, Begaye D, Maizes V. 29C. The University of Arizona Integrative Health Center: The Development and Testing of a New Business Model for Integrative Primary Care. Glob Adv Health Med 2018. [PMCID: PMC3875073 DOI: 10.7453/gahmj.2013.097cp.s29c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Focus Area: Sustainable Business Models This session will advance the development of sustainable complementary and integrative medicine (CIM) practice models by presenting the business plan for a model integrative primary care clinic, its results to date, and the plan for its continuous evaluation. The Arizona Center for Integrative Medicine recently opened the University of Arizona Integrative Health Center (UAIHC), an adult primary care clinic in Phoenix, Arizona, in affiliation with District Medical Group. Developed through an extensive planning by interdisciplinary experts and a strategic market forecasting approach, the business plan includes the clinic's mission and vision, market assessment, organizational structure and staffing plan, projected patient flow, and financial estimates. A hybrid financing approach that combines health insurance reimbursement with patient membership fees (in some cases partially underwritten by employer contributions) prevents barriers to a full IM approach including complementary medicine treatments, individual health coaching sessions, health promotion classes and groups, and extended visit lengths. By the time of the Congress, the UAIHC will have been in operation for 1 year. This presentation covers the development of the business plan, the components of the plan, the challenges involved in moving from the plan to current operations, and a description of the clinic patient population. Data will be reported on the number and characteristics of patients seen and use of clinic services, as well as the clinic's financial viability. An overview will be presented of the ongoing UAIHC multidimensional evaluation study (IMPACT) that assesses the effectiveness of integrative care provided, as well as the implementation of the practice model itself and how this may (or may not) contribute to patient and/or cost outcomes. It is anticipated that detailed evaluation of this clinic will provide future CIM clinics and practitioners with the data needed to successfully develop new practice models.
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Affiliation(s)
| | - Robert Crocker
- University of Arizona, Center for Integrative Medicine, Jackson, Mississippi, United States
| | - Dawn Begaye
- University of Arizona, Center for Integrative Medicine, Phoenix, United States
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, Tucson, United States
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Abstract
A majority of women undergoing conventional treatment for breast cancer also undertake complementary and integrative approaches. Practitioners knowledgeable about the evidence base behind common integrative approaches can help patients attain improved quality of life, and at times, improved survival. Evidence-based recommendations include the following: a plant-based diet for general health after diagnosis, and carbohydrate restriction for patients with estrogen receptor-positive postmenopausal breast cancer may be prudent. Other dietary recommendations include a 13-h daily overnight fast. Carefully selected patients may choose to fast the day before and the day of chemotherapy to decrease side effects. Specific food recommendations include avoidance or limitation of alcohol, and liberal culinary use of cruciferous vegetables, coffee, green tea, soy, and flaxseed. Promising supplements include diindolylmethane and melatonin. Omega 3 fatty acids may help with bone density in patients on aromatase inhibitors, but may increase chemotherapy resistance. Findings regarding the usefulness of multivitamins, vitamin D, vitamin C, and vitamin E are weak and/or mixed different exercise modalities may have different effects and thus play different roles in breast cancer therapy. Aerobic and resistance training combined during breast cancer chemotherapy may confer a survival benefit, while yoga may improve outcome in lymphedema patients. Current evidence suggests that meditation, yoga, breathing, music therapy, guided imagery, and hypnosis may improve mood and quality of life during breast cancer treatment. Acupuncture is useful for treating side effects of breast cancer therapies, including hot flushes, aromatase inhibitor-induced joint pain, chemotherapy-induced peripheral neuropathy, and vulvodynia. Vaginal moisturizers and vaginal rings supplying low-dose estrogen can be useful in the treatment of symptoms of estrogen-deprivation states caused by breast cancer treatments; such symptoms include vaginal dryness, dyspareunia, and sexual dysfunction. Carbon dioxide laser technology can rejuvenate atrophied vaginal mucosa and relieve dyspareunia, allowing avoidance of estrogen therapy. Tertiary sexual health centers are available for referral.
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Affiliation(s)
- Dawn Lemanne
- 1 The University of Arizona Center for Integrative Medicine , Tucson, Arizona.,2 Oregon Integrative Oncology , Ashland, Oregon.,3 National Institute of Integrative Medicine , Melbourne, Australia
| | - Victoria Maizes
- 1 The University of Arizona Center for Integrative Medicine , Tucson, Arizona
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14
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Maizes V. Preconception Counseling and Fertility. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Crocker RL, Grizzle AJ, Hurwitz JT, Rehfeld RA, Abraham I, Horwitz R, Weil A, Maizes V. Integrative medicine primary care: assessing the practice model through patients' experiences. BMC Complement Altern Med 2017; 17:490. [PMID: 29141643 PMCID: PMC5688715 DOI: 10.1186/s12906-017-1996-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The University of Arizona Integrative Health Center (UAIHC) was an innovative integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC used a hybrid payment model to deliver comprehensive healthcare that includes conventional and complementary medical treatments. METHODS Fidelity measures were collected to evaluate how well the IM care delivery process matched ideals for IM. Patient experiences are presented here. Patients visiting UAIHC on 1 of 10 randomly selected days between September 2013 and February 2015 were surveyed. Patients were asked about their experience with: holistic care; promotion of health, self-care, and well-being; relationship and communication with practitioners; and overall satisfaction. RESULTS Eighty-three patients completed surveys. Based on patient-reported experiences, UAIHC delivered IM care as defined by the practice model. CONCLUSIONS Patients received holistic care, established positive caring relationships with providers who promoted their self-care and well-being, and reported high overall satisfaction with UAIHC.
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Affiliation(s)
- Robert L Crocker
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Amy J Grizzle
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Jason T Hurwitz
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Rick A Rehfeld
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research (HOPE), College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Randy Horwitz
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Andrew Weil
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Victoria Maizes
- University of Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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Horwitz R, Maizes V. Environmental sensitivity as a trigger of erythema nodosum and perimenopausal symptoms. BMJ Case Rep 2017; 2017:bcr-2017-220433. [PMID: 28765184 DOI: 10.1136/bcr-2017-220433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old woman presented to the University of Arizona Integrative Medicine Clinic for advice on managing recurrent erythema nodosum (EN), along with recent onset perimenopausal symptoms. Her painful EN flares had occurred two to six times per year over the past 14 years, yet had attenuated over the past 5 years until recently, and she presented with bilateral EN lesions on the shins. An environmental exposure history revealed that a new plastic-containing water pot had been introduced at her office just prior to her latest EN flare. She was told to eliminate environmental exposure to plastics, including this new coffee pot. She eliminated exposures to heated plastics, and replaced her coffee pot with a stainless steel one. Within weeks of removing these potential environmental triggers, her EN lesions cleared completely, and her menses normalised. An unintentional re-exposure to plastics 2 months later resulted in an EN recurrence within 2 hours.
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Affiliation(s)
- Randy Horwitz
- University of Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Victoria Maizes
- University of Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
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Lebensohn P, Kligler B, Brooks AJ, Teets R, Birch M, Cook P, Maizes V. Integrative Medicine in Residency: Feasibility and Effectiveness of an Online Program. Fam Med 2017; 49:514-521. [PMID: 28724148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Online curricular interventions in residency have been proposed to address challenges of time, cost, and curriculum consistency. This study is designed to determine the feasibility and effectiveness of a longitudinal, multisite online curriculum in integrative medicine (IMR) for residents. METHODS Residents from eight family medicine programs undertook the 200-hour online IMR curriculum. Their medical knowledge (MK) scores at completion were compared to a control group from four similar residency programs. Study and control groups were comparable in baseline demographics, and MK scores. Course completion, MK scores, and course evaluations were assessed. RESULTS Of 186 IMR residents, 76.9% met completion requirements. The IMR group showed statistically significant higher MK scores at residency completion, the control group did not (IMR: 79.2% vs. CONTROL 53.2% mean correct). Over three-fourths of IMR participants (range 79-92%) chose the top two rating categories for each course evaluation item. In an exit survey, ability to access the curriculum for 1 additional year and intention to utilize IM approaches after residency were the highest ranked items. CONCLUSIONS The demonstrated feasibility, effectiveness, and positive evaluations of the IMR curriculum indicate that a multisite, online curricular intervention is a potentially viable approach to offering new curriculum with limited on-site faculty expertise for other family medicine residencies.
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Affiliation(s)
- Patricia Lebensohn
- University of Arizona Center for Integrative Medicine, University of Arizona College of Medicine
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Maizes V, Horwitz R, Lebensohn P, McClafferty H, Dalen J, Weil A. The evolution of integrative medical education: the influence of the University of Arizona Center for Integrative Medicine. Journal of Integrative Medicine 2015; 13:356-62. [DOI: 10.1016/s2095-4964(15)60209-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Maizes V, Brooks AJ, Lebensohn P. The Integrative Medicine in Residency Project: Feasibility and effectiveness of a multi-site web-based curriculum for primary care residencies. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kligler B, Brooks AJ, Maizes V, Goldblatt E, Klatt M, Koithan MS, Kreitzer MJ, Lee JK, Lopez AM, McClafferty H, Rhode R, Sandvold I, Saper R, Taren D, Wells E, Lebensohn P. Interprofessional Competencies in Integrative Primary Healthcare. Glob Adv Health Med 2015; 4:33-9. [PMID: 26421232 PMCID: PMC4563887 DOI: 10.7453/gahmj.2015.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 "meta-competencies" through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.
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Affiliation(s)
- Benjamin Kligler
- Mount Sinai Beth Israel Department of Integrative Medicine, New York, United States (Dr Kligler)
| | - Audrey J Brooks
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Brooks)
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Maizes)
| | - Elizabeth Goldblatt
- Academic Consortium for Complementary & Alternative Health Care, Seattle, Washington, United States (Dr Goldblatt)
| | - Maryanna Klatt
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, United States (Dr Klatt)
| | - Mary S Koithan
- Department of Family and Community Medicine, University of Arizona, United States (Dr Koithan)
| | - Mary Jo Kreitzer
- Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis (Dr Kreitzer)
| | - Jeannie K Lee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, United States (Dr Lee)
| | - Ana Marie Lopez
- University of Utah Health Sciences Center, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, United States (Dr Lopez)
| | - Hilary McClafferty
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr McClafferty)
| | - Robert Rhode
- Department of Psychiatry, University of Arizona, Tucson, United States (Dr Rhode)
| | - Irene Sandvold
- Medical Training and Geriatrics Branch, Division of Medicine and Dentistry, Bureau of Health Workforce, Health Resources and Services Administration, Department of Health and Human Services, Rockville, Maryland, United States (Dr Sandvold)
| | - Robert Saper
- School of Medicine, Boston University, Massachusetts, Academic Consortium for Integrative Medicine and Health, McLean, Virginia, United States (Dr Saper)
| | - Douglas Taren
- Mel and Enid Zuckerman College of Public Health, University of Arizona, United States (Dr Taren)
| | - Eden Wells
- School of Public Health, University of Michigan, Ann Arbor, United States (Dr Wells)
| | - Patricia Lebensohn
- Arizona Center for Integrative Medicine, University of Arizona, Tucson, United States (Dr Lebensohn)
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Maizes V, Brooks AJ, Lebensohn P. National Center for Integrative Primary Healthcare: Designing an introductory interprofessional integrative health course for primary care educational training programs. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Devries S, Dalen JE, Eisenberg DM, Maizes V, Ornish D, Prasad A, Sierpina V, Weil AT, Willett W. The reply. Am J Med 2015; 128:e27-8. [PMID: 25918928 DOI: 10.1016/j.amjmed.2015.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Division of Cardiology, Northwestern University, Chicago, Ill
| | - James E Dalen
- Weil Foundation, University of Arizona College of Medicine, Tucson
| | - David M Eisenberg
- Samueli Institute, Alexandria, Va; Department of Nutrition, Harvard School of Public Health, Boston, Mass
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; Department of Medicine, University of California, San Francisco
| | - Arti Prasad
- Section of Integrative Medicine and Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Victor Sierpina
- Department of Family Medicine, University of Texas Medical Branch, Galveston
| | - Andrew T Weil
- Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson
| | - Walter Willett
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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McClafferty H, Dodds S, Brooks AJ, Brenner MG, Brown ML, Frazer P, Mark JD, Weydert JA, Wilcox GMG, Lebensohn P, Maizes V. Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum. Children (Basel) 2015; 2:98-107. [PMID: 27417353 PMCID: PMC4928751 DOI: 10.3390/children2010098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 11/16/2022]
Abstract
Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents' self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1-8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.
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Affiliation(s)
- Hilary McClafferty
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
| | - Sally Dodds
- Psychiatry and Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
| | - Audrey J Brooks
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
| | - Michelle G Brenner
- Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA.
| | - Melanie L Brown
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL 60637, USA.
| | - Paige Frazer
- Community Faculty, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA.
| | - John D Mark
- Pediatric Pulmonary Medicine, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
| | - Joy A Weydert
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | | | - Patricia Lebensohn
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
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Devries S, Dalen JE, Eisenberg DM, Maizes V, Ornish D, Prasad A, Sierpina V, Weil AT, Willett W. A deficiency of nutrition education in medical training. Am J Med 2014; 127:804-6. [PMID: 24754969 DOI: 10.1016/j.amjmed.2014.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Ill; Division of Cardiology, Northwestern University, Chicago, Ill.
| | - James E Dalen
- Weil Foundation, University of Arizona College of Medicine, Tucson
| | - David M Eisenberg
- Samueli Institute, Alexandria, Va; Harvard School of Public Health, Department of Nutrition, Boston, Mass
| | - Victoria Maizes
- Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, Calif; Department of Medicine, University of California, San Francisco
| | - Arti Prasad
- Section of Integrative Medicine and Department of Internal Medicine, University of New Mexico, Albuquerque
| | - Victor Sierpina
- Department of Family Medicine, University of Texas Medical Branch, Galveston
| | - Andrew T Weil
- Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson
| | - Walter Willett
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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Perlman A, Horrigan B, Goldblatt E, Maizes V, Kligler B. The pebble in the pond: how integrative leadership can bring about transformation. Explore (NY) 2014; 10:S1-14. [PMID: 25169426 DOI: 10.1016/j.explore.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lebensohn P, Dodds S, Brooks AJ, Cook P, Guerrera M, Sierpina V, Teets R, Woytowicz J, Maizes V. Increasing Resident Recruitment into Family Medicine: Effect of a Unique Curriculum in Integrative Medicine. Explore (NY) 2014; 10:187-92. [DOI: 10.1016/j.explore.2014.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Indexed: 10/25/2022]
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Brooks A, Dodds S, Cook P, Maizes V, Lebensohn P. Comparison of Residents and Medical Students on Measures of Well-Being and Lifestyle. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5269.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Audrey Brooks
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Sally Dodds
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Paula Cook
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Victoria Maizes
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Patricia Lebensohn
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
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Brooks A, Dodds S, Cook P, Maizes V, Lebensohn P. Psychometric Analyses of the Arizona Lifestyle Inventory: A Multi-Dimensional Integrative Medicine Measure to Assess Wellness Behaviors. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5357.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Audrey Brooks
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Sally Dodds
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Paula Cook
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Victoria Maizes
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
| | - Patricia Lebensohn
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
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Lebensohn P, Dodds S, Brooks A, Cook P, Schneider C, Woytowicz J, Maizes V. A Longitudinal Study of Well-Being, Burnout and Emotional Intelligence in Family Medicine Residents. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5017.abstract] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patricia Lebensohn
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Sally Dodds
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Audrey Brooks
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Paula Cook
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Craig Schneider
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - John Woytowicz
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
| | - Victoria Maizes
- (1) Arizona Center for Integrative Medicine/University of Arizona, Tucson, AZ, USA
- (2) Maine Medical Center Family Medicine Residency, Portland, ME, USA
- (3) Maine-Dartmouth Family Medicine Residency, Augusta, ME, USA
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Lebensohn P, Dodds S, Benn R, Brooks AJ, Birch M, Cook P, Schneider C, Sroka S, Waxman D, Maizes V. Resident wellness behaviors: relationship to stress, depression, and burnout. Fam Med 2013; 45:541-549. [PMID: 24129866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Stress in medical education has been well documented, often with the primary focus on negative factors such as depression and burnout. Few studies have attempted to assess well-being mediating behaviors. This study describes the relationship between wellness behaviors and measures of well-being at the start of family medicine residency. METHODS Using an online questionnaire, first-year family medicine residents (n=168) completed standardized measures exploring perceived stress, depression, satisfaction with life, and burnout. A lifestyle wellness behavior measure was developed for the study. RESULTS Average reported perceived stress levels were consistent with ranges found for medical students and residents. Twenty-three percent of residents scored in a range consistent with depression risk. In terms of burnout risk, 13.7% scored in the high emotional exhaustion range and 23.8% in the high depersonalization range. Two thirds reported high life satisfaction. Higher depersonalization and less time in nurturing relationships were associated with greater likelihood of medication use for sleep, mood, and anxiety in females. Higher alcohol use was associated with increased levels of perceived stress, burnout, and depression. The two wellness behaviors most associated with higher well-being were restful sleep and exercise. CONCLUSIONS At the start of residency, well-being measures are consistent with findings in medical school. Restful sleep and exercise were associated with more positive well-being. Future longitudinal data analysis will help clarify the effect of residency training in well-being and lifestyle behaviors. Identification of protective factors and coping mechanisms could guide residencies in incorporating support services for residents.
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Maizes V. 09A. Preconception Counseling: A Critical Window for the Health Promotion of Children. Glob Adv Health Med 2013. [PMCID: PMC3875086 DOI: 10.7453/gahmj.2013.097cp.s09a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Focus Areas: Integrative Approaches to Care, Pediatrics Modern women are taught to ignore their biological clocks and proceed with their careers, the larger media message promising that fertility is possible at advanced ages with a bit of help from reproductive technologies. This can be a false promise. Men, too, are now known to have increased risks of fathering children with schizophrenia or autism after the age of 40. The fetal origins hypothesis posits that the environment of the womb has a profound effect on a human being, greatly increasing, or helping to prevent, a myriad of diseases. To maximally benefit, health-promotion activities must begin prior to conception. This session will describe the risks to fertility and health, the most common routes of exposure, and strategies to minimize risks. Dr Maizes will discuss how to reduce exposure to the thousands of environmental chemicals currently in use, many of which are endocrine disruptors. The known consequences to the fetus include increased risk of autism, leukemia, cancer, and cardiovascular disease. She will review the impact of the standard American diet, which reduces fertility and increases obesity in children, as well as evidence for whole-food diets and various macronutrients for increased fertility. She will discuss the physiological effect of stress on the hypothalamus and pituitary glands. Finally, she will address micronutrients that have been proven to reduce the risk of neural tube and heart defects and that are associated with lower levels of autism. Despite universal support from the AAFP, AAP, and ACOG, the majority of women of childbearing age in the United States are not taking a multivitamin. In this interactive session, Dr Maizes will present the evidence for integrative approaches that can optimize fertility as well as increase the likelihood of having a healthy child.
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Affiliation(s)
- Victoria Maizes
- Arizona Center for Integrative Medicine, Tucson, United States
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Dodds S, Brooks A, Woytowicz J, Cook P, Benn R, Maizes V, Lebensohn P. OA05.02. Relationships among well-being and wellness behaviors over time in residents in eight family medicine residencies. BMC Complement Altern Med 2012. [PMCID: PMC3373449 DOI: 10.1186/1472-6882-12-s1-o18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lebensohn P, Dodds S, Kligler B, Brooks A, Cook P, Maizes V. P03.01. Characteristics of residents and training sites influence successful completion of the Integrative Medicine in Residency program. Altern Ther Health Med 2012. [PMCID: PMC3373482 DOI: 10.1186/1472-6882-12-s1-p254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lebensohn P, Kligler B, Dodds S, Schneider C, Sroka S, Benn R, Cook P, Guerrera M, Low Dog T, Sierpina V, Teets R, Waxman D, Woytowicz J, Weil A, Maizes V. Integrative medicine in residency education: developing competency through online curriculum training. J Grad Med Educ 2012; 4:76-82. [PMID: 23451312 PMCID: PMC3312539 DOI: 10.4300/jgme-04-01-30] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/05/2011] [Accepted: 10/04/2011] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The Integrative Medicine in Residency (IMR) program, a 200-hour Internet-based, collaborative educational initiative was implemented in 8 family medicine residency programs and has shown a potential to serve as a national model for incorporating training in integrative/complementary/alternative medicine in graduate medical education. INTERVENTION The curriculum content was designed based on a needs assessment and a set of competencies for graduate medical education developed following the Accreditation Council for Graduate Medical Education outcome project guidelines. The content was delivered through distributed online learning and included onsite activities. A modular format allowed for a flexible implementation in different residency settings. EVALUATION TO ASSESS THE FEASIBILITY OF IMPLEMENTING THE CURRICULUM, A MULTIMODAL EVALUATION WAS UTILIZED, INCLUDING: (1) residents' evaluation of the curriculum; (2) residents' competencies evaluation through medical knowledge testing, self-assessment, direct observations, and reflections; and (3) residents' wellness and well-being through behavioral assessments. RESULTS The class of 2011 (n = 61) had a high rate of curriculum completion in the first and second year (98.7% and 84.2%) and course evaluations on meeting objectives, clinical utility, and functioning of the technology were highly rated. There was a statistically significant improvement in medical knowledge test scores for questions aligned with content for both the PGY-1 and PGY-2 courses. CONCLUSIONS The IMR program is an advance in the national effort to make training in integrative medicine available to physicians on a broad scale and is a success in terms of online education. Evaluation suggests that this program is feasible for implementation and acceptable to residents despite the many pressures of residency.
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Gagné L, Maizes V. Osteoporosis. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abel R, Ali A, Ammon P, Barrett B, Bell IR, Bergquist PE, Bodemer AA, Bonakdar RA, Capra JM, Coeytaux RR, Dahmer SM, Dandurand DE, Dattner AM, Degenhardt B, Desai AD, Desai GJ, Devries S, Dowling DJ, Dusek J, Earl CJ, Earley B, Eichenseher J, Figurski AC, Fortney L, Gagné L, Galland L, Gardiner P, Gordon A, Grassmann J, Greenfield RH, Gurgevich S, Hameed FA, Hanaway PJ, Harvie J, Hernke MT, Hewitt MJ, Hirekatur RS, Horwitz RJ, Humphreys C, Ivker RS, Jernberg J, Jonas W, Kaufman AJ, Kemper KJ, Khalsa DS, Khan SK, Kiefer D, Kligler B, Kohatsu W, Kuphal GJ, Lee RA, Lessens DM, Linkner E(L, Onna Lo YM, Locke AB, Lovett EA, Dog TL, Lumpkin M, Lupiani JH, Maizes V, Maker-Clark G, Mallory DJ, Mann JD, Marchand LR, Mark JD, Massey PB, McBride PE, McClure MW, Temple LM, Mertz MJ, Michelfelder AJ, Muller D, Mumber MP, Myers H, Nahas R, Naiman R, Najm WI, Newmark SC, Nicolai JP, Olshansky B, Pai ST, Park D, Perlman AI, Pierce S, Platt J, Plotnikoff GA, Podein RJ, Rabago D, Rakel D, Reed G, Rhode R, Rindfleisch JA, Ring M, Rosen LD, Rosenberger L, Rossman ML, Saper RB, Schneider C, Schubiner H, Selfridge NJ, Sethi T, Silverman H, Simmons AD, Smith C, Smith PW, St. John TM, Stanton A, Stevans JM, Stoler L, Sudak NL, Teitelbaum J, Underbakke G, Utzinger-Wheeler ML, Warne D, Warshowsky A, Weil A, Weydert JA, Wilhite M, Wissink T, Wolf AJ, Wu J, Zager SH, Zgierska A. Contributors. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Horrigan B, Weil AT, Maizes V, Ananth S. The American Board of Integrative Medicine. Explore (NY) 2012. [DOI: 10.1016/j.explore.2011.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Schiff E, Frenkel M, Shilo M, Levy M, Schachter L, Freifeld Y, Steinfeld I, Maizes V, Ben-Arye E. Bridging the physician and CAM practitioner communication gap: suggested framework for communication between physicians and CAM practitioners based on a cross professional survey from Israel. Patient Educ Couns 2011; 85:188-193. [PMID: 21041056 DOI: 10.1016/j.pec.2010.08.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Our study aimed to develop a framework to improve communication between physicians and CAM practitioners regarding mutual patients. METHODS Following a modified Delphi process, we developed preliminary recommendations regarding communication between physicians and CAM practitioners. We then surveyed 473 physicians and 781 CAM practitioners regarding their opinions on these recommendations. RESULTS High reliability and validity of the survey were found among the physicians and CAM practitioners (Cronbach's alpha score of .94 and .83, respectively). Physicians and CAM practitioners considered communication regarding mutual patients important (80% and 97%, respectively; P<.001). A medical/referral letter was the preferred communication mode. Physicians and CAM practitioners concurred on four elements that should be included in such a referral letter: conventional-CAM diagnosis with coherent terminology, possible conventional-CAM treatment interactions, description of the treatment plan and its goals, and quality issues regarding CAM supplements. CONCLUSIONS A practical framework for advancing physician-CAM practitioner communication is feasible, and may be applied in daily medical care with the goal of bridging the patient-physician-CAM practitioner communication gap. PRACTICE IMPLICATIONS Communication between physicians and CAM practitioners regarding mutual patients is important. Establishing a framework for the mode and content of such communication is feasible.
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Affiliation(s)
- Elad Schiff
- Department of Internal Medicine, Bnai-Zion Hospital, Israel
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Low Dog T, Maizes V. The role of integrative medicine in women's health. Altern Ther Health Med 2010; 16:16-17. [PMID: 20085173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Benn R, Maizes V, Guerrera M, Sierpina V, Cook P, Lebensohn P. Integrative medicine in residency: assessing curricular needs in eight programs. Fam Med 2009; 41:708-714. [PMID: 19882394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Integrative medicine in residency (IMR) is a competency-based online program designed to incorporate a core curriculum in integrative medicine (IM) into established residency training in family medicine. Results of a needs assessment survey developed to guide this curriculum design are presented and discussed. METHODS Faculty and residents from eight self-selected family medicine programs that agreed to pilot the IMR were invited to complete an online needs assessment survey. The survey included a mix of structured and open-ended questions. RESULTS A total of 222 respondents completed the survey, yielding a 60% response rate. Sixty-seven percent of faculty and residents preferred that IM be woven throughout all curriculum areas. The highest rated content topics were nutrition and supplements and physician wellness. Chronic illness, behavioral health, and outpatient medicine were the three top curricular areas seen to need enhancement with IM. Qualitative analysis revealed that 84% of respondents viewed IM as central to family medicine training, the care of patients, and the field of family medicine. Top challenges to implementation included limitations in time, resources, and acceptance. CONCLUSIONS The findings from the needs assessment serve as a resource for addressing curriculum design and potential challenges in implementation.
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Kligler B, Lebensohn P, Koithan M, Schneider C, Rakel D, Cook P, Kohatsu W, Maizes V. Measuring the "whole system" outcomes of an educational innovation: experience from the integrative family medicine program. Fam Med 2009; 41:342-349. [PMID: 19418283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Six family medicine residency programs in the United States collaborated on the development and implementation of an integrative family medicine (IFM) program, which is a postgraduate training model that combines family medicine residency training with an integrative medicine fellowship. This paper reports on effects of IFM on residency programs and clinical systems in which it was implemented. METHODS We used the Integrative Medicine Attitudes Questionnaire (IMAQ) to assess participants' attitudes toward integrative medicine before and after the program was implemented. We assessed residency program recruitment success before and after the program was implemented. We conducted interviews with key informants at each program to evaluate the effects of the IFM on the six participating residency programs. RESULTS IMAQ scores demonstrated a significant increase in the acceptance of integrative medicine after implementation of IFM. Recruiting data showed that participating programs filled at a rate consistently above the national average both before and after implementation. Analysis of interview data showed that programs became more open to an integrative medicine (IM) approach and offered a wider range of clinical services to patients. CONCLUSIONS Our mixed-methods strategy for evaluation of IFM showed that implementing the program increased acceptance of IM, did not affect residency fill rates, and increased use of IM in clinical practice. The combination of quantitative and qualitative methods was an effective strategy for documenting the "systems level" effects of a new educational program.
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Affiliation(s)
- Benjamin Kligler
- Arizona Center for Integrative Medicine/Beth Israel Residency in Urban Family Practice.
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Wallinga D, Maizes V. Foraging for healthy food in the global economy: ten steps we can all take. Explore (NY) 2008; 4:385-8. [PMID: 18984552 DOI: 10.1016/j.explore.2008.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- David Wallinga
- Food and Health Program, Institute for Agriculture and Trade Policy, Minneapolis, MN, USA
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Guerrera MP, Glick RM, Benn R, Kemper K, Kligler B, Maizes V. Integrative Patient-Centered Care. J Altern Complement Med 2008; 14:454. [DOI: 10.1089/acm.2008.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mary P. Guerrera
- University of Connecticut School of Medicine, Co-chair, Consortium Education Working Group
| | - Ronald M. Glick
- University of Pittsburgh Medical Center, Co-chair, Consortium Education Working Group
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Kligler B, Koithan M, Maizes V, Hayes M, Schneider C, Lebensohn P, Hadley S. Competency-based evaluation tools for integrative medicine training in family medicine residency: a pilot study. BMC Med Educ 2007; 7:7. [PMID: 17442108 PMCID: PMC1855050 DOI: 10.1186/1472-6920-7-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 04/18/2007] [Indexed: 05/14/2023]
Abstract
BACKGROUND As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs) developed for the program. METHODS The direct observation (DO) and treatment plan (TP) evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP). The OSCE I was implemented first in 2005 (n = 6), revised and then implemented with a second class of IFM participants in 2006 (n = 7). OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6). Data from the initial implementation of these tools are described using descriptive statistics. RESULTS Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. CONCLUSION As these tools are refined further they will be of value both in improving our teaching in the IFM program and as competency-based evaluation resources for the expanding number of family medicine residency programs incorporating integrative medicine into their curriculum. The next stages of work on these instruments will involve establishing inter-rater reliability and defining more clearly the specific behaviors which we believe establish competency in the integrative medicine skills defined for the program.
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Affiliation(s)
- Benjamin Kligler
- Albert Einstein College of Medicine, Bronx, NY/University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Mary Koithan
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Victoria Maizes
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Meg Hayes
- Oregon Health Sciences University, Portland, OR, USA
| | | | - Patricia Lebensohn
- University of Arizona School of Medicine Program in Integrative Medicine, Tucson, AZ, USA
| | - Susan Hadley
- Middlesex Hospital/University of Connecticut, Middlesex, CT, USA
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Maizes V, Koffler K, Fleishman S. The Integrative Assessment. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Maizes V. Developing a Patient Health Plan. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maizes V, Silverman H, Lebensohn P, Koithan M, Kligler B, Rakel D, Schneider C, Kohatsu W, Hayes M, Weil A. The integrative family medicine program: an innovation in residency education. Acad Med 2006; 81:583-9. [PMID: 16728816 DOI: 10.1097/01.acm.0000225225.35399.e4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The Integrative Family Medicine (IFM) Program is a four-year combined family medicine residency program and integrative medicine fellowship. It was created in 2003 to address the needs of four constituencies: patients who desire care from well trained integrative physicians, physicians who seek such training, the health care system which lacks a conventional integrative medicine training route, and educational leaders in family medicine who are seeking new strategies to reverse the declining interest in family medicine amongst U.S. graduates. The program was designed jointly by the University of Arizona Program in Integrative Medicine (PIM) and family medicine residency programs at Beth Israel/Albert Einstein College of Medicine (AECOM), Maine Medical Center, Middlesex Hospital, Oregon Health & Science University, and the Universities of Arizona and Wisconsin. One or two residents from each of these institutions may apply, and when selected, commit to extending their training by a fourth year. They complete their family medicine residencies at their home sites, enroll in the distributed learning associate fellowship at PIM, and are mentored by local faculty members who have training in integrative medicine. To date three classes totaling twenty residents have entered the program. Evaluation is performed jointly: PIM evaluates the residents during residential weeks and through online modules and residency faculty members perform direct observation of care and review treatment plans. Preliminary data suggest that the program enhances interest amongst graduating medical students in family medicine training. The Accreditation Council of Graduate Medical Education Family Medicine residency review committee has awarded the pilot experimental status.
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Affiliation(s)
- Victoria Maizes
- Program in Integrative Medicine, University of Arizona, Tucson, Arizona 85724, USA.
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Affiliation(s)
- Victoria Maizes
- Family and Community Medicine, and Public Health College of Medicine, University of Arizona, USA
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Schiff E, Kim YH, Maizes V. Vegetative states--an integrative approach. Altern Ther Health Med 2005; 11:26-33; quiz 34, 92. [PMID: 15712763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The integrative approach to vegetative state remains a challenge. In this article we have presented the evidence for conventional and alternative therapies that can be applied to this condition. Some are intended to support the patient and prevent complications; others enhance the ability of relatives to interact with their loved ones; while others are intended to shorten the vegetative state period. The approaches we reviewed were based on availability of data on MEDLINE and/or their potential to broaden our conceptual approach to vegetative state. Some approaches highlighted within the article including nutritional support, acupuncture, and homeopathy, seem to have a reasonable risk/benefit ratio. Yet, the complexity of vegetative state makes it challenging to recommend an integrative protocol. Rather we recommend an individualized approach, based on patient co-morbidities, caregiver and health professional preferences, and availability of therapists. Other approaches, including herbal medicine, mind-body therapies, intercessory prayer, energy medicine, and shamanism were not included due to the lack of available information and evidence. We acknowledge that a lack of evidence for efficacy is not equivalent to evidence for a lack of efficacy. Further research is critically needed to advance our treatment approach to this challenging state. Vegetative state is a condition that continues to humble the medical world. What we do not know eclipses that which we know. The critical question of what the vegetative state patient experiences continues to mystify us. Our philosophical stance insists that we treat the patient as one who is aware. Simultaneously we struggle with what, if anything, we can successfully do to "reawaken" the patient.
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Affiliation(s)
- Elad Schiff
- Program in Integrative Medicine, College of Medicine Tucson, Arizona, USA
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