Brinkhaus, Benno

Willich, S.N.

Witt, Claudia

English

PubMed

Witt, C

Brinkhaus, B

Willich, SN

German Medical Science

Future medical doctors need to be informed about CAM to ensure safe and competent patient care

Claudia Witt

B. Brinkhaus

S.N. Willich

Springer - Publisher Connector

Directory of Open Access Journals

Future medical doctors need to be informed about CAM to ensure safe and competent patient care []

87
Tijdschrift voor Medisch Onderwijs, maart 2010 | Vol. 29, nr. 1, p. 87-89
?Pro-contra topic
Complementary and Alternative Medicine
(CAM) remains a controversial topic. De-
spite its widespread use by patients,1 its
provision by a large number of physicians
and substantial student interest,2-3 it is
rarely taught by medical schools in Eu-
rope. By contrast, in the United States
(US) 82 medical schools have included
CAM-related content in their compulsory
curriculum3 and special educational
methods are used to teach about CAM.5
In a discussion on the teaching of CAM
at universities, it is important to clarify
which methods are designated by the
term CAM. CAM covers a broad variety of
treatment methods that are not part of
conventional medicine (http://nccam.nih.
gov/health/whatiscam/ and http://www.
nhsdirectory.org/default.aspx?page=
HLReport). These methods comprise
whole medical systems, such as naturopa-
thy, Chinese medicine and homeopathy,
as well as single interventions such as aro-
matherapy.1 6 The National Centre for
Complementary and Alternative Medicine
(NCCAM) in the US defines whole med-
ical systems as systems that are built
upon complete systems of theory and
practice. Such systems have evolved prior
to and separate from conventional medi-
cine (http://nccam.nih.gov/health/whatis
cam/overview.htm).
Although survey data show that deci-
sion-makers at German medical schools
are indeed interested in CAM, CAM is in-
tegrated in medical curricula to a very
limited extent only.7 This is underscored
by the fact that all chairs in CAM at med-
ical schools are endowed chairs. A possi-
ble explanation for this is that medical
schools feel bound to scientific medicine
and that scientific evidence for many
CAM treatments is scarce. However, some
universities have been involved in CAM
research for many years and offer lectures
on CAM.8-10
Since 2003, naturopathy treatments
(German: Naturheilverfahren) have been
included in the mainstream medical cur-
riculum in Germany, but the number of
teaching hours and the content taught 
varies greatly between universities. In
Germany, naturopathy is defined as a
combination of lifestyle medicine and
mind - body medicine (German: Ord-
nungsthe rapie), hydrotherapy, herbal
medicine, exercise therapy and dietetic
treatment. It is used either as a preventive
measure or therapeutically. It depends on
the university whether naturopathy alone
is taught or whether other CAM treat-
ments, such as homeopathy and Chinese
medicine, are also included in the cur-
riculum. In addition some universities
offer optional courses on complementary
medicine. In the spring of 2009, a confer-
ence on CAM education in German Uni-
versities was organized by the Carstens
Foundation, offering a platform for dis-
cussion about experiences, cooperation
and standardization in relation to CAM
courses.
In Switzerland and Austria CAM is not
included in the core medical curriculum.
Lectures are mainly optional and depend
on initiatives of individual universities. At
Vienna medical school, for example, a lec-
ture series on the fundamentals and the
Future medical doctors need to be informed about
CAM to ensure safe and competent patient care
C. Witt, B. Brinkhaus, S.N. Willich
88 Pro-contra topic
practice of CAM is offered by the Institute
of General Medicine. Additional, more
specialized, courses are offered in home-
opathy, acupuncture and hypnosis. All
medical students at Vienna medical
school have to attend a compulsory case-
based course on interdisciplinary patient
management and this course addresses
treatment options from both conventional 
medicine and CAM (e.g. homeopathy, os-
teopathy, herbal medicine, acupuncture,
neural therapy). Another example is the
medical school of Graz in Styria, which
offers an optional lecture series in CAM
with the main focus on homeopathy. In
Switzerland, at the medical schools of
Bern and Zürich, several courses are
taught including lectures and practical
courses in naturopathy, homeopathy, Chi-
nese medicine, anthroposophical medi-
cine and neural therapy. Most of these
courses are offered as electives for inter-
ested students and they are run by the
Kollegiale Instanz Komplementärmedizin
(KIKOM) in Bern and by the Institute of
Naturopathy of the Medical Department
in Zurich.
Also in the Netherlands CAM courses
are offered: a CAM elective at the Univer-
sity of Utrecht and a CAM course at the
University of Nijmegen.
An interesting aspect in relation to CAM
education is when CAM should be sched-
uled in the medical curriculum. The influ-
ence of CAM courses on the attitudes and
empathic abilities of students has been
discussed in the literature.11-16
A sound education is the predominant
aim of medical schools. This raises the
following question: should medical school
exclusively teach evidence-based content?
We agree that lectures at medical schools
should be mainly based on scientific
knowledge, but we argue that this should
also include descriptive data and informa-
tion. CAM has a special role in view of the
huge gap between its high usage among
the population and the paucity of scien-
tific data. This can partly be explained by
historical developments and by the fact
that the most commonly used CAM treat-
ments have been available for a longer pe-
riod than modern clinical research. Nev-
ertheless, the high usage of CAM in the
population justifies our claim that future
medical doctors should be informed
about CAM. Every second patient has had
experience with CAM and, without knowl-
edge of CAM, medical doctors are not
aware of possible interactions between
CAM and conventional treatments. Addi-
tionally, future doctors need to be compe-
tent to guide their patients through the
complex and seemingly overloaded CAM
market. This does not imply, however,
that they have to provide CAM treatment
in their own practice.
The primary aim of CAM lectures at
universities should therefore be 1) an in-
troduction to the most commonly used
CAM methods (e.g. naturopathy, home-
opathy and acupuncture) to give students
a deeper understanding of what CAM en-
tails. Case conferences could be an inter-
esting didactic approach for this pur-
pose,17 2) a summary of the current
evidence for CAM based on usage, effi-
cacy, effectiveness10 and safety. However
as evidence is rapidly changing it makes
little sense to focus on current research
results only. Instead, the overall aim of
CAM lectures should be to inform future
medical doctors about CAM and stimulate
critical appraisal of CAM treatments,
using the best evidence available. Teach-
ing about CAM also fits with a marked
movement in the US and Europe towards
a more integrative medical approach18
(http://www.imconsortium.org).
In our opinion, if medical schools
refuse to teach their students basic knowl-
edge and critical reflection about CAM,
Complementary and alternative medicine | C. Witt et al.
89
Complementary and alternative medicine | C. Witt et al.
Pro-contra topic
they are depriving their medical students
of the ability to provide competent and
safe patient care in the future.
References
1. Härtel U, Volger E. Inanspruchnahme und Akzep-
tanz klassischer Naturheilverfahren und alterna-
tiver Heilmethoden in Deutschland – Ergebnisse
einer repräsentativen Bevölkerungsstudie. Forsch
Komplementärmed 2004;11(6):327-334. [Consid-
eration and acceptance of traditional naturopa-
thy and complementary and alternative medicine
in Germany – Results of a representative popula-
tion study. Research in Complementary Medi-
cine].
2. Furnham A, McGill C. Medical students' attitudes
about complementary and alternative medicine. J
Altern Complement Med 2003;9(2):275-284.
3. Lie D, Boker J. Development and validation of the
CAM Health Belief Questionnaire (CHBQ) and
CAM use and attitudes amongst medical stu-
dents. BMC Med Educ 2004;4:2.
4. Barzansky B, Jonas HS, Etzel SI. Educational
programs in US medical schools, 1999-2000.
JAMA 2000;284(9):1114-1120.
5. Wetzel MS, Kaptchuk TJ, Haramati A, Eisenberg
DM. Complementary and alternative medical
therapies: implications for medical education.
Ann Intern Med 2003;138(3):191-196.
6. Witt CM. Komplementärmedizin: Weitere
Forschung ist die Basis für Integration in die Ver-
sorgung. Dtsch Arztebl. 2009;1056:A1786-A1789.
[Complementary medicine: further research is
the basis for integration in health care. German
Medical Journal].
7. Brinkhaus B, Joos S, Lindner M, Kohnen R, Witt
C, Willich SN et al. Integration of Complementary
and Alternative Medicine into German Medical
School Curricula – Contradictions between the
Opinions of Decision Makers and the Status Quo.
Forsch Komplementarmed Klass Naturheilkd
2005;12(3):139-143.
8. Ostermann T, Brinkhaus B, Melchart D. [Univer-
sity Forum Workshop for Natural Medical Treat-
ment and Complementary Medicine]. Forsch
Komplementarmed 1999;6(1):41-42.
9. Weidenhammer W. Forschung zu Naturheilver-
fahren und Komplementärmedizin: Luxus oder
Notwendigkeit? Dtsch Arztebl 2006;103:A-
2929/B-2551/C-2453. [Research into naturopathy
and complementary medicine: luxury or neces-
sity? German Medical Journal].
10. Witt CM, Linde K. The need for CAM research 
training. Forsch Komplementmed 2008;15(2):69-
70.
11. Frenkel M, Ben Arye E. The growing need to
teach about complementary and alternative med-
icine: questions and challenges. Acad Med
2001;76(9):251-254.
12. Sikand A, Laken M. Pediatricians' experience
with and attitudes toward complementary/
alternative medicine. Arch Pediatr Adolesc Med
1998;152(11):1059-1064.
13. Greenfield SM, Brown R, Dawlatly SL, Reynolds
JA, Roberts S, Dawlatly RJ. Gender differences
among medical students in attitudes to learning
about complementary and alternative medicine.
Complement Ther Med 2006;14(3):207-212.
14. Duggan K, Verhoef MJ, Hilsden RJ. First year
medical students and complementary medicine.
Ann R Coll Physician Surg Can 1999;32:157-160.
15. Owen DK, Lewith G, Stephens CR. Can doctors
respond to patients' increasing interest in com-
plementary and alternative medicine? BMJ
2001;322(7279):154-158.
16. Owen D, Lewith GT. Complementary and alterna-
tive medicine (CAM) in the undergraduate med-
ical curriculum: the Southampton experience.
Med Educ 2001;35(1):73-77.
17. Scheffer C, Edelhäuser F, Tauschel D, Hahn EG.
Symposium Fallkonferenz Integrative Medizin:
Vorbild für das Medizinstudium? GMS Z Med
Ausbild. 2007;24(1):Doc05. Zugänglich unter:
http:/ /www.egms.de/de/ journals/zma/2007-
24/zma000299.shtml. [Case conference on Inte-
grative Medicine: example for medical educa-
tion? Autumn issue of the German Journal of
Medical Education]. 
18. Willich SN. Editorial. EUJIM. 2009;1:163-164.
The authors:
Prof. dr. C. Witt, B. Brinkhaus, S.N. Willich, Institute
for Social Medicine, Epidemiology, and Health Eco-
nomics, Charité University Medical Center, 10098
Berlin, Germany.
Correspondence
Prof. dr. Claudia Witt, Institute for Social Medicine,
Epidemiology, and Health Economics, Charité Univer-
sity Medical Center, 10098 Berlin, Germany. 
Tel: +49-30-450529002; Fax: +49-30-450529902. 
E-mail: claudia.witt@charite.de
No potential conflict of interest relevant to this article was reported


[University Forum Workshop for Natural Medical Treatment and Complementary Medicine]. Forsch Komplementarmed.

Can doctors respond to patients' increasing interest in complementary and alternative medicine?

Complementary and alternative medical therapies: implications for medical education.

Development and validation of the CAM Health BeliefQuestionnaire(CHBQ)andCAMuseandattitudesamongst medical students.

Ergebnisse einer repräsentativen Bevölkerungsstudie. Forsch Komplementärmed.

First year medical students and complementary medicine. Ann R Coll Physician Surg Can.

for Social Medicine, Epidemiology and Health Economics,

Forschung zu Naturheilverfahren und Komplementärmedizin:LuxusoderNotwendigkeit?DtschArztebl.

Gender differences among medical students in attitudes to learning about complementary and alternative medicine. Complement Ther Med.

Medical students' attitudes about complementary and alternative medicine.

Pediatricians' experience with and attitudes toward complementary/alternative medicine. Arch Pediatr Adolesc Med.

Symposium Fallkonferenz Integrative Medizin: Vorbild für das Medizinstudium?

The growing need to teach about complementary and alternative medicine: questions and challenges. Acad Med.

The need for CAM research training.

WittCM.Komplementärmedizin:WeitereForschungistdieBasis für Integration in die Versorgung. Dtsch Arztebl.

http://doaj.org/search?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22id%22%3A%2296efd49d83e644d9b2505c8e47389e68%22%7D%7D%5D%7D%7D%7D

Future medical doctors need to be informed about CAM to ensure safe and competent patient care

Abstract

Similar works

Full text

Available Versions

German Medical Science

Springer - Publisher Connector

Directory of Open Access Journals

Springer - Publisher Connector