Medical School
Curriculum
Background
Supported by a five-year grant
from the National Institutes of
Health (NIH), University of Michigan
Integrative Medicine (UMIM) piloted
its first Complementary and Alternative
Medicine (CAM) courses for medical
students during the Fall Term of
2000. A unique aspect of the CAM
course sequence is that it is longitudinal,
extending across the entire four-year
U-M Medical School curriculum.
To date, implementation of the
curriculum has involved the participation
of approximately 600 undergraduate
medical students and 200 physicians/practitioners.
Instruction has touched upon the
following five CAM domains as identified
by the National Center for Complementary
and Alternative Medicine (NCCAM):
- Alternative medical systems
- Mind-body interventions
- Biologically-based therapies
- Manipulative and body-based
methods
- Energy therapies
First
Year Curriculum
This longitudinal course sequence
provides students with a foundation
in complementary and alternative
medicine (CAM). Through readings,
field visit experiences and lecture/small
group discussion, students will
explore the diversity of medical
practices, key issues facing researchers
and practitioners, and principles
of information gathering by undertaking
preliminary overviews of research
evidence.
Required Course Sessions
M1 Complementary and Alternative Medicine Unit
M1 Alternative Approaches to Musculoskeletal Pain
M1 Mind-Body Medicine: Theory and Practice
Educational Materials
M1 Web Course Tools, Web Course Pages, Online Longitudinal
Portfolios
M1 Case Studies, Longitudinal Case Studies
Complementary and Alternative Medicine Unit
Instruction focuses on tracing
patterns of CAM use by patients,
articulating key issues facing
CAM researchers and practitioners,
and presenting the National Center
of Complementary and Alternative
Medicine classification system
for CAM modalities. Information
presented within the unit provides
a foundation for establishing effective
relationships with patients who
use a diverse array of medical
treatments. The course unit consists
of an introductory lecture by Dr.
Warber, a half-day CAM field experience,
an afternoon of case-based, student-led
presentations and research discussions,
and small group discussions of
the provider-patient relationship
facilitated by CAM practitioners
and medical school faculty.
Alternative Approaches to Musculoskeletal
Pain
The course builds on information taught in preceding
courses and sequences (i.e., Patients and Populations,
Normal Cell, Doctor-Patient Relationship, Normal
Organ Systems I-Immunology, Normal Organ Systems
I-Musculoskeletal). Instruction focuses on examining
therapeutic techniques related to musculoskeletal
conditions, including massage, chiropractic, Shiatsu,
and pharmacological treatments. Discussion includes
the training, credentialing, and licensing of CAM
providers who treat musculoskeletal conditions as
well as the scientific evidence linked to particular
therapies. Students learn the physician perspective
on referral to body-based therapies.
Mind-Body Theory and Practice
The goal of the course is to build on information
taught in preceding courses and sequences within
the first year medical school curriculum, with
a particular emphasis on issues related to psychoneuroimmunology,
mental status, and achieving a positive health
state (i.e., "wellness"). Instruction focuses on
examining therapeutic techniques useful when addressing
lifestyle and health-risk factors as well as behavioral
health issues. Discussion includes various approaches
to training, credentialing, and licensing mind-body
medicine practitioners as well as an overview of
scientific evidence linked to specific treatments.
Students learn the physician perspective on referral
to mind-body therapies. A large group lecture introduces
students to Mind-Body Medicine applications and
to Mindfulness Meditation therapies. Small group
experiences include exposure to several therapeutic
approaches including hypnosis, guided imagery,
Yoga, and Tai Chi. Students also learn about advances
in the field of psychoneuroimmunology and engage
in a discussion with a panel of Mind-Body Medicine
professionals, including physicians who use these
techniques with patients.
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Second
Year Curriculum
The second year of this longitudinal
course sequence extends student
learning about complementary and
alternative medicine (CAM). Through
lectures, panel presentations,
and small group discussion, students
will examine the prevalence and
patterns of alternative therapy
use among patients, discuss credentialing
standards and government regulation,
and explore common clinical applications,
potentially adverse effects, and
current research evidence for efficacy
of the most commonly used CAM modalities.
Students will consider various
approaches to discussing these
topics with patients of diverse
backgrounds and health beliefs.
Required Course Sessions
M2 Multidisciplinary Perspectives on Herbs and Health
M2 Multidisciplinary Perspectives on Anxiety and
Depression
Elective Courses
M2 Selectives
Educational Materials
M2 Web Course Tools, Web Course Pages
M2 Case Studies, Longitudinal Case Studies
Multidisciplinary Perspectives on Herbs and Health
This course lays the foundation
for future learning about herbal
medicine in subsequent classes
and clinical experiences. Instruction
focuses on examining several of
the most commonly-used herbs. Discussion
includes various approaches to
training, credentialing, and licensing
herbal medicine practitioners as
well as an overview of scientific
evidence related to use of herbal
therapies. Students explore several
patient cases related to use of
Echinacea, Garlic, Ginkgo Biloba,
Ginseng, and Saw Palmetto. The
course will target eight specific
Intended Learning Outcomes (ILOs)
related to student knowledge of
CAM, two related to skill development
and one linked to professionalism.
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Multidisciplinary Perspectives
on Anxiety and Depression
The goal of this course is to build on information
taught in preceding courses and sequences within
the first and second year medical school curriculum,
with a particular emphasis on complementary and alternative
therapies for the treatment of anxiety and depression.
It also lays the foundation for future learning about
Complementary and Alternative Medicine (CAM) in subsequent
classes and clinical experiences. Instruction focuses
on examining therapeutic techniques (e.g., acupuncture,
exercise, herbal treatments, meditation, journaling)
useful in the treatment of anxiety and depression.
Discussion touches upon how to balance clinical experiences
and scientific evidence in making recommendations
for individual patients. Students explore the role
preconceived notions, biases, and expectations can
play when working with patients suffering from anxiety
and/or depression.
Selectives
The goal of the CAM elective courses is to build
on information taught in preceding courses and
sequences within the first and second year medical
school curriculum. Some electives extend student
awareness of alternative medical systems discussed
previously (e.g., Anthroposophic Medicine, Homeopathic
Medicine, Chiropractic Medicine) while others address
CAM topics touched upon only briefly in prior courses
(e.g., energy therapy, spirituality, mind-body
medicine). Each elective offers students the opportunity
to participate in active learning activities and
requires the submission of a written paper.
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Third
Year Curriculum
Educational Materials
M3 Seminars in Medicine – CAM and Cancer
M3 Advanced History-Taking
M3 Psychiatry Lecture Series Handouts
Seminars in Medicine: CAM and Cancer
This conference session is designed to enhance patient-based
learning and introduce issues related to the use of complementary
and alternative therapies in the treatment of cancer. It
is scheduled one Friday afternoon as part of the third
year Medical School curriculum.
 Advanced History-Taking
The course builds on information taught in preceding courses
and sequences to provide students with a basic understanding
of: (1) the importance of obtaining a patient history cognizant
of CAM use; (2) the need to gather a patient’s CAM
history in a sensitive manner; (3) critical safety and
interaction issues; and (4) consequences of a collaborative
approach to patient care.
Psychiatry Lecture Series Handouts
Handouts have been designed to supplement the third year
Psychiatry lecture series. Topics currently include:
- Psychopharmacology and CAM
- Anxiety Disorders and CAM
- Mood Disorders and CAM
- Child-Adolescent Psychiatry and Nutrition
- Liaison Psychiatry and CAM
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Fourth
Year Curriculum
Elective Courses
M4 Clinical Elective: Complementary and Alternative
Medicine
M4 Research Elective: The Scientific Basis of Complementary
and Alternative Medicine
Clinical Elective: Complementary
and Alternative Medicine.
The fourth year clinical elective in CAM is designed
to introduce students to the theory and practice
of CAM. Students spend 50% of their time with at
least two family physicians that integrate conventional
and complementary approaches. Didactic course content
includes an introduction to evidence-based medicine,
the current sociopolitical context of CAM usage,
alternative medical systems, nutritional approaches,
bodywork, and herbal medicine. Instructional strategies
include informal lectures, experiential learning,
and small group discussion of assigned readings,
clinical experiences, and a paper case. In the first
week, students are exposed to the various methods
of self-care (meditation, journaling, yoga, Tai-Chi
and Qigong). Students are expected to journal daily
and practice at least one other self-care modality
throughout the month. The elective culminates with
student presentations of an evidence-based review
a CAM modality of their choosing.
Research Elective: The
Scientific Basis of Complementary
and Alternative Medicine.
Michigan has a fourth year research requirement, "Science
in Clinics" in which students select a mentor and
devote a month to scientific activities. The students
select a CAM modality and a specific disease process.
They conduct a review of the relevant scientific
literature. They correlate the evidence in the literature
with the underlying pathophysiology of the disease
process and the proposed clinical use of the CAM
modality. The students draw conclusions about possible
modes of action, potential effectiveness, and the
safety of the investigated therapy. Students present
their work orally at the UMIM monthly Open Research
Meeting and complete a written report of their investigation
in a manner suitable for submission to a peer-reviewed
journal.
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