Residency Directors

STFM Group on Integrative Medicine

COMPETENCIES AND LEARNING OBJECTIVES

(passed by the STFM board in Jan, 2010 as recommended competencies for all family medicine residents)

Types of goals and objectives noted for each competency noted: attitudes (A), knowledge (K) and skills (S)

PATIENT CARE: COMPASSIONATE, APPROPRIATE, AND EFFECTIVE FOR THE TREATMENT OF HEALTH PROBLEMS AND THE PROMOTION OF HEALTH.

RESIDENTS ARE EXPECTED TO:

  1. 1. Demonstrate patient-centered history- taking, using a biopsychosocial approach that includes an accurate nutritional history, spiritual history, and inquiry of conventional and complementary treatments. (S)
  2. Facilitate health behavior changes in patients, using techniques such as motivational interviewing or appreciative inquiry. (S)
  3. Collaborate with patients in developing and carrying out a health screening and management plan for disease prevention, and treatment using conventional and complementary therapies when indicated. (S)

MEDICAL KNOWLEDGE: ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL,SOCIAL-BEHAVIORAL SCIENCE, APPLICATION TO PATIENT CARE.

RESIDENTS ARE EXPECTED TO:

  1. 4. Understand the evidence base for the relationships between health and disease and the following factors: emotion, stress, nutrition, physical activity, social support, spirituality, sleep, and environment. (K)
  2. Evaluate the strength and limitations of Evidence Based Medicine (EBM) as it applies to conventional and complementary approaches and its translation into patient care. (K)
  3. Demonstrate understanding of common* complementary medicine therapies, including their history, theory, proposed mechanisms, safety/efficacy profile, contraindications, prevalence and patterns of use. (K)

INTERPERSONAL AND COMMUNICATION SKILLS: EFFECTIVE EXCHANGE OF INFORMATION AND COLLABORATION WITH PATIENTS, FAMILIES, AND HEALTH PROFESSIONALS.

RESIDENTS ARE EXPECTED TO:

  1. Recognize the value of relationship-centered care as a tool to facilitate healing. (A, K)
  2. Demonstrate respect and understanding for patients’ interpretations of health, disease and illness that are based upon their cultural beliefs and practices. (K,S, A)
  3. Demonstrate respect for peers, staff, consultants and CAM practitioners who share in the care of patients. (S,A)

PRACTICE-BASED LEARNING AND IMPROVEMENT: INVESTIGATE/EVALUATE CARE OF PATIENTS, TO APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE, AND TO CONTINUOUSLY IMPROVE PATIENT CARE

BASED ON CONSTANT SELF-EVALUATION AND LIFE-LONG LEARNING.

RESIDENTS ARE EXPECTED TO:

  1. Identify personal learning needs related to conventional and complementary medicine. (K,A)
  2. Use EBM resources, including CAM, at the point of care. (S)
  3. Identify reputable print and online resources on conventional and complementary medicine to support professional

PROFESSIONALISM: A COMMITMENT TO CARRYING OUT PROFESSIONAL RESPONSIBILITIES AND AN ADHERENCE TO ETHICAL PRINCIPLES.

RESIDENTS ARE EXPECTED TO:

  1. Demonstrate the ability to reflect on elements of patient encounters, including personal bias and belief, to facilitate understanding of relationship-centered care. (S, A)
  2. Understand importance of self-care practices to improve personal health, maintain work equilibrium and serve as a role model for patients, staff, and colleagues. (A, K)

SYSTEMS-BASED PRACTICE: AWARENESS OF, AND RESPONSIVENESS TO, LARGER CONTEXT AND SYSTEM AND ABILITY TO CALL EFFECTIVELY ON RESOURCES TO PROVIDE OPTIMAL HEALTH CARE.

RESIDENTS ARE EXPECTED TO:

  1. Understand different reimbursement systems and their impact on patient access to both conventional and complementary interventions. (K)
  2. Understand national and state standards related to training, licensing, credentialing, and reimbursement of community CAM practitioners. (K)
  3. Collaborate with community CAM practitioners and other health care specialists in the care of patients, while understanding legal implications and appropriate documentation issues. (S, K)
  4. Identify strategies for facilitating access to integrative medicine services for their patients, including low income populations. (K)
  5. Understand the principles of designing a health care setting that reflects a healing environment. ** (K,S)

* Common modalities will vary by region but residents would be expected to identify at least one modality from

each of the five NCCAM domains. **as defined by the Samueli Institute

Skills that support the above competencies:

Residents will develop the following abilities:

  1. Efficiently elicit a typical day’s food and drink intake from a patient.
  2. Identify three patients with spiritual beliefs or practices that affected their health care and how you worked with them.
  3. Gather relevant information regarding safety, efficacy, and cost of a complementary therapies intervention and to communicate this information clearly to the patient.
  4. Develop a treatment plan with a patient using conventional and complementary therapies in concert for maximum benefit.
  5. Give examples of common herbs and supplements and explain available research regarding use, safety and efficacy or where to find that information.
  6. Identify patients who may benefit from mind/body techniques.
  7. Describe at least two relaxation techniques in sufficient detail and demonstrate efficiently in the patient care setting.
  8. Teach the principles of sleep hygiene.
  9. Prescribe nutrition and lifestyle recommendations based on current research specific to individual patient needs.
  10. Describe 3 dietary interventions that have been proven to decrease morbidity or mortality in:

a. Diabetes
b. Coronary Artery Disease
c. Pregnancy
d. Osteoarthritis
e. Hypertension

    11. Be able to explain what aspects the FDA regulates with respect to herbal products and dietary supplements.

      12. Assess one’s own healthcare habits and design an achievable plan for self care.

        Recommended Resources

        Here are some recommended resources as determined by a recent poll of STFM IMIG members. These are provide exceptional information about Integrative Medicine and it’s role in health care delivery.

        We hope that these resources will be useful to your residency in helping to evaluate and support your curriculum in the area of integrative medicine.

         

        Web Resources for Residency Directors:

        UpToDate
        UpToDate provides evidence based information, links, references, and quick facts about easily searchable topics. Includes the Lexi-Natural Products by Lexi-Comp. (Prices for annual personal subscriptions range from $195 to $495).

        Im4us.org 
        Toolkit for clinicians and residents working in and teaching in communities with underserved populations.

        National Center for Complementary and Integrative Health  
        This site offers a wealth of information on alternative therapies, supplements, recent research, and training opportunities. It has live video talks.

        University of Wisconsin Family Medicine Integrative Medicine Website
        An excellent resource for clinician learning modules and patient information handouts.

        University of Minnesota, Center for Spirituality and Healing
        Online modules of different healing modalities.

        Taking Charge of your Health
        Also from the  University of Minnesota  Fantastic website for modality and conditions overviews. Colorful and easy to navigate also great techniques for motivational interviewing.

        Complementary and Alternative Medicine in UME Digital Resource Repository (DRR)

        Contains curriculum materials to support the teaching of complementary and alternative medicine (CAM) topics in medical education programs.

        The DRR contains: peer-reviewed summaries on CAM topics (CAMpods), and teaching/learning resources (TLRs) which are user posted PowerPoint lectures, syllabi, case presentations, quality CAM-focused Web sites, and more.

        Arizona Center for Integrative Medicine
        Homepage for the Center for Integrative Medicine at University of Arizona. The site offers information on educational courses.

        Academic Consortium for Integrative Medicine and Health
        The mission of the Consortium is to advance integrative medicine and health through academic institutions and health systems.

        BU Alumni Medical Library 
        The BU Alumni Medical Library has gathered an expansive list of resources surrounding complementary therapies

        Clinical resources at the point of care

        Natural Medicines Comprehensive Database
        This database offers subscribers information on supplements (i.e. ingredients, interactions, safety), comparison of conventional and alternative approach to treatment of illnesses, CME courses, and daily updates. (for a fee) The Consumer Reports Web site also hosts the NMCD monographs.

        Natural Medicine 
        This site is the result of an international collaboration with the aim to provide clinicians and patients with information about complementary and alternative medicine. The site utilizes peer-reviewed and evidence-based information to delegate a well-defined grading scale for therapeutic interventions (for a fee).
        Medline Plus Complementary and Integrative Medicine 
        A free resource for information on complementary and alternative medicine. Dietary supplement information is sourced by Natural Standard. Patient information sheets in Spanish.

        Clinical resources at the point of care – Dietary Supplements

        Office of Dietary Supplements (ODS), NIH
        The Office of Dietary Supplements reviews and provides free information on dietary supplements.

        United States Pharmacopeia Dietary Supplements (USP)
        The United States Pharmacopeia (USP) is an official public standards–setting authority for all prescription and over–the–counter medicines and other health care products manufactured or sold in the United States. The site offers quality and safety information database that includes information on commercial supplements to members for a fee.

        Consumer Labs

        Consumer Labs is the leading provider of independent test results and information to help consumers and healthcare professionals evaluate health, wellness, and nutrition products. The site offers product reviews, recalls and warnings, and price checks to members (for a fee).

        Evidence based reviews and information

        The Agency for Healthcare Research and Quality (AHRQ)

        This site offers evidence reports on dietary supplements and complementary and alternative care practices.

        CAM on PubMed
        CAM on PubMed, a database on the Web developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, abstracts of) articles in scientifically based, peer- reviewed journals on complementary and alternative medicine. It has links to full text, and allows searchers to limit retrievals by publication type. Look for the Alerts and Advisories, treatment information, resources, links to other organizations (FDA, AHRQ, ODS etc.).

        Clinical Trial Database
        The Clinical Trial Database provides information on all CAM and dietary supplement clinical trials being conducted by the US government.

        Cancer education

        Memorial Sloan Kettering
        This site provides helpful information about herbs, supplements, and other integrative cancer medicine information.

        Nutrition Information

        Familydoctor.org
        Information about nutrition for adults, children, special diets, and weight management, including resources for patients at the point of care.

        Anti inflammatory Cook Book
        This resource resulted from an NIH-sponsored research study on the health effects of a naturopathic anti-inflammatory diet that was carried out by the Natural College of Naturopathic Medicine and Oregon Health and Science University.

        Teacher’s Guide to Pediatric Nutrition
        The Nutrition SIG of the Ambulatory Pediatric Associations presents this tool for teaching and self-learning.

        Textbooks and Handouts

        Integrative Medicine David Rakel (ED)

        Integrative medicine: principles for practice (Benjamin Kligler, Roberta A. Lee)

        Textbook of Functional Medicine (The Institute for Functional Medicine)

        Journals and Newsletters

        Alternative and Complementary Therapies (Green cover) www.liebertpub.com/ACT

        Alternative Therapies In Medicine and Health www.alternative-therapies.com

        BMC Complementary and Alternative Medicine Journal http://www.biomedcentral.com/bmccomplementalternmed

        Evidence-Based Complementary and Alternative Medicine (eCAM) http://www.ecam.oupjournals.org

        Integrative Medicine – A Clinician’s Journal www.imjournal.com

        Journal of Alternative and Complementary Medicine (blue journal) www.liebertpub.com/acm

        Journal of Nutrition http://jn.nutrition.org

        Topics in Integrative Health Care, an International Journal http://www.tihcij.com