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.

        Subscription Services

        Dynamed http://dynamed.ebscohost.com/

        Reference tool powered by Ebscohost with summaries for more than 3,200 topics. There is a mobile application available as well. ($395/year for physician subscription).

        MDConsult http://www.mdconsult.com/php/299798892-1761/homepage

        MDConsult includes access to full-text articles from over 80 medical journals and Clinics, 50 leading medical references across a wide range of specialties, clinically relevant drug information, and over 13,000 patient handouts. (Subscription $395/year – can get specialty topics added for an additional fee)

        Natural Medicines Comprehensive Database www.naturaldatabase.com

        Gives practical evidence-based information and ratings on over 85,000 supplements, herbals, and integrative therapies. You can also use clinical tools to check for interactions and adverse reactions, nutrient depletion, report adverse events, get CME, and more. (Individual subscriber full database $92.00/year, Hand-held version $59.00/year, Web and hand-held version combined $132.00/year.)

        Natural Standard www.naturalstandard.com

        This extensive database can be searched by subject or by medical condition. (Mobile and desktop version is $199.00/year for an individual subscriber, discounts available for institutional subscriptions)

        UpToDate http://www.uptodate.com/contents/search

        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).

        Non- Subscription Services

        The National Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov/

        NCCAM is the Federal Government’s lead agency for scientific research on CAM. Herbs at a Glance, a series of 42 patient information sheets, are listed at http://nccam.nih.gov/health/herbsataglance.htm

        NIH Office of Dietary Supplements http://ods.od.nih.gov/

        Provides overview of vitamins, minerals, and dietary supplements with two levels of information – Health Professional and QuickFacts.

        Dietary Supplements Labels Database http://dietarysupplements.nlm.nih.gov/dietary/

        Dietary Supplements Labels Database offers information about label ingredients, enabling users to compare label ingredients in different brands. Each dietary supplement has additional links to other government created HDS resources such as Medline, Clinical Trials.gov, and NCCAM.

        MedlinePlus – Dietary Supplements – For Free http://medlineplus.gov

        This consumer health database from the National Library of Medicine offers extensive information on dietary supplements.  http://www.nlm.nih.gov/medlineplus/druginformation.html (Free)

        University of Wisconsin Family Medicine Integrative Medicine Website www.fammed.wisc.edu/integrative
        An excellent resource for clinician learning modules and patient information handouts.

        Im4us.org http://www.im4us.org/

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

        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

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        Program for Integrative Medicine & Health Care Disparities
        Department of Family Medicine
        1 Boston Medical Center Place
        Dowling 5 South
        Boston, MA 02118
        Phone: 617.414.6795
        Fax: 617.414.3345

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