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      Naturopathy, complementary and integrative medicine in medical education – position paper by the GMA Committee Integrative Medicine and Perspective Pluralism Translated title: Naturheilkunde, Komplementäre und Integrative Medizin in der medizinischen Ausbildung – Positionspapier aus dem GMA-Ausschuss Integrative Medizin und Perspektivenpluralismus

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          Abstract

          Background:

          A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process.

          Objective:

          The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training.

          Method:

          The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine.

          Results:

          First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice.

          Conclusion:

          Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies.

          Zusammenfassung

          Hintergrund:

          Ein großer Anteil der Bevölkerung in Deutschland nimmt naturheilkundliche, komplementär- und integrativmedizinische Therapieverfahren in Anspruch. Mittlerweile existieren zahlreiche wissenschaftliche Studien, die einen Wirksamkeitsnachweis bei bestimmten Indikationen liefern. An deutschen Medizinischen Fakultäten werden ausgewählte Verfahren und deren Anwendung im Rahmen des Querschnittsbereichs 12 gelehrt, an einigen werden Wahlfächer mit eigenen Schwerpunktsetzungen angeboten. Bislang fehlt jedoch ein strukturiertes Curriculum, welches longitudinal die Lehre über das Medizinstudium hinweg verankert und alle Studierende befähigt, naturheilkundliche und komplementärmedizinische Optionen in der späteren Patientenversorgung zu berücksichtigen und wirksam in den Diagnostik- und Therapieprozess einzubinden.

          Zielsetzung:

          Ziel dieses Positionspapiers ist, die Relevanz des Themas für die medizinische Ausbildung darzustellen, begriffliche Klarheit zu schaffen sowie Kernkompetenzen und mögliche Implementierungsmöglichkeiten für die Ausbildung vorzustellen.

          Methode:

          Der Ausschuss Integrative Medizin und Perspektivenpluralismus der Gesellschaft für Medizinische Ausbildung erarbeitete in Zusammenarbeit mit dem Forum universitärer Arbeitsgruppen Naturheilverfahren und Komplementärmedizin das vorliegende Positionspapier in einem mehrstufigen konsensualen Prozess.

          Ergebnisse:

          Zunächst wurden unterschiedliche Oberbegriffe diskutiert und für die weitere Arbeit eine bestehende Definition für Integrative Medizin und Gesundheit ausgewählt. Darauf aufbauend wurde der Stand der Ausbildung und deren wissenschaftliche Fundierung in Deutschland im internationalen Kontext reflektiert. In einem weiteren Schritt wurde ein Kompetenzprofil für die medizinische Ausbildung, bestehend aus sieben Kompetenzbereichen, entwickelt und im Hinblick auf Naturheilverfahren, komplementäre und integrative Medizin detailliert dargestellt. Implementierungsmöglichkeiten wurden anhand möglicher Anknüpfungspunkte im Curriculum sowie anhand bereits etablierter Best-Practice-Beispiele aufgezeigt.

          Schlussfolgerung:

          Trotz unterschiedlicher Schwerpunktsetzungen an den einzelnen Fakultäten ist es gelungen, auf Grundlage einer gemeinsamen Begriffsdefinition eine Übereinkunft über die mögliche Kompetenzentwicklung und Verankerung in der medizinischen Ausbildung zu finden. Aktuell ist die Umsetzung in den Pflicht- und Wahlbereichen sehr heterogen. Im Rahmen der aktuellen Überarbeitung der Approbationsordnung bieten sich vielfache Anknüpfungspunkte für eine Einbindung naturheilkundlicher und komplementärmedizinischer Lehrinhalte insbesondere bei interprofessionellen und allgemeinmedizinischen Lehrangeboten. Durch die Implementierung und Begleitforschung zielgerichteter Lehr-Settings sollten die Grundlagen für eine langfristige und verbindliche Integration in die medizinische Ausbildung gelegt werden. Insgesamt wird deutlich, dass die Lehre im Bereich Naturheilverfahren und komplementäre und integrative Medizin das Potential zur Entwicklung umfangreicher ärztlicher Kernkompetenzen hat.

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          Most cited references106

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          Evidence based medicine: what it is and what it isn't

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            Doctor-patient communication: a review.

            Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patient communication.
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              Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review.

              The interest in complementary and alternative medicine (CAM) has increased during the past decade and the attitude of the general public is mainly positive, but the debate about the clinical effectiveness of these therapies remains controversial among many medical professionals. We conducted a systematic search of the existing literature utilizing different databases, including PubMed/Medline, PSYNDEX, and PsycLit, to research the use and acceptance of CAM among the general population and medical personnel. A special focus on CAM-referring literature was set by limiting the PubMed search to "Complementary Medicine" and adding two other search engines: CAMbase (www.cambase.de) and CAMRESEARCH (www.camresearch.net). These engines were used to reveal publications that at the time of the review were not indexed in PubMed. A total of 16 papers met the scope criteria. Prevalence rates of CAM in each of the included studies were between 5% and 74.8%. We found a higher utilization of homeopathy and acupuncture in German-speaking countries. Excluding any form of spiritual prayer, the data demonstrate that chiropractic manipulation, herbal medicine, massage, and homeopathy were the therapies most commonly used by the general population. We identified sex, age, and education as predictors of CAM utilization: More users were women, middle aged, and more educated. The ailments most often associated with CAM utilization included back pain or pathology, depression, insomnia, severe headache or migraine, and stomach or intestinal illnesses. Medical students were the most critical toward CAM. Compared to students of other professions (ie, nursing students: 44.7%, pharmacy students: 18.2%), medical students reported the least consultation with a CAM practitioner (10%). The present data demonstrate an increase of CAM usage from 1990 through 2006 in all countries investigated. We found geographical differences, as well as differences between the general population and medical personnel.
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                Author and article information

                Journal
                GMS J Med Educ
                GMS J Med Educ
                GMS J Med Educ
                GMS Journal for Medical Education
                German Medical Science GMS Publishing House
                2366-5017
                14 April 2022
                2022
                : 39
                : 2
                : Doc16
                Affiliations
                [1 ]Medical Faculty Mannheim of Heidelberg University, Department for Medical Education Research, Mannheim, Germany
                [2 ]University of Witten/Herdecke, Integrated Curriculum of Anthroposophic Medicine, Witten, Germany
                [3 ]Charité - University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt University of Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
                [4 ]Hahnemann Association of Homeopathic Physicians, Wiesbaden, Germany
                [5 ]University Hospital Freiburg, University Center for Naturopathy, Freiburg, Germany
                [6 ]University Hospital Tübingen, Institute for General Medicine and Interprofessional Care, Tübingen, Germany
                [7 ]Evang. Kliniken Essen-Mitte, Clinic for Naturopathy and Integrative Medicine, Essen, Germany
                [8 ]University Hospital Ulm, Department of Integrative Medicine, Clinic for General and Visceral Surgery, Ulm, Germany
                [9 ]University Hospital Hamburg-Eppendorf, University Cancer Center Hamburg, Hubertus Wald Tumor Center, Hamburg, Germany
                Author notes
                *To whom correspondence should be addressed: Angelika Homberg, Medical Faculty Mannheim of Heidelberg University, Department for Medical Education Research, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany, E-mail: Angelika.homberg@ 123456medma.uni-heidelberg.de
                Article
                zma001537 Doc16 urn:nbn:de:0183-zma0015372
                10.3205/zma001537
                9174075
                35692361
                d2c49053-12b9-4f03-a4e1-6d37c43306ed
                Copyright © 2022 Homberg et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 July 2021
                : 16 February 2022
                : 07 December 2021
                Categories
                Article

                medical training,curriculum development,skills,naturopathy,complementary medicine,integrative medicine,evidence-based medicine,health,patient orientation,interprofessional education

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