Medical students and CAM teaching

I have just been delving into BMJ Open for the first time and happened upon this article on complementary and alternative medicine (CAM) and factors influencing its inclusion in the undergraduate medical curriculum in the UK.

It is a GMC requirement, stated in Tomorrows’ Doctors in 2009 (applicable from 2011/12 intake), that graduate doctors must:

“Demonstrate awareness that many patients use complementary and alternative therapies, and awareness of the existence and range of these therapies, why patients use them, and how this might affect other types of treatment that patients are receiving.”

That can be interpreted pretty widely and the study was an email survey sent to the deans of all medical schools in the UK. These explored the current CAM content of the syllabi and issues around the level of satisfaction among students and staff with the current content. The paper on BMJ Open prints most of the various responses but it doesn’t seek to analyse them qualitatively in any formal way. Overall, 18 out of the 31 medical schools responded and all of them taught CAM to some degree (as per GMC requirements). Six of the responses indicated that CAM was taught formally and it was most frequently studied as part of a student selected component.

However, the author does suggest that there are ‘problematic approaches to CAM in a minority of survey responses’. He highlights that often CAM education is being delivered by practitioners or academics with a specific interest. The author suggests this is a ‘form of indoctrination’ and potentially of significant ethical concern. I imagine CAM practitioners would think that it is entirely normal that specialists talk about their own fields but I would suggest that the author has a point. For example, I for one might be more inclined to treat advice regarding proton pump inhibitors with more scepticism if it were presented by Big Pharma compared with a gastroenterologist. In my experience gastroenterologists don’t hold deep-rooted beliefs about what interventions are effective without a substantial body of evidence. I’m not sure the same can be said of many practitioners of complementary medicine.

I have my own reservations that those practitioners with a deep vested interest and personal commitment to their therapy will give a balanced view of the evidence-lite interventions of CAM.

Smith, K. (2011). Factors influencing the inclusion of complementary and alternative medicine (CAM) in undergraduate medical education BMJ Open DOI: 10.1136/bmjopen-2011-000074