Patricia Lebensohn

Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum

Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents’ self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1–8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation.

RECOMMENDED INTEGRATIVE MEDICINE COMPETENCIES FOR FAMILY MEDICINE RESIDENTS

BACKGROUND The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. METHODOLOGY In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. RESULTS In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. CONCLUSIONS This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care.

Interprofessional Competencies in Integrative Primary Healthcare

In October 2014, the National Center for Integrative Primary Healthcare (NCIPH) was launched as a collaboration between the University of Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Health and Medicine and supported by a grant from the Health Resources and Services Administration. A primary goal of the NCIPH is to develop a core set of integrative healthcare (IH) competencies and educational programs that will span the interprofessional primary care training and practice spectra and ultimately become a required part of primary care education. This article reports on the first phase of the NCIPH effort, which focused on the development of a shared set of competencies in IH for primary care disciplines. The process of development, refinement, and adoption of 10 “meta-competencies” through a collaborative process involving a diverse interprofessional team is described. Team members represent nursing, the primary care medicine professions, pharmacy, public health, acupuncture, naturopathy, chiropractic, nutrition, and behavioral medicine. Examples of the discipline-specific sub-competencies being developed within each of the participating professions are provided, along with initial results of an assessment of potential barriers and facilitators of adoption within each discipline. The competencies presented here will form the basis of a 45-hour online curriculum produced by the NCIPH for use in primary care training programs that will be piloted in a wide range of programs in early 2016 and then revised for wider use over the following year.

Increasing Resident Recruitment into Family Medicine: Effect of a Unique Curriculum in Integrative Medicine

INTRODUCTION Healthcare reform is highlighting the need for more family practice and other primary care physicians. The Integrative Medicine in Residency (IMR) curriculum project helped family medicine residencies pilot a new, online curriculum promoting prevention, patient-centered care competencies, use of complementary and alternative medicine along with conventional medicine for management of chronic illness. A major potential benefit of the IMR program is enhanced recruitment into participating residencies, which is reported here. METHODS Using an online questionnaire, accepted applicants to the eight IMR pilot programs (n = 152) and four control programs (n = 50) were asked about their interests in learning integrative medicine (IM) and in the pilot sites how the presence of the IMR curriculum affected their ranking decisions. RESULTS Of residents at the IMR sites, 46.7% reported that the presence of the IMR was very important or important in their ranking decision. The IMR also ranked fourth overall in importance of ranking after geography, quality of faculty, and academic reputation of the residency. The majority of IMR residents (87.5%) had high to moderate interest in learning IM during their residency; control residents also had a high interest in learning IM (61.2%). CONCLUSIONS The presence of the IMR curriculum was seen as a strong positive by applicants in ranking residencies. Increasing the adoption of innovative IM curricula, such as the IMR, by residency programs may be helpful in increasing applications of competitive medical students into primary care residencies as well as in responding to the expressed interest in learning the IM approach to patient care.

OA05.02. Relationships among well-being and wellness behaviors over time in residents in eight family medicine residencies

Methods Residents in the 2011 graduating class of the IMR (n=56) were assessed at the beginning of PGY2 and PGY3 and at graduation. Measures were self-administered online and included established measures of wellbeing: perceived stress, burnout (emotional exhaustion, depersonalization), depression, and satisfaction with life. Wellness behaviors assessed included restful sleep, nutrition, physical activity, mind-body activities, being in nurturing relationships, being outdoors in nature, and alcohol use. Stepwise regression analysis examined relationships between wellness behaviors and each wellbeing measure at each timepoint.

P03.01. Characteristics of residents and training sites influence successful completion of the Integrative Medicine in Residency program

Methods Resident and residency site characteristics were examined to determine factors influencing completion of the Integrative Medicine in Residency (IMR) curriculum for the 2011 graduating class. Completion criteria included finishing ≥80% of the online courses plus a final score on the medical knowledge test of ≥70%. Resident characteristics used as predictors included demographics; medical school type [US MD, DO, foreign medical graduates (FMG)]; and, responses to a post-match survey administered before the residency began in 2008 on previous participation in CAM courses or experiences, importance of the IMR in choosing residency, and interests in learning IM and applying IM after graduation. Site characteristics included: extent of IM in the residency culture (e.g., faculty practicing IM consultations; IM consultation on site; an IM 4th year fellowship at the site); faculty characteristics (i.e., faculty leader IM fellowship trained; faculty leader with designated IM teaching time); and curriculum delivery (i.e., using the IMR plus other IM teaching/rotation/electives; monthly IM case conferences; resident IM clinical application).

The Need for a Public Health Competency-Based Education for Integrative Health Care:

Integrative health care (IH) is an approach to health that utilizes biomedical and social determinants of health to promote health and prevent disease, focusing on primary, secondary, and tertiary prevention, and utilizing not only the clinician–patient relationship but also how the family and community contribute to health promotion and disease. IH is a nascent area of practice within public health training. However, many people with a graduate degree in public health have a clinical profession that contributes to integrative primary health. To support the development of a competency-based education for IH, the National Center for Integrative Primary Healthcare convened an interprofessional leadership team to develop 10 “meta-competencies” in integrative primary health care. Following the development of the meta-competencies, individual members of the leadership team worked with colleagues within their profession to develop subcompetencies for specific professions for each meta-competency, including public health. The meta-competencies and public health subcompetencies were used to develop an online 33-hour introductory IH course: “Foundations in Integrative Health.” The public health subcompetencies were used to guide the development of a case study for a 6-hour unit, “Interprofessional Practice in Community Settings and Systems at Large,” on how to conduct and utilize a community health assessment that focused on health equity issues related to diabetes, which can also be taken as a stand-alone course.

P05.34. Well-being and wellness behaviors among family medicine residents: an exploratory descriptive study

Methods FM residents in the 2011 graduating class (n=56) were assessed at four time points, the beginning of each of the three years of residency and at graduation. Measures were self-administered online and included established measures of well-being: perceived stress, burnout (emotional exhaustion and depersonalization), emotional intelligence (empathy and perspective taking), depression, positive and negative affect, satisfaction with life, mindfulness, gratitude, and a measure of wellness behaviors (sleep, nutrition, physical activity, mind-body activities, being in nurturing relationships, being outdoors in nature, and alcohol use).