Roberta Lee

Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal

The authors present a set of curriculum guidelines in integrative medicine for medical schools developed during 2002 and 2003 by the Education Working Group of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and endorsed by the CAHCIM Steering Committee in May 2003. CAHCIM is a consortium of 23 academic health centers working together to help transform health care through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing, and the rich diversity of therapeutic systems. Integrative medicine can be defined as an approach to the practice of medicine that makes use of the best-available evidence taking into account the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of both conventional and complementary/alternative approaches. The competencies described in this article delineate the values, knowledge, attitudes, and skills that CAHCIM believes are fundamental to the field of integrative medicine. Many of these competencies reaffirm humanistic values inherent to the practice of all medical specialties, while others are more specifically relevant to the delivery of the integrative approach to medical care, including the most commonly used complementary/alternative medicine modalities, and the legal, ethical, regulatory, and political influences on the practice of integrative medicine. The authors also discuss the specific challenges likely to face medical educators in implementing and evaluating these competencies, and provide specific examples of implementation and evaluation strategies that have been found to be successful at a variety of CAHCIM schools.

Palms, people, and health.

r c i alms, with their long, delicate evergreen leaves waving in the warm breeze, typically conjure up images of lush tropical islands. In reality, he Palm family (referred to as Arecaceae or almae by botanists) is quite diverse in strucure and habitat, with around 2,600 species ound in nearly every type of environment, rom rain forests to deserts. However, the ast majority of palms are found in tropical egions around the world. Few plants have layed a more prominent role as a source of aw materials for consumption, building, nd other functions of daily living for tradiional cultures. The Food and Agriculture rganization of the United Nations lists wo other families, grasses (Graminaeae) and egumes (Leguminosae), as the only other ajor plant families of similar utility to ankind. Indeed, 17 years ago, as a U.S. ublic Health Service physician assigned to ervice in the Eastern Caroline Islands of ap in the Federated States of Micronesia, I R.L.) witnessed the great utility of Cocos nuifera. This palm is probably most familiar to s in the West as a source of tasty coconut eat and coconut cream used in cooking, or example, the source of dried coconut sed in recipes for macaroons. As a Public Health Service physician, part f my professional obligation required serice to the outer islands of Yap; these 20 sland atolls were spread out over 800 miles f ocean. At that time, there existed no comercial airstrips for easy access for either inabitants or medical personnel to travel rapdly back and forth to and from the main sland of Yap. There was, however, a field hip that traveled from island to island cyling through—if all went well—on a onthly basis. If the field ship had mechancal difficulties, which was more often the ase given its great age and need for regular aintenance, the ship would not reach the slands for several months. To those living n the atolls, these delays meant forgoing hipments of medicine, food, or building upplies. My role as a visiting physician was o triage critical patients for transport on the hip for more comprehensive care at Yap k eneral Hospital. I would work with the edical officer at the island’s medical disensary, evaluating selected patients whom e or she deemed necessary of further assessent. In general, fewer than 200 to 300 peole lived on most of these small atolls. A day t each island was all the time I was allotted or a visit, the rest of the time was spent ushing through the vast Pacific Ocean on ur way to the next stop. On each voyage, I saw amazing examles of the ingenuity of these people to urvive with the existing natural resources t hand, and to an outsider they seemed xtremely limited. Because I had grown up n a very urbanized setting in San Franisco, these trips taught me a great deal bout the utility of plants. I saw many uses or Cocos nucifera or the coconut palm, alled niiw on mainland Yap or lu on the uter Yapese islands. The trunks are used or building and fuel, and the fronds are oven into baskets and hats. The outer usks, with their brown fiber known as oir, are made into a very strong rope. The ne meshlike fibers found on the trunk at he base of each leaf is used as a natural heesecloth. Plant medicine formulas are ounded and placed in the fiber and queezed or rubbed over the injury, allowng the sap of the plant to drip on the skin. he syrup from the inflorescence of C. ucifera is tapped and made into an alcoolic beverage known as tuba—it ferments ithin hours because the sweet palm sap ontains a naturally occurring yeast. ears ago, even before my rotation to Mironesia in 1988, it was known by many hysicians that in emergency situations, he water of young green coconuts could e used as an intravenous solution for deydration because the fluid was sterile and ich in potassium and sugar (pH 5.4; sugar .1 gm/dL; 288 mOsm/L). Today, many islands in the Pacific cean are more accessible by planes and ourist ships. The lifestyle of these islands as significantly changed; there is more nergy available for lighting, and now itchen appliances are to be found. It’s s