Victor S. Sierpina

Acupuncture: A Clinical Review

This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.

Approach to communicating with patients about the use of nutritional supplements in cancer care.

In recent years, complementary and alternative medicine has become popular among the general population in the Western world. Cancer patients have joined this global trend, often seeking supplements to conventional oncologic care, usually without their physicians’ knowledge. Among the most common forms of complementary and alternative medicine used by cancer patients are natural products such as herbs and megavitamins. The extensive use of nutritional supplements by cancer patients raises multiple questions and challenges for the physician. Since there are limited scientific data on the efficacy and safety of many nutritional supplements, advising patients about when to use them during the course of illness is difficult. This is true for each stage of cancer care: prevention, acute active care (radiation, chemotherapy, surgery), and post-acute care (follow-up visits and prevention of recurrence). The authors describe a patient-centered approach to the use of nutritional supplements in cancer care.

Integration of the biopsychosocial model: Perspectives of medical students and residents

Purpose To examine residents’ and medical students’ attitudes toward the incorporation of psychosocial factors in diagnosis and treatment and to identify barriers to the integration of evidence-based, mind–body methods. Method A random sample of third- and fourth-year medical students and residents was drawn from the Masterfiles of the American Medical Association. A total of 661 medical students and 550 residents completed a survey, assessing attitudes toward the role of psychosocial factors and the clinical application of behavioral/mind–body methods. Results The response rate was 40%. Whereas a majority of students and residents seem to recognize the need to address psychosocial factors, 30%–40% believe that addressing such factors leads to minimal or no improvements in outcomes. The majority of students and residents reports that their training in these areas was ineffective, yet relatively few indicate interest in receiving further training. Females are more likely to believe in the need to address psychosocial factors. Additional factors associated with greater openness to addressing psychosocial factors include (1) the perception that training in these areas was helpful, and (2) personal use of behavioral/mind–body methods to care for one’s own health. Conclusions There is a need for more comprehensive training during medical school and residency regarding both the role of psychosocial factors in health and the application of evidence-based, behavioral/mind–body methods. The current health care structure—particularly insufficient time and inadequate reimbursement for addressing psychosocial factors—may be undermining efforts to improve patient care through inconsistent or nonexistent application of the biopsychosocial model.

Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives

Fifteen U.S. academic programs were the recipients of a National Center for Complementary and Alternative Medicine R25 Education Grant Program to introduce curricular changes in complementary and alternative medicine (CAM) in their institutions. The authors describe the lessons learned during the implementation of these CAM education initiatives. Principal investigators identified these lessons along with discovered barriers and strategies, both those traditionally related to medical and nursing education and those unique to CAM education. Many lessons, barriers, and strategies were common across multiple institutions. Most significant among the barriers were issues such as the resistance by faculty; the curriculum being perceived as too full; presenting CAM content in an evidence-based and even-handed way; providing useful, reliable resources; and developing teaching and assessment tools. Strategies included integration into existing curriculum; creating increased visibility of the curriculum; placing efforts into faculty development; cultivating and nurturing leadership at all levels in the organization, including among students, faculty, and administration; providing access to CAM-related databases through libraries; and fostering efforts to maintain sustainability of newly established CAM curricular elements through institutionalization and embedment into overall educational activities. These lessons, along with some detail on barriers and strategies, are reported and summarized here with the goal that they will be of practical use to other institutions embarking on new CAM education initiatives.

Lessons learned from complementary and integrative medicine curriculum change in a medical school

Objectives  This paper describes a pilot study that examined lessons learned from the introduction of complementary and alternative medicine (CAM) elements into a medical school curriculum.

A Deficiency of Nutrition Education in Medical Training

1 Gaples Institute for Integrative Cardiology, Deerfield, Illinois and Division of Cardiology, Northwestern University, Chicago, Illinois; 2 Weil Foundation, University of Arizona College of Medicine, Tucson, Arizona; 3 Samueli Institute, Alexandria, Virginia and Harvard School of Public Health, Department of Nutrition, Boston, Massachusetts; 4 Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, Arizona; 5 Preventive Medicine Research Institute, Sausalito, California and Department of Medicine, University of California, San Francisco, California; 6 Section of Integrative Medicine and Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; 7 Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas; 8 Arizona Center for Integrative Medicine, College of Medicine, University of Arizona, Tucson, Arizona; 9 Departments of Nutrition and Epidemiology, Harvard School of Public Health; Channing Division of Network Medicine, Brigham and Womens Hospital and Harvard Medical School

Mind, Body, and Spirit: Family Physicians’ Beliefs, Attitudes, and Practices Regarding the Integration of Patient Spirituality into Medical Care

ABSTRACTThis study used a qualitative approach to explore family physicians’ beliefs, attitudes, and practices regarding the integration of patient spirituality into clinical care. Participants included family medicine residents completing training in the Southwest USA. The qualitative approach drew upon phenomenology and elements of grounded-theory. In-depth interviews were conducted with each participant. Interviews were recorded, transcribed and coded using grounded-theory techniques. Four main themes regarding physicians’ attitudes, beliefs, and practices were apparent from the analyses; (1) nature of spiritual assessment in practice, (2) experience connecting spirituality and medicine, (3) personal barriers to clinical practice, and (4) reflected strengths of an integrated approach. There was an almost unanimous conviction among respondents that openness to discussing spirituality contributes to better health and physician–patient relationships and addressing spiritual issues requires sensitivity, patience, tolerance for ambiguity, dealing with time constraints, and sensitivity to ones “own spiritual place.” The residents’ voices in this study reflect an awareness of religious diversity, a sensitivity to the degree to which their beliefs differ from those of their patients, and a deep respect for the individual beliefs of their patients. Implications for practice and education are discussed.

Integrating Complementary and Alternative Medicine Into Conventional Primary Care: The Patient Perspective

OBJECTIVE The aim of this study was to explore perspectives on integrating complementary and alternative medicine (CAM) into the conventional primary care setting among patients treated at a large academic family medicine clinic in Texas. METHODS We developed and administered a multiple choice questionnaire to evaluate perspectives of 502 patients on integrating CAM into the conventional primary healthcare system. All collected data were statistically analyzed to evaluate responses. RESULTS Among study participants, 66% indicated that they had used CAM treatments during the past year, 77% responded that they would be interested in using CAM during the next year, and 55.4% replied that they would like CAM therapies to be provided in their primary care clinic. CONCLUSION The use of CAM in primary care settings in southern Texas is widespread. However, in this primary care setting, patients would like their family physician to provide and supervise these therapies. PRACTICE IMPLICATIONS Patients believe that there is an increased need for family physician involvement in providing and supervising CAM treatments. Our findings are preliminary but can provide a basis for multicenter, cross-cultural studies to further evaluate the patient perspective on the process of integrating CAM into the conventional primary healthcare system so that healthcare policy makers can better address public need.

Teaching Self-Care: Taking Charge of Your Health

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr Sierpina at vssierpi@utmb.edu or Dr Kreitzer at kreit003@umn.edu. Submissions should be no more than 500 to 1,500 words. Please include any Web site or other resource that is relevant, as well as contact information.

Developing and implementing core competencies for integrative medicine fellowships

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing.” Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force’s process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.