Integrative Medicine and the Health of the Public A Summary of the February 2009 Summit (2009) / Chapter Skim
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5 Workforce and Education
5 Workforce and Education
Pages 111-132
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From page 111... ...
Goldblatt, the panelists elaborated on the implications of advances in integrative medicine for the education and training of the nation's health professionals and researchers and discussed strategies for changing curricula, including interdisciplinary approaches, team-based training, and expansion of core competencies in healthy living and wellness. An often-mentioned point in this session, described by Black and other panelists, is the need to expand interdisciplinary and multidisciplinary education to promote effective teamwork.
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From page 112... ...
There are several drivers to change within the realm of health care, many of which were described by other presenters throughout the summit and many of which are globally applicable. These drivers include expectations of the public and of individual patients, inequalities in health and health care, variations in the quality of care, health needs reflecting demographic shifts, the impact of lifestyle on health, advances in medical sciences, rising costs, and inefficiencies and failings of the system, Black noted.
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From page 113... ...
Theodore Roosevelt declared, "Far and away the best prize that life offers is the chance to work hard at work worth doing." The findings of nearly 500 articles about the positive effects of work on physical and mental health and well-being were recently compiled in a single review (Waddell and Burton, 2006)
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From page 114... ...
Efforts are now under way in the United Kingdom to develop training programs that help physicians, especially in family medicine, focus on the health aspects of work and worklessness. Workforce Reorientation Meeting the expectations of patients and the public, providing person-centered care, and incorporating greater awareness of social determinants of health into health care necessitates change in health professional education.
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From page 115... ...
Black emphasized that all health professions students should learn to collaborate effectively across disciplines, because the best health care plan may include a combination of treatments provided by diverse practitioners. Some health professionals may fear losing their professional identity within a team, but clustering in teams tends to be additive to professional skills and knowledge, as each team member provides unique expertise.
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From page 116... ...
Lifestyle and prevention need to be the cornerstones of the future health care system and thus a larger component of education. To help produce the necessary changes, medical education in the United Kingdom is being refocused around general principles that could be expanded to other professions.
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From page 117... ...
For example, the chair of the Joint Committee on Higher Surgical Training informed Black in January 2009 that "none of the surgical curricula contain any elements of complementary or alternative medicine." Barriers to Change Black noted that there are a number of barriers to reorienting the workforce to a more integrative approach to health. Competing demands for time and resources in health services and health professions training are formidable.
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From page 118... ...
The desire by people and patients for collaboration among their health care providers suggests a need to create innovative multidisciplinary educational experiences, training, and guidelines for all licensed health professionals. In Goldblatt's view, this multidisciplinary approach is appropriate in the didactic, clinical, and research spheres -- especially in clinical outcomes research, which can accommodate multifactorial approaches of integrative medicine.
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From page 119... ...
Education Curricula Mary Jo Kreitzer, University of Minnesota Kreitzer expressed the view that shifting the focus of the health care system from disease to health requires new models of care -- models that will use all appropriate licensed health care practitioners as primary care providers and allow them to practice to the highest and best use of their educations and capacities. Educating heath professionals in integrative medicine is as daunting a task as transforming health care.
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From page 120... ...
A new model of care suggests a different mix of health professionals, such as more nurse practitioners, physician assistants, and others to provide primary care, and a diminished focus on specialty care. A potential example of innovation could involve the 7,000 community health centers across the country that provide a medical home to indigent patients, furnish well-baby care, and fill other gaps in the health care system.
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From page 121... ...
This course is now taught to medical students in 70 medical schools, with plans to adapt it to nursing schools. The students write their own personal mission statement -- in effect, their own personal Hippocratic Oath.
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From page 122... ...
IMR is being piloted, collaboratively, in eight residency programs around the country. IMR includes 200 hours of mandatory training and could eventually be applied to training programs for primary care physicians, specialty physicians, physician assistants, and nurse practitioner programs throughout the United States and abroad.
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From page 123... ...
Students should also learn how historical relationships among professions affect collaboration and where the frictions tend to occur. Perlman described multiple challenges facing IPE, including the conventional medical mindset or culture, in which individual accomplishments are highly prized.
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From page 124... ...
Because federal officials and other policy leaders maintain competing visions, current policies do not account for this shortage and provide no buffer against its likely effects, said Cooper. As a shortage comes to bear, the medical education pipeline, which can be up to 12 years in length, will prevent a quick response and remedy.
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From page 125... ...
Yet today, nurses and other nonphysician health professionals do so routinely, and many are gaining broad competencies through doctorates and other graduate degrees. Their climb up the education ladder facilitates the shift away from physician dominance in performing health care functions.
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From page 126... ...
The General Medical Council also regulates osteopathic physicians, chiropractors, dentists, nurses, midwives, opticians, and pharmacists, while the Health Professions Council (HPC) covers 13 professions: art therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dieticians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, prosthetists/orthotists, radiographers, and speech and language therapists.
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From page 127... ...
This gives fundamental importance to maintaining an up-to-date and thorough medication record, including treatments provided through complementary modalities. Even if a single electronic health record for patients in all circumstances is not yet feasible, Webbased systems are being developed so that a contemporary summary can be made available to all practitioners involved in the patient's care.
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From page 128... ...
Maizes commented that people who train together often end up practicing together, so that interprofessional credentialing would be a logical extension of interprofessional education. Agreeing, Kreitzer suggested that community health centers can serve as both an integrated clinical site and a site for integrated education.
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From page 129... ...
However, the chronic disease epidemic calls for a new model of care that emphasizes education and peer support that can be provided in a group visit with a team-based approach. Achieving Interprofessional Education Panel members were asked how to achieve interprofessional education in institutions that may not see the value of this type of education.
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From page 130... ...
To improve professional education, the sphere of education should be widened to help current health professionals make the transition to integrative medicine, and to help patients assume more self-care. Primary 2 See Chapter 1 for a description of the priority assessment groups.
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From page 131... ...
Students choosing core careers had higher empathy than did those choosing noncore careers. Core refers to core specialties, (i.e., internal medicine, family medicine, obstetrics-gynecology, pediatrics, and psychiatry, which have greater patient contact)
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From page 132... ...
The group identified 3year goals that included development of economic incentives, which are essential to change the health care system; an interdisciplinary consensus on core competencies; and establishing national priorities for health care and health professions education. Academic institutions should recognize a responsibility to go beyond professional education and open their doors to educating the public.
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