Transforming health care
Integrative medicine and the medical school curriculum

May 8, 2009

By Colleen MacPherson

Faculty members in the Centre for Integrative Medicine in the College of Medicine have a vision for a transformed health care system, one where a visit to the doctor would be as much about physical, mental and social well-being as it would be about treating illness.

To get there from here will require “big conceptual shifts within the health care system,” shifts away from being disease-oriented to being health-oriented, said Dr. Louise Gagné, a family physician and specialist in integrative medicine. “Illness happens and we put out the fire with some medicine … but we haven’t supported people very well in understanding how to stay well. What we need to do is transform how physicians are educated and how medicine is practiced.”

That educational change is the priority of the centre, which was formally established in 2005, although its work has been ongoing since 2002. The centre’s focus is incorporating complementary and alternative medicine (CAM) content into the college’s medical curriculum, teaching future physicians about therapies, healing systems and self-help practices that do not generally enjoy widespread acceptance in the conventional medical system. Some examples include acupuncture, traditional Chinese medicine, massage therapy, natural health products, tai chi and meditation.

Today, the U of S medical school curriculum contains some 35 hours of CAM-related content integrated into 15 different courses. According to Dr. Joe Schnurr, a family physician and licensed acupuncturist, today’s students have a thirst for CAM content, but that has not always been the case. When first taught as a stand-alone course, complementary medicine “was seen as secondary, an add-on to conventional medicine,” he said.

Michael Epstein, a clinical associate professor in the Department of Community Health and Epidemiology and the centre’s managing director, went even further, describing the reaction to that first CAM course as “a combination of skepticism, astonishment and concern. But with each passing year, CAM has become a much more accepted part of medical education.”

Schnurr explained that teaching CAM as a separate course “made it look like an either/or prospect, so what we started to do was to weave CAM content into courses that were already there.” The goal is to teach students that “if you’re going to treat someone, you’re going to use the best treatment available. That might be conventional medicine, complementary medicine, or a combination of the two.”

The CAM-related content is divided into four main areas: foundational topics like culture, belief systems and evidence-based medicine; mind-body science; selected CAM therapies and their history, efficacy, standards and practice settings; and integrative approaches to medicine. Epstein noted that the cumulative evidence base for complementary and alternative medicine is doubling every five years, an indication of its growing acceptance within the medical field. And with an estimated one-third to one-half of the population of most Western countries using some form of complementary and alternative medicine, most physicians can expect to deal with some aspect of CAM as part of their practice.

“There is still all kinds of garbage that goes on in the alternative medicine world,” noted Gagné, so a significant component of CAM-related curriculum content is directed at teaching students to assess the current state of research. “We don’t need students to ‘believe’ in it. What we want to do is to give them the tools to have informed conversations with their patients.”

In addition to educating students, the centre also endeavours to promote health care reform through its well-attended integrative health seminar series. Schnurr said plans are also in the works for additional educational opportunities for practicing physicians. And to further the education of students, he said the centre would like to eventually establish a health clinic where future physicians can see integrative medicine, and its focus on wellness as opposed to disease, in action.

Such a centre would serve as a catalyst for building bridges within the health care system and allied health professions, Epstein said. “Most of the progress made in the 20th century was through specialization and division of labour. Most of the progress in the 21st century is going to be made by putting Humpty Dumpty back together.”

Although all Canadian medical schools incorporate CAM content into their curricula to some degree, the U of S has made more progress than most, thanks largely to the support the centre has received in the College of Medicine and across campus. Being a small university also helps, said Schnurr. “A few champions on a small campus can make a big difference.”

Epstein also attributes the centre’s success to what he calls “the magic of Saskatoon” where one can meet a colleague on the street and “conversations take place, bridges are built, in a way that seldom happens in larger centres such as Calgary, Vancouver or Toronto.”