S30: Integrative Medicine Educational Models in Residency: Research Design, Methods, and Outcomes

PatriciaLebensohn1, Sally Dodds1, Benjamin Kligler2, Rita Benn3Christin Scheffer4

1Arizona Center for Integrative Medicine, University of Arizona, USA

2Beth Israel Medical Center/Albert Einstein College of Medicine, USA; 3University of Michigan, USA; 4University of Witten/Herdecke, Herdecke, Germany


Eight diverse family medicine residencies in collaboration with the Arizona Center for Integrative Medicine implemented a core curriculum called Integrative Medicine in Residency (IMR). The curriculum was developed based on a needs assessment and following a competency-based model. A parallel comprehensive evaluation plan was created at multiple levels: the curriculum, the residents’ competencies, and assessment of residents’ wellbeing. The purpose of this symposium is to describe the educational research design, the methods of evaluation and implementation, and educational outcomes in the different settings where the IMR was implemented. Preliminary results will be presented, and early successes and challenges will be reviewed. In addition results on teaching patient-centeredness to final year medical students in an Integrative Medicine ward in Germany will be presented.


Research Methods Used:
  • Combined methods research (quantitative and qualitative)
  • Quasi-experimental designs (non-equivalent groups, time series)
Integrative Medicine in Residency (IMR) is a 200-hour curriculum developed in collaboration with eight family medicine residencies. It is implemented across three years of residency through approximately 170 hours of web-based content and 30 hours of program-specific experiential exercises. Curriculum development involved a preliminary needs assessment to inform the content areas and implementation preferences. Resident IM competencies were created following ACGME guidelines. A comprehensive educational research methodology was conducted in three areas:
  1. Curriculum Evaluation: Residents evaluated each course on meeting learning objectives, clinical utility, functioning of the online technology, and time to completion. Course completion rates were assessed through online reports.  Findings were used as formative feedback that guided changes to the content and delivery methodology.
  2. Residents’ Competencies: Different evaluation methodologies were applied to the competencies. These included a Medical Knowledge test, a resident Self-Assessment, faculty direct observation ratings of residents’ patient encounters, evaluation of treatment plans and responses to questions along the curriculum. A study of patient-centeredness of the residents’ approach to care was also assessed in a subset of the IMR programs. 
  3. Resident wellbeing: An important piece of teaching integrative medicine is to encourage physician self-care. The online curriculum and the experiential activities in individual residencies incorporate annual assessment of wellness behaviors and goal setting. Wellbeing measures used included: Perceived Stress, Burnout, Depression, Life Satisfaction, Gratitude, Mindfulness, Emotional Intelligence, and wellness behaviors. 
  4. Patient-centeredness approach is at the core of the practice of Integrative Medicine. Preliminary findings from two projects (one with the IMR residents and another with German medical students) measuring patients’ perceptions of the health provider will be presented and discussed.
We studied 3 classes of residents--the 2011 class graduated in June with 80% completion of the curriculum and the assessments. Data from this first class were used to adjust the content and methodologies. The class of 2012 (now in the third year of residency) and the class of 2013 (second year of residency) are still being evaluated against a control group from 4 family medicine residencies without an established IM curriculum in integrative medicine. Findings from a patient exit survey evaluated residents' patient-centered approach: competencies in integrative medicine history-taking and enabling behavior change. The symposium will comprise four brief presentations:
  1. The curriculum content, multi-dimensional evaluation components and methods, different curriculum implementation methodologies, and learner’s demographics.
  2. Teaching and assessing resident wellness and well-being.
  3. Preliminary findings related to implementation at individual sites and completion rates, improvements in self assessment ratings, and Medical Knowledge Test scores including comparison data.
  4. Findings on residents and medical students patient centeredness competencies from the patients’  surveys as compared to controls.