Teaching evidence-based complementary and alternative medicine: 1. A learning structure for clinical decision changes.

Complementary and alternative medicine (CAM) education is at a crossroads and has been an area of increasing debate. Public use of CAM has risen dramatically since 1997, with initial reports ranging from 30% to a possible 60% in the United States. Much attention has been directed to the education of the public regarding CAM, with respect to efficacy, potential harm, and integration. Far less attention has been paid to the education of CAM practitioners. In the current climate of integrative health settings, CAM practitioners should be trained to interact with conventional physicians, the public, and policy makers in an evidence-based format. In order to create communication effectively, an evidence-based approach may provide the common ground required for all schools of thought.

Teaching Evidence-Based Complementary and Alternative Medicine (EBCAM); changing behaviours in the face of reticence: a cross-over trial.

BACKGROUND: The effectiveness of teaching critical appraisal to students of Complementary and Alternative Medicine (CAM) has not been studied. In this study we attempt to determine if a workshop for final year students at a naturopathic college improved their ability to utilize critical appraisal concepts. METHODS: We assigned 83 Naturopathic Interns to two groups: Group A (n = 47) or Group B (n = 36). We conducted a baseline assessment of all subjects' critical appraisal skills. Group A was assigned to receive a 3(1/2) hour workshop on Evidence Based Medicine (EBM) and Group B received a workshop on bioethics (control intervention). The groups critical appraisal skills were re-evaluated at this time. We then crossed over the intervention so that Group B received the EBM workshop while Group A received the bioethics workshop. Assessment of critical appraisal skills of the two groups was again performed. RESULTS: The students mean scores were similar in Group A (14.8) and Group B (15.0) after Group A had received the intervention and Group B had received the control (p = 0.75). Group scores were not significantly improved at the end of the trial compared to at the beginning of the study (Group A: 15.1 to 16.1) (Group B 15.6 to 15.9). Student's confidence in reading research papers also did not improve throughout the course of the study. CONCLUSION: The final year is a difficult but important time to teach critical appraisal and evidence skills. Single, short intervention programs will likely yield negligible results. A multi-factorial approach may be better suited to implementing EBCAM than single short interventions.