Courses in complementary medicine at institutions of higher education in the United Kingdom

· Inaugural Issue

E Ernst, MD, PhD, FRCP, FRCPEd

K Schmidt, BSc (Hons), MSc

Complementary Medicine
Peninsula Medical School
Universities of Exeter and Plymouth
25 Victoria Park Road
Exeter EX2 4NT

E-mail: E.Ernst@exeter.ac.uk

Tel: +44 (0) 1392 424989

Fax: +44 (0) 1392 427562

 

Abstract

Due to growing interest in complementary medicine, more and more academic and non-academic courses have been set up in this area. The aim of this project was to evaluate the literature of complementary medicine courses offered at higher education institutions in the UK. All such institutions listed in a recent guide as offering such courses were asked to send their written material. The list excluded medical schools. Of 25 institutions contacted, 22 responded and 20 information packs could be evaluated according to predefined criteria. Several deficiencies in information provided emerged. Most importantly the aims of some courses were not well-defined and their contents were often unclear or incomplete. We conclude that many UK higher education institutions are now offering courses in complementary medicine. In several instances there is concern about the value of such courses.

Introduction

There is much evidence to show that, in the UK, the popularity of complementary medicine (CM) is growing 1. More and more courses in CM are therefore emerging for future CM providers. As a consequence, the number of CM providers is likely to increase; in the UK the number of CM practitioners is already similar to that of primary care physicians 2. The recent House of Lords report stated that there is evidence indicating that CM training courses vary in their content, depth and duration 3.

With this in mind, it seems relevant to attempt an assessment of the quality of the existing courses. This is clearly an insurmountable task. As a proxy, one might, however, evaluate the brochures issued about such courses. The aim of the current article is therefore to evaluate the literature of CM courses offered at institutions of higher education in the UK.

Methods

On 18th August 2002, ‘The Observer’ published several pages dedicated to guiding students to University courses: ‘Clearing 2002: University vacancies’ 4. It included a section entitled ‘complementary medicine’ which listed all 25 institutions of higher education offering CM courses. Medical schools were not included in this category. The following 25 institutions were named: Anglia Poly; Bradford College; Middlesex; Moray College (UHI); Napier; Oxford Brookes; Pembrokeshire College; Perth College (UHI); South Devon College; South East Essex College; Brighton; Central Lancashire; Derby; Glamorgan; Greenwich; North London; Salford; Westminster; Wolverhampton; Chelmsford; Blackpool & Fylde C; British College of Osteopathy & Medicine; Luton; Plymouth; Thames Valley. The list is nearly identical with that of the ‘Universities and Colleges Admissions Service’ which names 24 institutions offering CM courses. We telephoned the contact numbers provided and asked for a complete information pack on CM courses.

The information that had reached us by 4 September 2002 was evaluated descriptively according to predefined criteria (see Tables 1 and 2). Both reviewers independently assessed all materials. Discrepancies were settled through discussions.

Results

Of the 25 institutions contacted, 22 responded (response rate = 95.7%). As one of our aims was to assess the breadth of CM education, specialised colleges (not courses), e.g. British College of Osteopathic Medicine, were excluded. Plymouth indicated that no courses were currently offered (Autumn 2002). This left us with 20 information packs for evaluation. Key data are summarised in Tables 1 and 2.

Twelve of the CM courses were offered by Universities, the others by colleges and polytechnics. The respective faculties were often not stated; where they were, they ranged from ‘pure science’ to ‘hairdressing’. The aims of the courses were not always clearly defined in the brochures; often nebulous phraseology was used to describe them, e.g. “to provide a scientific study of the theoretical framework…”. The majority of the courses were designed specifically for (future) CM practitioners.

According to the brochures, the contents of the courses often seemed vague; important subjects like ethics, pathophysiology, diagnostic skills, differential diagnosis, epidemiology, statistics, research methodology, etc were rarely mentioned as part of a course. The stated entry criteria were often flexible and, in some instances, no formal qualifications seemed to be required. The lengths of the courses varied between 1 and 4 years full-time. Several institutions also offered part-time options. Most courses concluded with a Bachelor of Science degree. The costs for the courses were made transparent in only a few of the brochures.

Discussion

The data presented above confirm that, in the UK, there has been a remarkable proliferation of CM courses in institutions of higher education (the very first such course started only about 15 years ago at the University of Exeter). This means we are likely to see more and more academically educated providers of CM.

Obviously, the study of brochures of CM courses is an inadequate means of reliably assessing the quality of the courses themselves. Nevertheless, it provides a preliminary evaluation of the spectrum on offer. It also casts doubt on the rigour of some of the material reviewed by us. In this context it is noteworthy that, in the US, at least one CM course is under investigation for making misleading and deceptive claims 5. In the UK, the Lords’ report 3 was concerned about the content, depth and duration of CM courses.

While this evaluation is, to the best of our knowledge, the first of its kind in the UK, CM courses for medical students have been the object of previous research. A postal survey of all UK medical schools carried out by the British Medical Association in 1998, revealed that only 6 of the 26 institutions included CM courses within their undergraduate programmes 6. At that time, the remaining 17 schools had no plans to include such provision in the future. A more recent (2001) review by the General Medical Council suggested that more medical schools are now including some sort of formal teaching on CM 7. However, courses were variable in content and depth. Some schools had planned and developed core and elective options, others offered optional modules with no core teaching and some had no current provision at all. A survey of all the members and fellows of the Royal College of Physicians (London) found that many UK doctors refer patients to CM practitioners without formal training in CM 8.

A 1997 report of the American Medical Association stated that “medical schools should be free to design their own required or elective experience related to CM” 9. A 1997 – 1998 survey of 117 US medical schools found that 64% offered elective CM courses or included information about CM in a regular course 10. Topics included chiropractic, acupuncture, homoeopathy, herbal therapies, and mind-body techniques. Sixty-eight percent of the courses were stand-alone courses, and 31% were part of a required course. A survey of US schools of public health found that more than 80% did not offer CM courses even though the interest of students was considerable 11. A similar survey of all Japanese medical schools showed that 20% of these institutions now offer CM courses 12. In contrast, the majority (61%) of all German medical schools have courses in CM 13. A recent survey included 550 universities in 21 European countries. The results indicate that 40% of medical schools, 72% of health science faculties and 8% of other faculties offered CM courses 14.

In trying to develop a consistent educational approach to CM, Wetzel et al 10 made the following suggestions:

  • Focus on critical thinking and critical reading of the literature
  • Identify thematic content
  • Include an experimental component
  • Promote a willingness to communicate between different healthcare professions.

CM courses also offer a unique opportunity for teaching several issues which are fundamental to healthcare in general 15, for example:

  • Importance of empathy and therapeutic relationship
  • Relevance of patients’ preferences
  • Research methodology (CM research is often highly complex)
  • Critical thinking
  • History of medicine

Our evaluation does not provide evidence that these elements have been sufficiently adopted in CM courses for CM practitioners.

In conclusion, many UK institutions of higher education are now offering CM courses. Our assessment of the written material about CM courses sent out by the institutions indicates a large degree of variation and leaves many questions unanswered. An in-depth analysis of the course (rather than the brochures) would be desirable.


References

1.   Ernst E, White AR. The BBC survey of complementary medicine use in the UK. Complement Ther Med 2000;8:32-6.

2.   Mills S, Budd S. Professional organisation of complementary and alternative medicine in the United Kingdom 2000. A second report to the Department of Health. Centre for Complementary Health Studies, University of Exeter. 2000.

3.   House of Lords Science and Technology Committee. House of Lords Report. Science and Technology – 6th report. Session 1999-2000. ISBN 0 10 483 1006, The Stationery Office. 2000.

4.   NN. Clearing 2002. University vacancies. The Observer 2002;18 August:3-10.

5.   Consumer Health Digest. Arkansas Attorney General sues dubious naturopath and school. 2002;#02-35.

6.   Morgan D. Education and training in complementary and alternative medicine: a postal survey of UK universities, medical schools and faculties of nurse education. Comp Ther in Med 1998;6:64-70.

7.   General Medical Council. GMC Review Reports on UK Medical Schools, www.gmc-uk.org. 2002.

8.   Lewith GT, Hyland M, Gray SF. Attitudes to and use of complementary medicine among physicians in the United Kingdom. Complement Ther Med 2001;9:167-72.

9.   American Medical Association. Encouraging medical students’ education in complementary healthcare practices. Chicago, III. June 1997.

10.   Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine. JAMA 1998;280:784-7.

11.   Burke A, Gordon RJ, Bhattacharya B. A preliminary survey of complementary and alternative medicine (CAM) courses in graduate public health programs. 6 2001;171.

12.   Tsuruoka K, Tsuruoka Y, Kajii E. Complementary medicine education in Japanese medical schools: a survey. Complement Ther Med 2001;9:28-33.

13.   Pascoe GmbH. Expertenkreis Naturmedizin: Naturmedizin 2002. Ausbildungssituation an Deutschen Hochschulen. Internal document. Giessen; Germany. 2002.

14.   Barberis L, De Toni E, Schiavone M, Zicca A, Ghio R. Unconventional medicine teaching at the universities of the European Union. J Altern Complement Med 2001;7:337-43.

15.   Ernst E. A complementary course? Science & Public Affairs 1999;Oct:12-3.

 

Acknowledgement

We would like to thank Ms Nicola Watson for her invaluable help with this project.

 Table 1

CM courses offered in UK higher education institutions 2002

No. Institution Section/Faculty Title Aim Course contents*
Anglia Polytechnic University not stated Complementary Medicine (Aromatherapy) or (Reflexology)

BSc (Hons) or Diploma

“produce complementary practitioners who are trained to the highest level” aromatherapy, law and ethics in health and social care, health psychology of stress, reflexology, Bach Flower Remedies
Bradford College Pure and Applied Sciences Complementary Therapies

BSc (Hons)

not stated “mainly Chinese medical theory and the practise of Shiatsu but also…anatomy, physiology, pharmacology”
Middlesex University Health HNC Complementary therapies not stated holistic and scientific study skills, anatomy, aromatherapy, massage, client care, reflexology
Moray College Hairdressing, beauty and complementary therapies Complementary Therapies

HNC/D

“to produce skilled and qualified personnel for the health sector…” anatomy, physiology, chemistry, aromatherapy, reflexology, manual body treatments, counselling, psychology, communication, safe and hygienic practices, several optional units
Napier University, Edinburgh Complementary Therapies Complementary therapies (more specialised courses are also offered)

BSc (Hons)

to offer both an academic and professional qualification communication, neuromuscular principles, physiology, pathology, complementary therapies, using evidence, differential diagnosis, reflexology or aromatherapy, counselling

 


No.
Institution Section/Faculty Title Aim Course contents*
Oxford Brookes University School of Healthcare Complementary therapies (Clinical aromatherapy)

BA or BSc (Hons)

“…to extend skills of healthcare professionals…” a range of subjects including philosophical concepts, social and biological sciences, aromatherapy, bodywork and touch, massage, pain, practitioner/client interactions
Pembrokeshire College not stated Complementary therapies (range of more specialised courses also offered)

HNC/HND

not stated anatomy, physiology, IT, counselling, body massage, aromatherapy, reflexology, Reiki, biochemistry, nutrition, craniosacral therapy

 


No.
Institution Section/Faculty Title Aim Course contents*
Perth College Social, Health and Personal Care Complementary Therapies

HNC/HND

“Designed for those interested in a career in complementary therapies” aromatherapy, reflexology, Swedish massage, anatomy, physiology, psychology, counselling, chemistry, safe and hygienic salon practices
South Devon College, Torquay not stated Complementary Health Studies

HND

“progression route in complementary therapies” aromatherapy, reflexology, lymphatic drainage, massage, professional practice, nutrition, biochemistry, homoeopathy, stress management

No.
Institution Section/Faculty Title Aim Course contents*
South East Essex College Health and Social Studies Higher Health and Complementary Therapies (2 courses, A and B)

HNC & HND

A)   not stated

B)   not stated

anatomy, physiology, health promotions, stress management, biochemistry, psychology, professional practice, body massage, aromatherapy, reflexology
South East Essex College not stated Health and Complementary Therapies

HND

to progress to higher level study anatomy, physiology, health studies, psychology, aromatherapy, massage, reflexology, nutrition, disability, small business management
No. Institution Section/Faculty Title Aim Course contents*
University of Brighton Faculty of Health; School of Health Professions Oriental medicine (Acupuncture)

BSc (Hons)

not stated “theoretical and clinical aspects of acupuncture…particularly the clinical and philosophical basis of Chinese medicine”, research skills
University of Central Lancashire Faculty of Health, Division of Complementary Medicine Health sciences for complementary medicine

BSc (Hons)

“…to provide a recognisable academic qualification for people interested in pursuing a career in complementary medicine” sociology, psychology, physiology, therapeutic communication and approaches to practitioner/client relationships, pharmacology, touch, nutrition, counselling
No. Institution Section/Faculty Title Aim Course contents*
University of Derby School of Health & Community Studies BA (Hons) Complementary Therapies and Holistic Medicine “…to give an analytical and critical understanding of the practice of complementary therapies” anatomy, physiology, pathology, healing, research methods, nutrition, massage, reflexology, aromatherapy, 5 elements, Shiatsu, Traditional Chinese Medicine, evidence-based practice
University of Glamorgan Science – Health Sciences Chiropractic

BSc (Hons)

“…to train chiropractors…” “wide range of subjects including anatomy, biochemistry, biomechanics, physiology, radiology”
No. Institution Section/Faculty Title Aim Course contents*
University of Greenwich Health and Social Care Complementary therapies (3 different routes)

BSc (Hons)

not stated introduction to complementary therapies, study skills, physiological foundations of health, concepts of health, basic skills for complementary practitioners, understanding qualitative data, research methods, counselling
No. Institution Section/Faculty Title Aim Course contents*
University of North London Faculty of Science, Computing and Engineering

Department of Biological Sciences & Human Biology

Complementary medicine

BSc (Hons)

“…to provide a scientific study of the theoretical framework of this branch of complementary medicine and experience its practical applications.” cell biology, human physiology, data analysis, scientific professional studies, basic philosophy and theory of Traditional Chinese Medicine, Acupuncture 1, Herbal medicine 1, principles of Chinese diagnostics, principles of traditional Chinese treatment, acupuncture and moxibustion, Chinese materia medica, heteropathy of Chinese herbal treatment
No. Institution Section/Faculty Title Aim Course contents*
University of Salford Health Sciences Complementary medicine and health sciences

BSc (Hons)

“…give a strong foundation in complementary medicine…” biomedical science, research methods, pathophysiology, client-therapist interface
University of Westminster not stated Complementary Therapies

BSc (Hons)

“provide a comprehensive education in modalities of complementary therapy” herbal medicine, homoeopathy, nutrition, therapeutic bodywork, research methods, diagnosis, anatomy
No. Institution Section/Faculty Title Aim Course contents*
University of Wolverhampton School of Health Complementary Therapies

BSc (Hons)

“Equip you with the skills and knowledge required to enable you to set up, maintain and practise as a professional therapist” human function, complementary therapies, foundation studies, aromatherapy, reflexology, nutrition, theory of energy and Therapeutic Touch

 

*   selection of topics if list was too long (usually in order of mention in brochure)


Table 2

CM courses offered in UK higher education institutions 2002

No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
Anglia Polytechnic University

120 credits. “Applicants without this credit can be provided with a foundation programme of study and then transfer onto this pathway…”

2 years 4 years up to £1,100 a yr

Total: £2,200

not stated only course to include ethics

 

No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
Bradford College

age 18 or over, 12 UCAS points. “Exceptionally students may be accepted at the discretion of the College”

3 years not stated not stated not stated “There is no other degree course in the country that currently provides this” [a nationally recognised licence to practise Shiatsu]
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
Middlesex University

100 tariff pts

2 years not stated £1,100 p.a.

total £2,200

not available what are ‘holistic’ study skills?
Moray College

4 GCEs – including 2 A levels or a BTEC

“…applicants will be considered who do not hold formal qualifications…”

1 year 2 years published in March prior to forthcoming academic year   many subjects for 1 year (full-time), College also seems interested in people without formal qualifications
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
Napier University, Edinburgh

200 UCAS points

3 years not stated usually paid but if not eligible, £1,100 a yr

total: £3,300

not stated “The Centre of Complementary Therapies is the only one if its kind in the UK”
Oxford Brookes University

registered healthcare professional, 1 year’s experience, 120 CATS credits at level 1

3 years 3 – 5 years £1,075 p.a.

£3,225 total

not stated medical subjects seem to be less important than others
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
Pembrokeshire College

employment or voluntary employment in an organisation

2 years not stated HNC £327 not stated no formal qualifications seem to be required
Perth College

1 Higher or an appropriate group of NQ units

1 or 2 not stated not stated not stated salon practises
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
South Devon College, Torquay

“A levels/ND/Access to Science/vocational awards…All students will need professional skills, qualifications in aromatherapy and reflexology”

2 years not stated not stated not stated only for aromatherapists and reflexologists
South East Essex College

A)   40 UCAS points or equivalent

B)   40 UCAS points or equivalent

2 years (HND) 2 years (HNC) £1,100

total: £2,200

£575.00

total: £1,150

what is ‘higher health’?
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
South East Essex College

40 UCAS points or equivalent work experience

2 years not stated up to £1,100 a yr

total: £2,200

not stated formal qualifications do not seem to be essential
University of Brighton

“UCAS tariff…applications are welcome from candidates over 21 who have completed other relevant studies or gained life and work experience”

4 years 6 years up to £1,100 a yr

total: £4,400

not stated formal qualifications do not seem to be essential
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
University of Central Lancashire

200 UCAS pts

“…a 12 unit profile…” but “applications from individuals with non-standard qualifications…are welcome”

3 years not stated not stated not stated degree is named “unique” and “innovative”
University of Derby

5 GCSE subjects, including English, at grades A – C

12 pts at A level or UCAS tariff equivalent

3 years 5 years not stated not stated  
No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
University of Glamorgan

280 – 340 UCAS pts

(min. 260 points from a range of qualifications)

4 years not stated £1,100 pa

total £4,400

not stated only for studying chiropractic
University of Greenwich

160 UCAS points or equivalent

3 years 4-6 years £1,100 pa

total £3,300

£270 for 20 credit courses

total

understanding of qualitative but not quantitative data?

module on research methods and statistic

 

No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
University of North London

GCSE English and Mathematics Grade C or above plus one of following: 120 pts from 2 or more A2/vocational six-unit awards, including Biology; or 120 pts from a vocational 12-unit award in science, or a pass in BTEC national Diploma in Science with at least 3 merits in final yr

3 years 4+ years up to £1,075 pa

total: £3,225

not stated aim seems nebulous

 

 

No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
University of Salford

GCSE/O level: 4 passes at Grade C including English and Maths (other options too)

3 years 4 – 6 yrs not stated not stated looks relatively rational
University of Westminster

“… personal attributes necessary for clinical training as well as analytical capacity”

pass in GCSE Maths & English

3 years not stated £1,075 p.a.

£3,225 total

not stated  “…first named degree in the South of England in complementary therapies”. Separate courses are offered for herbal medicine, homoeopathy and Qigong

 

 

No. Entry requirements Duration   Cost for home students Comment *
    Full-time Part-time Full-time Part-time  
University of Wolverhampton

160-240 UCA points, other candidates will also be considered

3 years 5-6 years not stated   what is theory of energy?

 

noteworthy features of course or remarkable quote from brochure