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 18^th 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