Familiarisation for Medical Students
6.71 Given the increasing popularity of CAM it is
important to consider how far medical and other healthcare practitioners
should be made aware of the CAM therapies in their training. There
are two main reasons why familiarisation is important. First is
the belief that doctors should have an understanding of all the
health services their patients may be accessing. FIM believe this
is particularly important because if doctors do not ask patients
about their use of CAM, "there are confounding factors in
your delivery of orthodox care
that is bad for the patient"
(Q 101). There is an obvious potential for interactions between
CAM treatments and conventional medicine. Secondly, medical practitioners
(especially general practitioners) are often used by patients
as an information source for all health questions. It is
therefore necessary, as the Royal College of Physicians told us,
for medical students to "have some knowledge of CAM so that
they can advise their patients appropriately" (P 190).
6.72 The GMC, whose Education Committee advises medical
schools on their curricula, explained that their view towards
familiarisation with CAM is positive and that they are actively
encouraging medical schools to include this in undergraduate curricula.
Professor Graeme Catto, Chairman of the GMC Education Committee,
explained: "I think we would want medical students to become
familiar with all these techniques, and some, in a sense, are
more readily applicable than others, some are already moving into
conventional medicine, if you like, and others are far from that.
I think the understanding and awareness of what patients may come
to young doctors with is helpful in undergraduate medical education"
(Q 1037). Professor Catto also said that beyond making sure all
medical students had an awareness of CAM there is scope for allowing
those undergraduates with a special interest in the area to pursue
a deeper understanding of CAM: "Some will want to take that
information a stage further and will wish to become involved,
through the special study modules, in undertaking some treatments
themselves or experiencing, along with patients, what is happening.
A further stage then would be through special study modules or
related to intercalated degrees. Some may wish to pursue research
in these areas".
6.73 Although the GMC believed that familiarisation
was important, their evidence confirmed that up until now their
guidance in this area has been very vague: "Tomorrow's
presently refers only to the need for medical education to recognise
that there is a growing demand for treatments that do not conform
to the conventional orthodoxies" (P 96). We were pleased
to hear that the GMC are now taking a more proactive role. They
explained: "Tomorrow's Doctors is due to be revised
in the near future to reflect our view that the universities need
to provide some familiarisation with complementary and alternative
therapies to students in training".
6.74 We received a wealth of evidence from other
witnesses on this matter. The majority (including FIM (Q 1010)
and the main professional bodies representing the therapies in
our Group 1) have supported the idea that all medical undergraduate
courses should include information on CAM.
6.75 The Council of Heads of Medical Schools agree
that there is a need for medical education to recognise the growing
demand for treatments that do not conform to conventional orthodoxies
(Q 245). They gave evidence showing there is enthusiasm for this
amongst medical students (Q 243). They stated their position was
supportive: "Undoubtedly we perceive interest amongst our
undergraduate students in CAM. That is not only in medicine but
in other healthcare professions (for those of us who have those
within our faculties). The position of the Council of Heads of
Medical Schools is that we would be supportive of familiarisation
with the philosophy and techniques of CAM in the undergraduate
medical curriculum for the prime reason that large numbers of
our patients are accessing this form of treatment and it is therefore
an important piece of knowledge for undergraduates to have".
They proposed that the main scope for programmes of familiarisation
lies in two levels: "There should be a small amount of teaching
that is for the whole undergraduate corpus, with the ability of
those who wish to, to take special study modules and to have more
detail on CAM. That is actually quite a common structure amongst
United Kingdom medical schools".
6.76 We are aware that there are two approaches familiarisation
can take; one is a sympathetic approach to CAM, highlighting its
benefits to patients, and the other is an unsympathetic approach
highlighting CAM's weaknesses and using it as an example of the
dangerous, unproven, unregulated side of healthcare. Both these
approaches have been suggested to us. Professor Michael Baum,
Professor of Surgery at the Royal Free and University College
Hospital, explained that: "As part of the teaching of my
medical students I use the claims of complementary and alternative
medicine to illustrate the demarcation between science and non-science"
(P 243). He assured us he would be outspokenly hostile towards
the idea of teaching "alternative medicine" in the undergraduate
medical curriculum "other than as an illustration of uncritical
thinking" (P 242). However the majority of submissions have
suggested that CAM familiarisation should exist so that doctors
are aware of their patients' options and can understand why they
may be making certain choices. The GMC explained that medical
schools teach evidence-based medicine "
so it isn't
inappropriate that some schools look at pitfalls related to CAM"
(Q 1044). During their regular visits to assess individual medical
schools they had found no evidence of any school taking an antagonistic
view of CAM.
6.77 We recommend that familiarisation should
prepare medical students for dealing with patients who are either
accessing CAM or have an interest in doing so. This familiarisation
should cover the potential uses of CAM, the procedures involved,
their potential benefits and their main weaknesses and dangers.
6.78 During our Inquiry we visited the University
of Southampton Medical School and were given a presentation on
their familiarisation module: see Appendix 5. We were impressed
with the content and approach of the Southampton CAM module and
are glad that several other medical schools now offer similar
modules. However, overall medical school provision of information
on CAM is sketchy. The GMC provided us with some information about
the existing provision of CAM familiarisation in some of the other
United Kingdom medical schools which were visited during their
assessment of Universities' success at implementing the principles
set out in the Council's recommendations in Tomorrow's Doctors
(see Box 8). This showed significant variation in the extent of
CAM familiarisation in United Kingdom medical schools.