Integrated teaching at Swansea medical school

FIH: What made you decide to add this component? 

Professor Rhys Williams:  Students are receptive and staff are interested and enthusiastic.  It's also important in terms of patient safety to know about the interactions between herbal therapies and orthodox drug regimens.  Finally, the General Medical Council requires it - as stated in the Quality assurance of basic medical education and the report Tomorrow's doctors.

The Swansea school of medicine is greatly indebted to both Dr Anona Blackwell and Dr Mary Hoptroff for their joint work in leading the project.  As part of this, I'm reminded of the survey which Natalie Taylor, then a student, and Dr Blackwell carried out and published, describing  what was happening in medical schools across Wales in relationship to CAM familiarisation (eCam Advanced Access, 2008).

FIH: What does the training consist of? 

Dr Mary Hoptroff: There's not a 'course' as such - just as there's not an 'anatomy course' or a 'cardiology course' - the information's threaded through everything we teach. 
 
In the first year, we introduce students to the principles of integrated health, and to four major complementary practices: chiropractic, homeopathy, acupuncture and herbalism.
 
In year 2, we explore how to apply principles of integrated health to consultations: how a practitioner can encourage a positive attitude and lifestyle changes like exercise regimes.  We also look at other approaches which may be helpful like reflexology, aromatherapy, relaxation and yoga.
 
Year 3 looks at inter-professional approaches to healthcare and the precautions needed for safe practice.  If there are referrals to complementary and integrated health care practitioners, what are the ethical and social issues for a medical practitioner?  What's the evidence for and against nutritional therapies, talking therapies and spiritually-oriented therapies such as prayer and meditation?
 
Then in year four we try to bring it all together into a considered personal and professional position - embracing the individual student's preference and allowing for patient choice.  We teach them to apply this in a conscious way to consultations.
 

FIH: Do your students explore integrated practice in the real world?
 
Dr Mary Hoptroff: Yes. We run 'LOCS' - learning opportunities in a clinical setting.  Some of these give opportunities to attend clinics with complementary and integrated health care practitioners.  Also, each term, eight out of 72 students can choose to submit a detailed assignment on a complementary theme.
 
 
FIH: Research among your students suggests they are very enthusiastic about this.  Do you think medical students see things differently from new entrants a few years ago? 
 
Dr Mary Hoptroff:  There is evidence that more members of the general public visit a CAM or integrated health practitioner each year than attend all the A&E departments in the UK. This trend is a general one and if students are to be prepared for contemporary medical practice they need to have been exposed to integrated health topics and the practice of complementary and alternative medicine at a basic level. Students to date have been very interested and we expect this trend to continue.

FIH: Why do you think doing this will make your students better doctors?
 
 
Professor Rhys Williams:  Students will be more aware of the healthcare choices their patients have chosen, and it may make them more tolerant of complementary practitioners and their views.  It will also be less likely that they encounter activities which are unknown to them in their practice.

Dr Mary Hoptroff:  Students who have looked at health care issues from wider perspectives than they perhaps would have done, may develop more open attitudes  in diagnosis, management and in communication with and in caring for their patients. And not insignificantly, students may identify methods which will also help them towards a healthier attitude and life style, with improved skills in stress management and relaxation - always a benefit to the modern physician!