FAMU-4019 - Complementary and Integrative Medicine (CIM)

FAMU-4019 - Complementary and Integrative Medicine (CIM)

Elective Title: Complementary and Integrative Medicine (CIM)
Course Number: FAMU-4019
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Samuel Mathis, M.D. Periods Offered: 1-7, 9-12 excluding holiday period 8 
Coordinator: Jessica Prescott & Christopher Pleasant Other Faculty: Victor Sierpina, M.D. Galveston, Texas)
Location to Report on First Day:
Contact Course Coordinator Chris Pleasant (chpleasa@utmb.edu) or Jessica Prescott (jlpresco@utmb.edu)

Knowledge: 1. Be able to define and describe in general the following domains of Complementary and Integrative Medicine (CIM): Alternative Medical Systems, Mind-Body Medicine, Biologically-based Therapies; Manipulative and Body-Based Methods; Bioenergetic Therapies
2. Describe the patient-centered, relationship-centered, and motivational interviewing techniques used in integrative medicine
3. Identify and use data bases and other evidence-based sources to answer patient questions and solve clinical problems related to CIM.
4. Describe the process of referral and collaboration with alternative therapy practitioners such as chiropractors, acupuncturists, massage therapists and others
5. Identify current research evidence for efficacy and cost-effectiveness of CIM approaches, as well as methodological issues.
6. Appreciate and describe the important role of CIM approaches to self-care for both the physician and the patient

Students who complete this course will be able to:

-Identify appropriate alternative and integrative methods of healthcare for use in common medical conditions.

-Identify and utilize information sources to evaluate the safety and efficacy of alternative and integrative therapies.

-Describe how the allopathic healthcare system works from the perspective of patients seeking holistic medical care.

-Define and /or describe the terms: Holistic Medicine, Integrative Medicine, Alternative Medicine, Homeopathy, Herbal -Medicine, Acupuncture, Chinese Medicine, Aryuvedic Medicine, Energy Medicine, Neutriceutical and Mind Body Medicine.

Description of course activities
Students will directly observe holistic medical doctors and alternative practitioners in the clinic setting. In addition to readings and computer modules on related topics; students will watch movies such as Sicko, The New Medicine and The Business of Being Born. Students will be encouraged to participate personally in healing modalities such as chiropractic care, massage, aromatherapy and hypnosis. Students will participate in a home visit to a patient or patients who are living in a holistic way and seeking holistic medical care from the allopathic medical system. Students will keep a journal of activities and the things they learned during each activity. In addition, students will write a paper on a topic chosen jointly with faculty.

Students will participate in OLLI (Osher Lifelong Learning Institute)
1. Interact in a meaningful way with active healthy older adults by observing them in action, interviewing or speaking with them. Sample questions: What brought you to join OLLI? What activities do you like to do here and why? Tell me about what you think healthy aging is? Others as appropriate.

2. Participate in group movement activities with seniors, e.g., functional fitness, Zumba, Pilates, yoga, and/or tai chi
3. Select and read at least one peer reviewed article on healthy aging and discuss with faculty or include in their assigned essay

Type of students who would benefit from the course
Any medical student, or allied health science student who has an interest in this area. Also any professional who plans to treat patients who are using alternative therapies on their own or in conjunction with a health care providers recommendation. This elective is particularly helpful for students planning to pursue primary care.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8am 5pm
Tuesday 8am 5pm
Wednesday 8am 5pm
Thursday 8am 5pm
Friday 8am 5pm

 Average number of patients seen per week: 35-40
 Call Schedule: Some weeknight activities may be expected

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    To faculty at seminars and to faculty and other students, community members, and CIM practitioners at the journal club
  B. Frequency / Duration of Presentation(s)?
    1-2 times weekly
  C. Format - What guidelines are set for the student's presentation?
    cases, site visits, and papers
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily log of clinical experiences, including required research paper on an approved topic, with minimum of 5 pages & 5 references (Times New Roman, 12 pt, double spaced, 1" margins).
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Using EBM guidelines, RCT's, meta-analyses, and otherwise ranking the evidence
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Selected with assistance of faculty, CAM on PubMed, Health Notes Online, and other databases including Medline.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Weekly oral discussions with Electives Director (Julie McKee) and other faculty (Susie Gerik).

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Oral discussion with faculty. Journal Club presentation. Completion of online modules. Written assignments: self-care plan, a required research paper on an approved topic, with minimum of 5 pages & 5 references (Times New Roman, 12 pt, double spaced, 1" margins).

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.