In recent years, there has been a growing movement to ensure that healthcare is more “evidence based,” which requires that providers know how to access clinically relevant research evidence and incorporate it into their clinical practice. Providers of complementary and alternative therapies are not exempt from this cultural demand, particularly as patients and third party payers expect more in terms of transparency and integrative care. This shift impacts CAM educational institutions, which face the contemporary charge to include research content and model EIP in their curricula. This can be a challenge for healthcare cultures that embrace traditional principles of holism and clinical autonomy, as well as philosophies of health and disease that may appear inconsistent with science and systematic observation.
The National Center for Complementary and Alternative Medicine has provided funding to aid in this undertaking through the CAM Practitioner Research Education Project Grant Partnership. As described previously in this column,1
the program pairs CAM schools with research-intensive institutions to develop CAM students’ knowledge of research-related information and management, with the long-term goal of integrating research into clinical practice. Northwestern Health Sciences University, located in Bloomington, Minnesota, in collaboration with the Center of Spirituality and Healing at the University of Minnesota, recently received NCCAM funding for one of these grants; NWHSU is unique among grant recipients in that it offers educational programs in chiropractic, massage and acupuncture, and Oriental medicine. As part of the NCCAM funded project, a research-related curricula will be developed to integrate the principles of EIP and information management across all three of the CAM programs at NWHSU.
An important part of this project is to gain a better understanding of CAM student and faculty views regarding EIP to identify potential barriers early in the project and develop a research-related curriculum that will meet both student and faculty needs. To accomplish this, the project team took the opportunity during the planning phase to conduct a series of focus groups with students and faculty. The results highlighted many similarities in student and faculty attitudes toward research and EIP, but also some interesting differences.
“I think as students it's important to question everything that you're told on a daily basis . . . it's a set of skills that you should be able to take out into practice once you actually graduate.”
There was general consensus among students across the three NWHSU programs that research and EIP are important and relevant in today's healthcare climate and necessary for success in their future clinical practices. The students identified how incorporating research into clinical practice would benefit them, including demonstrating treatment effectiveness, establishing cultural authority, communicating with patients and the healthcare community, providing answers to clinical questions, and securing third-party payer reimbursement. They saw research to be especially relevant in the context of cross-disciplinary referrals, integrative settings, and discussing treatment options with patients.
CAM students’ comfort with technology and expectations for ready access to large volumes of information was apparent throughout the discussions. This implies that these are norms for their generation, which may not be true with faculty. This difference becomes particularly relevant in the context of information mastery and how each group locates and uses research-related information.
The students observed a variation among faculty members’ ability and willingness to incorporate research-related information in their courses, as well as faculty attitudes toward the relevance of research in CAM clinical care. On one end of the spectrum, students provided examples of current classes where they actively discussed recently published studies and were required to cite peer-reviewed research in assignments. On the other end of the spectrum, they noted that some class content relied on the views of an “expert,” sometimes the instructor, which from the students’ perspective discouraged critical thinking and healthy exploration of their disciplines’ belief systems.
Despite conflicting messages from faculty, these students felt it was their individual responsibility and professional obligation to utilize available research and maintain an EIP. Students were overwhelmingly enthusiastic about a formalized effort to expose them to research in their coursework and saw it as essential to prepare them to be competitive and competent in the healthcare marketplace.
“I perceive a hunger for this. I see it as advancing this institution, I see it enhancing the profession, the way people perceive this profession, and I'm really excited about the personal professional development. I think the students are starved for this.”
In general, the faculty who participated affirmed the value of EIP and supported teaching it throughout the curriculum. They felt students need basic skills to locate credible sources of information and critically appraise it with a healthy degree of skepticism. Faculty identified that research-related competencies should include the ability to write a case study and follow the necessary steps for publication, synthesize the body of research on a given topic, discuss research in plain language, address uncertainty or not knowing, and actively participate in research on some level.
The faculty did not see the students’ interest in research extending beyond the classroom, citing a lack of perceived value and motivation as possible explanations. This perception was in contrast to students’ statements in the focus groups, where they identified their use of research as crucial to clinical practice. Interestingly, there was a similar mismatch in perceptions of faculty interest: these faculty members all supported EIP, whereas the students perceived that most faculty do not value this approach.
Basic science, clinical science, and library faculties all saw their role as change agents who could cultivate a cultural shift at NWHSU that would embrace the principles of EIP. Further, they felt it was their responsibility to model the use of EIP principles and research as lifelong professional skills. Interestingly, they also felt that EIP skills were integral to their own personal development as healthcare providers and educators.
Despite their general enthusiasm and support, the faculty expressed some reservations about EIP. For example, these faculty members found it important to acknowledge the limitations and possible disadvantages of EIP, particularly as it relates to the varied cultural and social context of CAM healing traditions. They also wanted students to understand that research is a fluid and dynamic process, one that encompasses many ways of knowing and evolves with new findings. Interestingly, they identified that the critical thinking skills used to evaluate information should be applied to the very notion of research itself. The students, on the other hand, did not express these same reservations, and in general were less vocal about the limitations of EIP.
Incorporating Stakeholder Perspectives
Perhaps the most encouraging findings were the readiness with which both students and faculty could identify practical ways EIP can enhance clinical practice, as well as their understanding of the increasingly prominent role research plays in the current healthcare system. Moreover, the focus groups identified what appears to be genuine enthusiasm for a cultural shift at NWHSU that would champion EIP and use it as a means of improving the growth and stature of the CAM professions.
The project team has used the results of the focus groups to refine the research-related competencies of the project's research curriculum. In doing so, the project team has conveyed to students and faculty that it is listening to their input and doing its best to make this project useful to them as end users. Given the skepticism and tension that can exist between clinical care and research, any effort to better understand the CAM community's perspectives will ultimately facilitate the success of this project.