Profession An Exploration of Attitudes and Beliefs in Relation to Education and Cultural Change Belinda Anderson PhD LAc Academic Dean Pacific College of Oriental Medicine New York Associate Professor Albert Einstein College of Medicine ID: 910605
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Slide1
Evidence-Based Medicine and the Chinese Medicine Profession
An Exploration of Attitudes and Beliefs in Relation to Education and Cultural Change
Belinda Anderson, PhD,
LAc
Academic Dean, Pacific College of Oriental Medicine (New York)
Associate Professor, Albert Einstein College of Medicine
Acupuncturist and Chinese Herbalist, New York University Fertility Center
Slide2ContentBrief history of how PCOM-NY got involved with research
Current externally funded research projectsNIH funded 5-year Evidence Informed Practice research projectPilot pre-grant data
Qualitative exploration of attitudes, beliefs and perspectives
Scientific worldview differences between MD and PCOM students
Conclusions and lessons learned
Slide3Brief HistoryMy research background/history
The NESA/Harvard NIH grantPartnering with EinsteinInterprofessional student exchange program
Faculty appointment
3 externally funded research grants
Slide4Current Research Projects
NIH National Center for Complementary and Integrated HealthK07 Career development awardEvidence Informed Practice: Faculty and Curriculum Development
2013 – 2018
Patient Centered Outcomes Research Institute (PCORI)
Acupuncture clinical trial
2015 - 2018
Health Resources and Services Administration (HRSA)
Residency training program in wellness and prevention
2015 – 2018
Council of Colleges for Acupuncture and Oriental Medicine
Investigating the scientific worldview differences between MD and PCOM students
2016 - 2017
Slide5NIH EIP Project
Slide6Components
EIP skills/knowledge StudentsDeveloped a Foundations of EIP (FEIP) course – in all CM programsPre and post tested self-reported skills/knowledge and importance
Faculty
Online EIP modules – University of Minnesota
FEIP course in doctoral upgrade program
Incorporating EIP into 70% of didactic entry-level CM curriculum
Incorporating EIP into 100% of clinical entry-level CM curriculum
Attitudes/beliefs/perspectives
Pre-grant pilot data
Qualitative study
Slide7NIH EIP Project – Pilot Data
Surveys undertaken to provide data for the NIH proposalExploring faculty and student’sResearch skills and usage
Support for research
Attitudes, beliefs and perspectives about evidence-based medicine
Slide8Pilot Data Survey
Faculty
Students
#
Close-ended Qs*
14
18
# Open-ended Qs
1
1
Response Rate
89% (102/115)
42% (176/420)
Prior Research Ed.
51%
40%
Prior Res. Ed. Grad Level41%34%
* Close-ended
questions with
5-point
Likert
answers (Strongly agree; Agree; Neutral; Disagree; Strongly disagree).
Results expressed as %Agree + Strongly agree
Slide9Outcome of Surveys#(% strongly agree + agree)
Faculty
Students
Research Literacy –
can
find/evaluate
75
85*
Supportive
of
research
88
-
Interest in p
articipating in research
& EIP Training73-EIP is of value to complementary & integrative medicine81
76
*4
th
year students who had taken the introductory research course
#
Anderson et al. 2014. JACM 9:705; Anderson et al. 2016. Explore 12:366
Slide10Outcomes of Student Survey(% strongly agree + agree)
Research Value
1
st
year
2
nd
year
3
rd
year
4
th
year
Trend
Outside
the profession*83858280NSCompatibility of science & CM63
47
50
31
P
<0.01
Desire for further research training---33-
* Referral, insurance coverage, public perception
Slide11Similar Survey at NESA and OCOM(Wayne et al. 2010. Explore 6:22)(% strongly agree + agree)
Year 1
Year 2
Year
3
Trend
Research value outside the profession
92
85
85
NS
Research learning & participation
76
67
37
p
<0.0008Research value to improving clinical practice
87
76
45
p
<0.005
Slide12Challenges Going in
Resistance – themes from open-ended survey questionsIncompatible paradigmsCooptation
Relevancy to CM practice
Cultural issues
These issues were not highlighted by the faculty needs analysis using the instrument developed at Northwestern Health Sciences University
Suspected unique challenges within CM profession
Slide13Qualitative study
Slide14Qualitative Study
First cohort taking Fundamentals of Evidence Informed Practice as part of the doctoral upgrade program (DACM)Average years in practice 11.5Analysis of online forumsBased on
Kaptchuk
and Miller (2005).
What is the most ethical model for the relationship between mainstream and alternative medicine: opposition, integration or pluralism?
Academic Medicine. 2005,
80:286-290
They were asked to
discuss the most ethical model for the relationship between mainstream and alternative medicine
31 of 33 students participated
There were 33 initial
posts (average 428 words/post), 127
response
posts (average
of four
responses/initial post, with average
length of response of 108 words).
Slide15Opposition/Integration/Pluralism(Kaptchuk
& Miller 2005)
Opposition
-
rejection of alternative medicine by conventional medicine
Integration
- amalgamating
conventional and alternative
therapies together
in a holistic approach to the treatment of disease and promotion of
wellness
Pluralism
-
conventional and alternative therapies
used together, but where cooperation
, research, and open communication and respect between practitioners preserves the integrity of each of the treatment systems
Slide16Major Themes
Major Themes
Total
# comments
Total # & % of students that mentioned
Preference for the pluralistic model
23
21 (68%)
Opposition to integrative model
21
15 (48%)
Importance of patient centeredness
18
17 (55%)
Power imbalance &co-option issues
23
12 (39%)Imp of interprofessional education1310 (32%)
Issues –
research methodology & paradigms
10
7 (23%)
“I choose pluralism as our best ethical option
”“The limitations of homogenizing two incongruous perspectives do a disservice to both. Interpreting a completely different system using a singular language is at best incoherent, and at worst, ineffective or harmful”.
“The goal above all else is that the patient gets the best care
”
“Western Medicine is in charge of our destiny, and that is due to their social, economic and political influences
”
“It seems that education is key. In order for there to be respect and referrals among different modalities, we need to understand what each modality does, and where its strengths and limitations lie. All practitioners need to know when to refer out, and have an idea of where to refer”
“Western based science looks at the world by tearing it up into very small pieces that can be analyzed. By doing this to Eastern medicine, meaning and understanding are often lost. Western medicine is interested in coming up with explanations for things, but we don’t always have quick explanations for how treatments work and therefore they become easily dismissed as invalid“
Slide17Minor Themes
Minor Theme
Total # of comments
Total # & % of students that mentioned
Pluralism requires patients be able to advocate for themselves
6
4 (13%
Prior education focused on integrative model
5
5 (16%)
Against opposition model
5
5 (16%)
Pluralism maintains the integrity of CM
3
3 (10%)
Importance of thousands of years of anecdotal evidence
3
2 (6%)
Pluralism is also in CM
3
2 (6%)
“Creating an environment where the patients ability to be part of the game – and accommodate them when they are sub optimally resourced – is something our medical practices and institutions should endeavor to be nimble and responsive to without judgement, agenda or manipulation”. “Most of us had no idea about this term in our medical system prior to this class. We were all stuck on integration”
“I do agree that opposition (at least ongoing opposition) is unethical and unreasonable as a strategy for functional relationship”
“If I had to choose, I would choose pluralism, but this choice is only chosen, as the least damaging to the integrity of our medicine”
“heralded in the West is the newest technology or drug, while heralded in the East is a lifetime of experience treating the human mechanism”
“this pluralistic streak in our own medicine has been integral to its continued evolution”
Slide18Scientific Worldviews
Slide19Survey Instrument
Validated - Thinking about Science Survey Instrument – Cobern 2000 SLCSP 151. Kalamazoo, MI: Scientific Literacy and Cultural Studies Project
Designed to measure
differences in scientific worldviews
- socio-cultural
resistance to, and support for,
science
The instrument consists of 60 questions with 5-point
likert
scale answers
Categories of Qs - epistemology
;
science and economy
;
science and the
environment; public
policy and science; science and public health; science, religion and morality; science, emotions and aesthetics; science, race and gender; and science for all
Slide20Research Questions
Do MD and CM students have different scientific worldviews?Do students who chose, or not, to participate in the interprofessional
exchange program have
different scientific worldviews?
Does an inter-professional student education exchange program
change
their
scientific worldviews?
Slide21Outcomes
Q
Category
# Qs statistically different
# agree/disagree
Public policy
4
0
Public
health
4
0
Epistemology
4
3
Emotion & Aesthetics
31Economy
2
0
Race & gender
2
2
Science for all10Environment/Resource0
0
Religion & morality
0
0
Response rates – Einstein (122/170 = 72%; PCOM 48/107 = 45%)
Slide22Questions where Einstein & PCOM students were on opposite sides of neutral (3)*
Q Category
Question
Einstein*
PCOM*
P
Value
Public health
8. Scientific knowledge is the single most important factor in the improvement of medicine and public health.
3.26
2.6
0.002
Race and gender
53. The scientific community is mostly dominated by white men and is often unfriendly to minority people.
3.31
2.88
0.02
Epistemology
60. Scientific knowledge is the truest form of knowledge.
3.32
2.67
0.001
Epistemology
33. The methods of science are the most reliable source of true, factual knowledge.
3.66
2.81
<0.0001
Race and gender
23. The scientific community is mostly dominated by men and is often unfriendly to women.
3.35
2.92
0.01
Economy
42. Science is our best source of useful knowledge.
3.69
2.79
<0.0001
Epistemology
34. Science is the best source of reliable knowledge.
3.75
2.90
<0.0001
*Means of
Likert responses:
Strongly agree = 5; Agree = 4; Neutral = 3; Disagree = 2;
Strongly
disagree =
1)
Slide23Conclusions & Lessons Learned
Slide24Conclusions and lessons learned
CM students, faculty and practitioners:Are not anti scienceUnderstand and support the role of research in legitimizing CM
But are
concerned
about:
Autonomy and continued authentic practice of CM
Cooptation
Inappropriate research methodology being used for CM
Keeping the patient at the center
The need for interprofessional education to engender respect and understanding
Slide25Acknowledgments
Research mentorsDrs. Ben Kligler, Paul Marantz at EinsteinDr. Roni Evans, University of
Minesotta
Dr. Corbin Campbell
,
Teachers College Columbia
University
Research Colleagues
Drs. Diane McKee, Arya Nielsen, Claudia
Citkovitz
,
Funding bodies: NIH, PCORI, HRSA, CCAOM
Institutional support: PCOM, Einstein, Teachers College Columbia University
Slide26Thank youBelinda (Beau) Anderson
Pacific College of Oriental Medicine 110 William St, 19th floor
New York, NY 10038
212 982 3456 x216
banderson@pacificcollege.edu