and Complementary and Alternative Medicine (CAM) educators gathered
at Georgetown University in June 2005 for The National
Education Dialogue to Advance Integrated Health Care (NED), they were
looking for ways to create common ground in the education of health
care professionals. Since creating major change is never easy, they
took time to reflect on the basic principles underlying change.
Dale W. Lick, PhD, the facilitator of the NED meeting, was selected
in part due to his experience working with leaders of diverse institutions
to create common ground for change. Lick, a professor in the Learning
Systems Institute at Florida State University, told NED participants, "even
the word 'change' scares people and makes them feel uncomfortable.
When you're seeking change, learning must precede change. If
you're thinking about a really major change, you need a lot of
learning first." Traditionally, Lick said, you work to change
people's behavior, so that eventually you'll change their
beliefs and assumptions. But when you're seeking major organizational
changes, you often need to start by looking at, and changing, basic
assumptions. Then it becomes possible to change beliefs and behaviors,
and that leads to sustainable change. Transformational leaders must
create a shared, inspiring vision that provides direction, motivation,
and commitment to your desired long-range future, Lick said. "In
change efforts, vision is the essential direction-setter, people-aligner,
Lick invited NED participants to think about key roles they can play as part
of any change process:
A change sponsor has the power to sanction or legitimize change – it
might be the organization's board, or a president, division director,
or department head.
• A change agent is an individual or group responsible for implementing
the desired change.
• A change target is an individual or group that must change as a result
of the change process.
A change advocate is someone who desires change but doesn't have the
authority or power to sanction it; they can recommend actions to those who
do have the authority to legitimize change.
"The key thing is, if you don't have strong sponsorship, your project
is almost certain to fail," Lick said. "If your sponsorship isn't
strong enough, first work to strengthen it." Change advocates should find
ways to help people change appropriate assumptions and increase learning among
potential sponsors and others, he advised.
Innovative Curriculum at Georgetown University School of Medicine
Faculty at the Georgetown University School of Medicine have been working to
develop an improved curriculum in ways that exemplify the principles put
forth by Dr. Lick. Their primary goal is to train better physicians. One
step in that process, they find, is to train physicians who are familiar
"Mind-body approaches are particularly important ...by their very nature
they put high value on and teach the power of self-awareness and self-care," says
the Georgetown website. "In so doing, they help shape the new integrative
model of healthcare – one in which treatment is balanced with teaching;
in which prevention and self-care are given as much respect as procedures and
If you go to that website today, you'll see that information on CAM is
integrated throughout Georgetown's curriculum. For example, the anatomy
course looks at the anatomy of acupuncture; physiology includes biofeedback
and neuromuscular manipulation; while human endocrinology discusses stress
hormone modulation through the relaxation response, meditation, imagery, and
breathing. Georgetown also offers a master's level course in CAM (within
the physiology department) and a five-year program combining that course of
study with an MD degree.
In part, this wealth of information and options is due to a five-year, $1.7
million grant from the National Institutes of Health (NIH) that supported the
planning phase to incorporate CAM into the curriculum. Even more, this integration
is due to a step-wise strategy that started on a small scale and gradually
gained support from many levels of the organization. For example, a course
for first-year medical students on "Mind-Body Medicine: An Experiential
and Didactic Introduction" started as a pilot program. The course is
held two hours a week for eleven weeks and includes approaches such as relaxation,
meditation, guided imagery, biofeedback, writing exercises, movement, music.
and art. It's designed to help students become self-aware and foster
self-care strategies that should help them in their own lives (this is particularly
important for stressed-out medical students.) It also gives them a clear sense
of how helpful these skills can be for their future patients.
"Initially we planned to get a pilot started, look at outcomes, gauge
student reactions, and see how it went," says Aviad Haramati, PhD, professor
of physiology, biophysics, and medicine. "Based on that, we'd make
modifications. As the program improved, we'd scale it up." Haramati's
research interests for 20 years focused on regulation of renal and electrolyte
physiology during growth, and cardiovascular-renal-endocrine regulation of
volume homeostasis in heart failure – not exactly CAM-centered. However,
he is keenly interested in improving the training of physicians and other health
professionals and, over the years, has helped develop major curricular initiatives
at Georgetown. His solid professional background (and numerous teaching awards)
give him additional credibility when he talks about the ways mind-body training
will benefit medical students.
"The first thing we did was pull together a team of people with credibility
within the organization, opinion makers, people with open minds," he recalls. "The
second thing we did was ask ourselves, what is the problem? Are there things
we could do better? Most initiatives fail because they come in with pre-programmed
solutions. You have to start by asking the right questions."
At Georgetown, several prominent members of the curriculum committee were invited
to participate in the mind/body program, to see what this innovation meant
for students. Once they experienced it themselves, they began to realize how
valuable self-care skills could be. Lick says "learning must precede
major change." This was an example of learning in practice.
The mind-body program for medical students started out with funding from the
NIH grant, but that grant ended in late spring 2006. However, after seeing
the positive effects of the mind-body program, the Dean of Medical Education
decided to continue funding the key aspects of the program under the general
budget for medical education. That's an example of a successful experiment
winning support from a "change sponsor" within the organization.
Examples of Effective Change Shared at NED
At the NED gathering, Dr. Haramati shared other ways in which Georgetown has
drawn on familiar terminology and well-respected traditions to facilitate
constructive change. For example, at an international conference of 300 medical
science educators that met at the Georgetown University Conference Center,
a yoga instructor with a PhD in cell biology was invited to lead short exercises
during breaks between plenary talks. "We presented yoga as a physiological
process," Haramati recalls. "When the instructor introduced chanting,
she pointed out the effect of the breath and its resonation through nasal
passages, the rib cage, and the abdomen. The exercises weren't threatening,
because they were presented within a familiar context." For many in
the room, this was the first time they'd ever engaged in this sort
of exercise at a conventional science meeting, much less joined in a yogic
Georgetown was founded by the Jesuits, whose philosophy includes a tradition
of caring for the whole person. When the medical school went through an accreditation
review for the Liaison Committee on Medical Education, it re-examined its mission
statement, which at that time was several paragraphs long. The academic committee
charged with this responsibility came up with a new mission statement, just
one sentence long: "Guided by the University's Jesuit tradition
of cura personalis, of caring for the whole person, Georgetown University School
of Medicine will educate, in an integrated way, knowledgeable, skillful, ethical,
and compassionate physicians and biomedical scientists, dedicated to the care
of others and the health needs of our society."
This new mission statement points Georgetown in the direction of integrative,
holistic care, and it does so by relying on the founders' philosophy. "We
found language and ideas embedded in the traditions of this school that will
help us create better physicians and better medicine," Haramati says. "In
our case, it was the Jesuit tradition. Obviously, people working in other situations
need to find other ways of encapsulating their ideas in familiar, non-threatening
language. But it can be done. Be creative! You've got to be creative,
but you can do anything you want."
When working for change within a large organization such as a medical school,
you can't be impatient, Haramati reflects. It's essential to take
a long-term perspective and notice opportunities when they arise. "You
have to understand what the culture of the institution will absorb at any given
point. When you move too quickly, you risk outrunning your support system...which
in this case means the faculty, the students, the culture. You need to bring
people along with you; you need to listen to them along the way. As we began
to look at the curriculum initiative, we could have pushed for a comprehensive
treatment of CAM. Instead, we made a conscious choice to sacrifice completeness
in order to have a varied presence...a broad beginning."
Elaine Zablocki is the former editor of CHRF News Files and Alternative
Medicine Business News.
Books Dr. Lick Recommends:
Managing at the Speed of Change by Daryl R. Conner
Leading at the Edge of Chaos by Daryl R. Conner
Diffusion of Innovations (Fifth Edition) by Everett M. Rogers
Dr. Haramati recently served as program
chair for the North American Research Conference on Complementary & Integrative
Medicine, held in Edmonton, Canada, May 24th-27th, 2006. This conference
to showcase original CAM research, including presentations on basic
science, methodology, health services, education, and clinical research.
The conference drew more than 600 CAM and conventional researchers,
educators, and providers from around the world. Conference abstracts
are posted on the Internet in a database that can be searched by author,
subject, or keyword. For more information, visit http://www.imconsortium-conference2006.com/.
(10/28/06: Invalid link. Use http://www.imconsortium.org/cahcim/conference2006.html )
For more information about CAM education at Georgetown, visit http://som.georgetown.edu/cam/cam_education.htm or http://camprogram.georgetown.edu/.