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From the Townsend Letter
November 2006


Pathways to Healing
Leadership for Change
by Elaine Zablocki

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When conventional 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 Lick, PhDDale 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, and emotion-grabber!"

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 with CAM.

"Mind-body approaches are particularly important 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 pharmacological interventions."

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.

Aviad Haramati, PhD"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 chant.

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 was designed 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 (10/28/06: Invalid link. Use )

For more information about CAM education at Georgetown, visit or

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October 28, 2006