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From the Townsend Letter for Doctors & Patients
October 2005

Pathways to Healing
by Elaine Zablocki

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Four Portland Colleges Collaborate in CAM Education and Research
Portland, Oregon, is the only city in the United States that's the home of three different CAM educational institutions. They are:

  • Western States Chiropractic College (WSCC)
  • National College of Naturopathic Medicine (NCNM)
  • Oregon College of Oriental Medicine (OCOM)

In addition, the state's school of medicine, Oregon Health & Science University (OHSU) is also based in Portland.

Over the years, this geographic proximity has evolved into a remarkable collaboration, marked by an attitude of mutual respect and appreciation among different approaches to healing. The four institutions are working together in research, education, and most recently, in clinical services.

These relationships started out in a low-key way during the late 80s, when WSCC and the OHSU department of family medicine worked together on low back pain research. Then the National Center for Complementary and Alternative Medicine (NCCAM) funded research on dementia, multiple sclerosis, and cranio-facial disorders, with all four schools participating.

In 2002 NCCAM awarded OHSU an R25 grant, designed to help medical schools incorporate material about CAM into their curriculum. Professionals from the four schools worked together to develop the new curriculum which includes 17 hours of required material throughout the four years of medical school, plus elective offerings and an extension of CAM material into the physician's assistant, nursing and dentistry programs.

For example, during their first year medical students now receive two hours of education about stress management, including mind/body skills, and three hours on the biology of disease. During the second year they have two hours called "Introduction to CAM Professionals." The third year, they study herb/drug interactions and how to talk with patients about alternative medicine. They analyze various approaches to back pain, including acupuncture and chiropractic, and they have an opportunity to watch patients experience various treatments.

Anne NedrowInterestingly, these hours of training aren't labeled as "CAM," according to Anne Nedrow, MD, OHSU medical director for women's wellness and integrative medicine. "We just include the things they need to know in the basic curriculum. For example, during the first year we discuss "enhancing host defenses/decreasing susceptibility to disease." We don't say, "this is the integrative medicine approach to not getting sick."

Rich Barrett, ND, associate professor at NCNM, helped design the curriculum. In looking at this sort of program, he says, it's important to be clear about its goals. "The (OHSU) grant is designed to educate MD students about CAM; it is not designed to turn them into competent CAM practitioners. It is designed to create 'CAM literacy'."

"That's a very useful term coined by Edward Keenan, PhD, associate dean at OHSU," Barrett says. "It means that when patients mention unfamiliar terms, such as subluxation or Qigong, homeopathy or baptisia, these new physicians will understand the information and take it in stride. Optimally, they will be more comfortable interacting with other providers to coordinate care and cross-refer."

CAM Grand Rounds
In 2003, as part of the R25 grant, OHSU developed a series of CAM ground rounds, in which practitioners from several disciplines jointly discuss hard-to-treat clinical cases, such as chronic pain, depression, fibromyalgia, and obesity. Usually, about 80 people attend the monthly presentations, including students and faculty from all four schools. Afterwards, the presentations are archived on the OHSU web site.

Rich BarrettBarrett says the quality of the evidence in the CAM Grand Rounds presentations has been remarkably high. "Another striking thing has been the areas of convergence and divergence among the disciplines, similar to observing the intersection of Venn diagrams," he says. "Usually, the three western-based traditions (chiropractic, naturopathic and conventional medicine) have assessments that are quite similar. The naturopathic physician will add functional assessments, while the chiropractic physician will usually emphasize orthopedic approaches. Oriental medicine is based on a different paradigm."

"It also seems remarkable how much the assembled panelists agree about patients needing a better diet, getting exercise, and employing stress reduction and counseling when indicated," Barrett adds. "The MD specialists who present are trending more and more in that direction."

Robert KanekoOne of the advantages of these monthly meetings is that they bring the various disciplines together, and once people get acquainted, other interesting things start to happen. For example, one of the OHSU physicians asked Robert Kaneko, LAc, dean of clinics at OCOM, if they'd like to send some of their intern acupuncturists over to the OHSU Richmond Clinic to treat patients. "She seemed to be bit hesitant about asking," Kaneko recalls, "because they didn't have any funds in their budget for payment. Of course, we are very happy that she asked us, because it is a wonderful experience for our students, and they're working in a team setting with western-trained physicians."

As the various disciplines get to know each other better, the process can lead to unexpected benefits. "One of the interesting by-products of the collaboration was that as we got to know each other better as CAM schools, we realized we weren't communicating with each other as much as we should," says David Peterson, DC, professor at WSCC. "The goal of the grant is to make medical students more literate about CAM, but we realized we also need to make ourselves more literate about the other CAM disciplines. I think we'll continue those relationships among ourselves, and also our relationship with the medical school, after the funding ends."

Integrative Medicine Clinic at OHSU
The most recent step in this collaboration is a new integrative medicine clinic at OHSU, which opened last March. It's staffed by a faculty member from WSCC, a doctoral level graduate from OCOM, a naturopathic physician who is an OHSU faculty member, a psychologist who's also a licensed acupuncturist, and a person with doctorate in ministry. Currently they are employees on contract, but Nedrow predicts that within the next year they're likely to receive OHSU faculty status, at an assistant professor level.

The clinic staff meets together every month for an hour and fifteen minutes. "We are working consciously on how to become a team," Nedrow says. "We take turns presenting a case so we can learn more about how each discipline approaches it."

It is essential for healthcare professionals to learn to work as a team, Nedrow believes, because no single person can care optimally for an individual from cradle to grave. "Most likely, each person's health will be optimized through a team of healthcare providers through a lifetime, including MDs with different specialties, as well as non-MD health professionals," she says. "In the past, creating a team has been the patient's responsibility. Now, I believe we need to learn the skills of collaboration, and help patients build their teams."

Oregon CAM Course at OHSU
Western States Chiropractic College
National College of Naturopathic Medicine
Oregon College of Oriental Medicine (OCOM)
To view the CAM Grand Rounds presentations

Elaine Zablocki is the former editor of CHRF News Files and Alternative Medicine Business News.


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