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.
- Western States Chiropractic
- National College of Naturopathic Medicine
- Oregon College of Oriental Medicine
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
These relationships started out in a low-key way during the late
80s, when WSCC and the OHSU department of family medicine worked
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
includes 17 hours of required material throughout the four years
medical school, plus elective offerings and an extension of CAM material
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
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.
Interestingly, 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
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
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
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.
Barrett 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."
One 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
Oregon CAM Course at OHSU
Western States Chiropractic College
National College of Naturopathic Medicine
Oregon College of Oriental
view the CAM Grand Rounds presentations
Elaine Zablocki is the former editor of CHRF
News Files and Alternative
Medicine Business News.