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Table 2 Study Characteristics of Included Studies and Thematic Categories (1 CM education provision, 2 The development of educational competencies to develop clinical skills and standards, 3 Application of new educational theory, methods and technology in CM, 3 Future Challenges facing CM education)

From: A critical integrative review of complementary medicine education research: key issues and empirical gaps

  Author/Year Country Methods Data source Participant recruitment Key Results/Outcomes reported Group 1 2 3 4
1 Chen, Y., et al. 2015 [76] Taiwan Qualitative. Cross sectional survey. Free form open answers and interviews Trainees’ survey data were extracted from post-OSCE questionnaires and interviews Five TCM OSCEs were administered, and the educational backgrounds of the 37 participants were analyzed. OSCEs can be used in evaluating, teaching, and certifying TCM clinical competencies to improve the quality of TCM practices. 3
2 Forman, L., et al. 2006 [77] USA Quantitative. Cross sectional survey A 27-item questionnaire was distributed to first-through fourth-year osteopathic medical students. Preferred learning methods, current use of computers as an educational tool, and attitudes regarding the role of computers in medical education based on their skill level were evaluated. 246 students (80% of enrolled students) responded to the questionnaire. Participants in the study were full-time students in the first through fourth years of osteopathic medical school. Students’ opinions of the importance of computer technology in their education is based mainly on their self-assessed technical competency levels. Understanding this dynamic may aid medical educators in the implementation of computer-assisted instruction. 3
3 Frenkel, M., et al. 2007 [70] Israel Mixed methods. Observational cross sectional survey. Pre-course semi-structured questionnaire and an anonymous open essay about students’ experiences with an educational intervention in their final year of study, emphasizing evidence-based learning, patient-centered care, and communication skills with conventional health care providers during 4 academic years, 2001–2005. 62 students were exposed to the educational initiative in integrative medicine to CAM students CAM practitioners feel better equipped to communicate with conventional health care practitioners after exposure to a structured educational initiative that emphasizes critical thinking, patient-centered care, and communication skills with conventional practitioners. 2
4 Grace, S., et al. 2006 [67] Australia Quantitative. Observational cross sectional survey. 45-item questionnaire mailed to members of the Australian Natural Therapists’ Association and the Australian Traditional Medicine Society. 617 responses (22%) A significant relationship exists between the confidence practitioners had in identifying clients requiring referral and their training in Western medical and CM diagnostic techniques. 32% of respondents reported a lack of confidence in identifying patients requiring referral with the potential to compromise the safety of clients and the effectiveness of practice. 2
5 Grace, S., et al. 2007 [64] Australia Mixed Methods. Survey Analysis and Interview The aim of this study was to compare two CAM curricula: chiropractic and naturopathy. Accredited naturopathy and chiropractic programs in Australia were located. Key learning areas and approaches to clinical training were identified and compared. Course structures and subject/unit descriptions for accredited naturopathic courses were examined via websites where they existed. In addition, Course Co-ordinators, Directors of Study or other appropriate academics/persons from each naturopathic training institution were invited to take part in a short interview (telephone or email) to clarify subject content and course structure and give details of clinical training. The study found 30 naturopathy courses that conformed to the requirements of either DEST or professional associations. Detailed curricula were available for 17 programs. Interviews, either by telephone or email, were conducted with representatives of 12 training institutions Chiropractic registration guarantees a uniform level of training for all practitioners. This training was found to comply with accreditation board requirements. The naturopathy courses in the study had elected to comply with the requirements for state government and professional association accreditation, and a level of uniformity was evident amongst the various courses. It is pertinent to note that although both groups of practitioners are entitled to practise as primary contact practitioners, chiropractors and naturopaths had markedly different focuses on medical science training. A review of naturopathy curricula is warranted in the context of uniformity of training for primary contact practitioners. 1
6 Grant, A., et al. 2012 [78] Australia Qualitative. Ethno-qualitative research using an ethnographic methodology. Interviews conducted with ten naturopathy lecturers to investigate reflective approaches to decision making and pedagogy. The scholarly reflections of academic lecturers who taught in the naturopathy program were gathered using interviews and reflective prompts. The approach to the collection and interpretation of data for this investigation was constructivist in epistemology and ethnographic in methodology Ten individual interviews with key academic lecturers from the disciplinary grouping of Natural and Complementary Medicine (NCM) were undertaken in 2009. Interviews were arranged by email, and semi-structured interviews conducted. All the naturopathy lecturers interviewed expressed that they had gone through significant changes in their teaching practice as a result of the changes in delivery for the subjects and their exposure to a more involved educational system. This reflective process impacted upon their academic practice as they underwent a process of professional upheaval and reshaping of professional practice. 3
7 Joshi, H., et al. 2013 [75] India Mixed Methods (?) Three educational interventions were applied to a specific subject in Bachelor of Ayurvedic Medicine and Surgery (BAMS) program 2011–2012 and 2012–2013. Three integrative educational interventions were introduced to develop and evaluate the effectiveness of teaching methods in an Ayurveda curriculum. The test results in the first experiment showed that the integrative method is comparable with the conventional teaching method. In the second experiment, the test results showed that the integrative method is better than the conventional method. The student feedback showed that all the three methods were perceived to be more interesting than the conventional one. The development of testable integrative teaching methods is possible in the context of Ayurveda education. Students find integrative approaches more interesting than the conventional method. 3
8 Long, C., et al. 2014 [74] USA Mixed methods. Cross sectional survey. A survey to elicit information on the faculty development initiatives was administered via e-mail to 9 program directors. The survey was designed to elicit information in 6 areas: EBP competencies that were developed and adopted; target audiences; size, formats, and hours of training programs; instructional approaches; evaluation methods; and faculty incentives to participate. All 9 completed the survey, and 8 grantees provided narrative summaries of faculty training outcomes. The grantees found the following strategies for implementing their programs most useful: assess needs, develop and adopt research literacy and EBP competencies, target early adopters and change leaders, employ best practices in teaching and education, provide meaningful incentives, capitalize on resources provided by grant partners, provide external training opportunities, and garner support from institutional leadership. Instructional approaches varied considerably across grantees. The most common were workshops, online resources, in-person short courses, and in-depth seminar series developed by the grantees. Training programs and workshops are the most useful way to train faculty in evidence based medicine and research literacy. 2
9 McCabe, P., 2008 [67] Australia Quantitative. Observational study. Survey Survey of 43 Australian providers of naturopathy and WHM education. Information sourced from the public record revealed that these providers collectively offered 104 courses in naturopathy and WHM. Of the 43 providers, 29 valid questionnaires were returned, representing 33 campuses across Australia—a 70.2% response rate by campus. Educational standards vary widely, with some practitioners not likely to be adequately prepared for practice. There is a need for better integration of complementary care with mainstream healthcare, and education in CM needs to be at least to the level of a bachelor degree. 2
10 Rowe, T. 2009 [66] USA Quantitative. Observational cross sectional survey. Three separate surveys targeted at homeopathic students, homeopathic faculty and homeopathic school directors. It consisted of 40 questions 91.5% of respondents completed the survey. School Director Survey, 20. Teacher Survey, 48. Student Survey, 88. Homeopathic Schools and Training Programs currently in the United States: 29. Homeopathic Teachers in the United States: 250. Homeopathic Students Currently Enrolled in the United States: 1080. 1
11 Schwartz, J., 2010 [79] USA Mixed methods. Observational cross sectional survey and interviews A survey of faculty teaching at schools in three CM fields and followed up with additional interviews. NA Acupuncture, chiropractic, and massage faculty lack awareness of the capabilities of online education and the elements of good online learning, with the perception that what they teach cannot be taught online because of its kinesthetic requirements. The faculty hold this perception in spite of the success of medical science and related health care fields in the online environment, and they do not seem to separate the kinesthetic from the didactic. 3
12 Steel, A., et al. 2015 [72] Australia Quantitative. Cross-sectional online survey The survey included items examining respondent attitudes and beliefs about research, personal research experience, and future intended research activity. Statistical analysis determined descriptive frequencies. Backwards stepwise logistic regression was used to identify characteristics of faculty interested in enrolling in a higher degree by research (HDR). The survey was completed by 202 of 389 academic and operational staff conducted at a dual sector private CM education institution in Australia. Respondents perceived research as important to their personal professional goals (86.0%) although confidence in being able to undertake research was less common (56.5%). The perceived importance of publication of research to the respondents’ personal professional goals was also notably high (80.0%) although confidence in their own ability to produce research publications was lower (52.9%). 2
13 Toupin April, K., et al. 2013 [71] Canada Mixed methods. Observational cross sectional survey and interviews A two-phase study consisting of an electronic survey and subsequent semi-structured telephone interviews conducted with curriculum/program directors in regulated Canadian CAM schools. Questions assessed the extent of the research, evidence-based health care, IPC training and continuing education, as well as the C/P directors’ perceptions about the training. Descriptive statistics were used to describe the schools’, curriculum’s and the C/P directors’ characteristics. Content analysis was conducted on the interview material. 28 C/P directors replied to the survey and 11 were interviewed, representing chiropractic, naturopathy, acupuncture and massage therapy schools. Future CM providers should understand research findings and be able to rely on high quality research and to communicate with conventional care providers as well as to engage in continuing education. Limited length of the curriculum was one of the barriers to such improvements. 2
14 Viksveen, P., 2011 [65] Norway Quantitative. Cross sectional survey Cross sectional survey of current homeopathy undergraduate education in Europe in 2008. Data from 145 (94.8%) out of 153 identified courses were collected. Eighty-five (55.6%) responded to a questionnaire survey. For others some data was extracted from their websites. Only data from the questionnaire survey is used for the main analysis. Data from 145 (94.8%) out of 153 identified courses were collected. Eighty-five (55.6%) responded to a questionnaire survey plus data from websites. The average course had 47 enrolled students and 142 graduates, lasted 3.6 years part-time. Of 85 courses most had entry requirements and provided medical education (N = 48) or required students to obtain this competence elsewhere (N = 33). Average teaching hours were 992 overall, with 555 for homeopathy. Four of five courses were recognised/accredited. Recognised/accredited part-time courses lasted significantly longer than nonrecognised/non-accredited courses, and offered significantly larger numbers of teaching hours in homeopathy. 6500 students were enrolled. 21,000 had graduated from 153 identified European undergraduate homeopathy courses. 1
15 Viksveen, P., et al. 2012 [68] Norway Qualitative. Interview A qualitative study based on grounded theory methodology involving telephone interviews with 17 educators from different schools in 10 European countries. It used constant/simultaneous comparison and analysis to develop categories and properties of educational needs and theoretical constructs and to describe behaviour and social processes. The main questions asked of subjects were “What do you think is necessary in order to educate and train a competent homeopath?” and “How would you define a competent homeopath?” Telephone interviews with 17 educators from different schools in 10 European countries The educators defined a competent homeopath as a professional who, through her knowledge and skills together with an awareness of her bounds of competence, is able to help her patients in the best way possible. This is achieved through the processes of study and self-development, and is supported by a set of basic resources. Becoming and being a competent homeopath is underpinned by a set of basic attitudes. 2
16 Wardle, J., et al. 2013 [80] Australia Qualitative. Interview Semi-structured interviews were conducted with 20 naturopaths practising in Australia to explore current perceived challenges in the naturopathic profession in Australia. 20 naturopaths practicing in Australia Grassroots naturopaths identify a number of challenges that may have significant impacts on the quality, effectiveness and safety of naturopathic care. Given the increasingly mainstream role that naturopaths are playing in the healthcare system in Australia, it is imperative that some of the issues of concern raised by naturopaths receive appropriate policy focus. This may include the development of appropriate regulatory regimes and the development of minimum standards of practice and education that value traditional naturopathic principles and philosophies, as well as ensuring ethical and effective clinical practice. 4
17 Wardle, J. and Sarris, J., 2014 [17] Australia Qualitative. Focus groups Focus groups conducted with current and recent students of 4-year naturopathic degree programs to ascertain how they interact with clinical teaching materials, and their perceptions and attitudes towards teaching materials in naturopathic education. A total of 24 students and recent graduates participated in the focus groups. Naturopathic students have a complex and critical relationship with their learning materials. Although naturopathic practice is often defined by traditional evidence, students want information that both supports and is critical of traditional naturopathic practices, and focuses heavily on evidence-based medicine. Students remain largely ambivalent about new teaching technologies and would prefer that these develop organically as an evolution from printed materials, rather than depart from dramatically and radically from these previously established materials. 3
18 Zwickey H et al. 2014 [73] USA Mixed methods. Survey and interview An electronic survey was administered to principal investigators of the nine R25 education grants. The survey consisted of 36 closed- and open-ended questions. Follow- up questions were sent via email to clarify responses as needed. Data were compiled for review and content was analyzed for common themes among institutions. A qualitative analysis was performed using three independent reviewers. This team identified the most successful strategies that the individual institutions used, in addition to the most substantial challenges they encountered. Nine R25-funded CAM colleges While each institution designed approaches suitable for its own research culture, the guiding principles were similar and the need to develop evidence-informed skills and knowledge was important to help students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. These nine CAM institutions faced multiple challenges and developed similar and dissimilar strategies for success. An enriched, EBM-infused CAM curriculum can better prepare future CAM practitioners for communicating effectively with their conventional medicine colleagues. Practitioners in the twenty-first century will need to understand how research and evidence-based practice are related and support one another in order to truly bring about optimal patient care. 2