Attitudes, expectations and plans of entering medical students toward complementary and alternative medicine

Abstract

This study examines the views of incoming medical students toward complementary and alternative medicine (CAM) and integrative medicine (IM). Additionally, their expectations for inclusion of CAM topics in their medical school education are examined. Their plans for incorporating CAM into their future medical practices are also examined. The relationship between these variables and a set of background variables including socioeconomic status, exposure to diversity and previous experience with CAM is also examined for correlation and predictive value. Legitimacy provides a framework for this research to examine medical students' views on CAM and IM. Every healthcare profession is assigned a level of legitimacy by the public and other healthcare practitioners. These legitimacy levels vary greatly among the myriad of healthcare practices, and in part determine the participation levels of each healthcare profession in the greater healthcare system. The views of medical students toward CAM and IM, as measured by legitimacy scales developed for this research, provide insight into the question of the role of CAM and IM in the evolving U.S. healthcare system. Incoming students to the Medical School at the University of Minnesota - Twin Cities Medical School were surveyed to provide the data for this analysis. Scales were developed from the survey items to form the basis for comparison among variables. In addition to several other background variables, a CAM Familiarity scale was developed as measure of student experience with CAM. Scales were also developed for each of four dependent variables. The CAM Legitimacy scale was developed as a measure of student perceptions of CAM and its role in the healthcare market. The CAM Expectations scale is a measure of student expectations for the inclusion of CAM topics in their medical school curriculum. IM is used to describe an approach to medical practice which emphasizes such elements as the practitioner-patient relationship, care for the whole person, evidence-informed care, and a team approach to care which draws on the strengths of many healthcare professionals to achieve optimal health. The IM Legitimacy scale is an indication of student views toward this approach to care. Lastly, the CAM Plans scale is a measure of student intent to incorporate CAM into their future medical practices. One hundred six medical students completed the survey out of 168 students who received the survey, resulting in a completion percentage of 63 percent. Selected findings of the survey are summarized here:1) Higher levels of CAM use and familiarity are associated with a higher legitimacy rating of CAM. In the case of CAM Use and CAM Legitimacy (r = .46, p < .01) and for CAM Familiarity and CAM Legitimacy (r = .29, p < .01); 2) Higher levels of CAM use and familiarity are also correlated with student plans to incorporate CAM into their future medical practices. In the case of CAM Use and CAM Plans (r = .43, p < .01) and for CAM Familiarity and CAM Plans (r = .23, p < .05); 3) The linear regression model designed to explore the predictive value of student characteristics on IM Legitimacy rating was statistically significant (R2=.46, p < .01). In this model, CAM Familiarity had predictive value for IM Legitimacy ratings with a standardized regression coefficient of .40 (p < .01).4) The linear regression model designed to explore the predictive value of the intermediate outcome variable of CAM Familiarity, CAM Use, CAM Legitimacy and CAM Expectations on CAM Plans was statistically significant (R2 = .76, p < .001). In this model, CAM Legitimacy had strong, positive predictive value for CAM Plans with a standardized regression coefficient of 0.78 (p < .001). The study builds upon previous work examining attitudes toward CAM and considerations for inclusion of CAM topics in medical school curricula. Implications for medical school curricula and learning activities follow from this study. As medical school curricula adapt to the societal and student expectations, the manner in which health care is delivered will change, hopefully for the better.