Table 1

Curriculum for an online elective course in IM: modules and learning objectives

Module
and clinical setting
Learning objectives
KnowledgeApproachSkills and reflections
Day 1
 Introducing IM modalities: herbal medicine in integrative oncology and palliative careCore themes, cross-cultural aspects, clinical indications, safety-related issuesConsidering clinical effectiveness versus risks (including drug–herb interactions)How to establish an open and non-judgemental discussion with a patient undergoing chemotherapy
 Learning assignmentsIndividual assignment: viewing video clips (1-hour total):
Concepts in traditional herbal medicine, dilemmas associated with herbal medicine use in cancer care, herbal medicine and cancer—a cross-cultural perspective; transition from an ‘alternative’ to an ‘integrative’ medicine model
Meeting the integrative mentor (in student pairs): 45 min discussion with IPs
 Introducing IM modalities: mind–body medicine in the surgical settingImplementation of Western and Eastern mind–body approaches in the preoperational settingUnderstanding how mind–body therapy can alleviate both ‘physical’ and ‘psychological’ concernsExperiencing breathing/relaxation techniques
 Introducing IM modalities: acupuncture in the hospital settingTCM concepts of yin-yang and qi, TCM basic science and clinical researchUnderstanding of the TCM systematic diagnostic approachExperiencing ‘qi’ through guided self-acupressure
Day 2
10 min Zoom-guided group qi gong led by an integrative oncology therapist
 Meet the expert:
 the IP intake in the supportive care setting
Core issues of the IP consultation: referral, assessment, EBM, shared decision-making, communication with other healthcare practitionersExploring the patient’s health-belief model and EBM, which are prerequisites of patient-centred careHow to design and assess a patient-tailored treatment programme
 Learning assignmentsIndividual assignment: viewing video clips (1 hour total):
How to codesign the integrative oncology treatment programme, integrative oncology in the treatment of gastrointestinal concerns, interview IP on how to combine multidisciplinary integrative treatment plan based on herbal medicine and TCM
Meeting the integrative mentor (in student pairs): 45 min discussion with integrative non-MD practitioners
 Introducing IM modalities: touch therapies in the hospital settingAcquaintance with manual/touch therapies and their clinical indications in surgical and internal medicine wardsAwareness of specific versus non-specific effects in touch therapyHow to assess the manual therapy research design (eg, control groups) and outcomes in clinical studies
 Meet the expert:
 GYN-oncologists and acupuncturists working together in the intraoperative setting
Introducing an integrative GYN–oncology model aimed at facilitating supportive and palliative careMultidisciplinary teamwork with IO practitioners may facilitate effectiveness and safetyHow to establish communication with the IM practitioner in the multi-isciplinary setting
Day 3
5 min Zoom-guided breathing exercise led by an integrative family physician
 Meet the expert:
 searching the evidence for effectiveness and safety of IM treatments
Familiarity with IM-friendly medical search engines to assess effectiveness, safety and interactions of dietary supplementsUnderstanding the need for an ongoing search of the literature for EBM on safety and effectivenessHow to effectively search research data on herbs and supplements in open-access medical search engines
 Learning assignmentsIndividual assignment: viewing video clips (1 hour total): key concepts in traditional herbal medicine; IM in palliative care: cancer-related fatigue, pain, anxiety and insomnia
Meeting the integrative mentor (in student pairs): 45 min discussion with paramedical practitioners (eg, nurse and social worker)
 Meet the expert:
 shiatsu and art therapy in the paediatric haemato-oncology setting
Learning the role of touch therapies in improving children’s quality of life in supportive cancer careAssessing the synergistic potential of touch and art therapies via multidisciplinary teamworkHow to establish non-verbal communication with children undergoing life-threatening treatments
 International perspective: on being an IP in Milano during the COVID-19 epidemicDiscussing the role of IM in an acute medical–social crisisA holistic bio-psycho-social-spiritual perspective may facilitate self-care among both patients and healthcare providers.Discuss tools for which IM can help physicians during a medical crisis, facilitating resilience and professional growth
Day 4
10 min Zoom-guided tai-qi exercise led by an integrative psychiatrist
 Meet the expert:
 the integrative pain clinic
Specific integrative modalities to consider in pain treatmentThe contribution of integrative care in facilitating patient-centred care in patients suffering from painHow can integrative care extend the biophysical pain perspective, and which practical therapies are effective and safe?
 Meet the expert:
 integrative psychiatry
The role of acupuncture and integrative care in acute and chronic psychiatric conditionsIntegrative manual therapies may extend the efficacy of pharmacological and psychological treatment in psychiatric care‘First, do not harm’: what are the absolute and relative contraindications to integrative care in psychiatry?
 Learning assignmentsIndividual assignment: viewing video clips (1 hour total):
AM, homeopathy, European herbal medicine
Meeting the integrative mentor (in student pairs): 45 min discussion with the integrative mentor in specialised settings (paediatrics, family medicine, oncology, pain, neurology, psychiatry, internal medicine and surgery)
 Meet the expert:
 homeopathy in the family medicine and hospital settings
Exposure to homeopathy practice in family medicine and in preclinical and clinical oncology settingNon-judgemental listening does not compromise the physician’s scientific rigourHow to keep an open yet sceptical approach toward a medical intervention with no known scientific mechanism
 Meet the expert:
 AM in paediatrics and primary care
Philosophical and practical aspects of AMAM can be integrated in paediatric and primary care, enriching available conventional therapies.How to facilitate physician–child–parent–teacher communication through AM and its related Waldorf education
Day 5
10 min Zoom-guided meditation led by a spiritual care provider
 Meet the expert:
 the patient’s search for alternative remedies in home and hospital end-of-life care
Learning practical keywords useful to identify undisclosed use of ‘alternative’ treatmentsPatients’ use of alternative remedies does not necessarily reflect a rejection of conventional medicine but may suggest unmet needs and concerns which need to be considered by the integrative teamHow to communicate with patients expressing an alternative health-belief model of care
 Learning assignmentsIndividual assignment: viewing video clips (90 min total): analysing two patient–physician role-plays aimed at identifying 10 core themes during the initial intake with a patient using herbal medicine during oncology treatment
Meeting the integrative mentor (in student pairs): 45 min discussion with the integrative mentor in a specialised setting (internal medicine, family medicine, oncology, psychiatry, paediatrics and surgery)
 Meet the expert:
 integration of an inpatient complementary medicine service
Review of integrative care initiatives in 13 hospital departments/units (eg, urology, general surgery, rehabilitation, cardiology, invasive radiology, GYN, haematology, internal medicine and gastroenterology)Integrative care is relevant in a wide range of medical professions, based on a multidisciplinary approach and open and creative communication with the conventional medical team.How can I promote an integrative care service in my own practice in the future?
 Meet the expert:
 integrative neurology
IM is useful in many neurological conditions (eg, migraine, multiple sclerosis and pain syndromes).Students need to consider complementary/complementary medicine use in patients with recurrent and chronic neurological conditions.How can an integrative perspective enrich palliative pain treatment in patients with debilitating neurological disease?
 International perspective of IPs: (Germany, UK, Italy and Israel)
 Establishing an integrative continuity of care: from primary to secondary and tertiary levels of care
Integrative care has a significant therapeutic role in each of these three levels of medical care. However, fragmentation of care (as opposed to continuity of care) is a major concern.Students are expected to identify barriers obstructing continuity of care, especially between ambulatory care and the hospital.How can IM prioritise continuity of care despite fragmentation of treatment between medical settings and professions?
  • AM, anthroposophical medicine; EBM, evidence-based medicine; GYN, gynecology; IM, integrative medicine; IO, integrative oncology; IP, integrative physician; TCM, traditional Chinese medicine.