Integrative Medicine Increasing in Family Medicine Residency Programs

To the Editor: We commend and strongly support the effort of the Journal of the American Board of Family Medicine (JABFM) and the American Board of Family Medicine to address the issue of redesigning Family Medicine (FM) residency. Such forward and creative thinking has become essential in a rapidly changing era of health care and post-graduate medical education. The series of articles^1–5 presented a creative number of options for residency redesign. As a consortium of academic health centers committed to integrative medicine (IM), we wish to share another—that of incorporating a robust IM curriculum within the standard 3-year FM residency. As alluded to in Dr. David's article, several programs have created a 4-year FM residency which include IM or other areas of concentration such as sports medicine or a master's in public health.²

A group of 8 existing FM residency programs (University of Arizona, Tucson, AZ; Beth Israel, New York City, NY; Carolina's Medical Center, Charlotte, NC; University of Connecticut, Hartford, CT; Hennepin County Medical Center, Minneapolis, MN; Maine Medical Center, Portland, ME; Maine-Dartmouth, Augusta, ME; and University of Texas Medical Branch, Galveston, TX) are now participating in an Integrative Medicine In Residency (IMR) Project. They are currently in the process of developing a 3-year pilot curriculum to be implemented in July 2008 in which the didactics of both IM and FM are woven together via online curriculum support. The content of the curriculum is being informed by a needs assessment survey completed by faculty and residents of these programs. This stakeholder-based process and teaching strategy will provide for a scaleable in-depth approach rooted in our discipline's core values and traditions while incorporating IM's innovative ways to educate and practice primary care. The areas of emphasis include:

1. Relationship-centered care, communication and motivational interviewing,

2. Collaborating with broadly conceived teams of health professionals including complementary and integrative practitioners,

3. Recommending a full spectrum of evidence-based, cost-effective therapeutic options for our broadly constituted, ethnically diverse, and underserved communities,

4. Using a mind-body-spirit, bio-psycho-social approach to treat and support the health of each individual,

5. Respecting the natural capacity of the body and the patient to heal,

6. Acknowledging the importance of physician self-care and well-being.

The possibilities for enhanced training are myriad, particularly for many chronic conditions in which traditional medical interventions may come up short. Some examples of integrative approaches include: the use of fish oil as part of secondary prevention of cardiovascular disease, management of elevated triglycerides, as well as for stroke prevention; the use of an elimination diet to assess gluten sensitivity or milk product intolerance in the treatment of irritable bowel syndrome; and the use of mind–body interventions for migraines.

IM has become a leading edge of thought, practice, and education at a time when FM has to respond compassionately and comprehensively to patients within a dysfunctional and unsustainable health care system. Faculty development and teaching methods must keep pace with providing practices that empower both future physicians and patients toward maintaining health. We believe this cohort of pilot programs will provide an excellent model for residency education as we all move forward into this uncharted terrain.

The flowering of our specialty as it renews itself in the years ahead is supported through the principles and values of IM. This change is firmly rooted in FM's tradition of leadership in educational innovation and dedication to the primacy of whole-patient care.