Course curriculum,Education,Integrative medicine,Medical students," /> Course curriculum,Education,Integrative medicine,Medical students,"/> Incorporation of integrative medicine education into undergraduate medical education: A longitudinal study
Search JIM Advanced Search

Journal of Integrative Medicine ›› 2017, Vol. 15 ›› Issue (6): 442-449.doi: 10.1016/S2095-4964(17)60367-4

• Research Article • Previous Articles     Next Articles

Incorporation of integrative medicine education into undergraduate medical education: A longitudinal study

Saswati Mahapatraa, Anjali Bhagraa, Bisrat Fekadub, Zhuo Lic, Brent A. Bauera, Dietlind L. Wahner-Roedlera   

  1. a Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA;
    b Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota 55905, USA;
    c Biostatistics Unit, Mayo Clinic, Jacksonville, Florida 32224, USA
  • Received:2017-01-24 Accepted:2017-03-29 Online:2017-11-15 Published:2017-11-15
  • Contact: Dietlind L. Wahner-Roedler, MD; E-mail:


Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person. We implemented a longitudinal IM short-course curriculum into our medical school education. This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students.


A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies. Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school. Paired data analysis was done, and only students who completed surveys at both time points were included in final analyses.


Of 52 students in each class, 17 (33%) in the class of 2015 and 22 (42%) in the class of 2016 completed both surveys. After the IM curriculum, students' knowledge of and comfort with several IM therapies-biofeedback, mindfulness, and the use of St. John's wort-improved significantly. Students' personal health practices also improved, including better sleep, exercise, and stress management for the class of 2015. Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year.


It is feasible to incorporate IM education into undergraduate medical education, and this is associated with improvement in students' knowledge of IM and personal health practices.

Key words: Course curriculum, Education, Integrative medicine, Medical students

1 Eisenberg DM, Kaptchuk TJ, Post DE, Hrbek AL, O’Connor BB, Osypiuk K, Wayne PM, Buring JE, Levy DB. Establishing an integrative medicine program within an academic health center: essential considerations.Acad Med. 2016; 91(9): 1223-1230.
2 Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, Lee R, Remen RN; Education Working Group,Consortium of Academic Health Centers for Integrative Medicine. Core competencies in integrative medicine for medical school curricula: a proposal.Acad Med. 2004; 79(6): 521-531.
3 Alwhaibi M, Bhattacharya R, Sambamoorthi U.Type of multimorbidity and complementary and alternative medicine use among adults.Evid Based Complement Alternat Med. 2015; 2015: 362582.
4 Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL.Trends in the use of complementary health approaches among adults: United States, 2002-2012.Natl Health Stat Report. 2015; 10(79): 1-16.
5 Elewonibi BR, BeLue R. Prevalence of complementary and alternative medicine in immigrants.J Immigr Minor Health. 2016; 18(3): 600-607.
6 Burke A, Nahin RL, Stussman BJ.Limited health knowledge as a reason for non-use of four common complementary health practices.PLoS One. 2015; 10(6): e0129336.
7 Astin JA.Why patients use alternative medicine: results of a national study.JAMA. 1998; 279(19): 1548-1553.
8 Nahin RL, Stussman BJ, Herman PM.Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample.J Pain. 2015; 16(11): 1147-1162.
9 Giordano J, Boatwright D, Stapleton S, Huff L.Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice.J Altern Complement Med. 2002; 8(6): 897-906.
10 Flaherty G, Fitzgibbon J, Cantillon P.Attitudes of medical students toward the practice and teaching of integrative medicine.J Integr Med. 2015; 13(6): 412-415.
11 Pearson NJ, Chesney MA.The CAM education program of the National Center for Complementary and Alternative Medicine: an overview.Acad Med. 2007; 82(10): 921-926.
12 Marcus DM.How should alternative medicine be taught to medical students and physicians?Acad Med. 2001; 76(3): 224-229.
13 Cook DA, Gelula MH, Lee MC, Bauer BA, Dupras DM, Schwartz A.A web-based course on complementary medicine for medical students and residents improves knowledge and changes attitudes.Teach Learn Med. 2007; 19(3): 230-238.
14 Chez RA, Jonas WB, Crawford C.A survey of medical students’ opinions about complementary and alternative medicine.Am J Obstet Gynecol. 2001; 185(3): 754-757.
15 Xu S, Levine M.Medical residents’ and students’ attitudes towards herbal medicines: a pilot study.Can J Clin Pharmacol. 2008; 15(1): e1-e4.
16 Templeman K, Robinson A, McKenna L. Student identification of the need for complementary medicine education in Australian medical curricula: a constructivist grounded theory approach.Complement Ther Med. 2015; 23(2): 257-264.
17 Teixeira MZ, Lin CA, Martins Mde A.Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates’ attitudes.Sao Paulo Med J. 2005; 123(2): 77-82.
18 Rampes H, Sharples F, Maragh S, Fisher P.Introducing complementary medicine into the medical curriculum.J R Soc Med. 1997; 90(1): 19-22.
19 Frye AW, Sierpina VS, Boisaubin EV, Bulik RJ.Measuring what medical students think about complementary and alternative medicine (CAM): a pilot study of the complementary and alternative medicine survey.Adv Health Sci Educ Theory Pract. 2006; 11(1): 19-32.
20 Forjuoh SN, Rascoe TG, Symm B, Edwards JC.Teaching medical students complementary and alternative medicine using evidence-based principles.J Altern Complement Med. 2003; 9(3): 429-439.
21 Lie DA, Boker J.Comparative survey of complementary and alternative medicine (CAM) attitudes, use, and information-seeking behaviour among medical students, residents & faculty.BMC Med Educ. 2006; 6: 58.
22 Lie D, Rucker L, Cohn F.Using literature as the framework for a new course.Acad Med. 2002; 77(11): 1170.
23 Karpa K.Development and implementation of an herbal and natural product elective in undergraduate medical education.BMC Complement Altern Med. 2012; 12: 57.
24 Hoellein AR, Lineberry MJ, Kifer E.A needs assessment of complementary and alternative medicine education at the University of Kentucky College of Medicine.Med Teach. 2008; 30(3): e77-e81.
25 Nicolao M, Täuber MG, Heusser P.How should complementary and alternative medicine be taught to medical students in Switzerland? A survey of medical experts and students.Med Teach. 2010; 32(1): 50-55.
26 Chaterji R, Tractenberg RE, Amri H, Lumpkin M, Amorosi SB, Haramati A.A large-sample survey of first- and secondyear medical student attitudes toward complementary and alternative medicine in the curriculum and in practice.Altern Ther Health Med. 2007; 13(1): 30-35.
27 Brinkhaus B, Joos S, Lindner M, Kohnen R, Witt C, Willich SN, Hahn EG.Integration of complementary and alternative medicine into German medical school curricula—contradictions between the opinions of decision makers and the status quo.Forsch Komplementarmed Klass Naturheilkd. 2005; 12(3): 139-143.
28 Dogas Z, Kardum G, Mirić L, Sevo V, Tolić T, Ursić A, Vasiljević P, Zekić S.Attitudes towards science and alternative medicine of medical, economics and business, and electrical engineering students in Split, Croatia.Croat Med J. 2003; 44(1): 75-79.
29 Kanadiya MK, Klein G, Shubrook JH Jr.Use of and attitudes toward complementary and alternative medicine among osteopathic medical students. J Am Osteopath Assoc.2012; 112(7): 437-446.
30 Längler A, Boeker R, Kameda G, Seifert G, Edelhäuser F, Ostermann T.Attitudes and beliefs of paediatric oncologists regarding complementary and alternative therapies.Complement Ther Med. 2013; 21(Suppl 1): S10-S19.
31 Loh KP, Ghorab H, Clarke E, Conroy R, Barlow J.Medical students’ knowledge, perceptions, and interest in complementary and alternative medicine.J Altern Complement Med. 2013; 19(4): 360-366.
32 Greiner KA, Murray JL, Kallail KJ.Medical student interest in alternative medicine.J Altern Complement Med. 2000; 6(3): 231-234.
33 Oberbaum M, Notzer N, Abramowitz R, Branski D.Attitude of medical students to the introduction of complementary medicine into the medical curriculum in Israel.Isr Med Assoc J. 2003; 5(2): 139-142.
34 Silverstein DD, Spiegel AD.Are physicians aware of the risks of alternative medicine?J Community Health. 2001; 26(3): 159-174.
35 Rees CE, Wearn AM, Dennis I, Amri H, Greenfield SM.Medical students’ attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study.Med Teach. 2009; 31(2): 125-132.
36 Wahner-Roedler DL, Lee MC, Chon TY, Cha SS, Loehrer LL, Bauer BA.Physicians’ attitudes toward complementary and alternative medicine and their knowledge of specific therapies: 8-year follow-up at an academic medical center.Complement Ther Clin Pract. 2014; 20(1): 54-60.
37 Wahner-Roedler DL, Vincent A, Elkin PL, Loehrer LL, Cha SS, Bauer BA.Physicians’ attitudes toward complementary and alternative medicine and their knowledge of specific therapies: a survey at an academic medical center.Evid Based Complement Alternat Med. 2006; 3(4): 495-501.
38 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG.Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42(2): 377-381.
39 Cowen VS, Cyr V.Complementary and alternative medicine in US medical schools.Adv Med Educ Pract. 2015; 6: 113-117.
40 Zakrzewska JM, Fry H, Larkin KE.A case study of methods used to tackle a common pedagogic problem in medical and dental education: time pressure.Med Teach. 2003; 25(4): 391-397.
41 Peluso M, Takizawa P.Student involvement in the development of integrated curricula.Med Educ. 2010; 44(11): 1120-1121.
42 Lehrer MD, Murray S, Benzar R, Stormont R, Lightfoot M, Hafertepe M, Welch G, Peters N, Maio A.Peer-led problem-based learning in interprofessional education of health professions students.Med Educ Online. 2015; 20: 28851.
43 Bulte C, Betts A, Garner K, Durning S.Student teaching: views of student near-peer teachers and learners.Med Teach. 2007; 29(6): 583-590.
44 Lin JA, Farrow N, Lindeman BM, Lidor AO.Impact of near-peer teaching rounds on student satisfaction in the basic surgical clerkship.Am J Surg. 2017; 213(6): 1163-1165.
45 Raty SR, Teal CR, Nelson EA, Gill AC.Near-peers improve patient safety training in the preclinical curriculum.Med Educ Online. 2017; 22(1): 1289315.
46 Bond AR, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, Saper RB.Embodied health: the effects of a mind-body course for medical students.Med Educ Online. 2013; 18: 1-8.
47 Greeson JM, Toohey MJ, Pearce MJ.An adapted, fourweek mind-body skills group for medical students: reducing stress, increasing mindfulness, and enhancing self-care.Explore (NY). 2015; 11(3): 186-192.
48 Kraemer KM, Luberto CM, O’Bryan EM, Mysinger E, Cotton S. Mind-body skills training to improve distress tolerance in medical students: a pilot study.Teach Learn Med. 2016; 28(2): 219-228.
[1] Brody Slostad, Tejinder Khalsa, Kathleen Young, Hildalicia Guerra, Anjali Bhagra. A case-based approach to integrative medicine for cardiovascular disease prevention. Journal of Integrative Medicine, 2020, 18(2): 159-162.
[2] Charles Dalcanale Tesser, Ari Ojeda Ocampo Moré, Melissa Costa Santos, Emiliana Domingues Cunha da Silva, Fátima Terezinha Pelachini Farias, Lúcio José Botelho. Auriculotherapy in primary health care: A large-scale educational experience in Brazil. Journal of Integrative Medicine, 2019, 17(4): 302-309.
[3] Mohammad Hossein Ayati, Ata Pourabbasi, Nazli Namazi, Arman Zargaran, Zahra Kheiry, Amir Hooman Kazemi, Bagher Larijani. The necessity for integrating traditional, complementary, and alternative medicine into medical education curricula in Iran. Journal of Integrative Medicine, 2019, 17(4): 296-301.
[4] Mikhail Teppone. Medicine has always been “Modern” and “Scientific” from ancient times to the present day. Journal of Integrative Medicine, 2019, 17(4): 229-237.
[5] Tamer Aboushanab, Mohamed Khalil, YaserAl Ahmari. The present state of complementary medicine regulation in Saudi Arabia. Journal of Integrative Medicine, 2019, 17(3): 147-149.
[6] Hanae Naceiri Mrabti, Nidal Jaradat, Mohamed Reda Kachmar, Abdelaziz Ed-Dra, Abdelilah Ouahbi, Yahia Cherrah, Moulay El Abbes Faouzi. Integrative herbal treatments of diabetes in Beni Mellal region of Morocco. Journal of Integrative Medicine, 2019, 17(2): 93-99.
[7] Fung-Kei Cheng. An overview of the contribution of acupuncture to thyroid disorders. Journal of Integrative Medicine, 2018, 16(6): 375-383.
[8] Chang-quan Ling, Jia Fan, Hong-sheng Lin, Feng Shen, Zhen-ye Xu, Li-zhu Lin, Shu-kui Qin, Wei-ping Zhou, Xiao-feng Zhai, Bai Li, Qing-hui Zhou, on behalf of the Chinese Integrative Therapy of Primary Liver Cancer Working Group. Clinical practice guidelines for the treatment of primary liver cancer with integrative traditional Chinese and Western medicine. Journal of Integrative Medicine, 2018, 16(4): 236-248.
[9] Nian Huang. Integrative medicine is an evolving field and the future of healthcare: A summary of the 2017 Integrative Medicine Shanghai Forum. Journal of Integrative Medicine, 2018, 16(2): 71-71.
[10] Lizhou Liu, Simone Petrich, Blair McLaren, Lyndell Kelly, G. David Baxter. An integrative Tai Chi program for patients with breast cancer undergoing cancer therapy: Study protocol for a randomized controlled feasibility study. Journal of Integrative Medicine, 2018, 16(2): 99-105.
[11] Arthur Yin Fan, Sarah Faggert. Distribution of licensed acupuncturists and educational institutions in the United States in early 2015. Journal of Integrative Medicine, 2018, 16(1): 1-5.
[12] Xuan Liu, Li-juan Xiu, Jian-peng Jiao, Jing Zhao, Ying Zhao, Ye Lu, Jun Shi, Yong-jin Li, Min Ye, Yu-fang Gu, Xiao-wei Wang, Jing-yu Xu, Ci-an Zhang, Yong-ying Liu, Yun Luo, Xiao-qiang Yue. Traditional Chinese medicine integrated with chemotherapy for stage IV non-surgical gastric cancer: A retrospective clinical analysis. Journal of Integrative Medicine, 2017, 15(6): 469-475.
[13] Andrian Liem, Kuncoro Dewi Rahmawati. The meaning of complementary, alternative and traditional medicine among the Indonesian psychology community: A pilot study. Journal of Integrative Medicine, 2017, 15(4): 288-294.
[14] Jin Yu, Chao-qin Yu, Qi Cao, Li Wang, Wen-jun Wang, Li-rong Zhou, Jing Li, Qiao-hong Qian. Consensus on the integrated traditional Chinese and Western medicine criteria of diagnostic classification in polycystic ovary syndrome (draft). Journal of Integrative Medicine, 2017, 15(2): 102-109.
[15] Wen-jian Wang, Teng Zhang. Integration of traditional Chinese medicine and Western medicine in the era of precision medicine. Journal of Integrative Medicine, 2017, 15(1): 1-7.
Full text



[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[3] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[4] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[5] Xue-mei Liu, Qi-fu Huang, Yun-ling Zhang, Jin-li Lou, Hong-sheng Liu, Hong Zheng. Effects of Tribulus terrestris L. saponion on apoptosis of cortical neurons induced by hypoxia-reoxygenation in rats. Journal of Chinese Integrative Medicine, 2008, 6(1): 45-50
[6] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[7] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[8] Min Cheng, Qiong Feng, Shu-wen Qian, Hui Gao, Cui-qing Zhu. Preliminary assay of p-amyloid binding elements in heart-beneficial recipe. Journal of Chinese Integrative Medicine, 2008, 6(1): 68-72
[9] Xi Lin, Jian-ping Liu. Tai chi for treating rheumatoid arthritis. Journal of Chinese Integrative Medicine, 2008, 6(1): 82
[10] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88