Table 3. How is CAM taught in UGME?
Reference Participants Education Approach/ Intervention Duration and frequency Instructors background Outcome measure Outcomes Assessment Limitations
Bailey and Colleagues 201521 Fourth year medical students at Duke University, USA Initially a 90-minute interactive seminar providing introductory core learning. This developed into a seminar and I.M. fair. Included I.M. fields were nutrition, massage, acupuncture, yoga and biofeedback. The program changed over time from assigned to student selected teaching modalities. 1 hour seminar + 4 hour fair during which each student attended 4 x 40 minute workshops. This structure was adapted and repeated from 2005 -2013 Duke University faculty, staff and community CAM providers 1, 2a, 2b, 3 Qualitative and descriptive data from course evaluations completed by students, and quantitative data from the AAMC graduate questionnaire.  Pre and post knowledge testing was completed for an unspecified period of time, then removed. Removal of pre-post knowledge testing
da Silva and Colleagues 201322 Third and fifth year medical students at Rio Preto Medical School. Brazil Third year students receive acupuncture classes as part of their formal curriculum. Fifth year students attend acupuncture outpatient clinics Third year: 6 hours of classes Fifth year: 4 x afternoon sessions in clinic Not specified 1, 2a, 2b, 3 5 question, 1-5 scale evaluation completed by 2011 and 2012 cohort. Subjective assessment of knowledge and likelihood of identifying when CAM is suitable for patients. Lack of objective measure of knowledge or skills
Forjuoh and Colleagues 200329   Third year medical students of a state, public medical school in Texas, USA Interactive educational sessions on family medicine, with CAM teaching integrated within. In addition, EBM was taught as a tool to teach CAM, enabling students to critically appraise therapies for their safety and efficacy in clinical practice. 5 hour clerkship session x 6 weeks Faculty members including the director of research and a family physician 1, 2a, 2b     Likert scale and Wilcoxon signed rank test used in a pre and post-curriculum questionnaire evaluating changes in students perceived knowledge, attitudes, and skills. Lack of objective measure of knowledge or skills, and small sample size, further reduced by 19% that did not complete the evaluation.
Frenkel and Colleagues 200734 4 graduates from the School of Medicine, University of Texas, USA who had completed 4 years of the CAM project The curriculum had included multiple multidisciplinary lectures, workshops, electives and structured rotations and additional educational activities. Integrated teaching across 4 years Two family medicine physicians 1, 2a, 2b, 3 Qualitative in-depth, face to face, semi-structured interviews – coded and thematically interpreted Very small sample size and interviewer bias  
Hassed 200430 Undergraduate medical students at Monash University, Australia learning integrated CAM over the 5 year duration of the medical degree. Core curriculum teaching including mindfulness-based stress management programs, lectures and forums on complementary medicine, and integration into weekly case-based teaching. This covers principles, research, evidence base, ethics and clinical applications. Additional opportunities to undertake optional CAM electives offered. 3 day transition camp with self-care theme, 2 introductory lectures, 6 x 2 hour tutorials, 2 mind body medicine lectures, 8 hour CAM teaching in second year Optional elective: 12 weeks x 2 hours Not specified N/A Nil Overview of ‘holistic’ nature of the medical program lacked student perspectives and outcomes assessment
Hoffmann and Colleagues 201923 40 first-year medical students at University of Iowa Carver College of Medicine, USA The experimental group viewed educational videos and participated in hands-on massage practice The control group only viewed the educational videos. Hands on massage x 11 hours and/or Educational videos x 4 hours, over 6 week period Two co-course directors and five current massage therapy students 1, 2a, 2b WHO Quality of Life Bref Survey, 6-8 students from both groups participated in post-course focus groups, knowledge assessment using non-validated tools. Participants completed pre- and post-course assessments of knowledge, attitudes, and personal wellness Small sample size   Some non-validated assessment tools
Jeffries 200131 Unspecified sample size of medical students from Creighton University School of Medicine, USA Senior elective with lectures and group discussions. Included conducting research on CAM, a scientific evaluation of efficacy, and a clinical rotation. 4 week duration CAM practitioners supervising clinical rotation 1 Post-course survey assessing student satisfaction Unknown sample size Lack of pre-evaluation Lack of objective outcome measure
Karpa 201228 23 fourth year medical students from Pennsylvania State University College of Medicine, USA A herbal/natural product course using classroom presentations and active learning mechanisms that include experiential rotations, case-based learning, and team-based learning. 40 classroom hours, and clinical rotations. The course was carried out annually over 3 academic years Pharmacology faculty member, multidisciplinary faculty members and guest lecturers with varied backgrounds 1 & 2a Final course grades determined on the basis of in-class presentations, attendance, participation and professionalism in class and clinical rotations. Likert-type questions and narrative responses used to assess student opinion of knowledge and skills imparted by the elective and overall course content Limited enrollment capacity and scheduling difficulties reducing the sample size Inability to directly measure the impact that the course has had on student-patient interactions in clinical encounters
Laken and Cosovic 199526 Seven medical students electively enrolled from Wayne State University Medical School, USA Senior elective delivered using didactic lecture, films, first-hand experience and observation of alternative practitioners. Students explored hypnosis, chiropractic, therapeutic touch, medication, biofeedback, acupuncture, homeopathy, naturopathy, and massage therapy. 7 days of formal teaching 1 day observation clinical placement Alternative medicine practitioners in the Detroit area 1 Student evaluation of course structure and content Lack of objective assessment of knowledge
Lehmann and Colleagues 201435 30 medical students at the Institute for General Practice and Family Medicine at the Otto Von Guericke University, Germany Elective course involving introductory lectures followed by discussion, performance of practical exercises, and student presentations on a self-chosen topic. Also included a one day excursion to the European library for homeopathy (Kothen). Three weekend course OR a block course – total of 56 hours in either form Conventional medicine practitioner 1, 2a, 3 Semi-structured discussions for a qualitative analysis. Topics included experience of the seminar, and anticipated use of homeopathy in future practice. Voluntary participation in an optional subject may have lead to less critical, more positive results on the survey, Small sample size of students, bias
Ma and Colleagues 201436   251 students at a Chinese Military Medical University, China EBM course formally included in the curriculum, combining lectures with small group discussion and student-teacher exchange sessions. It included 5 lectures and 2 seminars. 20 hour course Faculty staff 1 & 2a Pre and post training surveys with comparisons of percentage change of scores pre and post training using 6 point Likert scale  
Mahapatra and Colleagues 201732 17 students (33%) in the class of 2015 and 22 students (42%) in the class of 2016 from Mayo Clinic School of Medicine, USA A mandatory short I.M. curriculum across all years of medical school. Content focused on basic science and experimental and evidence based knowledge. Not specified I.M. professionals and physician faculty members with expertise in integrative therapies. 1 & 2a Paired data analysis of students who completed two surveys in their first and third year. Chi-square test, Wilcoxon rank sum test, McNamara agreement test, signed rank test used.   Lack of objective measure of students knowledge      
Maharaj 201037 Selective modules Retrieved to 24/ 160 students from University of the West Indies, Jamaica Assessing spiritual health and an introduction to alternative medicine practices Not specified Not specified 1 No formal evaluation, positive responses expressed in writing by students No formal evaluation of the program
Owen anLewith 200127 Unspecified number of undergraduate medical students at Southampton University, U.K. Optional modules addressing the issues raised by CAM, and examining its evidence base. Covered CAM therapies included homeopathy, chiropractic, osteopathy and acupuncture. Additional local clinic attachments in both NHS and private practice 8 session module, repeated bi-annually, over a 3 year period   Three doctors 1 & 2a Subjective student questionnaire with Likert-based format + Written comments encouraged Lack of pre and post intervention knowledge measure
Perlman and Stagnaro-Green 201024 New Jersey Medical School at the University of Medicine and Dentistry, USA Evolution of a complementary, alternative, and integrative medicine course with clearly stated core competencies and goals. The program included lectures and demonstrations of acupuncture and manipulation. Included teaching about appraising evidence and the ethical issues raised, and proposed a clerkship in 3rd and 4th year. 4 year integrated teaching Faculty members with advanced training or knowledge of CAM, including a faculty member from the local massage school N/A Not specified No formal evaluation of the program
Tahzib and Daniel 198625     Unspecified number of undergraduate medical students at the University of Sokoto, Niger Lectures, tutorials, seminars demonstrations of techniques such as acupuncture, practical exercises in analyzing medicinal plants, and supervised field visits to high grade traditional medical practitioners. 90 hours over 6 years: 60 hours of content, 30 hours of clinical placement Academic medical staff, visiting experts, scholars from other universities, traditional medical practitioners N/A Not specified No student evaluation Lack of objective knowledge assessment
Int J Med Educ. 2021; 12:140-149; doi: 10.5116/ijme.60e2.f3ed