Anthroposophy is understood as a way to develop individual and autonomous competencies for recognizing the spiritual dimensions of the human being and the world. Anthroposophy aims to enhance a comprehensive and self-directed development of personality. Thus, Anthroposophic Medical Education focuses not only on innovative ways to teach and to learn Anthroposophic Medicine, but aims to contribute to a humanistic education that enables the learners to practice an integrative and patient centred health care.
A major topic regarding education for a patient centred medicine (1) focuses on the development of physician empathy (2). A review of the working group of the Integrated Curriculum for Anthroposophic Medicine (ICURAM) showed that empathy often declines during medical education (3), important reasons for which were found in stress and in clinical education. Further relevant determinants for the development of empathy during undergraduate medical education seem to be reflective practice, focusing on the psycho-social dimension of disease and human being, peer influence and role modelling (4,5). A non-reductionistic understanding of the human being as in anthroposophy may also enhance empathy and patient centeredness (6).
As an example for an integrative medical education the ICURAM-program was developed, a six-year curriculum in Anthroposophic Medicine that is integrated throughout the medical training at Witten Herdecke University in Germany. As educational principles of the ICURAM-program, the ESPRI2T approach was developed combining Exploratory learning, Supported participation, Patient based learning, Reflective practice, Integrated Learning, an Integrative approach and Team based learning (7,8). Preliminary evaluations showed that such an integrative medical curriculum with a student centred educational strategy is of interest to more than half of medical students (8). First studies on ICURAM graduates indicate that such a program is not only helpful to learn Anthroposophic Medicine but also can contribute to a positive and sustainable experience of the students ́ medical training and can have a positive impact on both the development of their professional and personal identity and empathy as doctors-to-be (9). The importance of a non-reductionistic anthropology for a whole systems approach in integrative medicine has been elaborated (6,10,11) as well as innovative didactical methods like artistic sculpturing in anatomy (12).
Several elements of the ICURAM program as an example for integrative medical education were published, e.g. the perception practice (13) and integrative clinical clerkships (14). For the final year rotations, clinical education wards (CEWs) have been developed in internal medicine, paediatrics and neurology. They foster supported active participation of students in health care (15). Related research indicates that integrating students as active members of health care teams is not related to impairment of perceived health care quality but to high patient centeredness, empathy and patient enablement (16,17). A clinical reflection training was developed on request of the first participating CEW students. This regular training under the guidance of a psychosomatic specialist allows intra- and interpersonal challenges arising from clinical practice to be reflected and appropriate individual solutions to be jointly developed (18,19).
According to the German regulation for undergraduate medical education, a small part of the regular curriculum (“QB12”) contains rehabilitation, physical medicine and naturopathy where different forms of complementary and alternative medicine are presented, mostly in lectures (20). Similar surveys regarding the status of teaching of CAM (including Anthroposophic Medicine) in Switzerland have been published (21,22). A case conference for integrative medicine has been piloted as a patient – based multidimensional method to compare and to reflect upon different methods of medicine including conventional and different forms of complementary medicine (23).
Educational research has also been published regarding the quality of postgraduate medical training in integrative medicine at anthroposophic hospitals in Germany and Switzerland (24) including an analysis of problems (25) and recommendations for solutions (26).
July 2017
Dr. med. Christian Scheffer, MME (Bern)
Integriertes Begleitstudium Anthroposophische Medizin - Universität Witten / Herdecke
Gemeinschaftskrankenhaus Herdecke
References
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Physician empathy : definition, out-come-relevance and its measurement in patient care and medical education. GMS Z Für Med Ausbild. 2012; 29(1), pp. Doc11
Empathy decline and its reasons : a systematic review of studies with medical students and residents. Acad Med J Assoc Am Med Coll. 2011; 86(8), pp. 996–1009
Determinants of physician empathy during me-dical education : hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Med Educ. 2014; 14, pp. 122
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259065/Towards non-reductionistic medical anthro-pology, medical education and practitioner–patient-interaction : The example of Anthroposophic Medicine. Patient Educ Couns. 2012; 89(3), pp. 455–60
Learner Centered Educational Strategies : The ESPRI2T-Approach as a Model for Integrative Medical Education. Explore J Sci Heal. 2013; 9(5), pp. 332
Integrative medical education : educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM). Patient Educ Couns. 2012; 89(3), pp. 447–54
‘Idealism Became Viable, Something I Can Put into Practice’ : The Meaning of an Integrated Curriculum for Anthroposophic Medicine for its Graduates. J Altern Complement Med. 2014; 20(5), pp. A99–100
Integrative medicine and whole systems approaches : From heterogeneous practice to compre-hensive scientific concepts. Eur J Integr Med. 2009; 1(4), pp. 189
The importance of epistemology and medical anthropology for an adequate integra-tion of anthroposophic concepts and medicine in academic science. Leiden, NL: University of Applied Sciences Abstract book. 2014; pp. 26
(oral presentation)Artistic sculpture in anatomy : Training minds for holistic and integrative activity—A pilot study in medical education. Eur J Integr Med. 2009; 1(4), pp. 196
Educating medical students in clinical perception : an evaluation study. BMC Complement Altern Med. 2012; 12(1), pp. P374
Educating Psychiatry in Integrative Medicine : A Five-Year Comparative Study on Students’ Judgement and Assessment Results in Psychiatric Clerkships. EXPLO-RE J Sci Heal. 2013; 9(5), pp. 330
Lernen durch aktive Partizipation in der klinischen Patientenversorgung : Machbarkeitsstudie einer internistischen PJ-Ausbildungsstation. GMS Z Für Med Ausbild. 2009; 26(3), pp. Doc31
Can final year medical students significant-ly contribute to patient care? : A pilot study about the perception of patients and clinical staff. Med Teach. 2010; 32(7), pp. 552–7
Active Student Participation May Enhance Patient Centeredness : Patients’ Assessments of the Clinical Education Ward for Integrative Medicine. Evid Based Complement Alternat Med. 2013; pp. 1-8
A reflective practice intervention for professi-onal development, reduced stress and improved patient care : A qualitative developmental evaluation. Patient Educ Couns. 2013;
Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication : a qualitative analysis. BMC Med Educ [Internet]. 2016; 16(1),
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https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0823-xEvaluation of the current status of Rehabilitation, Physical Medi-cine and Naturopathy education 10 years after the reform of the Medical Licensure Act : a nationwide survey of German Medical Universities. GMS J Med Educ [Internet] 2017; 34(1),
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327655/The teaching of complementary medicine in Swiss medical schools : A survey of the current status and of expert opinions about the integration of alternative … Swiss medical curriculum. Suedwestdeutscher Verlag fuer Hochschulschriften 2009; pp. 68
Complementary medicine courses in Swiss medical schools : actual status and students’ experience. Swiss Med Wkly. 2010; 140(3), pp. 44-51
Symposium Fallkonferenz Integrative Medizin. GMS Z Für Med Ausbild. 2007; 24(1), pp. Doc05
The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland : the example of anthroposophic hospitals. BMC Complement Altern Med. 2014; 14, pp. 191
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Lösungsvorschläge für Probleme in der integrativme-dizinischen Weiterbildung von Ärzten an anthroposophischen Kliniken Deutschlands und der Schweiz. Com-plement Med Res. 2014; 21(5), pp. 284–93
Exemplary literature
Heusser P, Scheffer C, Neumann M, Tauschel D, Edelhäuser F. Towards non-reductionistic medical anthro-pology, medical education and practitioner–patient-interaction: The example of Anthroposophic Medicine. Patient Educ Couns. 2012 Dec 1;89(3):455–60.
http://www.pec-journal.com/article/S0738-3991(12)00035-3/fulltext
Heusser P, Eberhard S, Berger B, Weinzirl J, Orlow P. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals. BMC Complement Altern Med. 2014 Jun 16;14:191.
https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-191
Heusser P. Holistic Thinking in Basic Sciences and Medicine. A New Elective at the University of Bern. Over-all Concept and Evaluation Strategy, Specific Needs Assessment, Pilot Course with an Emphasis on Role-Play, and Feasibility Study. Thesis for the Attainmentof the ‚Master of Medical Education’ (MME). University of Bern, in Cooperation with the University of Illinois at Chicago (Prof. Ara Tekian). Bern 2006
http://www.mme-alumni.uzh.ch/masterthesen/thesen_anzeige.php%3fID=86&sprache=de
Lutz G, Scheffer C, Edelhaeuser F, Tauschel D, Neumann M. A reflective practice intervention for professional development, reduced stress and improved patient care-A qualitative developmental evaluation. Patient Educ Couns. 2013 May 1;
http://linkinghub.elsevier.com/retrieve/pii/S0738399113001298
Lutz G, Roling G, Berger B, Edelhäuser F, Scheffer C. Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis. BMC Med Educ [Internet]. 2016 Dec [cited 2016 Nov 25];16(1).
http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0823-x
Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med J Assoc Am Med Coll. 2011 Aug;86(8):996–1009.
http://www.ncbi.nlm.nih.gov/pubmed/21670661
Scheffer C, Tauschel D, Cysarz D, Hahn E, Längler A, Riechmann M, et al. Lernen durch aktive Partizipation in der klinischen Patientenversorgung - Machbarkeitsstudie einer internistischen PJ-Ausbildungsstation. GMS Z Für Med Ausbild. 2009;26(3):Doc31.
http://www.egms.de/static/de/journals/zma/2009-26/zma000623.shtml
Scheffer C, Tauschel D, Neumann M, Lutz G, Cysarz D, Heusser P, et al. Integrative medical education: educational strategies and preliminary evaluation of the Integrated Curriculum for Anthroposophic Medicine (ICURAM). Patient Educ Couns. 2012 Dec;89(3):447–54.
https://www.ncbi.nlm.nih.gov/pubmed/22738823
Scheffer C, Edelhäuser F, Tauschel D, Riechmann M, Tekian A. Can final year medical students significantly contribute to patient care? A pilot study about the perception of patients and clinical staff. Med Teach. 2010;32(7):552–7.
http://www.ncbi.nlm.nih.gov/pubmed/20653376
Scheffer C, Tauschel D, Neumann M, Lutz G, Valk-Draad M, Edelhäuser F. Active Student Participation May Enhance Patient Centeredness: Patients’ Assessments of the Clinical Education Ward for Integrative Medicine. Evid Based Complement Alternat Med. 2013;2013:1–8.
http://www.hindawi.com/journals/ecam/2013/743832/