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Love Your Silo and Leave It: Are We Educating Integrative Practitioners for Integrated Practice? PDF Print E-mail
Written by John Weeks   

Love Your Silo and Leave It: Are We Educating Integrative Practitioners for Integrated Practice?

Summary: The definition of "integrative medicine" endorsed by a consortium of 44 medical schools specifically notes the importance of integrating not just modalities, but also of integrating "healthcare professionals and disciplines." Accreditation standards of the licensed integrative practice fields each require competencies in "referral" and most in "collaboration." But are these fields adequately educating about each other? Marketing work led by Beth Rosenthal, PhD, MPH, is finding that interprofessional education (IPE) is yet in its infancy. Meantime, a recent Institute of Medicine report on continuing education strongly promotes not only interprofessional education but also conferences with "carefully tailored learning environments" to enhance understanding between different disciplines. This is a column on the state of integrative practice education in leaving the silos that limit optimally integrated team care.
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Ever think that members of another profession should know more about your own? Otherwise, they can't possibly make the best use of your services, right?

I have heard some version of this view expressed countless times by licensed complementary and integrative practitioners.  The accompanying argument goes like this:
Medical doctors should have required courses on us.  Even if their curriculum is already stuffed, they need to make room for information about what we bring to the patient. Respect for patient choices requires it.
Rosenthal: Opening reflection on interprofessional education
The demand is that the MDs get out of their silos. I am reminded of the comedian Flip Wilson in his cross-dressed persona as Geraldine, exasperated at her inattentive spouse: "Flip, why don't you turn off that TV and, look at me for awhile?"

What's recommended for the goose is not, however, typically in the education of the gander. I have been learning about these gaps from my colleague Beth Rosenthal, PhD, MPH. Rosenthal is marketing a book on inter-professional education (IPE) that was developed and published by a not-for-profit with which I work. She's reaching out to academics across the integrative practice fields, from integrative medicine to chiropractic, naturopathic medicine and massage therapy.

Should education about other disciplines be required of heath professions students?
The book has the prosaic title Clinicians' and Educators' Desk Reference on the Licensed Complementary and Alternative Healthcare Professions. The idea is that just as a professional might want to have a PDR or an herbal desk reference nearby, he or she could enhance patient care by quickly accessing information about a set of disciplines, written by leaders of those disciplines, whose services may be just right for patients in a given moment.

mission-driven (and self-serving) message: "Shouldn't it be a requirement to have such a book as a required text in health professions education for all soon-to-be clinicians?"

Rosenthal is learning that most in the so-called CAM disciplines have virtually no mandatory training that focuses on other professions. Even most supportive, IPE-oriented integrative academics will echo the struggle in medical schools where present requirements are bursting curricular seams.  Uh, maybe we should develop an elective.

I have come to view Rosenthal's book marketing as a sort of tip of the spear, pointedly nudging open a deeper dialogue toward expanding if not utterly creating interprofessional education in these programs.

This is interesting. A review recently completed of accreditation standards for licensed integrative practice fields found that all require competencies in "referral," and most require them in "collaboration." A few are beginning to specify experience in "integration."(1) Similarly, and even more explicitly, in the MD-centered field of integrative medicine, the endorsed definition requires that practitioners not only integrate "modalities" but also "healthcare professionals, and disciplines."

How can practitioners optimally refer and collaborate if they remain ensconced in separate silos and don't know much about other disciplines? 

Recent study urges IPE in continuing education form and function
A recent Institute of Medicine report, Redesigning Continuing Education in the Health Professions, is laced with remediation plans for the silos created by the isolation in which much professional education takes place. The authors recommended a new, multidisciplinary Continuing Professional Development Institute (CPDI) to address these short-comings: "The CPDI can help shift the medical culture by expanding the concept of continuing professional development to include interprofessional teams of practitioners. Such team treatment is proving of great value in many fields, but many facilities do not yet train their professionals in teams."

The authors further recommend that continuing education "should bring health professionals from various disciplines together in carefully tailored learning environments." The reason: "As team-based health care delivery becomes increasingly important, such interprofessional efforts will enable participants to learn both individually and as collaborative members of a team, with a common goal of improving patient outcomes."

Unfortunately, with few exceptions, even in the integrative practice fields, conferences and continuing education typically draw members from a single professions.

A rare multiprofessional conference: Will it embrace the opportunities?
A notable exception is the annual Integrative Healthcare Symposium (IHS) sponsored by Diversified Business Communications, the business that also owns, an Integrator sponsor. At these conferences - the 2010 conference drew over 1500 participants - medical doctors are the discipline most represented. Yet the subsets of holistically-oriented nurses, chiropractors and naturopathic physicians are also significant, and growing. Members of the AOM, massage therapy and other fields are also in attendance.  

Such diversity at a conference is yet rare in the integrative practice fields. We need to intentionally create more of it, and then take advantage of the possibilities, such as the IOM suggests. To date, even IHS conference planners have not embraced the programmatic, IPE opportunities presented by this uniquely mixed demographic.  Some exploration along these lines is underway for the March 4-6, 2011 IHS conference. Stay tuned.

Most of us in the integrative practice fields view ourselves as shapers of a better healthcare. Isn't the IOM's call to shift medical culture toward collaborative care a perfect fit for leadership?  Shouldn't integrative practice educators and clinicians model interprofessional education that supports team care, whether at shared sites or in community networks?

If you think not, well, just turn to the IOM and say: "Shush, Geraldine."

(1) The review was for the ACCAHC Accrediting Agency Special Interest Group and is based on standards found via these agency websites: , , ,, and

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