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On Harnessing the Power of Medical Students to Reach their Peers
EDUCATION
ON HARNESSING THE POWER OF MEDICAL STUDENTS TO REACH THEIR PEERS |
Aaron Winkler, MD, Victor S. Sierpina, MD, and Mary Jo Kreitzer, RN, PhD |
European and American culture historically ebbs and flows in relation to mind–body medicine.1 As we reach the limit of western medicine to treat epidemics like obesity and attention deficit, the tide is flowing in favor of mind–body approaches. A google-news search for “mindfulness” on January 12th, 2014 showed articles published in the prior week in several major news outlets including The Times, The Guardian, The Telegraph, Harvard Health Publications, and Medscape, all with positive headlines such as, “Mindfulness Meditation May Ease Anxiety and Stress,”2 and “How Mindfulness can Help Your Children.”3 Companies have begun offering lunch-time mindfulness meditation.4 The effect of mindfulness on elite athletic performance has been studied5 and reached popular awareness. During the Sochi Winter Olympics, an article on athletes using imagery to prepare for events was one of
Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr. Sierpina at [email protected] or Dr. Kreitzer at [email protected]. Submissions should be no more than 500–1500 words. Please include any website or other resource that is relevant as well as contact information.
Education
top 10 most-emailed articles on The New York Times' website.6 Similar positivity may be starting to take hold at medical institutions, but more progress remains to be made. A recent study from the Mayo Clinic in Minnesota asserts that between 2004 and 2012, “the attitudes of physicians in our department of medicine toward complementary and alternative therapies (CAM) became much more positive, and physicians showed an increased willingness to use CAM to address patient care needs. However, knowledge of and experience with many specific CAM treatments did not change.”7 One way to increase future physician knowledge of and experience with integrating CAM and conventional approaches [integrative medicine (IM)] is to harness the energy of IM-minded medical students to inform and engage their classmates. Precisely this is currently taking place at Wake Forest University School of Medicine, even though no formal IM curriculum is available. A vital student organization has grown over just a few years. This success is the result of factors that should be reproducible at other schools. First, there has been strong faculty mentorship locally at Wake Forest and nationally at AMSA's annual leadership training program (LEAPS into IM). Second, there is financial support locally through Wake's Center for Integrative Medicine (CIM) and Student Wellness Center (SWC) and also nationally from organizations such as the Weil Foundation. Last, perhaps most important and least discussed, there has been strong longitudinal mentorship between students. The story is simple: In 2011, a single Wake Forest student reconstituted a defunct IM interest group and, in parallel, worked with the counseling department to find funding for student wellness programming. She attended
“LEAPS into IM” the following summer and used the very modest grant funds to organize a simple “introduction to IM” lunch talk for her fellow students. A member of the following class attended at the lunch talk. She had never heard of IM but was intrigued and attended LEAPS the following summer. These two students were working against the grain. Their peers were unaware of or uninterested in IM modalities. But their work began to bear fruit with the following class. One student arrived already certified as a yoga instructor. She used some of the funds recently earmarked for student wellness to start a free-for-students weekly yoga class. Garnering impressive attendance, the class had to be moved to a bigger room to hold the regular crowd of 30–40 MD and PA student attendees. A second student well-versed in IM dietary approaches brought organizational prowess and utilized student activities funding to bring in diverse speakers throughout the year to teach IM as it relates to cardiovascular health, chiropractic care, and nutrition. A third student (the author of this piece) applied to LEAPS and, with an interest group already in place, was able to direct the grant funds toward clinical research. As with all strong teams, the whole became much greater than the sum of its parts. Strong support for each other's ideas bred the following successful initiatives:
A yoga hike during new student orientation Participation in a community garden Pre-exam meditation Post-exam detox with fruit juiced to order and a loving kindness meditation-centered yoga class
The results of these efforts have begun to seep into the fabric of student life.
EXPLORE November/December 2014, Vol. 10, No. 6 411
There are now plans to invite large numbers of students to do community service at the community garden. The weekly yoga class is so well attended that plans have been laid to continue to offer it as the current teacher moves on in her medical training. Students who had already noticed the similarity between the unhealthy diets mentioned in atherosclerosis lectures and the unhealthy food served at school events saw an alternative in the healthy lunches provide at IM lunch talks. At the request of peers, the interest group wrote and distributed a one-page document on how to provide healthy lunches at a reasonable cost. The next class of IM student leadership is already running and planning events. It is not far-fetched to think that within three to four years students will simply expect there to be a yoga class, expect to meditate before exams, and expect that student groups who serve pizza will find their events less well attended than those with pita sandwiches and fresh vegetables. This past summer I attended LEAPS. The LEAPS experience was far more than I hoped for; life-changing in all the ways other students describe. I find myself seeking out quiet corners during lunch hours to engage in the walking meditation practice I learned there. I rely more on journaling to emotionally process medical training. I am more open to and accepting of the leadership of others. By connecting with like-minded students, I was able to bring the idea of pre-test meditation sessions from a colleague at another institution to my own school. Thanks to past LEAPS awards and the IM student organization that has grown at Wake Forest, I was able to apply with a very different kind of project than my predecessors: novel clinical research. I proposed and am
now currently enrolling subjects in a study of the effects of living ornamental plants placed in the hospital rooms of cardiothoracic surgery patients, tracking their recovery for both objective and subjective benefits. The concept and method were honed with mentorship provided at LEAPS. Funding for the project was provided by the CIM here at Wake Forest thanks to the current director Dr. Jeffery Feldman's advocacy in support of student research. Here at Wake Forest, the opportunities available for students interested in integrative modalities has blossomed: from no events to a single awareness event each year to weekly yoga, meditation opportunities, hikes, multiple talks from diverse IM practitioners, a student plot in a community garden, and student-led clinical research. There has been synergy between a strong team of diversely talented students, a supportive faculty, external leadership training opportunities, and a fertile funding environment. The national mood toward IM modalities is positive, and medical students are aware. Some medical schools such as Georgetown do offer formal teaching in IM concepts and treatments. But this is the exception rather than the rule. Many medical students may progress through their training without any meaningful experience of IM at all. In this setting, helping interested students reach their peers offers a way to break the logjam. Wake Forest's IM student organization is evidence that with institutional support, faculty mentorship, and national leadership training programs like LEAPS, today's medical students are ready to bring IM modalities into their own lives, the lives of their peers, and most importantly into the lives of their future patients.
412 EXPLORE November/December 2014, Vol. 10, No. 6
REFERENCES 1. Harrington A. The Cure Within: A History of Mind-Body Medicine. New York: W.W. Norton; 2008. 2. Harvard Health Publications; 2014. 3. The Times; 2014. 4. Gelles D. The mind business. FT Magazine. 〈http://www.ft.com/cms/s/2/ d9cb7940-ebea-11e1-985a-00144feab49a. html#axzz2sqm5v1al.〉; 2012. 5. Bernier M, Thienot E, Codron R, Fournier JF. Mindfulness and acceptance approaches in sport performance. J Clin Sports Psychol. 2009;4:320–333. 6. Clarey C. Olympians use Imagery as Mental Training. The New York Times. 〈http:// www.nytimes.com/2014/02/23/sports/ olympics/olympians-use-imagery-as-men tal-training.html?hpw&rref=sports.〉; 2014. 7. Dietlind L, et al. 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. http://dx.doi.org/10.1016/ j.ctcp.2013.09.003).
Aaron Winkler, is an MD Candidate at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
Victor S. Sierpina, MD, is the W.D. and Laura Nell Nicholson Professor of Integrative Medicine, Professor Family Medicine, Director of Medical Student Education, at the University of Texas Medical Branch in Galveston, Texas. He is an associate editor for EXPLORE.
Mary Jo Kreitzer, PhD, RN, is the founder and director the Center for Spirituality and Healing and a professor in the School of Nursing at the University of Minnesota, Minneapolis, Minnesota.
Education
ON HARNESSING THE POWER OF MEDICAL STUDENTS TO REACH THEIR PEERS |
Aaron Winkler, MD, Victor S. Sierpina, MD, and Mary Jo Kreitzer, RN, PhD |
European and American culture historically ebbs and flows in relation to mind–body medicine.1 As we reach the limit of western medicine to treat epidemics like obesity and attention deficit, the tide is flowing in favor of mind–body approaches. A google-news search for “mindfulness” on January 12th, 2014 showed articles published in the prior week in several major news outlets including The Times, The Guardian, The Telegraph, Harvard Health Publications, and Medscape, all with positive headlines such as, “Mindfulness Meditation May Ease Anxiety and Stress,”2 and “How Mindfulness can Help Your Children.”3 Companies have begun offering lunch-time mindfulness meditation.4 The effect of mindfulness on elite athletic performance has been studied5 and reached popular awareness. During the Sochi Winter Olympics, an article on athletes using imagery to prepare for events was one of
Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity, and interdisciplinary nature of the field. Please submit to Dr. Sierpina at [email protected] or Dr. Kreitzer at [email protected]. Submissions should be no more than 500–1500 words. Please include any website or other resource that is relevant as well as contact information.
Education
top 10 most-emailed articles on The New York Times' website.6 Similar positivity may be starting to take hold at medical institutions, but more progress remains to be made. A recent study from the Mayo Clinic in Minnesota asserts that between 2004 and 2012, “the attitudes of physicians in our department of medicine toward complementary and alternative therapies (CAM) became much more positive, and physicians showed an increased willingness to use CAM to address patient care needs. However, knowledge of and experience with many specific CAM treatments did not change.”7 One way to increase future physician knowledge of and experience with integrating CAM and conventional approaches [integrative medicine (IM)] is to harness the energy of IM-minded medical students to inform and engage their classmates. Precisely this is currently taking place at Wake Forest University School of Medicine, even though no formal IM curriculum is available. A vital student organization has grown over just a few years. This success is the result of factors that should be reproducible at other schools. First, there has been strong faculty mentorship locally at Wake Forest and nationally at AMSA's annual leadership training program (LEAPS into IM). Second, there is financial support locally through Wake's Center for Integrative Medicine (CIM) and Student Wellness Center (SWC) and also nationally from organizations such as the Weil Foundation. Last, perhaps most important and least discussed, there has been strong longitudinal mentorship between students. The story is simple: In 2011, a single Wake Forest student reconstituted a defunct IM interest group and, in parallel, worked with the counseling department to find funding for student wellness programming. She attended
“LEAPS into IM” the following summer and used the very modest grant funds to organize a simple “introduction to IM” lunch talk for her fellow students. A member of the following class attended at the lunch talk. She had never heard of IM but was intrigued and attended LEAPS the following summer. These two students were working against the grain. Their peers were unaware of or uninterested in IM modalities. But their work began to bear fruit with the following class. One student arrived already certified as a yoga instructor. She used some of the funds recently earmarked for student wellness to start a free-for-students weekly yoga class. Garnering impressive attendance, the class had to be moved to a bigger room to hold the regular crowd of 30–40 MD and PA student attendees. A second student well-versed in IM dietary approaches brought organizational prowess and utilized student activities funding to bring in diverse speakers throughout the year to teach IM as it relates to cardiovascular health, chiropractic care, and nutrition. A third student (the author of this piece) applied to LEAPS and, with an interest group already in place, was able to direct the grant funds toward clinical research. As with all strong teams, the whole became much greater than the sum of its parts. Strong support for each other's ideas bred the following successful initiatives:
A yoga hike during new student orientation Participation in a community garden Pre-exam meditation Post-exam detox with fruit juiced to order and a loving kindness meditation-centered yoga class
The results of these efforts have begun to seep into the fabric of student life.
EXPLORE November/December 2014, Vol. 10, No. 6 411
There are now plans to invite large numbers of students to do community service at the community garden. The weekly yoga class is so well attended that plans have been laid to continue to offer it as the current teacher moves on in her medical training. Students who had already noticed the similarity between the unhealthy diets mentioned in atherosclerosis lectures and the unhealthy food served at school events saw an alternative in the healthy lunches provide at IM lunch talks. At the request of peers, the interest group wrote and distributed a one-page document on how to provide healthy lunches at a reasonable cost. The next class of IM student leadership is already running and planning events. It is not far-fetched to think that within three to four years students will simply expect there to be a yoga class, expect to meditate before exams, and expect that student groups who serve pizza will find their events less well attended than those with pita sandwiches and fresh vegetables. This past summer I attended LEAPS. The LEAPS experience was far more than I hoped for; life-changing in all the ways other students describe. I find myself seeking out quiet corners during lunch hours to engage in the walking meditation practice I learned there. I rely more on journaling to emotionally process medical training. I am more open to and accepting of the leadership of others. By connecting with like-minded students, I was able to bring the idea of pre-test meditation sessions from a colleague at another institution to my own school. Thanks to past LEAPS awards and the IM student organization that has grown at Wake Forest, I was able to apply with a very different kind of project than my predecessors: novel clinical research. I proposed and am
now currently enrolling subjects in a study of the effects of living ornamental plants placed in the hospital rooms of cardiothoracic surgery patients, tracking their recovery for both objective and subjective benefits. The concept and method were honed with mentorship provided at LEAPS. Funding for the project was provided by the CIM here at Wake Forest thanks to the current director Dr. Jeffery Feldman's advocacy in support of student research. Here at Wake Forest, the opportunities available for students interested in integrative modalities has blossomed: from no events to a single awareness event each year to weekly yoga, meditation opportunities, hikes, multiple talks from diverse IM practitioners, a student plot in a community garden, and student-led clinical research. There has been synergy between a strong team of diversely talented students, a supportive faculty, external leadership training opportunities, and a fertile funding environment. The national mood toward IM modalities is positive, and medical students are aware. Some medical schools such as Georgetown do offer formal teaching in IM concepts and treatments. But this is the exception rather than the rule. Many medical students may progress through their training without any meaningful experience of IM at all. In this setting, helping interested students reach their peers offers a way to break the logjam. Wake Forest's IM student organization is evidence that with institutional support, faculty mentorship, and national leadership training programs like LEAPS, today's medical students are ready to bring IM modalities into their own lives, the lives of their peers, and most importantly into the lives of their future patients.
412 EXPLORE November/December 2014, Vol. 10, No. 6
REFERENCES 1. Harrington A. The Cure Within: A History of Mind-Body Medicine. New York: W.W. Norton; 2008. 2. Harvard Health Publications; 2014. 3. The Times; 2014. 4. Gelles D. The mind business. FT Magazine. 〈http://www.ft.com/cms/s/2/ d9cb7940-ebea-11e1-985a-00144feab49a. html#axzz2sqm5v1al.〉; 2012. 5. Bernier M, Thienot E, Codron R, Fournier JF. Mindfulness and acceptance approaches in sport performance. J Clin Sports Psychol. 2009;4:320–333. 6. Clarey C. Olympians use Imagery as Mental Training. The New York Times. 〈http:// www.nytimes.com/2014/02/23/sports/ olympics/olympians-use-imagery-as-men tal-training.html?hpw&rref=sports.〉; 2014. 7. Dietlind L, et al. 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. http://dx.doi.org/10.1016/ j.ctcp.2013.09.003).
Aaron Winkler, is an MD Candidate at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
Victor S. Sierpina, MD, is the W.D. and Laura Nell Nicholson Professor of Integrative Medicine, Professor Family Medicine, Director of Medical Student Education, at the University of Texas Medical Branch in Galveston, Texas. He is an associate editor for EXPLORE.
Mary Jo Kreitzer, PhD, RN, is the founder and director the Center for Spirituality and Healing and a professor in the School of Nursing at the University of Minnesota, Minneapolis, Minnesota.
Education