Integrative Health Elective for medical students at the College of Physicians and Surgeons

Description
The Department of Medicine has always done an outstanding job teaching medical students the essential principles of Internal Medicine. During their Internal Medicine rotation, they learn how to acquire and organize the information necessary to generate a differential diagnosis. They learn about the pathophysiology of the diseases we treat and the pharmacologic therapies available. However, during this rotation the focus is on disease. The amount of knowledge they have to master often does not leave time to learn about factors that influence health but that may not be considered part of a traditional medical education. Understanding patients’ diet and exercise habits, the environment in which they live, their spiritual beliefs and ways of managing stress can be as important in helping them reach a state of health as prescribing the correct medication. Similarly, while responsible physicians always seek to know how other medical practitioners (surgeons or psychiatrists, for example) are treating their patients, it is easy to overlook the complementary, non-standard methods patients often seek outside the medical system.

The Integrative Health elective will allow students the opportunity to learn how to interview patients about topics as diverse as nutrition, sleep habits, and potential toxic exposures resulting from their habits or their environment. They will see the impact that spiritual concerns can have on a patient’s health.  They will learn about the risks and purported benefits of the “natural” or herbal remedies patients often take on their own. They will also learn about complementary methods of treating patients, such as acupuncture, yoga, and meditation, and will see how these can be used in conjunction with standard medical care. This course will provide a useful adjunct to the essentials of Internal Medicine taught during the Major Clinical Year. It will teach knowledge and skills that will be relevant in any medical subspecialty and will help provide our students with the broadest possible understanding of their patients. By teaching them non-pharmacologic ways to help patients return to health, it will augment the armamentarium at their disposal as they treat patients with complex and interlocking sets of symptoms.

Schedule
The student will spend one day a week under the supervision of Dr. J. Gregory Mears in the Division of Hematology/Oncology. He is the Director of Integrative Therapies for the Division. The student will be introduced to the interweaving of evidence based integrative therapies such as meditation, yoga and acupuncture in the management of patients with malignancies and other chronic hematologic illnesses. The student will be provided copies of relevant research papers for review and discussion.

The student will spend one or two days a week under the supervision of Dr. Elena Ladas. Dr. Ladas is an Assistant Professor of Nutrition in Pediatrics and in the Institute of Human Nutrition, and Co-Director of the Center for Comprehensive Wellness. Students will have an option for either an adult or pediatric rotation.  They will be able to observe acupuncture, massage, yoga, and dietary/supplement counseling with adults or children with cancer.  In pediatrics, they will get exposure to both an inpatient and outpatient setting; the adult service is limited to an outpatient setting.  If they were interested in research, Dr. Ladas would be able to introduce them to research opportunities in this field.

The student will spend one or two days with Kathleen Sanders, FNP-BC, MPH. She is an Integrative Health Nurse Practitioner in the Department of Hematology-Oncology. She is trained in nutrition and supplement counseling as well as in mind-body modalities; she uses guided imagery, Mindfulness Based Stress Reduction, a Mindful Eating program, and clinical hypnosis to treat her patients. In this setting, students will have the opportunity to observe the utility of adding evidence-based complimentary modalities for the management of pain, anxiety, fatigue, and sleep disorders, and for stress related to procedures, infusions, surgery and life style change issues. They will also be given time to work with motivational interviewing as a way to help patients make self-care changes during challenging times in their lives.

Under the supervision of Linda Golding, Staff Chaplain, the student will spend one day a week shadowing chaplains from the CUMC Department of Pastoral Care & Education as they visit patients and families throughout Milstein, CHONY and selected outpatient clinics.  The student will have the opportunity to observe, learn, write about and practice listening skills attuned to the spiritual, that is the non-physical, concerns of patients and families and how these impact their medical care. They will have the opportunity to observe the ways in which chaplains lead groups of patients, families, staff. They will learn how meditation, coloring and reiki can support patient healing, what prayer is and isn't, and when to make a referral to a chaplain.

            Dr. Pooja Shah is the director of the Integrative Medicine track in the Family Medicine residency. Students will spend one session a week with Dr. Shah in the Family Medicine clinics, learning how to treat complex chronic pain syndromes without opioids. They will have the opportunity to observe and when appropriate to practice comprehensive history taking (including biopsychosocial histories) and comprehensive physical examinations. They will spend time observing procedures including joint injections, myofascial release, trigger point injections, and acupuncture services. They will learn some mind-body practices and how to teach them to patients.

            Finally, students will meet with the course director, Dr. Elizabeth Mayer, once a week. Dr. Mayer is an Associate Professor in the Division of Rheumatology. This time will be used to review the student’s experiences of the preceding week and to shape the elective to match the student’s individual interests.

Eligibility
This elective is open to medical students enrolled at Columbia University’s College of Physicians and Surgeons, and to medical students at some other medical schools. For more information please contact Dr. Elizabeth Mayer (eaw11@columbia.edu) or Brooke Rawson, Program Coordinator at P&S (212-305-1642).