Building Research across Inter-Disciplinary Gaps (BRIDG)
Clinical Research Training Program in Complementary and Integrative Health
The National University of Natural Medicine (NUNM) and the University of Washington (UW) host a unique collaborative research training program (BRIDG, Building Research across Inter-Disciplinary Gaps) focused on preparing the next generation of clinical complementary and integrative health (CIH) researchers. Supported by an ongoing grant from the National Center for Complementary and Integrative Health (NCCIH), the BRIDG program provides up to 3 years of postdoctoral research training support for doctoral-level CIH clinicians (e.g., ND, DAOM, DC, DPT, DO), and conventionally trained (e.g., PhD, MD) researchers who are interested in learning how to conduct clinical CIH research.
The BRIDG program has two inter-related programs referred to as the “T90” and “R90” programs for training elements offered at the UW and NUNM respectively. The T90 program is based at the Seattle, WA campus of the UW, and offers an immersive training experience for doctoral-level CIH clinicians interested in learning the methods and processes of clinical and translational research, with dedicated mentorship. The R90 program is based in Portland, OR on the campus of NUNM, and offers immersive training to conventionally trained researchers interested in observing and researching CIH practices, with dedicated mentorship. Both programs include didactic training via coursework, seminars and retreats, plus research activities to support the development of independent research careers.
The program directors represent the multi-disciplinary nature of the training program and include: Heather Zwickey, PhD and Ryan Bradley, ND, MPH at NUNM and Cathryn Booth-LaForce, PhD and Yvonne Lin, PhD at the UW.
eHealth Literacy in NHIS Subpopulations
Principal Investigator: Siobhan Maty, PhD
Student Investigator: Daryl Nault
Background: The Internet is a primary communication source for health information. Electronic health information (eHealth) is a juncture for public health, health services, health education, and web-based services. eHealth literacy as identified by Norman and Skinner (2006), is used to describe, required for an individual’s “ability to seek, find, understand, and appraise health information from electronic sources, and apply the knowledge gained to address or solve a health problem”.1,2 Six key literacies are classified as representing eHealth literacy as a construct: (1) traditional education, (2) computer skills, (3) information seeking, (4) health application, (5) scientific analysis, and (6) media evaluation literacies. For any eHealth modality to be effective, it is prerequisite for users to be comfortable with the technology used. The millennial generation was born in a time (1980-2000) when digital technology was first becoming widely available to the public. Millennials are the first generation to grow up with widespread Internet access, making them a population of interest when studying eHealth literacy. Supplement users, much like millennials, have been depicted as a healthy, well-educated group that also seeks much of their information from the Internet.3 The 2002-2012 National Health Interview Survey (NHIS) Alternative Health supplement data supports current evidence that supplement use rates have continued to increase over the past 30 years.4
Objectives: To explore, describe, and test the conceptual framework of eHealth literacy (eHL) within a nationally representative survey population.
Methods: Using a sample of 32,911 from the 2012 NHIS cross-sectional household survey, several analyses will be performed. Two of six eHL components, scientific and media literacy, are more abstract in their nature and, consequently, are difficult to measure with survey data. The analyses described in this protocol will use NHIS variables as a proxy to represent the four-eHL components that are measurable as independent variables. In order to capture a more complete view of eHL within a nationally representative subpopulation, self-reported health information source will be used as a variable to represent the best available approximation for abstract eHL’s. Initially, a Principal Components Analysis will assess whether or not independent variables suggestive of eHealth literacy appear to measure a similar construct. After key variables are identified, a cross tabulation of demographics and these key variables will be performed to elucidate differences between the millennial and non-millennial populations, as well as the millennial supplement users and non-supplement users. Logistic regression will be used to determine association between supplement use and eHealth literacy variables. Associations between eHealth literacy variables and sources supplement users report using to obtain information on their supplement of choice will also be investigated.
OHSU Exchange Program: Evidence-Based Medicine Faculty Shadowing Program
In 2007 NCNM was awarded a research education grant (R25) from National Institutes of Health – National Center for Complementary and Alternative Medicine (now National Center for Complementary and Integrative Health). The focus of the grant was to introduce research literacy and evidence-based medicine (EBM) into the NCNM curricula. The first four years emphasized evidence-based teaching initiatives within the classroom setting and the second four years focused on evidence-based practice in clinical education. In 2015, the Evidence-Based Medicine Faculty Shadowing Program was piloted in collaboration with Oregon Health & Science University. The purpose was to introduce NCNM faculty to new teaching strategies that could be used to integrate EBM into NCNM’s naturopathic and classical Chinese medicine curricula. During the program, NCNM faculty were paired with an OHSU faculty member for two months, observing their resident teaching shifts and other clinical teaching sessions. This unique opportunity allowed NCNM faculty members to observe how OHSU incorporates evidence-based medicine into clinical teaching, introduced them to new interprofessional relationships, and provided inspiration to develop and implement new teaching strategies on their own clinic shifts. A publication on this project is in development.
Research Education Grant: Research in Complementary and Alternative Medicine Program
Funding: NIH R25 Grant
Abstract: In 2007 NCNM was awarded a research education grant (R25) from National Institutes of Health – National Center for Complementary and Alternative Medicine (now National Center for Complementary and Integrative Health). The focus of the grant was to introduce research literacy and evidence-based medicine (EBM) into the NCNM curricula. The first four years emphasized evidence-based teaching initiatives within the classroom setting. In 2011 the grant was renewed for an additional four years. The second four years focused on evidence-based practice in clinical education.
The following published papers describe the grant activities and initiatives:
- A Train The Trainer Model For Integrating Evidence-Based Medicine Into A Complementary And Alternative Medicine Training Program
- Teaching Evidence-Based Medicine At Complementary And Alternative Medicine Institutions: Strategies, Competencies, And Evaluation
NUNM-CR: A Case Report Collection Tool
Principal Investigators: Kim Tippens, MSAOM, MPH and Ryan Bradley ND, MPH
Student Investigator: Melissa Barber
Abstract: The proposed feasibility study examines a novel tool to generate case reports to contribute to research and clinical practice. To our knowledge, there are no electronic data entry systems that prompt clinicians to include critical components of patient care to efficiently produce a case report. The CAse REport (CARE) guidelines provide a checklist of clinical elements to include. We are further applying these guidelines through an online case report data capture tool (National College of Natural Medicine-Case Report, or NCNM-CR), using the Research Electronic Data Capture (REDCap) platform. NCNM-CR has the potential to provide a framework for the production and assessment of case reports.
The specific aim of the proposed project is to assess the feasibility of using NCNM-CR as a tool to help generate case reports among practicing healthcare providers. We define feasibility as usability (practitioner-perceived effectiveness, efficiency, and satisfaction) and acceptability among users. Our secondary aim is to assess health practitioner-perception of whether NCNM-CR (a) contributes to clinical reasoning skills and (b) serves as a tool for case-based learning. Our research team will recruit four to eight healthcare providers representing different health disciplines (naturopathic, Chinese and/or allopathic medicine) to test NCNM-CR for the production of case reports. We intend to: (1) recruit providers from NCNM faculty and the Academy for Integrative Health and Medicine meetings; (2) have participants answer a pre-questionnaire and be trained to use the NCNM-CR tool; (3) have participants identify patient cases of interest for their case reports; (4) have participants use NCNM-CR to write a case report while documenting comments they have, the time it takes to complete NCNM-CR, and to write a case report; (5) have participants answer a post-questionnaire and participate in a focus group meeting to assess the NCNM-CR tool; and (6) if participants complete a case report, assess the quality of case reports generated using NCNM-CR according to the CARE Guidelines.
We will explore whether NCNM-CR is a feasible tool (effective, efficient, satisfactory, and acceptable) for use by healthcare providers to generate case reports. Our research team seeks to contribute to current research and clinical practice by providing a tool designed to help all healthcare providers, including Complementary and Integrative Health providers, to produce high quality case reports.
Empathy and Burnout Among Naturopathic Medical Students
Principal Investigator: Melissa Gard, ND
Student Investigator: Matt Hicks
In recent years investigators have studied empathy among physicians, residents, and medical students in order to better understand how it affects doctor-patient interactions, outcomes, and quality of life for physicians. Physicians and/or medical students with higher ratings of empathy have been correlated with higher rates of overall patient satisfaction as well as other admirable attributes such as professionalism and competency. Although it is an important interpersonal skill, especially among healthcare providers, the prevailing view is that empathy declines over the course of medical school and residency due to stress and professional burnout. When experienced by medical professionals, burnout has been shown to decrease the quality of care patients receive.
The primary aim of this study is to determine if burnout and a decline in empathy exists among Naturopathic medical students. No such studies have been done with this population. An electronic questionnaire was sent to Naturopathic students at the National University of Natural Medicine to measure empathy and burnout as well as demographics, using the Interpersonal Reactivity Index and the Maslach Burnout Inventory.
Study findings showed that there was no significant difference in empathy between program cohorts or between students in clinical internships versus those who were not. It also showed that burnout was prevalent among students and was inversely correlated with empathy, with empathy being positively correlated with higher senses of personal accomplishment. The prevalence of emotional exhaustion, a subset of burnout, increased for students in their final years of naturopathic medical school. Those who were in clinical internships and/or concurrent degree programs also had increased rates of emotional exhaustion, as compared to those who were not. Although a longitudinal study would provide more definitive evidence, the current findings suggest that interventions to prevent burnout and increase empathy may benefit the naturopathic medical student population.
Access the published paper here: https://www.sciencedirect.com/science/article/pii/S2212958818300855