Positive Health Online

The Challenges

As we enter the new decade there are many challenges ahead for Complementary and Alternative Medicine (CAM) education providers and it will be difficult at this time to predict the overall effect. For example, as with most sectors of society, the economic crisis will be a major factor with many potential students wishing to train, but being unable to afford the fees as well as the other expenses of full or part time education. However, on the other hand, there are potential students with redundancy settlements or facing a forced career change who will have an opportunity to follow an ambition and retrain in a chosen career. For the private sector, the pressure of the economic crisis will be very challenging. The Further and Higher Education (F. & H.E.) sectors face significant reductions in Government funding, in the order of 13% for H.E. over the next three years, which will require an increase in the efficiency while attempting to maintain the quality of learning experience; otherwise courses will close due to lack of viability as students will not join substandard provision.


Over the past decade groups such as Sense About Science have campaigned against not only educational provision, but in the case of Homeopathy, also the access of patients to this treatment within the NHS. These attacks have been resisted by groups such as Homeopathy Worked for Me,[1] formed to oppose the erosion of patient choice especially for many of those with chronic conditions for which orthodox healthcare has provided little relief. The House of Commons, Science and Technology Committee report's recommendation that Homeopathy should no longer be funded on the NHS[2] was a further set back. However, the report's identification that the only acceptable research methods are Randomized Controlled Trials (RCTs), showed how little consideration and understanding there had been by the committee of the complexities of the clinical setting. Members and associates of the anti-CAM pressure groups that write newspaper columns have also taken to unprofessionally attacking individuals without affording the courtesy of an informed, right of reply.[3] In addition, the attacks on education providers provision is most often based on quoting lecture notes out of context without seeking a balanced or informed understanding, which does little to encourage such institutions to do anything other than keep what they do away from such individuals or groups.

The falling numbers on some courses, brought about by a decrease in demand and some over provision, as well as the harassment and personal attacks by anti-CAM pressure groups, has led to some course closures most notably in Homeopathy, but also Acupuncture and eclectic programmes such as Complementary Therapies.[4] However, with such a robust and diverse private sector whenever there are course closures in the F. & H.E. sector, there are still quality courses available for applicants to choose. Unfortunately, each H.E. course closure, which most often is for several of the above reasons, is rapidly identified as evidence of victory by the anti-CAM pressure groups.[4] It is ironical that both the House of Lords, Select Committee in Science and Technology in 2000[5] and the Foundation of Integrated Health[6] recommended increasing standards of education and clinical training. However the pressures of the past few years have meant that there are now fewer CAM degree courses offered either within or in collaboration with universities. In addition, the reduction of university course provision is depriving the professions concerned of the development of the very research that the therapies are criticised for not having.

The Changing Pattern of Provision

The economic challenges of the past few years have already lead to private courses being under pressure. Across the Complementary Medicine sector, from Osteopathy to Homeopathy over the past two years, many providers have experienced a reduction in intake, sometimes as high as 50%. This significant recent change has been on top of the steady evolution in the nature of provision over the past 15 years. In the late 1990s there was a dramatic increase in demand for courses both in the private and F. & H.E. sectors.[7] By the middle of the last decade, provision was beginning to change[8], with the private institutions continuing to offer a wide variety of courses and Further Education colleges beginning to develop Foundation degrees in Complementary Medicine. Most frequently the Foundation courses included the therapies of Aromatherapy, Reflexology and Massage. By September 2009 approximately 40 Foundation degree courses were offered in England and Wales. These courses are normally delivered by F.E. providers in partnership with universities that are required to offer the opportunity for students to progress onto relevant Honours degree courses. A requirement of Foundation degrees is collaboration with employers; however in a profession characterized by self-employment there are not the large employers to provide the necessary placements. Therefore work experience for students most often focussed around working in a college clinic or the supervision of cases taken outside the institution.

However, for therapies requiring a more extensive education and training, the provision of University validated courses, frequently in collaboration with private providers, continued to grow in the early years of the 21st century. These mutually beneficial arrangements led to the development of the quality assurance procedures for CAM courses of private providers, research activities, staff development opportunities, as well as in many cases the ability to take advantage of funding council income and financial assistance for students.

For professions such as Osteopathy, Chiropractic, Acupuncture and Herbal Medicine in which degree level education has become the minimum entry qualification, there has been more recently the development of Integrated Masters courses. These programmes have provided the opportunity to not only move the academic qualification to a higher level, but also to provide an additional year to complete the high number of clinical hours required for registration with the professional body, further develop research skills as well as consolidate clinical skills. Also, as many students entering the complementary medicine professions, up to a third on some courses, are mature students frequently already holding first degrees, the offer of Integrated Masters avoids such students having to pay full cost fees which would be incurred because of recently introduced Equivalent and Lower Qualification (ELQ) legislation.

The Evolution of Course Content

With the challenges of starting and maintaining a successful practice especially in the current economic climate, it is even more important that CAM courses include training in business skills. Other curriculum developments needed to strengthen the employment opportunities include embedding governance in clinical experience so that graduates are familiar with the standards required not only for the safe and effective private practice, but also to enable them to obtain employment by contracting with the NHS. Wherever possible courses, both within the private and public sector, need to provide not only supervised clinical training but also placements, so that students are more familiar with working in a variety of environments to develop the skills and experience to strengthen their employability.

To further strengthen the skills of students, the health sciences content of courses needs to be sufficiently strong, not only to ensure that 'red flags' are efficiently recognized and where appropriate referrals to other healthcare professionals is managed, but being confident to communicate in the biomedical model is an important facilitator in developing integrated provision with GPs and others in the NHS.

The professional bodies are an important driver for curriculum development. Continuing professional development requirements needed to maintain registration with professional bodies will be an aspect of provision that increasing numbers of educational institutions want to provide, to ensure practitioner skills are kept up-to-date, thereby strengthening their employability skills.

Further Developments

As the many CAM professions develop, a wide range of levels of educational provision will continue to be required. Currently the undergraduate level most widely available in universities or in collaboration with them is BSc (Honours) courses. However, mirroring the developments in Osteopathy, Chiropractic and Chinese Medicine, the development of Integrated Masters would meet the demand for graduates who, through the additional year of full time study beyond BSc, are more experienced and confident practitioners, and with enhanced research skills will be able to contribute to the evidence base of their profession. With the development of Integrated Masters, educational providers are also likely to seek the validation of MSc courses that require a substantial research dissertation this would lead to the further development of the research skills of the practitioner as well as contributing to research into the therapy concerned. MSc graduates with the experience of having carried out a research project are well prepared to complete MPhil or PhD. The ability to train to these levels of research acumen and advanced practitioners skills, will be essential if the professions are going to be able to meet the challenges of this decade, especially the demand for the evidence base for techniques and mechanisms in CAM.

References

1.    Homeopathy Worked for me: Trustees@homeopathyworkedforme.org
2.    www.parliament.uk/parliamentary_committees/science_technology/s_t_homeopathy_inquiry.cfm
3.    Guardian Series: Bad Science. Faith makes regulating herbal medicine difficult. 20th February 2010.
4.    www.guardian.co.uk/education/2008/aug/27/highereducation.research
5.    House of Lords. Sixth Report of the House of Lords Select Committee on Science and Technology. HL123. London, England: Stationery Office; 2000.
6.    Foundation for Integrated Medicine . Integrated healthcare - a way forward for the next five years. London, England: The Foundation for Integrated Medicine; 1997.
7.    Isbell B. Finding the right complementary therapies course. Complementary Therapies in Nursing and Midwifery 10, 92-96. 2004.
8.    Isbell B. A Decade of University Complementary Therapies Provision. Positive Health 135, 20-23. 2007.

Further Information

For additional information about courses contact: School of Life Sciences Admissions, University of Westminster, 115 New Cavendish Street, London W1W 6UW. Tel: +44 (0)20 7911 5883; Fax: +44 (0)20 7911 5079;   cav-admissions@wmin.ac.uk    www.westminster.ac.uk/schools/science