BY KAREN SPURGEON WELCH, MD, ABFM, Fellow, Integrative Medicine and Behavioral Health, Clinical Instructor, Family Medicine, UTMBGalveston and Victor, S. Sierpina, MD
As public and professional interest has increased over the years in Integrative Medicine, there has been an increase in the types and quality of training in this field, including fellowship training. As part of a task force of the Academic Consortium for Integrative Medicine and Health, a team of us outlined in an Academic Medicine article what ought be core competencies for such fellowships(1).
At the time of our study, there were about 15 Integrative Medicine fellowships in the US, including some, such as at the University of Arizona, that are primarily online. Their emphasis varies but generally includes enhanced content on Pain Management, Nutritional Science, Mind-Body Medicine, and Lifestyle Medicine.
One driver of this move to expanding fellowships is the establishment of the American Board of Integrative Medicine (ABoIM) which now offers board certification in Integrative Medicine open only to fellowship-trained physicians. The purpose of this newly formed board is to provide the public with an identified group of physicians with substantial, and to some degree standardized, skills in Integrative Medicine.
Integrative medicine, as defined by the Academic Consortium for Integrative Medicine & Health: “Integrative medicine is a practice that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” Integrative medicine pairs synergistically with behavioral medicine in addressing and preventing conditions of behavior and lifestyle, which are now leading cause of death worldwide, as well as conditions that call for patient-centered options, from primary management of mood and functional disorders to collaborative management of cancer.
At UTMB-Health, we recently started a new fellowship in Integrative and Behavioral Medicine with one of the authors (KW) as the inaugural fellow. In order to design, implement, and fund this program, many months of work and effort were required not only by faculty, administrators, financial folks, graduate medical education department but by the incoming fellow who actively engaged in helping to create objectives, milestones, and learning activities that would be useful and of interest to her goals but also to serve for a scaffolding for future fellows.
Our UTMB-Health fellowship is intended primarily for graduates of Family Medicine residencies who are prepared with a robust foundation in behavioral health and full spectrum medical care. The fellow manages outpatient family medicine patients ranging in age from infant to elderly. The fellow partners with patient and family and coordinates multidisciplinary treatment teams in managing illness and cultivating wellness.
The overreaching goals of the Integrative and Behavioral Medicine Fellowship at UTMB is to produce physicians that are:
• Knowledgeable of the bio-psycho-social dynamics that effect wellness
• Skilled in elucidating patient’s values, desires, and health goals
• Equipped to approach patient care from a holistic and patient-centered perspective
• Experienced in integrative and behavioral modalities
• Prepared to act as healer to patients and leader in community and medical profession
The fellowship is one year in length, structured with longitudinal behavioral component throughout the year of training and integrative focus blocks that are four weeks each. Behavioral skills focus on mood management, behavior change, and health coaching and are obtained by way of instructor-led courses, self-guided learning, patient encounters alongside a marriage and family therapist, encounter audio recordings, and expert mentorship. These skills are practiced through each integrative block of the fellowship. Integrative focus blocks such as integrative oncology, women’s health, men’s health, and pain medicine are taught by way of texts and media, national conferences, and mentor guidance. The fellow may also choose to obtain training in a special skill such as functional medicine, motivational interviewing, acupuncture, mindfulness, or medical hypnosis.
A unique component of UTMB’s fellowship is participation in an integrative oncology consultation service throughout the fellowship. Patients living with cancer or in survivorship seek consultation for guidance in maximizing wellness, managing effects of treatment, and choosing integrative therapies that combine well with their overall treatment plan. A cancer diagnosis can feel disempowering, and integrative care can play a role in restoring hope, meaning, and a sense control.
Specialty training in integrative medicine and behavioral health enables the fellow to meet needs that are becoming more apparent in current medical climate: identifying health goals; guiding the patient through evaluation of integrative options; identifying behaviors that might be targeted as part of treatment or as means of prevention; working with the patient to make sustained behavior change and to move toward health goals. The optimal medical care of the future is now being trained for and modeled at the UTMBHealth fellowship in Integrative and Behavioral Medicine.
(1) Ring M, Brodsky M, Low Dog T, Sierpina V, et al. Developing and Implementing Core Competencies for Integrative Medicine Fellowships. Academic Medicine. March 2014: Volume 89(3); 421–428.