Interprofessional Education on Complementary and Integrative Medicine

Interprofessional education and complementary and integrative medicine (CIM) strive for patient‐centred medical care. Combining both concepts in education seems promising to prepare students for future health care. This article explores the question of what should be considered in undergraduate interprofessional training on complementary and integrative medicine for students of medicine and other health care professions and what benefits can be expected.

broad set of health care practices that are not integrated into the dominant health care system. At present, neither doctors, nurses nor other health professionals may feel sufficiently qualified to satisfy patients' preferences for complementary medicine or to advise them appropriately. 3 To meet the demand for holistic care, it is necessary to combine complementary medicine with conventional health care. This integrative medicine is an approach which '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'. 4 6,7 To meet the demand for holistic care, it is necessary to combine complementary medicine with conventional health care. Nevertheless ing with a complex problem. 8 The assessments in all three Delphi rounds related to a potential CIM training programme that could be offered within an interprofessional setting at medical schools.
In the first and second rounds, the experts identified and weighted suitable competencies and topics. These results are published elsewhere. 9 In the third round, the experts discussed teaching methods and framework conditions ( Figure 1).
Selection criteria for the participating experts were defined by a steering group (AH, general practitioner, nurse, patient representative, teaching coordinator and course administrator); for example, the experts should have various professional backgrounds and a wide range of experience in teaching and patient care. Physicians were selected from the outpatient and inpatient sectors, and from various disciplines such as paediatrics and geriatrics. In addition, students, patient representatives, health insurance representatives and stakeholders, such as institute directors, were invited to incorporate the perspectives of learners, patients and medical faculties. Experts were recruited through professional associations, for example membership F I G U R E 1 Delphi process: Overview of the three rounds of the survey process lists of the Society for Medical Education or through the Association of Representatives of German Students of Medicine and Physiotherapy.
Participation in the previous Delphi rounds was a prerequisite for participation in the subsequent rounds to ensure a dynamic consensus-finding process. Anonymity within the survey process was strictly maintained to prevent the authority, personality or reputation of some participants from dominating others. Participants were personally invited by e-mail. A reminder was sent after 3 and 6 weeks. After each round, the participants received a comprehensive report in which all results were summarised and presented.
In all, 40 experts were invited to the third Delphi round to answer the following two open questions used for the analysis in this study.
In your opinion, what are the greatest.
1. benefits and/or opportunities 2. barriers and/or challenges when offering an interprofessional CIM teaching programme at a medical school?
The statements were analysed directly on the text material by authors AH and BS independently of each other using content analysis. 10 All free-text answers were broken down and arranged according to comparable statements; key categories and subcategories for both questions were formed inductively from these statements with the help of MAXQDA 11 (VERBI Software, 2019) and then all statements were grouped into these categories. Finally, AH and BS discussed their identified categories and assignments until consensus was reached.

| RE SULTS
The response rate was 90 % for the invitation to the third Delphi round (n = 40), and 55 % for the original expert panel (n = 65). All participants of the third round (n = 36) answered the two open questions underlying this presentation ( Table 1).
The stated benefits/opportunities could be assigned to the main categories of patient care, teaching and learning, and faculty development. Two statements could not be assigned because they were too general. One of them emphasised the importance of interprofessional teaching ( Table 2).
The cited barriers/challenges could be assigned to the main categories of teaching and learning, faculty development, and implementation. Three statements could not be assigned because they emphasised the benefits of interprofessional teaching ( Table 3). The complete quotations are available in the Supporting Information.

| DISCUSS ION
The experts named numerous different benefits and barriers that could arise from offering an interprofessional CIM training. In the following, the results are discussed according to the key categories.   there is also a lack of structures to not only provide a pool of scientists and practitioners but also clearly define the subject area.
This means that pioneers are needed to take up the field and give it an evidence-based foundation. It has already been shown that evidence-based medicine and complementary medicine can be combined well conceptually. 14 This connection also seems important in view of the concern that scientific knowledge might be lost through teaching in this area.

Categories Example quotations
Teaching and learning Uncritical teaching • To present the diversity of complementary medicine and enable students to form their own judgment (6) • Teaching an open but also critical approach to CIM methods (36)

Content overload and arbitrariness
• To develop a curriculum that covers as many important complementary fields as possible and also clearly sets out the limits of complementary methods (9) • Wanting to teach far too much content or competencies (10) Differences in prior knowledge and experience • To design CIM contents in such a way that every student is challenged and benefits without being overburdened. The students from the different areas have different levels of prior knowledge according to the respective courses of study with their main focus. Thus, the students are at different starting levels (1) • Different previous knowledge, learning requirements. Profession-specific reservations about the other professional groups. Different levels of experience with regard to teaching/learning methods and potentially, as a result, reservations about certain formats (13) Lack of openness and motivation among students • The motivation of the students will be very different (10) • Depending on the level of training, especially of medical students, orthodox medical thinking is already strongly developed. Therefore, complementary medicine could be difficult to accept (16)

Faculty development
Lack of acceptance • Lack of acceptance by the scientific disciplines (28) • Institutions/faculty may not support the programme, may not award any credits relevant to doctoral studies, and consequently the seminar is not taken (32) Fail to reach an agreement • The relevance of CIM may vary in the different areas (8) • To compile a curriculum that is relevant and interesting for the participating students (9) Loss of scientific thinking • Loss of critical reflection on medicine, nursing and care in general, because CIM is for the most part not evidencebased (21) • Lack of evidence. Promotion of procedures and methods that would be taught at the scientific level without proof of benefit and thus may not fulfil the task of teaching and research in terms of quality (29)

Implementation
Difficult scheduling • Scheduling different study programmes (18) • That it represents an additional time burden and that the workload is too great for interested students (35)

Recruitment of lecturers
• Difficulty in finding suitable lecturers with a university degree and sufficient experience (10) • Selection of suitable lecturers who critically evaluate the available data and communicate it in a balanced way to the students (36) Unequal composition of participants • If too few people from one professional group participate, this can confirm stereotypes or make the implementation of learning with each other more difficult (3) Notes.: N = 36; Numbers in brackets indicate experts' sequential identification number; quotations are arranged according to the frequency of mention in the main categories, subcategories and identification numbers.

| Conclusion
The results suggest that, from the experts' point of view, interprofessional education focusing on CIM is suitable to meet future challenges in the health care sector. In particular, it is assumed that the different perspectives of the individual professional groups on the needs of the patient, as well as consider the different care paradigms (conventional and complementary medicine) in interprofessional training, will have positive effects on holistic and team-based care and on faculty development. It might be challenging to teach the topics within an interprofessional setting in a critical manner. However, the results indicate that it is important to create structures to define CIM content in the interprofessional field and underpin it with a scientific basis to provide high-quality teaching that meets the scientific demands of the faculties, as well as the individual expectations of the patients.

ACK N OWLED G M ENTS
We would like to thank all the experts who were willing to take part in the time-consuming survey rounds and who contributed to a lively exchange with their many comments. Open access funding enabled and organized by ProjektDEAL.

CO N FLI C T O F I NTE R E S T
None.