Table 1

Summary of responses

	Question 1		Question 2		Question 3		Question 4		Question 5		Question 6
A	Y	1	Y	2	N	3	N	4	C	5	N	6
B	C	7	N/A		C	8	C	9	C	10	N
C	Y	11	N/A		C	12	N		N		N
D	Y		N/A		Y	13	N		C	14	C	15
E	Y	16			C	17	N	18	C	19	N	20
F	Y				Y		N		C	21	N
G	Y		N/A		Y	22	N		C	23	N
H	C	24	C	25	C	26	C	27	C	28	N	29
I	Y	30	N/A		Y	31	C	32	C	33	C	34
J	Y		N/A		N		C	35	C	36	N
K	Y		N/A		N		N		C	37	N
L	C	38			C	39	N		C	40	N
M	Y	41	N/A		C	42	C	43	C	44	C	45
N	Y		N/A	46	C	47	N	48	C	49	N
O	Y	50	N/A		Y	51	N		C	52	N
P	C	53	N/A		C	54	C	55	C	56	C	57
Q	Y	58	N/A		Y	59	Y	60	C	61	N
R	Y	62	N/A		Y	63	N		C	64	N

Comments
1.	Our curriculum includes a few occasions when complementary medicine is discussed. This occurs particularly in relation to a clinical oncology attachment that students undertake in the penultimate year of the course. Students also have an opportunity, should they wish, to choose to write about some aspects of complementary medicine, although very few students take up this option.
2.	Complementary medicine has been discussed among the curriculum planners of the MBCHB programme (in *** medical school) and we felt that it had a very limited place in our course. We are keen to emphasise that patients may choose to be supported by complementary medicine approaches, but we are very keen to stress the practice of evidence based medicine.
3.	We are not aware of any requests, pressures or requirements from any groups of individuals or statutory bodies to include complementary medicine in our curriculum.
4.	We have no plans to amend our curriculum with respect to complementary medicine at present.
5.	I do not think that staff would be in favour of an increased prominence of complementary medicine within medical education as they are all very keen to support evidence based teaching and practice. However, we are keen to ensure that students understand that patients may wish to choose such a clinical pathway.
6.	In answer to your final question as to whether or not we consider the matter to be a problem, I am a little uncertain as to what the question is getting at. We believe that we have the balance of complementary medicine teaching and information right within our curriculum and have no plans to change it.
7.	Students encounter CAM several times along our spiral curriculum, Their first encounter is early in year 1 with a trigger being present in a PBL case, this trigger is supported with a plenary entitled ‘Complementary and alternative medicine’ and a Pharma-CAL-ogy tutorial on alternative therapies. The topic is revisited again in year 2 within a PBL case and then CAM is considered throughout all the year 3 and 4 pathway weeks. In year 5 it is embedded within a number of indicative presentations.
8.	I believe we were asked about the level of CAM in our syllabus by the GMC relatively recently
9.	None at present, we do however systematically review our content and if there were enough evidence to suggest we needed greater coverage, efforts would be made to ‘fill the perceived gap’.
10.	I suspect as with any change in curriculum, their position would depend on the rationale and evidence for such an increase.
11.	During our 4th year (equivalent to 3rd year in most university medical courses) all students have one day of teaching and experience in CAM. The aim of this day is to introduce CAM to all the students so that they get an opportunity to hear about how patients use CAM in dealing with health problems. They get some idea of who does what and why and when it can be beneficial. I have attached the timetable from last autumn. There may also be opportunities for students to pursue a 4 week SSM into an aspect of CAM later in the same clinical year.
12.	Our current level of inclusion seems to meet needs.
13.	CAM included formally following request from GMC in 2001. No outstanding requests following curriculum revision in 2005.
14.	Opposed.
15.	Medical students need to be aware of CAM and the types of therapies patients might be taking.
16.	The curriculum contains both taught components (within a fully integrated curriculum) and practice components—during clinical attachments in relation to pain management and palliative care, and general practice.
17.	“Tomorrow's Doctors 2”, from GMC, included CAM as a theme.
18.	Not at present.
19.	Some staff would be in favour and others would be opposed to an increased prominence of CAM in the curriculum.
20.	Not currently.
21.	Opposed.
22.	GMC.
23.	Varies. I think all staff appreciate that some understanding of CAM is important as so may people/patients use it.
24.	In 2008/09 the school was inspected by the GMC Education Committee (QABME). In their draft report they say that they were satisfied that “students were aware of alternative and complementary therapies and learn about them in Year 2, and a student-selected component is available”. Also some community placements in Year 2 (referred to as ‘Medicine in Society’) are with CAM practitioners ∼ only a small minority of students are exposed to them though. The exposure to CAM in the ‘core’ curriculum in Year 2 is minimal, in my view ∼ just one lecture-workshop by a professor of CAM from the University of ***.
25.	Surely it is unlikely that any MBBS curriculum in the UK makes no reference to CAM? ∼ it is a requirement under Tomorrow's Doctors 2003.
26.	The implication of your Q is that CAM is under-represented (or not at all) in the MBBS curriculum ∼ not really applicable in our case. Numerous medical students here are strongly in favour of CAM and would no doubt like greater coverage. However there are also students who are adamantly opposed, and would like the school to reduce its coverage (eg, by dropping certain community placements in Y2). The GMC is satisfied with the current treatment of CAM in our MBBS curriculum (see Q1).
27.	I shall be making a proposal to introduce a new module with elements interspersed throughout the MBBS curriculum. The module would have 8 major topics, of which CAM would be one.
28.	Academic staff at *** hold views on CAM that span the spectrum from strongly opposed to favourable. Special criticism has been directed here at the dubious scientific basis for homeopathy. One expects inevitable resistance when existing curricular content has to make way for new elements, particularly if those have an uncertain evidence base.
29.	I personally feel that our school's existing MBBS provision on CAM is too little, but any curricular element has to justify its inclusion.
30.	We have a lecture on complementary medicine as part of our introductory clinical pharmacology course.
31.	The GMC Tomorrow's Doctors outcome of “Demonstrating awareness that many patients use complementary and alternative therapies” etc is the statement against which we are judged, so that is the main driver. Students are certainly interested in complementary medicine and we used to have an SSC run by enthusiasts which was popular, but that did not prove sustainable. There is no great clamour for increased coverage.
32.	We are in the midst of a curriculum review, so the location of teaching may change, but it is unlikely that the coverage will be much different in extent.
33.	Not really.
34.	Not when considered in the context of all the other outcomes in Tomorrow's Doctors that have to be addressed in 5 years!
35.	We are currently undertaking a curriculum review and CAM will be considered together with every other element that is covered in the 4 year programme to determine when, if and how the learning and teaching on this subject will be covered.
36.	I do not have sufficient insight into the thoughts of the totality of our faculty to be able to answer this question honestly. It is likely that I will be better informed during the curriculum review process.
37.	Subjective response likely to reflect my attitudes. Not in favour of increasing from present level. The answer is not evidence (robust) based, but I think current staff would think level of content is not in need of change.
38.	A couple of lectures that cover patient-centred treatment, which explicitly review a range of CAM therapies and their perceived value. Also CAM issues are raised in the core teaching where relevant—for example acupuncture in the context of the physiology of pain, herbal remedies especially in the context of drug interactions, but also where they have known mechanisms of action. Other than that, there are student selected components for those who are interested.
39.	The GMC mentions teaching about CAM in Tomorrow's Doctors (“Graduates must be aware of the existence and range of such therapies, why some patients use them, and how these might affect other types of treatment that patients are receiving”), so this is a requirement.
40.	No one to my knowledge has objected to the GMC requirement above, which encompasses the psychological benefits of alternative approaches and how this can assist conventional therapy. Beyond that, I think that if an alternative therapy had an evidence base on a par with conventional medicine then staff would be happy to devote a proportionate amount of time to it, but not to CAM that lack evidence. We have far too little time to teach the basis for conventional, proven medicines.
41.	In the core curriculum there is a session in Year 1 where the students have a lecture on CAM (lecture notes attached) and this is followed by a session where they meet a CAM practitioner with one of their patients. The lesson plan for this session is also attached. Additionally we have various SSC options including SSCs in CAM (in general) and homeopathy (intro document for same attached).
42.	Not really. *** has a lot of CAM practitioners - certainly in the central area and so it is something students are aware of. I don't think CAM teaching is a requirement of the TD3. CAM teaching is not particularly in demand from students.
43.	We think we have got it about right at present. I would like to see perhaps another teaching session on CAM later in the curriculum perhaps in years 3–5. Their current teaching in Year 1 comes a bit early.
44.	I think that would vary from person to person. In fields like rheumatology many, perhaps the majority of patients, use or have used some form of CAM, so the case for it there is strong. I think that the answer to that question also depends on the quality of the teaching. We follow a reasonably/sufficiently evidence-based approach—for instance we held a public debate between a homeopathic researcher and an epidemiology professor.
45.	I personally, as a consultant senior lecturer, think that there are issues about CAM education that need to be addressed in the curriculum.
46.	However we did discuss and used a Delphi technique to decide on content etc.
47.	GMC requirements.
48.	We monitor and quality assure the current CAM content.
49.	They accept the current level we have in the curriculum—any more would be very difficult due the need for other subjects in current curriculum.
50.	Yes, ours is a PBL centred course, and complementary medicine is flagged as a learning objective in a number of modules. Homeopathy, acupuncture and herbal medicine are also available for study in depth as special study modules (SSCs). We have a senior lecturer of homeopathy on faculty staff.
51.	The original decision was influenced by the GMC, and also by pharmacologists who wanted students to be aware that patients used CAM.
52.	This depends on which staff you consult!
53.	We have a PBL based curriculum. Within the PBL cases there are incidents of patients taking or requesting CAM treatments. We support this with a number of seminars and lectures. The aim is to give the students an awareness of CAM rather than detailed knowledge. Some students choose to look at CAM as part of their student selected studies.
54.	The GMC requires an awareness of CAM but does not require detailed knowledge or the ability to prescribe CAM.
55.	The curriculum is constantly under review but we do not at present have specific plans to amend the CAM component.
56.	We are in favour of educating the students about CAM but do not see that increased time or effort directed towards CAM would be appropriate given the other important areas within the curriculum which need to be given increased attention such as substance mis-use and prescribing.
57.	As above.
58.	In Years 2 and 4.
59.	As it is common question from patients, we think it is important for students to be aware of.
60.	Dr ***, consultant oncologist is looking at this currently.
61.	Would need to be reviewed to ensure balance is correct, may be some resistance.
62.	Yes, taught within the community part of the programme.
63.	GMC.
64.	Possibly in favour.

The 18 responding medical schools have been randomly designated as A–R in the table. Answers for each question (where a response was given) are indicated by Y for ‘Yes’, N for ‘No’, and N/A for ‘Not Applicable’. Where no explicit ‘Yes/No’ response was given but a comment was provided instead, this is indicated by C. The numbers in the body of the table refer to comments, which are set out below the table. All identifying features of specific medical schools or individuals have been removed.
CAM, complementary and alternative medicine; GMC, General Medical Council; PBL, problem-based learning; SSC, student selected component; SSM, special study module; TD3, Tomorrow's Doctors 2003.