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Integrative Family Medicine Program

Maine Medical Center Family Practice Residency Program
Complementary and Integrative Medicine Project

Personnel: Experience and Key Responsibilities
Ann Skelton, M.D. will serve as program director. Dr. Skelton is the family practice residency Program Director and Assistant Chief of the Department of Family Medicine at MMC. In her role as the CAM education program director, Dr. Skelton will oversee administration of the project and the budget. She will supervise the project, engaging the faculty, residents and community CAM providers in the process, and ensuring timely completion of its objectives. She will assist in planning of workshops and in the curricular retreats. She will dedicate time for each faculty leader to work on the project and ensure that other faculty responsibilities do not interfere with their dedicated time. She will provide the leadership necessary to assure the integration of the CAM curriculum into the residency. Once implemented, she will evaluate and modify the CAM educational program. With the faculty expert, she will identify key individuals to promote and monitor the project as members of the Advisory Committee, which she will chair. She will attend the CAM education grant awardees annual meeting and file all project reports. As outlined above, she has extensive experience in faculty and curriculum development projects with successful outcomes.

Faculty expert:
The faculty expert will play a central role in this project. Craig Schneider, M.D. completed his residency in Family Practice at the Maine Medical Center Family Practice Residency Program and will finish his two-year fellowship in Integrative Medicine at the University of Arizona College of Medicine in the spring of 2001. In his studies in the Program in Integrative Medicine, he has learned about the history, theory, strengths and weaknesses of various medical systems including allopathic, chiropractic, osteopathic, naturopathic, homeopathic and Chinese medicine. He has worked with practitioners from different systems to understand their approaches and has evaluated literature from all over the world. Areas of instruction have included philosophy of science, history of medicine, placebo effect, mind/body integration, spirituality and medicine, nutritional medicine including use of appropriate dietary supplements, botanical medicine, energy therapies, interactive guided imagery, medical hypnosis, counterstrain manipulation, and research in CAM and integrative medicine. In his current fellowship practice, as in family medicine in general, a great deal of emphasis is placed on the doctor-patient relationship and ways of tapping into the patient's intrinsic healing responses. He helps patients sort through all the available treatment options in an intelligent way, helping them avoid untoward interactions and unhelpful therapies. He teaches mind/body techniques such as guided imagery, hypnosis, meditation and breathing techniques. He does some counterstrain manipulation, and often uses botanical medicines. He partners with and often refers to practitioners of Chinese medicine who use acupuncture and herbal therapies. In the program he has participated in patient case conferences, which involve an interdisciplinary team approach including physicians, a naturopath, a homeopath, Chinese medical practitioners, clinical pharmacist, spiritual advisor (rotating to represent different traditions), mind/body practitioners, registered dieticians and a variety of guest practitioners. Clearly, Dr. Schneider will bring a wealth of experience and knowledge when he joins us as our faculty expert upon completion of his fellowship.

His familiarity with our residency program, institution and community will facilitate his progress as faculty expert. During his grant-supported time with us, Dr. Schneider will assist the program director in convening the Advisory Committee, and will collaborate with local CAM providers in the Portland area to bring their perspectives to our educational program development project. He will help us to identify national experts as presenters in our introductory seminar and workshops. His presence as an in-house expert will provide guidance and support for our faculty leaders as they develop new skills and learn about CAM. He will work with our four faculty leaders and their CAM counterparts to develop a resident lecture series and will present some of those teaching sessions himself. We see contributing to the body of scientific knowledge as an important aspect of any efforts in this area, ripe as it is for research. Throughout the grant period, some of Dr. Schneider's time will be devoted to research, either in CAM education or in particular CAM therapies. During the second and third years, after the residency curriculum is developed and implemented, he will engage institutional representatives in exploration of the 1998 MMC CAM Task Force recommendations, and, with the program director, lead efforts to establish a standing institutional committee to address issues related to CAM.

Faculty coordinator:
Cynthia Cartwright, MT, RN, MSEd will serve as the faculty coordinator. In addition to her experience as a medical technologist and science/health teacher, Ms. Cartwright has worked as an educational consultant with the residency program for over seven years. Most recently, she has worked as the project coordinator for our faculty development in informatics and EBM project. In this role, she works half-time designing workshops, coordinating the Task Force meetings, purchasing equipment, collaborating with the MMC Information Systems department, coaching faculty members in use of informatics and EBM, evaluating the project and disseminating the results. She has developed an EBM resources Intranet website widely used by faculty, residents and community physicians.

In her role as faculty coordinator, Cynthia Cartwright will assist the program director and faculty leaders in planning the workshops and will develop workshop brochures and evaluation tools. With the program director and the faculty expert, she will engage the Advisory Committee and implement their recommendations. She will work with FPC staff to develop schedules and systems for the CAM providers to work within the FPCs. She will organize the one-day curricular planning retreat, including providing participants with a synopsis of the literature, from which they can shape their curricular objectives, sample curricula from our program and an agenda for the retreat. Once developed and approved by the Advisory Committee, Ms Cartwright will organize the CAM curriculum into our standard format. With the program director, she will be responsible for evaluation of the project and of the curriculum, including workshop evaluation and evaluation of each component of the CAM curriculum by residents and by patients, staff, faculty and graduates of the program. She will attend the annual CAM education project grant awardees meetings. In a more direct capacity as a teacher in our program, she will serve as a CAM coach, working in a longitudinal basis over grant months 13-30 with outpatient preceptors and with residents as they see patients in the FPCs to identify opportunities to integrate CAM with usual care in the ambulatory setting. Finally, she will work with the faculty expert to develop mutually interesting research hypotheses and will investigate them during the project period.

Faculty leaders:
Our four faculty leaders are excellent physicians, innovators and leaders within our residency program. Victoria Hayes, M.D. , will be our faculty leader in manipulative therapy. She sees patients in the Falmouth Family Practice Center, precepts residents and teaches UVM medical students. Dr. Hayes spends one day a week at a local university student health center and holds a Certificate of Added Qualifications in Adolescent Medicine.

Jeffrey Aalberg, M.D. , our faculty leader in acupuncture, has participated extensively in curriculum development, most notably in surgery and emergency medicine. He is the medical director of our Family Practice Centers and has led the faculty group in developing a vision for practice which includes complementary medicine.

D. Scott Marr, M.D. will head the homeopathy/herbal arm of this project. He completed his Family Practice Residency at Maine Medical Center in 2000 and a fellowship in Primary Care Sports Medicine at Maine Medical Center in 2001. Dr. Marr maintains a practice in family medicine at the Falmouth Family Practice Center and sports medicine at the Portland Family Practice Center where he precepts residents, students, and sports medicine fellows.

Finally, George Dreher, M.D. , double-boarded in psychiatry and family medicine, will be our faculty leader in mind-body interventions. Dr. Dreher has continually pursued opportunities for professional growth, and has enriched our residency program as he has done so. With STFM grant support, he learned teaching techniques in Direct Observation and brought them back to our program. He was recently selected to complete a national course in end-of-life care, and is now heading an institutional group to improve palliative care at MMC. His faculty project in informatics was the development of a website for palliative care for the MMC Intranet. He expects to explore many aspects of CAM with relevant application to his work in end-of-life care. As a psychiatrist, he has extensive training in "mind-body" medicine in general. Dr. Dreher is well qualified to expand his knowledge and skills in this area and integrate the practice of biofeedback, hypnosis and meditation in his work at the FPC and into his teaching in our residency program.

Each faculty leader will enhance his or her knowledge, skills and attitudes in a designated area of CAM, will work with a community CAM mentor to maintain and reinforce those skills, will help to design the CAM curriculum, and will participate in the project as a member of the Advisory Committee. Each faculty leader will have one half-day weekly dedicated to this project over the first 18 months. Each faculty leader will identify a national educational experience in his or her area of CAM and will pursue professional growth in that area. He or she will reinforce skills and knowledge learned at the national conference by working with the community CAM mentor on a longitudinal basis. He or she will facilitate the integration of the CAM provider's practice into the FPCs by working with the faculty coordinator on scheduling of office space, patients and advertising services to patients and by introducing the community CAM providers to others in the practice. He or she will work with the program director, faculty expert and community CAM mentor to identify a national consultant and to plan the workshop in his or her content area. The faculty leaders will disseminate the results, with the program director, faculty expert and faculty coordinator in a variety of local, regional and national settings and on our web-site.

Community CAM providers:
Ralph Thieme, DO, LAc, will serve as our teacher and provider of acupuncture. Dr. Thieme is a licensed acupuncturist, trained at the Oriental Medical Institute of Hawaii. He has a specialty consultation practice in OMT and acupuncture at the University of New England College of Osteopathic Medicine in Biddeford, Maine where he is also a clinical professor.

Greg Thompson, DO, will work with us as a teacher in homeopathy. His current practice centers around homeopathic therapy, but he also provides osteopathic manipulative services and is certified with special proficiency in osteopathic manipulative medicine. He has worked closely with the Maine-Dartmouth residency program introducing homeopathic therapy to their residents.

Donald Hankinson, DO, also a diplomate of the American Board of Special Proficiency in Osteopathic Manipulative Medicine, specializes in cranial therapy with a certificate of competency in that area. Dr. Hankinson is an acknowledged leader among his peers in osteopathic manipulative medicine (OMM), and has been named Director of the Division of OMM at Maine Medical Center.

Elinor Christie, MA, LCPC will serve as our mind-body intervention community expert. Ms. Christie has extensive experience as a licensed clinical professional counselor, and served as the coordinator and key instructor in behavioral medicine for our residency program between 1979 and 1991. More recently, she has been studying and lecturing regarding the integration of Eastern and Western philosophy and medicine. Ms. Christie has been using the techniques of Herbert Benson, M.D. , in her current position as behavioral medicine coordinator and instructor in MMC's cardiac rehabilitation program over the past four years. In this role, she has used relaxation techniques, biofeedback and other complementary therapies to facilitate secondary prevention of cardiac events.

Each community CAM provider will participate in the education and curricular planning process as a member of the Advisory Committee. He or she will work with his faculty counterpart, the faculty expert, faculty coordinator and program director to identify national consultants and to plan the educational workshops. The community CAM providers will mentor our faculty leaders on a longitudinal basis over the grant period in their own offices and as they see patients at the FPCs, for a maximum of two half-days monthly. They will participate in the curriculum planning retreats and provide information about resources for the curriculum: equipment, books, software and potential teachers. They will help the faculty coordinator purchase the equipment needed for the provision of CAM services within the FPCs. They will see patients on referral from the resident and faculty physicians in the FPCs on a regular basis, monthly to start and more often as patient demands and referrals increase. They will be directly involved as teachers in the residency curriculum, once established. They will include residents in their work with patients in their offices and will teach in a didactic setting. Our community CAM consultants have affirmed their commitment to their roles on the project in letters included at the end of our program plan.

Administrative Assistant:
The administrative assistant, Penny Savage, will assist in all aspects of the project, and will provide support directly to the faculty expert and coordinator. She will make travel arrangements for consultants and staff. She will coordinate the Advisory Committee meetings and will document their activities with minutes. Penny will schedule the mentoring sessions for faculty leaders with community CAM providers, and will arrange meetings between our faculty expert and various local CAM practitioners. She will maintain all records and files, and will prepare reports, papers, manuscripts and presentations relative to the project.

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