The mission of NCCAM Is to promote research "dedicated to exploring complementary and alternative healing practices in the context of rigorous science." The most recent Strategic Plan specifically adds the goals to "explore the ability of CAM therapies to enhance resilience, positive affect, and coping in order to improve health and well-being, prevent or slow disease progression." The Plan "states as a guiding principle that 'When there is evidence that a specific CAM practice works, it is a high priority to study why it works.'"-- NCCAM Strategic Plan 2005-2009. Over the past fifteen years, the field of CAM/integrative medicine has developed tremendous new resources both in clinical research and in medical education. However many challenges remain. Regarding clinical outcomes research, we still lack a real understanding of why CAM therapies seem to work well in some patients and not in others-and we lack an ability to predict accurately in whom they will be effective. In medical education, we now have many established teaching programs, but virtually no data on how these programs actually impact the competency of the physicians they are training. The two specific projects proposed in this application will begin to address these questions. The first project-"Qualitative Evaluation of Patients'Responses to Integrative Medicine Interventions"-will be a qualitative study nested within two ongoing clinical trials of integrative medicine interventions: one in patients with asthma, and the other in patients with diabetes. This project will use focus groups and structured interviews to allow us to go beyond the limits of traditional quantitative studies and apply qualitative analysis to understand why certain patients respond to CAM/integrative medicine where others do not. The second project --"Evaluation of an Internet-based Curriculum in Integrative Medicine for Primary Care Residents"- will involve developing and implementing the competency-based evaluation strategy for a new internet-based residency curriculum. This project will attempt to correlate on-line measures of cognitive competence with actual changes in practice patterns of the residents involved, providing a new strategy to determine the impact of internet-based interventions beyond the cognitive skills domain where they are typically measured.
This project has relevance both to patient care and to physician training. If we are able to deepen our understanding of which patients are most likely to respond to a CAM/lifestyle-oriented approach to chronic disease, our treatments can be applied with a larger probability of success. If we can successfully train physicians via the Internet on CAM approaches, the number of physicians competent to advise their patients on the safety and effectiveness of CAM treatments will be greatly increased.