Putting embodied knowledge into practice: a follow up study of graduates from complementary medicine training courses

The use of complementary and alternative medicine (CAM) is an interesting social phenomenon for at least one, very simple, reason: one in ten people every year and one in three in their lifetimes use, and usually pay out of pocket, for CAM in the UK, when they have access to 'modern scientific' healthcare free at the point of use. Sociological studies of health and illness have traditionally focused on the practice of medical doctors to the neglect of understanding individuals' own ways of dealing with health problems within their family or community. In fact, most cases of illness (especially milder symptoms) are never seen by doctors. CAM therapists constitute a 'mid-way' between formal medical care and informal care by family or friends. Research into CAM is growing, especially studies that look at why patients use CAM therapies and the effectiveness of individual treatments. However, we still know surprisingly little about the practitioners of these types of therapy. CAM is a rapidly growing way for people to seek health advice and care, so it is important to understand more about the knowledge and skills that underpin this kind of healthcare, and how practitioners attempt to ensure the safety and quality of their practice.

This study seeks to understand more about issues such as patient safety, regulation of practitioners and questions about the knowledge on which the practices are based. This will benefit the public who will have access to better information about these CAM therapies; mainstream health care practitioners who currently find it difficult to advise their patients about CAM because there is so little research in the field; and CAM professions because it will provide an independent insight into many of the key challenges that they are facing at the moment, including preparing students for practice.

The Principal investigator (PI) is well placed to do this study. For her PhD, she undertook a study of students of two complementary therapies: osteopathy and homeopathy. She observed and participated in their classes over an academic year to understand their learning process. This kind of study had not been done before and the results brought new insights into the kind of knowledge about health, illness and the body that these two professions claim, in particular, the extent to which their knowledge is 'embodied'. This means that their knowledge and skills can not be represented by words in text books but are the result of an accumulation of bodily and sensory experiences, relating for example to touch or communication about emotions. This has important implications for the way that these practitioners are trained and regulated. Since then, the PI has worked closely with these professions on issues such as accrediting educational courses and patient safety in practice. She has also successfully applied for funding to run an academic conference on the regulation of these professions.

For this study, the PI proposes to contact individuals who participated in the original study and have now gone into practice to find out about their careers and the ways in which their knowledge and skills have developed since graduating. Most complementary therapists work independently rather than having established career structures like doctors, nurses or midwives, so it will be interesting to find out how they ensure they have enough support and continue to develop their skills. This is also a unique opportunity because the research will be able to directly compare the values and practices articulated in training with how they are put into practice after graduation. The study will involve not only talking to practitioners about their experience, but also actually watching them in their daily working lives to see if what their say is the same as what they do, and to enable real events to spark off detailed discussions about how they deal with the realities of daily practice.

Given the growing importance of CAM both in terms of its increasing use in most industrialized countries, and in terms of its politicisation due to its contested knowledge base, there will be a number of non-academic beneficiaries from the research. These are:

Small businesses and the self-employed in the CAM sector and policy makers and regulators in the business and enterprise field: CAM is a growing sector of SMEs (small and medium enterprises) (Mintel 2007), and given the wider growth in the care industry, this research will offer insights about the key issues facing people making a living in this way. A member of the steering group from the Department of Business, Enterprise and Regulatory Reform will support the project in terms of policy and business implications.

Educational institutions in the CAM sector: The challenges of maintaining a high quality, safe and financially sustainable practice need to be address by educational institutions. This work will highlight the challenges faced by graduates and inform curricula development.

Policy makers and regulators in the health field: Many changes are underway in the regulation of CAM, and this project will provide insights into the challenges of regulating this diverse group of practices (Gale 2011b). In addition, there is an increasing demand from NHS patients to provide CAM service, but ongoing problems with integration of services, which this project will be able to provide insight to in terms of the governance and professional development of practitioners.

Professionals in the CAM and conventional healthcare sectors: Currently one of the biggest problems is lack of communication between the CAM and conventional sectors, not least because patients often do not tell their doctors about their use of CAM because they are wary of negative responses or do not think it is relevant. The inclusion of a general practitioner and CAM practitioners on the study reference group will guide the best form of dissemination to promote a more constructive relationship.

The Study Reference Group (SRG) will provide a forum for debating these issues in terms of:
the design of the study (questions to ask in the interview, focus of observations)
the analysis of the data (anonymized data on emerging findings will be shared with the SRG to gain different perspectives)
the dissemination of the findings (identifying appropriate methods of dissemination, developing the timetable for a User Dissemination Event, identifying potential future projects or applications of the research).

The Study Website will provide the means for accessing a wider audience, including those from abroad. The conference the PI is running in May 2011 on the Regulation and Professionalization of CAM is being attended by delegates from Australia, Norway, Portugal, Sweden, Canada, Saudi Arabia and India. Many of these countries, in part due to the World Health Organisation declaration on Traditional Medicine (2000) are facing very similar issues in terms of the growing use and provision of CAM.