Increasing Physician Awareness of the Common Uses and Contraindications of Herbal Medicines: Utility of a Case-Based Tutorial for Residents

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Abstract
Objectives: To determine the need for incorporating herbal medicine into residency curricula and to assess efficacy of a case-based tutorial. Design: Pilot survey of residents' knowledge, practice, and desire to learn about herbal remedies indicated need for instruction. A case-based tutorial was given as a required conference for residents. Participants were pretested, post-tested within 2 weeks, and their satisfaction evaluated. The pretest, tutorial text, and post-test were distributed at clinic to residents who had missed conference. The tutorial was also placed online. Settings/location: Stony Brook University Hospital and Northport VA Medical Center, affiliates of the State University of New York at Stony Brook, School of Medicine, Stony Brook, NY. They serve a suburban/rural population. Subjects: Eight-two (82) residents were pretested (49 medicine, 7 preventive medicine, 12 family medicine, 10 obstetrics-gynecology, and 4 anesthesia). Sixty-six (66) participated in the tutorial. Residents in the pilot group (n = 12) graduated before the tutorial was given. It was not offered to anesthesia residents (n = 4). Because of scheduling, only 37 tutorial participants were available for post-testing. Intervention: Tutorial on uses, contraindications, and drug interactions of popular herbal medicines was presented as a live session, text-only exercise, and online. Results: Pretest scores revealed a knowledge deficit, room for improvement in doctor-patient dialogue, and demand for instruction on herbal medicine. The mean knowledge score of all post-tested participants (n = 37) rose from 34% to 61% (p < 0.0001). The live lecture group (n = 29) increased from 32% to 63% (p < 0.0001). The text-only group (n = 8) increased from 40% to 55% (p = 0.004). Satisfaction was high. Residents did not access the online tutorial, so it was not evaluated. Conclusions: Residents request instruction on uses, contraindications, and drug interactions of herbal medicines and should ask patients about use more routinely. A live, cased-based tutorial appears effective for introducing herbal medicine into residency curricula.