Satkarin Khalsa, M.D., has delivered yoga programs for medical doctors for years. This year the director of Alberquerque Integrated HealthMedicine scored a breakthrough. Her doctor students were able to earn continuing medical education credit (CME) for learning how to practice yoga.
For patients of integrative medical doctors as well as their more conventionally-minded colleagues, the affirmation of Khalsa's educational program by the American Academic of Family Physicians (AAFP) decision was a breakthrough. Yet the more important impact may be on health care reform measures: the health of physicians themselves, and the ways that mindfulness can shift empathy, teamwork and practice.
Seminars on the science of yoga have earned CME credits for years. The International Research Congress on Integrative Medicine and Health, sponsored through a consortium of 51 medical schools, typically has content on yoga research. John Kepner, MBA, the executive director of the International Association of Yoga Therapists, reports that some of his members have courses that offer CMEs.
The milestone, first reported in integrative medicine consultant Glenn Sabin's Fon Therapeutics blog, is that the medical doctors are getting CME credit for learning how to do yoga poses.
This shift was clarified by a series of email exchanges between Sabin and Khalsa that were prompted by a query I sent. As reported here, Khalsa wrote:
"Last year [the AAFP] specifically wrote that the approval was for 'presenting the evidence that yoga is effective, but not approved to teach the practice itself.' This year I included non-medically trained yoga teachers/therapists, and I included specific wording in the needs assessment/statement of purpose, and the course objectives, that participants would be learning yoga tools and breathing techniques for wellness and stress reduction."
Khalsa, who directs the pricey and well-attended annual Mountain Pose Medicine and Yoga Festival, gave credit for the change to programs developed by HuffPost Medical Editor Dean Ornish, M.D. She added:
"I know of no other CME course that's been accredited by a national organization like the AAFP, approving yoga teachers to teach for CME. [The approval is] based on the Ornish program, and the stress reduction/yoga 'pillar' that is now approved by Medicare. Physician wellness CME courses are a new concept."
The Ornish program has been approved for Medicare coverage.
While the rationale for the CME may be to train medical doctors in skill sets that can be useful for clinical programs delivered to patients, the more immediate value may be in addressing the Biblical adage of physicians to heal themselves. There is a service-learning aspect to medical doctors learning yoga poses then taking the time to practice them -- may turn out to have both broader societal benefits.
In a time in which physician burnout is at high levels, developing mindfulness practices such as yoga can only be beneficial in the doctor's own life as a powerful antidote to some of the daily administrative and payment -- not to mention patient-related -- stress. Mindfulness associated with yoga practice can have multiple benefits.
For instance, in a report from Georgetown University on the impact of a mindfulness program on students, the positive outcomes as self-reported by the students were quite broad. [1] The NIH-funded study offered a two-hour mindfulness course to 111 medical students for 11 weeks. The program, led by Aviad Haramati, Ph.D., Georgetown's complementary and integrative medicine leader, reported benefits related not only to diminished stress, less anxiety, and the ability to cope. Each is remarkable in itself. Yet the benefits of mindfulness also extended to the students' ability to pay attention, to listen to others, and to even empathize with "classmates' concerns and struggles."
In an era in which all parties are challenged to develop better interprofessional education and team care , breathe deeply is probably an appropriate invocation for almost any of the difficult moments. Imagine introducing heavy doses of mindfulness into the tough clinical contexts, payment debates and administrative hassles that the system's move toward Accountable Care Organizations and other new delivery strategies entail.
The innovation in health professional education of medical doctors receiving CME for learning yoga poses will ultimately rebound well for patients. Yet the first benefit will likely be to the doctors who engage the learning. And the ultimate benefit may well be to inject more listening, attentiveness and empathy into the stakeholders and decision makers assaulted by the burdensome dimensions of our problematic payment and delivery system. That would be a step in the right direction.
[1] Shah, K.; G. Wong, P. Saunders, N. Harazduk, R. Tractenberg, and A. Haramati. Comparison of medical and graduate students' perceptions of their stress and mindful awareness following a mind-body skills course. Accepted to the 2006 North American Research Conference on Complementary and Integrative Medicine, 2006.
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