Integration of Complementary and Integrative Medicine Competencies in General Practice Postgraduate Education – Development of a Novel Competency Catalogue in Germany

Integration of Complementary and Integrative Medicine Competencies in General Practice Postgraduate Education – Development of a Novel Competency Catalogue in Germany | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integration of Complementary and Integrative Medicine Competencies in General Practice Postgraduate Education – Development of a Novel Competency Catalogue in Germany Jan Valentini, Carina Klocke, Corina Güthlin, Stefanie Joos This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-400535/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Complementary and Integrative medical procedures (CIM) play an important role in general practice (GP). Consequently, in some countries (e.g. USA, Australia) specific curricula for the integration of CIM competencies in GP postgraduate education exist. Although Germany is one of the countries where CIM is strongly integrated in general practice, no such catalogue exists up to date. The aim of this study was to define a set of CIM competencies that are seen as relevant and feasible for postgraduate education in the German general practice setting. Methods Firstly, a survey among GP trainees (n= 138) was performed in order to assess needs and attitudes towards CIM. Then, existing competency-based CIM curricula were identified in international literature, translated into German and compared with the needs assessment from the survey. Finally, in a multi-stage Delphi procedure, GP trainers, GP trainees and members of professional CIM associations (n= 131) evaluated a list of CIM competencies according to relevance and feasibility for general practice. Results Within this multistage process a final catalogue of 16 competencies was defined, covering the following areas: Medical knowledge, patient care and communication, practice-based learning, professionalism and competencies based on the German health care system. Conclusion The final catalogue of CIM competencies is intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies cover basic skills and are not intended to replace existing additional qualifications awarded by the medical associations in specific CIM methods, such as acupuncture or manual medicine. Therefore, a list of relevant competencies on CIM is available in order to serve as add-on for postgraduate education in general practice in Germany. Integrative & Complementary Medicine Integrative medicine general practice family medicine residency postgraduate medical education medical education competency catalogue Figures Figure 1 Introduction International literature shows that Complementary and Integrative medical procedures (CIM) play an important role in general practice (GP)( 1 , 2 ). When compared to other countries as the USA, the number of general practitioners (GPs) providing CIM in Germany is rather high. There is some evidence suggesting that up to 60% of GPs are using CIM in Germany ( 3 – 5 ). Over the last two decades some countries (e.g. USA, Australia to the best of our knowledge) have developed specific competency-based curricula for the integration of CIM competencies in GP postgraduate education. For the first time in the USA in 2000, a list of 18 competencies in the field of complementary and alternative medicine for postgraduate education in family medicine was published, with the competencies each assigned to either attitudes, skills, and/or knowledge (ASK) ( 6 ). In 2013 and on behalf of the Society of Teachers of Family Medicine (STFM), Locke et al. published a revised list of these competencies. When doing so, the overarching assignments to the ASK were removed and a total of 19 competencies were described. These competencies were assigned to different categories such as patient care, medical knowledge, interpersonal and communication skills, practice-based learning and development, professionalism, and systems-based care. In addition, a list of nine skills was described to support these 19 competencies ( 7 ). Individual universities in the various American states were in charge of the implementation of this competency-based curriculum, and was exemplarily evaluated by Gardiner et al. in 2013. For this purpose, an online survey was conducted by the Council of Academic Family Medicine to elicit the knowledge and attitudes of residency faculty regarding CIM competencies as well as the inclusion of CIM in the local residency regulations. The results showed that the majority of the CIM competencies are known and considered to be an important part of the curriculum for future GPs. Various barriers (e.g. lack of time, lack of qualification of training officers, lack of access to CIM experts, etc.) which stood in the way of implementation were also identified ( 8 ). A further development of a CIM curriculum was described by Lebensloh et al. in 2012: GP postgraduate trainees were able to complete parts of the curriculum via online training. The evaluation of this training demonstrated a positive assessment with regard to the feasibility of the online training, achievement of learning objectives, clinical benefit, and technical implementation by the GP postgraduate trainees ( 9 ). In 2014, the same research group published data showing that the Integrative Medicine in Residency Curriculum is attractive to many medical students. It is also increasingly leading them choose a residency in family medicine as the integrative medicine curriculum allows them to broaden their skills and knowledge in patient care as well as responds to the increasing interest in learning integrative medicine ( 10 ). In Australia, the area of CIM was first included in the Curriculum for Australian General Practice for general medical education by the Royal Australian College of General Practitioners (RACGP) in 2007. Subsequently in 2016, the RACGP published a stand-alone chapter on integrative medicine ( 11 ). Core competencies in general medicine for the area of CIM are described and adapted according to the respective level of medical training. These are acquired sequentially, built on each other and completed throughout the entire medical education, postgraduate training and continuing education. Thus, CIM has been successfully implemented throughout GP medical education in Australia ( 12 ). In Germany, postgraduate training to become a GP is a structured and regulated five-year medical qualification with a final examination. The content of GP postgraduate education is regulated by the German Medical Association in the (Model) Specialty Training Regulations (MWBO) ( 13 ). With the novel adaptation of the MWBO of 2018, Germany focusses on a competency-oriented approach ( 14 , 15 ). In addition, the German Society for General Medicine and Family Medicine (DEGAM) has developed a competency-based curriculum for General Medicine which defines, in addition to the MWBO, competencies for GP postgraduate education based on the CanMed roles, an outcomes-based framework of physician competencies ( 16 – 18 ). After completing postgraduate education physicians can take structured additional qualifications in the field of CIM, which are awarded by the medical association. The following additional qualifications in the field of CIM can currently be acquired in Germany after completion of a postgraduate training: Acupuncture, Homeopathy, Manual Medicine/Chirotherapy, Medical Balneology and Climatology, Naturopathic Methods as well as Physical Therapy ( 13 ). Up to date in Germany, there are some CIM topics integrated in undergraduate medical education in the German Medical Licensure Act. However, there is no such equivalent in GP postgraduate education (MWBO) in Germany. The competency-based curriculum for General Medicine of the DEGAM, includes for the first time in the main chapter “therapy” a single competency labelled "complementary medical procedures" (chapter III.3) without providing further details on its content ( 16 ). More detailed information on CIM procedures or corresponding CIM competencies are neither included in the MWBO nor in the competency-based curriculum for GP postgraduate training of the DEGAM. Thus, a specific catalogue for teaching CIM competencies in GP postgraduate training is missing in Germany. Therefore, the aim of the present work is to close this gap and to develop a catalogue of CIM competencies for GP postgraduate education. Methods Multi-stage Delphi procedure In a multistage Delphi procedure, we addressed the question of which CIM competencies are seen as relevant and feasible for GP postgraduate education in Germany (see Fig. 1). Firstly, a survey among GP postgraduate trainees in Baden-Württemberg, Germany (n = 138), was performed in order to assess attitudes and needs towards CIM. The results showed a high interest towards CIM as well as perceived uncertainty with regard to different practical topics. The vast majority of the GP trainees would support the implementation of CIM training in the GP postgraduate training program ( 19 ). Then, in a literature review, existing CIM curricula were identified. The competency-based curriculum of the STFM on Integrative Medicine was then defined as a best practice example and used as a blueprint ( 7 ). These competencies and learning objectives (19 basic competencies plus 12 supporting skills as, for example, “Residents are expected to do the following: Demonstrate understanding of common complementary medicine therapies, including their history, theory, proposed mechanisms, safety/efficacy profile, contraindications, prevalence and patterns of use.”) were translated into German. In a next step, these basic and supporting skills were compared with the needs assessment from the survey, combined in a single catalogue and adapted to the German context resulting in a list of 23 competencies. This catalogue needed to be evaluated and further refined via a multistage Delphi process. As the first stage, a Delphi Survey was performed within the Complementary Medicine Working Group of the German Society of General Practice (n = 10) ( 20 ). The members were asked to rate the importance and feasibility of the included CIM competencies and were given the possibility to add free text comments or rewording suggestions after each competency. Finally, an overall rating of the importance of such a CIM catalogue for general medical education was to be given. As a result of this survey, the free text comments and ratings were considered and a further adaptation and reduction of CIM competencies resulted in 20 competencies. Finally, as a second step, the list of 20 competencies was evaluated with respect to relevance and feasibility for general practice by GP trainers, GP trainees and members of professional CIM associations in terms of a survey. The methods and results of this second Delphi survey on the 20 competencies are shown in the following as these form the resulting novel CIM catalogue. Second Delphi-Survey: Participants and data collection Participants of the second Delphi Survey were GP postgraduate trainees enrolled in the postgraduate GP training programme of the Competence Center for Postgraduate Medical Education in Baden-Württemberg, Germany (KWBW). The KWBW offers, amongst various topics related to family medicine, CIM workshops ( 21 ). All active GP postgraduate trainees (n = 432) of the KWBW and n = 52 graduates of the KWBW program received an email with an invitation to participate in the online survey. Furthermore, n = 250 GPs of teaching clinics of the University of Tübingen, enrolled in undergraduate and postgraduate medical education in Baden-Württemberg, Germany, received the invitation via email. Additionally, members of professional CIM associations from the Hufelandgesellschaft e.V., the largest German umbrella organization for integrative medicine societies, took part in the survey. The invitation to participate in the online survey was distributed through the newsletter of the Hufelandgesellschaft e.V. as well as through the newsletters of various affiliated CIM societies, respectively. The number of GPs who received the invitation via this channel cannot be determined. Survey The survey was launched in July 2019 and was accessible to participants until 31st January 2020. No email reminder was sent. Participation was voluntary, and the data were collected anonymously. In addition to ten sociodemographic questions, participants were asked to rate the importance and relevance for the daily work of twenty single CIM competencies on a four-point Likert-scale (1 = important 4 = not important). The importance and relevance of the whole competency catalogue (i.e. the list of the 20 competencies as a whole) were also rated on the same four-point Likert-scale. Furthermore, the participants were asked two questions which could be answered with a free text, namely: “Do you have further comments or suggestions for the novel CIM catalogue? and Is anything missing?” The survey was given to two GP postgraduate trainees and to two GPs with no prior involvement on CIM education for pilot-testing with the think aloud method before implementation. Analysis and Evaluation Statistical analysis was conducted with SPSS Version 27 (SPSS INC.; IBM, USA). Mean, median, quantiles, absolute frequencies and percentages are reported according to the scale level. Subgroup analysis between GP postgraduate trainees and GP specialists was conducted with non-parametric Mann-Whitney-U test. Subgroups smaller than n = 5 participants as well as cases with more than five missing values were excluded. For the selection of the competencies for the final catalogue, the rate of consent (sum of participants rating an item as “important” or “rather important”, Likert-scale 1–2, in percent) has been calculated for each item. A competency was selected for the novel catalogue if total consent was at least 80% or if total consent was < 80% but ≥ 80% among GP trainees in the subgroup analysis, as it reflects the needs of the target group. The overarching goal was to come up with the lowest number of competencies (for sparseness) which are deemed to be relevant. Ethics According to a communication from the Ethics Committee of the Medical University of Tübingen, according to the German federal law of § 3 Abs. 6 BDSG / LDSG BW, no formal ethical vote is required for the collection of anonymous data. Results Sociodemography Overall, n = 131 participants joined the survey. The mean age of the participants was 49 years. Overall, the gender distribution of the participants was female in 56 %, while within the group of GP trainees, the proportion of female participants was significantly higher with 73%. The proportion of participants within GP postgraduate education was 35%. More than one-third (38%) of the participants were GP trainers. The number of participants who hold one or more CIM specializations was almost 50%. As for CIM specializations awarded by the medical association, participants were mostly specialized in homeopathy (43%), acupuncture (40%) and naturopathy (34%). Almost 40% indicated other CIM related trainings, such as osteopathy and nutritional medicine (multiple responses possible). More than one-third (39%) of the participants were members of a professional CIM society. The vast majority of the participants were actively involved in patient care. More or less three quarters of the participants stated that they use CIM in a professional and private context. Further details on the sociodemography are shown in Table 1 . Table 1 sociodemographic characteristics Characteristic Participants (n = 131)* Age, years (mean (SD)) 48.9 (12.816), min. 27, max. 77 Sex, n (%) Diverse 1 (0.8%) Female 72 (55.8%) Male 56 (43.4%) In postgraduate education, n (%) Yes 46 (35.1%) female 34 (73.9%) male 12 (26.1%) No 85 (64.9%) diverse 1 (1.2%) female 38 (45.8%) male 44 (53.0%) CIM Specialisation, n (%)** Yes 68 (51.9%) Acupuncture 27 (39.7%) Homeopathy 29 (42.7%) Manual Medicine/Chirotherapy 6 (8.8%) Medical Balneology and Climatology 2 (2.9%) Naturopathic Methods 23 (33.8%) Physical Therapy 1 (1.5%) Other, CIM related trainings 30 (44.1%) No 62 (47.3%) Patient care, n (%) Yes 123 (93.9%) No 8 (6.1%) Professional Use of CIM, n (%) yes 103 (78.6%) No 28 (21.4%) Private Use of CIM, n (%) yes 96 (73.3%) No 35 (26.7%) GP trainers, n (%) yes 48 (36.6%) No 83 (63.4%) CIM teaching, n (%) yes 26 (19.8%) No 105 (80.2%) Members of professional CIM associations, n (%) yes 51 (38.9%) No 80 (61.1%) * variable n due to missings (n = 130 to n = 131) ** multiple responses possible Evaluation of competencies The ratings of every single competency are reported in Table 2 . After applying the above described cut-off criteria, 16 out of 20 competencies were included into the final catalogue. These competencies are covering knowledge, skills and attitude (ASK) on the following CIM topics: Medical knowledge, patient care and communication, practice-based learning and continuing education, professionalism, and competencies with regard to the German Health care system ( 22 ). The importance rating of the whole catalogue is high, 78% of all participants ranked it on the four-point Likert-scale as “1 = important” or “2 = rather important. The relevance of the competencies for daily work presented in the survey was rated with 79% (important & rather important). The final list of competencies in English and German language can be found within the additional files (see Additional Files 1 and 2). Subgroup analysis of postgraduate physicians and specialists A subgroup analysis of GP postgraduate trainees and GP specialists was performed. A significant different rating was merely shown for questions no. 12 (“ GP trainees should be able to use evidence-based sources of information concerning CIM” , U = 1283.000, Z= -3,567, p ≤ 0.05 ) and no. 18 (“ GP trainees should know conditions and general framework of different professional groups offering CIM treatments [e.g. natural practitioners/Heilpraktiker]” , U = 1370.000, Z= -3,020, p ≤ 0.05 ) . The total consent as well as subgroup consents for question no. 12 was > 80%, it thus has been selected for the novel catalogue. For question no. 18, total consent was < 80% (67.9%) for GP specialists but 82.6% within the group of GP postgraduate trainees. Therefore, it has been included in the final list of competencies. Table 2 Results of the evaluation of CIM competencies of the 2nd Delphi survey GP trainees should…(competency)* n Mean (SD) Quantile 50/25/75 (Rather) important %* 1. Medical knowledge …be able to explain common CIM (complementary medicine, integrative medicine, naturopathy) concepts. (q1) 131 1.74 (0.865) 2/1/2 84.7 …be able to explain common CIM treatments including their respective theories, postulated modes of action, limitations. (q2) 131 1.81 (0.842) 2/1/2 83.2 …know the available evidence of effectiveness, interactions, and safety concerning the most common CIM concepts or understand where to find this information. (q3) * 131 1.84 (0.812) 2/1/2 78.6 …be able to give advice concerning CIM therapies for the most frequent consultation issues in family medicine. (q4) 131 1.76 (0.802) 2/1/2 83.2 2. Patient care and communication …conduct a biopsychosocial health interview, including aspects of lifestyle and usage of CIM. (q5) 131 1.75 (0.788) 2/1/2 84.7 …be able to jointly develop a treatment plan including conventional and complementary therapies with a patient and, if necessary, refer to appropriate facilities/therapists. (q6)* 131 1.99 (0.907) 2/1/3 74.8 …be able to clear up patients about CIM treatments, which could potentially harm health and budget. (q7) 131 1.41 (0.579) 1/1/2 95.4 …be able to use non-pharmacological treatments (e.g. home remedies) for frequent issues of consultation (e.g. pain, fever, uncomplicated infections, etc.) or guide their patients thereto. (q8) 131 1.21 (0.425) 1/1/1 99.2 …be able to use common phytotherapeutics and supplements for frequent issues of consultation (e.g. pain, fever, uncomplicated infections, etc.). (q9) 131 1.45 (0.623) 1/1/2 94.7 …be able to consult regarding different relaxation techniques (meditation, mind and body practices, mindfulness, tai chi, yoga, etc.). (q10) 131 1.88 (0.775) 2/1/2 81.7 …be able to specifically apply placebo and self-efficacy effects as needed for the therapeutic process. (q11) 131 1.60 (0.698) 2/1/2 92.4 3. Practice-based learning …be able to use evidence-based sources of information concerning CIM. (q12) 131 1.69 (0.692) 2/1/2 88.5 …be able to identify their individual learning needs concerning CIM. (q13) 131 1.89 (0.675) 2/1/2 84.0 4. Professionalism …show respect and sympathy for patients‘ interpretations of health, disease and suffering, based on individual attitudes and therapy requests concerning CIM. (q14) 131 1.47 (0.636) 1/1/2 93.9 …be open-minded and remain open to dialogue when it comes to another understanding of health and disease by medical and non-medical colleagues involved in a treatment. (q15) 131 1.54 (0.694) 1/1/2 90.1 …be able to take suitable action for self-care as needed. (q16) 131 1.43 (0.621) 1/1/2 94.7 5. Competencies based on the German Health Care System …know conditions and general framework of medical educations and medical specialist training (e.g. additional training) concerning CIM treatments. (q17)* 131 2.37 (0.705) 2/2/3 57.3 …know conditions and general framework of different professional groups offering CIM treatments (e.g. natural practitioners/Heilpraktiker). (q18) 131 2.15 (0.815) 2/2/3 67.9*** …know conditions and general framework for the medical practice concerning common CIM treatments (e.g. availability, prescription, legal regulations). (q19) 131 1.90 (0.711) 2/1/2 82.4 …consider conditions for patients’ access to complementary therapy care (e.g. remuneration and costs) during their treatment. (q20)* 131 1.99 (0.775) 2/1/2 77.1 * Competencies in grey were not included into the novel CIM catalogue. Ratings in bold were included in the novel CIM catalogue. ** Five-point Likert-scale was used: “(rather) important” reflects the rate of consent and is the sum of items “1 – important” and “2 – rather important”. *** Competency was included after subgroup analysis; rate of consent among GP trainees 82.6%. Discussion In a rigorous multi-step approach, a competency-based catalogue containing 16 basic competencies on CIM for GP postgraduate education in Germany has been developed. This approach was chosen analogously to the development of competency-based curricula as successfully used in the field of general practice or spiritual care ( 23 , 24 ). Competency-based medical education has been firmly established in the Anglo-American world for some time and is internationally regarded as a showcase model ( 25 ). In contrast, competency-based learning objectives have only recently been implemented for continuing education in Germany ( 14 ). To the best of our knowledge, this is the first competency-based catalogue on CIM for GP postgraduate education in Europe. Within a multi-stage Delphi procedure international best practice examples were translated and adapted to German context instead of reinventing the wheel. A similar approach was used by Steinhaeuser et.al for the development of the competency-based curriculum in general practice in Germany ( 23 ). GP trainees and GP trainers were equally involved in the following process of rating relevance and feasibility of potential competencies in order to get different perspectives. However, there are some limitations to this selection. Both groups may have had a special interest in CIM (also represented by the high percentage of participants with some form of CIM specialty), and thus may have overrated the relevance. However, to evaluate the specific competencies a basic knowledge of CIM is essential. The participation in the survey was anonymous and voluntary and it was not possible to draw conclusions about individual participants. Therefore, the motivation of participants was unclear (supporter or rejecter of CIM). Additionally, the GP trainees and GP trainers were mainly located within the same federal state, where seminars on CIM topics had already been implemented in GP postgraduate training. Since several mailing lists were used for the recruitment of the participants of the second Delphi Survey, the response rate cannot be determined. For the second Delphi Survey, we included GP trainees and GP trainers equally which showed a congruent rating for the majority of the competency assessments. One of the significant differences in the rating of competencies between these groups was competency no. 18 and related to competencies based on the German Health Care System. As GP trainees may not be familiar with all the conditions and general framework of German Health Care System at the beginning of their professional career, they may have ranked the importance of these competencies higher. Similar uncertainties were congruently reported in a former need assessment of GP trainees on CIM which was conducted by our study group ( 26 ). As we focused on the ratings of GP trainees and GP specialists in order to cover the different levels of work experience, we did not distinguish gender differences during all stages of the multistage Delphi procedure. As shown by Joos et al., CIM is already strongly integrated in primary care in Germany, although there is no specific CIM catalogue ( 3 ). This discrepancy could also pose risks, especially since competencies as an evidence-based approach when providing CIM was not part of their former GP training. In a qualitative study, Ostermaier et al. could show that almost all more experienced GPs integrated at least some CIM in their clinical practice with a high degree of pragmatism ( 27 ). In contrast, young GP postgraduate trainees rate the importance of an evidence-based approach while providing CIM higher than their GP trainer. This could also be seen in our subgroup analysis on the competency no. 12 GP trainees should be able to use evidence-based sources of information concerning CIM , where a significant difference between the rating of GP trainees (97.8% rating (rather) important) vs. GP (83.5% rating (rather) important) could be shown. Similar results are also shown by a study group of Linde et al. where GP postgraduate trainees expressed doubts regarding the evidence-based approach of CIM and specific effects over placebo ( 28 ). Consequently, GP postgraduate trainees may tend to be more critical towards CIM compared to their trainers or experienced GPs. Compared to the competency-based curriculum of the STFM on Integrative Medicine, which was used as a blueprint for the present catalogue ( 7 ), we included a new competency in the category professionalism: no. 15 GP trainees should be able to take suitable action for self-care as needed. There is growing evidence showing that the work strain and burnout risk in GP postgraduate trainees, as well as in physicians in general, is increasing over the last decades ( 29 ). Therefore, a promotion of physical and mental health seems to be essential in order to preserve the well-being of the physicians as well as their patients. This competency goes hand in hand with the principles of preserving health and well-being as described by Aaron Antonovsky in the basic concepts of Salutogenesis ( 30 , 31 ). These principles represent a fundamental approach in primary care and show a large overlap with many complementary medicine procedures (e.g., exercise, nutrition, and relaxation elements) underlining why CIM procedures are so prominent in GP. The final competency-based catalogue on CIM is intended to complement the German Competence-Based Curriculum General Practice of the DEGAM by serving as a kind of red thread for continuing education in the field of CIM or to be integrated into it ( 16 ). The potential addressees of such a novel CIM catalogue are GP postgraduate trainees, competency centers for postgraduate education in GP offering CIM teaching modules, as well as GP trainees and GP trainers providing continuing education in GP. The GP postgraduate training KWBW for example included CIM in their set of core competencies for becoming a GP ( 21 ). However, as family medicine covers a wide range of medical fields, merely two teaching units of 45 minutes each could be budgeted for covering the core competencies in this field. Specific teaching modules need to be developed and implemented in order to make these CIM competencies achievable by GP trainees. Ideally, this could be accomplished by the use of appropriate entrustable professional activities combined with appropriate assessments ( 32 , 33 ). Given the fact that structures in GP postgraduate training are already available, there are very good chances for the implementation of the catalogue. After implementation of this catalogue, further evaluation is needed in order to test the practicability of this catalogue. This may be done by assessing a gain of knowledge, attitude and/or skills in the area of CIM within GP trainees. This could ultimately lead to achieving the goal of improving patient care while addressing CIM topics. Finally, a full Kern-cycle, representing a six-step approach of curriculum development for medical education, could be completed ( 34 ). Conclusion The competencies on CIM included in this novel catalogue are basic competencies intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies can be seen as basis for addressing and counseling patients regarding CIM methods in daily practice and should be mastered by all GP postgraduate trainees by the end of their training. These basic competencies are not intended to replace the additional training in CIM awarded by the German medical associations e.g. of acupuncture or manual medicine. Additionally, some of the competencies may also be transferred to other medical specialties as e.g. internal medicine, psychosomatics or surgical specialties and therefore may be included into a variety of existing medical education programs. Altogether, this novel competency-based catalogue on CIM provides the foundation for a comprehensive and nation-wide competency-based GP postgraduate education on CIM in Germany. Abbreviations ASK Attitudes, skills, and/or knowledge BDSG Federal Data Protection Act [ Germa n: Bundesdatenschutzgesetz] CIM Complementary and Integrative Medicine DEGAM German Society for General Medicine and Family Medicine [ German : Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin] GP General practice GPs General practitioners KWBW Competence Center for Postgraduate Medical Education in Baden-Württemberg, Germany [ German : Kompetenzzentrum Weiterbildung Baden-Württemberg] LDSG BW State Data Protection Law Baden-Württemberg [ German : Landesdatenschutzgesetz Baden-Württemberg] MWBO (Model) Specialty Training Regulations [ German : (Muster-)Weiterbildungsordnung] RACGP Royal Australian College of General Practitioners SD Standard deviation STFM Society of Teachers of Family Medicine Declarations Ethics approval and consent to participate We confirm that all methods were carried out in accordance with relevant guidelines and regulations, e.g. Declaration of Helsinki. According to a communication from the Ethics Committee of the Medical University of Tübingen, no formal ethical vote is required for the collection of anonymous data according to the German federal law of § 3 Abs. 6 BDSG / LDSG BW. Therefore, submission of a study protocol to the Ethics Committee of the Medical University of Tübingen was not required. Consent from all study participants was obtained by actively clicking the checkbox in the online survey; otherwise, participation in the survey was not possible. Consent for publication Not applicable Availability of data and materials The novel Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees can be downloaded in English and German language here: https://www.medizin.uni-tuebingen.de/de/das-klinikum/einrichtungen/institute/allgemeinmedizin/forschung/komplementaere-und-integrative-medizin/kompetenzbasiertes-curriculum-zur-komplementaeren-und-integrativen-medizin The datasets and further additional files used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors' contributions JV, CG and SJ drafted the concept and design of the study and were responsible for data collection. JV wrote the draft. CK performed data analysis and contributed to writing the draft. SJ supervised the study. All authors critically revised the manuscript, as well as read and approved the final manuscript. Acknowledgements The authors gratefully thank native English speakers Hannah Fuhr for reviewing this manuscript. References Linde K, Alscher A, Friedrichs C, Joos S, Schneider A. Die Verwendung von Naturheilverfahren, komplementären und alternativen Therapien in Deutschland - eine systematische Übersicht bundesweiter Erhebungen [The use of complementary and alternative therapies in Germany - a systematic review of nationwide surveys]. Forsch Komplementmed. 2014;21(2):111-8. Marstedt G, Moebus S. Inanspruchnahme alternativer Methoden in der Medizin. Berlin: Robert Koch-Institut Berlin. Heft 9. Joos S, Musselmann B, Szecsenyi J. Integration of complementary and alternative medicine into family practices in Germany: results of a national survey. Evid Based Complement Alternat Med. 2011;2011:495813. Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med. 1998;158(21):2303-10. Pirotta M, Kotsirilos V, Brown J, Adams J, Morgan T, Williamson M. Complementary medicine in general practice - a national survey of GP attitudes and knowledge. Aust Fam Physician. 2010;39(12):946-50. Kligler B, Gordon A, Stuart M, Sierpina V. Suggested curriculum guidelines on complementary and alternative medicine: recommendations of the Society of Teachers of Fam Med Group on Alternative Medicine. Family medicine. 2000;32(1):30-3. Locke AB, Gordon A, Guerrera MP, Gardiner P, Lebensohn P. Recommended integrative medicine competencies for family medicine residents. Explore. 2013;9(5):308-13. Gardiner P, Filippelli AC, Lebensohn P, Bonakdar R. Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies. Explore. 2013;9(5):299-307. Lebensohn P, Kligler B, Dodds S, Schneider C, Sroka S, Benn R, et al. Integrative medicine in residency education: developing competency through online curriculum training. J Grad Med Educ. 2012;4(1):76-82. Lebensohn P, Dodds S, Brooks AJ, Cook P, Guerrera M, Sierpina V, et al. Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine. Explore. 2014;10(3):187-92. Royal Australian College of General Practicioners RACGP. Curriculum for Australian General Practice 2016. 2016. http://curriculum.racgp.org.au/. Accessed 02 Apr 2021. Royal Australian College of General Practicioners RACGP. IM16 - Integrative medicine contextual unit 2016. 2016. https://www.racgp.org.au/education/education-providers/curriculum/contextual-units/processes/im16-integrative-medicine. Accessed 02 Apr 2021. Bundesärztekammer. (Muster-)Weiterbildungsordnung 2003. 2015. http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/MWBO.pdf. Accessed 02 Apr 2021. Bundesärztekammer. (Muster-)Weiterbildungsordnung 2018. 2018. www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/muster-weiterbildungsordnung/. Accessed 02 Apr 2021. Chenot J, Steinhäuser J. Die novellierte Musterweiterbildungsordnung. Z Allg Med. 2019;95(4):156-9. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin DEGAM. Kompetenzbasiertes Curriculum Allgemeinmedizin 2015. 2015. https://www.degam.de/files/Inhalte/Degam-Inhalte/Sektionen_und_Arbeitsgruppen/Sektion_Weiterbildung/Curriculum_01-10-15_neu.pdf. Accessed 02 Apr 2021. Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach. 2007;29(7):642-7. Frank J. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005. Valentini J, Flum E, Schwill S, Krug K, Szecsenyi J, Joos S. Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Arzten in Weiterbildung [Complementary and Integrative Medicine in Postgraduate Training Programs in Germany: An Assessment among Family Medicine Trainees]. Complement Med Res. 2018;25(4):233-9. Joos S, Breivogel B, Gündling P, Güthlin C, Heusser P, Musselmann B, et al. Komplementärmedizin in der hausärztlichen Praxis - Zur Gründung der Arbeitsgruppe Komplementärmedizin (AG KompMed) in der DEGAM [Complimentary Medicine in Family PracticeAbout the Newly Established DEGAM-Group Complementary and Alternative Medicine (AG KompMed)]. Z Allg Med. 2010(86):337–41. Stengel S, Förster C, Fuchs M, Bischoff M, Ledig T, Streitlein-Böhme I, et al. Developing a seminar curriculum for the Competence Centerfor General Practice in Baden-Wuerttemberg– a progress report. GMS J Med Educ. 2021;38(2):Doc36. Thomas-Hemak L, Palamaner Subash Shantha G, Gollamudi LR, Sheth J, Ebersole B, Gardner KJ, et al. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience. PeerJ. 2015;3:e766. Steinhaeuser J, Chenot JF, Roos M, Ledig T, Joos S. Competence-based curriculum development for general practice in Germany: a stepwise peer-based approach instead of reinventing the wheel. BMC Res Notes. 2013;6:314. Anandarajah G, Craigie F, Jr., Hatch R, Kliewer S, Marchand L, King D, et al. Toward competency-based curricula in patient-centered spiritual care: recommended competencies for family medicine resident education. Acad Med. 2010;85(12):1897-904. Ten Cate O. Competency-Based Postgraduate Medical Education: Past, Present and Future. GMS J Med Educ. 2017;34(5):Doc69. Valentini J, Flum E, Schwill S, Krug K, Szecsenyi J, Joos S. Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung [Complementary and Integrative Medicine in Postgraduate Training Programs in Germany: An Assessment among Family Medicine Trainees]. Complement Med Res. 2018;25(4):233-9. Ostermaier A, Barth N, Schneider A, Linde K. On the edges of medicine - a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations. BMC Fam Pract. 2019;20(1):55. Huber CM, Barth N, Linde K. How Young German General Practitioners View and Use Complementary and Alternative Medicine: A Qualitative Study. Complement Med Res. 2020;27(6):383-91. Bugaj TJ, Valentini J, Miksch A, Schwill S. Work strain and burnout risk in postgraduate trainees in general practice: an overview. Postgrad Med. 2020;132(1):7-16. Antonovsky A. Salutogenese: Zur Entmystifizierung der Gesundheit. Tübingen: dgvt-Verlag; 1997. Petzold TD. Systemische und dynamische Aspekte von Ganzheit in einer Theorie der Allgemeinmedizin [Systemic and Dynamic Aspects of the Entireness in a Theory of Family Medicine]. Z Allg Med. 2011;87(10):407-13. Berberat PO, Harendza S, Kadmon M. Entrustable professional activities - visualization of competencies in postgraduate training. Position paper of the Committee on Postgraduate Medical Training of the German Society for Medical Education (GMA). GMS Z Med Ausbild. 2013;30(4):Doc47. Hahn EG. Integrative medicine and health in undergraduate and postgraduate medical education GMS J Med Educ. 2021;38(2):Doc46. Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculum development for medical education: a six-step approach.3rd ed. Baltimore: Johns Hopkins University Press; 2016. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Title and description: Supplementary table 1: Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees (English Version) Additionalfile2.docx Title and description: Supplementary table 2: Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees (German Version - Kompetenzbasiertes Katalog zur Komplementären und Integrativen Medizin für Ärztinnen und Ärzte in Weiterbildung zum Facharzt für Allgemeinmedizin) Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 18 Jun, 2021 Reviews received at journal 02 Jun, 2021 Reviewers agreed at journal 02 Jun, 2021 Reviewers invited by journal 25 Apr, 2021 Editor assigned by journal 25 Apr, 2021 Editor invited by journal 22 Apr, 2021 Submission checks completed at journal 22 Apr, 2021 First submitted to journal 07 Apr, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-400535","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":22649003,"identity":"23fe0cf8-c0bd-4ac3-ba39-c3be8e1c477a","order_by":0,"name":"Jan Valentini","email":"data:image/png;base64,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","orcid":"","institution":"University Hospital and Faculty of Medicine Tuebingen","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jan","middleName":"","lastName":"Valentini","suffix":""},{"id":22649004,"identity":"1975795a-46b0-4d2c-8688-8e341d0df510","order_by":1,"name":"Carina Klocke","email":"","orcid":"","institution":"University Hospital and Faculty of Medicine Tuebingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Carina","middleName":"","lastName":"Klocke","suffix":""},{"id":22649005,"identity":"f393353f-ebc9-40a1-9ccd-c380d10ccfc6","order_by":2,"name":"Corina Güthlin","email":"","orcid":"","institution":"Goethe University Frankfurt","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Corina","middleName":"","lastName":"Güthlin","suffix":""},{"id":22649006,"identity":"75656bfe-840a-45d5-9d17-b0fad9a0f451","order_by":3,"name":"Stefanie Joos","email":"","orcid":"","institution":"University Hospital and Faculty of Medicine Tuebingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Stefanie","middleName":"","lastName":"Joos","suffix":""}],"badges":[],"createdAt":"2021-04-07 08:59:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-400535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-400535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":8380177,"identity":"649f5e55-46fd-4707-b7b1-6dd3812ca22a","added_by":"auto","created_at":"2021-04-23 17:18:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":138320,"visible":true,"origin":"","legend":"This figure illustrates the different action steps of the multistage Delphi Process conducted to identify the competencies for the novel catalogue.","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-400535/v1/bc94629ae260f338f179e8bf.jpg"},{"id":13688797,"identity":"9d24f691-9534-4f15-8a93-eaae329a6a2a","added_by":"auto","created_at":"2021-09-17 12:26:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549509,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-400535/v1/05791a4d-a3ee-45d1-87be-c2952d862f8b.pdf"},{"id":8380307,"identity":"a628f895-22cb-4fd3-ac2d-bc6de6a41e0e","added_by":"auto","created_at":"2021-04-23 17:21:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28295,"visible":true,"origin":"","legend":"Title and description: Supplementary table 1: Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees (English Version)","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-400535/v1/0140b6b34dba0f6ad0d9a5e1.docx"},{"id":8380308,"identity":"0f8cd78e-d7f2-4842-b536-13031717d2dd","added_by":"auto","created_at":"2021-04-23 17:21:47","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28633,"visible":true,"origin":"","legend":"Title and description: Supplementary table 2: Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees (German Version - Kompetenzbasiertes Katalog zur Komplementären und Integrativen Medizin für Ärztinnen und Ärzte in Weiterbildung zum Facharzt für Allgemeinmedizin)","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-400535/v1/bd4c21737bd83f3e802d654c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eIntegration of Complementary and Integrative Medicine Competencies in General Practice Postgraduate Education – Development of a Novel Competency Catalogue in Germany\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eInternational literature shows that Complementary and Integrative medical procedures (CIM) play an important role in general practice (GP)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). When compared to other countries as the USA, the number of general practitioners (GPs) providing CIM in Germany is rather high. There is some evidence suggesting that up to 60% of GPs are using CIM in Germany (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Over the last two decades some countries (e.g. USA, Australia to the best of our knowledge) have developed specific competency-based curricula for the integration of CIM competencies in GP postgraduate education.\u003c/p\u003e \u003cp\u003eFor the first time in the USA in 2000, a list of 18 competencies in the field of complementary and alternative medicine for postgraduate education in family medicine was published, with the competencies each assigned to either attitudes, skills, and/or knowledge (ASK) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In 2013 and on behalf of the Society of Teachers of Family Medicine (STFM), Locke et al. published a revised list of these competencies. When doing so, the overarching assignments to the ASK were removed and a total of 19 competencies were described. These competencies were assigned to different categories such as patient care, medical knowledge, interpersonal and communication skills, practice-based learning and development, professionalism, and systems-based care. In addition, a list of nine skills was described to support these 19 competencies (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Individual universities in the various American states were in charge of the implementation of this competency-based curriculum, and was exemplarily evaluated by Gardiner et al. in 2013. For this purpose, an online survey was conducted by the Council of Academic Family Medicine to elicit the knowledge and attitudes of residency faculty regarding CIM competencies as well as the inclusion of CIM in the local residency regulations. The results showed that the majority of the CIM competencies are known and considered to be an important part of the curriculum for future GPs. Various barriers (e.g. lack of time, lack of qualification of training officers, lack of access to CIM experts, etc.) which stood in the way of implementation were also identified (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A further development of a CIM curriculum was described by Lebensloh et al. in 2012: GP postgraduate trainees were able to complete parts of the curriculum via online training. The evaluation of this training demonstrated a positive assessment with regard to the feasibility of the online training, achievement of learning objectives, clinical benefit, and technical implementation by the GP postgraduate trainees (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In 2014, the same research group published data showing that the Integrative Medicine in Residency Curriculum is attractive to many medical students. It is also increasingly leading them choose a residency in family medicine as the integrative medicine curriculum allows them to broaden their skills and knowledge in patient care as well as responds to the increasing interest in learning integrative medicine (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Australia, the area of CIM was first included in the Curriculum for Australian General Practice for general medical education by the Royal Australian College of General Practitioners (RACGP) in 2007. Subsequently in 2016, the RACGP published a stand-alone chapter on integrative medicine (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Core competencies in general medicine for the area of CIM are described and adapted according to the respective level of medical training. These are acquired sequentially, built on each other and completed throughout the entire medical education, postgraduate training and continuing education. Thus, CIM has been successfully implemented throughout GP medical education in Australia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Germany, postgraduate training to become a GP is a structured and regulated five-year medical qualification with a final examination. The content of GP postgraduate education is regulated by the German Medical Association in the (Model) Specialty Training Regulations (MWBO) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). With the novel adaptation of the MWBO of 2018, Germany focusses on a competency-oriented approach (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In addition, the German Society for General Medicine and Family Medicine (DEGAM) has developed a competency-based curriculum for General Medicine which defines, in addition to the MWBO, competencies for GP postgraduate education based on the CanMed roles, an outcomes-based framework of physician competencies (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). After completing postgraduate education physicians can take structured additional qualifications in the field of CIM, which are awarded by the medical association. The following additional qualifications in the field of CIM can currently be acquired in Germany after completion of a postgraduate training: Acupuncture, Homeopathy, Manual Medicine/Chirotherapy, Medical Balneology and Climatology, Naturopathic Methods as well as Physical Therapy (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUp to date in Germany, there are some CIM topics integrated in undergraduate medical education in the German Medical Licensure Act. However, there is no such equivalent in GP postgraduate education (MWBO) in Germany. The competency-based curriculum for General Medicine of the DEGAM, includes for the first time in the main chapter \u0026ldquo;therapy\u0026rdquo; a single competency labelled \"complementary medical procedures\" (chapter III.3) without providing further details on its content (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). More detailed information on CIM procedures or corresponding CIM competencies are neither included in the MWBO nor in the competency-based curriculum for GP postgraduate training of the DEGAM. Thus, a specific catalogue for teaching CIM competencies in GP postgraduate training is missing in Germany. Therefore, the aim of the present work is to close this gap and to develop a catalogue of CIM competencies for GP postgraduate education.\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eMulti-stage Delphi procedure\u003c/h2\u003e\n\u003cp\u003eIn a multistage Delphi procedure, we addressed the question of which CIM competencies are seen as relevant and feasible for GP postgraduate education in Germany (see Fig.\u0026nbsp;1). Firstly, a survey among GP postgraduate trainees in Baden-W\u0026uuml;rttemberg, Germany (n\u0026thinsp;=\u0026thinsp;138), was performed in order to assess attitudes and needs towards CIM. The results showed a high interest towards CIM as well as perceived uncertainty with regard to different practical topics. The vast majority of the GP trainees would support the implementation of CIM training in the GP postgraduate training program (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThen, in a literature review, existing CIM curricula were identified. The competency-based curriculum of the STFM on Integrative Medicine was then defined as a best practice example and used as a blueprint (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). These competencies and learning objectives (19 basic competencies plus 12 supporting skills as, for example, \u003cem\u003e\u0026ldquo;Residents are expected to do the following: Demonstrate understanding of common complementary medicine therapies, including their history, theory, proposed mechanisms, safety/efficacy profile, contraindications, prevalence and patterns of use.\u0026rdquo;)\u003c/em\u003e were translated into German. In a next step, these basic and supporting skills were compared with the needs assessment from the survey, combined in a single catalogue and adapted to the German context resulting in a list of 23 competencies.\u003c/p\u003e\n\u003cp\u003eThis catalogue needed to be evaluated and further refined via a multistage Delphi process. As the first stage, a Delphi Survey was performed within the Complementary Medicine Working Group of the German Society of General Practice (n\u0026thinsp;=\u0026thinsp;10) (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e). The members were asked to rate the importance and feasibility of the included CIM competencies and were given the possibility to add free text comments or rewording suggestions after each competency. Finally, an overall rating of the importance of such a CIM catalogue for general medical education was to be given. As a result of this survey, the free text comments and ratings were considered and a further adaptation and reduction of CIM competencies resulted in 20 competencies. Finally, as a second step, the list of 20 competencies was evaluated with respect to relevance and feasibility for general practice by GP trainers, GP trainees and members of professional CIM associations in terms of a survey. The methods and results of this second Delphi survey on the 20 competencies are shown in the following as these form the resulting novel CIM catalogue.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eSecond Delphi-Survey:\u003c/h2\u003e\n\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n\u003ch2\u003eParticipants and data collection\u003c/h2\u003e\n\u003cp\u003eParticipants of the second Delphi Survey were GP postgraduate trainees enrolled in the postgraduate GP training programme of the Competence Center for Postgraduate Medical Education in Baden-W\u0026uuml;rttemberg, Germany (KWBW). The KWBW offers, amongst various topics related to family medicine, CIM workshops (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e). All active GP postgraduate trainees (n\u0026thinsp;=\u0026thinsp;432) of the KWBW and n\u0026thinsp;=\u0026thinsp;52 graduates of the KWBW program received an email with an invitation to participate in the online survey.\u003c/p\u003e\n\u003cp\u003eFurthermore, n\u0026thinsp;=\u0026thinsp;250 GPs of teaching clinics of the University of T\u0026uuml;bingen, enrolled in undergraduate and postgraduate medical education in Baden-W\u0026uuml;rttemberg, Germany, received the invitation via email. Additionally, members of professional CIM associations from the Hufelandgesellschaft e.V., the largest German umbrella organization for integrative medicine societies, took part in the survey. The invitation to participate in the online survey was distributed through the newsletter of the Hufelandgesellschaft e.V. as well as through the newsletters of various affiliated CIM societies, respectively. The number of GPs who received the invitation via this channel cannot be determined.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eSurvey\u003c/h2\u003e\n\u003cp\u003eThe survey was launched in July 2019 and was accessible to participants until 31st January 2020. No email reminder was sent. Participation was voluntary, and the data were collected anonymously. In addition to ten sociodemographic questions, participants were asked to rate the importance and relevance for the daily work of twenty single CIM competencies on a four-point Likert-scale (1\u0026thinsp;=\u0026thinsp;important 4\u0026thinsp;=\u0026thinsp;not important). The importance and relevance of the whole competency catalogue (i.e. the list of the 20 competencies as a whole) were also rated on the same four-point Likert-scale. Furthermore, the participants were asked two questions which could be answered with a free text, namely: \u003cem\u003e\u0026ldquo;Do you have further comments or suggestions for the novel CIM catalogue?\u003c/em\u003e and \u003cem\u003eIs anything missing?\u0026rdquo;\u003c/em\u003e The survey was given to two GP postgraduate trainees and to two GPs with no prior involvement on CIM education for pilot-testing with the think aloud method before implementation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eAnalysis and Evaluation\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was conducted with SPSS Version 27 (SPSS INC.; IBM, USA). Mean, median, quantiles, absolute frequencies and percentages are reported according to the scale level. Subgroup analysis between GP postgraduate trainees and GP specialists was conducted with non-parametric Mann-Whitney-U test. Subgroups smaller than n\u0026thinsp;=\u0026thinsp;5 participants as well as cases with more than five missing values were excluded.\u003c/p\u003e\n\u003cp\u003eFor the selection of the competencies for the final catalogue, the rate of consent (sum of participants rating an item as \u0026ldquo;important\u0026rdquo; or \u0026ldquo;rather important\u0026rdquo;, Likert-scale 1\u0026ndash;2, in percent) has been calculated for each item. A competency was selected for the novel catalogue if total consent was at least 80% or if total consent was \u0026lt;\u0026thinsp;80% but \u0026ge;\u0026thinsp;80% among GP trainees in the subgroup analysis, as it reflects the needs of the target group. The overarching goal was to come up with the lowest number of competencies (for sparseness) which are deemed to be relevant.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eEthics\u003c/h2\u003e\n\u003cp\u003eAccording to a communication from the Ethics Committee of the Medical University of T\u0026uuml;bingen, according to the German federal law of \u0026sect;\u0026nbsp;3 Abs. 6 BDSG / LDSG BW, no formal ethical vote is required for the collection of anonymous data.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eSociodemography\u003c/h2\u003e\n\u003cp\u003eOverall, n\u0026thinsp;=\u0026thinsp;131 participants joined the survey. The mean age of the participants was 49 years. Overall, the gender distribution of the participants was female in 56 %, while within the group of GP trainees, the proportion of female participants was significantly higher with 73%. The proportion of participants within GP postgraduate education was 35%. More than one-third (38%) of the participants were GP trainers. The number of participants who hold one or more CIM specializations was almost 50%. As for CIM specializations awarded by the medical association, participants were mostly specialized in homeopathy (43%), acupuncture (40%) and naturopathy (34%). Almost 40% indicated other CIM related trainings, such as osteopathy and nutritional medicine (multiple responses possible). More than one-third (39%) of the participants were members of a professional CIM society. The vast majority of the participants were actively involved in patient care. More or less three quarters of the participants stated that they use CIM in a professional and private context. Further details on the sociodemography are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003esociodemographic characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;131)*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge, years (mean (SD))\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48.9 (12.816), min. 27, max. 77\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiverse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72 (55.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56 (43.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIn postgraduate education, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46 (35.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003efemale 34 (73.9%)\u003c/p\u003e\n\u003cp\u003emale 12 (26.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85 (64.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ediverse 1 (1.2%)\u003c/p\u003e\n\u003cp\u003efemale 38 (45.8%)\u003c/p\u003e\n\u003cp\u003emale 44 (53.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCIM Specialisation, n (%)**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68 (51.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAcupuncture 27 (39.7%)\u003c/p\u003e\n\u003cp\u003eHomeopathy 29 (42.7%)\u003c/p\u003e\n\u003cp\u003eManual Medicine/Chirotherapy 6 (8.8%)\u003c/p\u003e\n\u003cp\u003eMedical Balneology and Climatology 2 (2.9%)\u003c/p\u003e\n\u003cp\u003eNaturopathic Methods 23 (33.8%)\u003c/p\u003e\n\u003cp\u003ePhysical Therapy 1 (1.5%)\u003c/p\u003e\n\u003cp\u003eOther, CIM related trainings 30 (44.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62 (47.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePatient care, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e123 (93.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (6.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProfessional Use of CIM, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103 (78.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (21.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrivate Use of CIM, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96 (73.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (26.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGP trainers, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48 (36.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83 (63.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCIM teaching, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (19.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e105 (80.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMembers of professional CIM associations, n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51 (38.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 (61.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e\u003csup\u003e*\u003c/sup\u003e variable n due to missings (n\u0026thinsp;=\u0026thinsp;130 to n\u0026thinsp;=\u0026thinsp;131) ** multiple responses possible\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eEvaluation of competencies\u003c/h2\u003e\n\u003cp\u003eThe ratings of every single competency are reported in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. After applying the above described cut-off criteria, 16 out of 20 competencies were included into the final catalogue. These competencies are covering knowledge, skills and attitude (ASK) on the following CIM topics: Medical knowledge, patient care and communication, practice-based learning and continuing education, professionalism, and competencies with regard to the German Health care system (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003cp\u003eThe importance rating of the whole catalogue is high, 78% of all participants ranked it on the four-point Likert-scale as \u0026ldquo;1\u0026thinsp;=\u0026thinsp;important\u0026rdquo; or \u0026ldquo;2\u0026thinsp;=\u0026thinsp;rather important. The relevance of the competencies for daily work presented in the survey was rated with 79% (important \u0026amp; rather important).\u003c/p\u003e\n\u003cp\u003eThe final list of competencies in English and German language can be found within the additional files (see Additional Files 1 and 2).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eSubgroup analysis of postgraduate physicians and specialists\u003c/h2\u003e\n\u003cp\u003eA subgroup analysis of GP postgraduate trainees and GP specialists was performed. A significant different rating was merely shown for questions no. 12 (\u0026ldquo;\u003cem\u003eGP trainees should be able to use evidence-based sources of information concerning CIM\u0026rdquo;\u003c/em\u003e, U\u0026thinsp;=\u0026thinsp;1283.000, Z= -3,567, p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003cem\u003e)\u003c/em\u003e and no. 18 (\u0026ldquo;\u003cem\u003eGP trainees should know conditions and general framework of different professional groups offering CIM treatments [e.g. natural practitioners/Heilpraktiker]\u0026rdquo;\u003c/em\u003e, U\u0026thinsp;=\u0026thinsp;1370.000, Z= -3,020, p\u0026thinsp;\u0026le;\u0026thinsp;0.05\u003cem\u003e)\u003c/em\u003e. The total consent as well as subgroup consents for question no. 12 was \u0026gt;\u0026thinsp;80%, it thus has been selected for the novel catalogue. For question no. 18, total consent was \u0026lt;\u0026thinsp;80% (67.9%) for GP specialists but 82.6% within the group of GP postgraduate trainees. Therefore, it has been included in the final list of competencies.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eResults of the evaluation of CIM competencies of the 2nd Delphi survey\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGP trainees should\u0026hellip;(competency)*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean (SD)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eQuantile\u003c/p\u003e\n\u003cp\u003e50/25/75\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e(Rather) important %*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1. Medical knowledge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to explain common CIM (complementary medicine, integrative medicine, naturopathy) concepts.\u003c/em\u003e (q1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.74 (0.865)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e84.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to explain common CIM treatments including their respective theories, postulated modes of action, limitations.\u003c/em\u003e (q2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.81 (0.842)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e83.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;know the available evidence of effectiveness, interactions, and safety concerning the most common CIM concepts or understand where to find this information.\u003c/em\u003e (q3)\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.84\u003c/p\u003e\n\u003cp\u003e(0.812)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e78.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to give advice concerning CIM therapies for the most frequent consultation issues in family medicine.\u003c/em\u003e (q4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.76 (0.802)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e83.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2. Patient care and communication\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;conduct a biopsychosocial health interview, including aspects of lifestyle and usage of CIM.\u003c/em\u003e (q5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.75 (0.788)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e84.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to jointly develop a treatment plan including conventional and complementary therapies with a patient and, if necessary, refer to appropriate facilities/therapists.\u003c/em\u003e (q6)*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.99\u003c/p\u003e\n\u003cp\u003e(0.907)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to clear up patients about CIM treatments, which could potentially harm health and budget.\u003c/em\u003e (q7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.41 (0.579)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to use non-pharmacological treatments (e.g. home remedies) for frequent issues of consultation (e.g. pain, fever, uncomplicated infections, etc.) or guide their patients thereto.\u003c/em\u003e (q8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.21 (0.425)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e99.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to use common phytotherapeutics and supplements for frequent issues of consultation (e.g. pain, fever, uncomplicated infections, etc.).\u003c/em\u003e (q9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.45 (0.623)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e94.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to consult regarding different relaxation techniques (meditation, mind and body practices, mindfulness, tai chi, yoga, etc.).\u003c/em\u003e (q10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.88 (0.775)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e81.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to specifically apply placebo and self-efficacy effects as needed for the therapeutic process.\u003c/em\u003e (q11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.60 (0.698)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e92.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3. Practice-based learning\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to use evidence-based sources of information concerning CIM.\u003c/em\u003e (q12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.69 (0.692)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e88.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to identify their individual learning needs concerning CIM.\u003c/em\u003e (q13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.89 (0.675)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e84.0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4. Professionalism\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;show respect and sympathy for patients\u0026lsquo; interpretations of health, disease and suffering, based on individual attitudes and therapy requests concerning CIM.\u003c/em\u003e (q14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.47 (0.636)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e93.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be open-minded and remain open to dialogue when it comes to another understanding of health and disease by medical and non-medical colleagues involved in a treatment.\u003c/em\u003e (q15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.54 (0.694)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e90.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;be able to take suitable action for self-care as needed.\u003c/em\u003e (q16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.43 (0.621)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e94.7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5. Competencies based on the German Health Care System\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;know conditions and general framework of medical educations and medical specialist training (e.g. additional training) concerning CIM treatments.\u003c/em\u003e (q17)*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.37\u003c/p\u003e\n\u003cp\u003e(0.705)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/2/3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;know conditions and general framework of different professional groups offering CIM treatments (e.g. natural practitioners/Heilpraktiker).\u003c/em\u003e (q18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.15 (0.815)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/2/3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e67.9***\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;know conditions and general framework for the medical practice concerning common CIM treatments (e.g. availability, prescription, legal regulations).\u003c/em\u003e (q19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.90 (0.711)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e82.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026hellip;consider conditions for patients\u0026rsquo; access to complementary therapy care (e.g. remuneration and costs) during their treatment.\u003c/em\u003e (q20)*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.99\u003c/p\u003e\n\u003cp\u003e(0.775)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/1/2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e77.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e* Competencies in grey were not included into the novel CIM catalogue. Ratings in bold were included in the novel CIM catalogue.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e** Five-point Likert-scale was used: \u0026ldquo;(rather) important\u0026rdquo; reflects the rate of consent and is the sum of items \u0026ldquo;1 \u0026ndash; important\u0026rdquo; and \u0026ldquo;2 \u0026ndash; rather important\u0026rdquo;.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*** Competency was included after subgroup analysis; rate of consent among GP trainees 82.6%.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn a rigorous multi-step approach, a competency-based catalogue containing 16 basic competencies on CIM for GP postgraduate education in Germany has been developed. This approach was chosen analogously to the development of competency-based curricula as successfully used in the field of general practice or spiritual care (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eCompetency-based medical education has been firmly established in the Anglo-American world for some time and is internationally regarded as a showcase model (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). In contrast, competency-based learning objectives have only recently been implemented for continuing education in Germany (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). To the best of our knowledge, this is the first competency-based catalogue on CIM for GP postgraduate education in Europe. Within a multi-stage Delphi procedure international best practice examples were translated and adapted to German context instead of reinventing the wheel. A similar approach was used by Steinhaeuser et.al for the development of the competency-based curriculum in general practice in Germany (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). GP trainees and GP trainers were equally involved in the following process of rating relevance and feasibility of potential competencies in order to get different perspectives. However, there are some limitations to this selection. Both groups may have had a special interest in CIM (also represented by the high percentage of participants with some form of CIM specialty), and thus may have overrated the relevance. However, to evaluate the specific competencies a basic knowledge of CIM is essential. The participation in the survey was anonymous and voluntary and it was not possible to draw conclusions about individual participants. Therefore, the motivation of participants was unclear (supporter or rejecter of CIM). Additionally, the GP trainees and GP trainers were mainly located within the same federal state, where seminars on CIM topics had already been implemented in GP postgraduate training. Since several mailing lists were used for the recruitment of the participants of the second Delphi Survey, the response rate cannot be determined.\u003c/p\u003e\n\u003cp\u003eFor the second Delphi Survey, we included GP trainees and GP trainers equally which showed a congruent rating for the majority of the competency assessments. One of the significant differences in the rating of competencies between these groups was competency no. 18 and related to competencies based on the German Health Care System. As GP trainees may not be familiar with all the conditions and general framework of German Health Care System at the beginning of their professional career, they may have ranked the importance of these competencies higher. Similar uncertainties were congruently reported in a former need assessment of GP trainees on CIM which was conducted by our study group (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). As we focused on the ratings of GP trainees and GP specialists in order to cover the different levels of work experience, we did not distinguish gender differences during all stages of the multistage Delphi procedure.\u003c/p\u003e\n\u003cp\u003eAs shown by Joos et al., CIM is already strongly integrated in primary care in Germany, although there is no specific CIM catalogue (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e). This discrepancy could also pose risks, especially since competencies as an evidence-based approach when providing CIM was not part of their former GP training. In a qualitative study, Ostermaier et al. could show that almost all more experienced GPs integrated at least some CIM in their clinical practice with a high degree of pragmatism (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). In contrast, young GP postgraduate trainees rate the importance of an evidence-based approach while providing CIM higher than their GP trainer. This could also be seen in our subgroup analysis on the competency no. 12 \u003cem\u003eGP trainees should be able to use evidence-based sources of information concerning CIM\u003c/em\u003e, where a significant difference between the rating of GP trainees (97.8% rating (rather) important) vs. GP (83.5% rating (rather) important) could be shown. Similar results are also shown by a study group of Linde et al. where GP postgraduate trainees expressed doubts regarding the evidence-based approach of CIM and specific effects over placebo (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e). Consequently, GP postgraduate trainees may tend to be more critical towards CIM compared to their trainers or experienced GPs.\u003c/p\u003e\n\u003cp\u003eCompared to the competency-based curriculum of the STFM on Integrative Medicine, which was used as a blueprint for the present catalogue (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e), we included a new competency in the category professionalism: no. 15 \u003cem\u003eGP trainees should be able to take suitable action for self-care as needed.\u003c/em\u003e There is growing evidence showing that the work strain and burnout risk in GP postgraduate trainees, as well as in physicians in general, is increasing over the last decades (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). Therefore, a promotion of physical and mental health seems to be essential in order to preserve the well-being of the physicians as well as their patients. This competency goes hand in hand with the principles of preserving health and well-being as described by Aaron Antonovsky in the basic concepts of Salutogenesis (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e). These principles represent a fundamental approach in primary care and show a large overlap with many complementary medicine procedures (e.g., exercise, nutrition, and relaxation elements) underlining why CIM procedures are so prominent in GP.\u003c/p\u003e\n\u003cp\u003eThe final competency-based catalogue on CIM is intended to complement the German Competence-Based Curriculum General Practice of the DEGAM by serving as a kind of red thread for continuing education in the field of CIM or to be integrated into it (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). The potential addressees of such a novel CIM catalogue are GP postgraduate trainees, competency centers for postgraduate education in GP offering CIM teaching modules, as well as GP trainees and GP trainers providing continuing education in GP. The GP postgraduate training KWBW for example included CIM in their set of core competencies for becoming a GP (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e). However, as family medicine covers a wide range of medical fields, merely two teaching units of 45 minutes each could be budgeted for covering the core competencies in this field. Specific teaching modules need to be developed and implemented in order to make these CIM competencies achievable by GP trainees. Ideally, this could be accomplished by the use of appropriate entrustable professional activities combined with appropriate assessments (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eGiven the fact that structures in GP postgraduate training are already available, there are very good chances for the implementation of the catalogue. After implementation of this catalogue, further evaluation is needed in order to test the practicability of this catalogue. This may be done by assessing a gain of knowledge, attitude and/or skills in the area of CIM within GP trainees. This could ultimately lead to achieving the goal of improving patient care while addressing CIM topics. Finally, a full Kern-cycle, representing a six-step approach of curriculum development for medical education, could be completed (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":" \u003cp\u003eThe competencies on CIM included in this novel catalogue are basic competencies intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies can be seen as basis for addressing and counseling patients regarding CIM methods in daily practice and should be mastered by all GP postgraduate trainees by the end of their training. These basic competencies are not intended to replace the additional training in CIM awarded by the German medical associations e.g. of acupuncture or manual medicine. Additionally, some of the competencies may also be transferred to other medical specialties as e.g. internal medicine, psychosomatics or surgical specialties and therefore may be included into a variety of existing medical education programs. Altogether, this novel competency-based catalogue on CIM provides the foundation for a comprehensive and nation-wide competency-based GP postgraduate education on CIM in Germany.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eASK \u003c/strong\u003eAttitudes, skills, and/or knowledge\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBDSG\u003c/strong\u003e Federal Data Protection Act\u003c/p\u003e\n\u003cp\u003e[\u003cem\u003eGerma\u003c/em\u003en: Bundesdatenschutzgesetz]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCIM \u003c/strong\u003eComplementary and Integrative Medicine\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDEGAM \u003c/strong\u003eGerman Society for General Medicine and Family Medicine\u003c/p\u003e\n\u003cp\u003e[\u003cem\u003eGerman\u003c/em\u003e: Deutsche Gesellschaft f\u0026uuml;r Allgemeinmedizin und Familienmedizin]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGP \u003c/strong\u003eGeneral practice\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGPs\u003c/strong\u003e General practitioners\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKWBW \u003c/strong\u003eCompetence Center for Postgraduate Medical Education in Baden-W\u0026uuml;rttemberg, Germany\u003c/p\u003e\n\u003cp\u003e[\u003cem\u003eGerman\u003c/em\u003e: Kompetenzzentrum Weiterbildung Baden-W\u0026uuml;rttemberg]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLDSG BW \u003c/strong\u003eState Data Protection Law Baden-W\u0026uuml;rttemberg\u003c/p\u003e\n\u003cp\u003e[\u003cem\u003eGerman\u003c/em\u003e: Landesdatenschutzgesetz Baden-W\u0026uuml;rttemberg]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMWBO \u003c/strong\u003e(Model) Specialty Training Regulations\u003c/p\u003e\n\u003cp\u003e[\u003cem\u003eGerman\u003c/em\u003e: (Muster-)Weiterbildungsordnung]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRACGP \u003c/strong\u003eRoyal Australian College of General Practitioners\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD \u003c/strong\u003eStandard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTFM \u003c/strong\u003eSociety of Teachers of Family Medicine\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that all methods were carried out in accordance with relevant guidelines and regulations, e.g. Declaration of Helsinki. According to a communication from the Ethics Committee of the Medical University of T\u0026uuml;bingen, no formal ethical vote is required for the collection of anonymous data according to the German federal law of \u0026sect; 3 Abs. 6 BDSG / LDSG BW. Therefore, submission of a study protocol to the Ethics Committee of the Medical University of T\u0026uuml;bingen was not required. Consent from all study participants was obtained by actively clicking the checkbox in the online survey; otherwise, participation in the survey was not possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe novel Competency-based Catalogue on Complementary and Integrative Medicine for GP trainees can be downloaded in English and German language here:\u003c/p\u003e\n\u003cp\u003e\u003ca href=\"https://www.medizin.uni-tuebingen.de/de/das-klinikum/einrichtungen/institute/allgemeinmedizin/forschung/komplementaere-und-integrative-medizin/kompetenzbasiertes-curriculum-zur-komplementaeren-und-integrativen-medizin\"\u003ehttps://www.medizin.uni-tuebingen.de/de/das-klinikum/einrichtungen/institute/allgemeinmedizin/forschung/komplementaere-und-integrative-medizin/kompetenzbasiertes-curriculum-zur-komplementaeren-und-integrativen-medizin\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets and further additional files used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJV, CG and SJ drafted the concept and design of the study and were responsible for data collection. JV wrote the draft. CK performed data analysis and contributed to writing the draft.\u003c/p\u003e\n\u003cp\u003eSJ supervised the study. All authors critically revised the manuscript, as well as read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully thank native English speakers Hannah Fuhr for reviewing this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLinde K, Alscher A, Friedrichs C, Joos S, Schneider A. Die Verwendung von Naturheilverfahren, komplement\u0026auml;ren und alternativen Therapien in Deutschland - eine systematische \u0026Uuml;bersicht bundesweiter Erhebungen [The use of complementary and alternative therapies in Germany - a systematic review of nationwide surveys]. Forsch Komplementmed. 2014;21(2):111-8.\u003c/li\u003e\n\u003cli\u003eMarstedt G, Moebus S. Inanspruchnahme alternativer Methoden in der Medizin. Berlin: Robert Koch-Institut Berlin. Heft 9.\u003c/li\u003e\n\u003cli\u003eJoos S, Musselmann B, Szecsenyi J. Integration of complementary and alternative medicine into family practices in Germany: results of a national survey. Evid Based \u003cem\u003eComplement\u003c/em\u003e Alternat Med. 2011;2011:495813.\u003c/li\u003e\n\u003cli\u003eAstin JA, Marie A, Pelletier KR, Hansen E, Haskell WL. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med. 1998;158(21):2303-10.\u003c/li\u003e\n\u003cli\u003ePirotta M, Kotsirilos V, Brown J, Adams J, Morgan T, Williamson M. Complementary medicine in general practice - a national survey of GP attitudes and knowledge. Aust Fam Physician. 2010;39(12):946-50.\u003c/li\u003e\n\u003cli\u003eKligler B, Gordon A, Stuart M, Sierpina V. Suggested curriculum guidelines on complementary and alternative medicine: recommendations of the Society of Teachers of Fam Med Group on Alternative Medicine. Family medicine. 2000;32(1):30-3.\u003c/li\u003e\n\u003cli\u003eLocke AB, Gordon A, Guerrera MP, Gardiner P, Lebensohn P. Recommended integrative medicine competencies for family medicine residents. Explore. 2013;9(5):308-13.\u003c/li\u003e\n\u003cli\u003eGardiner P, Filippelli AC, Lebensohn P, Bonakdar R. Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies. Explore. 2013;9(5):299-307.\u003c/li\u003e\n\u003cli\u003eLebensohn P, Kligler B, Dodds S, Schneider C, Sroka S, Benn R, et al. Integrative medicine in residency education: developing competency through online curriculum training. J Grad Med Educ. 2012;4(1):76-82.\u003c/li\u003e\n\u003cli\u003eLebensohn P, Dodds S, Brooks AJ, Cook P, Guerrera M, Sierpina V, et al. Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine. Explore. 2014;10(3):187-92.\u003c/li\u003e\n\u003cli\u003eRoyal Australian College of General Practicioners RACGP. Curriculum for Australian General Practice 2016. 2016. http://curriculum.racgp.org.au/. Accessed 02 Apr 2021.\u003c/li\u003e\n\u003cli\u003eRoyal Australian College of General Practicioners RACGP. IM16 - Integrative medicine contextual unit 2016. 2016. https://www.racgp.org.au/education/education-providers/curriculum/contextual-units/processes/im16-integrative-medicine. Accessed 02 Apr 2021.\u003c/li\u003e\n\u003cli\u003eBundes\u0026auml;rztekammer. (Muster-)Weiterbildungsordnung 2003. 2015. http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/Weiterbildung/MWBO.pdf. Accessed 02 Apr 2021.\u003c/li\u003e\n\u003cli\u003eBundes\u0026auml;rztekammer. (Muster-)Weiterbildungsordnung 2018. 2018. www.bundesaerztekammer.de/aerzte/aus-weiter-fortbildung/weiterbildung/muster-weiterbildungsordnung/. Accessed 02 Apr 2021.\u003c/li\u003e\n\u003cli\u003eChenot J, Steinh\u0026auml;user J. Die novellierte Musterweiterbildungsordnung. Z Allg Med. 2019;95(4):156-9.\u003c/li\u003e\n\u003cli\u003eDeutsche Gesellschaft f\u0026uuml;r Allgemeinmedizin und Familienmedizin DEGAM. Kompetenzbasiertes Curriculum Allgemeinmedizin 2015. 2015. https://www.degam.de/files/Inhalte/Degam-Inhalte/Sektionen_und_Arbeitsgruppen/Sektion_Weiterbildung/Curriculum_01-10-15_neu.pdf. Accessed 02 Apr 2021.\u003c/li\u003e\n\u003cli\u003eFrank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach. 2007;29(7):642-7.\u003c/li\u003e\n\u003cli\u003eFrank J. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005.\u003c/li\u003e\n\u003cli\u003eValentini J, Flum E, Schwill S, Krug K, Szecsenyi J, Joos S. Komplement\u0026auml;re und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Arzten in Weiterbildung [Complementary and Integrative Medicine in Postgraduate Training Programs in Germany: An Assessment among Family Medicine Trainees]. Complement Med Res. 2018;25(4):233-9.\u003c/li\u003e\n\u003cli\u003eJoos S, Breivogel B, G\u0026uuml;ndling P, G\u0026uuml;thlin C, Heusser P, Musselmann B, et al. Komplement\u0026auml;rmedizin in der haus\u0026auml;rztlichen Praxis - Zur Gr\u0026uuml;ndung der Arbeitsgruppe Komplement\u0026auml;rmedizin (AG KompMed) in der DEGAM [Complimentary Medicine in Family PracticeAbout the Newly Established DEGAM-Group Complementary and Alternative Medicine (AG KompMed)]. Z Allg Med. 2010(86):337\u0026ndash;41.\u003c/li\u003e\n\u003cli\u003eStengel S, F\u0026ouml;rster C, Fuchs M, Bischoff M, Ledig T, Streitlein-B\u0026ouml;hme I, et al. Developing a seminar curriculum for the Competence Centerfor General Practice in Baden-Wuerttemberg\u0026ndash; a progress report. GMS J Med Educ. 2021;38(2):Doc36.\u003c/li\u003e\n\u003cli\u003eThomas-Hemak L, Palamaner Subash Shantha G, Gollamudi LR, Sheth J, Ebersole B, Gardner KJ, et al. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience. PeerJ. 2015;3:e766.\u003c/li\u003e\n\u003cli\u003eSteinhaeuser J, Chenot JF, Roos M, Ledig T, Joos S. Competence-based curriculum development for general practice in Germany: a stepwise peer-based approach instead of reinventing the wheel. BMC Res Notes. 2013;6:314.\u003c/li\u003e\n\u003cli\u003eAnandarajah G, Craigie F, Jr., Hatch R, Kliewer S, Marchand L, King D, et al. Toward competency-based curricula in patient-centered spiritual care: recommended competencies for family medicine resident education. Acad Med. 2010;85(12):1897-904.\u003c/li\u003e\n\u003cli\u003eTen Cate O. Competency-Based Postgraduate Medical Education: Past, Present and Future. GMS J Med Educ. 2017;34(5):Doc69.\u003c/li\u003e\n\u003cli\u003eValentini J, Flum E, Schwill S, Krug K, Szecsenyi J, Joos S. Komplement\u0026auml;re und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei \u0026Auml;rzten in Weiterbildung [Complementary and Integrative Medicine in Postgraduate Training Programs in Germany: An Assessment among Family Medicine Trainees]. Complement Med Res. 2018;25(4):233-9.\u003c/li\u003e\n\u003cli\u003eOstermaier A, Barth N, Schneider A, Linde K. On the edges of medicine - a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations. BMC Fam Pract. 2019;20(1):55.\u003c/li\u003e\n\u003cli\u003eHuber CM, Barth N, Linde K. How Young German General Practitioners View and Use Complementary and Alternative Medicine: A Qualitative Study. Complement Med Res. 2020;27(6):383-91.\u003c/li\u003e\n\u003cli\u003eBugaj TJ, Valentini J, Miksch A, Schwill S. Work strain and burnout risk in postgraduate trainees in general practice: an overview. Postgrad Med. 2020;132(1):7-16.\u003c/li\u003e\n\u003cli\u003eAntonovsky A. Salutogenese: Zur Entmystifizierung der Gesundheit. T\u0026uuml;bingen: dgvt-Verlag; 1997.\u003c/li\u003e\n\u003cli\u003ePetzold TD. Systemische und dynamische Aspekte von Ganzheit in einer Theorie der Allgemeinmedizin [Systemic and Dynamic Aspects of the Entireness in a Theory of Family Medicine]. Z Allg Med. 2011;87(10):407-13.\u003c/li\u003e\n\u003cli\u003eBerberat PO, Harendza S, Kadmon M. Entrustable professional activities - visualization of competencies in postgraduate training. Position paper of the Committee on Postgraduate Medical Training of the German Society for Medical Education (GMA). GMS Z Med Ausbild. 2013;30(4):Doc47.\u003c/li\u003e\n\u003cli\u003eHahn EG. Integrative medicine and health in undergraduate and postgraduate medical education GMS J Med Educ. 2021;38(2):Doc46.\u003c/li\u003e\n\u003cli\u003eThomas PA, Kern DE, Hughes MT, Chen BY. Curriculum development for medical education: a six-step approach.3rd ed. Baltimore: Johns Hopkins University Press; 2016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Integrative medicine, general practice, family medicine residency, postgraduate medical education, medical education, competency catalogue","lastPublishedDoi":"10.21203/rs.3.rs-400535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-400535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eComplementary and Integrative medical procedures (CIM) play an important role in general practice (GP). Consequently, in some countries (e.g. USA, Australia) specific curricula for the integration of CIM competencies in GP postgraduate education exist. Although Germany is one of the countries where CIM is strongly integrated in general practice, no such catalogue exists up to date. The aim of this study was to define a set of CIM competencies that are seen as relevant and feasible for postgraduate education in the German general practice setting.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eFirstly, a survey among GP trainees (n= 138) was performed in order to assess needs and attitudes towards CIM. Then, existing competency-based CIM curricula were identified in international literature, translated into German and compared with the needs assessment from the survey. Finally, in a multi-stage Delphi procedure, GP trainers, GP trainees and members of professional CIM associations (n= 131) evaluated a list of CIM competencies according to relevance and feasibility for general practice.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWithin this multistage process a final catalogue of 16 competencies was defined, covering the following areas: Medical knowledge, patient care and communication, practice-based learning, professionalism and competencies based on the German health care system.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe final catalogue of CIM competencies is intended to serve for GP training complementing the German competency-based curriculum for general practice. These competencies cover basic skills and are not intended to replace existing additional qualifications awarded by the medical associations in specific CIM methods, such as acupuncture or manual medicine. Therefore, a list of relevant competencies on CIM is available in order to serve as add-on for postgraduate education in general practice in Germany.\u003c/p\u003e","manuscriptTitle":"Integration of Complementary and Integrative Medicine Competencies in General Practice Postgraduate Education – Development of a Novel Competency Catalogue in Germany","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-23 17:18:45","doi":"10.21203/rs.3.rs-400535/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-06-18T11:19:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-06-02T09:00:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6a8feb56-4ffe-4503-987e-02c280b61da8","date":"2021-06-02T06:18:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-04-25T14:48:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-04-25T14:42:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-04-22T08:47:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-04-22T07:55:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2021-04-07T08:48:36+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fdc6bf19-4551-40a6-9436-e0b76ac37c29","owner":[],"postedDate":"April 23rd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":3854131,"name":"Integrative \u0026 Complementary Medicine"}],"tags":[],"updatedAt":"2021-09-16T04:14:03+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-23 17:18:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-400535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-400535","identity":"rs-400535","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}