Table 4.
Scores on Direct Observation Evaluation Tool Across Program Sites (n = 11)
| Competency and Behaviors | Mean Score (range 1–3) | Standard Deviation | Percent Rated as DNO* |
| Direct Observation Evaluation Tool | |||
| Uses patient-centered care techniques (Competency #3) | |||
| a. Takes a history which includes the patient's understanding of their illness | 2.5** | 0.50 | 0% |
| b. Incorporates information about family, community, and occupational factors into history-taking | 2.9 | 0.30 | 0% |
| c. Inquires regarding role of stress in patient's health and self-care/stress management strategies | 2.9 | 0.32 | 0% |
| d. Inquires about sources of pleasure or happiness in patient's life | 2.7 | 0.47 | 0% |
| e. Inquires about care from other practitioners or healers and the impact of this on the patient | 2.6 | 0.50 | 0% |
| f. Integrates prevention and health promotion into the visit | 2.7 | 0.50 | 33.3% |
| Uses communication skills that enhance the physician/patient relationship (Competency #4) | |||
| a. Uses appropriate introduction | 2.9 | 0.30 | 0% |
| b. Uses appropriate eye contact, body language, physical distance/proximity | 2.9 | 0.30 | 0% |
| c. Appropriately uses non-medical terms and clear language | 2.8 | 0.42 | 0% |
| d. Demonstrates empathy and compassion | 2.8 | 0.42 | 0% |
| e. Uses open-ended questions, allowing adequate time for patient's responses | 2.9 | 0.30 | 0% |
| Facilitates lifestyle changes in patients (Competency #5) | |||
| a. Assesses readiness for change | 2.6 | 0.52 | 0% |
| b. Negotiates prioritization of areas in need of change | 2.4** | 0.79 | 12.5% |
| c. Identifies potential obstacles and mitigating strategies | 2.7 | 0.44 | 2.5% |
| d. Formulates plan that is appropriate to the stage the patient is at | 2.5** | 0.79 | 22.2% |
| Practices constructively and collaboratively with other health team member (Competency #7) | |||
| a. Communicates respectfully with other members of the team | 2.6 | 0.58 | 62.5% |
| b. Actively solicits input on patient care from other team members | 2.6 | 0.58 | 66.7% |
| Integrates mind-body recommendations into practice appropriately (Competency #9) | |||
| a. Inquires about previous and current use and response to mind-body therapies | 2.9 | 0.30 | 0% |
| b. Discusses potential applications of mind-body therapies to specific patient | 2.8 | 0.42 | 9.1% |
| c. Identifies potential obstacles and mitigating strategies to the use of mind-body therapies | 2.6 | 0.52 | 11.1% |
| d. Demonstrates/teaches mind-body technique(s) to patients or refers patient appropriately | 2.6 | 0.55 | 37.5% |
| Integrates botanical recommendations into practice appropriately (Competency #10) | |||
| a. Inquires about previous and current use and response to botanical therapies | 2.9 | 0.32 | 0% |
| b. Discusses potential applications of botanical therapies specific to patient | 2.5** | 0.55 | 25.0% |
| c. Identifies potential obstacles and mitigating strategies to the use of botanicals | 2.3** | 0.58 | 57.1% |
| d. Recommends botanicals to patients or refers patients appropriately | 2.3** | 0.58 | 57.1% |
| Integrates nutrition recommendations into practice appropriately (Competency #11) | |||
| a. Inquires about previous and current use and response to nutritional therapies | 2.9 | 0.30 | 0% |
| b. Discusses potential applications of nutritional therapies to specific patient | 2.8 | 0.38 | 22.2% |
| c. Identifies potential obstacles and mitigating strategies to the use of nutritional therapies | 2.7 | 0.49 | 22.2% |
| d. Recommends nutritional interventions to patients or refers appropriately | 3.0 | 0.00 | 33.3% |
| Integrates physical activity recommendations into practice appropriately (Competency #12) | |||
| a. Inquires about previous and current use and response to physical activity | 2.7 | 0.44 | 10.0% |
| b. Discusses potential applications of physical activity to specific patient | 2.8 | 0.41 | 25.0% |
| c. Identifies potential obstacles and mitigating strategies to the use of physical activity | 2.6 | 0.52 | 25.0% |
| d. Recommends physical activity interventions to patients or refers appropriately | 2.7 | 0.50 | 50.0% |
| Counsels and supports patient regarding spirituality (Competency #13) | |||
| a. Inquires about previous and current spiritual or religious practice in a sensitive manner if indicated | 3.0 | 0.00 | 33.3% |
| b. Discusses potential relevance of spirituality to health if indicated | 2.7 | 0.50 | 50.0% |
| c. Refers for pastoral care or other spiritual approach when appropriate | 2.5** | 0.71 | 75.0% |
| Composes and administers individual integrative medicine treatment plan (Competency #14) | |||
| a. Produces a coherent and readable written treatment plan for new patients and reviews this plan with faculty | 3.0 | 0.00 | 12.5% |
| b. Incorporates evidence-based approach into treatment plan, when possible | 2.5** | 0.55 | 25.0% |
| c. Builds in to treatment plan comments on what patient already is doing well and where they have already shown strength and resources | 2.8 | 0.45 | 37.5% |
| d. Incorporates feedback from faculty effectively into treatment plan | 3.0 | 0.00 | 22.2% |
| e. Communicates plan clearly to patient, including discussion of potential obstacles to and facilitators of its implementation | 2.8 | 0.41 | 22.2% |
* DNO = Did Not Observe
** Scores ≤ 2.5 were determined to be below acceptable