THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 9, Number 4, 2003, pp. 577–579 © Mary Ann Liebert, Inc. Taking on the Herbal Education Challenge: Commentary on Increasing Physician Awareness of the Common Uses and Contraindications of Herbal Medicines. Utility of a Case-Based Tutorial for Residents KATHI J. KEMPER, M.D., M.P.H. 577 U se of herbs and dietary supplements (H/DS) is particularly common among pa- tients suffering from incurable, chronic, or re- current conditions such as those who receive care in tertiary hospitals housing residency training programs (Sparber et al., 2000). In ad- dition, patients experiencing psychosocial problems such as those seen in many resident continuity clinics also frequently turn to herbal remedies (Kessler et al., 2001). Even healthy persons such as athletes and pregnant women (who need regular sports physicals and prena- tal care, respectively) use H/DS, primarily to enhance their performance or well-being (Al- laire et al., 2000; Baylis et al., 2001; Harnack et al., 2001; Ranzini et al., 2001). Despite the wide- spread use of using H/DS, only approximately 40% of patients who use complementary and alternative medical (CAM) therapies discuss their use with their physicians (Eisenberg et al., 1998). Rates of discussing such use with resi- dent physicians are largely unknown. Because patients may not initiate discussions with their physicians about herbal remedies (viewing them as irrelevant, of no interest to their clinician, or beyond the clinician’s exper- tise), doctors have been urged to inquire rou- tinely about patients’ use of H/DS (Eisenberg et al., 2001; Greger, 2001; Wynia et al., 1999). However, physicians have generally been poorly prepared to ask or address clinical ques- tions about H/DS. Medical school courses in CAM rarely provide detailed information about H/DS or how to report adverse effects (Konefal, 2002). An increasing number of physician-oriented journal articles, reference books, and Internet sites on herbs and other di- etary supplements, such as the PDR for Herbal Medicines, the Natural Medicine Compre- hensive Database, the Longwood Herbal Task Force (Gardiner and Kemper, 2000), and HerbMed ® (www.herbmed.org) are available. However, they have not been included in stan- dard medical school or residency curricula, and few are familiar to practicing clinicians. Fur- thermore, reference books and Internet sites re- quire an active learning approach. Unless the clinician learns about the resource, accesses it and reads it, the information is unlikely to be acquired. Mikail and colleagues (pp. 571–576) used a number of strategies proven to enhance learn- ing in adult learners. Adult learning theories suggest that adult learners learn best when (1) the learning objectives are clear, (2) the mate- rial is relevant to their daily lives, (3) learning is self-paced, focused, and brief, (4) there are opportunities for active learning and interac- tion, and (5) there are opportunities to test and apply the information to their daily lives (Knowles et al., 1998). By asking for residents’ preferences about learning about H/DS (most Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC, and Department of Pedi- atrics, Pediatrics, Harvard Medical School, Boston, MA.