What Do Naturopaths Learn in Medical School?
Naturopathic physicians (in contrast to traditional naturopaths) receive medical training that is similar to medical doctors in some ways, and different in others. In addition to a comparison of educational paths between naturopathic and medical doctors, there are important differences in the course curriculum between various medical programs.
In this article, I will give an outline of my own course curriculum at the Southwest College of Naturopathic Medicine. Although it is important to keep in mind that this is just an example, and that medical programs vary from place to place, and from time to time. For example, during my four years at SCNM (1999-2003) I participated on the Curriculum Committee, and help to redesign the delivery of course content to future naturopathic medical students.
As we will see, about 75% of the naturopathic course curriculum is the similar to a conventional medical school, with the other 25% making up the important differences such as naturopathic philosophy, clinical nutrition, mind/body medicine, and botanical medicine.
Naturopathic Medicine First Year Curriculum
The first year of the naturopathic medicine program I attended was largely focused on graduate-level instruction in the basic sciences: human anatomy (including cadaver lab), neuroanatomy (with human brain dissection), human physiology, embryology (the study of human embryonic and fetal development), histology (the study of human tissues), endocrinology, microbiology (with lab), immunology, and medical biochemistry. These courses were taught primarily by medical doctors and PhD's in science and the textbooks we used were the similar textbooks used in any medical school, such as Grant's and Netter's anatomy and Mark's medical biochemistry. Out of the 87.5 credit-hours of naturopathic medical school classes that I took in my first year, approximately two-thirds of the curriculum was focused on instruction in the basic sciences.
In addition to the coursework in the basic sciences, we also had a course in epidemiology. Epidemiology is the study of the incidence and distribution of disease in a population, including the transmission of communicable diseases and its prevention primarily through good hygiene and immunization practices. Perhaps contrary to what one might expect, naturopathic doctors are not taught in medical school to recommend against vaccination of our patients. We are taught about the relative risks and benefits of various vaccinations and their delivery systems, how to administer vaccines according to a delayed or alternative vaccination schedule, and how to help patients who voluntarily decline vaccinations to reduce their risk of contracting vaccine-preventable diseases through healthy lifestyle practices. While it is true that some naturopathic doctors are against vaccination, these are not in the majority and, for the record, some medical doctors are against vaccines as well.
During our first year of naturopathic medical school, we also had our first course in clinical pharmacology- or the study of medicinal drugs. People are sometimes surprised to learn that naturopathic physicians learn pharmacology and that, in states with naturopathic medicine licensure, we can and do prescribe them for our patients. Naturopathic physicians are not against pharmaceutical medications, but generally prefer to use natural remedies, like herbal medicine and nutrition, whenever possible. This not only reduces the chances of experiencing disturbing side effects of drugs, but also in may help to make drugs more effective when we do choose to use them. For example, sustained overprescription of antibiotics by medical doctors has led to a sharp increase in antibiotic-resistant bacteria. Reserving medications such as antibiotics only to situations where they are absolutely necessary can actually help to make them more effective in the long run, and reduce the incidence of infection with antibiotic-resistant bacteria like MRSA and C. diff.
In addition to this standard medical coursework, naturopathic doctors also learn the basics of naturopathic philosophy of medicine. For example, we took a course called Physician Heal Thyself in which we learned how keeping ourselves physically and psychologically healthy will better serve our patients- skills sorely needed by physicians of all types. We also had a course in Healthy Communication as a fundamental principle of naturopathic medicine is to act as teachers and guides to our patients. As you may be aware, having poor communication skills is one of the top complaints patients have about their doctors. Naturopathic doctors are known as physicians who listen because we take the time to get to know our patients and to thoroughly understand their questions and concerns.
Naturopathic Medicine Second Year Curriculum
Our second year of naturopathic medical curriculum largely continued with the basic medical sciences. Along with more medical biochemistry and medical genetics, we had 12 credit-hours in pathophysiology, which is the study of disease according to the standard Western medical model. In addition to these classes, we also began our coursework in Traditional Chinese Medicine, which employs a functional medical model, in contrast to the anatomy-based model used in Western medicine.
We also started learning about clinical nutrition during our second year in naturopathic medical school. Medical doctors learn about clinical nutrition as well, but it is typically sprinkled throughout their other coursework. One of the primary differences between naturopathic and conventional medical schools is the strong focus on diet and nutrition as a therapeutic modality. My naturopathic medicine curriculum included a total of 15 credit-hours dedicated solely to clinical nutrition, and a third of this coursework was taken during our second year.
Building upon the basic sciences, the second year is when we began to learn about how to do physical exams and diagnostic lab assessments. A total of 17.5 credit hours during the second year of naturopathic medical curriculum was dedicated to physical examination and assessment, and lab testing like blood and urine analysis, x-ray, computerized tomography (CT), magnetic resonance imaging (MRI), and ultrasound. We also continued our coursework in pharmacology, learning about drug toxicology, side-effects, and interactions.
Naturopathic Medicine Third Year Curriculum
In the third year of naturopathic medicine curriculum, the focus started to shift more towards clinical assessment and treatment, of patients as this was the year we began our physician-supervised clinical training. A total of 36.5 credit-hours was focused upon the continuation of instruction on physical exam and lab assessment, along with clinical case taking. We also began coursework in medical specialty areas, like emergency medicine, obstetrics, gynecology, and urology.
We continued our coursework in pharmacology and also began our curriculum in medical research. Although critics of naturopathic medicine sometimes complain that we do not practice science-based and evidence-based medicine, that is simply not true. The vast majority of naturopathic medical curriculum is focused on modalities which are substantiated by science and medical research. In addition, we also learn how to conduct and evaluate medical research. Indeed, some naturopaths go on to have an entire career that focuses upon medical research instead of seeing patients.
While it is true that certain modalities that naturopathic doctors learn about, such as hydrotherapy, mechanotherapy, acupuncture, and homeopathy, are generally not considered to have a foundation in known medical science and/or research, these are actually a relatively small part of what naturopaths learn in medical school. The degree to which non-evidence-based modalities are employed varies greatly from practitioner to practitioner. It is also important to realize that many medical doctors engage in non-evidence-based medicine such as polypharmacy (prescribing multiple drugs simultaneously), off-label use of pharmaceutical agents, and any number of holistic modalities that naturopathic doctors may also employ.
Naturopathic Medicine Fourth Year Curriculum
In the fourth year of naturopathic medical school, students are mostly continuing their supervised clinical training, but also continue with coursework. Additional courses in specialty areas such as pediatrics, dermatology, cardiology, gastroenterology, neurology, geriatrics, and oncology are taken. Naturopathic medical doctors also receive training in minor surgery during the fourth year. Finally, we conclude our study of medical research, including the presentation of a research project.
By the end of my naturopathic medical program, I had logged over 80 credit-hours of supervised clinical rotations and case review, which is approximately equivalent to about 800 real-time hours in clinical training, spaced out over two years. While most naturopathic doctors do not complete three to seven-year residency programs like medical doctors, it is important to understand that residency training for medical doctors occurs, for the most part, after they have become licensed to practice medicine.
Summary of Naturopathic Medicine Curriculum
Keeping in mind that the exact length and content of medical curricula vary from school to school, and over time. In my specific experience, I received exactly 375.5 credit-hours of instruction, which translates to 3750 hours of time spent in the classroom and/or clinical training. Here is the breakdown:
Standard Medical School Coursework
(75% of total)
- Basic Sciences (e.g. anatomy, physiology, pathology): 84.5 credit-hours (23%)
- Clinical Training and Case Review: 81 credit-hours (22%)
- Clinical Assessment (e.g. physical exam, lab tests, imaging): 41 credit-hours (11%)
- Medical Specialty (e.g. gastroenterology, cardiology, obstetrics): 41 credit-hours (11%)
- Pharmacology, medical research, and public health: 22 credit-hours (6%)
- Practice Management, Medical Ethics and Jurisprudence: 11 credit-hours (3%)
Non-Standard Medical School Coursework
(25% of total)
- Physical Medicine / Physiotherapy: 22 credit-hours (6%)
- Traditional Chinese Medicine / Acupuncture: 19.5 credit-hours (5%)
- Clinical Nutrition: 15 credit-hours (4%)
- Botanical (Herbal) Medicine: 14 credit-hours (4%)
- Homeopathy: 14 credit-hours (4%)
- Psychology / Mind-Body Medicine: 10 credit-hours (3%)
- Naturopathic Medicine Philosophy: 7 credit-hours (2%)
- Hydrotherapy: 3.5 credit-hours (1%)
Medical training for naturopathic doctors shares some important similarities with conventional medical programs, including basic science classes, diagnosis and assessment, pharmacology, and medical research. As a general guideline (individual cases will vary), a naturopathic medicine program is about 75% similar to that of a conventional medical school.
The other 25% of the naturopathic curriculum is what sets naturopathic doctors apart from medical doctors. The biggest differences are specific training in diet and nutrition, botanical medicine and physiotherapy, mind-body medicine, and of course, naturopathic medical philosophy.