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Amri also noted the polarization observed in the second survey. She says, overall, females, older students and those who had used CAM had more positive attitudes towards holistic treatment of health conditions and became more positive in their attitude over time. However, males and non-CAM users had more negative tendencies toward the effectiveness of CAM therapies and continued to become more negative over time.

"One explanation for the decrease in positive attitude about CAM may result from the students' increased medical knowledge and contact with skeptical clinicians, which are not counter-balanced by CAM teaching," Amri explains.

Survey Methodology

Researchers used a survey called Integrative Medicine Attitude Questionnaire (IMAQ), which included 28 questions relevant to CAM, with each item accompanied by a 7-point Likert scale (point scale with responses ranging from strongly disagree to absolutely agree plus don't know). The IMAQ include three major foci: Attitudes toward holism; effectiveness, credibility and value of CAM; and focus on the doctor-patient relationship, reflection and self-care.

The IMAQ also asked questions about students' age, gender, race, specialty choice, whether they had used CAM or seen a CAM practitioner previously and whether they were interested in or had already undertaken a CAM course.

A total of 604 first-year medical students at six schools completed the questionnaire. Only students who indicated willingness to complete the second questionnaire were contacted to participate in the second survey three years later. A total of 154 out of 487 (31.6 percent) of fourth year students at four schools completed the questionnaire.

The authors note limitations of the study and recommend additional resea
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