A Question of Degree
When considering becoming a naturopathic doctor, the impulse to compare and contrast NDs’ and MDs’ educations is almost unavoidable. After all, an MD is the more common medical degree; it only makes sense to use it as a basis for comparison. And plenty of differences, as well as similarities, certainly do exist between the two, both in education and in medical practice. But when comparing the training and philosophies of NDs and MDs, it’s important to remember that there is no right or wrong: each field is unique and offers distinct benefits to patients and the medical field as a whole.
Medicine can be seen as analogous to a tree. There are many different branches of medicine, each branch possessing its own tools and methodologies. But just as branches belong to a single tree and share common roots, so too are all medical fields based on the same founding principle: the protection and improvement of the patient’s health. NDs and MDs represent two distinct branches of the medical tree, each sharing the same foundation, or “trunk.” So if you want to become a health care practitioner, understanding the similarities and the differences between the two branches of medicine is essential to determining which branch may suit you best.
Curricula structure, courses and credits
The first two years: A strong science background
Naturopathic medical education is imbued with a unique philosophy
grounded in the six principles of naturopathic medicine
, which include holistic, nontoxic approaches, along with an emphasis on disease prevention
and optimizing wellness
. Accordingly, ND school curricula include certain areas of study
not covered in conventional med school, such as clinical nutrition, homeopathic medicine and psychological counseling. However, future NDs also receive training in many of the same biomedical and diagnostic sciences as their MD counterparts, and the result is a comprehensive and well-rounded medical education.
The general educational structure is very similar for both ND and MD students. In both programs, the first year emphasizes the biomedical sciences, such as anatomy and biochemistry. During the second year, classes focus on the diagnostic sciences, including areas like evidence-based medicine and physiological assessment. Both programs progressively increase students’ problem-based learning and integrated coursework, allowing students to comprehend how the different learned concepts affect one another.
During the first two years, ND students’ credit loads are almost identical to those of MD students. In nearly every biomedical science, ND students are required to complete as many credits as, if not more than, MD students. Specifics vary by school, but a 2010 course comparison of the University of Washington
’s (UW) MD program and Bastyr University
’s ND program shows that during the first two years, UW MD students complete a total of 150 credits and Bastyr ND students complete 151.5 credits, most of them in comparable biomedical and diagnostic science courses.
ND & MD Programs: The first two years
Some key aspects of ND education reflected in the bar graph:
- The first two years of the ND curriculum also include early introduction to naturopathic modalities, such as homeopathy, nutrition and botanical medicine. This exposure occurs in many different courses over these two years, and therefore is not called out separately in the ND school course catalogue.
- While many conventional medical schools use a systems-based approach to medical education, most naturopathic medical programs currently do not. In a systems-based approach, anatomy, physiology, pathology and diagnostic skills are each taught individually for each body systaem (i.e., respiratory, digestive, nervous system, etc.). And although some ND schools may be moving toward a more systems-based approach to education, classes in a typical ND program are not divided by system, but rather focus on how a symptom in one part of the body may affect the patient’s entire anatomy and well-being.
- Some ND school curricula also begin clinical training during the first and second years, just as some MD school curricula initiate observational shifts at that time.
Third and fourth years: hands-on experience via clinical training
After the first two years, both ND and MD curricula focus on applying medical knowledge to real-life situations; simultaneous classroom studies support this training. Both curricula strive to maximize the synchronization of classroom and clinical training during these key years, thereby improving the quality and practicality of the students’ educations.
However, it is during these later years that MDs’ educations begin to differ noticeably from those of NDs. MDs complete clerkships, which are courses in various medical specialties, and although MD students see plenty of patients during these clerkships, their roles are primarily observational: they are not primarily responsible for patient care.
Third- and fourth-year ND students have increasing opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics, which offer diverse patient populations. This period of clinical training goes well beyond the observation and is absolutely essential to NDs’ educations – so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate prepared to begin practice and to diagnose and treat patients, whereas MD students are required to complete residencies after graduation in order to gain clinical experience.
Post-graduation: residencies and shadowing
Examining third- and fourth-year clinical training brings up another major difference: medical residencies.
- MD residencies are mandated and regulated by conventional medical schools. As a result, an abundance of such opportunities exist at a wide variety of medical facilities all across North America. Every graduate of conventional med school must expect to complete a post-graduation residency.
- Naturopathic residency opportunities, on the other hand, are not nearly as common because unlike conventional medical residencies, they are not yet required or funded by the federal government. Only 5 to 10 percent of new NDs participate in formally approved residency positions, all of which are associated with colleges approved as residency sponsors by the Council on Naturopathic Medical Education (CNME). There are some naturopathic residency opportunities available, and the naturopathic medical community is working to create more all the time, but such programs are not required (except in Utah). In place of a residency, many new NDs choose to practice with or shadow an experienced ND before setting up their own practices.
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Training generalists vs. specialists
Primary care physicians. When examining a naturopathic medical curriculum, especially in comparison with that of a conventional medical school, remember this important differentiating factor: all future NDs are in training to become primary care physicians. In other words, a naturopathic medicine program is by definition a specialization in primary care – a field of medicine in extreme shortage in the US today
. The majority of conventional med school students opt for careers in particular specialties and receive further training in specific areas, such as emergency medicine, major surgery or oncology. While ND curricula do cover such specialty subjects, they are not studied in depth. ND students learn to recognize the symptoms of diseases that may fall outside of their scope of practice (such as cancer) so that they can refer patients to specialists as appropriate. This is not to say that some NDs don’t go on to expand their educations and develop specialty areas post-graduation. But the focus in naturopathic med school is on learning to treat those diseases that fall within the realm of general practice.
Holistic perspective. As primary care naturopathic physicians, NDs approach patient care and treatment from a holistic perspective. While conventional medicine usually focuses on treating and eliminating the symptoms of a disease, naturopathic practitioners are trained to determine the underlying cause of the condition and to treat that cause, rather than just the resulting symptom. The patient is seen as a complete system, and the medicine’s emphasis is on whole-patient wellness.
Patient referrals. In their practices, NDs often comanage patients with MDs and make referrals as appropriate, so another defining aspect of naturopathic medical training is a strong emphasis on collaboration and effective communication with other types of health care practitioners. In conventional medicine, there can exist a tendency to refer only to other doctors within the same branch of medicine. Naturopathic medicine, however, stresses the importance of cooperation with practitioners across the medical spectrum.
The goal of NDs is always to optimize patient care and to empower patients to positively influence their own health and wellness.
ND curriculum improvements and quality assurance
Online naturopathy programs
. The topic of patient interaction also becomes of paramount importance when it comes to online naturopathy programs. When considering an ND program, it is crucial to make sure it’s at an accredited ND school
. Although online programs
offering “degrees” in naturopathy exist, such a program does not qualify its graduates to become licensed NDs. Moreover, online programs offer no opportunity for clinical training and doctor-patient interaction, both of which are essential components in the education of any medical doctor.
The AANMC and CCACO. The naturopathic medical community is constantly striving to improve ND curricula, and important milestones have been accomplished in recent years. The AANMC-member schools have made significant progress in establishing both knowledge- and practice-based competency requirements for ND program graduates. These requirements are created by the AANMC's Council of Chief Academic and Clinic Officers (CCACO), which is comprised of deans and assistant deans from all of the schools.
. Additionally, the Council on Naturopathic Medical Education (CNME)
, the programmatic accrediting body of the ND schools, sets and enforces high academic standards for the ND schools. Presently, the CNME is encouraging schools to perform more outcomes-based assessments and analyses, which are used to support curriculum development. Problem-based learning also continues to gain importance, as it aids ND students in developing their critical thinking skills.
Overall, ND curricula continue to expand and improve, utilizing the structure of medical education in North America while maintaining the principles and philosophies inherent to naturopathic medicine. And as the naturopathic medical schools continue to expand and improve, NDs play an increasingly important and relevant role in the health care system.
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