What Exactly Do You Study?...

"So, is that hard?" 

I had just introduced myself to the new nurse manager of Med/Surg at work, and I told him I am a naturopathic medical student. I thought my eyes were going to roll right out of my head. 

Naw, it's a piece of cake. We do yoga, chant and gather medicinal herbs under the full moon. While some of my classmates probably definitely do those things as exercise or as part of a spiritual practice or just for fun, I am here to tell you that naturopathic medical school is NOT EASY.

Naturopathic doctors have varying scopes of practice across the United States, but the school teach to the broadest scopes of practice. For example, in the state of Oregon, NDs are virtually equal to MDs and DOs in scope, which means we have a comparable medical knowledge base. At the end of my five years at NUNM, I must pass boards that will grant me licensure in the state of Oregon. I must know everything that an MD or DO in primary care must know. 

Then there is all that "other stuff" that sets naturopathic physicians apart from other healthcare practitioners. A really common question I get is something like "What exactly are you learning?" or "So, what do you study?" I am learning conventional medicine alongside of botanical medicine, naturopathic manipulative therapy, homeopathy, hydrotherapy, clinical nutrition, IV therapy, mind-body medicine and lifestyle counseling.  

I really love the way my curriculum is organized. Many medical schools across the US are turning to a "block system" approach. Instead of learning many different concepts about different organ systems or parts of the body, one system is studied at a time. The first year of medical school is a 100 mph run through of physiology, biochemistry, microbiology, public health, immunology and anatomy. I felt like I lived at school last year. First year ND students study naturopathic history and philosophy and are introduced to hydrotherapy, botanicals, nutrition, physical medicine, homeopathy, and pharmacology as well. The second year you get into the blocks. So this fall I am in what we call the "Phys Med" block, or rather, the Musculoskeletal, Ortho, Exercise Physiology & Rehab block. We are learning how the musculoskeletal system should work, what types of pathology may occur, how to diagnose conditions, which orthopedic exams to perform, when and how to order and over-read radiographic images, when to refer or transfer, and which pharmaceuticals, botanicals, manual or manipulative therapies may be indicated for certain conditions.

Basically, it feels like everything. We get everything we need to know all at once. Next term we move into the Cardiology & Pulmonary block, and I couldn't be more excited (is it just me, or do EKGs sound like a ton of fun?). If you want to see what the ND curriculum looks like for NUNM, go here. (I am on the five year track, so year two is split over two years.) NUNM is currently the only naturopathic medical school on the block system. I believe NUNM has the most robust, evidence-based curriculum too, but that could be biased. 

In addition to lectures, tutorials and labs, we do clinical rotations at one of a handful of ambulatory medical clinics run by the school. As a first year student, I was put in the clinic to do 40 hours of observation. It was wonderful to have patient contact right away and learn from the older students. 

Prior to entering the clinic as a secondary intern, each student is expected to pass the OSCE I and  the NPLEX I, which is our basic sciences boards. We use the same USMLE preparatory materials. Students at conventional school follow a similar path and take boards before beginning clerkships. Before the last year of school (the fourth or fifth year), ND students must pass the OSCE II. Students in their last year of school are expected to act as primary interns and manage their own patients (under the supervision of the residents and attending physicians). Not every graduating ND student is guaranteed a residency, so the ND schools make sure to pack in well over 1000 clinical hours (including preceptorship hours). 

Thankfully more and more residencies are opening up for ND students.  I plan on completing one because I think they are necessary for further training and education. NUNM has so many resources, including brilliant faculty and attendings, and I want to learn everything I can while I am here. However, many students, past and present, have not completed residencies after graduation, and are not worse doctors for it. When residencies were extremely limited, many new NDs would find an older doctor to act as a mentor and practice with him or her. 

ND residencies are not federally funded (which is why there are so few) and are typically funded by the seven, soon to be eight, schools in the US. However, some practicing NDs will fund residencies or a graduating student can privately set up a residency with a practicing doctor. While the flexibility is appreciated, the limited number of residencies fuels competition, requiring those who want one to be the best of the best. 

So far educational highlights for me include learning point of care ultrasound (POCUS), botanical medicine and physical manipulation techniques/adjustments. I am looking forward to cardiology because we will get to spend some time in OHSU's simulation lab, and I am really excited to start the natural childbirth series (fingers cross that happens next year). Going to medical school feels like gaining super powers. 

In summary, naturopathic medical school is a beast, and it requires resilience, stamina and the ability to learn and utilize massive amounts of information. Those qualities are required of anyone enrolled in a healthcare provider program: nursing, allopathy, osteopathy, physician's assistant schools, etc. And just like many health professions schools, ND schools produce licensed providers who have all the tools to ensure great patient care. 

Do you have still an unanswered question? Let me know!