Integrating complementary and alternative medicine in education- a needs assessment among students and primary care professionals in Bulgaria

Introduction: Bulgaria has healing traditions now classified as complementary and alternative medicine (CAM), which is gaining popularity but is not yet considered part of the national healthcare system. Integrating CAM with conventional treatments at a primary care (PC) level could provide cost-effective solutions to the rising inpatient expenditures and the increasing misuse of antibiotics in the country. However, there is no national agreement on how CAM should be integrated into medical and pharmacy education. The study aimed to conduct a needs assessment for CAM education identifying the knowledge, attitudes and practices among university students and PC professionals. Methods: The cross-sectional online self-administered survey took part from April to October 2021 among stu-dents and PC professionals. Four instruments were developed with identical structures specifically targeting general practitioners and pharmacists, medical and pharmaceutical students. They were invited to participate through their official, professional and academic platforms. Descriptive statistics were used to analyse the data. Results: Overall, 393 volunteers participated, 185 professionals and 208 students. Although, 24% of the pro-fessionals and 28% of the students knew about CAM, more than 50% of the participants would like to know more about CAM and the different CAM modalities like anthroposophic medicine, Tibetan medicine, Traditional Chinese Medicine, osteopathy, yoga and Ayurveda. The study found that a high percentage of participants re-ported using CAM to maintain their health. Homeopathy, folk medicine, phytotherapy, apitherapy, aroma-therapy, Schussler therapy, and Flower therapy were among the most commonly practiced modalities. The results suggest that CAM education is necessary but should be evidence-based. Conclusions: This survey has identified deficiencies in training on CAM education. The inclusion of CAM into the education curriculum can broaden professional perspectives and address the needs of consumers. Therefore, this study advocates for the establishment of a national consensus on integrating CAM education into both graduate and postgraduate programs within the framework of integrative medicine and One Health philosophy, fostering effective partnerships among all healthcare professionals and facilitating harmonious and impactful collabora-tions between all therapeutic and preventive modalities. This work was supported by the Fund Nauka, the Medical University of Varna (Ethics approval with Protocol N degrees 101, 2021).