Development and validation of the ADVANCER framework for naturopathic education and practice: A delphi study

Background: There has been little attempt to date to narrow the education-practice gap in naturopathic medicine. A framework that brings naturopathic medicine education and practice closer together could help codify the knowledge of naturopathic medicine by providing simultaneous guidance on curriculum development and clinical decision-making in the discipline. Objective: To develop, refine and validate the Advancing Naturopathic Education and Practice (ADVANCER) framework. Methods: Published literature and pertinent government, professional association and institutional websites were scoped to identify key constructs for the ADVANCER framework. The constructs were grouped into ten domains, with each domain defined and translated into teaching and clinical practice outcomes. A two-round e-Delphi method, comprising international experts in naturopathic medicine education, was used to refine and validate the framework definitions and outcomes. Results: Sixteen academics, from five different countries, participated in the Delphi study. In round one, nine of the ten domains of the ADVANCER framework were rated as either very important or extremely important by 81.2% of participants. Only 68.8% of participants rated the tenth domain as either very important or extremely important. Participant feedback on each domain were pooled and reviewed, and where suggested changes were recommended by more than one participant, respective definitions and outcomes of each domain were amended. In round two, at least 90% of participants rated each domain of the amended ADVANCER framework as either very important or extremely important, meaning consensus to retain these domains, definitions and outcomes had been reached. Conclusions: The study findings indicate that the ADVANCER framework is conceptually sound and potentially applicable to diverse institutions and countries. An important next step of this research is to establish whether implementation of the ADVANCER framework within naturopathic medicine education and practice is feasible, effective and sustainable.