Canadian College of Naturopathic Medicine Programs: A Comprehensive Overview

The Canadian College of Naturopathic Medicine (CCNM) stands as a leading institution in naturopathic medical education. CCNM has two campuses, one in Toronto and another in the Metro Vancouver area known as the Boucher Campus. This article explores the programs offered by CCNM, its history, curriculum, clinical opportunities, and its commitment to evidence-based practice within the context of naturopathic medicine.

History and Establishment

CCNM was established in Toronto as the Ontario College of Naturopathic Medicine (OCNM) in 1978 by naturopaths Robert B. Farquharson, Gregory "Asa" Hershoff, John G. LaPlante, William Morris, Eric Shrubb, and Gordon Smith. OCNM originally offered a post-graduate program to doctors from other health professions, such as medical doctors and chiropractors. The school moved to its first permanent building in Kitchener, Ontario in 1981. OCNM incorporated as the non-profit, charitable Institute of Naturopathic Education and Research in 1983. The college's legal operating name is the Institute of Naturopathic Education and Research.

In February 2021, the Canadian College of Naturopathic Medicine (CCNM) and the Boucher Institute of Naturopathic Medicine (BINM) merged into a single, combined naturopathic institution under the name Canadian College of Naturopathic Medicine. The merged institution offers ND programs at both the CCNM campus in Toronto, Ontario, and at the former BINM campus in New Westminster, British Columbia.

Naturopathic Medicine Program

CCNM - Toronto also offers the first-ever naturopathic medicine bridge delivery for international medical graduates (IMGs). The IMG bridge delivery offers foreign-trained medical doctors who have made their home in Canada an opportunity to further their health care careers as naturopathic doctors.

CCNM offers a degree program in naturopathic medicine, a form of alternative medicine that has been criticized by scientists as pseudoscientific. CCNM teaches naturopathic medicine, a form of alternative medicine, rather than evidence-based medicine. The CCNM - Toronto Campus offers a four-year, full-time naturopathic medicine program; the only Doctor of Naturopathy degree in Canada. CCNM graduates are eligible to write the licensing examinations for all regulated jurisdictions in Canada and the United States to become naturopathic doctors.

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Curriculum Overview

The curriculum integrates clinical practice. The biomedical sciences segment of the curriculum (years 1 and 2) involves the study of anatomy (gross anatomy and prosection), embryology, clinical physiology, biochemistry, microbiology, immunology, public health, pharmacology, clinical pathology and laboratory diagnostics. Prior to commencing fourth year (clinical internship), students are required to pass a clinic-entry exam (i.e. OSCE-III).

Accreditation

Accreditation is a voluntary process that ensures schools are providing a rigorous, standards-based education that combines traditional natural health knowledge with modern medical training. Schools are required to meet a prescribed set of standards before being accredited and must be reviewed for reaccreditation at least every seven years. The standards are made publicly available, and can be viewed in the CNME Handbook of Accreditation.

Initial CNME accreditation was granted to the ND program in April 1987 and last reaffirmed in October 2019. A comprehensive evaluation visit for reaccreditation of the program took place in June 2024, and the CNME Board of Directors-at its meeting on October 31, 2024-placed the program’s accreditation status on probation and deferred a decision on the reaccreditation of the program for a period of six months, during which time its current accredited status remains in place.

Initial CNME accreditation was granted to CCNM’s ND program in September 2000 and last reaffirmed in May 2020. The next full-scale evaluation is scheduled for late 2026 or early 2027, with a decision on continued accreditation to be made in spring 2027.

Initial CNME accreditation was granted October 2012 and last reaffirmed in October 2022. The next full-scale evaluation visit is scheduled for spring 2029, with a decision on continued accreditation to be made in fall 2029.

Initial CNME accreditation was granted April 1991 and last reaffirmed in May 2022. The next full-scale evaluation visit is scheduled for fall 2028, with a decision on continued accreditation to be made in spring 2029.

Initial CNME accreditation was granted in November 1999 and last reaffirmed in May 2019. The next full-scale evaluation is scheduled for winter 2026, with a decision on continued accreditation to be made in spring 2026.

Initial CNME accreditation was granted in January 2021-retroactive to May 2020-for a period of four years, and was last reaffirmed in May 2024 for a period of six years. The next comprehensive evaluation visit for reaccreditation is scheduled for the winter of 2030 with a decision on continued accreditation to be made at the spring 2030 Council meeting. Additionally, a focused onsite visit is scheduled for fall 2026 to assess the program’s progress in addressing outstanding recommendations.

Trent University Partnership

“This agreement with CCNM creates a clear and compelling pathway for students to pursue enriching careers in the expanding field of naturopathic medicine,” said Dr. Cathy Bruce, president and vice-chancellor of Trent University. Students admitted directly from high school will begin their studies at Trent, receiving tailored academic advising to meet prerequisites and prepare for competitive entry into CCNM’s professional program.

“CCNM is thrilled to deepen our longstanding relationship with Trent,” added Dr. Rahim Karim, president and CEO of CCNM. In addition to the new double degree, the agreement also strengthens pathways for students in Trent’s Medical Professional Stream (MPS). “This partnership combines the unique strengths of both institutions to create a more seamless and enriching academic journey for students,” said Dr. Sarah West, dean of Science at Trent University.

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Clinical Opportunities

Clinical rotations take place at the Robert Schad Naturopathic Teaching Clinic (RSNC), BNTC, and several community health clinics (e.g. Located at the Leslie campus, the RSNC logs upwards of 26,000 patient visits each year. It is one of several teaching clinics where licensed NDs work train fourth-year interns. The clinic features a botanical compounding room, a hydrotherapy suite, private consultation rooms, conference rooms and a laboratory for in-house testing.

The CCNM, in partnership with the William Osler Health System and Local Health Integration Network, opened the Brampton Naturopathic Teaching Clinic (BNTC) in 2013 at the Brampton Civic Hospital as a pilot project. The BNTC is the first naturopathic clinic in a hospital in Canada. The clinic was opened in support and as a component of Osler's "philosophy to help ensure greater access to community care options.", and its steering committee includes representatives from both CCNM and the Brampton Civic Hospital. Similarly to the RSNC, licensed NDs train fourth year interns at this location.

Evidence-Based Practice (EBP) Integration

Evidence-based practice (EBP) involves the conscientious use of the best available evidence, in combination with clinician experience and patient preference in an effort to optimize clinical care. It involves the systematic, conscientious, and judicious analysis and application of published research to clinical decision making. The development of evidence-based healthcare is attributed to the work of several individuals including Archie Cochrane , McMaster University investigators and Sacket et al. A number of benefits have been attributed to the use of EBP, including improved patient outcomes and reduced health care costs. Accordingly, there has been increased attention to integrate EBP in a wide range of healthcare disciplines, including traditional complementary and integrative medicine (TCIM) systems such as naturopathic medicine.

Naturopathic Medicine is a distinct system of healthcare that combines scientific and traditional evidence to support the delivery of a range of natural therapeutic approaches. The practice is defined and guided by a set of principles. The therapeutic modalities used by naturopathic doctors vary by jurisdiction but often include dietary counselling, nutritional supplementation, herbal medicine, homeopathy, physical medicine, and lifestyle counselling. In order to qualify for licensing, Naturopathic Doctors (NDs) are required to complete a bachelor’s degree, a 4-year naturopathic medicine program at an accredited college and successfully complete licensing exams. There are approximately 2400 NDs in Canada. Naturopathic medicine is licensed in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Nova Scotia. The naturopathic medicine programs currently include a substantial focus on evidence-based practice; however, this represents a significant increase compared to previous cohorts.

In 2002 a series of papers was published that presented an approach to teaching EBP for TCIM. Several authorities have argued that naturopathic practice is opposed to EBP ; however, this suggestion is not adequately supported by current evidence. Qualitative research has revealed primarily favourable views of EBP among practitioners of Naturopathic Medicine. Similarly, a recent survey of Canadian NDs reported that attitudes, use and skills in EBP were all relatively high, noting that there was room for improvement. Additionally, 93% of respondents reported an interest in undertaking further education to improve EBP skills. The findings of this survey highlighted an opportunity to improve EBP uptake among practicing Canadian NDs by increasing EBP skills acquisition.

EBP Continuing Education (CE) Course

Recognising the potential value of EBP education, a process was undertaken to co-designed an EBP Continuing Education (CE) course that was tailored to the needs of Canadian NDs. Co-design involves the collaboration of researchers and end-users in an effort to conduct research that is relevant and useful. Practicing NDs, including representation from educators, leaders in the profession, and new graduates, provided input into course design via three focus groups. The findings from the focus groups were combined with best practices in EBP education to create a CE course. Overall, the focus group participants indicated a high level of interest in participating in the course and an interest in learning foundational EBP skills such as searching for evidence, critically appraising evidence, assessing risk of bias and applying evidence to clinical care. The Theory of Planned Behaviour was also used to inform the design of the course. The course attempted to increase perceived behavioural control through the use of skill building exercises. The present publication reports on the delivery and evaluation of the abovementioned CE course.

The primary objective of the project was to assess the feasibility and acceptability of the pilot EBP CE course for Canadian NDs. Secondary objectives were to assess changes in self-reported EBP attitudes, skills and use, and objectively measured EBP knowledge. The course consisted of five, one-hour, weekly sessions that were delivered synchronously through a virtual platform during the months of November and December, 2021. The course was delivered by the continuing education department of the Canadian College of Naturopathic Medicine; this was the first time an EBP course was delivered. Sessions were video recorded with transcription, which were available to participants for viewing following each session. The sessions included a combination of didactic teaching, group discussion, and skill-building exercises. When co-designing the course, participants recognized the wide range of EBP skills and knowledge within the profession and suggested having material tailored to those needing to review basic concepts and those wanting to learn more advanced topics; this material was incorporated into the first and final sessions of the course. The sessions were primarily facilitated by MA with segments of instruction from ML and KC and a professor from the methodology department of a local university.

This study was designed to assess feasibility and acceptability as primary outcomes. Because this project is the first to assess changes in EBP skills, attitudes and use following EBP training among NDs, the magnitude of change was unknown, preventing formal sample size calculation. The primary outcomes (i.e., feasibility and acceptability) were assessed quantitatively and qualitatively. Feasibility was assessed by counting (a) the number of participants recruited within the 3-week recruitment period, (b) the number of participants attending each of the CE sessions, and (c) the number of participants completing the data collection instruments. To assess acceptability of the program materials and delivery, a satisfaction survey was administered at the end of the course.

Secondary outcomes were measured using the Evidence-Based Practice Attitudes and Utilization Survey (EBASE). This self-administered questionnaire is used to assess six constructs including use of EBP, EBP skills, EBP attitudes, EBP-related training, and barriers and enablers to EBP uptake, as well as demographic characteristics. For the purpose of the present project, only questions related to use, skills, attitudes and demographics were asked in order to minimize participant burden while capturing the data most relevant to the study objectives. Data on the former three constructs were used to generate sub-scores related to EBP use, skills, and attitudes. EBASE has been used in cross-sectional studies involving a a wide range of health care disciplines, including nursing students , chiropractors, osteopaths, Western herbalists, yoga therapists and traditional Chinese medicine practitioners, from across several geographic regions, including North America, Europe and Australia, allowing for comparisons between professions and regions. While EBASE does assess self-reported EBP skill level, we acknowledge that perceived EBP knowledge and skills may be prone to bias. As such, we administered the EBASE in combination with a 16-question, multiple-choice quiz at baseline and after the course in order to objectively assess changes in EBP knowledge.

Additionally, social media posts were created for naturopathic virtual communities of practice that include Canadian members. The recruitment strategy was designed to be multi-faceted to ensure all eligible licensed Canadian NDs had an opportunity to complete the course. Participation in the course was voluntary and participants self-selected to participate. An incentive was offered to encourage participation and retention. All data were collected through the institution’s secure electronic data capture system, Research Electronic Data Capture (REDCap). The first invitation (sent prior to course commencement) invited participants to complete an eligibility screening questionnaire and to review and sign the informed consent form. Eligible participants were then invited to complete the baseline data collection form (week 0). This included completion of EBASE and the EBP knowledge quiz. Following the final session (week 5), participants were invited to complete EBASE and the EBP knowledge quiz a second time, as well as the course satisfaction survey.

Data were imported into Microsoft Excel for cleaning and coding, and subsequently into R for analysis. In cases of missing data, the last observation was carried forward. Categorical demographic data were reported using frequencies and percentages. The a priori statistical plan was to use descriptive statistics for demographic data only (due to the pilot nature of our study). Changes in the secondary outcomes (EBASE sub-scores and knowledge quiz) were analyzed using paired sample t-tests (t) if data were normally distributed or the Wilcoxon signed rank test (W) if data were not normally distributed. Normality was assessed using the Shapiro-Wilk test. Exploratory analyses assessed for differences in demographic variables (age, length of time in clinical practice, time spent on research and teaching), course attendance, and baseline quiz score. Kendall’s Tau Correlation Coefficient (τ) was used to assess for correlations between ordinal variables. A coefficient between 0.10-0.29 was defined as a weak association, while a moderate association was defined as 0.30-0.49 and a strong association was defined as 0.50-1.00. Qualitative data from the satisfaction survey were analyzed using structured framework analysis, an approach commonly used in evaluation studies. The purpose of the satisfaction survey was to inform revision of the course in subsequent iterations. This study received approval from the Research Ethics Board of the CCNM (CCNMREB038.Aucoin.Newton.Cooley).

Course registration opened on October 19 2021, and closed November 5 2021. Eighty-one participants registered for the course , with 61 participants meeting criteria for the study, agreeing to participate, and completing baseline assessments (week 0). The demographic characteristics of participants that completed the baseline assessments are presented in Table 2. Participants were primarily aged between 30 and 49 years (75%), and two-thirds (64%) identified as women. There was variety in the length of time since participants completed their highest qualification and the clinical setting in which participants practiced. Of the 61 participants included in the analysis, 39 participants (64%) attended four or five of the sessions in person or had viewed the recording.

Participants expressed a high degree of satisfaction with the course. Eighty-nine percent of participants “agreed” or “strongly agreed” that they were satisfied with the course. Participants provided a range of comments about aspects of the course that were most and least helpful, as well as suggestions for improvement. There were a large number of positive comments about the course as a whole (“This course was a great comprehensive review of evidence-based practice”; “I found all of it beneficial”; “This was an excellent course, I have no suggestions to improve”). With respect to the level of difficulty of the course, a wide range of responses were received. Some respondents commented that the review of the basic concepts of EBP was helpful (“Refreshing my past knowledge on the types of trials, p-value and odds ratio and how to search better”), while others cited this material as unhelpful because it was too high-level or simple (“intro lecture - mostly review though I understand this is important to establish a baseline”; “I would love to dive deeper still but I can also appreciate that this is targeted to varying levels of comfort”). Similarly, some participants appreciated the more advanced topics while others reported that some sections were too challenging and that the pace of the course was too fast. Participants appreciated many components of the course content, including sections on critical appraisal, searching for evidence and statistics.

With respect to the course format and resources, participants reported a combination of positive and negative comments about the online delivery format. There was a high level of appreciation for the interactive and practical components of the course and an interest in providing more opportunities to practice the skills being taught (“More practice in reviewing studies [and] searching for literature”). Participants suggested reviewing more sample journal articles and patient cases. Several participants were interested in undertaking quizzes to assess their own comprehension of the material and some suggested homework or assignments (“Make it longer with more assignments and practice.”). While not part of the formal evaluation, some of the comments posted on the webinar platform were very insightful. In response to the discussion about the role of evidence in naturopathic medicine, one participant posted the comment “I think our profession overly depends on clinical pearls and anecdotal info. I hope we…

Outcomes of the EBP CE Course

Recent evidence indicates that Canadian Naturopathic Doctors (NDs) are interested in EBP skill development. The primary objective of the present study was to assess the feasibility and acceptability of a co-designed EBP Continuing Education (CE) course for Canadian NDs. The CE course was evaluated using a pre-post design involving licensed Canadian NDs. On course completion, participants reported on their level of satisfaction and provided suggestions for improvement. EBP skill, attitudes and use were assessed using the validated Evidence-Based Practice Attitudes and Utilization Survey. EBP knowledge was objectively assessed using a quiz. Changes in EBP skill, attitudes, use and knowledge were compared between baseline and the end of the course.

Sixty-one NDs met eligibility criteria. Eighty-nine percent of participants agreed or strongly agreed that they were satisfied with the course. There was a significant increase in self-reported skill and objectively measured EBP knowledge, but no substantive change in EBP attitudes or use of evidence over time. Some participants indicated the level of difficulty was too high while others reported that it could have been more difficult. Delivery of the co-designed EBP CE course was found to be both feasible and acceptable. Preliminary evidence suggests that participation in the course was associated with improvements in EBP knowledge and skill.

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