CORRESPONDENCE

RE: KIRK-SMITH AND SHEPPARD-HANGER (2001) EVALUATION OF

AROMATHERAPY AND CORE CURRICULUM TRAINING.

THE INTERNATIONAL JOURNAL OF AROMATHERAPY 10: 124-125

I tot+ agl-ee with the notion that

research should be a core subjecr

in aromatherapy curricula. I

would go further, and suggest that

aromatherapy professional aasocia-

tions should not accredit curricula

unless research is included.

A curriculum is a detailed descrip-

tion of what will be taught in a parti-

cular subject and is designed to achieve

specific education goals. The purpose

of any education program is to prepare

students for their professional role in

the society in which they will eventually

work. l‘he needs of society will, to a

large extent, influence the educational

requirements of any health discipline,

including aromatherapy, and there-

fore, curriculum content. As Kirk-

Smith and Sheppard-Hanger point out

‘aromatherapy is considered to be a

therapeutic modality’. Aromatherapy

graduates will practice ‘therapeuticall>-’

within the prevailing health system of

the country in Tvhich they work. III

111041 countries that mt‘anb in a climate

\\ here evidence-based practice pre-

dominates. Research underpin5

evidence-based practice.

l‘he current focus on evidence-

based pl-actise c\olved because one of

the main concerns of health care is the

satrty of the client. It it this cc,ncept

that is al the root of legislative and

professional regulation of practitioners

and acci~cditation of education prep-

grams Lhar lead to registration 01

professional recognition. In most

coulltrics aromatherapy is not speciti-

call) regulated b! legislation, but the

common law of the countl7; in xvhich

they practice and duty of‘ care, applies.

Medico-legal issues may arise for aro-

matherapists a\ complemrntar) thera-

pie\ are more completely integrated

into health svstcms.

Research knowledge will allo\\

aromatherapists to effectively evaluate

and demonstrate their practice,

improve the care they provide, develop

themselves professionally and add to

the aromatherapy knowledge base.

‘I‘hese are important considerations

should a medico-legal situation arise.

In addition, modern consumers are

IveIl informed and expect some evi-

dence of the safety and value of the

health options they uti1iLe.

Kirk-Smith and Sheppard-

Hanger state that research \\oultl

demonstrate that ‘aromatherapy is eth-

ically ha,ed in a similar \\a! to other

therapeutic disciplines’. Resexch ma)

do that, but ethical practice depends

on the professional conduct 01 practi-

tioners, xvhich is set out “in codes pro-

fessional of conduct and ethic\ and

legal requirements, l-athcl- than in the

research basis of a protsvon. Ethical

conduct of research i\ a separate issue

and is monitored in a different way.

4 number of important issue5 have

occurred in complementary therapies

over the last few years that support the

need to include reseal-ch in aromather-

spy education programs. In the UK

the Foundation for Integrated

Medicine (1!1!47) stated in a report that

there is a common body of knolvledge

and skills complementary and conven-

tional practitioners need, and

suggested a cor~m~o~~ undergraduate

component in genera1 principles, skills

and values. This document includes

discussion about research. While it

does not specifically state research

should be included in complementary

therapy or aromatherapy curricula, it

flags the importance of a research hasis

for conl],lrmentar~ care.

I hc House of Lords Select

Committee Inquii-) into Co~nplemrn-

tar) and .-Uternative Medicine (CAM)

(2000) includes references to aro-

mathrrap). It considered patient Wis-

faction, evidence of safety and efficacy,

training and research as important

considerations. In the UK and other

countrie\ such a, :lu\tralia and

YS.4. governments are turning theil-

attention to com1,lelilentar~ thrraples.

hfallr ha\ c set up otticra 01 depart-

ments ~0ncernetl with complcnieritar~

therapies that i~~clritlr the research

ba\i\ of the\? therapies.

In an recctlt address IO a summit

on coniplemenrar~ medicine, the presi-

dent to the Australian hledical AGO-

ciation (.iMA) stated that the key to

acceptance ofcomplementaly therapies

is having an evidence ba5c. ‘I‘hc :\MA

has established an advisory committee,

one of whose functions is to advise the

government, another, is to advise doc-

tors and their clients about complemen-

tary therapies (l’helps, 2000).

hlo5t existing aromatherapy cnr-

ricula do not contain a discreet

research module or address research at

all. One Au5tralian curriculum

(Battaglia, 1995) has a short module

on re5exch that aims to review the sci-

entific validation of aromatherapy,

Battaglia state, that )ome practihillg

aromatherapi~t~ do not understand

reseal-ch requirements and discusses

5omc’ common research methotl. It

does not contain enough detail to

equip the student to critique, or under-

take research.

In deciding the content of a research

module one has to examine the role

the \tudrnt i5 being prepal-ed to per-

form. lo my mind the core compo-

ncnt\ of an ai-orri3th~rapi~t’s role, if

they are PI a&sing therapeutically, are:

their level of experience and place of

work. It is important to note that roles

and tasks are not the same thing. lasks

are the specific actions that fit into one

or more components of the role. For

example, giving an aromatherapy

massage is a task that fits in the thera-

peutic practice component of the role.

Other tasks involved in giving a mas-

sage may be counselling, education

and management so that the task,

giving a massage, encompasses several

components of the role.

Evidence-based practice means,

not onl) conducting research, but also

using research findings to inform prac-

tice as Kirk-Smith and Sheppard-

Hanger state. lb do this effectively,

practitioners need to be able to define

the problem, know what questions to

ask about the research they read, where

to find the evidence they require, how

to access the information (a great deal

of research is not easily accessible and

is difficult to understand), how to cri-

tique a research report, how to apply

the information in their practice and

evaluate the effects. These actions

require research skills at a basic level

and apply to all health-care disciplines,

conventional and complementary. In

many way> evidence-based practice is

the interface between theory, research,

and practice.

.lb effectively critique a research

report an aromatherapist must have

knowledge of’ research methods and

holr to assess rigor in research reports

Iher-apeutic care or clinical prac-

tice that inlolyes assessing and

treating client\, developing care

plans and monitoring progress.

This is probably the major thru,

of most aromatherapists.

Counselling, which is different

f1-om giving advice and health

education.

Education, usually of individual

clients, but may bc to groups,

colleague5 and the M idel

community. Self-education and

continuing profe55ional develop-

ment are important component

considerations.

Management and administra-

tion, such as running a business,

documenting ca*-e, communica-

tion Jvith, and referral to, other

health prof&5sionals.

Kesearch, which includes qualit)

m;~nagenlent/audit, \vhich i3

referred to as e\ aluation by Kirk-

Smith and Sheppard-Hanger.

Most arornatherapists would not

see themselves as undertaking

research, but they all use research

in some \\a), even if they are not

alvare that the\ do \o.

.

These initiatives point the wal

tinxard. .l‘he) send the challenge to

complementary therapists, including

aroniathrr-apists, to demonlrtl-ate the 1

value of their therapies. ~l‘he! can onl)

do that if they have research skills.

Therefore, if research ia not included

in education programs aromatherap>

may be lrft brhintl, takrn o\‘er or rrlr- Iridi\ idual pram titionera will

gatcd to the fring:cs\ of health care. combine these role components to a ~ xgaltllraa of the I-ehearch method

I prefer to u\e the term ‘reseal-Cll’

in a \cr\ f~roatl wnbe. ‘l‘he locus of a

reseal-c-h module should be on disco\

et-ing thing,, using many wa) s of

knowing, at~tl t-eading and criticaft>

evaluating t-cscarch as weft as doing it.

I-hat is, dc\efoping research marencss

and reflective practice.

In ortlrr to incorporate research into

al-omatherapy cul-r-icula, misunder-

standing about research will need to bc

addres5ec1, and a great deaf of

‘I.C5Cill< I1 m~ttlofog!,’ dispelled.

Krwarch i\ a ,kilf that can be IWI-tied.

~~romatherapist~ \\ifl also have Lo stop

hiding behind the catch 0.1 that

‘at.omatherap~ i\i too (otnpfes to be

studied using rxistitlg research meth-

ods’, n hich is fixnkll- not twc’, \ho\\s

i,ynol-ante of wwar~ h methocl~ and is

cclttnterpt-otlttcti\e. Thi5 debate i\

la1 gvl\ dt)Out (f\ldlItitilti\e lYS~~lKl1

methods f~eing rctlurtiont\t atid

l~ll\uit,lt,f~~ to \rtit1\ ~ll~onl‘~tllcl~~lf’~.

I heir ~uitabifit\. or not. tic~fxwtlr 011

the l-csc;lrctl ~f”“\liOll. 1101 rhe ttwxp\

tx’illg stiitlirtl. Both cfuailtit.iti\c dtl(f

cfuafit,lti\ c nlethod\ IIA\C. ‘I f)f;l( c‘ 111

rescarchill,~ i~ff Iiralth modalities,

in Inding ;uomathet-ap\. Incfwti. t 11c.1

coulcl bc i-egarclcd ;I\ t fle yang m1t1 ! in

of re\va~c-ft. Thrrr i\ a great deal ot

cfuatltitati\ e reseat-ch in arornathet iif,\.

much of \\hich is fahoratory based.

i\romatlier.af)i~t~ nretl to knov how to

decide if the findings ot wc h 4tudie\

are clinically rclt7 silt.

l~~afuation, or clinical audit i\ ;I

legitimate t-csearch mctllod \\ith it4

ow1 philo~ol~t~icaf basis, f,rocessc5,

rncmitoring methods and convmtion4.

Most of the steps in the audit 1,1-c,ce\5

are the \arne as in an! other- research

mrthod but the purpox fat \\ hich

audits and thvil- t-esufts are wed, is cfif-

terent. (:finic-al audit and ‘hard wicnc c’

are both used in con\entionaf flealth

care. .lI~ey both fia\e a place in the

strrtf\ of arotrlather;~f~~, hut it\ 5t;ltvtl

before, tllc choice to use an audit oi

another method lvill depend 011 t hr

question being asked. iLlan> t!f)es of

aromatherapy rrsenrch, not onf~ cwfw

ation studies, can proceed at the once

time, and xc currentf~~ doing 10.

I here are benefits of‘ including

t-twarch in a~oniatherap~ cl11 ricula in

addition to thow 4uggeated I~\

llle f)rotrAonaf de1 elopmvnt ot

individual practitic,ners (:gitin

quafitic ation9, puf,fication\. make

f~rcwt~t~itions, Cle\~clOp lllilll~l~lTC’-

merit skills and irnf~twe theit

knmvfcdge

developing critical af~pmi~al

skills and retlcctivc f)r;tctic e that

featf~ Lo imprcn~etl practice

improved client outconIc\

benchmal-king and inlpro\-ing

c al e

developing agreed cGdt-rice-tmsrd

aromat herapy 11rx rice guidelines,

~vhtch are then tested and mon-

tot-cd in prxticx setting:\.

Some of thev f)cnetit\ could tlit,ectl!

tl-an~fate into the aims and objective\

of a reseat-ch niodul~.

I‘he purpose ot a I-ewarch module

could lx to introduce research ab 3 core

coniponcnt of the aromathei aft) c ttr-

ricufunt in order to c,ufti\ate coniniit-

mrnt to rcscarch antf evidence,-f)asetl

arom;ttflci-;t1)~, f,ref>arr accountable

aild reflecti\ e arom;tthcrapist, ( on-

mittctf to irnf)l-o\illg Lflrir fltactice5

ant1 vxfxtntliny, tfie rote of ai omnthct--

.,,I\ i l l the llGlftll \\ \tc’lll.

chat1ge ,lgt?lt and enc-c,u,-age \tudents niotlule could include an outline of: c oniinittees

to reflect on their l)rac rice and develop

jkills in critical thinking. It should hc

de~~clopctl on thr lwnlisr t ha.

although the major-it! of aromathera-

pists ma\ not undertake research, the)

all need research skills to function at an

appropriate professional level in the

prevailing health system.

l

l

~

. I I

Some of the objective5 could be foi l

students to:

develop understanding of the

principle5 of research

identifi the main steps in the

research process

develop skills in critiquing

rrsearch and reflective practice

understand the difference5

betwwn quantitative, qualitative

and claluationiaudit re5carch

method5 and \vhrn it i5 appropri-

ate to use them

identifi the main steps in the

re5earch process

tlilderstand the ficroi-\ that need

to be considcl-eel when planning

rc5carch including calrc rr’ports

m&l-stand how research find-

ing5 can intijrm pram tic-c and

facilitate change

use rewarch to plan and monitor

care

~lnder~tand the rclc\ance of

research to ilt~omat hrr;ip\ thrr;t-

pcutic practice.

I l

i .

.

I\ hat research allcl eYidcllcx-

bawd cart are from the br-oad

L iew tliwrs9etl elservhere in this

letter

the thl-cc major rrrearch meth-

ods - qiAit,lti\e, quantitative

and elaluationiaudit, and when

they \vould be used

the principles of evidence-based

care

the major steps in the research

process including defining the

research question, how to under-

take a literature review (itself a

very useful . research method),

common rc\cal-ch methods, data

analysis and interpretation

the use of questionnaires and

qu0tionnaire development

ho\\ to critique research literaturt

including how IO asses\ rigot- in

the major research methods and

how to detect bias in order to

determine the therapeutic rele-

\ance of research finding-\ alld

as5e55 the claims and conclusion5

being made by the researchers

t-esearch terminolog)

introduce statistical and thematic

data anal! sis methods and Ilo\\ to

intcl-pwt data , the f~,cus shoulc~

he on lvhat data can tell the

rcatic~- rathel- than on c~omputing

statistic5

ethic al issues in reseat-& includ-

ir1,q the need for informed

i* itriting t-rscatc h report5 ;ITld

cornrnunitatitIg the results.

Reseat-ch etl~l~;~tion program5 could be

pt-esented at t\vo levcl5. -I’hc fit-st at

beginning Ivvcl that fi)cuw5 on

c\ iclence-ba5etl practice, critical

appraisal and increasing research

a‘rvareness. The wcond could be an

advanced module for those that Ivant

to undertake a research pt-eject and

could include 1% tiring a research pro-

posal and/or a grant application and

mentoring the student through the

conduct of the research. ‘l‘his xvould

allo\\ a professional development

path!vay in aromat hct-ap\ research to

be developrd. It al5o allows a stepwise

approach that may he better suited to

student leal-ning need5 and easier fat

education providers to achicye.

I‘here is a need to move atvay from

examinations as an assessment method

and focus on the dernon~tt.ation of

coII~l)ctcncc, Itntlrrstandillg, and the

ability of the student to translate the-

ory into practice. As5es5ment task\

must be relevant to the content of’ the

module and the Ic\cl that the ecluca-

tion court i\ set at (heginnitlg 01

ad\ awed). Some srlggested a55es5ment

~ mcthotl\ are:

0 critique a pica c’ 01 published

research

rrs~;11c~t1 liyyttiyyg~ coIlIt tw yyyotyi-

tored

diwII\\ the ohsrac-tcs to yrc‘w2y-~ II

in tlyr ~tudent’a in& idual siltya-

tion and some strategies for 0, er-

Itl;ltll~l~il~l~ t(‘il( ty(~y~\ ilyy(t t~l0fC\\i0Iyi~t

assc)cintioIys for comment. Itic bg

qur5CoIy i\ -who 5houtcl con~cnc \uch

il comyyyiltw ayytl co-ortliyyalc IIlK

,“-“‘tY\s

c-0yyIiyyg ttycyyy

compa* e ZlYld Contrast I\\ 0 ~

research methods.

1 hc length of any of thcsc tasks should

The r~Iotlutr coutd bc detivcretl iyy a

Ilulilhr~- of ~\a\ 5. It coultl be deli\ ewtt

in face-to-face teaching sessions or I)\, hc I .iOO-2000 \vords tlcl)cyIdiiIg 0Iy

,tisraYIce edutatioyy. The deli\ cy \ thr \\()I-k load of the cui-riculuni a5 a

method will largeI\ depend on the \\ 1101c.

ywo~~rccs of the educarion r~roviclrn Fvaluarion of the ryyodr~le i\ tlil’f~r-

.\noTher ~\a! i\ ro tlrvrtop a rrw;~rc~ty ent from assessing students. I he 5riI-

ad\-1soI7 scheme, cffcctivcl! a nicntoI-- drnr\, rr;it hey-\ and any ottycy- r&wyIt

iyyg 41 \~CIYI, po~sihl~ ~triougty ~LYI ay o- t)odirs 4youttl r~atryair lhr niodule.

marherap! prottssional association. ‘I his should include the performance

of the reachers and rtye yyyodutr ~‘oiy-

tent. ‘I he iiyli~rynation from the c~alria-

tioyy is rywd to I-c’\isc ayyd irripy~o~e the

module if necesbai.~.

that would hr witable toy- hoth c’st~vy-I-

vyIcrt1 antt t~egiIiyiiiig i-eseaictyci\.

Research 1, orkshop> could he held ;I\

t)arr 01’ rtir advisor\ 4ctyeme. Suc,ti a

scheme depends on having mcntoi-s

nitty y-c\v;w II 3kitt\ aiyd lime. a~aitahte

IO aa\isr theii colleagues in rhis \~a\.

The principles of adult Icay-ning

should he riritisetl in the detivei-\ of the

n~od~y1e. I he subject shoutcl hc taught

1,~ reachers \virty research kiIo\~letlge

and experience and this could he difti-

Cult fOY- \OY11e ~l~Olll~l~tWel-ii}~\ KtlOOt\.

ForgiyIg coltegiare links 1, ith local uiii-

P 0 Box IOli

KannockhuI-n 333 1

\ic-loI-ia, .\rysty-atia

Fax: + (0:x) 9288 3390

I-inail: I~L~SNINT@ a\-hm.org.ary One could anticipate that there \vill be

a great deal 01’ 0ppoGtiory to the pi-~~-

posal. The first task fill he 10 con\,ince

stakeholder, that it is neces\a1-v.

-1‘hcrefore. it 1, il l hc important to

di,ciI5, the concept with all i-etel,ant

\takeholdet \. estwc 1a1h aromatlyerap! \crsitivs antI cottc,qc\ ttral t~,y\e thrw (:~yyyyiyIiiyg. F. aiyd llall, ,J. (2001) The

py of’e9\ioii,~l ,I\\OC ialioiI4 alltt \killa coultl be con\itleyrtl. t~qiltarioiy of ~~oiIIl~l~i~yt.yytal\ and

txmlti;il- to al-olniil hcrapy. ‘t‘hc i4sucs

mtl IMI I iu5 IO ieerm II ii1 ai-oniathei--

al’! drc the saint’ in other health pro-

tis4ioyiat g~-c1up4, foi ~x,~mpte. yyurw~. ~

tiictutliiig research in existing aro-

yiiathcrat)~ c IIrricrIla i5 a conyl~trx thal-

trngv rh;it Ina! rrctirire ~tliln~irlg thr

bchavioiII- of pi-actising aromathwa-

pints ;iiy(t ay-oryyatty~y-al)! c~ttucarioiy

providers. nlow ttyalI wet, I-ewaI-ch is a

dynamic entity that is not an abstract

domaiyy of Itye few. It is applied in da-

to-da) aroiiiatherap~ practice, thus it

is the domain of evei?hody. Inctud-

in,? ywearch in aromarherap!- curri-

cula should not he an option ~ it is

iyylpcy-ativc.

1 his ‘Iellei.’ has turned into a

saga. I hope it uitt he thought provok-

ing and add to the discussion begun 1,)

KiI-k-Smith and Sheppard-Hanger,

‘I‘hayyk you foI ‘ti$leiying’.

Ii)i~rs Gricerel!,

-Ii-i,ha Dunning RK, Phi), hlF.d,

t.‘K(:h.\

l’ooranii Pinpuna