Original Research
Traditional & Complementary Medicine

The Gap Between Knowledge and Perception on Education in Traditional and Complementary Medicine Among Medical Staff in Malaysia

Background: T&CM in Malaysia’s Healthcare Landscape

Traditional and Complementary Medicine (T&CM) occupies a distinctive position in Malaysia’s healthcare system. The country’s multicultural population — comprising Malay, Chinese, Indian, and indigenous communities — has a rich heritage of traditional healing practices, including Traditional Malay Medicine, Traditional Chinese Medicine, Ayurvedic medicine, and various indigenous healing traditions. National survey data indicate that the lifetime prevalence of T&CM use among Malaysians is approximately 69.4%, with 55.6% having used T&CM within the 12 months preceding assessment.

Recognising the significance of T&CM in Malaysian healthcare, the Ministry of Health (MOH) has actively promoted the integration of T&CM into mainstream health services. This effort has been formalised through the establishment of a dedicated Traditional and Complementary Medicine Division within the MOH, the development of a national T&CM policy, and the enactment of the Traditional and Complementary Medicine Act in 2016. As of recent years, T&CM services have been established in multiple MOH hospitals, offering modalities such as traditional Malay massage, acupuncture, and herbal medicine alongside conventional medical care.

However, a fundamental challenge in this integration process is the preparedness of medical staff to engage with T&CM. Western-trained physicians, nurses, and allied health professionals constitute the backbone of Malaysia’s health workforce, yet their medical education has traditionally included minimal, if any, exposure to T&CM. This knowledge gap has important implications for patient safety, as medical staff may be unable to counsel patients on potential interactions between T&CM and conventional treatments, identify adverse effects of T&CM use, or provide informed guidance on the evidence base for various T&CM modalities.

Study Design and Methodology

This cross-sectional study was conducted at five selected public hospitals in Malaysia, employing a quantitative survey methodology. A total of 477 medical staff participated, encompassing a range of professional cadres including doctors, nurses, pharmacists, and allied health professionals. The survey instrument assessed two primary domains: knowledge regarding T&CM (encompassing awareness of various modalities, understanding of evidence bases, and knowledge of regulatory frameworks) and perceptions regarding education in T&CM (including attitudes towards integrating T&CM into medical curricula, perceived need for T&CM training, and views on the complementary role of T&CM in healthcare).

The researchers were particularly interested in examining whether a discrepancy existed between what medical staff know about T&CM and how they perceive the importance of T&CM education — the “gap” referenced in the study title. A significant gap in either direction would have different implications: a knowledge-exceeds-perception gap would suggest that medical staff know about T&CM but do not see value in formal education about it, while a perception-exceeds-knowledge gap would indicate that staff recognise the importance of T&CM education but lack the knowledge itself.

Knowledge Assessment Findings

The study revealed that most medical staff demonstrated limited knowledge regarding T&CM. Despite working in a healthcare system where the government actively promotes T&CM integration, and despite serving a population where the majority have used T&CM, many respondents could not accurately describe the evidence base for common T&CM modalities, were unaware of potential herb-drug interactions, and had limited understanding of the regulatory framework governing T&CM practice in Malaysia.

This knowledge deficit is not unique to Malaysia. International literature consistently shows that healthcare professionals trained in western medicine often receive little or no formal education about T&CM during their professional training. Studies from Turkey, Saudi Arabia, the United States, and various Asian countries have documented similar gaps, suggesting this is a systemic issue in medical education globally rather than a failing specific to Malaysian training institutions.

Perception and Attitudinal Findings

Interestingly, despite their limited knowledge, a substantial proportion of medical staff expressed positive perceptions about the potential role of T&CM education. Many recognised that their patients used T&CM regularly and acknowledged that they would benefit from better understanding these practices in order to provide safer, more comprehensive care. This perception-knowledge gap — where the perceived need for education exceeds current knowledge levels — represents an opportunity for intervention.

The finding suggests that medical staff are not inherently resistant to T&CM integration but rather are inadequately equipped through their current training to engage with it competently. This receptivity is a valuable foundation upon which T&CM education programmes can be built, as attitudinal barriers to learning about T&CM appear to be lower than knowledge barriers.

Patient Safety Implications

The knowledge gap identified in this study has direct implications for patient safety. When medical staff are unfamiliar with T&CM, several risks emerge. Patients may not disclose T&CM use to their healthcare providers, fearing disapproval or dismissal, which creates dangerous blind spots in clinical assessment. Healthcare providers may be unable to identify situations where T&CM use is contraindicated or where herb-drug interactions could cause harm. Patients seeking guidance on T&CM may receive inaccurate or dismissive advice, potentially driving them to unregulated practitioners or unreliable sources of information.

The Malaysian context adds urgency to these safety concerns. The wide availability of traditional herbal products through diverse retail channels, including traditional medicine shops, pharmacies, and online platforms, means that consumers have ready access to products whose safety and efficacy may not have been rigorously evaluated. Medical staff who can engage knowledgeably about T&CM are better positioned to identify potential risks and guide patients towards evidence-based choices.

The Educational Imperative

Based on their findings, the researchers advocated for the formal integration of T&CM education into medical training curricula at both undergraduate and postgraduate levels. Such education need not aim to train conventional medical professionals as T&CM practitioners, but rather to equip them with sufficient knowledge to discuss T&CM intelligently with patients, identify potential safety concerns, understand the regulatory landscape, and make appropriate referrals to qualified T&CM practitioners when indicated.

This recommendation aligns with international trends in medical education. The World Health Organization’s Traditional Medicine Strategy 2014–2023 explicitly called for strengthening the knowledge base around T&CM and integrating traditional medicine services into healthcare delivery where appropriate. Several medical schools globally have begun incorporating complementary and alternative medicine (CAM) modules into their curricula, providing a range of models that Malaysian institutions could adapt.

In Malaysia, the development of T&CM education has progressed along two tracks: academic education offered by universities (primarily for T&CM practitioners) and skills-based education. However, the education of conventional medical professionals about T&CM remains underdeveloped. This study provides evidence to support policy advocacy for closing this gap, with the ultimate goal of ensuring that all healthcare professionals in Malaysia can provide safe, informed, and respectful care to patients who use T&CM.

The Malaysian T&CM Regulatory Framework

Understanding the regulatory framework is an important component of T&CM literacy for medical professionals. The Traditional and Complementary Medicine Act, enacted in 2016, established a comprehensive legal framework for T&CM regulation in Malaysia. The Act covers the recognition and registration of T&CM practitioners, the establishment of self-regulatory bodies, educational requirements, and quality standards for practice. Seven modalities have been recognised: Traditional Malay Medicine, Traditional Chinese Medicine, Traditional Indian Medicine, homeopathy, chiropractic, osteopathy, and Islamic medical practice.

Medical staff who are familiar with this regulatory framework are better equipped to guide patients toward registered, qualified T&CM practitioners and away from unregistered or unqualified individuals whose practices may pose safety risks. This regulatory knowledge also supports appropriate interdisciplinary collaboration between conventional and T&CM practitioners, a goal that is central to Malaysia’s health policy vision for T&CM integration.

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