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ARTICLE
The Certificate
Program In Medical Acupuncture:
Focused Training For Health Care Professionals
Steven K. H. Aung, MD
ABSTRACT
Established in 1991, the Certificate Program in Medical Acupuncture
(Faculty of Extension, University of Alberta) has provided training
to physicians, dentists, and physical therapists. This article delineates
the CPMA as a focused training program for health care professionals.
It is broadly similar to that of other programs found in the United
States, Canada, Britain, Australia, New Zealand, and other countries.
These programs provide concise instruction to licensed medical professionals,
allowing an integration of acupuncture into their practices, according
to recent guidelines developed by the World Health Organization. Further
research is necessary to judiciously compare and assess these programs.
KEY WORDS
Acupuncture, Medical Acupuncture, International Acupuncture, Certificate
Program in Medical Acupuncture (CPMA), Training Programs
INTRODUCTION
Acupuncture is no longer considered a fringe or alternative medical
therapy among many physicians in Western societies as was the case only
a quarter of a century ago. Indeed, this ancient therapy has survived
more than 20 centuries of practice and continues to pass the stringent
test of time. It is now widely recognized and accepted as one of the
leading modern complementary therapies, especially for the management
of chronic pain.1,2
This article highlights a relatively new concern; namely, the formal
training of medical acupuncturists. More specifically, it delineates
the training of medical acupuncturists in the Certificate Program in
Medical Acupuncture (CPMA) at the University of Alberta in Edmonton.
Broadly similar programs in Canada, the United States, the United Kingdom,
Australia, and New Zealand are discussed within the context of what
the World Health Organization recently designated as limited or focused
acupuncture training intended for medical professionals.3,4
While it is appropriate to speak of a developing, integrative model
of medical acupuncture in the Western world,5 the concept of "medical
acupuncture" is not without controversy.6 Skepticism can be attributed
to the fact that training programs for physician acupuncturists entail
far fewer instructional hours than the number required for non-physician
acupuncturists. The rationale is that physicians have already completed
intensive education and training in the areas of diagnostic procedures,
pathology, anatomy, physiology, hygiene, first aid, and medical information
systems. Physicians are primarily interested in acupuncture procedures
that can be readily integrated into their practices.
Overview of the CPMA
The CPMA, originally a pilot project in the Faculty of Extension, University
of Alberta, was modeled on earlier intensive medical acupuncture courses
I presented at Grant MacEwan Community College (Edmonton, Alberta),
the Royal Jubilee Hospital (Victoria, British Columbia), various programs
presented for the Australian Medical Acupuncture Society, the Medical Acupuncture
Society of New Zealand, the American College of Acupuncture, and the
Puerto Rico Association of Medical Acupuncture.
The CPMA is designed to meet the growing demands of health care professionals
for medically-oriented instruction in acupuncture. Only licensed and
practicing physicians, dentists, and physical/occupational therapists
are accepted into the program. Admission decisions are made by the Faculty
of Extension Department of Applied Sciences administrators, where the
program resides. A CPMA Academic Advisory Committee composed of an instructor,
faculty administrators, and several graduates moderates the CPMA.
Offered annually, the CPMA is a comprehensive 225-hour course that encompasses
the following 4 instruction modules:
1. Basic Elementary Acupuncture: Traditional Chinese Medicine (TCM)
and acupuncture philosophy and concepts are discussed and presented
in historical perspective. Topics include Qi and Blood, meridians, acupoints,
organ systems, etiology, pathogenesis, and dual diagnosis.7
2. Fundamental Acupuncture: topics include the indications, contraindications,
and precautions of acupuncture, 4-diagnosis, other TCM diagnostic techniques,
differentiation of syndromes, needling methods and ancillary techniques
of acupuncture such as electroacupuncture, acupressure, moxibustion,
and cupping. Other needling techniques and vital energy balancing procedures
are also reviewed.
3. Microsystems of Acupuncture: the theory and application of 5 major
microsystems, hand, foot, nose, scalp, and ear, are presented. These
microsystems are viewed as complementing classic acupuncture.
4. Clinical Acupuncture: the emphasis in this module is clinical problem-solving
and development of diagnostic skills, acupoint prescriptions, and viable
treatment plans. Clinical areas covered include family medicine, physical
medicine and rehabilitation, neurology, and oncology.
Each of these modules is presented in 2 sessions for 3 full days, Friday,
Saturday, and Sunday. Students must pass an 8-hour written take-home
examination and an oral/practical examination before being allowed to
proceed from the 1st to the 2nd to the 3rd module. Competency in the
4th module is assessed on the basis of a student's diagnostic and therapeutic
performance/skills.
In terms of pedagogy, as the program proceeds, time is devoted to workshops
and clinical case studies involving patients. Students are encouraged
to present their patients for assessment (2 short cases and 1 long case)
in mid-morning and mid-afternoon sessions of modules 1 through 3, while
module 4 deals exclusively with a "hands on" assessment of
patients. Module 4 occurs in the outpatient clinic of the Department
of Physical Medicine and Rehabilitation at the University of Alberta Hospital. Groups of 2 to 3 students are responsible
for presenting their patient's case to the class. Provided diagnosis
and treatment forms are submitted to the instructor at the completion
of the module. Patients sign an informed consent form; they tend to
find the clinical experience rewarding.
Chinese Acupuncture and Moxibustion8 is the textbook used in the CPMA.
Students receive a list of relevant readings (for example: 1, 2, 6,
9, 10), and Web sites such as the comprehensive site developed in the
Medical School at Aristotle University of Thessaloniki (http://users.med.auth.gr/~karanik/english/main.htm).
Slides and an occasional videotape are used as teaching aids. I also
demonstrate Qi Gong, dietetics, and herbal medicine as well as Feng
Shui throughout my teachings so that students will appreciate how acupuncture
interconnects with the other major TCM therapies.
Students who advance through all 4 levels and pass a final examination
receive a certificate (CMAc) from the University of Alberta at its June
graduation ceremony each year. The final examination is more than 8
hours long and consists of 120 multiple-choice questions, 80 acupoint
identifications, 6 general short essay questions, 6 clinical short essay
questions, and a 20-minute oral/practical examination. It is conducted
in the presence of an invited external examiner such as Sung J. Liao
(1st class), Wang Xuetai (3rd class), and Francois Beyens (8th class).
This ensures the integrity of the examination procedures and enhances
the legitimacy of the program. The external examiner is also expected
to present a public lecture on a relevant topic in medical acupuncture.
Graduates of the CPMA are eligible to participate in the Golden Road
to Golden Needle (GRGN) Postgraduate Medical Acupuncture Training Program,
a 300-hour course I organized in cooperation with several institutions
in Beijing (including the Beijing College of Traditional Medicine and
Research Institute, the Beijing International Acupuncture Training Center, the Beijing College of Acupuncture
and Orthopedics, and the Faculty of Medicine, Capital University of
Medical Science, Beijing). The GRGN aims to supplement the instruction
provided in the CPMA and offer additional intensive clinical experience.
Approximately one-third of CPMA graduates participate in the GRGN. CPMA
graduates established the "Dr. Aung's Club" where I offer
advanced lectures and workshops as well as an annual medical acupuncture
retreat. Some CPMA graduates spend time in my clinic to gain additional
experience in the modern, integrative approach to medical acupuncture.6,11,12
The CPMA has received recognition from a number of professional organizations,
including the Colleges of Physicians and Surgeons of Alberta, British
Columbia, and Saskatchewan, and has been granted continuing medical
education credit (CME) hours by the College of Family Physicians of
Canada.
Survey of CPMA Graduates
At the completion of the 4th class of the CPMA in 1995, 99 graduates
were given an informal survey in the form of a questionnaire. The central
objectives were to assess the usefulness of the CPMA to its graduates
and to document the practice of medical acupuncture by graduates of
the program (S.K.H.A., CPMA survey of graduates, classes 1-4, 1991-1995.
Unpublished report, 1996). The response rate was 55%; key general findings
were:
-
Most
CPMA graduates were middle-aged, female physical therapists (PTs).
-
Acupuncture
accounted for about 40% of the total clinical practice of PTs, and
12% of the total clinical practice of physicians.
-
The most
common conditions treated were back challenges, general pain, and
headache.
-
Most respondents
viewed themselves as classic acupuncturists who provide acupuncture
in a complementary manner to help manage their patients' pain.
-
The average
treatment session was 16 to 30 minutes and included the stimulation
of 5 to 8 acupoints.
-
The average
treatment session was 16 to 30 minutes and included the stimulation
of 5 to 8 acupoints.
-
Generally,
chronic conditions were treated 1 to 2 times a week for 9 to 12
sessions; acute conditions, 2 times a week for 1 to 4 sessions.
-
Respondents
used 5 key acupoints: SP 6, LI 4, ST 36, GB 34, and PC 6.
-
Most respondents
rated the clinical results they achieved as good or excellent.
-
General
pain and headache were considered the most responsive to acupuncture;
fibromyalgia and chronic fatigue the least responsive.
-
The most
common complications observed were local bleeding/bruising and fainting;
several respondents reported no complications.
-
About
half the respondents reported the use of acupuncture as a preventive
strategy, largely for immunoenhancement.
-
Cupping
and moxibustion were the 2 ancillary techniques most commonly used.
-
Most respondents
considered the CPMA an adequate or very adequate course of instruction,
especially module 4 with its emphasis on diagnosis and differentiation
of syndromes.
-
Most respondents
considered the total instruction and examination hours of the CPMA
to be sufficient.
-
Most respondents
considered the GRGN to be a useful program for clinical enrichment.
-
Many respondents
perceived a need for more advanced training in medical acupuncture
and TCM.
The age data is reflective
of the CPMA as a course for health care professionals who have spent
a number of years receiving their training and developing their clinical
practice. Data on gender reveal that most PTs practicing in Canada
are women, unlike physicians and dentists. The GRGN was generally
perceived as very useful. Re-spondents were asked to provide general
comments on their medical acupuncture practice as well as the CPMA.
Most of these comments were positive.
The first 4 classes of the CPMA averaged 25 students each, with PTs
accounting for 56%, physicians 29%, and dentists 14% (there was also
one registered nurse). A trend toward slightly larger classes and
more participation by physicians appears evident: the 9th class (1999-2000)
consisted of 35 students, with PTs making up 60% of the class, physicians
34%, and dentists 6%.
The survey of graduates described above indicates that the CPMA is
successful in providing acupuncture training to physicians, physical
therapists, and other health care professionals. The results have
allowed the students to begin utilizing acupuncture as a complementary,
effective, and safe treatment, serving to enhance primary care and
the quality of life for patients. The survey clearly points to the
need for ongoing instruction in medical acupuncture, even at a more
advanced master's level.
Two ongoing initiatives are worth mentioning. First, the Faculty of
Continuing Medical Education at the University of Calgary is considering
recognizing the CPMA, and providing it in cooperation with the Faculty
of Extension, University of Alberta. Second, graduates of the CPMA
have been invited to act as clinical preceptors to guide current students.
The CPMA is a viable model of a limited, or focused, medical acupuncture
training program for licensed health care professionals. At the recent
World Health Organization acupuncture consultation meeting in Milan,3,4,13
such training was discussed. It was suggested that a minimum of 200
hours of instruction in acupuncture would be suitable for the medical
modality (licensed physicians and certain other qualified graduates).
Such a course of instruction would encompass a basic introduction
to TCM and acupuncture, location of classic and extraordinary acupoints,
applications of acupuncture in biomedicine, acupuncture safety guidelines,
and the various treatment techniques.
Other Focused Training Programs
The CPMA is not alone in providing focused training in acupuncture
in Canada or around the world. For many years, the Acupuncture Foundation
of Canada Institute (AFCI) has offered such programs in various cities
across the country. The AFCI provides a 9-part core curriculum that
must be completed over a 3-year period (225 AFCI credit hours), and
is available to licensed physicians, PTs, dentists, chiropractors,
naturopaths, RNs, and licensed acupuncturists.
In the United Kingdom, focused training is provided by the British
Medical Acupuncture Society (BMAS). The basic course4 consists of
2 introductory sessions offered 2 weekends, 1 month apart, in different
locales, with separate sessions for physicians and dentists. Upon
completion of the course, participants receive a certificate of basic
competence. Intermediate-level special topics are also offered over
a 3-year period, and special seminars and other courses are provided
by and for its members. BMAS surveys its members to understand the
scope of their medical acupuncture practices and needs.14
Other European initiatives beyond the scope of this brief article
deserve mention. The Belgium-based International Congress of Medical
Acupuncture and Related Techniques (ICMART) plays a major role in
bringing European medical acupuncturists together on an annual basis
to share their knowledge and experiences. The Beijing-based World
Federation of Acupuncture-Moxibustion Societies (WFAS) plays a similar
international role, especially in regard to sharing and promoting
the Chinese heritage of medical acupuncture, mainly for non-physician
acupuncturists. These 2 organizations, however, do not provide formal
training programs. Several training programs for international students
(aside from the GRGN mentioned above) are available in China; perhaps
the most substantial is one that has been offered for many years at
the Nanjing College of Traditional Chinese Medicine (an official World
Health Organization collaborating center).
In the United States, the American Academy of Medical Acupuncture
(AAMA) has offered Medical Acupuncture for Physicians since the early
1980s, a focused training initiative through the Office of Continuing
Medical Education, UCLA (University of California Los Angeles) School
of Medicine. This office has granted the program 200 Category 1 credit
hours. Open only to licensed physicians, the program features an introductory
weekend, a home video study unit, and a 10-day clinical session. Graduates
are accepted as members of the AAMA.
The AAMA regards medical acupuncture as a specialty. A comprehensive
United States National Proficiency Examination in Medical Acupuncture15
has been developed. The examination is not restricted to AAMA members.
Moreover, the AAMA is seeking designation as an official CME sponsor.16
This initiative, if successful, would integrate medical acupuncture
into the US health care system and provide considerable legitimacy
for the practice of medical acupuncture, not only in the US but in
all Western societies.
Another major US initiative is the National Commission for the Certification
of Acupuncturists (NCCA), which offers a diploma for candidates who
pass the NCCA certification examination.17 This procedure is especially
designed for non-physician acupuncturists who have received a few
thousand hours of didactic education and also have clinical experience.
It is currently recognized in most states. The NCCA emphasizes the
use of clean needle techniques, the judicious use of herbal medicine
in conjunction with acupuncture, and adherence to a national code
of ethics.
The NCCA was the major force behind the creation of the North American
Free Trade Association (NAFTA) Acupuncture and Oriental Medicine Commission.
In its annual meetings, it seeks to bring together physician and non-physician
acupuncturists from Canada, the US, and Mexico to learn from one another
other and share their perspectives. The AAMA recently began to participate
in these meetings.
Several other programs are available in the United States that do
not fall under the aegis of the AAMA or the NCAA. Since the early
1990s, the University of Miami School of Medicine has provided a basic
acupuncture CME course for physicians. In 1996, the New York Medical
College developed a 300-hour Certificate in Medical Acupuncture Program
for physicians and dentists. The American College of Acupuncture in
New York offers an annual CME program for its members, and the Puerto
Rico Association of Medical Acupuncture offers a similar program at
times. The Academy of Pain Research in San Francisco and the UCLA
Center for East-West Medicine are in developmental stages of CME initiatives.
The Australian Medical Acupuncture College (AMAC) focused training
model centers around the development of a core curriculum of 250 hours
of acupuncture training for physicians, encompassing seminars, workshops,
long-distance learning modules, and clinical case presentations. As
a federal model, it would be applicable in all Australian states.
In recent years, a New Zealand initiative has granted membership in
the Register of Medical Acupuncturists of New Zealand to physicians
who have at least 150 hours of formal and approved acupuncture training
endorsed by the World Health Organization. The latter is assessed
by a panel of 3 senior members of the Medical Acupuncture Society
of New Zealand.
Finally, every few years, the Pan-Pacific Medical Acupuncture Forum
brings together participants from the United States, Canada, Australia,
and New Zealand.
CONCLUSION
The CPMA is only one of a number of medical acupuncture focused training
programs in Canada and around the world. Perhaps it would be useful
for dedicated students to participate in as many of these programs
as possible to open themselves to many different perspectives. Moreover,
it would be a worthwhile research endeavor to compare these programs
in a rigorous and objective manner to assess their strengths and weaknesses.
This would enable the development of meaningful international standards
in the vitally important area of medical acupuncture focused training
for physicians and other health care professionals.
Perhaps one day, a standard focused training program will be provided
in different venues by an entity such as the World Health Organization.
Meanwhile, we can be pleased with the progress made over the past
2 decades. The leadership shown by the AAMA in promoting acupuncture
as a medical specialty is commendable, not only for the benefit of
medical practitioners but for the good of patients everywhere. Both
practitioners and patients have an additional treatment of choice
to alleviate pain and balance the vital energy of body, mind, and
spirit. Medical acupuncture is a valuable tool for the medical practitioner's
diagnostic and therapeutic armamentarium. Students should always be
taught how to use this tool with the highest standards of competence,
compassion, and both quantitative and qualitative research efforts
according to their various interests and specialties. It is most beneficial
for this to be included as part of the university-level medical school
curriculum.
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Acupuncture Med. 1994;12:104-107.
12. Aung SKH. Traditional Chinese medicine and cancer care:
an integrated approach. Can J Clin Med. 1997;4:3-7.
13. Helms JM. WHO acupuncture consultation meeting. Harmony
(newsletter of the Canadian Medical Acupuncture Society). 1997;3:1-2.
14. White A. The BMAS basic course: a consumer survey. Acupuncture
Med. 1996;14:29-30.
15. Reed J. Credentialing in medical acupuncture: the AAMA
certificate of proficiency in medical acupuncture. Medical Acupuncture.
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Medical Acupuncture. 1998;10:6-8.
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AUTHORS'
INFORMATION
Dr Steven K.H. Aung practices integrative Traditional Chinese Medicine
and biomedicine in his clinic in Edmonton, Alberta, Canada. Founder
and instructor of the Certificate Program in Medical Acupuncture, Faculty
of Extension, University of Alberta, Edmonton, Dr Aung is also Associate
Clinical Professor in the departments of Medicine and Family Medicine,
University of Alberta, as well as advisor on medical acupuncture for
the World Health Organization.
Steven K.H.
Aung, MD, FAAFP
9904 - 106 Street NW
Edmonton, Alberta, Canada T5K1C4
Phone: 780-426-2760
Fax: 780-426-5650
Email: skha@aung.com
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