The World Health Organization recently published the WHO Global Report on Traditional and Complementary Medicine 2019, in which the WHO calls for government recognition of credible traditional and complementary medicine health professionals to be included in each country's health care system.
Currently, almost all health care disciplines' accreditation agencies in the U.S. require interprofessional education and collaborative practice (IPE/CP). What is IPE? The WHO defined it as follows:
"Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. This is a key step in moving health systems from fragmentation to a position of strength." (WHO Framework for Action on Interprofessional Education and Collaborative Practice, 2010).
Creating Competencies for Interprofessional Education
In 2009, the Interprofessional Education Collaborative (IPEC) created competencies for interprofessional education. Initially, IPEC consisted of allopathic and osteopathic medicine, dentistry, nursing, pharmacy, and public health. IPEC now has more than 20 core members and has supporting members such as the Academic Collaborative for Integrative Health.
ACIH represents the educational organizations for acupuncture / OM, chiropractic, direct-entry midwifery, massage therapy and naturopathic medicine. ACIH is also well-represented on the National Academy of Medicine's Global Forum for Innovations in Health Professional Education, which focuses on IPE/CP and emphasizes the importance of inclusive, collaborative, team-based, patient-centered care.
The IPEC core competencies (some of which are now included in the AOM professional doctorate competencies) include these four domains:
With the national and international growth and interest in integrative health and medicine (driven by the fact that one in two Americans now accesses complementary and integrative health), and coupled with the national focus on the nonpharmacological treatment of pain due to the opioid crisis, isn't it time our disciplines are included in the health care team?
Opening a Door: Revised Pain Management Standards
In addition, the Joint Commission, an independent, not-for-profit organization that accredits nearly 21,000 health care organizations and programs in the United States, recently revised its pain management standards. The updated standards, effective Jan. 1, 2018, require that commission-accredited hospitals provide nonpharmacological pain modalities, including acupuncture as one option, by licensed, independent practitioners.
The Joint Commission's revision mandate will now require accredited hospitals to provide nonpharmacological approaches to pain and hire licensed, independent practitioners. In order to fill this need, acupuncturists must be trained in interprofessional education.
The Challenge: Lack of Education (on Both Sides)
Physicians and other conventional medicine health professionals are facing the dilemma of how to incorporate these services into conventional health care. The lack of training about "complementary" therapies during medical school and residency does not prepare physicians, or other health professionals, for a team-based, inclusive approach that accommodates complementary and integrative health practitioners.
In recent years, there have been successful models of integration of nonconventional services, but overall the conventional medicine field has been cautious to embrace this integration. The lack of knowing "what the other party [practitioner] knows" has a major impact on moving forward with inclusivity of services.
Historically, while physicians have carried out the task of delivering "evidence-informed" care and acted as the authority in care management hierarchy, today this may come across as being overprotective of the patients and cautious with nonconventional modalities. Physicians' limitation in understanding other providers' level of education, national certification / licensure requirements and scope of practice, can impact the integration of integrative services into mainstream health care. In addition, there is a gap in training of complementary and integrative health providers that results in lack of understanding of the culture and hierarchy of responsibilities in care delivery within conventional medical settings.
The Solution: Building Bridges to Collaboration and Integration
In order to be able to deliver comprehensive care, it is essential to fill these educational gaps by building bridges between different disciplines and modalities through ongoing interprofessional education programs. With the changes in the landscape of care delivery, a successful model that thrives on inclusivity and interprofessional team care will be the future of health care.
In 2002, the Institute of Medicine held the "Health Professions Education: A Bridge to Quality" summit. This summit emphasized its position:
"All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. (Institute of Medicine, 2003. Health Professions Education: A Bridge to Quality. Washington, D.C.: The National Academies Press.)
During this time, the ACIH created the Competencies for Optimal Practices in Integrated Environments (September 2010). Concurrently, standards for the professional doctorate were developed by consensus by the Accreditation Commission for Acupuncture and Oriental Medicine's (ACAOM) Doctoral Task Force, with input received at public hearings and online. The resulting standards for the ACAOM professional doctorate were organized by domains, with a focus on the competencies required by a health care professional in a multidisciplinary setting, as well as working with patients as a member of a health care team.
The standards for a first professional doctoral program (FPD) were published in February 2013 and the first program was approved to initiate the accreditation process in September 2014.
The professional doctorate program learning outcomes include a set of 28 doctoral competencies that cover the core competencies defined by the IOM. Specifically, teamwork and collaboration are emphasized in the ACAOM competencies.
Several ACAOM-accredited schools have developed courses to meet the core competencies needed for health care professionals, including interprofessional communications, health care systems, evidence-informed practice and integrative case management. The skills students are learning are filling some gaps needed to get our graduates into health care systems.
"If we adopt these standards into our profession, there is a light at the end of the tunnel. The frustrations ... about the difficulty of communicating with other healthcare providers can change. Through communication and education we can (contribute) ... to a positive interprofessional working relationship." (Pacific College of Oriental Medicine student).
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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