Understanding the Challenges of U.S. Acupuncture Practice (Pt. 7)

Editor’s Note: Part 1 of this eight-part monthly series ran in the June issue.

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Acupuncture remains outside of mainstream medicine, and 60% of U.S. licensed acupuncturists are unable to earn a living.^1-3 Acupuncture is not a uniform profession, and it has not established its own education- and practice-based competencies focused on appropriate knowledge, skills and abilities (KSAs) [see part 6].⁴

This inconsistency, variation and lack of KSAs contribute to the difficulty the acupuncture profession is experiencing when trying to integrate into the mainstream health care system.

Inconsistent Training

As of the time of this writing, 57 acupuncture schools in the U.S. have achieved accreditation with ACAOM.⁵ Although there are comprehensive standards and criteria for accreditation according to ACAOM, acupuncture training has a wide variation from state to state.⁵

For example, the training length varies from 2,000 hours to more than 4,000 hours among different acupuncture schools. In addition, the professional competencies vary in different acupuncture schools; e.g., the Atlantic Institute of Oriental Medicine in Florida offers the course “Differentiation of Syndromes,” which is part of acupuncture and Chinese medicine diagnosis, while the Jung Tao School of Classical Chinese Medicine in North Carolina offers “Energetic Diagnosis” instead.^6-7

Stumpf, et al., point out that acupuncture training varies among different schools, and practice styles vary among graduates.⁴ Furthermore, licensure regulations vary among different states.

Compared to mainstream medicine, which is characterized as consistent in medical education, certification, licensure, and practice scopes, the acupuncture profession should change these inconsistencies if it intends to integrate into mainstream medicine.

There exists a debate regarding several controversial topics within the acupuncture profession. Examples of such topics include what the minimum amount of time of academic training should be, what professional title should be issued to a provider, and how the profession is united to cope with the challenges from other professions.⁸

McKenzie, et al., stated that the leading professional organizations for the acupuncture profession hosted dialogue with multiple parties that included practitioners, educators, and other related members to discuss these topics.⁸

In terms of training time, in general, acupuncturists complete a two-year associate or four-year undergraduate degree program with any major, spend three to four years in acupuncture school to receive their master’s degree, and then complete two years of doctoral training before they receive their doctoral degree in acupuncture and Chinese medicine. They are eligible for acupuncture licensing after they finish their master’s degree.

Inadequate Training

Compared to medical degree doctors, the years of acupuncture training are significantly fewer. In general, the requirements for becoming a medical doctor in the U.S. include completing a four-year undergraduate degree program, four years in medical school, and then three to seven years of residency training before being eligible for medical licensing.

Although a minimum length of 1,905 hours for an acupuncture program is required by ACAOM, the acupuncture training hours among different acupuncture schools vary.⁵ The training can range from 2,000 to more than 4,000 hours before students are eligible for acupuncture licensing, according to different state acupuncture board requirements.

Furthermore, according to ACAOM’s accreditation manual, the acupuncture program criteria require more than 70% of the Chinese medical curriculum and more than 20% of the Western medical curriculum.⁹ As a result, acupuncturists have a much lower percentage of Western medicine topics included in their training compared to other professions.

In addition, the unique TCM concepts, such as qi, yin/ yang, five elements, Chinese pinyin terms, etc., could confuse Western medical practitioners and patients because they are not familiar with this terminology.

The most important difference between acupuncture and medical school preparation is that acupuncture students do not have the three to seven years of residency training as do medical school students. As a result, the lack of a match to the level of Western medicine training will contribute to the disqualification of the acupuncture profession to meet the requirements of mainstream medicine.

Lack of EBM Knowledge

The acupuncture program at the master’s level does not require evidence-based medicine (EBM) in the curriculum. Incorporating an EBM approach into the CAM curriculum will contribute to the creation of new curriculum, the development of faculty professional competency, and possible changes in academic culture in CAM and faculty behavior.^10-13

However, it is challenging to implement the EBM approach into the curriculum at CAM institutions. First, the students’ motivation in learning EBM courses and research decline as they progress through their degree programs due to increased awareness of CAM research methodology flaws and increased interest in clinical activities instead of research.^14-16

Second, time constraints in faculty development training, limited accessibility of faculty, and less institutional support make it difficult to provide faculty with effective EBM training and further impact the integration of the EBM approach into future teaching and practice.^11,13,17-18

Third, EBM resource inaccessibility and a lack of hands-on practice with EBM concepts are barriers to implement EBM into a CAM training program.^11,19

Although faculty and students at CAM institutions express support and interest in EBM, they lack knowledge of research and the EBM process.²⁰ Students at CAM institutions place a value on the EBM approach, but show low levels of interest and even resistance in having EBM content and training in their study.^14-16

In addition, faculty at CAM institutions display a lower score of self-efficacy on EBM knowledge compared to the score before taking the EBM training course compared to the post-course.^19,21

Students in CAM programs present a specific mindset that scientific methods in EBM may not be consistent with the principles of CAM.^14,16 Researchers suggest that including EBM in the medical curriculum can help the development of professional competencies of critical thinking.²²

The lack of EBM knowledge and skills of acupuncture students might compromise acupuncture professional competency, contributing to the disqualification of this profession to meet the requirements of mainstream medicine.

References

1. Stumpf SH, Kendall DE, Hardy ML. Mainstreaming acupuncture: barriers and solutions. Compl Health Practic Rev, 2010;15:3-13.
2. Stumpf SH, Hardy ML, Kendall DE, Carry CR. Unveiling the United States acupuncture workforce. Compl Health Practic Rev, 2010;15(1):31-39.
3. Stumpf SH, Carr CR, McCuaig S, Shapiro SJ. The US acupuncture workforce: the economics of practice. Am Acupuncturist, 2011:56.
4. Stumpf SH, Hardy ML, McCuaig S, et al. Acupuncture practice acts: a profession’s growing pains. Explore: J Sci Healing, 2015;11:217-221.
5. Comprehensive Standards and Criteria. The Accreditation Commission for Acupuncture & Oriental Medicine, 2018.
6. Course descriptions. Atlantic Institute of Oriental Medicine, 2018.
7. Didactic course descriptions. Jung Tao School of Classical Chinese Medicine, 2018.
8. McKenzie M, Sale D, Ward-Cook K, et al. Acupuncture and Oriental Medicine. In: Clinicians’ and Educators’ Desk Reference on the Integrative Health and Medicine Professions, Third Edition. Academic Collaborative for Integrative Health, 2017.
9. Standards and Criteria Manual: Master’s Level and Postgraduate Doctoral (DAOM). The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), Oct. 21, 2017.
10. Bowe CM, Lahey L, Armstrong E, Kegan R. Questioning the “big assumptions.” Part I: addressing personal contradictions that impede professional development. Med Education, 2003;37(8):715-722.
11. Connelly EN, Elmer PJ, Morris CD, Zwickey H. The Vanguard Faculty program: research training for complementary and alternative medicine faculty. J Alt Compl Med, 2010;16:1117-1123.
12. Evans R, Maiers M, Delagran L, et al. Evidence informed practice as the catalyst for culture change in CAM. Explore: J Sci Healing, 2012;8:68-72.
13. Hammerschlag R, Lasater K, Salanti S, Fleishman S. Research scholars program: a faculty development initiative at the Oregon College of Oriental Medicine. J Alt Compl Med, 2008;14:437-443.
14. Anderson BJ, Kligler B, Cohen HW, Marantz PR. Survey of Chinese medicine students to determine research and evidence-based medicine perspectives at Pacific College of Oriental Medicine.Explore: J Sci Healing, 2016;12:366-374.
15. Haas M, Leo M, Peterson D, et al. Evaluation of the effects of an evidence-based practice curriculum on knowl- edge, attitudes, and self-assessed skills and behaviors in chiropractic students. J Manipulative Physiol Ther, 2012;35:701-709.
16. Wayne PM, Hammerschlag R, Savetsky-German J, Chapman TF. Attitudes and interests toward research among students at two colleges of acupuncture and Oriental medicine. Explore: J Sci Healing, 2010;6:22-28.
17. Landrum RE. Are there instructional differences between full-time and part-time faculty?. College Teaching, 2009;57:23-26.
18. Rogers J. Aspiring to leadership—identifying teacher-leaders. Med Teacher, 2005;27:629-633.
19. Allen ES, Connelly EN, Morris CD, et al. A train the trainer model for integrating evidence-based medicine into a complementary and alternative medicine training program. Explore: J Sci Healing, 2011;7(2):88-93.
20. Zwickey H, Schiffke H, Fleishman S, et al. Teaching evidence-based medicine at complementary and alternative medicine institutions: strategies, competencies, and evaluation. J Alt Compl Med, 2014;20:925-931.
21. Long CR, Ackerman DL, Hammerschlag R, et al. Faculty development initiatives to advance research literacy and evidence-based practice at CAM academic institutions. J Alt Compl Med, 2014;20:563-570.
22. Kotur PF. Introduction of evidence-based medicine in undergraduate medical curriculum for development of professional competencies in medical students. Curr Opinion Anesthesiol, 2012;25:719-723.