Abstract
Abstract
Background:
Academic medical centers have long been centers for distribution of knowledge in the allopathic medical tradition. More often, these medical schools are including in their curricula, integrative medical techniques, including acupuncture.
Objective:
The aim of this article is to describe a “blueprint” for developing an academic medical acupuncture practice.
Methods:
The elements described include the three main pillars of an academic medical center: (1) clinical practice; (2) education; and (3) research.
Results:
Over a 5-year term, development of an academic medical practice was established at a major academic medical center with elements of all three main pillars.
Conclusions:
An academic medical acupuncture practice requires thoughtful planning guided by those elements common to allopathic academic medical practice as well as the planning challenges unique to acupuncture practice. Academic medical acupuncture programs are a true possibility within the allopathic medical tradition.
Introduction
A
Methods
In developing the medical acupuncture service at a major academic medical center, the current author applied the development of the three main pillars in an allopathic academic medical practice—(1) clinical practice, (2) education, and (3) research—into that of a medical acupuncture service. The next three sections elucidate how these three main pillars are “built.”
Clinical Practice
Most often, clinical practice defines the overall clinical service offered at an academic medical center, but this is merely the first element in starting a de novo academic practice. Agreement with the hospital for space and time to practice, and obtaining licensing and credentialing may not be trivial feats.
Often, the medical staff office, particularly staff members who are unfamiliar with integrative therapies, may not know how to credential practitioners. For medical acupuncturists, certification by the American Board of Medical Acupuncture (ABMA) is a helpful first step in establishing credibility that will satisfy the hospital administration. The AMBA lists several requirements for obtaining certification that include graduation from an accredited allopathic or osteopathic medical school in the United States or Canada, or possession of final certification by the Educational Commission for Foreign Medical Graduates (ECFMG) if graduation is from a medical school in some other country.
Other requirements are possession of a current, valid unrestricted license to practice allopathic or osteopathic medicine in a state or jurisdiction of the United States, or province of Canada, and have a moral and ethical standing satisfactory to the Board. In addition, completion of a minimum of 300 hours of systematic acupuncture education, successful passing of the written proficiency examination, and attestation of a minimum of 2 years of medical acupuncture clinical experience are also needed for ABMA certification. 2
Another challenge practitioners may incur is a establishing a patient referral network. It would be prudent to make a plan with the hospital's billing department, not only to set a fee schedule, but also understand what may be covered for the services and what entity will cover them. In addition, making sure to be listed in directories as a medical acupuncturist as well as according to one's primary allopathic specialty or subspecialty may aid potential patients in locating the practice. Many times, “word of mouth” referrals by other allopathic providers may bring in a significant referral base. Often, these providers may be unaware that either the practitioner or the medical doctor even offers acupuncture services. It is well-documented that allopathic providers do refer patients to integrative therapies, particularly when such practitioners are consumers of these services themselves. 3
Finally, clinic-specific resources should be considered to aid the successful start of an acupuncture service. These include—but are not limited to—personnel needs, administrative assistance, supply ordering and storage, and billing and scheduling support. Educating important members of the team about the nuances and differences in acupuncture practice increases understanding throughout the service and promotes a more-efficient patient experience.
Educational Curricula
Medical education occurs at several different levels. Most undergraduate medical curricula now include some, albeit not comprehensive, exposure to integrative medical therapies. More often than not, formal exposure to the integrative therapies does not occur at the graduate medical education level. Motivated residents and fellows may ask their individual program directors for guidance. Development of a formal rotation should include the steps described by Kern et al. 4 These steps include a general needs assessment followed by a targeted needs assessment, development of goals and objectives, development of educational strategies, implementation, and formal evaluation and feedback. These elements are described in the Discussion section, which provides an example of the development of a formal graduate medical education program that included the above elements as well as the additional elements.
Research
The academic medical center is the ideal setting for basic science and clinical research related to acupuncture for motivated individuals. Academic institutions have rigorous institutional review boards and collaborative resources for researchers. Research may occur in many forms. Basic science research is often collaborative between practitioners and bench scientists who have significant access and skills to measure physiologic parameters. Clinical research is also often collaborative, incorporating physician–scientists and members of several clinical specialties, including medical acupuncture, anesthesiology, surgery, and others. Often, in an academic medical center, access to a statistician is useful to aid understanding and presenting collected data. This is an easier endeavor often when a clinical practice is established at an academic medical center.
Results
Over a 5-year term, development of an academic medical practice was established at a major academic medical center with elements of all three pillars. See the Discussion section.
Discussion
The elements of clinical practice, medical education, and research may be sequentially developed over time or in parallel if resources allow. Additional elements are also quite useful. These elements were included along with the three main pillars for the development of a formal graduate medical education program.
Additional Elements
General needs assessment
Acupuncture is a medical modality that is currently often not included as part of the graduate medical educational curricula. Most physicians who choose to follow a path that includes proficiency in acupuncture often undertake their coursework after they have completed a specialty program in graduate medical education.
Targeted needs assessment
Neurology and anesthesiology residents and fellows at the academic medical center rotated through specialty clinics electives. A medical acupuncture service was one of these clinics. In this case, a formal curriculum related to acupuncture was developed to meet the educational needs of the residents and fellows.
Goals and objectives
The goals and objectives for the formal graduate medical education program included three basic prongs:
(1) An introduction to basic acupuncture concepts, including Qi, Yin, Yang, and meridians (2) An introduction to evidence based acupuncture by reviewing the current literature (3) Educating practitioners to understand when patients might benefit from an acupuncture referral.
Education strategies
The educational strategies utilized included PowerPoint slide presentations posted to the internet, posted articles for review, case vignettes for discussion, and direct observation and interaction with patients in the clinic.
Implementation
Implementation of the curriculum is often a process in evolution. Initially residents were assigned to the rotation for merely observation, but with resident and program coordinator input, the added educational strategies were supported by the College of Medicine at the University of Illinois.
Evaluation and feedback
Evaluation took place on several different levels. Attitudes and knowledge were evaluated by a pre- and post-test. Formal evaluation of a resident by the faculty as well as formal evaluation of the faculty by the resident was administered by the department of neurology. In addition, development of an evaluation tool for evaluation of the curriculum and program by the resident was necessary. An example is shown in Appendix 1.
Summary
The academic medical center is the ideal setting for hosting continuing medical education programs. In addition to showcasing the hosting institution as a center for academic medical acupuncture, it also allows for networking and shared experiences regionally.
Conclusions
Development of an academic medical acupuncture practice requires integration of the clinical aspects of acupuncture practice with a robust educational curriculum, including evaluation of the curriculum and inquiry exemplified by bench research or clinical studies. Different institutions offer different opportunities with respect to these elements, which may, in turn, reflect the heterogeneity in academic medical acupuncture practices.
Footnotes
Disclosure Statement
No conflicting financial interests exist.