Perspectives on Teaching Acupuncture to Medical Students

INTRODUCTION

There is an interest among many medical students (MSs) in acupuncture. The challenge is how best to encompass this inquisitiveness in an acupuncture program for rotating MSs. Also, various international surveys delineate acupuncture perceptions among MSs that are helpful when structuring such a program. For example, an Irish survey of MSs found that among 15 alternative medicine modalities, acupuncture, massage, and meditation had the highest interest (p < 0.05). ¹ Rio Preto Medical School in Brazil found that on a scale of 1–5, students rated 4.6 for the idea that acupuncture is important in the medical curriculum and 4.6 for wanting more information on acupuncture. ² Reasons for students to participate in elective courses in acupuncture included personal experience, the sense that conventional medicine is incomplete, and that acupuncture or homeopathy could help bridge this gap. ³ A German study found that those participating in elective courses in acupuncture and homeopathy scored higher on the “care orientation” attitude over science orientation with these students aspiring to specialize in family medicine more and general surgery less. ⁴ A survey of students and internists in Israel found that 74% believed that acupuncture had more effect than placebo and that 42% thought acupuncture should be included in medical education. ⁵ There were no statistically significant differences between group attitudes other than 47.5% of students felt that acupuncture should be recommended for medical conditions while 35% of residents and 12.6% of internal medicine staff felt similarly. ⁵ Here, we describe a 4th-year MS rotation to address the interest noted in prior studies.

CURRICULUM

The Acupuncture and Integrative Medicine Center, Joint Base Andrews, Maryland, has a robust relationship with the Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland. For 23 years, this clinic has offered an elective 4th-year MS rotation in acupuncture. Over time the curriculum has been fined-tuned to meet the interests and expectations of the MSs. MSs observe the practice styles of five physicians and two licensed acupuncturists, one of whom was a medical doctor in China. The students experience a variety of acupuncture techniques, which leads to a better breadth of training. Given that most MSs are in their 4th year, many have already decided on a residency path at the time of their rotation. Therefore, early in the rotation, “we inquire as to what specialty a student is planning to pursue.” Specific emphasis is placed on relating acupuncture to their projected field of medical specialty. For example, if the student advocates neurology, then we make special efforts to have the student participate in neurology cases.

Objectives for the rotation include exposure to various acupuncture and integrative therapies, to include traditional oriental medicine, battlefield acupuncture (BFA), Chinese scalp acupuncture, cupping, gua sha, electrical, and LASER therapy. We advocate safety considerations by discussing acupoints that risk inducing labor in the pregnant female, Aguille Semi-Permanente (ASP) needle side effects, pneumothorax risks. Didactics provided by acupuncturists include topics such as the use of piezoelectricity, weight management, functional medicine, and cupping.

The students are afforded the opportunity to observe a primary care clinic that incorporates acupuncture and integrative medicine fully into every patient’s treatment plan. In such a model, primary care patients are offered an acupuncture treatment, if warranted, as an option during the first visit. For example, a patient might be proposed medication, physical therapy, chiropractic manipulations, injections, and acupuncture. Without influencing the patient, the choice for acupuncture is frequent. Students benefit by observing a wider scope of acupuncture options for diverse pathologies in a physician’s practice.

Students attend a formal 4-h training course in BFA ⁶ and receive a letter of certification upon completion. They are taught how to explain BFA therapy to patients, the expected risks and outcomes from BFA, and answer basic questions regarding BFA therapy. The U.S. military has approved this certification for potential credentialing for the isolated use of BFA within the military system by non-acupuncturists, so students depart with a useful skill to use soon after the rotation, into their residency years, and beyond.

Because typically acupuncture results are presented predominantly on patient charts as pain measurements, we have a library collection of cases that visually illustrate acupuncture results on a patient. They include examples such as pre- and posttreatment with tendino-muscular meridians for edema, pre- and post-chest X-rays for atelectasis, ⁷ blood pressure graphs, ⁸ treatments for dermatologic conditions such as psoriasis, growth charts for failure to thrive, ⁹ and audiograms in hearing/tinnitus patients. We discuss the cases with students and relate any, as applicable, to their projected field of specialty. Students become comfortable assisting or performing under supervision treatments with acupuncture needling, cupping, piezo-electric pen therapy, auricular acupuncture, and electroacupuncture.

Students participate in group class sessions for stress management and weight loss. In these classes, patients are given quick, simple acupuncture treatments and comprehensive teaching on lifestyle, relaxation methods, and functional medicine to include nutrition and supplement usage.

By the end of the rotation, students can treat a newly acquired pain patient, recommend therapy options that are likely to be successful, and perform these therapies under supervision. As they participate in the care of patients, the students develop an appreciation of the opportunities to use acupuncture and other alternative modalities.

RESULTS

The acupuncture rotation has become a popular clinical elective rotation for USUHS. The recent class size during this period has averaged 174 students per year. In the 4th year, there are 7 rotation blocks available for electives with 135 other rotations listed in the school course catalog. In acupuncture, we have the capacity for one to two students per block. Over the past 3 years, we have averaged 13 student elective rotators per year at our clinic. Mathematically, given the number of students, blocks, and rotations available, one would expect any rotation to average nine students per year. Thirteen students are better than the average 4th-year rotation uptake and nearly the expected maximum capacity for our ability to support rotations.

One student in 2023 subsequently followed up with a research project in acupuncture in collaboration with the clinic providers. We have not provided a formal survey for data analysis, but at the conclusion of the rotation, students have almost universally expressed interest in incorporation of acupuncture into their future practice, and many plan to further their knowledge after specialty training to enroll in the 300-h acupuncture program leading to full credentialing.

DISCUSSION

During ancient times, students embraced the “Masters” and followed them to see how they treated illness and learned their philosophy. There was not a standard curriculum. As Dr. Niemtzow remarked (private communication—July 12, 2024) “There was a willingness to teach and a willingness to learn without following a strict schedule. Perhaps we forget that disease does not follow a rigid lesson plan, and treatment sometimes must be innovative and not follow a strict syllabus.”

Expanding hands-on awareness of acupuncture at the MS level will enhance the future of acupuncture practice, as it will help ensure that more future physicians would be willing to consider acupuncture as a treatment option for a wider variety of conditions and, thus, be more likely to refer patients to an acupuncturist. A study of 40 students in the United Kingdom found that placement in a complementary medicine service would influence the rate of future referrals for 76%. ¹⁰ Western medicine might be improved by the incorporation of acupuncture in all facets of medical care. If patients see their primary care provider or a subspecialist, acupuncture should be available to expand the treatment options.

As a next step in our program, we hope to interface with USUHS faculty to get an advance list of rotating students and their proposed specialties. With that information, we would like to coordinate a day to see patients in the corresponding subspecialty clinic for the purpose of offering acupuncture treatments and to increase the students’ ability to apply acupuncture to their future practice.

Long term, there is also a benefit to the seasoned practitioner by experiencing acupuncture. A survey of family physicians noted that controlling for clinical pace and years of training, acupuncture instruction was significantly associated with preventing and decreasing depersonalization (p < 0.05). ¹¹ Depersonalization is the sense of lacking depth, purpose, and reality. The crisis of physician burnout probably has depersonalization as a major factor.

The United States Air Force has a scholarship program in the 300-h medical acupuncture program, and in the past 3 years, an average of 20 young physicians applied for about 15 annual slots for the program. These applicants hailed from a wide variety of clinical specialties. Though we do not have exact numbers, many are those that participated in the 4th-year USUHS elective rotation. These physicians are diversified their specialization and included anesthesia/pain and neurology, family medicine, emergency medicine, internal medicine, pediatrics, aviation medicine, critical care, hematology/oncology, interventional radiology, obstetrics and gynecology, orthopedics, psychiatry, rheumatology, and sports medicine. It is very rewarding to observe the continued interest in integrating acupuncture into medical specialties.

CONCLUSION

The teaching model that we have incorporated involves many facets of acupuncture without following a rigid curriculum. Teaching follows the flow of daily appointments. This unfiltered experience lends credibility to acupuncture in the minds of students who regularly see a more satisfied patient population than in other rotations. As a result, we work to serve the interest in acupuncture noted in surveys around the world. This continues to be more popular than the average 4th-year elective rotation at USUHS.