Transcript of Acupuncture Education Roundtable

Arnyce Pock: To begin, I’d like to extend a warm good evening or good morning to everyone depending on where you are! I’m Dr. Arnyce Pock, an internal medicine specialist as well as a medical acupuncturist and am one of the Associate Editors of the journal. I currently serve as the Associate Dean for Curriculum at the Uniformed Services University of the Health Sciences—our country’s military medical school, here in Bethesda, Maryland. I’m pleased to be joined tonight by my co-host, Dr. Libin Jia from the National Institute of Health. We appreciate everyone joining us for this special round table discussion focusing on acupuncture education around the globe.

Libin Jia: Hi, good morning or good evening, everyone. Welcome to this special event on acupuncture education. My name is Libin Jia, as you know from the emails I sent to you all for this event. I’m working at the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine, Division of Cancer Treatment and Diagnosis. We’re interested in different medical systems on cancer treatment, including complementary and alternative methods such as acupuncture. Our office held several conferences on acupuncture research and applications. We are very happy to see you all, hopefully our discussion will bring the current developments on global acupuncture education to many. Thank you all and welcome! Should we let other people introduce themselves as well?

Arnyce Pock: Since we have participants from at least six different locations around the globe, I was wondering if each of you could briefly introduce yourselves, letting our readers know where you work, your professional background, and since this special edition focuses on acupuncture education, what type of learners do you work with the most?

Libin Jia: Thank you, Arnyce. So, Dr. Jan, could you briefly introduce yourself?

Andrew Jan: Hi everyone. I’m from Western Australia and have spent 35 years working as an emergency physician. About 28 years ago, I trained as a medical acupuncturist here in Australia, so I had two specialties—emergency physician and medical acupuncturist. I’m also an Adjunct Professor at the University of Notre Dame Fremantle, where I help train MD students, particularly in research.

I completed my PhD on using acupuncture as an analgesic in the emergency department, which was fascinating and rewarding. These days, I work part-time doing acupuncture. I’m involved with the Australian Medical Acupuncture College, where we run journal clubs and train doctors to become medical acupuncturists.

Locally, I’m part of an acupuncture interest group that brings together medical acupuncturists and Traditional Chinese Medicine (TCM) practitioners, reflecting our two-tiered system in Australia. In our southwest region, I’m engaged in education and journal clubs related to acupuncture.

Libin Jia: Okay, thank you Dr. Jan. Next, Clare, could you introduce yourself?

Clare Foley: Hi there. I’m a licensed naturopathic acupuncturist and first trained in acupuncture in Ireland in 2008. I qualified, went to China, and did six months of training in hospitals there. And I was really impressed by the system in the hospitals there. I wanted to have that in my own country, but I could see we had a lot of problems integrating acupuncture in Ireland. So, I became a scientist to try to do research in acupuncture and see if I could use that to move things forward here. I did an undergraduate degree in physics and biology and then I went to Belgium and did a two-year master’s in biophysics. And I’ve started publishing on mechanisms of acupuncture and I’m teaching that material now as continuing professional development (CPD) courses for acupuncturists.

I found that something that is kind of missing in the literature is how acupuncture works, not just what it does, but really how it works—so that we have a model of how it works. It would be really satisfying to Western scientists and to doctors and even just to lay people, if you can say in an easy way how it [acupuncture] works without saying, well, this part of the brain is responsible for pain and that’s activated, or something like that. Something more holistic and something that’s more faithful to the original writings on acupuncture from the Nei Jing (ancient Chinese medical literacy). So I’ve tried to put all those together and come up with a more holistic model of mechanism using not just biomedical information but using physics as well.

Libin Jia: Okay, great. Thank you. Next, could we have Dr. Yair Maimon to give a brief introduction?

Yair Maimon: I’m the Dean of an online TCM [Traditional Chinese Medicine] Academy where we offer courses in pediatric, 5-element, and oncology acupuncture. In fact, our program on oncology acupuncture has already generated 700 graduates from five different continents. It’s probably one of the most extensive teaching programs focused on oncology acupuncture. Overall, the [TCM Academy] platform has 35,000 practitioners from all around the globe. I do a lot of education. Before this, a long time ago, I was at a very large school in Israel when I taught medical doctors and non-medical personnel—about 2,000 students at one point. I’ve been very involved in education all my life. I’m the president of the ETCMA, which is the European TCM Association that has 24 countries in Europe gathering 30 different associations. I’m very active there.

I’m currently in London because of the World Federation of Acupuncture-Moxibustion Societies (WFAS) conference. I’m the Vice President of WFAS, which is one of the larger organizations based in China, which is involved with acupuncture. So, I’m attending the meeting this weekend and will later be flying to the States to join the SIO conference [Society of Integrative Oncology] where I’m very active and am the co-chair of the special interest group on acupuncture.

I’m also an Honorary Adjunct Fellow at Sydney University in Australia. International in focus, I’ve done a lot of research, mainly in the last years, on herbal medicine. I have few international patents pertaining to herbal medicine and integrative oncology. My latest research is about prevention of secondary recurrence of bladder cancer, which is very interesting. In fact, in the coming months, I will speak about closing the circle, actually taking an herbal formula, doing a lot of preclinical and clinical research and bringing it to the level of commercializing it. So, as you can see, I’m very active, very traditional in my approach. And I just recently published a book which I’m launching at the end of the month with the late Giovanni Maciocia about herbal medicine and cancer. And we are in the final stages of preparing another book about evidence-based oncology acupuncture, which will cover about 700 or 800 different areas of oncology acupuncture and includes 700–800 research references, trying to bridge the gap between researcher practitioners and clinical oncologists.

Libin Jia: Thank you for your introduction. Dr. Lao., could you give us your introduction?

Lixing Lao: Sure. Thank you for the invitation. I’m Dr. Lixing Lao. I currently work in Virginia at the Virginia University of Integrative Medicine, where we train acupuncturists. Our school now is the second largest acupuncture school in the United States. We offer a 3-year Master of Science in Acupuncture degree and also a 4-year Doctor of Acupuncture doctoral degree. I currently serve as Professor and President of the school.

My training began in Shanghai, at the Shanghai University of Chinese Medicine in China. I graduated in 1983—a long time ago. I came here [to the United States] for my PhD training and worked at the University of Maryland for many, many years as a professor in the School of Medicine, teaching at the Center for Integrative Medicine. And I worked in Hong Kong, as the Director of the School of Chinese Medicine, University of Hong Kong. So, I have been working on clinical training, acupuncture education, and research. I’ve conducted research in evidence-based Chinese medicine. This is my career. Nice to meet you all. Thank you.

Libin Jia: Thank you, Dr. Lao for your introduction. Okay, next one. Could we have Dr. Kim from South Korea to give us an introduction? Briefly, thank you.

Seung-Nam Kim: I’m currently working in Dongguk University in South Korea. And most of all may know that South Korea has two kinds of licenses for medical doctors. The first one is a conventional Western doctor and the second is for Korean medicine; the second can do acupuncture practice or prescribe herbal medicine to patients. They are licensed from the government. So, we have 11 Korean medicine universities in South Korea. Dongguk University is one of them and I’m teaching acupoint, practice of acupuncture, and the underlying mechanism [of acupuncture] to students there. I graduated from Kyunghee University in South Korea and licensed as Korean Medicine Doctor (KMD). I am interested in the mechanism of acupuncture, and entered the graduate school in Kyunghee University, where I was studying the underlying mechanism of acupuncture on brain diseases such as Parkinson’s disease or Alzheimer’s disease and dementia under Professor Hi-Joon Park.

And I felt my knowledge is very poor. So, I began studying at the Weill Cornell Medicine in New York, Unites States, for my postdoc training. I studied neurobiology and development at the Weill Cornell Medical College for five years, then was hired in Dongguk University. So, I started teaching acupuncture students for maybe 10 years. I teach them how to treat patients with acupuncture, moxibustion, bloodletting, electro-acupuncture, along with the mechanism of acupuncture based on the research—scientific research and also clinical research. I also opened a lab that is studying the mechanism of acupuncture and am interested in how acupuncture can affect the brain modulation and how GABAergic/dopaminergic systems are changed by acupuncture treatment in various diseases. So I’m now a researcher and teaching in Dongguk University about acupuncture training. Thank you.

Libin Jia: Thank you, Dr. Kim. Okay, our next person is Dr. Zhou from Shanghai University of Chinese Medicine, could you give us a brief introduction? Thank you.

Shuang Zhou: Hello everyone. I’m Zhou from the School of Acupuncture and Moxibustion at Shanghai University of Traditional Chinese Medicine. I’m also a graduate from this school. I’m interested in the mechanism of acupuncture manipulation techniques such as lifting and thrusting or trolling or rotating manipulations. I want to study whether these manipulations can enhance the efficiency of acupuncture treatment. I’m glad to attend this conference today. Thank you.

Libin Jia: Okay, thank you. Okay, so now Dr. Pock, could you start with one of the discussion questions?

Arnyce Pock: Be glad to, but I think we might be missing Dr. Wang.

Libin Jia: Okay. Dr. Wang, could you also give a brief introduction?

Fan Wang: So, I work in Shanghai University of TCM and I’m a teacher in acupuncture and moxibustion school. And we have about 11 teaching offices in my school. My office is just one of them. And I mainly teach acupuncture and moxibustion techniques. And I mainly teach acupuncture with a combination of online and offline models. We mainly teach the Chinese students and the international students. Okay, thank you.

Libin Jia: Thank you, Dr. Wang. Okay, Dr. Pock, please continue.

Arnyce Pock: Thank you. We certainly have a tremendous array of experience and expertise present tonight! So, our first question is this: Since students from different backgrounds and different cultures may have different learning preferences, what have you found to be the most effective teaching strategy or technique when working with acupuncture students? We’ll open this up to any of you.

Andrew Jan: In the workshops I’ve been part of, I’ve found that balancing theory and hands-on practice is essential. The hands-on aspect is important—it helps people feel the point, connect with the body energetically, and grasp how this approach differs from Western medicine.

With that in mind, I’ve become particularly interested in introducing Taoist concepts of Qi and meridians more experientially. If acupuncturists can go beyond intellectual, anatomical, and procedural learning to feel Qi in their bodies—through practices like Taoist meditation and Qi Gong—it provides a much deeper foundation. That experiential understanding can become the heart of their journey as acupuncture practitioners. That’s my perspective.

Yair Maimon: I’ll try to add. I’ve been teaching extensively to really a large array of students. To me, Chinese medicine is, first of all, a medicine. So, I believe if we teach it as a medicine, which is based on numbers starting within and then going through the five elements. If one is understanding the basic theory behind the medicine and goes step by step, then it’s very easy to grasp. So, to me, it’s systematic teaching—teaching from the basics of medicine, its foundation and then ending up in treatment and treatment strategies and diagnosis. What I found effective is really to go step by step. And I think the key is to arrive at a proper diagnosis and then apply the acupuncture and whatever is needed, according to understanding the medicine and being able to fully diagnose the patient.

Arnyce Pock: These are all excellent points, thanks. Does anyone else have any related thoughts?

Clare Foley: Here’s something that I found was missing in my education and that clients have fed back to me about acupuncturists that they’ve been to in general, in my country anyway. In the Western model where you go to an acupuncturist for an hour-long session, clients expect a certain level of empathy. And in the classical teachings in the Ling, and in the Huangdi Neijing in general, there’s a whole chapter on the shen and the foundation of the shen. And in the opening paragraphs, they say the most important thing to heal in somebody is to first address the shen. The paragraphs are difficult to interpret as it’s hard to know what people were talking about thousands of years ago, but if we’re talking about shens and connecting with a patient and their illness, it might have something to do with empathy. And it’s something that’s missing in medical education in general—that is the bio-psychosocial model of treating people, where you include in your questioning of the patient, the biographical information, asking what is going on in the person’s life, what was happening when the illness began? So not only the physical symptoms but also the state of mind of the patient.

Obviously, we look at emotions, if there’s grief, if there’s repressed anger, these things are important. But I found that that is something that is lacking in acupuncture education and it’s something that I learned through practice from clients that they’re looking for that from their acupuncturists. And I have since found in teaching acupuncturists a lot of the CPD [continuing professional development] courses that are popular, people are talking about how to, I don’t know, maybe develop a better bedside manner, so they can deal with people on the mental-emotional level as well as with their physical symptoms.

Arnyce Pock: Thanks for bringing that up, as it really speaks to the power of human connection, which transcends and affects all people and all cultures. Does anyone have any other thoughts or strategies that they found to be particularly effective? Dr. Lao?

Lixing Lao: Yes, here are some of my observations because I can understand the differences in different cultures. We in China look at medicine and acupuncture differently. In the West, we really talk about psychological emotion aspect. In China this is less emphasized, but now of course, there is increased demand [on treating psychological disorders in recent years]. And I want to share about technique part. Because I trained in China and teach in the United States, I can comment on differences because there’s some difference based on different culture in different countries. Some techniques in China were properly used but not widely used in the United States. For example, [in the United States] we often cannot use moxa in offices because it [is smoky] and smells like marijuana. Therefore, it is not possible to use [moxibustion in an office building setting]. But in China, it [use of moxibustion] is very popular, almost every clinic uses it to make treatments more effective, more special.

Just to give some more examples, in China more invasive techniques like herbal injections to the points and inserting a small knife into the deep tissue—which is in United States considered a surgical procedure—we cannot perform [here in most of states in the USA]. In China we insert needles with bared hand to an acupuncture point, but in the United States we often use guide tubes. So, something changed based on the different culture and different laws regulation (such as CNT—“clean needle technique” procedure) and different environment. But what in common is that we all use acupuncture to stimulate the body which initiates a response from brain [central nerve system]—a body chain reaction. Therefore, no matter what stimulation you give to patients, we all get good results. As you can see all the clinical studies, many trials reported very positive results. These are my observations. Thank you.

Arnyce Pock: Thanks very much! Does anyone have any other thoughts or comments?

Seung-Nam Kim: May I have a chance to say something about South Korea? Because people talk about the differences between cultures, I think South Korea is very different from other countries because the patients have some kind of consensus about the traditional Chinese medicine because they are an Eastern culture. And also the Korean medical doctor. I already told you before, Korean medical doctor has kind of different position in South Korea compared to Western medicine doctors. So patients expect the Korean medical doctor….how can I say…when patients come to the clinic, they expect to hear from the doctors about their symptoms and all about the medical knowledge from the doctors, not only the acupuncture treatment. So we have to teach students all about acupuncture treatments and the related knowledge. But it’s also important that we teach them all about the [non-acupuncture based] anatomical and medical knowledge. So, it’s pretty much complex in South Korea to teach the acupuncturist. Thank you.

Arnyce Pock: Thank you. And I think that’s a common challenge that we probably all have. Dr. Jia, in the interest of time, should we go on to our next question?

Libin Jia: Sure. So, based on your own teaching experiences and the students’ feedback, what aspect of acupuncture education do you think needs to be improved and why? Do you have any suggestions or solutions for how to create a better experience for our learners?

Lixing Lao: I can start with the training. Thank you. I’ve been training students for many years and realized that different countries and even within the same country, different programs and different medical schools train differently. For example, in Europe, the requirement for [a medical acupuncture] license in Germany only requires 120 hours training. In the United States, 200 hours [is the minimum] for a medical acupuncturist, but the non-physician requires much longer hours, 3,000 hours typically. In China, it’s even longer—they have five-year programs including Western medicine, Chinese medicine and acupuncture. So different countries, different areas have different approaches of training. But for the acupuncture alone, I’m familiar with this training in the United States. The one year of internship requires students to quantitatively deliver 250–300 treatments for patients under clinical supervision.

Our trained student is capable and confident in performing acupuncture. I was trained in China, where we have lots of patients. However, in the internship (the last year of study), we had to rotate to different departments. Therefore, we have only one or two months—or maybe three months (based on different schools and programs) of training in an acupuncture department. Then we had to move to different departments, such as the Western medicine department, or Chinese internal medicine herbal department or Chinese medicine orthopedic department. Although different countries have different training styles, in China we don’t have a quantitative requirement (e.g., required number of patients or treatments)—only the amount of time that you have to be there—five or six days a week.

In the United States, we require the number of hours you have to complete and the number of patient treatments you have to treat independently. So the strength part of the training here is the students have more acupuncture hand-on experience, but the weakness is the lack of integration with Western-based medical training. That is needed and our school has changed its name from Virginia University of Oriental Medicine to the Virginia University of Integrative Medicine (VUIM).

That is because at VUIM we want to incorporate more modern science into training, but we still lack available clinical experience [in biomedical setting]. We don’t have an affiliated hospital. This is a strength in China, as they have lots of affiliate hospitals to a university of Chinese medicine. This year, I brought my students to Shanghai at the end of September for two weeks. They learned tremendously. We have inpatient rounds and saw numerous outpatients, learning lots of knowledge [from] both the Western medicine and Eastern point of view.

I believe in the United States, [acupuncture] schools need more collaboration with Western medical hospitals for better training our acupuncture students. The students needed to obtain more knowledge in the Western medicine field. Even though we do not train our students to be Western medicine physicians, or to prescribe Western medicine or perform Western medicine diagnosis, we need students to understand Western medicine and be able to communicate with other health care providers so we can more efficiently integrate both Western medicine and Eastern medicine into patient care. This is my observation and opinion.

Libin Jia: Great. Thank you, Dr. Lao for your comments. You touched on the point of reducing acupuncture risks and noted that not only do they need to train in the field of acupuncture but they also need to learn at least some basic knowledge of conventional Western medicine for the integration. Thank you. Any other comments? Okay. Dr. Maimon.

Yair Maimon: There is a saying that states about the difference between Western and Chinese medicine. That is, that Western medicine is hard to learn but easy to practice, while Chinese medicine is relatively easy to learn but hard to practice. I think it captures a lot. In acupuncture you can achieve high, medium, or low levels, and it seems very easy to learn how to put needles in some points and get results. But I think it all depends on the level of acupuncture that we are expecting. If we expect a high level of skill, then the weakness usually relates to the amounts of hours that people are spending in studding the theory, understanding the depth of Chinese medicine. As I said before, being able to arrive at a precise, deep Chinese medical diagnosis before they choose the points. And as a professor which I met said, I think there is a big lack in practice and in guided practice. Usually there is little time spent in supervised practice especially in the West, there are no good facilities as there are in Western medicine, where you can spend a year or more as an [acupuncture] intern.

In Chinese medicine you’re expected to jump to practice or study, as much as, you can and then pretty much go immediately to practice. I think this is one of biggest weaknesses of acupuncture, the lack of good facilities or good training places that will do a good internship for people who study. Another important area is the amount of time and the seriousness that people devote to studying this profession. They expect to be studying a technique, but it is [more than that] it’s a [type of] medicine which requires the same depth of knowledge and study as Western medicine in order to achieve a high level. So, it all depends. We need to treat holistically, not just symptomatically, but that requires quite a lot of training.

Clare Foley: Good points. I would absolutely agree with both of those. And on top of just the lack of clinical training in the West compared to China a major problem is that a lot of graduating acupuncturists really don’t have good needling practice.

But even if they didn’t have a huge amount of medical knowledge, if they could have an ability to communicate how it works—or just a module on communication about mechanisms, that would also be a good step forward.

Libin Jia: Thank you, Dr. Foley. Okay, Dr. Jan.

Andrew Jan: I am involved in educating medical acupuncturists, and I believe three key aspects need to be addressed.

First, understanding how it works and when is especially important for medical acupuncturists. However, more important than how is when it works. Can I justify using acupuncture in a particular situation, or should Western medicine take precedence? Knowing when acupuncture should come first, second line or as an adjunct is critical to the decision-making process.

The second aspect is acquiring the best technique. What is the best approach to achieve the most effective results? Achieving good results requires extensive needling practice and learning from different mentors to explore various techniques.

Thirdly, I feel that acupuncture is an internal art at its core. It’s just as much about the practitioner’s growth—their mind, hands, and Shen—as it is about the patient. The deeper your understanding of Shen, the more you connect with your inner self, and the more you can grow as a practitioner and become a better healer. Shen is a challenging concept to teach, but I’m passionate about promoting it.

Shuang Zhou: I talked before, but I want to share that for the practical skills training our school uses the direct observation of procedural skills in our daily acupuncture skills training. And the assessment process contains three stages: preparation, operation, and feedback. In the preparation stage, our teachers explain the acupuncture procedures and key points to students to ensure they understand the details, preparing them for practical operations. And during the operation stage, teachers observe the student’s operations and scores them based on their job skill, recording their strengths and weaknesses. And the teacher’s observation will be detailed and comprehensive to ensure fair and just scoring. And in the feedback stage, our teachers provide their insights and suggestions on the students’ performance after they complete their operations, guiding them for further practice.

Our DO [direct observation] scales cover the entire process of acupuncture operations, including disinfection of the point, localization, needle insertion, and the needle manipulation and needle withdrawal. Through incorporating these thoughts in our daily training for acupuncture, we are teaching our students to gain a deeper understanding of the requirements and the key points of these manipulations and allowing them more standardized practice. And the immediate feedback from teachers enables them to promptly identify their efficiencies and then make targeted improvement resulting in more refined and fluid procedure skills.

Libin Jia: Okay, thank you for your comments. Okay. Maybe we should move on.

Lixing Lao: Can I have a question? I’m wondering if these three steps involve practice on a patient, on a human, or on an acupuncture model? And where do the daily practices occur (in a clinical setting or in classroom)?

Shuang Zhou: In the first, when they first studied the acupuncture, they were practiced on other students. They practice on each other. Yes. And when they are familiar with the manipulations, they can practice on the patients.

Libin Jia: Thank you for the question.

Yair Maimon: I’ll add one weakness, which is obvious, but it should be stated: there is a lack of training for teachers. It’s more a grassroots movement. People start as practitioners and then develop slowly into being a teacher. But I think there is a lack of structure of how somebody become a teacher of acupuncture and Chinese medicine.

Libin Jia: Sure. Thank you all for the comments. Okay, I think we may need to move on to another question.

Arnyce Pock: Since the COVID-19 pandemic forced many of us to convert from in-person teaching to online teaching, are there any techniques or strategies that any of you have found to be particularly helpful? Dr. Maimon, I believe you’ve had a lot of experience in this area. I wonder if you could start us off?

Yair Maimon: I mean, I’ll tell you one of the secrets. I used to teach face to face, presenting, say, X amount of material in an hour, but online you can actually teach much more. And so, the bottom line is that there is a need for much more preparation on the teacher’s side to keep people’s attention. Teaching online is an art and it’s not an easy art. So I think it needs a lot of preparation and paying extra attention to details, and explaining in diagrams using different techniques such as small movies, et cetera. It requires a lot of extra work on the teacher’s side. When you’re in front of a class, it’s much easier, but it takes longer actually.

Arnyce Pock: Great, thank you. Anyone else with any experience or thoughts about teaching acupuncture online or in the virtual space? Dr. Lao, please go ahead.

Lixing Lao: Yes, actually during the pandemic, we were one of the schools that were quite successful by opening online teaching. We survived the pandemic, while most schools [experienced] a financial crisis because the students’ volume decreased.

What we did, for the most challenging part, the clinical sessions (because we cannot see the patient during the pandemic period)—we efficiently used time online for teaching students’ patient intake skills. So, the student learnt dramatically how to intake and analyze the patients’ case.

In contrast with a real clinic—where students are very busy giving treatments and learning needle techniques, there is little time to have a deep discussion with the patient. Online we have lots of time and what we usually do is have the teacher play [the role of] the patient, so there will be intake from the teacher. Our students then participated in discussion and a Q&A session. Finally, they would write a medical chart and submit it to the teacher for feedback. We realized that it was very helpful for our students to learn how to do a good intake. When the pandemic was over, we were able to open the clinic and students very quickly showed their capability of understanding and analyzing the case, deciding the principle of treatment, and the treatment protocol. I think we were quite successful.

Arnyce Pock: Excellent. Thanks for sharing that. Dr. Jan?

Andrew Jan: With COVID and everything, I think it made teaching a bit better in some ways. It allowed us to handle the theory side of things differently—usually, you’d just go over that in a lecture room, but suddenly, we could pre-record or put them online. It freed up a lot of time and made it easier for students to engage with the material at their own pace. Of course, the hands-on parts had to happen separately, but overall, the process became more efficient. Students didn’t have to attend university as much, and honestly, I think it was a bit of a blessing. It tidied the way we taught.

Fan Wang: To share some experience in my teaching because I teach acupuncture and moxibustion techniques, and in our course, we need the students to do a lot of practice, but the time of the online course and the format of the online course is not enough. So, we let students practice after their class and we let the students use online software on their mobile phones. And when they practice, we let the student put some videos and pictures of their practice sessions on the software so that our teacher can see their practice and can give them some feedback. So I think this is a good way to improve—to do more practice and they can get feedback from the teachers. So this is my experience on this. Thank you.

Arnyce Pock: And how did your students respond to that? Did the students like that approach?

Fan Wang: Some students don’t want to do many practices, but while most of the students liked this way, some students didn’t, but this is homework and part of the assessment and we have to give them a grade on this. So, they have to do this. But most students like this way because they can get the feedback from the teachers.

Arnyce Pock: That’s fantastic. Thank you! Dr. Lao, did you have some thoughts as well?

Lixing Lao: Yeah. This is an issue in our school, we discussed extensively, but this issue—it’s a very good idea to ask a student to film them, and some teachers use this technique, but it brings up another concern. State laws require that any unlicensed students must be under supervision in order to put needles in other people’s bodies, so they cannot do it by themselves. That’s the issue raised. So, we had to stop this type of practice. Unfortunately, this was the case because the school didn’t want to be responsible if someone injured another person or something happened—then who would take responsibility? So, it’s a good idea to be very cautious. It’s unfortunate that we cannot do this.

Arnyce Pock: Definitely an important point. Thanks. We have just a few minutes left before the top of the hour and I think we had one last question, so Libin, would you like to pose that to our panelists?

Libin Jia: Sure. This is the last question for you. In just one or two sentences, what are your thoughts or ideas regarding the future of acupuncture education?

Lixing Lao: I can start. I think acupuncture schools in the United States provide sufficient clinical training for their students. The students are confident and independent, But we lack Western medical training. I really hope in the future we can have more collaboration with doctors in conventional Western medical schools and increase the availability of clinical training in hospitals. That’s the good way to help to improve acupuncture integration into mainstream medicine in the United States.

Libin Jia: Great. Thank you, Dr. Lao. Can anyone else provide a quick summary for the future of acupuncture education. Okay, Dr. Maimon.

Yair Maimon: I want to bring a different point of view, maybe painful point of view. I think the future relies very much on international collaboration and the ability to create international database and to standardize in a good way. But, we have to be aware to keep and respect the diversity of training in Chinese medicine worldwide. So to me, the future very much depends on international collaboration, standardization as far as diagnosis—like using ICD-11 [International Classification of Disease codes] for example, where we have standardized codes for diagnosis. So, I think international collaboration is one of the key factors for me, for the good future of not just acupuncture, but of medicine overall.

Libin Jia: Thank you. As for a database, is it for people to record their own practice experience, or can people share by searching a database?

Yair Maimon: The database would be a place where people can actually share their clinical practice, record their clinical efficacy and obviously if there are concerns or safety issues they will note them as well. The database would be shared and available worldwide. There’s millions of acupuncture sessions being performed every day. With the proper education and proper ability to capture and maintain an international database, we will know where acupuncture is more effective, where it’s less effective, and when a specific condition might need a certain kind of approach. Artificial Intelligence (AI) standardization of an international database probably will be the future of the profession. If this happens, then it has the potential to make acupuncture go beyond the border of being esoteric and becoming fully integrated into general practice.

Libin Jia: That’s a good point. Thank you for the suggestive idea. Anyone else have thoughts for the future of acupuncture education? Dr. Foley?

Clare Foley: I’d like to see the language of the ancient Chinese science be better translated into the Western science. I see them as more the same than they’re different, but that there’s been a lot of poor translation in the past from people who were translating from the Chinese into English, but they didn’t have medical knowledge and they didn’t realize that they were reading scientific texts.

So yeah, words like Qi have been translated as “life force,” but it actually has a much bigger meaning than that. It’s more to do with forces like natural forces, which is compatible with science, those kinds of terms. I’d also like to see the acupuncture channels recognized as physiological, so that we’re not teaching two different systems—we’re talking about the same physiological systems.

Libin Jia: Very good points. Thank you, Dr. Foley. Dr. Jan, would you like to add something?

Andrew Jan: Simulation training plays a significant role in other areas of medicine—with mannequins and similar tools. I think acupuncture education could be gained from different areas of medical teaching. Another essential point Dr. Maimon mentioned is figuring out where acupuncture fits the range of therapies available for various conditions. I believe AI could play a significant role in helping us navigate and refine these decisions in the future.

Finally—and this is something I’ve brought up prior, but I’m always struck by how many Western acupuncturists, as well as practitioners of TCM, have little to no personal connection with Qi in their bodies. They don’t meditate, and they don’t practice Qigong. I feel this should be a foundational part of acupuncture education moving forward. Practitioners need to embody this work to understand and truly advance in acupuncture.

Libin Jia: Great. Thank you for your comments, Dr. Jan.

Seung-Nam Kim: Thank you for the comments and for communication with other professionals about the acupuncture. I think the anatomical basis of acupuncture points is pretty important because sometimes students are wondering where we put the acupuncture needles, and what structures are under the points, or what is the target of the acupuncture treatment.

So, to answer those questions, we have to know what and/or how acupuncture stimulates the muscles or nerves or blood vessels under the acupoint. So I usually bring my mobile ultrasound device to show the structures under the points and teach so students can see these structures, and how they may be related to the acupuncture effect, connecting them with the research of basic science. I think the anatomical structures are also very important to teaching the acupuncture training or mechanisms. Thank you.

Libin Jia: Great. Thank you so much Dr. Kim and all other commentators. Now let’s give Dr. Pock a chance to summarize our discussions.

Arnyce Pock: Thank you, but Dr. Zhou, did you have a thought before we conclude? Please go ahead.

Shuang Zhou: Yes. I think technological advances integrating professional techniques such as artificial intelligence and the medical engineering, will help us improve the quality of acupuncture skills, teaching and clinical practice. For example, we are trying to use a motion video analysis model to analyze the videos of practitioners’ acupuncture manipulations recorded during their daily training. And by tracking the movement pattern of the needle body parameters such as amplitude will be collected. And comparing these data with those from the senior experts will allow for objective calculations of differences and providing quantitative measures of manipulation qualities. That’s our training. Thank you.

Arnyce Pock: Thank you for sharing that; it’s definitely a look into the future, and the future is now! Well, we want to be respectful of everyone’s time as we realize that for some of you it really is the middle of the night. But we really wanted to thank everyone for joining us from each of your different countries and different time zones, and most importantly, for helping us build a foundation for that truly international collaboration that Dr. Maimon mentioned, as this conversation is a great springboard for that!

We also wanted to extend a special thank you to the journal of Medical Acupuncture for sponsoring this event and to Dr. Richard Niemtzow, whose vision led to the development of this special edition on Acupuncture Education that will include a transcript of tonight’s discussion.

So again, thank you all for joining us. We really appreciate the discussion and hope we have a chance to meet again, in person, if not virtually, in the near future! Thanks once again.

Libin Jia: Yes, thank you all so much for your participation on this roundtable discussion.