Model implementing Medical Acupuncture Education at the Continuing Education Courses in McMaster University

Talk by Dr. A. Fargas-Babjak Dr. A. Elorriaga-Claraco The McMaster University Health Sciences Continuing Education Department

I would like to share with you experiences gained in the last few years, as well as our Model implementing in Medical Acupuncture Education at the Continuing Education Courses in McMaster University.

As there is increased demand for acupuncture and other complementary therapies in Canada and world-wide, there is a need to expand the availability of education in Acupuncture and other complementary therapies. The educational institutions, such as Universities and Colleges, have an obligation to establish appropriate specific gold standards for structure and resources to such a program, open and implement good education in these areas.

Before we go any further, I just would like you to understand that historically Canada was one of the few western countries where education in medical acupuncture was offered in very systematic and unique way by educated teachers, members of the Acupuncture Foundation of Canada, and later the Acupuncture Foundation of Canada Institute. During the last 27 years, people like Dr. Joe Wong, Dr. Linda Rapson, Dr. Steven Aung, and others, kept leadership in this area.

Until recently, only a few universities offered acupuncture as an elective or an occasional lecture for M.D. students of physiotherapy. As for example, the University of Toronto had Professor Bruce Pomeranz, or the University of Western Ontario in London had Dr. Wolfgang Sporel, a Professor in Anesthesiology, and over the last 10 years Dr. Steven Aung at the University of Alberta, here in Edmonton, offer acupuncture courses through University extension. Based on those premises, McMaster University medical acupuncture group developed courses in integration of acupuncture in pain management.

We all agree that acupuncture is an effective and gentle therapy. The World Health Organization (WHO) and the international scientific community have endorsed acupuncture as a legitimate form of therapy. They established guidelines for specific standards for the training and priority for teaching and safety of acupuncture. In 1999, the WHO published a document where they recommend a minimum of 200 hours of theory and practice for qualified physicians (and certain other graduates) who wish to become competent in acupuncture as a form of therapy in modern western clinical practice. They advised that such a course should have specific recommendations about technique and safety.

Despite these recommendations, integration of acupuncture teaching into our modern medical system continues to be a challenge. The lack of a well defined curriculum internationally accepted and the need to integrate information from contemporary biomedical science with clinical information from classical sources make the teaching of acupuncture challenging. Acupuncture educators need to provide an intellectual framework respectful of western biomedical sciences and at the same time preserving the effective practical clinical aspects of the tradition. This task was undertaken in Medical Acupuncture at McMaster.

Once the decision was made to start these courses, after negotiations with University representatives, and support of the UCLA Program, specifically Dr. Joseph Helms, whose book on Bioenergetic Medical Acupuncture is used as a basic textbook which students have to study. We launched out first workshops in September 1998.

The main goal of our education is to avoid paradigm approach. We are trying to use integration and avoid students to function in one or other paradigm, Western, Eastern, or Traditional Chinese paradigm. The approach is a problem-solving approach to the design of effective acupuncture and electro-acupuncture inputs for the treatment of musculoskeletal pain and common functional disturbances. This approach is based on the integration of information from precise musculoskeletal examination, current information from physiology and pathology, basic and clinical research, and anecdotal clinical reports from miscellaneous written sources. These inputs consist of a combination of classical and contemporary techniques involving the use of acupuncture needles and electrostimulators.

The course is eclectic, systematic, and practical acupuncture approach, which is easy to integrate with other contemporary diagnostic and treatment approaches. Integration is achieved through the use of a systematic standardized clinical approach which allows the clinician to define and select specific therapeutic goals for the treatment. Outcome measures are always established using the integrated musculoskeletal examination approach, or defined in terms of functionality or quality of life. This gives us the tools to assess the effect of the treatment in a clinically meaningful manner.

The teaching of the acupuncture points is done in a uniquely pedagogic fashion, including lecture-workshop format, drawings of the surface anatomy of the underlying muscular and neurovascular structures, and utilization of anatomy laboratory where real anatomical specimens and other audiovisual aids are used, with task oriented workshops in which students integrate all this information with integrated examination technique and they then generate effective acupuncture input.

Workshops provide a learning environment for the practice of needling skills necessary to implement the treatment safely and effectively. This multidimensional approach is used from the first day of the course and repeatedly applied to the study of treatment for common musculoskeletal pain and functional problems and students are allowed to advance rapidly in the learning process.

Our mandate and goal is to support active and self-directed learning and disseminate the information among the health care providers in order to improve the health care of the 20th Century.

The system of testing is built in during the beginning of each Unit, to allow us to evaluate each individual regarding their progress. Participants receive material for homework, which is evaluated and marked, and they have to generate questions for the upcoming workshops. This intense study has allowed participants to explore integration of acupuncture into their specific practice in a very effective way.

During the beginning of each workshop, we collectively define learning objectives which initially are outlines, suggested by us, but altered along the way to accommodate all participants needs. The lecture/workshop ratio is 1:2. In class, interaction is very open since we have interdisciplinary groups consisting of physios, medical doctors, chiropractors, and osteopaths.

Many times people ask the question: “How much basic science anatomy physiology I need in order to help another person?” We are trying to expand the knowledge of all participants and allow them to open and expand the dimensions. We are encouraging them to refine their kinesthetic intelligence to learn how to palpate, how to feel tissues and detect dysfunction, flow restriction, muscle tightness, etc. We are also helping them to perfect their knowledge of anatomy physiology with help from each other, as they are competent health care providers. Many times we witness that the chiropractor helps the physician and vise-a-versa, or the physiotherapists helps to understand the chiropractors certain examination, etc. Small groups allow this interaction where we are learning from each other. We are trying to increase the awareness that we are biologically unique. Every patient has biological individuality. We need to respect cultural backgrounds of the patients and non-compartmentalize. We need to look always at the individual as dynamic, non-static individual. Acupuncture is all about wholeness and information.

Just to give you a few testimonials which we received from our students:
“This is the best workshop … We had a lot of hands on …. Excellent program …. I would return for further training ….. We were treated as intelligent people who are capable of self-directed learning ….. Best feature – Workshops ….. Anatomy sessions ….. This whole course was wonderful ….. Being a Doctor is all about healing somebody and this course was an eye-opener in that respect…. Course taught to crawl, walk and flight, in a period of five units – highly recommended …. Enjoy additional tool to treat in practice ….. Patients are considered and treated as a whole person.”

Feedback from participants is extremely encouraging and comments which you just heard are just an example of the participants satisfaction. Constructive criticism appears periodically which has only helped us to better the program along the way.

Peter Drucker, a futurist, stated: “In health care a conceptual shift is likely to lead from health care being defined as a fight against disease, to being defined as a maintenance of function and healthy life”. And that would mean that acupuncture, as a gentle specific sensory stimulation technique which modulates internal responses has a great future!

Since life wouldn’t be interesting without challenges and current environment continues to challenge yesterday’s decisions, a process of changing, adding, subtracting, continue in order to help all of us teachers and students to gain more understanding of ourselves and the world around us.

In conclusion, there is this great need for dissemination of knowledge and integration of gentle ecologically sound approaches as acupuncture is into our health care. Society needs our help and we have an obligation to respond, and I hope that the education at McMaster fulfills the needs of society.