Bloom’s Taxonomy, Acu-Schools, and POCA

As many of you know, we’re in the process of getting POCA Tech licensed to operate as a “private career school” by the Oregon Department of Education. It’s a lengthy, 8-step process, and we’re currently working on Step 2. Well, to be perfectly accurate, Robert Hayden is working on Step 2. (Without Robert’s heroic volunteer service to POCA, POCA Tech *might* open sometime around 2020 — no promises.) Some of us are trying to help him. Step 2 is the hardest piece of the application, because it requires us to map the entire program and then describe the curriculum in detail. In the process of doing this, we came across a set of principles called Bloom’s Taxonomy.

The Oregon Department of Education (let’s call them OR/DOE to save space) is enamored of Bloom’s Taxonomy. Here’s a description that they helpfully provided to us in a handout:
“Benjamin Bloom was an academic in the field of education who came up with this taxonomy as a tool for instructional design. It describes different domains of learning, and within each domain, different levels that describe the process by which learning takes place. There are three domains within the taxonomy: Cognitive, Psychomotor, and Affective. Within the cognitive domain, there are six levels: know, comprehend, apply, analyze, synthesize, and evaluate.”

The OR/DOE created a visual graphic of these six levels. (I’ll upload the whole handout into the POCA Tech forum; it’s pretty cool. Edited: In Step 2 of the licensing application, they want us to describe how we are going to impart competencies to our students. Their handout emphasizes, “Competencies are about DOING, not simply knowing — no competencies below level 3!” Here’s where it gets interesting, because I’m pretty sure that my acupuncture education, and the educations of most students I know, took place ENTIRELY below level 3.

Level 1, Know, means “you tell me the information and I can tell it back to you. I can recognize basic terminology.” Level 2, Comprehend, means that I can do all that  AND explain it — how something works and why. Level 3, Apply, means “I can tell information back to you, explain it, give you examples, and DO something with the information. I can apply what I know and test it out in specific situations. I can bring theory into my own practice.” Emphasis mine. It gets progressively more interesting and complex after that — by Level 4, Analyze, I can apply theory to my practice, explain what happened, and why I did or didn’t get the result I thought I would get; I can take theory apart and put it back together in the context of real life.

You other people who have succumbed to the scourge of Facebook as I have (thanks, Ellen Vincent) might have noticed that I was involved in a long weird conversation on the page Acupuncturists on Facebook. (Thanks, David Lesseps.) From my perspective, it was mostly about me protesting that acupuncturists really can’t prove anything about which Chinese medicine theories work in real life with real patients, and why, and Other Acupuncturists ( apparently that’s what they want us to call them) admonishing me that I didn’t have sufficient reverence for the classics. Nobody changed anybody’s else’s mind, as far as I can tell, but I think there are some benefits to having those kinds of conversations in public. Back when I was a new acupuncturist, I would have been really happy to come across a conversation in which somebody told me that I didn’t need to read the Ling Shu in Chinese in order to be helpful to someone in pain. Anyway, the closest we got to agreement was when one of the Other Acupuncturists acknowledged that a lot of English texts about acupuncture theory are really pretty bad, but a bunch of people are now devoting their lives to translating and understanding the classics and so in 20 years, we will know a lot more about what clinical relevance the classics have.

In the meantime, the bulk of conversations that Other Acupuncturists have about the classics seem to me to be at Level 2 of the Bloom Taxonomy. They can say back, via translation, what they think the classics are telling us, and even explain them.  But when it comes to what we can actually DO with that information in the context of treating real people with real health problems and real limitations of time and money, we’re out of luck — for at least the next 20 years? They can venerate the classics and they can explain them ad nauseam, but when it comes to how the vast majority of ordinary practitioners are going to apply them — apparently, nobody’s even thought about that until recently.  Competencies are about DOING, not simply knowing — dear OR/DOE, could you send that memo to the rest of the acupuncture profession, please?

What’s really interesting about all this is the bigger picture of our process with OR/DOE. We made a philosophical choice that POCA Tech would not grant a Master’s degree, but only a Master’s level certificate. If we had chosen to grant a Master’s degree, we would have had to go through the Office of Degree-Granting Institutions at OR/DOE — and admittedly, I don’t know anything about what that process is like. Because we chose to identify ourselves as a lowly technical school, we ended up with the Office of Private Career Schools, which means that  1) we’re lumped in with the tattoo schools and the welding schools, and 2) the standards that we have to follow, so far, show every indication of being significantly more rigorous — in a GOOD way — than ACAOM’s. For Step 1, we had to prove that we were training students for jobs that actually exist. Now in Step 2, we have to show that we are focused on developing genuine competencies; we can’t get away with rote memorization and multiple-choice quizzes. Maybe the degree-granting acupuncture institutions have to meet these standards too, but I really wonder how they do it. My own Master’s degree would never have stood up to the scrutiny of the Office of Private Career Schools.

For many of us, who never got above levels 1 and 2 of Bloom’s Taxonomy in our acupuncture education, it’s POCA itself that has made it possible for us to begin to apply, analyze, synthesize, and evaluate. We’re helping each other, by means of our coop, to become genuinely competent as acupuncturists in the real world. I really thought that getting licensed by the OR/DOE was just another hoop on our way to training punks, kind of like acupuncture school is often just another hoop on the way to a license — but it turns out it’s a reaffirmation of our radical intentions, and our radical differences from the rest of the profession.

One of the things that a lot of us have come to love about POCA and community acupuncture is that, because we don’t have a lot of money to pay for services, we end up teaching ourselves — and then each other — how to do things. Sometimes it can get frustrating; our progress is slow because everybody’s learning how to do everything for the first time. But overall, it’s thrilling to become competent at things you never thought you’d be competent at, especially when you did it by trial and error. There’s a quote by Dave Grohl that’s making the rounds of the Internet that made me think of POCA and POCA Tech and all of us:

“When I think about kids watching a TV show like American Idol or The Voice, then they think, ‘Oh, OK, that’s how you become a musician, you stand in line for eight f*cking hours with 800 people at a convention center and… then you sing your heart out for someone and then they tell you it’s not f*ckin’ good enough.’ Can you imagine?” he implores. “It’s destroying the next generation of musicians! …Musicians should go to a yard sale and buy and old f*cking drum set and get in their garage and just suck. And get their friends to come in and they’ll suck, too. And then they’ll f*cking start playing and they’ll have the best time they’ve ever had in their lives and then all of a sudden they’ll become Nirvana. Because that’s exactly what happened with Nirvana. Just a bunch of guys that had some sh*tty old instruments and they got together and started playing some noisy-ass sh*t, and they became the biggest band in the world. That can happen again! You don’t need a f*cking computer or the internet or The Voice or American Idol.”

We might suck some of the time, or a lot of the time, but we’re DOING it.

Author: lisafer

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  1. Lisa – Learning is good. You are learning about the “science” of education. Competencies, standards and Blooms Taxonomy are some of the building blocks of how to educate and teach. While there are “faculty” in every acu “school” there are very very VERY few educators. I am referring to people trained in how to set up and operate any training program. I try not to refer to acu training programs as “schools” because they are not schools. Most are some kind of marionette show. This is not a surprise to you or other POCA peeps.

    Shortly you will run up against standards. When I am teaching about the diff between competencies and standards I use a baking metaphor. Competencies are the ingredients. Standards are the measuring tools. They work together but are not the same. When I recently reviewed a set of AOM competencies and standards the two ran together as though they were the same. This is a clear signal that the “educators” who prepared the document did not understand the difference. In theory competencies should be determined by the workers who perform them, as in the workers should know best what it means to be a [fill in job title]. Accreditation bodies handle the measurement task of determining whether the students and the licensees know what they are doing. The acu profession has bodies that “act like” this but have really not known what they are doing. I am working with AAAOM right now to try and get this right.

    There are 30 years of history wherein licensees have been “acting like” (i) healthcare professionals, (ii) “doctors”, (iii) “educators”, etc.; as though acting like was the same as being.

    Blooms levels 5 and 6 are synthesis and evaluation. This is where the research comes in. Most LAcs need not be involved with these two levels. However, each profession should be and these domains should be driven by the educator segment of that profession.

    Acupuncture is a vocation, not a profession so you are working with the appropriate gov unit. Vocational programs are not the same as institutions of higher ed. The pretense that AOM training programs – college of this and university of that – practice is laughable. IMO many of the workforce problems LAcs face is a direct function of the preening and primping in place of bothering to learn.

    I know POCA will stay with the learning. I have high hopes for POCA. Instincts are good. IMO 1200 hours is plenty of time to learn how to needle. Reading a Chinese folk text is for those people who were once known in music culture as poseurs, wannabes. Acupuncture and working in healthcare is for folks who want to earn a living wage helping others get better. Acupuncture is a kind of medicine. Richard Dawkins wrote/said “there is no alternative medicine. There is only medicine that works and medicine that doesn’t work.”

  2. Hey Steven —

    thanks for your comment. As always I appreciate your perspective. In working to put together POCA Tech, I’m having my mind blown all over again about the state of the acu-profession. Back in the day of the FPD fights, I would look at the ACAOM standards and just fume; I was so mad that they seemed to be so unconnected to the actual work of being a punk. Now I feel confident that we can work with the standards to get POCA Tech accredited, but I’m starting to understand that it was the competencies issue I was really mad about all along. How can the workers determine the competencies if so few people are really working? And if the institutions of the profession know so little about what the work is like that they don’t bother to distinguish between gross and net income?

    I’m feeling really proud of what POCA’s accomplished these days; I think it’s really important that we have put our energy towards making 1) a cooperative, and 2) a technical school — so that we can focus on what’s real, which is the work and the economic connection between acupuncturists and patients.

    Can you say more about what you are doing with AAAOM to fix things? It seems like none of this can really be fixed without a laser focus on jobs and job creation, and unfortunately, as far as I can tell, we are the only ones who are doing that currently.

  3. Lisa – Some recent revelations have confirmed for me what I started doing in 2011 which was to work with AAAOM as well as with POCA and NGAOM. Here is my big aha. If one counted up all the LAcs represented by all these groups including the Council of State Assns and the Chinese and Korean groups the total LAcs lumpoed together is approx 3,000. With ~25,000 LAcs that means about 12% of all LAcs are “organized.” The #1 issue is jobs or earning a living wage by working in your chosen vocation which has finally become a national concern.

    POCA has known this for a longtime. The Guild (NGAOM) is focused on this. AAAOM (under Jabbour’s leadership) is focused on this. The schools are not so focused on this. They are interested in surviving. I have two main objectives: (1) reform education and (2) conform the profession.

    Reform education means stopping the predatory practices that include tuition mills and visa portals. Conforming education means including training in mainstream clinics alongside other healthcare workers such as RNs, PAs, MAs, PTs, MDs, etc. These goals are shared by NGAOM and AAAOM.

    AAAOM is currently embroiled in a disagreement with ACAOM to adopt the FPD without mandating clinical training in mainstream sites. ACAOM used the term “recommend” when we wanted “required.” This is my version and not necessarily how AAAOM would express the view.

    The Guild is working to create referrals through other unions for Guild members. This includes a stronger base of competency in medicine. Sounds fancy but it really is not. All it means is being able to cross-refer and communicate competently. I oppose isolation which has led to the workforce dead end we are all trying to get out of. The Guild and POCA do not see eye to eye on fees. I say there is room for both. It is just a matter of working out the strata.

    Acupuncture remains caught in a struggle between the schools of which there are far too many and the pro orgs that hardly work together and represent so few. The schools do not want things to change. The pro orgs are more united than in the past to move towards a model that supports entry training as needlers with full blown TCM as an option and not a mandate. There is strong support across the pro orgs to work more closely with mainstream medicine but this remains somewhat twisted. The recent ACCAHC Primary Care tome is a case in point. Two other points of focus are inclusion of LAcs in Essential Health Benefits and Medicare bot of which are confusing for most LAcs. I also am working on eliminating foreign language versions of the licensing exams. This is a safety issue that is also tied to the school problems.

    The biggest challenge is communication among the pro orgs. POCA is a pro org but remains out of the loop. That will end once you apply for your ACAOM cert. Still on board with that?

    What is a Masters certification? That is interesting.

  4. In reverse order, combining a couple of things:

    The goal of POCA Tech is to train punks to work in POCA clinics. For punks to work in POCA clinics, they have to have a license in most states. To have a license in most states, they have to either graduate from an ACAOM-accredited school and/or sit for the NCCAOM. We are pursuing other routes, but currently the main route to sit for the NCCAOM is to graduate from an ACAOM-accredited school. This is why POCA Tech absolutely must get ACAOM accreditation.

    During the FPD battle, one very important thing that I learned was that ACAOM does not mandate a degree (not a doctorate, and not a master’s either). ACAOM accredits Master’s level programs, which means that the school itself gets to decide whether it wants to offer a Master’s degree, or a Master’s level certificate/diploma. Because we are a technical school, we are choosing not to try to grant Master’s degrees, and just grant a certificate.

    On the topic of mainstream medicine, did you read this thread: I remain skeptical that there is any broad-based funding for acupuncture in mainstream medicine. Having a close-up view of the healthcare reform efforts here in Oregon makes me even more skeptical.

  5. Lisa – Thanks for the reminder on the ACAOM “loophole” for Master certificate. This is validation for the reality of how the acu profession began…and where it remains despite the FPD and DAOM hoopla. Nothing wrong with that. My fixation with mainstream medicine is not about reimbursement. It is about patient safety and pro isolation. One is a good idea the other is not. POCA clinics provide a low cost choice for folks without insurance. Plenty of people in that spot. The POCA goal may be to train LAcs to work in POCA clinics but the issue remains competencies. Putting needles in bodies is not an economic matter. Getting payed is. Anatomy and phys have been subjects glossed over in training programs in favor of Chinese texts that build an image of competency. I recall the discussion with the low cost clinics. I wish POCA students could train there. I evaluated an FQHC that ran a chronic pain clinic staffed by LAcs and DCs. Good outcomes. Bad triage. Anyone with almost any license can learn to do that. Are we disagreeing on something? There is ZERO public $$ for acu in mainstream medicine right now. However, healthcare reform will insure a lot more folks will come to POCA clinics and ask if they can get treatment under their new coverage.

  6. What an important, high-level discussion!! Thank you Lisa and Steve!

    Lisa– You’re “right” to feel proud of creating POCA Tech as an extension of the POCA cooperative. I continue to be deeply impressed by your vision, intentions AND deeds. POCA rocks!

    And Steven’s focus on education reform and his commitment to shining a light on and improving workforce issues represent huge contributions.

    “Acupuncture is a vocation, not a profession…” Something tells me there might be some blow-back on THAT statement, but not from “punks”!!

    I share Steve’s perspective about integration with mainstream medicine: “Putting needles in bodies is not an economic matter. Getting payed is.” Indeed!

    “Acupuncture and working in healthcare is for folks who want to earn a living wage helping others get better. Acupuncture is a kind of medicine. Richard Dawkins wrote/said “there is no alternative medicine. There is only medicine that works and medicine that doesn’t work.”

    Steve, I’m pretty sure you’ve got all this right!!