Position Paper Responses Part 2

Without going into lots of detail about the emails we’ve gotten, let’s talk about competencies. Our position paper originally included a request for ACAOM to review and revise their competencies as outlined in their Program Standards. The thing is, though…they already had. We just didn’t know it.

If you’re a POCA member (and come on, why are you not a POCA member? we’re so fun!) here’s the discussion about that on the forums.

If you’re not a POCA member and don’t want to be (can’t imagine why!) you can find the new ACAOM master’s competencies mixed in with the FPD competencies in this document: https://acaom.org/wp-content/uploads/2016/10/fpd_standards_acaom2013-web.pdf
See Appendix A.

The master’s competencies are also listed at the end of this post. (You’re welcome.)

Comments on the new ACAOM master’s standards, in no particular order.

1) Hallelujah.

Seriously, there is a LOT to like here. I don’t love every single word and phrase in these competencies, but once you run them through a filter of trauma-informed care and social medicine, there’s nothing POCA can’t live with and they’re really pretty fantastic compared to what they replaced.

2) Note that “AOM” does not equal TCM. We’re no longer being required to teach TCM.

As lots of TCM acupuncturists like to say, TCM is “so much more than acupuncture”. OK, sure. And acupuncture is so much more than TCM. TCM dates to 1958, and there is SO MUCH acupuncture not encompassed by TCM happening before that, after that, and outside of its boundaries. I know lots of people don’t think much of acupuncture if you take out all the herbalized theories, the lifestyle counseling, and the adjunct modalities, but the thing is, there are also plenty of us, acupuncturists and patients, who are really excited about acupuncture all by itself. We’re excited about Master Tung and Dr. Tan and auricular and Korean 4-needle and…the list of interesting and clinically useful ways to practice plain old acupuncture goes on and on and on.

The neat thing about the new ACAOM competencies from our perspective is that they recognize how many different skills go into being an acupuncturist — like critical thinking, professional judgement, cultural sensitivity, collaborating with patients to figure out treatment plans, choosing different treatment strategies, etc. All the things that POCA punks do without even realizing they’re doing them.  Acupuncture isn’t rocket science but that doesn’t mean it’s easy or simple to be a good clinician. POCA punks know that and we’ve learned it all over again at POCA Tech, as we’re working on teaching beginning students how to be punks.

And if you look carefully at those competencies, and you think about how to teach efficiently and at the higher levels of Bloom’s Taxonomy, it’s clear that you can fit those educational competencies into 1350 hours, no problem, especially when you’re not trying to teach herbs.

3) If ACAOM doesn’t require us to teach TCM, why are the national boards based on TCM?



4) Note how these competencies have nothing to do with being “a technician” or “an acupuncture assistant”.  (What does that even mean, anyway???) Acupuncturists who are using clinical systems and methods of diagnosis other than TCM, or who are using acupuncture by itself, without adjunct modalities like lifestyle counseling, aren't assistants who need to be supervised by TCM doctors. We're ACUPUNCTURISTS, full stop. We're not doing a reductive version of what you're doing, we're doing something else.

ACAOM’s Revised Masters’ Level Competencies

PATIENT CARE DOMAIN #1: Foundational Knowledge
Note: competencies in this domain are identified as core (master’s level) competencies.

• The learner must demonstrate the ability to acquire and utilize the knowledge of AOM basic principles, modes of diagnosis, and treatment strategies in the care of patients.

PATIENT CARE DOMAIN #2 : Critical Thinking/Professional Judgment
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Engage in good judgment that relies on knowledge and experience, is sensitive to context, and is self-correcting.
B. Apply critical thinking skills, professional judgment, and cultural sensitivity to patient health care concerns.
C. Document and support AOM treatment choices.
D. Identify, locate, and assess appropriate sources of information to support professional judgment and the analysis of clinical courses of action.

PATIENT CARE DOMAIN #3: History Taking and Physical Examination
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Provide a comfortable, safe environment for history taking and the patient examination.
B. Conduct a history and physical examination with appropriate documentation.
C. Recognize clinical signs and symptoms that warrant referral to, or collaborative care, with other health professionals.

Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Collect and organize relevant information to facilitate the development of a diagnosis
B. Access relevant resources such as classical and modern literature, research literature, and clinical experience in arriving at a diagnosis.
C. Formulate an Oriental medicine diagnosis pursuant to AOM principles and theory.
D. Describe and apply the biomedical pathophysiological process responsible for the patient’s clinical presentation.
E. Integrate relevant physical exam findings, laboratory, and diagnostic tests and procedures into an AOM diagnosis.
F. Explain the subjective and objective findings that warrant consultation with or referral to other health care providers.

PATIENT CARE DOMAIN #5: Case Management
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Describe the role of the patient in successful treatment outcomes.
B. Demonstrate cultural competence in case management.
C. Employ a comprehensive process for the care of patients.
D. Collaborate with the patient to develop short, medium, and long term treatment plans.
E. Modify plans consistent with changes in the patient’s condition.
F. Assess patient outcomes.
G. Communicate with other health care providers to determine an appropriate plan of care.
H. Manage inappropriate patient behavior.
I.  Educate patients about behaviors and lifestyle choices that create a balanced life and promote health and wellness.
J.    Provide a report of findings and health care plan to the patient.
K. Create reports and professional correspondence relevant to the care of patients.
L. Identify a range of referral resources and the modalities they employ.
M. Use information systems in case management.

Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Describe the principles and methods of AOM treatment modalities including contraindications.
B. Accurately locate acupuncture points and articulate their functions.
C. Safely use acupuncture equipment and administer the acupuncture treatment consistent with CNT and OSHA protocols.
D. Safely and effectively administer when appropriate other AOM treatment modalities which may include moxibustion, electrical stimulation, cupping, gua sha, bleeding and manual therapy and administer additional modalities such as magnetic and laser stimulation, taiqi, and qigong.
E. (herbal competencies for herbal programs)

PATIENT CARE DOMAIN #7: Emergency Care
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Identify subjective and objective findings that indicate urgent referral.
B. Identify risk factors and findings that suggest medical conditions requiring referral.
C. Implement key emergency first-aid procedures, including CPR.
D. Describe the legal implications of providing emergency care.
E. Describe correct emergency care documentation, and follow-up procedures.
F. Develop an emergency care plan for private office and multi-disciplinary settings

SYSTEMS-BASED MEDICINE DOMAIN #1: Education and Communication
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Summarize the applicability of AOM to bio medically-defined diseases and syndromes.
B. Communicate with other health care professionals in their own terms.
C. Demonstrate knowledge of other health care disciplines. 
D. Discuss AOM in terms of relevant scientific theories.
E. Articulate expected clinical outcomes of AOM from a biomedical perspective.
F. Translate, explain and discuss AOM terminology in order to communicate effectively. 
G. Demonstrate AOM techniques and discuss their relevance in multi-disciplinary settings.
H. Access relevant and appropriate information from a wide variety of sources to support the education of colleagues.
I. Describe and discuss the clinical scope of AOM in an informed, authoritative, and appropriate manner.

PROFESSIONAL DEVELOPMENT DOMAIN #1: Ethics and Practice Management
Note: competencies in this domain are identified as core (master’s level) competencies.

The learner must demonstrate the ability to:
A. Apply data and information concerning confidentiality and HIPAA, informed consent, scope of practice, professional conduct, malpractice and liability insurance, requirements of third-party payors, OSHA, professional development, other applicable legal standards to improve practice management, and records management systems.
B. Develop risk management and quality assurance programs.
C. Practice ethically and behave with integrity in professional settings.
D. Articulate the strengths and weaknesses of multiple practice and business models, and be able to create and implement:
1.   Practice/office policies and procedures.
2.   Business/professional plans designed to support success in professional
3.   Marketing/outreach plans designed to support success in professional practice.
E. Describe and apply a variety of billing and collection systems.
F. Demonstrate use of electronic health records and electronic medical records systems.

Author: lisafer

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  1. I love those competencies! I look forward to the day when programs are evaluated on how well they develop these in their graduates rather than on how many hours of training they provide. And I REALLY look forward to the day when Acupuncturists can talk about the caliber of their training without falling back on number of hours, which has become a really stupid pissing match with other professions.

  2. Oh, and about that technician thing — one of cornerstones of our belief system about acupuncture has been that the energetic interaction of the provider and recipient is critical — that the diagnosis becomes part of the treatment – and that the effect is not about needle into assigned point. NOw, I don’t know if there is “scientific” evidence to support that, but it’s hard to imagine where we’d draw any line about what one tier could do that another couldn’t. Even if there were any evidence that the historical 1300 hours of training wasn’t enough to create a competent practitioner.

    Which brings me to what, I hope, is my last comment — one thing that does seem to be kind of unique about LAcs — the degree to which we don’t trust our own colleagues to know their own limits. I think about this often around the herb conversation — I know that I’m not fully trained in herbs, and I know that herbs can be risky, and so I limit my use of herbs. I’m not trained in estim, so I don’t use it at all. But if my colleagues mistrust my professional judgment so greatly that they think I must be legally excluded from recommending or selling herbs, than we’ve got a much bigger problem than we’ve been acknowledging. If we don’t trust our schools to create practitioners who know their limits, let’s address that.

  3. In the last week or so an LAc has been making a big push on FB to get folks to enroll in their marketing/practice building classes.

    One of the first “ads” said it was really important that practitioners learn to make over 100K/year because otherwise the gainful employment rules would shut down all of the acupuncture schools.

    So that brought up a whole bunch of stuff. First off, it looks like the GE rules aren’t going anywhere, and even if they did they were only going to apply to for-profit schools (I suppose under the new admin they might apply only to non-profit schools), and that they wouldn’t shut down any schools, just make it harder for people to take out loans. (Which maybe would be a good correction — if you can’t put together private money for school, how are you going to get a business going?)

    It’s maddening to be told, hey, your 100K education didn’t teach you skills sufficient to pay off those loans, so now purchase more education from me so that I can teach you how to make enough, so that you can protect the school that put you into this debt in the first place.

    Not surprisingly a big part of the advice is that we need to charge more – you know, really value ourselves. (This hardly helps control health spending. At some point we lose the “cost effective” argument.)

    Interesting – this idea of value, as though charging more increases your value. (Or that more hours of education increases the value of the profession.) Value relates to benefit. If the extra hours of education brings no benefit, they bring no value. Charging more doesn’t increase the value of the treatment, it increases the cost.

    Anyway, this is a long way around the barn to say that I hope the schools and institutions that have the power to change things see how sensible it would be to reduce the cost of the education. If the schools are worried about GE rules, than a less expensive education sure would help. I know that a shorter education (like the one I received) is sufficient to create a successful practitioner.

    Seems like a no-brainer.

  4. Unfortunately I think the same fear that those folks have about PT’s and other similar practitioners would apply in this case – if schools made a cheaper and briefer route to being a licensed acu, they’d have to sell the FPD stuff even harder. I can only imagine that other schools have the same issue that MUIH had when I was there – they lost a lot of big donors in the last economic crash and created a lot (omg, muih, a LOT) of certificate programs, plus raised the costs of the ones already in place, to stay viable. I don’t know if I see any of them being willing to kick out one of the toothpicks holding up the curriculum they’re holding onto for dear life.

  5. Hey I don’t disagree with anything you’ve written, but I think public safety is basically the public icing on the cake of everyone’s self-interest. Saftey-wise it does make sense, bottom-line wise for schools I don’t see it when I look at how they’ve set everything up. At every touchpoint of this profession everyone in a position to keep things as they are has a vested financial interest in doing so. Unless demand at the entry point goes down dramatically what sense does change make? I’m excited to see the competencies change (not just because I went to a 5E school and am basically TCM illiterate, heh) – it’s a real moment of potentially altering the foundation of all of this.