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Program Criteria

The NOMAA programmatic criteria include a 4,000 hour minimum curriculum for an entry-level Doctor of Oriental Medicine (O.M.D.) Professional degree program. This represents a 1,652 hour increase above the present California Acupuncture Board (CAB) requirement for Licensed Acupuncturists, and is 1,000 hours higher than the California AB 1943 requirement of 3,000 hours to be implemented in January 2005. The NOMAA curriculum is 1,585 hours greater than the Licensed Doctor of Oriental Medicine requirement in New Mexico and similarly greater than the Licensed Acupuncture Physician requirement in the state of Florida.

The need for the continued improvement in Oriental medicine training is dictated by the increasing use of alternative or complementary health care approaches by the American public. It is essential that the education of future practitioners address the challenges associated with the growing utilization of Oriental medicine. The NOMAA Oriental medical sciences is consistent with the needed competencies expressed by the profession and also compares favorably with the major Chinese medicine schools in China when all criteria is adjusted to the same basis. Summary curriculum consists of the follow topics and hours:

Doctorate Curriculum: Overview of curriculum content.

Curriculum Development: History and development of the doctorate curriculum.

The Gold Standard: Comparison of NOMAA doctorate curriculum with two Chinese programs.

The Education of Traditional Chinese Medicine in China: A brief introduction and discussion by Qiao Wangzhongon of Beijing University on TCM education.

Stakeholder Deliberations: Overview of the California Acupuncture Board's Competencies Task Force proceedings.

Graduate Input: Concerns about potential impact on recent graduates.

Training for Practice: The importance of using practice-driven competencies criteria.

Prerequisites: What students need to know before training to become a doctor of oriental medicine.

Download detailed Curriculum Standards (PDF file)

Doctorate Curriculum

The curriculum leading to the O.M.D. degree consists of basic biomedical sciences, Oriental medical sciences, clinical medicine and related topics, taught during the first two or three years. The last eighteen to twenty four months of training consists of a comprehensive clerkship program involving supervised clinical training with emphasis on developing high competency levels in clinical practice.

A summary of the training requirements and expanded curriculum are provided below.

Curriculum
Hours
Basic Medical Sciences
500
Oriental Medical Sciences
140
Clinical Medicine
600
Clinical Clerkship
1,50
Total
4,000

Basic Medical Sciences

Basic medical sciences study includes a core curriculum of anatomical and physiological science and clinical disciplines for developing an understanding of the structure and function of the human body under normal and pathogenic conditions, including the physiological view of Oriental medicine. Courses include anatomy, physiology, pathology, pathophysiology, immunology, endocrinology, biochemistry, microbiology, neuroanatomy, behavioral medicine, and nutrition. Pharmacology and botany/pharmacognosy are respectively studied under Clinical Medicine and Herbal Medicine.

Curriculum
Hours
Basic Medical Sciences
500

Anatomy
Physiology
Pathology and pathophysiology
Immunology
Endocrinology
Medical biochemistry
Medical microbiology
Neuroanatomy
Behavioral medicine
Nutrition (Including vitamins)

60
90
90
35
45
45
30
30
30
45

Pharmacology (1)
Botany/ Pharmacognosy (2)

1. Included in clinical medicine and case management studies in the form of pharmacological assessment, and drug and herb interactions, respectively.

2. Included as a stand-alone course in the herbal medicine study.

Oriental Medical Sciences

Oriental Medical Sciences (Years 1, 2, and 3) (1400 hours)
Oriental medical sciences cover a minimum of 1400 hours of training involving the principles and theories of Oriental medicine (200 hours), needling therapy (acupuncture) (250 hours), herbal medicine (450 hours), internal and general medicine (250 hours), and orthopedics and external medicine (250 hours).

Principles and Theories of Oriental Medicine (200 hours)
This area of study involves a minimum of 200 hours didactic training on the principles and theories of the historic basis and current understanding of Oriental medicine. Most important to Oriental medicine is a sophisticated pathogenic model that considers disease to the result of external pathogenic as well internal factors often involving behavior and emotions, that ultimately affect the physiological balance of the body, and thereby causing disease. These concepts are similar to the idea of maintaining homeostatic balance in order to support physiological balance. One of the basic premises of Oriental medicine relies on a complex framework of correspondences that group certain anatomic, physiologic, sensory, behavioral, and other features with specific internal organs, which are further correlated with the five dominant annual climatic phases. These systems are thought to dynamically interrelate by certain modes of operation, which are considered in viewing pathology and formulating some treatment strategies.

Needling Therapy (acupuncture) (250 hours)
The study of needling therapy (acupuncture) involves a comprehensive 250 hour minimum study of the historic, anatomic, and physiological basis needling and its clinical application. Understanding of the neurovascular nodal (acupoints) pathways distributed longitudinally along vascular routes of the body, and their segmental and axial relationships to the peripheral and central nervous system, including the knowledge of needling induced processes, is essential to developing competencies in the application of needling therapy.

Internal and General Medicine (250 hours)
Study of internal medicine requires a minimum of 250 hours of study and covers the principles in applying Oriental medical modalities, with emphasis on needling therapy and herbal medicine to treat internal and general conditions, including infectious diseases, using historic and evidence-based criteria. Internal medicine would normally be completed immediately preceding clinical clerkship.

Herbal Medicine (450 hours)
The herbal medicine program involves a 450 hour minimum comprehensive study on botany/pharmacognosy, the principles and clinical application of Chinese/Oriental herbal medicine, including the hands-on physical identification and study of the most common herbs, and how to combine herbs to produce efficacious herbal formulas, as well as hands-on preparation of prescriptions in the institution's herbal pharmacy. Study can include introduction to related Chinese classics and other texts.

Orthopedics and External Medicine (250 hours)
The study of orthopedics, including traumatology, involves a comprehensive study of the musculoskeletal system as it is viewed by discrete longitudinal muscular distributions of Oriental medicine. External medicine mainly involves dermatological problems. This course of study consists of a minimum of 250 hours instruction. Oriental orthopedic studies involve the assessment and treatment by major body regions including: the head and neck; shoulder and upper extremities; body trunk and pelvis; and lower extremities. Treatment approaches are based on historic and evidence-based criteria with emphasis on needling therapy, herbal medicine including external application when appropriate, manual therapy, and therapeutic exercise. Orthopedics and external medicine would normally be completed immediately preceding clinical clerkship.

Curriculum
Hours
Oriental Medical Sciences
1400
Oriental Medicine Theory
Historic & Literature Background
Current Physiological Basis
Vitality & Endocrine Glands
Pathogenic Model
Diagnosis
200
Acupuncture
Distribution Vessels
Neurovascular Nodes (Acupoints)
Physiological Basis of Needling
Node Laboratory
Needling Techniques
Needling Therapy
250
Internal & General Medicine
Pediatrics
Geriatrics
Ophthalmic Disorders
Gastrointestinal Disorders
Gynecology
Reproduction Disorders
Respiratory Diseases
Hepatic Disorders
Cardiovascular
Renal Disorders
Immune System Conditions
Endocrine System Problems
Vitality & Emotions
Affective Behavior
Substance Withdrawal
Emergency Care
250
Herbal Medicine
Botany/Pharmacognosy
Herbal Medicine
Physiological Effect & Nature
Toxic Effects & Contraindications
Properties of Most Commonly Used Herbs
Herbal Formulary
Principles of Combining Herbs
Preparation of Formulas
Herbal Pharmacy Internship
Most Commonly Used Formulas
Clinical Application of Herbal Medicine
450
Orthopedics and External Medicine
Chinese Muscular Distributions
Assessment & Diagnosis
Manual Therapy (TuiNa)
Exercise Therapy
Electroacupuncture & PENS
Head, Face & Neck Problems
Shoulder Problems
Upper Extremity Problems
Body Trunk & Thoracic Spine
Low Back & Pelvis Problems
Hip & Lower Extremity Problems
250

Clinical Medicine

Clinical medicine consists of patient assessment and diagnosis, case management approaches, evidence based medicine methodology, and principles of public health.

Curriculum
Hours
Clinical Medicine
600

Assessment & Diagnosis
Clinical Science Review
Practice of Medicine Survey
Standard Physical Examination
Comprehensive History Taking
Pharmacological Assessment
Diagnostic Analysis (ICD-9)
Laboratory Tests & Diagnostic Imaging
Patient Rapport & At Risk Population
Awareness

360

Case management
Primary, Secondary & Specialty Care
Responsibilities
Psychosocial Assessment
Treatment Contraindications
Interactions of Drugs & Herbs
Reports, Testimony & Medical Review
Special & Emergency Care
140
Evidence based methods
50
Public health
50

Clinical Clerkship

Supervised and independent practice clerkship takes place during the third and fourth year of training involving the clinical application of Oriental medicine, which is preceded by the clinical observation participation in the second year. The clerkship program consists of at least 1440 hours clinical training in which 75% is to take place in a clinical facility owned and operated by the institution. It is recognized that institution clinics receive a broad range of patients reflecting problems prevalent in their local area.

Curriculum
Hours
Clinical Clerkship
1,500

Clinical Observation
Supervised Practice 1
Supervised Practice 2
Monitored Practice
Electives (Including practice management)

160
300
300
680
60


Curriculum Development

The NOMAA curriculum requirements for a 4,000 hour entry-level professional doctor of Oriental medicine (OMD) degree are based on the Oriental medicine schools of China which have been in existence for some 40 years. These institutions are considered the world gold standard for Oriental medicine. The curriculum of similar professional schools in South Korea was considered as well. Although the core curriculum of the Chinese and Korean schools is excellent, there are many demands on practitioners in the United States. This concerns use of acceptable uniform diagnostic approaches, record keeping, patient referral, meeting certain competencies, and participation in government program or insurance reimbursement. Hence, all procedures and standards appropriate to a professional doctor of Oriental medicine training program and practice need to be consistent with acceptable standards of medical care. During the curriculum analysis and development, critical input was sought from the Oriental medicine profession to address needed competencies for an entry-level doctor of Oriental medicine degree in the practice of Oriental medicine at a primary care level. Input was also derived from key Oriental Medicine schools in the United States.

Certain studies and reviews over the past few years have indicated a need for improving educational standards, especially in view that there were no national programmatic standards for an entry-level OMD program prior to these being offered by the NOMAA. During the course of developing these standards, the California Acupuncture Board impaneled a Competencies Task Force (CTF) to recommend possible increased educational hours for the State of California. Participants in the CTF included professional organizations and schools in California as well as individuals from schools outside California and from related national organizations. NOMAA representatives also participated in this effort.

The curriculum was developed with input mainly from the profession and participation of selected schools. Much of the effort on didactic hours of training was derived from participation in the CAB's Competencies Task Force effort during 2001-2002 where a range from 3,150 to 4,050 hours was recommended. This results in an average of 3,600 hours, which compares favorably with (only 10% less then) two Chinese professional schools. Emphasis of NOMAA was on establishing educational requirements that the profession deemed to be sufficient to provide excellent training in the science, art, and practice of Oriental medicine (OM) that is consistent with providing primary care services while protecting the safety and welfare of the citizens of the United States. Several areas were explored including what training hours are required by states such as New Mexico and Florida which already license professional doctor or physician level programs in acupuncture and Oriental medicine, as well as at least one of the top schools in California along with another school not in California or New Mexico. The two major Chinese Medicine schools examined are located in the cities of Beijing and Chengdu as possible gold standard references. A summary comparison of these schools and organizations with the NOMAA standard is provided in the The Gold Standard (below).

The Gold Standard

Comparison of the NOMAA 4,000 hour curriculum shows excellent agreement with the Chinese school requirements. Professional schools specializing in Chinese medicine were established during the 1950s in most major cities in China. The schools located in Beijing and Chengdu China were selected since they are typical of standards of the other schools throughout China and Korea. When all the hours are compared on the same basis the Beijing and Chengdu schools have 4,175 and 3,974 hours respectively (See Table 1). Chinese schools accept students directly from high school where they receive introductory and prerequisite training that is somewhat equivalent to two years college before the study of Chinese medicine. So, these didactic hours are subtracted their original total for a one-for-one comparison.

There is close agreement in prerequisite training, biomedical sciences, Oriental medical sciences, and noncredit electives. The main differences are in herbal medicine of 450 hours for NOMAA while the Beijing and Chengdu schools offer 207 and 198 hours respectively and in clinical medicine with 600 hours for NOMAA compared to 324 and 330 hours for Beijing and Chengdu. The lower number in herbs is result of a strong emphasis on this area in the Chinese clinical clerkship program. Differences in the clinical clerkship of 2,240 and 1,920 hours for Beijing and Chengdu compared with 1,500 hours for NOMAA are due to injection therapy, surgery, obstetrics, and bone setting being included in the Chinese program. Presently, three or four states already allow injection therapy and so consistent standards need to be established for this area. Likewise, the public could be well served by Oriental medicine schools in the United States eventually reaching the same level of practice.

Curriculum
NOMAA
Beijing
Chengdu
Basic Medical Sciences
500
450
450
Oriental Medical Sciences
950
936
1052
Herbal Medicine
450
207
198
Clinical Medicine
600
324
330
Clinical Clerkship
1,500
2240
1920
Total
4,000
4157
3974

The Education of Traditional Chinese Medicine in China

Qiao Wangzhong
Beijing University of Traditional Chinese Medicine
Article printed with permission of the author.

Preface
Traditional Chinese Medicine (TCM) has a long history in China, it is not only looked upon as a bright pearl, but also a treasure house in Chinese ancient culture. TCM has made great contribution to the health of Chinese people for thousands years, and it became an independent medical system in world medical field with its special clinical effect, rational theory system and rich practice experience.

In Chinese medical history TCM was born, spread and developed along with Chinese people against various diseases, TCM education has also been carried out from one generation to another for thousands years. It is clear that TCM education has its objective basis, that is, TCM science and technology.

To develop TCM and to promote TCM education, there are many problems needed to be discussed and solved. In this paper, a brief introduction and discussion on TCM education will be made.


The Basis of TCM Education
TCM has been handed down from ancient time to now. The reason for the lastingness of TCM, as being realized by most people, lies in that it has great vitality, that is, TCM has rational property, scientific theory system and rich contents. In this sense, the advantage of TCM is just the basis of TCM education.

TCM applies its special concepts and theory to reveal and interpret the arising and growing of diseases and to determine the treatment principles. TCM has formed a perfect knowledge and theory system. For example, TCM applies Yin - yang, five elements (water, fire, metal, wood and earth), internal organs (viscera), jingluo (Channels and collateral), vital energy and blood, and so on, to explain various physiological phenomena and to illustrate the cause of diseases (pathology), the interpretation of the cause (pathogenesis), the diagnosis, treatment and prevention of diseases.

TCM emphasizes the concept of viewing human body's various parts as an organic whole. On the view of TCM, human body, as a microcosm, is connected with the macrocosm. From the concept, there is a close relation between human body and the nature, between human body and society. Although this idea was advanced a long time ago, it has something in common with today's medical model.

TCM emphasizes the idea of determining treatment principles and methods based on the differentiation of symptoms and signs. It is the essence of TCM theory system. This theory has significance to clinical practice, only according this idea to determine diagnosis, principles, prescription and drugs, can treatment get satisfactory effect.

Clinical effect is the real reasons of TCM having vitality, it is also the starting point and the end-result of TCM practice. Now, mankind faces serious harm from AIDS, tumor, cardiac cerebral and other obstinate diseases. In this situation, TCM should make more effort to raise clinical effect of treating these diseases and should further apply modern science and technology to develop TCM theory and to improve TCM practice. In the same time, the endangerment from these serious diseases is also a challenge to TCM education, requesting TCM education to make more effort to develop medical science and technology and to meet the needs of treating and preventing these diseases.

To read the full article by Qiao Wangzhong, click here; Traditional Chinese Medicine

Stakeholder Deliberations

Since the training provided in California schools has consistently been ahead of other states, it seemed appropriate to use suitable information available in California that would indicate how well recent graduates are prepared to enter private practice. In addition, the curriculum of existing schools was examined to determine if there is a consistency between clinical specialties being taught and what types of conditions that are typically seen in the clinical setting.

While NOMAA was involved in developing its programmatic criteria, the California Acupuncture Board put together a task force of Oriental medicine professionals including some that were working on the NOMAA standards plus others, including non-practitioners and people from other states, that represented opposition to California's need to increase educational standards. This task force concentrated on competency issues which resulted in a range of proposed total hours from about 3,150-4,050 hours. The net result was a recommendation of 3,000 hours to support the requirements of AB 1943. The total Oriental medicine portion of this recommendation consists of 1,250 hours derived by the task force. This is consistent with the NOMAA criteria of 1,300 hours and compares favorably with the Beijing and Chengdu schools respectively with 1,187 and 1,298 hours.

Graduate Input

A survey was conducted by researchers from the University of California at Los Angeles (UCLA) and the Southern California University of Health Sciences which clearly indicates a need for improved educational standards. Some 45.6% of recipients felt at the conclusion of their clinical clerkship they were either not adequately or somewhat adequately trained to practice independently once they graduated. Some 77.7% of recipients felt it necessary to take postgraduate courses to expand their training. It is clearly obvious that the clinical clerkship from 800-900 hours is insufficient to prepare new graduates to enter independent practice. The NOMAA requirement of 1,500 hours for clinical clerkship and how the program is supervised addresses this main problem. The 1,500 hours is also in the same range of the adjusted Chinese school requirements. There are numerous other deficiencies noted in this study that have also been addressed in the NOMAA criteria, including training to be consistent with the likely cases that graduates are likely to see.

Training for Practice

Another aspect of why new graduates have difficulties in going into private practice is a possible disparity between what the students are taught and what types of cases a practitioner is likely to see in the clinical setting. Many schools spend considerable efforts on teaching internal medicine and none on orthopedics or at least very little on this subject. However, in clinical practice perhaps 70% of the patients come to a practitioner of Oriental medicine for pain and musculoskeletal problems.

The NOMAA criteria address this issue by requiring 200 hours of the Oriental medicine sciences to cover orthopedics. Internal and general medicine is still addressed with 250 hours of training.

Prerequisites

The NOMAA criteria require a minimum of three years college training although schools should give preference to those students with a baccalaureate degree. Prerequisite courses are required in English, biology, inorganic chemistry, organic chemistry, and physics. These courses need be completed before students can be enrolled in the O.M.D. program. The early biomedical and Oriental medicine sciences courses cannot be properly taught without completion of the prerequisite courses.


   
 
   
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