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:
Curriculum: Overview of curriculum
Development: History and development
of the doctorate curriculum.
The Gold Standard:
Comparison of NOMAA doctorate curriculum with
two Chinese programs.
Education of Traditional Chinese Medicine in China: A
brief introduction and discussion by Qiao Wangzhongon of Beijing
University on TCM education.
Deliberations: Overview of the California
Acupuncture Board's Competencies Task Force proceedings.
Input: Concerns about potential impact
on recent graduates.
for Practice: The importance of using
practice-driven competencies criteria.
What students need to know before training to
become a doctor of oriental medicine.
detailed Curriculum Standards (PDF
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.
|Basic Medical Sciences
|Oriental Medical Sciences
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.
|Basic Medical Sciences
Pathology and pathophysiology
Nutrition (Including vitamins)
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
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).
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
(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.
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.
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
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
|Oriental Medical Sciences
Historic & Literature Background
Current Physiological Basis
Vitality & Endocrine Glands
Neurovascular Nodes (Acupoints)
Physiological Basis of Needling
& General Medicine
Immune System Conditions
Endocrine System Problems
Vitality & Emotions
Physiological Effect & Nature
Toxic Effects & Contraindications
Properties of Most Commonly Used Herbs
Principles of Combining Herbs
Preparation of Formulas
Herbal Pharmacy Internship
Most Commonly Used Formulas
Clinical Application of Herbal Medicine
and External Medicine
Chinese Muscular Distributions
Assessment & Diagnosis
Manual Therapy (TuiNa)
Electroacupuncture & PENS
Head, Face & Neck Problems
Upper Extremity Problems
Body Trunk & Thoracic Spine
Low Back & Pelvis Problems
Hip & Lower Extremity Problems
Clinical medicine consists of
patient assessment and diagnosis, case management approaches, evidence
based medicine methodology, and principles of public health.
Assessment & Diagnosis
Clinical Science Review
Practice of Medicine Survey
Standard Physical Examination
Comprehensive History Taking
Diagnostic Analysis (ICD-9)
Laboratory Tests & Diagnostic Imaging
Patient Rapport & At Risk Population
Primary, Secondary & Specialty Care
Interactions of Drugs & Herbs
Reports, Testimony & Medical Review
Special & Emergency Care
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.
Supervised Practice 1
Supervised Practice 2
Electives (Including practice management)
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.
|Basic Medical Sciences
|Oriental Medical Sciences
of Traditional Chinese Medicine in China
Beijing University of Traditional Chinese Medicine
Article printed with permission of the author.
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
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
To read the full article by Qiao Wangzhong, click here; Traditional
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.
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
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.
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.