CLINICAL TRAINING AND INTERNSHIP

Purpose
Clinical Training and Internship provide very essential supervised, practical experience and is constantly emphasized throughout the program. It is here that the student becomes a true practitioner of Chinese medicine. This understanding goes to the heart of the philosophy that there is an essential unity of thought and action: "Knowledge is the beginning of action, and action is the completion of knowledge. Learning to be a sage involves only one effort. Knowledge and action should not be separated." (Wang Yang-Ming) Each student will be required to take responsibility to discover his own truths and abilities in diagnostics, needling, and treatment techniques, ethics, and practice management.

Clinical training provides valuable hands on experience and education that complements the academic side of the Master of Acupuncture and Oriental Medicine Degree program. This practice is required by CAHM to qualify for graduation and to satisfy state and national requirements. Through clinical practice, a student becomes a true practitioner of Chinese medicine.

Students complete 840 hours of clinical training in Acupuncture and Oriental Medicine in order to fulfill CAHM Master of Acupuncture and Oriental Medicine Degree requirements. During this time, students must also perform at least 250 supervised patient treatments.
 

Course Educational Objectives
The course will enable students to formulate accurately an Acupuncture and Oriental Medicine diagnosis, to determine an effective treatment strategy based upon the diagnosis formulated; to assess the effectiveness of the treatment strategy and its execution; to enable students to prescribe and formulate correctly an herbal medicine treatment, to determine an effective herbal formula based upon the diagnosis, and to assess the effectiveness of the herbal treatment strategy and its execution; to prepare students for Hawaii State Board of Acupuncture Licensure, National Certification in Acupuncture and National Certification in Herbal Medicine and enable graduates to set up and maintain successful professional practice of Acupuncture and Oriental Medicine.

CLINICAL TRAINING & INTERNSHIP CLASSIFICATIONS
Clinical training for acupuncture and herbs are divided into the following clinical classifications: Clinic Observation, Clinic Assistant, Acupuncture Intern I, and Acupuncture Intern II. The successful completion of each preceding level is prerequisite to advancing to the next level of the program.

CLINIC OBSERVATION

During the first semester students come to the clinic for an introduction to clinical protocol and procedures. Through observation, students will accumulate practical experience and develop an appreciation for both the art and science of acupuncture.

Course Objective
Students will learn relevant clinical protocol and procedures. They see how the various theories they are learning are applied during treatment and learn how Licensed Acupuncturists and/or Acupuncture Interns outline a treatment plan.

Students will learn about Equipment and Safety:

• Needles: Gauges, Types, Selection, Replacement, Inspection
• Other Equipment: Cups, Moxa, Seven Star, etc.
• Clean Needle Technique & Sterilization: Necessity and Various Methods
• Relevant State and Federal Regulations Concerning Equipment & Safety
• Avoiding Harm from Typical Procedures: Needling, Moxa, Cupping, etc.
• First Aid & Fainting During Treatment
• Personal and Office Cleanliness and Hygiene

CLINIC ASSISTANT

After completing the prerequisites for Clinical Assistant, students begin accompanying either a licensed acupuncturist or an acupuncture intern in the clinic. Clinical Assistants first learn clinic tasks and duties that provide for efficient and effective treatment. Students accompany either acupuncturists or interns on their daily routine. Students check in patients and show them to their room, learn moxibustion and cupping techniques, learn how to properly dispose of acupuncture needles and learn sterilizing techniques, assist in the general cleaning of the clinic and help in the preparation and dispensing of herbal prescriptions. Students train to take patient medical history, to do rudimentary pulse and tongue diagnosis, and to properly remove acupuncture needles from patients.

Students also learn human service skills. Sometimes patients, because of their pain and illness, are difficult or ill tempered. Students must learn to be patient, kind, and sympathetic. Students are taught to respect patient's privacy, while at the same time making them feel welcome and comfortable. While assisting the acupuncturists, supervising acupuncturists discuss a case as it presents itself, so that students can develop an appreciation for the art and science of diagnosis and treatment.

Course Objectives
This clinical experience is dedicated to train students to:

• Integrate TCM, Taoist Medicine, Herbal Medicine, and Biomedical semester concepts
• Put classroom learning, clinical theories and skills into practice.
• Steadily increase self-confidence and professional poise.

Clinic Assistant Competencies
Diagnostic Skills and Treatment Planning in Acupuncture and Oriental Medicine

• History Taking / Charting
• Methods of Observation, Audio-Olfaction, Inquiry, Palpation, and Differential Diagnosis
• Recognition of Symptoms Requiring Referrals, including Infectious Disease
• Methods and Systems for Planning, Carrying Out and Evaluating a Treatment
• Prognosis and Contraindications of Treatment
• Making Appropriate Referrals
• Consideration of Special Factors or Symptoms Indicating Potential for Increased Risk to the Patient (Immune Compromised Patient, Diabetic Patient), the Need to Modify Standard Therapeutic Approach (Infants and Children, Pregnancy), and Apparently Benign Presentations that may have a More Serious Cause (Hypertension, Headaches)
   

Collecting Data and Formulating a Diagnosis

• Observation -Noting the Spirit, Color, Body Structure, Tongue, Symptom Site, and Patient's Complexion; Olfactory Examination - Odor of the Patient's Body and Patient's Secretions, Discharges and Breath
• Audio Examination - Sound of Patient's Voice, Abdominal Sounds, Respiration and Cough Quality Palpation - Noting the Temperature, Moisture, Texture, Sensitivity, Tissue Structure, Rhythms and Qualities of the Abdomen, Chest, Ear, Channels and Points, and Radial and Regional Pulses
• Enquiry - Asking General Questions, Questions about Medical History, Chief and Secondary Complaints, Sleep Patterns, Excretions, Thirst and Appetite, Digestion, Nutritional Levels and Patterns, Medications, Chills and/or Fever, Perspiration, Pain, Emotional State, Life Style, Exercise, Use of Alcohol, Tobacco, and Drugs, Reproductive Cycles and Menstruation, Leucorrhoea, Sensations of Heat, Cold, Dizziness, Tinnitus, Palpitations and Chest Constriction
• Physical Examination Adjuncts - such as Akabane and Electrical Stimulation

ACUPUNCTURE INTERN I

Third year students have had sufficient theory, observation and practice to take responsibility for patient care during their Acupuncture Internship, in which they treat fellow students under supervision. Students integrate their knowledge and utilize concepts presented in Traditional Chinese Medicine Theory, Taoist Medicine, Herbal Medicine, and Biomedical Clinical Sciences with the observations they are making in Clinic. Students devise treatment plans, apply relevant technique and perform treatment under supervision. Students develop correct, effective application of theories and techniques, acquiring wisdom and mastery through practical experience. Together, students learn, develop, and share in clinical knowledge and experience.

Course Objectives
This clinical experience is designed to train students to:

• Correctly diagnosis and treat patients under supervision.
• Put classroom learning, clinical theories, and skills into practice.
• Develop confidence in the ability to formulate diagnosis and determine treatment strategy based on the diagnosis formulated
• Develop effective treatment protocols and procedures
• Steadily increase self-confidence and professional poise.
• Begin preparation for independent practice.

Acupuncture Intern I Competencies
Assessing Effectiveness of the Treatment Strategy and its Execution

• Reexamination of the Patient; Comparing with Previous Condition and Expectations; Modifying of the Treatment Plan, if required, Based Upon that Statement.
• Recognizing Situations Where the Patient Requires Emergency or Additional Care or Care by Practitioners of Other Healthcare (or Medical) Modalities, and to Refer Such Patients to Whatever Resources are Appropriate to their Care and Well-Being.

Performing Treatment by Applying Appropriate Techniques

• Proper Sterilization and Aseptic Procedures
• Preparation of the Patient, including Proper Positioning for Application of Techniques
• Effective Communication with Patients Regarding the Nature of Illness and Treatment Plan
• Accurate Location of Acupoints, Safe and Effective Needle Insertion Techniques Based on Point Function, Recommended Needling Depths, Underlying Anatomy at the Site, Desired Effect of Needling, and Nature of the Illness
• Protocols in Compliance with NCCAOM Guidelines on Sanitation, Asepsis, and Clean Needle Handling
• Safe and Effective Application of Adjunctive Techniques, Moxabustion, and Manipulation
• Effective Control of Emergency Situations

ACUPUNCTURE INTERN II
 

Students perform a minimum of 250 supervised treatments incorporating acupuncture, diet, and herbal therapy. Students have developed sensitivity, awareness of protocol, and professional standards and ethics. The spiritual discipline of Taoism and the practice of Chi Kung have given them an extra dimensional insight and intuitive awareness into the unique needs of patients. Within this healing milieu, students have learned how to creatively personalize and tailor therapies for effective case management. Knowledge and its practical application are unified, and the students are ready to become independent practitioners. During this part of our program, all the skills learned are fully utilized and students manage all aspects of running a clinical practice, from keeping patient records up to date to collecting fees, developing the skills to begin their own practices.

Students gain valuable knowledge and clinical experience in a professional clinic setting including: practice management, patient protocol, handling difficult cases, completing a student's preparation for independent practice.

Course Objectives
This clinical experience is designed to train students to:

• Further, develop and refine professional skills developed in Acupuncture Intern I Internship.
• Gain valuable clinical experience with a wide selection and variety of patients.
• Serve the community by providing low cost health care.
• Develop confidence, competencies, and poise for future independent practice.
• Complete preparation and training for independent practice.

Acupuncture Intern II Competencies
Counseling and Communication Skills

• Communications Skills: Listening, Counseling, Explaining, and Teaching
• Managing Psychological Reactions That May Arise During Treatment and Making Appropriate Referrals
• The Availability of Additional Appropriate Modalities For Patient Referral and the Ability to Communicate with Other Health Professionals Regarding Patient Care

Ethics and Practice Management

• Professional Discipline, Development, Maturity, Confidentiality, and Informed Consent
• Understanding the Scope of Practice; Recognition and Clarification of Patient Expectations
• Record Keeping: Legal Requirement, Release of Data
• Ethical and Legal Aspects of Referring Patients to Another Practitioner
• Professional Conduct and Appropriate Interpersonal Behavior
• Overview of Status, Laws, and Regulations Governing Acupuncture and Oriental Medicine in America
• General Liability Insurance and Legal Requirements; Professional Liability Insurance: Risk Management and Quality Assurance

Complying with Practices as Established by the Profession and Society at Large

• Application of a Code of Ethics and Practice of Responsible Record Keeping and Patient Confidentiality
• Maintenance of Professional Development through Continuing Education and of Personal Development by Continued Cultivation of Compassion