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Acupuncture Today
August, 2002, Vol. 03, Issue 08
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Doctoral Programs: The Future of Oriental Medicine?

Acupuncture Today Interviews Terry Courtney, MPH, LAc and Carol Taub, LAc

By Editorial Staff

History was made in the Oriental medicine profession this summer when the Accreditation Commission of Acupuncture and Oriental Medicine gave its approval to Bastyr University in Kenmore, Washington and the Oregon College of Oriental Medicine (OCOM) in Portland, to begin offering clinical doctoral programs.

The approval made Bastyr and OCOM the first two schools in the country to offer accredited doctoral degrees, and signaled what could be the start of the next trend in acupuncture and Oriental education.

Upon learning that both schools' programs had received approval, Acupuncture Today spoke with Terry Courtney, MPH, LAc, chair of the acupuncture and Oriental medicine program at Bastyr, and Carol Taub, LAc, OCOM's dean of academic affairs, to gain some insight on the scope and breadth of each institution's doctorate, and to have a better understanding of how doctoral programs will change the acupuncture and Oriental medicine profession.

Acupuncture Today's Interview with Terry Courtney

Acupuncture Today (AT): Congratulations on your program getting approved.

Terry Courtney: Thank you.

AT: The doctoral program has been a long time in coming. How and why did Bastyr decide to go in this direction?

Terry Courtney: About three years ago, the faculty of our acupuncture and Oriental medicine program began looking at the doctorate and its goals and outcomes. We realized that the doctoral program's goals matched the visions in our program in terms of further developing master's-trained practitioners in advanced traditional Chinese medicine and in the Western sciences. We wanted to develop advanced levels of academic excellence and clinical expertise. We also felt that the resources our program has access to as part of a larger university would greatly assist us in developing a quality program.

AT: What effect will the doctoral program have on the master's program? Is there going to be any crossover between the programs?

Terry Courtney: No, there is no crossover. It's a completely separate course of study which is done upon completion of the master's degree. The curriculum, clinical training and focus of the doctorate are entirely above and beyond what we offer in the master's program. We actually have two routes of admission. Recent graduates from a master's program can apply. We also invite applications from practitioners in the field.

AT: Is it going to be open to anybody who has a master's degree, say, someone from a school in Texas or New York?

Terry Courtney: Yes. The doctoral program does require previous training in both acupuncture and Chinese herbal medicine. For applicants who completed master's level training in acupuncture without herbal training, we can offer a separate Chinese herbal medicine certificate program. This certificate course or its equivalent would need to be completed before commencing with the doctoral program. In addition, we would look at the Western sciences an applicant has taken and assess whether any remediation is required. There may be situations where in order to be fully prepared, an applicant needs to take extra science courses.

AT: If somebody needed to make up an extra class, would those classes be offered at Bastyr?

Terry Courtney: Yes. It is not uncommon in many doctoral level training programs that one may need to focus on completing prerequisite work first.

AT: When will you enroll your first class of students?

Terry Courtney: That's dependent on final approval from the Northwest Association of Schools and Colleges (NASC). This is the regional accrediting body for Bastyr. We have two levels of accreditation: the program level, which is ACAOM, and the university level, which is regional. We're very pleased that ACAOM has approved us to start, but we also have to get approval from NASC. I'm in the process of completing the application for NASC. Once we have their approval, then we'll have a start date.

AT: Who's going to head up the program?

Terry Courtney: Dr. Joseph Chu and I will head the program together. Dr. Chu is our vice president for academics and research here at the university. He's in charge of the all the degree programs. This includes all academic programs and the Research Institute. Dr. Chu has also been involved in the planning and the curriculum development for the doctoral program. One of the nice things about offering the doctoral program at Bastyr is that we've been able to utilize a number of faculty across departments in assisting us with the planning process. For example, faculty from the basic sciences department, nutrition, psychology, research institute, etc. have all helped to create the curriculum.

Part of the reason we focused on oncology is because we have a number of faculty across departments who have a background in this area. We also felt that this is a great way to do cross-department teaching by offering a doctoral in this area.

AT: How long is the program?

Terry Courtney: It's eleven quarters, a little bit under three years. It's a part-time course of study that averages about eight credits a quarter, which is between two and three classes. It is specifically designed for someone who is maintaining a clinical practice and also in school at the same time. We are also looking at developing a full time schedule of study for people who want to do the doctoral in a shorter amount of time and do not plan to try maintaining a full-time practice while they are in school.

AT: How does Bastyr's program relate to the one being offered at OCOM?

Terry Courtney: Bastyr's clinical doctoral program has a focus in oncology. Our goal is to train practitioners to be able to work in integrated medical settings and be able to treat patients by utilizing TCM along with the allopathic course of treatment patients may also be receiving. My understanding is that the focus of OCOM's doctoral program is in women's health and pain management.

AT: Bastyr has sister college agreements with Chengdu and Shanghai Universities in China. How will the doctoral program affect those students? Will they be able to come to the States and earn their doctoral here?

Terry Courtney: The sister college agreements between Bastyr University and Chengdu and Shanghai are primarily a one-way affiliation, at least at the student level. Bastyr's doctoral students will be required to complete hospital rotations in China, both at Chengdu and Shanghai. This experience in China is in addition to required rotations here in Seattle at an outpatient cancer treatment facility that we have an agreement to work with.

AT: You're also chair of the Accreditation Commission for Acupuncture and Oriental Medicine, so if it's all right, I'd like to ask you a few questions from that perspective.

Terry Courtney: Sure.

AT: How many other schools have applied or are in the process of applying for the doctoral program?

Terry Courtney: There are several other schools that are in the application process.

AT: What are ACAOM's plans for accrediting doctoral programs in the future?

Terry Courtney: As doctoral applications come in that meet all the Commission's criteria, we will move forward on processing them. We can appreciate that the level of rigor and infrastructure needed to provide an academically rigorous doctoral program will limit the number of schools that are initially able to apply, as well as ACAOM's ability to approve them. However, ACAOM is open to receiving applications from any interested college. There isn't any limit on the number of schools that will be approved to offer the program.

AT: What are ACAOM's criteria for acceptance?

Terry Courtney: Schools are required to fill out a "substantive change form" based on ACAOM's standards for the accreditation of doctoral programs -- for example, faculty resources, program of study, library resources, staff resources, quality clinic facilities in appropriate allopathic settings, etc. The substantive change application is quite comprehensive and requires a school to clearly articulate all aspects of their proposed doctoral program. The Commission is then able to assess the application and determine whether all the necessary resources will be in place to support the program and its educational objectives. The purpose of the substantive change process is not only to ensure that a proposed doctoral program has the potential of meeting appropriate standards of higher education for quality doctoral training, but it is specifically designed to ensure that the offering of a doctoral program will not adversely impact the quality of the ACAOM accredited master's program in acupuncture or Oriental medicine. As part of the doctoral substantive change review process, ACAOM must ensure that critical resources will not be taken from the master's program to support the doctoral program.

Once a school has been approved by the Commission to start a doctoral program, the school must submit a candidacy report within 12-18 months of commencement. Following this step, schools then need to follow all the standard accreditation steps that other schools would normally take at the master's level. The accreditation review process is essentially the same for doctoral programs as it is for master's programs.

AT: Do you think the doctoral programs are going to replace the master's programs?

Terry Courtney: That's an interesting question. In many ways, it is up to our profession to determine this on a state-by-state basis. The evolution of the profession might very well move in the direction of doctoral as entry-level. ACAOM's current process has the flexibility to allow that to happen. Certainly other professions in the health care field have gone in this direction. I would note that the way that ACAOM has structured its current doctoral standards, colleges can elect to offer fully integrated entry-level doctoral programs where students in the doctoral program can receive both a master's and a doctoral degree upon completion of the curriculum for both master's and doctoral training. This structure would permit states that choose to do so, to revise their licensure standards to require graduation from an ACAOM-accredited or candidate doctoral program for licensure. However, before states could do this, there would have to be a critical mass of doctoral programs available in the U.S. If states moved in this direction before there were enough doctoral programs in place, it would pose a tremendous barrier to licensure and access to the field from a consumer perspective.

AT: We've noticed that a lot of states have begun introducing laws calling for increased education and training hours for acupuncturists. What is the Commission's position on increased education?

Terry Courtney: ACAOM's position is that if there is a clearly documented need for it, in terms of public safety concerns, and/or a specific change in required competencies of an acupuncturist, then an increase in hours may be warranted and necessary. However, if proposed hours increases for education are taking place that are not based on either public safety concerns and/or a change in the necessary clinical competencies, then all that's happened is that the consumer will ultimately be affected, because the increased educational costs, student loans, etc. will all eventually trickle down to the consumer. Academically speaking, any time hours in a program are changed, it's usually been based on one of those two things.

AT: So if it's not broke, then don't fix it?

Terry Courtney: The issue is clearly documenting in a statistically sound way, that there is a problem and then proposing a resolution that has academic merit. There are many ways to "fix" things. Sometimes it is a change in emphasis in the curriculum; sometimes a problem merits additional hours. It is not always more hours that guarantees that something will be fixed. To date, sound evidence that the curriculum is a problem hasn't really been demonstrated in many of the states that have considered changes to the educational standards for licensure.

AT: There has also been some discussion about the choice of the first two schools to get approved for the doctoral program. You're the program chair at Bastyr, and also the chair of ACAOM. Dr. Goldblatt is the president of the Council of Colleges of Acupuncture and Oriental Medicine, and also the president of OCOM. What would you say to those people crying favoritism on the part of your school and OCOM getting the doctoral programs?

Terry Courtney: I anticipated that occurring as both OCOM and Bastyr have significant infrastructures that allow for the doctoral program to be developed and supported rather easily. I also anticipated that in some ways, our strengths as institutions would probably be held specifically against us, and there's not much I can say about that. When you look at the rigors and requirements of these doctoral programs, a school has to have significant resources. As I said earlier, that's a tough step for many schools to take that are actually doing a great job at the master's level.

Taking the next step up to the doctoral level is a significant jump. If ACAOM simply approved doctoral programs that are not credible, it impacts the reputation and credibility of not only the Commission, but of the profession as a whole. I think that while it's easy to attempt to reduce the situation to one of favoritism, I also think it requires one to reflect and appreciate the level of rigor required with the doctoral, and to appreciate that the two schools that have so far been approved have been able to demonstrate adequate resources and academic rigor to offer credible doctoral programs.

Comments regarding favoritism are extremely unfortunate because they diminish the strengths these schools have when people reduce it to that level. It is also critical to state that ACAOM's process for approving any program is based exclusively on the Commission's professional judgment of program quality. The Commission consistently enforces its strict conflict of interest policies to ensure that its program approval decisions are based solely on program quality and are free from any inappropriate influences. This is one of the reasons the U.S. Department of Education has strict requirements of accreditors in the area of sound and unbiased decision making, and why ACAOM has been consistently found to fully meet those requirements.

AT: How do you think the move to offering doctorate programs will change the profession?

Terry Courtney: That's the $50 million dollar question, isn't it? In some ways, I think it is going to benefit the profession tremendously. In other ways, it remains unseen. For example, the doctoral degree will probably greatly assist the hospital credentialing process used to determine professional status and compensation within that setting. Or it may be that someone with a doctoral degree who wants to teach is going to be in demand. Also, practitioners with a doctoral degree who are interested in clinical research will certainly be better positioned to either pursue grants or participate directly in research. There are lots of professional benefits to this degree, but ultimately it's up to the professional community to decide what this degree is going to mean on a day-to-day basis. Since at the present time, there is no change in the scope of practice between a master's level trained acupuncturist and a doctoral level trained acupuncturist, it's really up to the profession to decide what it means in terms of expectations. That's why it's important for people to be involved politically to help shape the future of the profession.

AT: But if there isn't going to be a change in the scope of practice, why pursue the doctoral degree?

Terry Courtney: There are a couple of reasons. For one, there are people who want a higher level of education and want to take the study of TCM to a deeper and more profound level of understanding. This is not only for themselves, but for the benefit of their patients as well. There are also people who really want to learn research skills and become much more actively involved in research initiatives in Oriental medicine. The doctoral program has clinical training as its principal emphasis. However, the program also includes competencies in clinical research, which is vital in enabling practitioners to be educated consumers of scientific research in the field to support their professional practices. It is also important for allowing practitioners to participate in health care research should they choose to do so. There are also some people who, for whatever personal, professional or family reason, want to complete a doctoral degree.

I think it's safe to say that somebody could be interested in a doctoral degree and not necessarily be interested in the specific specialty area offered in a particular doctoral program. However, doctoral programs train students in skill sets that are transferable to other areas of interest. For example, someone may apply to Bastyr who does not necessarily plan to specialize in oncology, but wants to be able to do research in an acupuncture/Oriental medicine context. Our doctoral program would give them the training to do that. Similarly, the doctoral gives more advanced competencies in Oriental medicine diagnostic and treatment skills that are transferable to other areas of medicine.

So, does applying to our program mean that one has to practice oncology upon graduation? Absolutely not. But does it mean that you can take advantage of the course work, clinical training and research in the doctoral program for your future betterment and the benefit of your patients? Absolutely. Doctoral programs are meant to be both focused and also broad enough so that people can think about going through the program of study regardless of whether they end up practicing that particular specialization. We are able to teach you skills that become transferable to other areas of interest.

AT: Any last comments you'd like to add?

Terry Courtney: I just think it's just remarkable how much change and progress our profession continues to make, and I think it's an exciting time to be working in the field. The profession and the colleges spent almost a decade working on the skeleton for these doctoral programs, and conceptualizing it with the Accreditation Commission. I think there needs to be some very good recognition for the practitioner and educational community for all the effort that was put into this before doctoral programs were able to be launched, because it's been a very long time in coming.

AT: Thank you.

Acupuncture Today's Interview with Carol Taub

Acupuncture Today (AT): Congratulations to you and OCOM on getting the doctoral program.

Carol Taub: Thank you. We're excited.

AT: The doctoral program has been a long time in coming. How and why did the Oregon College of Oriental Medicine decide to go in this direction?

Carol Taub: OCOM has been discussing and developing a doctoral program for about 10 years. We knew that it would be a long time coming, but there was the concept that some day there would be doctoral-level education in this field, and that OCOM would like to be able to offer it.

I think in our minds that the goals of doctoral education have to do with the growth of the profession as a whole, and that Oriental medicine would not be as healthy a profession if it weren't able to develop some practitioners at a doctoral level - people who would not only be very expert in clinical practice, but who would have more ability to teach at the master's and doctoral level; to do research; to be clinical faculty and classroom faculty; and to have specialized areas of clinical practice. We saw these as roles that needed to be developed for the profession, and that as an institution, we would like to have a part in it.

AT: What effect will the doctoral program have on the master's program? Is there going to be any crossover between the programs?

Carol Taub: There are some definite, positive benefits we have defined that we have already talked with our students about. One benefit is that we're going to bring master faculty from China to teach in the doctoral program. While they're here teaching, they will also be available for students to do clinical observation with them, because they will have some faculty practice hours in the clinic. They will give master classes and offer elective courses for students in the master's program. We think having those faculty members on campus is going to be a tremendous boon to the students who are in the master's program.

One of the goals of the doctoral program is to strengthen faculty in our master's program. Some of the teachers who are currently teaching in our master's program will become students in the doctoral program. Each year, the school is going to sponsor a few faculty members to go through the doctoral program. That's another plus for the master's degree students in that their own faculty will be in a formal learning situation and improving their own skills and knowledge. In addition, we will be actively inviting faculty from other colleges of TCM to apply to our program. We are very interested in focusing on faculty development during the first few years, which would benefit master's degree students at other colleges as well.

AT: Is the program going to be open to any student who has obtained a master's degree in acupuncture, say, someone from a school in Texas or New York?

Carol Taub: Geography won't be a limiting factor, but we do have admissions requirements we've decided on for the first few years of our program, which include the prospective doctoral student having already had five years of clinical practice. The accreditation standard is that the person needs to have a master's degree in Oriental medicine or an equivalent, but in addition to that requirement, we've added that we want them to have at least five years of clinical experience. We may not always do it that way. Down the line, it could change and we would have people who are interested in stepping right from the master's to continue (on to the doctoral program), but in the beginning, we saw the program we wanted to create as being for experienced practitioners who wanted to go back to school to specialize in an area, and who are interested in being future faculty, clinical faculty, and researchers.

You're probably aware that there's an issue for people who went to school a long time ago and have many years of clinical experience but don't have an accredited master's degree. I'm an example of that; I went to acupuncture school and graduated in 1981, when schools were not accredited and did not offer degrees. We also have a different type of pathway of entry for those practitioners, because we think those are the people that really will bring the clinical knowledge and experience. But they are probably going to have to do some self-study to get ready for the program and take some challenge exams.

AT: If somebody needed to make up an extra class before getting into the doctoral program, would OCOM offer those types of classes?

Carol Taub: We're not going to actually offer classes, but we're going to print out a study guide for practitioners in which we define the core curriculum in our current master's program. People have to bring themselves to that level. We think that those who have been in practice for at least five years will be able to do this through self-study with guidance. For example, if someone needs work in the herbal realm, we'd want them to know X number of herbs and formulas and perform diagnosis at the appropriate level. We will provide a list of books and sample study questions in each area of our curriculum - acupuncture, herbs and Western biomedicine. The study guide will be available in September.

AT: When will you enroll your first class of students?

Carol Taub: We're going to start the application process in September. We'll have all the information available, including the application form and study guides, and begin to accept applications. The application deadline is mid-January 2003; the start of the program will be in mid-July.

AT: Who's going to head up the program?

Carol Taub: We have hired Shelly Simon to be vice-president of academic affairs at OCOM. Part of those duties will include her being director of the doctoral program. She's got a long history in the health field and also in the field of higher education. She's a doctor of chiropractic. She also has a doctor of education, as well as a master's in public health and an RN degree. She's got an incredible background. We're thrilled to have her.

Shelly hasn't actually started yet; she's consulting with us over the summer as we're trying to get some of these materials ready, but her start date is in mid-September.

AT: How long is the program?

Carol Taub: It's 25 months, and it's organized in monthly modules. Doctoral students will come onto campus for four or five intensive days a month. We're hoping it will allow practitioners - since we're making it a requirement that people already have five years of clinical practice - to maintain a clinical practice and still do the program.

AT: How does OCOM's program relate to the one being offered at Bastyr?

Carol Taub: We have heard that their program is more of an in-residence program as opposed to intensive modules. I've heard that Bastyr is going to offer oncology as a specialty. Our areas of specialty, at least in the beginning, are pain management and women's health, and possibly gerontology. That may not be until the following year. We've already developed the curricula for these three areas. Research is certainly a piece that runs throughout the curriculum, as is the study of the Chinese classics. A number of curriculum areas are there throughout the entire program. Our program will focus on the treatment of complex chronic conditions. We have three major phases to the program: advanced acupuncture for the first six months, internal medicine for the next 12 months, and the specialization area for the last seven months. The focus on complex, challenging, chronic conditions runs throughout the program. The specialization areas include six weeks in China, specifically working at the hospital within the specialty area. I think it's going to be great because we're bringing doctors from China who have these specialties as faculty for the doctoral students, then those doctors will return to China with the students and work in the hospitals with the students, so there'll be continuity between their studies in the U.S. and in China.

AT: That answers our questions about the doctoral program. We do have some questions that are more "political," if you're comfortable answering them.

Carol Taub: Sure; I'll take a stab at it.

AT: Do you think the doctoral programs are going to replace the master's degree programs?

Carol Taub: I think the answer to that is that we don't know at this point in time. I think OCOM's philosophy, similarly to the Accreditation Commission, has been that master's degree education was a very substantial entry level for the safe, effective general practice of Oriental medicine, and that the doctoral degree was deemed to be at a different level for the creation of specialists, scholars, researchers, teachers, etc. In that model, the idea of maintaining it that way seems very feasible to us, and yet we know that things may evolve differently in the profession.

AT: Another thing we've noticed is that a lot of states have begun introducing laws calling for, or at least suggesting, increased education and training hours for acupuncturists. What is OCOM's position on increased education?

Carol Taub: Speaking for myself, I think that there is always more to learn in any field of health care. We want our graduates to be lifelong learners. We want them to do continuing education, and we want the ones who are really serious to go ahead and pursue a doctoral degree. But we feel that for our graduates, with the number of hours that we have in our course and the quality that we offer here, their education is more than adequate for good, safe, effective practice. That's why we've been resistant to the idea of adding more hours, because you can always add more hours. We have people coming to us all the time, saying, "This would be interesting to add to the curriculum" or "This would strengthen the curriculum." That may be true, but would bring the programs to a level where they are not manageable for students within the framework of a master's degree education. We are confident that our students receive more than what is necessary to get out there and start working as good, safe, effective practitioners.

AT: The phrase we'd said to Terry Courtney about this was that if it's not broke, don't fix it.

Carol Taub: Yes. Exactly. I think that improving the quality of education should be the focus, rather than raising the number of hours.

AT: There has also been some discussion about the choice of the first two schools to get approved for the doctoral program. Terry Courtney is the program chair at Bastyr, and also the chair of ACAOM. Dr. Goldblatt is the president of the Council of Colleges of Acupuncture and Oriental Medicine, and also president of OCOM. What would you say to those people crying favoritism on the part of Oregon and Bastyr getting the doctoral programs?

Carol Taub: I can only speak for our own program. I know what it took for us to create this doctoral program. We had 10 years of general planning, and a year of a tremendous amount of expert input into developing this program. We worked with our faculty; we worked with our outside consultants, both in the field of education and medical doctors; and we worked with people who had accreditation experience in other fields, so we just did everything we could to follow those doctoral guidelines in great detail and develop a program that we thought would answer all of the things the Commission was asking for. I don't know whether the schools that weren't accepted put the same level of resources and time into their doctoral applications.

I think what Liza and Terry bring to the process is a really sophisticated understanding of what the Accreditation Commission is looking for in terms of quality. I know whenever we showed Liza the pieces after we had written them, she was able to look at it and say, "Well, I don't think this quite answers the question that they're asking here." So we'd go back to the drawing board to work on it some more. Terry and Liza have a lot of expertise.

AT: How do you think the move to offering doctorate programs will change the profession?

Carol Taub: I hope that it's going to strengthen the profession as a whole in the ways that I mentioned earlier, by creating stronger faculty; researchers; clinical faculty; scholars; and people at a different level than even a really good general practitioner. It will help us develop true specialists in certain areas of medicine. It will bring the profession to a level where other professions will be able to look at us and say our profession now has people in it who have earned an accredited doctoral degree. I personally think it's a big problem for the profession that people are using the title of doctor, or that some states allow them to use the title of doctor, but they haven't earned a doctoral degree. I think that's very confusing to the consumer, and to other doctors who they may want to interact with. So I think having a true, accredited doctoral degree developed is a move in the right direction. I think it's going to develop the future leaders and scholars and teachers in the field.

AT: In our interview with Terry Courtney, she had mentioned that the doctoral program isn't really going to change the scope of practice for acupuncturists. The question that we asked her, and that we'd like to ask you, is that if doesn't change the scope of practice, why would a person with a master's degree choose to pursue the doctoral degree?

Carol Taub: I don't expect that everyone will want to - or should - necessarily pursue a doctoral degree. I think the people who will want to are going to be the people who are hungry for more depth and breadth of knowledge; who are hungry to develop a specialization area and identify themselves in that way, as a specialist; and who want to work really closely with Western medical professionals, possibly with better access to hospitals. I think there are practitioners out there who just want to learn more. They want to get to the next level and go beyond what you can do in continuing education workshops and really further their knowledge. I hope there are people like that, because that is the type of doctoral student we would like to enter our doctoral program, as well as those with academic leadership capabilities.

We're only accepting about 18 students into our first class. At least for the first few years, the small cohort group of highly experienced practitioners will be our starting point. We will be evaluating the program from its onset. Part of good education is the ability to analyze it and shift it as needed.

AT: Any last comments you'd like to add?

Carol Taub: I think that the advent of clinical doctoral programs is an exciting advance for the profession as a whole, and we look forward to seeing positive growth and evolution in the coming years.

AT: Thank you for your time.


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