The question of whether the acupuncture and Oriental medicine profession should establish standards for accrediting first-professional doctoral programs has been debated at length for more than two decades.While a consensus on the benefits of a doctoral program has yet to be reached, the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) has assumed the responsibility of laying out a framework for an accredited doctoral degree.
In December 2002, the Commission took a considerable step forward in the doctoral degree process, when it issued a national survey to determine whether there was adequate support from the profession for the creation of standards for first-professional doctoral programs in acupuncture and Oriental medicine, along with a timeline for ACAOM-accredited schools to transition from offering Master's degree programs to doctoral programs. The survey was posted first on acupuncturetoday.com, then printed in the February 2003 issue of Acupuncture Today to increase awareness of ACAOM's proposal, and to allow practitioners, educators, students and others a chance to provide feedback to the Commission.
Between December 2002 and April 2003, a total of 935 responses were received from students, practitioners and other interested parties. ACAOM conducted an analysis of the results in June 2003, and recently posted the analysis for review on its Web site.
- The majority of those who took the survey listed themselves as practitioners, patients or students. (Respondents were allowed to select more than one category.) More females (571) than males (344) answered the survey (20 respondents declined to indicate gender). There was a nearly even split among respondents in terms of age group: 454 were 45 years of age or younger; 465 were over age 45; and 20 declined to comment.
- Five states (California, Colorado, Maryland, New York and Oregon) accounted for over 56 percent of the response group. Eleven states were not represented in the survey.
- There was no clear support for, or opposition to, the ACAOM doctoral proposal; 48.5 percent of the respondents "support" or "strongly support" ACAOM's proposal, while 49.1 percent "oppose" or "strongly oppose" it. Only 22 people who took the survey said they were neutral on the subject.
- When analyzed by type of respondent, students and members of state and/or national organizations were the only groups in which a majority of members supported the doctoral proposal. All other groups (administrators, regulators, patients, practitioners and faculty members) generally opposed it.
- The principal reasons for supporting the doctoral program were that it would increase the overall quality of patient care; bring increased credibility and prestige to the profession; and increase overall standardization and uniformity in training.
- The principal reasons in opposition to the doctoral proposal were that the current training is sufficient for entry-level competency; that a 4,000 hour curriculum would not be needed to achieve entry level competency; and that it would hurt minority acupuncture/Oriental medicine traditions.
Based on the results of the analysis, the Commission has decided that, while there is not adequate support to transition to doctoral-level education at this time, ACAOM should nevertheless develop standards for first-professional doctoral programs for institutions that are interested in offering such training. Toward that end, the Commission in 2004 will convene a Doctoral Task Force, comprised of representatives of several of the profession's leading organizations, to develop standards for an entry-level doctoral program. To learn more about the survey and the composition of the new task force, Acupuncture Today contacted ACAOM Executive Director Dort Bigg for more information.
Acupuncture Today (AT): There was a nearly identical split in the survey - 48.5 percent of the respondents supported the doctoral proposal, while 49.1 percent opposed it. Why do you think there was such a split?
Dort Bigg (DB): I really can't speak for the individuals who chose to complete this survey, but I believe that most of the individuals who chose to respond, did so based on their strong feelings about this issue, both pro and con. The survey shows that the vast majority of respondents were either strongly supportive of the ACAOM doctoral proposal or in strong opposition to it, with relatively few respondents in between. There is obviously significant disagreement and strong feelings within the profession on the topic of doctoral education, and many of these differences are regional, with respondents from the West Coast generally supporting the ACAOM doctoral proposal and those from the East Coast opposing it.
AT: When you analyze the results of the survey by category, you'll see that a majority of students and representatives of state and national organizations supported the proposal, but everybody else - practitioners, faculty members and regulators - generally opposed it. What does that say to you about the state of the AOM profession?
DB: It says to me that the profession and all its communities of interest are not of one mind on the subject of doctoral education. It also appears to reflect a profession that is too focused on fighting amongst itself, rather than focusing on the real external threats that the profession faces. This is consistent with some of the recent legislative and regulatory battles that have raged over the past few years with regard to educational requirements for licensure.
The constant infighting and bickering among different segments within the profession is the principal reason the national organizations agreed to sponsor and support the national visioning process for the profession. The visioning process is designed to result in a national visioning conference of approximately 75 individuals representing all of the profession's key stakeholders with the intent of establishing a national vision for the future direction of the profession. If this process succeeds, the levels of disagreement and strife within the profession should lessen. At least, that's the intent.
AT: Of the faculty members who did support the doctoral proposal, 70 percent of those trained outside North America were in favor of the proposal. Only a third of those trained in North America supported it. What do you think was the rationale behind these responses?
DB: I really can't respond to your question as I have no current data on the reasons faculty trained in North America as opposed to being trained in other countries responded the way they did.
AT: The two main reasons given among those who supported the proposal were increased credibility and prestige, and increased overall quality of patient care. How would the doctoral program improve patient care and raise the profession's prestige and credibility?
DB: Although I am not speaking for myself, many who supported ACAOM's doctoral proposal and submitted additional written comments in the survey felt that doctoral training would provide an education of greater breadth and depth than what is currently offered in Master's programs, and that this would result in more advanced diagnostic and clinical skills, which translates into improved patient care. They have also cited the fact that in many other health care professions, doctoral education is the entry-level educational standard for practice, and the fact that our educational standards are currently at the Master's level has resulted in the profession not being taken as seriously as it should by state legislators, managed care administrators, and other health care providers such as physicians. They believe that if the profession adopts doctoral-level educational standards, the profession will achieve a greater level of prestige and respect, will have a better foundation on which to seek legislative and regulatory changes to advance the profession's interests, and will make inroads relative to inclusion in the managed care system.
AT: Of those who opposed the proposal, the chief reason was that the current training is sufficient for entry into the profession. What is ACAOM's stance on the current level of training? Does it need to be improved? If so, how?
DB: Certainly, the safety record for the profession is excellent for those trained under the current Master's level requirements, and we believe that the graduates of current programs are providing safe and effective services to consumers as reflected in patient satisfaction surveys. Having said that, as a nationally recognized accrediting agency, ACAOM needs to ensure that its standards and accreditation processes have the support of all the profession's stakeholders and take into account developments within the profession. It is for this reason that ACAOM recently adopted amendments to our Master's standards. But just because Master's standards are already in place and the graduates of Master's programs are providing safe and effective services to their patients, does not mean that ACAOM should not develop doctoral standards for those colleges that wish to offer them. In the final analysis, it will be the marketplace, not ACAOM or anyone else, that determines whether doctoral or Master's-level education becomes the entry-level standard for the field.
AT: Regarding the creation of a doctoral task force: How did ACAOM arrive at this decision?
DB: As you know, there has been substantial debate among various segments of the profession relative to doctoral education for the field. These debates have clearly been reflected in the publications of professional AOM organizations and in a few state regulatory/legislative proposals to increase state educational requirements for licensure. As a U.S. Department of Education-recognized accrediting agency, ACAOM must ensure that its accreditation standards and processes are responsive to all our communities of interests, including educators, practitioners, licensing boards, professional organizations, consumers and the like.
Given these debates, to fulfill our responsibilities as an accrediting agency, ACAOM believed it needed to assess whether there was sufficient support among all the profession's stakeholders to move towards doctoral education. The Commission conducted the national survey to assess whether there was sufficient support within the profession for ACAOM to develop standard for first-professional doctoral programs in AOM and to adopt a transition period during which all educational institutions currently offering ACAOM accredited or candidate acupuncture or Oriental medicine programs at the Master's level must convert those program to the doctoral level. The results of the survey revealed substantial disagreement within the profession on whether ACAOM should require programs to transition to doctoral training. Since many of the survey respondents did not support a transition to doctoral education, and expressed strong support for retaining the current Master's level standards, the Commission felt it did not have sufficient support to require all Master's programs to convert to doctoral programs. However, given the substantial support for doctoral education among other segments of the profession, the Commission believed that it should develop accreditation standards for doctoral training. This is the impetus for the establishment of the task force.
ACAOM will not be requiring any of our current accredited or candidate institutions and programs to convert their Master's-level programs to the doctoral level, but we will develop standards for first-professional doctoral programs to allow educational institutions that wish to do so to offer such programs, and to provide the profession's stakeholders the opportunity to determine the future of doctoral training for themselves.
AT: What are the task force's short-range and long-range goals?
DB: The ultimate goal of the task force will be to develop curriculum standards for first-professional doctoral programs in acupuncture and in Oriental medicine. The task force will initially examine state educational requirements for licensure and scopes of practice, with a particular focus on those states with higher requirements and broader scopes of practice. This step will hopefully educate task force members on state requirements to help ensure that the standards ultimately adopted will be responsive to the needs of the various states that choose to move in the direction of doctoral education for licensure. The task force will also initially identify the professional competencies that graduates of first-professional doctoral programs should possess. Based on all of this information, the task force will then develop draft standards for doctoral training.
AT: How is the task force comprised?
DB: The task force will include three representatives of the American Association of Oriental Medicine (AAOM); three from the Acupuncture and Oriental Medicine Alliance; four from the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM); two from the Federation of Acupuncture and Oriental Medicine Regulatory Agencies (FAOMRA); two from ACAOM; one representative from the World Federation of Chinese Medicine Societies; and one representative from the National Federation of Chinese TCM Organizations.
All of the organizations that have been invited to appoint representatives to the task force have been advised that their appointees must agree to support the work of the task force to develop credible standards for first-professional doctoral programs in the field. Task force representatives who do not support its mission and work will be requested to resign. In addition to this general requirement, specific criteria are in place for task force members appointed by each organization. For example, the AAOM and Alliance representatives must possess significant experience as practitioners and/or significant experience in education within the field, and all must be licensed practitioners. The CCAOM representatives must be faculty members, clinical directors or academic deans in acupuncture and Oriental medicine colleges, and not college administrators. All CCAOM representatives must be teaching faculty. FAOMRA representatives must be practitioner members of licensing boards who are willing and able to represent all FAOMRA members and the interests of state regulators, rather than just the interests of the specific licensing board on which they sit.
We believe this composition will be quite effective in ensuring that the task force's work reflects the views and perspectives of practitioners, educators, regulators, professional organizations and other relevant stakeholders in the AOM profession.
AT: How will ACAOM ensure that the views of all of the profession's stakeholders are taken into account?
DB: First, the composition of the task force itself is designed to ensure that the major perspectives within the profession are taken into account as the standards are developed, including those of practitioners, professional associations, educators, regulators, etc. To ensure input from state professional organizations and practitioners, the national professional organizations such as AAOM have agreed to coordinate input into the standards development process from their state affiliates and by seeking input from their membership. For example, AAOM could serve as an extremely effective liaison between the Doctoral Task Force and state affiliates.
In addition to the composition of the task force, ACAOM intends to publish drafts of the standards and invite written public comment on them. We will also be conducting public hearings to permit practitioners, educators, regulators, members of the public, and other relevant stakeholders to provide oral testimony on the content of the standards. All public comment will be submitted to the task force as it considers further revisions and refinements to the standards, and subsequent drafts of the standards will go through the same public comment process until there is sufficient support to adopt the standards as final.
AT: Why wasn't the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) included in the task force?
DB: NCCAOM chose not to participate based on its mission, which relates to measuring competencies, rather than assessing the quality of education.
AT: Do you plan on adding representatives from any other organizations in the future?
DB: At this time, ACAOM sees no need to include other groups. We believe the task force's size and composition are optimal to complete its charge.
AT: How often will the task force meet?
DB: I would anticipate the task force meeting two times per year until standards are developed and finalized. We will be attempting to hold the first task force meeting sometime before the Spring 2004 national AOM meetings.
AT: What does ACAOM, and for that matter, the AOM profession, hope to achieve with the creation of this task force?
DB: The immediate goal is to convene a credible task force of nationally recognized experts in AOM practice, education and regulation that is likely to have the support of the AOM community to provide leadership in developing standards for first-professional doctoral programs in acupuncture and in Oriental medicine. The development of credible standards for first-professional doctoral programs in AOM is, of course, the ultimate reason ACAOM established this task force.
AT: Are there any closing remarks you'd like to make?
DB: My only comment is that we are interested in hearing from anyone who wishes to provide suggestions that will help the task force conduct its work. The most useful comments at this early stage would be relative to the professional competencies that the graduates of first-professional doctoral programs should possess. If any of your readers wish to provide written comments they should be mailed to ACAOM's Maryland office at 7501 Greenway Center Drive, Suite 820, Greenbelt, Maryland 20770. I can assure you that all comments received will be submitted to the task force for consideration.
AT: Thank you.
Editor's note: The complete analysis of the ACAOM doctoral survey is available at www.acaom.org, under the "Documents & Forms" section.