Increasingly, acupuncture and Oriental medicine (AOM) schools are expanding intern experiences beyond on-site school clinics through off-site clinics. A recent survey of the 49 member colleges of the Council of Colleges of Acupuncture and Oriental Medicine found that 24 schools in 13 states offered acupuncture intern work shifts at 116 clinics, ranging from mobile clinics to hospices.Not only does this role for AOM colleges in their local communities expose more potential clients to acupuncture, it greatly enhances students' clinical education through real-world practical experience.
There is a broad range of multidisciplinary clinical settings in which each school responds to its community's specific needs. These include hospitals; multi-specialty centers; research-based centers; long and short-term rehabilitation centers; family practice clinics; nursing homes; out-patient geriatric/assisted living centers for seniors; drug treatment centers; HIV/AIDS treatment facilities; pediatric, cancer, and other specialty care centers; clinics addressing specific community group needs, such as for women's health and inner city/low income/multi-racial groups; and sports medicine clinics.
A number of these clinics are affiliated with university teaching hospitals. Supervisors and students alike take the opportunity to present in-service education so that their allopathic colleagues can make the most of the internships. This educational role benefits students' communications skills and can result in more referrals of patients by physicians for acupuncture services. Interns have reported being impressed by the positive response of the patients and medical staff who have been welcoming, available to talk, and interested in working side by side. The welcome is especially helpful when dealing with treatment rooms that are not set up for acupuncture and support staff that are unfamiliar with Oriental medicine procedures.
Several AOM programs send interns to clinics that have a large patient population of recent immigrants. Not only do interns have to learn about the healthcare culture of the immigrants and perhaps some of their language, they also get a chance to see a variety of illnesses that does not often appear in school clinics. A student might be faced for the first time with hepatitis, severe trauma, or polio. There might also be issues about compliance with the treatment plan because of economic constrictions or specific cultural biases.
One culture that is often unknown to students is that of street people. Interns can find that the self-reporting of this population may be inaccurate and fairly emotional. The reward of working with this population is unique because acupuncture may help to resolve physical problems by calming the mind so that patients can let go of their attachment to the emotional stress.
A majority of physician referrals in these settings are for pain, but once patients are relaxed and receptive, they often describe other health problems and benefit by resolving more than their primary condition. Interns have found that although most of their new patients are not familiar with acupuncture before their referral, there is usually a waiting list for return visits.
As at school clinics, the healing process in off-site clinics can prove to be incremental. When patients improve emotionally and physically, they tend to reveal more history and symptoms. Interns may have to chart additional conditions and learn to refer to western diagnostic terminology so they can write chart notes in Western terms. With layered conditions and a treatment time that is often less than that of a school clinic, interns must target the chief complaint and unravel the rest over a series of treatments.
Administratively, it can be challenging for AOM schools to work with bureaucracies associated with non-school clinics. Coordinators have observed that setting up programs has become more complicated over the years. Sometimes it is difficult working with large organizations because they can be insular and change their requirements from year to year. Background screenings and other requirements for interns have increased recently and are inconsistent from one setting to another. There is also more recordkeeping, more intricate HIPAA compliance, and a requirement for more diligent oversight. That administrators persevere in maintaining these relationships is a testament to their value. Because integrated medicine is seen as being a strong component of the future of acupuncture practice, the exposure interns get during their training in off-site clinical settings is good preparation.
There are many benefits to off-site clinical experience: providing acupuncture to people who cannot afford it, inspiring interns to work with disadvantaged populations in their professional careers, showing medical colleagues how helpful AOM can be, developing a sense of professional responsibility in AOM practice, and the possibility of retaining some of the same patients when the interns start their own private practice.
Physicians at off-site clinics have reported that some of the incentives for integrated care involving AOM include excellent clinical results and improvements in case management. Additionally, medical doctors have benefited by getting a chance to see what other modalities can offer, and how these treatments can be administered in a less expensive and less invasive manner than is often the case with the Western diagnostic system. Allopathic colleagues have appreciated that acupuncture can be more effective in the long-term than relying solely on medication for symptom relief, especially concerning complaints of non-specific pain.The off-site clinics in which the Council's member colleges participate not only provide opportunities to broaden the experience of AOM students, but also reflect the institutional commitment of the colleges to one of the major founding goals of the Council: to increase public awareness of and access to high quality health care provided by well-trained practitioners of AOM.