Development of Chinese Medicine Education in the United States: Two Examples of Pacific College of Health and Science New York and Eastern School of Acupuncture and Traditional Medicine : Chinese Medicine and Culture

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Development of Chinese Medicine Education in the United States: Two Examples of Pacific College of Health and Science New York and Eastern School of Acupuncture and Traditional Medicine

Jin, Qi-Hui1; Zhou, Yan2; Kouo, Thomas3,✉; Xiao, Bin4,✉

Author Information
Chinese Medicine and Culture 5(4):p 221-227, December 2022. | DOI: 10.1097/MC9.0000000000000034
  • Open

Abstract

1 Introduction

Chinese Medicine (CM) originated in China and spread to Europe in the 17th century. Acupuncture, as an important part of CM, was brought to the United States during the 1800s.1 After many years of professionalization and legislation, acupuncture, compared to Chinese herbal medicine, has become one of the most popular complementary and alternative medicines in the United States.2 The US National Health Interview Survey (NHIS) 2007 explored that about 14.01 million Americans have been receiving acupuncture treatment in 2007.3 As of January 1, 2018, there are 37,886 licensed acupuncturists practice in California (12,135; 32.03%), New York (4438; 11.71%), and Florida (2705; 7.13%),4 respectively. One hundred and thirty-three diseases, conditions, or symptoms were recognized by the World Health Organization which can benefit from acupuncture.5 Among the 50 states in the United States, only South Dakota, Oklahoma, and Alabama do not have legislation and regulation on Acupuncture; the rest of the 47 states and the District of Columbia require licensure to be able to practice.6 However, none of the states has legislation and regulation on Chinese herbal medicine. Herbal products are generally regulated as dietary supplements. Currently, 51 Acupuncture and Oriental Medicine schools throughout the United States have received accreditation and recognition by the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM).6 According to ACAHM,7 California, New York, and Florida are the top three states that have most licensed acupuncturists. They have 13, 3, and 6 accredited Acupuncture and Oriental Medicine schools, respectively. Only education offered by colleges which received the ACAHM accreditation are accepted for licensing in all US states except California, and as the pre-requisite for taking the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) examination. Previous studies have looked at complementary and alternative medicine curriculum in the American medical schools. We have chosen two cases of acupuncture schools in the United States to provide more details of CM education including their school history, curriculum, student and faculty number, teaching clinics, and etc. Previous studies have rarely discussed the history and curriculum of these two schools, and there was no systematic analysis of CM education in the United States. This study aims to discuss and compare these two cases based on the information collected through literature search and interview.

2 History of CM education in the United States

In 1969, the first and only organized acupuncture class in the United States was held at the Institute for Taoist Studies (ITS) in Los Angeles.8 Ten students sat and learned acupuncture from Dr. Gim Shek Ju who taught an apprenticeship program at the ITS.9 Dr. William Prensky and Dr. Steven Rosenblatt were two of the 10 students who followed Dr. Ju for over 5 years learning CM and acupuncture. They were two of the earliest non-Asian acupuncturists in the United States. They had played a major role in the development of CM and acupuncture at the beginning of the CM education.10 They were graduate students in psychology at the University of California, Los Angeles (UCLA), and, during that time they were doing research on pain relief without any big improvement. They were looking for another modality or method that is something new and different from what they were doing. Tai Ji practices were brought to their mind. After studying and discussing a few weeks of Tai Ji with Marshall Hoo, they were introduced to Dr. Gim Shek Ju, and started learning CM and acupuncture in 1969.

Two years later, in 1971, before President Nixon’s visit to China, a reporter from the New York Times named James “Scotty” Reston published a seminal article about his experience of receiving acupuncture for abdominal pain due to appendicitis in China.11 Acupuncture has become the attention of the public and the US medical community. Along with the booming period, Dr. William Prensky and his team founded the National Acupuncture Association (NAA) and helped to draft out the first legislation of practicing acupuncture and accreditation of the first two acupuncture colleges in the United States.8 California Acupuncture College (CAC) was one of the first accredited educational acupuncture school and eligible for licensure which founded by a group of NAA members in the early 1976.

About the same time frame in the 1970s, auricular acupuncture as another form of practice in the United States was introduced to assist opioid addiction treatment in New York. In the mid-1970s, Dr. Michael Smith who worked at Lincoln Hospital in the South Bronx area of New York was inspired by a research that was done by Chinese neuro-surgeon H.L. Wen about reducing opium withdrawal symptoms by using electrostimulation on ear Lung point.12 In the early 1990s, Lincoln Detox, a department at Lincoln hospital, started to offer a 2-week training program to certify Acupuncture Detoxification Specialists. This training program allows non-acupuncture practitioners to perform NADA protocol under licensed acupuncturists or medical doctors’ supervision.12,13 As more and more people know about and are learning acupuncture and herbal medicine, a national level credentialing organization was needed in the meantime. The NCCAOM was established in 1982. It is a non-profit organization that serves as a board examination and certification for state-level licensure. According to the state licensure requirements on the NCCAOM website, each state regulatory board has different requirements for licensure. The NCCAOM holds four examinations including the Foundations of Oriental Medicine, Acupuncture with Points Location, Biomedicine, and Chinese Herbology.14

The ACAHM, a specialized accreditation agency recognized by the United States Department of Education (USDE), was founded in 1984 to serve as the nationally recognized accrediting agency in acupuncture and East Asian Medicine (EAM) programs and institutions exclusively providing EAM-related programs.15 In 1990, Clean Needle Technique (CNT) certificate was added for licensure in acupuncture provided by the Council of Colleges of Acupuncture and Herbal Medicine (CCAHM).16 The CCAHM provides training on assessment and allows for interprofessional collegial sharing of resources but does not act as a regulating body. Each accredited institution is required to perform comprehensive assessment including faculty evaluations. Evaluations are provided by students at the completion of each course offering.

3 Current acupuncture practice in the United States

Acupuncture was firstly legalized in April 1973 in Nevada in the United States. As of 2021, there are a total of 47 states and the District of Columbia that have regulations on acupuncture practice. However, Chinese herbal medicine is only regulated as dietary supplements, so it does not require a license to practice. As only acupuncture is legalized, this section will introduce acupuncture practice instead of the general CM practice.

As of July 14, 2020, according to the New York Labor department, there are 3,986 active licensed acupuncturists providing both physical and mental health care to society. According to the scope of practice for acupuncture in California, for instance, acupuncturists can perform or prescribe the use of Asian massage, acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal, and mineral products, as well as dietary supplements to promote, maintain, and restore health.17 In January 2020, Medicare, a government national health insurance program for people aged 65 or older, included acupuncture treatments for chronic lower back pain.18 More and more mainstream commercial health insurance started to cover acupuncture for pain management, morning sickness, or nausea during pregnancy or chemotherapy, headache, migraine, anesthesia during surgery, etc. Currently, most acupuncture practices accept insurances that cover acupuncture but paying out-of-pocket is still the major payment method.

To become a licensed acupuncturist in the United States, one needs to find an ACAHM-accredited school and completes the total education hours requirement that applies to the state that one wants to practice. The minimal education hours in acupuncture set by the NCCAOM is 1,905 hours, while California Acupuncture Board requires 3,000 hours. Once finished with the acupuncture and CM program, one can register to participate in the board exam held by NCCAOM or California Acupuncture Licensing Examination (CALE) after obtaining the CNT certificate from CCAHM. CALE is the exam for licensure in California. After passing the required exams, one can apply for an acupuncture license in the respective state of practice. In addition, 60 points of continuing education unit (CEU) are required to renew the NCCAOM certification in a 4-year recertification cycle. Only 27 states require NCCAOM certification for licensure.

4 Acupuncture and Chinese herbal medicine educational programs

In the United States, there are two most common acupuncture-related master’s programs - Master of Science in Acupuncture (MSAc) and Master of Science in Traditional Oriental Medicine (MSTOM). Certificate in Chinese herbal medicine (CCHM) is a complementary certificate that helps MSAc holder to practice herbal medicine in the regulated states. For doctorate programs, there are Doctor of Acupuncture (DAc), Doctor of Acupuncture and Chinese Medicine (DACM), and Doctor of Acupuncture and Oriental Medicine (DAOM).19 For example, the Oregon College of Oriental Medicine (OCOM), DACM enables graduates of master’s programs of acupuncture and CM to augment their knowledge, skills, and behaviors to a level consistent with OCOM’s entry-level DACM standards.19 This program allows master students to attain an entry-level doctoral degree which fills the gap of becoming a licensed acupuncturist at master level before proceeding to the terminal and highest level of DAOM. The DAOM program is an advanced clinical doctoral program. Candidates must be licensed active acupuncturists throughout the duration of this program. Some schools offer both English and Mandarin doctorate program. For example, the Five Branches University provides opportunity of international externships in Asian countries.

Each state has a different education requirement. To meet professional education requirement in acupuncture or oriental medicine programs, for example, New York state stipulated that a minimum of 4,050 hours of classroom instruction, supervised clinical experience, and out-of-classroom or out-of-clinic study assignments must be achieved. Professional education requirement varies in different states. Passing the NCCAOM examinations is one of the requirements for licensure in each state, however, meeting the education requirement is the other.

There are currently enough textbooks available in both eastern and western medicine for students to use in their courses. In the past 10 years, there has been a tremendous number of new textbooks written in English or translated from Chinese language. The foundational texts have become standardized for more than 20 years. Supplementary texts on specific topics such as CM Theory have also been recently published.

5 Pacific College of Health and Science-New York Campus

Pacific College of Health and Science (PCHS) is a for-profit private school originally founded in 1986 in San Diego. Its former name was Pacific Institute of Oriental Medicine (PIOM). PIOM only offered acupuncture programs as well as acupuncture and herbal medicine programs when it was established. As PIOM was accredited by CCAHM and the New York State, the school changed its name to Pacific College of Oriental Medicine in 1990. It became the first accredited acupuncture school in New York. As the school expands, its New York and Chicago campuses were founded in 1993 and 2001, respectively.

In 2008, the doctorate program at Pacific College San Diego received its accreditation. In 2010, the Swedish Institute and Pacific College New York were bought by the same owner of Pacific College of Oriental Medicine. It resulted in the merging of acupuncture programs in both schools. The Swedish Institute’s acupuncture curriculum was based on Master Jeffrey Yuen’s teaching in Classical Chinese Medicine (CCM), whereas the Pacific College’s acupuncture curriculum was based on TCM. CCM utilizes the complete channel system which takes ancient cycles and patterns into consideration in diagnosis and treatment. After the merger, the new curriculum which consists of both CCM and TCM is taught only at Pacific College New York campus.

The Pacific College New York was founded by Alex Tiberi and Jack Miller, while the Swedish Institute was family owned since the late 1800s. Paula Eckardt was the former President of Swedish Institute, while Jack Miller is currently the President of PCHS.

As of January 1, 2020, the Pacific College of Oriental Medicine changed its name to the PCHS. The school offers degree programs such as MSAc, MSTOM, Associate of Occupational Studies in Massage Therapies (AOS), Master of Science in Nursing (MSN), and online transitional doctorate programs – Doctor of acupuncture (tDAC) and Doctor of acupuncture and Chinese medicine (tDACM), and online certificate programs in Medicinal Cannabis, Health Coaching, Integrative Public Health, Yoga, and Cosmetic Acupuncture.

Prior to the coronavirus disease 2019 (COVID-19) pandemic, the MSAc, MSTOM, and AOS programs were taught in person. Starting from March 2020, all programs have an online component. Some courses have gone virtual completely while some courses become hybrid. The instructors at PCHS utilize quizzes/examinations, papers, or presentations to measure course outcomes. Students who attend in each course are required to buy specific textbooks by themselves. There are also recommended books as well as other resources stated in the course syllabus for students use as reference for their study. In the MSAc program, students are required to take both western medicine, biology, and the oriental medicine course which account for 30.34%, 1.87%, and 20.97%, respectively.

The school’s curriculum for the MSAc program emphasis heavily on student’s hands-on experience in the clinical settings. The school has a clinic where the clinical training mainly takes place. There are several offsite clinics that have affiliations with PCHS where students can apply to do their clinical courses outside of the school. As of August 2022, these offsite clinics include the New York Harm Reduction Educators, The Institute for Family Health, Yinova, Kamwo, and Columbia University Health Clinic.

According to the PCHS policy, the instructor must have a master’s degree and at least 4 years of experience in the field of teaching and 5 years of experience in clinical supervision in order to teach in the MSAc and MSTOM programs. The program review is conducted by the school faculty governance committees internally. The chairs of every department of the school perform a review of the faculty each trimester. Externally, the American Association of Colleges of Osteopathic Medicine (AACOM) audits the school every 3 years, while the Western Association of Schools and Colleges’ Senior College and University Commission audits the school every few years.

Approximately 1,950 students have graduated from MSTOM and MSAc programs. In 2021, PCHS has conducted a survey with graduates. The response showed that 87.6% of the graduates remained practicing in the CM field. As of July 30, 2022, the current student number in MSAc and MSTOM programs at PCHS-NY is 124 and 241. The total student number at PCHS-NY is 1,793.

6 Eastern School of Acupuncture and Traditional Medicine

The Eastern School of Acupuncture and Traditional Medicine (ESATM or the Eastern School) is an institutionally accredited school by ACAHM for both the MSAc and Certificate in Traditional Herbology (CTH) programs.

ESATM was founded in 1997 by Julie Puretz, LAc. Julie intended to establish the Eastern School to introduce the profession of acupuncture in New Jersey.20 Thus, it was the first acupuncture school in the state. The curriculum was initially modeled after the curriculum of Tri-State College of Acupuncture where she graduated. The school, which is fully accredited by ACAHM, remains the only college of EAM in New Jersey State offering a licensing program before 2021.7

In 2015, the ESATM re-conceived the curriculum and changed from seminar style to trimesters. The fall 2016 semester featured a new, expanded curriculum designed to educate and prepare students to be outstanding practitioners in the field of Asian medicine, and hence the institution was approved for the first master’s degree in acupuncture in the state of New Jersey.

The college has been active in the CCAHM since its founding in 1997, with the current Dean, Dr. Thomas Kouo, having served for 6 years on the Executive Committee as a representative of the ESATM. Moreover, he served as the past chair of the CCAHM Herb committee. Currently, he is serving as the Vice-President of CCAHM and co-chair of the CCAHM School Clinics Committee. The ESATM has made a concerted effort to be a leader within the field. This effort leads to the subsequent success of establishing community acupuncture and herbal medicine schools. The ESATM began its institutional accreditation with the ACAHM in 2003 and has maintained its accreditation without interruption since then.7 Prior to 2016, the college offered a master’s level Certificate in Acupuncture, and in 2016 the New Jersey Office of the Secretary of Higher Education approved the school’s Master of Science degree in Acupuncture, a milestone for the school and for the state.

In addition to its programs, the ESATM has enjoyed a consistently well-attended series of CEU classes held several times per year taught by Kiiko Matsumoto and Jeffrey Yuen. Additionally, ESATM’s 2019 Strategic Plan called for an expansion of ESATM’s CEU program to create an additional viable revenue stream. With a brief period of inactivity due to the COVID-19 pandemic, the ESATM has enjoyed an expanded program with the Sports Medicine Acupuncture Certification (SMAC) program and the Neuropuncture training held on the campus. These two major programs have attracted other inquiries for CEU offerings that have helped to increase revenues without additional investment of ESATM resources. Practitioners have traveled from all over the country to attend these classes at the ESATM and the school’s positive reputation is built through positive exposure and association. When the COVID-19 pandemic closed the state down, the ESATM had been making contingency plans and the institution was able to move to remote classes and clinics without any loss of class time. No staff or faculty missed any days of work due to the state shutdown and the transition to remote operations. Their transition was successful, and their community came together to figure out how to make the best of the online clinic through guided casework and a modified form of telemedicine that they piloted. When it was safe to do so, the school brought its clinic back to campus and has been back with few interruptions since. Their staff was evacuated from campus early in the pandemic and have learned to work effectively and efficiently from home. As the COVID-19 pandemic is not over, the staff has maintained a half/half presence on campus and working remotely. The Eastern School has shifted its modes of communication from an “open door” policy, to email or ZOOM meeting correspondences. The “open door” policy remains, but the staff is not in the office as much as they used to be.

All of the wonderful changes that the Eastern School has recently adopted stand as a reminder that we must continually work diligently to meet the challenges of a growing school in a dynamic profession. The ESATM lives by the ethic of perpetual work to improve its educational programs and its administrative effectiveness. While the school remains relatively small, each team functions collaboratively and supportively to maintain its solid foundations. The College has a “group process” structure where individuals work as a team to perform educational analysis, foster curriculum revision, and utilize a variety of evaluation methods to assess learning outcomes. Their inter-team communication remains a strength by which they have been able to efficiently adjust and exhibit strong, good judgment in keeping the institution thriving even under difficult circumstances. The self-study process which is based on ACAHM requirements and criteria gives the college a framework within which the entire community participates and grows as a result of their own self-reflective review.

For CM education in these two colleges, there are some similarities and differences in the curriculum (See Table 1). The Eastern School has another CTH program, so it does not have any herbology course in MSAc.

Table 1 - Comparison of MSAc curriculum settings between PCHS and ESATM
PCHS ESATM
Course category No. of courses Units Credit hours Hr% Unit% No. of courses Units Credit hours Hr% Unit%
Oriental medicine 10 28 420 16.77 20.97 13 39 585 21.66 25.77
Acupuncture 11 24.5 450 17.96 18.35 9 27 405 15.00 17.84
Western medicine 16 40.5 660 26.35 30.34 13 39 585 21.66 25.77
Body work (Qigong, Tuina) 3 4.5 90 3.59 3.37 4 8 120 4.44 5.29
Clinical 15 26.5 735 29.34 19.85 8 28.7 860.5 31.86 18.96
Business 2 5 75 2.99 3.75 2 6 90 3.33 3.96
Biology 1 2.5 45 1.80 1.87 0 0 0 0.00 0.00
Herbology 1 2 30 1.20 1.50 0 0 0 0.00 0.00
Miscellaneous medical research, integrative medicine, comprehensive exam review) 0 0 0 0 0 3 3.66 55 2.04 2.42
Total 59 133.5 2505 52 151.36 2700.5
ESATM: Eastern School of Acupuncture and Traditional Medicine; MSAc: Master of Science in Acupuncture; PCHS: Pacific College of Health and Science.

7 Discussion

Over the past 50 years, acupuncture, a typical symbolism of CM, has been recognized by the US federal government as a form of healthcare profession due to the tremendous contributions and efforts of acupuncture professionals. The ancient origins of using herbal medicine in the United States is also indisputable. After the Dietary Supplement Health and Education Act of 1994 was passed and became law, herbal medicine practices were officially legalized.21 Although herbal products can be traded on the market, they are still not allowed to claim any therapeutic effects. That makes practicing the whole form of CM which contains acupuncture and Chinese herbal medicine in the US challenging. Until today, some states still do not have a clear regulation or law on herbal medicine practice. That is the reason curriculum of acupuncture schools and the licensing process vary in different states in the United States. Meanwhile, acupuncture has become the most recognizable representative of CM.

Acupuncture education has always been a key factor in promoting the development of CM profession. In addition to Chinese mainland the United States also has an organized and influential CM education system to the world.22,23

If we classify the curriculum arrangements of the two schools in a modular way, PCHS has the largest number of western medicine courses (16 modules) with the highest credit ratio. It can be seen that PCHS pays great attention to the knowledge of modern medicine in its overall teaching. When students learn acupuncture and traditional medicine, western medicine content needs to be taken into account. In addition, there are 15 clinical courses in PCHS, which ranks the second in the number of modules. The credit hours for clinical courses are as high as 735. This indicates that PCHS attaches great importance to clinical practice. In the ESATM program, the number of courses between Eastern medicine and Western medicine is the same, each has 13 modules, 39 credits, and 585 credit hours. This shows that the school attaches equal importance to Eastern and Western medicine. Similar like PCHS, ESATM also focuses on clinical courses. Having 860.5 credit hours, clinical courses rank first among all modules. It is obvious that both schools attach great importance to clinical practice, which reflects the characteristics of CM education, or all medical education. Only with more clinical practice can we combine theory with practice and achieve better learning effects and outcomes. PCHS curriculum includes business course, which is also relatively unique in CM education, so that students can have the basic knowledge of business operation and lay the foundation for independent medical practice or clinic operation after graduation. The biggest difference between the two schools is that PCHS contains a herbology module, while ESATM does not. Herbology at ESATM is an additional course related to the degree in TCM. ESATM contains miscellaneous modules of Medical Research, Integrative Medicine, and Comprehensive Exam Review, while PCHS has no such related modules. In terms of class size, PCHS is a larger school and thus has more students than the smaller ESATM. Additionally, the emphasis on Western Medicine and Integrative Medicine at PCHS is in contrast with the emphasis on CM and traditional medicine practice at ESATM.

The strength of this article is that through investigation and analysis of the two typical and most representative CM schools in the eastern state, we can see that the CM education in the United States, particularly acupuncture education, has entered the localization development. It is foreseeable that the joint efforts of local CM practitioners in promoting legislation and certification, the development of CM in the United States will have a bright future.

The weakness of this article is that due to the limitations of time and human resources, only two CM schools in eastern state have been studied, and some of the views discussed may inevitably be partial. The development of Chinese herbal medicine education is lagging behind compared to acupuncture education, and we expect Chinese herbal medicine to receive more attention in the United States. Therefore, our future research will explore more schools in order to understand and discover more features and highlights of CM education in the United States.

8 Conclusion

Over the past few decades, an estimated 40,000 people have received formal education at acupuncture colleges in the United States. Acupuncture, one of the best growing areas of CM education in the United States, is receiving increasing attention. Acupuncture education has established a solid foundation in the United States. With the clear implementation of doctoral programs and the need for non-pharmacological pain management, acupuncture is likely to play a huge role in the integrated healthcare system in the United States.

Acknowledgments

The authors would like to express their gratitude for the support from Kimberlie Wilson, LAc, DACM, Cynthia Neipris, LAc, DACM and Ashley Kowal, EdD.

Funding

This study is financed by the grant from the school of Acupuncture-Moxibustion and Tuina SHUTCM (No. 2022SHUTCMKCJS060).

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

Bin Xiao and Qi-Hui Jin participated in the research design. Qi-Hui Jin, Yan Zhou, Thomas Kouo and Bin Xiao participated in the writing of the paper. Qi-Hui Jin and Yan Zhou participated in the literature retrieval, interview, and survey.

Conflicts of interest

The authors declare no financial or other conflicts of interest.

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Keywords:

Acupuncture school; Chinese medicine; Education; United States

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