A Report to the Minister of Health and Long-Term Care on ...

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September 2006Regulation ong>ofong> ong>Healthong> Prong>ofong>essions in Ontario:New DirectionsA ong>Reportong> ong>toong> ong>theong>ong>Ministerong> ong>ofong> ong>Healthong>ong>andong> ong>Longong>-ong>Termong> ong>Careong> onRegulaong>toong>ry Issues ong>andong>Matters respecting ong>theong>use ong>ofong> ong>theong> “Docong>toong>r Title”in TraditionalChinese MedicineSubmitted by ong>theong>ong>Healthong> Prong>ofong>essionsRegulaong>toong>ry Advisory Council(HPRAC)

ong>Healthong> Prong>ofong>essions Regulaong>toong>ryAdvisory Council55 St. Clair Avenue WestSuite 806 Box 18Toronong>toong> ON M4V 2Y7Tel (416) 326-1550Fax (416) 326-1549Web site www.hprac.orgE-mailHPRACWebMaster@moh.gov.on.caConseil consultatif de réglementationdes prong>ofong>essions de la santé55, avenue St. Clair Ouest,pièce 806, casier 18Toronong>toong> ON M4V 2Y7Tél (416) 326-1550Téléc (416) 326-1549Site web www.hprac.orgCourrielHPRACWebMaster@moh.gov.on.caSeptember 29, 2006Hon. George Smiong>theong>rmanong>Ministerong> ong>ofong> ong>Healthong> ong>andong> ong>Longong>-ong>Termong> ong>Careong>10 th floor, Hepburn Block80 Grosvenor StreetToronong>toong>, Ontario M7A 2C4Dear ong>Ministerong>,HPRAC is pleased ong>toong> provide you with its recommendations concerning ong>theong> use ong>ofong> ong>theong> docong>toong>r title intraditional Chinese medicine as you requested in your letter ong>toong> us ong>ofong> January 18, 2006.Throughout our work on this matter, we have been impressed with ong>theong> thoughtful consideration given byindividuals ong>andong> organizations ong>toong> ong>theong> questions you raised. People put a great deal ong>ofong> time inong>toong> shapingong>theong>ir comments ong>toong> us, ong>andong> HPRAC benefitted from ong>theong>ir experience ong>andong> judgment. We also want ong>toong>underline that ong>theong> consensus ong>ofong> those who participated in our consultative program was clear: that ong>theong> barset for Ontario’s stong>andong>ards for use ong>ofong> ong>theong> docong>toong>r title should be at least equivalent ong>toong> ong>theong> highest stong>andong>ardsin any jurisdiction where TCM is regulated, ong>andong> ong>theong> public interest should be paramount.For those who are embarking on this new regulaong>toong>ry voyage, ong>theong>re will be many interesting ong>andong>challenging steps ahead. We appreciate having been a small part ong>ofong> this exciting journey.Yours truly,Barbara Sullivan, ChairPeter Sadlier-Brown, Vice-ChairBarry BrownKevin DoyleEnnis FiddlerMary Mordue

Traditional Chinese Medicine:Educational Requirements ong>andong> Use ong>ofong> Titles by PractitionersThe ong>Ministerong>’s QuestionOn January 18, 2006 HPRAC received a referral from ong>theong> ong>Ministerong> ong>ofong> ong>Healthong> ong>andong> ong>Longong>-ong>Termong> ong>Careong> regarding ong>theong> use ong>ofong> ong>theong> title “docong>toong>r” ong>andong> ong>theong> relevant educationalrequirements for practitioners ong>ofong> Traditional Chinese Medicine.Specifically, ong>theong> ong>Ministerong> requested:• Advice regarding ong>theong> educational requirements relating ong>toong> ong>theong> use ong>ofong> ong>theong> “docong>toong>r”title by certain members ong>ofong> ong>theong> proposed new college, ong>toong> be called ong>theong> College ong>ofong>Traditional Chinese Medicine (TCM) Practitioners ong>ofong> Ontario.• Recommendations regarding how ong>theong> stong>andong>ards for ong>theong>se educationalrequirements should be set ong>andong> measured.The treatment ong>ofong> current TCM practitioners in relation ong>toong> potential new applicants ong>toong> ong>theong>prong>ofong>ession is anoong>theong>r issue for consideration. On this matter, ong>theong> ong>Ministerong> is seekingadvice on mechanisms ong>toong> recognize how current practitioners acquired ong>theong>ir skills,knowledge ong>andong> judgment ong>toong> practice as well as how future applicants seeking registrationin ong>theong> prong>ofong>ession (ong>andong> use ong>ofong> ong>theong> title “docong>toong>r”) should be prepared. The ong>Ministerong>indicated that HPRAC’s advice would be shared with ong>theong> new College, ong>andong> would beconsidered by ong>theong> Ministry in its review ong>ofong> proposed College regulations.HPRAC was asked ong>toong> report ong>toong> ong>theong> ong>Ministerong> by September 30, 2006 with itsrecommendations.HPRAC’s ResponseIn considering this referral, HPRAC recommends that ong>theong> use ong>ofong> ong>theong> docong>toong>r title berestricted ong>toong> individuals completing advanced training from an accredited educationalfacility. Programs leading ong>toong> ong>theong> Dr. TCM designation should meet a minimum set ong>ofong>requirements that are comparable ong>toong> those in oong>theong>r jurisdictions, ong>andong> ong>toong> those ong>ofong> oong>theong>rprong>ofong>essions granting ong>theong> docong>toong>r title.Individuals currently practicing TCM should be required ong>toong> pass an approved licensingexamination in order ong>toong> ensure that ong>theong>y meet equivalent academic stong>andong>ards forregistration in ong>theong> Dr. TCM class. As well, all cong>andong>idates for registration in ong>theong> docong>toong>rclass should be required ong>toong> pass an approved competency examination.1

1. Hisong>toong>ry ong>ofong> ong>theong> ReferralOn December 7, 2005, ong>theong> Ontario government introduced Bill 50, ong>theong> TraditionalChinese Medicine Act, 2005 ong>toong> regulate ong>theong> prong>ofong>ession ong>ofong> traditional Chinese medicine.The Bill enacts a new health prong>ofong>ession act ong>andong> incorporates ong>theong> “ong>Healthong> Prong>ofong>essionsProcedural Code”, which is Schedule 2 ong>ofong> ong>theong> Regulated ong>Healthong> Prong>ofong>essions Act, 1991(RHPA).The Act will define ong>theong> scope ong>ofong> practice for ong>theong> newly regulated prong>ofong>ession ong>ofong> traditionalChinese medicine as “ong>theong> assessment ong>ofong> body system disorders using traditional Chinesemedicine techniques ong>andong> treatment using traditional Chinese medicine ong>theong>rapies ong>toong>promote, maintain or resong>toong>re health”.The Bill restricts ong>theong> use ong>ofong> ong>theong> titles “traditional Chinese medicine practitioner” ong>andong>“acupuncturist” ong>toong> members ong>ofong> ong>theong> College. In addition, Bill 50 amends OntarioRegulation 107/96 (Controlled Acts) under ong>theong> RHPA by revoking previous provisionsallowing anyone ong>toong> perform acupuncture, ong>andong> adding provisions allowing acupuncture ong>toong>be performed by members ong>ofong> Colleges ong>andong> by persons registered ong>toong> practise under ong>theong>Drugless Practitioners Act. Persons who perform acupuncture as part ong>ofong> an addictiontreatment program within a health facility will be permitted ong>toong> perform ong>theong> procedure.Complementary amendments ong>toong> oong>theong>r Acts will also take effect.The Bill provides for a new college, ong>theong> College ong>ofong> Traditional Chinese MedicinePractitioners ong>ofong> Ontario. The College Council, with ong>Ministerong>ial review ong>andong> approval ong>ofong>ong>theong> Lieutenant Governor-in-Council, may make regulations:1. Prescribing stong>andong>ards ong>ofong> practice involving ong>theong> circumstances in which traditionalChinese medicine practitioners must make referrals ong>toong> members ong>ofong> oong>theong>r regulatedhealth prong>ofong>essions.2. Prescribing ong>andong> governing ong>theong> ong>theong>rapies involving ong>theong> practice ong>ofong> ong>theong> prong>ofong>essionong>andong> prohibiting oong>theong>r ong>theong>rapies.3. Regulating ong>theong> use ong>ofong> ong>theong> title “docong>toong>r” for certain members ong>ofong> ong>theong> College,prescribing a class ong>ofong> certificates ong>ofong> registration for ong>theong>se members ong>andong>prescribing stong>andong>ards ong>andong> requirements including non-exemptible requirementsrelating ong>toong> ong>theong>se certificates.The introduction ong>ofong> ong>theong> Bill followed recommendations ong>ofong> an MPP Consultation Groupon Traditional Chinese Medicine ong>andong> Acupuncture, led by Markham MPP Tony Wong(The Wong Committee), ong>andong> earlier recommendations by HPRAC in favour ong>ofong> regulatingtraditional Chinese medicine including acupuncture. 11 Bill 50, An Act respecting ong>theong> regulation ong>ofong> ong>theong> prong>ofong>ession ong>ofong> traditional Chinese medicine, ong>andong> makingcomplementary amendments ong>toong> certain Acts, December 7, 2005. An application for ong>theong> regulation ong>ofong>traditional Chinese medicine ong>andong> acupuncture was first submitted ong>toong> ong>theong> Ontario government in 1994.2

An important aim ong>ofong> ong>theong> legislation is ong>toong> ensure that practitioners ong>ofong> traditional Chinesemedicine meet high entry-ong>toong>-practise stong>andong>ards ong>andong> demonstrate continuing competencyin ong>theong>ir practice. The Bill’s restrictions on ong>theong> titles used by practitioners are intended ong>toong>promote public confidence in ong>theong> skills, training ong>andong> qualifications ong>ofong> practitioners. Forong>theong> first time in Ontario, patients will be assured that practitioners ong>ofong> traditional Chinesemedicine meet ong>theong> requirements ong>ofong> a prong>ofong>essional College. These requirements willinclude rigorous training, quality improvement activities ong>andong> ong>theong> provision ong>ofong> stringentcomplaints ong>andong> discipline processes on a par with oong>theong>r regulated health prong>ofong>essions.2. HPRAC’s Approach ong>toong> ong>theong> QuestionThe Consultation ProcessIn July 2006, HPRAC circulated ong>andong> posted on its website a letter ong>toong> interested personsong>andong> stakeholders inviting feedback ong>andong> oong>theong>r information pertinent ong>toong> ong>theong> ong>Ministerong>’sreferral. By month’s end more than fifty submissions were received. Among thoseproviding comments were individuals currently practicing TCM in Ontario, existingregulated health colleges, organizations representing TCM practitioners, ong>andong> oong>theong>rorganizations who commented on ong>theong> use ong>ofong> ong>theong> docong>toong>r title in general. HPRAC’s analysisong>ofong> submissions also identified where additional information was required.The Advisory Council ong>theong>n conducted key informant interviews involving individualscurrently working in ong>theong> TCM field in Ontario, British Columbia, ong>theong> United States ong>andong>China. 2 These interviews tapped a wealth ong>ofong> experience regarding TCM educationalinstitutions, clinics, accreditation ong>andong> licensing bodies, ong>andong> ong>theong> perspective ong>ofong> Westernmedical schools.HPRAC’s interviews also explored matters such as:• Current processes ong>andong> techniques for setting ong>andong> measuring educational stong>andong>ards.• Educational requirements ong>andong> competencies necessary ong>toong> qualify for ong>theong> TCM“docong>toong>r” title in oong>theong>r jurisdictions.• The requirements necessary ong>toong> link with accreditation bodies such as U.S.Accreditation Commission for Acupuncture ong>andong> Oriental Medicine (ACAOM) oraccreditation bodies in China, such as ong>theong> State Administration ong>ofong> TraditionalChinese Medicine (SATCM) 3 .• Current processes for assessing equivalency stong>andong>ards for practitioners who havereceived ong>theong>ir training eiong>theong>r wholly or partly outside ong>ofong> ong>theong> academic stream.2 A questionnaire ong>andong> discussion documents formed ong>theong> template from which key informant interviewswere conducted. This approach contributed ong>toong> ong>theong> thoroughness ong>andong> integrity ong>ofong> ong>theong> interview process.3 Established in 1986, SATCM is considered a state bureau under ong>theong> Ministry ong>ofong> Public ong>Healthong>.3

Those who made submissions ong>andong> interviewees agreed on ong>theong> need ong>toong> regulate TCMpractitioners in Ontario. There was a consensus that regulation will improve ong>theong>prong>ofong>ession for practitioners ong>andong> patients alike. Most respondents ong>toong>ld HPRAC that ong>theong>docong>toong>r title should only be conferred where ong>theong> applicant has achieved a high level ong>ofong>training in a rigorous academic program. This requirement achieves two purposes; itestablishes stong>andong>ards for TCM docong>toong>rs that are comparable ong>toong> physicians, ong>andong> maintainsong>theong> credibility ong>ofong> ong>theong> prong>ofong>ession. Respondents urged that ong>theong> name ong>ofong> ong>theong> newly regulatedprong>ofong>ession, TCM, appear conjointly with ong>theong> Docong>toong>r title ong>toong> avoid possible publicconfusion with physicians.British Columbia, which has regulated TCM since 2004, was referred ong>toong> ong>ofong>ten – both as amodel for emulation, as well as a model from which many lessons could be learned.Similarly, some commended ong>theong> body ong>ofong> work ong>ofong> ong>theong> ACAOM ong>andong> ong>theong> NationalCertification Commission for Acupuncture ong>andong> Oriental Medicine (NCCAOM) in ong>theong>United States as ‘setting ong>theong> bar’ for accreditation ong>andong> competency testing, while oong>theong>rswere concerned that ong>theong>se organizations ong>andong> ong>theong>ir stong>andong>ards would not work in aCanadian setting.Both in submissions ong>andong> in interviews, HPRAC found a variety ong>ofong> views relating ong>toong> howthose who are currently in practice - many without academic training - should berecognized.Supplemental ResearchHPRAC supplemented its consultations with a concise literature review ong>ofong> educationalcredentials required for ong>theong> use ong>ofong> titles within regulated health prong>ofong>essions, ong>andong> for TCMin particular, ong>andong> ong>theong> accreditation ong>ofong> educational providers ong>andong> ong>theong>ir programs, bothdomestically ong>andong> internationally.The review also located information on educational requirements ong>andong> accreditationstong>andong>ards in selected Asian, North American ong>andong> Commonwealth jurisdictionsspecifically, Taiwan, Singapore, China, California, British Columbia ong>andong> Australia.These jurisdictions are leaders within ong>theong> TCM community with well regardedaccreditation requirements for practitioners.3. BackgroundOver ong>theong> past fifteen years, ong>theong>re has been a significant increase in public interest inalternative approaches ong>toong> health care in Canada ong>andong> ong>theong> United States. For example, anAmerican study found that those using a complementary or alternative ong>theong>rapy grew from33.8 per cent in 1990 ong>toong> 62.1 per cent in 2002. 4 Seventy-nine per cent reported that using4 José A. Pagán ong>andong> Mark V. Pauly, Access To Conventional Medical ong>Careong> And The Use OfComplementary And Alternative Medicine, ong>Healthong> Affairs, Volume 24, Number 1, 2005.4

oth conventional ong>andong> alternative ong>theong>rapy is better than using one alone. 5 In Canada,according ong>toong> a 1999 national survey by ong>theong> Berger Population ong>Healthong> Moniong>toong>r, more than25 per cent ong>ofong> Canadians reported using some form ong>ofong> alternative health care, up from 20per cent in March 1993. 6 Also in Canada, a nation-wide study sponsored by ong>theong>Canadian ong>Healthong> Food Association, released in Ocong>toong>ber 2005, found that Canadiansspend $2.5 billion annually on natural health products. 7 Like ong>theong>ir Americancounterparts, Canadians also see complementary approaches as a means ong>ofong> augmentingtraditional treatments. 8For many ong>theong> use ong>ofong> complementary or alternative treatments such as traditional Chinesemedicine is part ong>ofong> ong>theong>ir cultural heritage. People who are new ong>toong> Canada from China,Hong Kong, Korea, Singapore, Taiwan ong>andong> oong>theong>r Asian countries have brought with ong>theong>mexpertise in ong>theong> practice ong>ofong> TCM, as well as demong>andong> for access ong>toong> highly skilledpractitioners.“Thousong>andong>s ong>ofong> Ontarians use complementary ong>andong> alternative ong>theong>rapies as a routinepart ong>ofong> ong>theong>ir on-going health care. This shift…can be traced ong>toong> several keydevelopments…including evolving patterns ong>ofong> immigration ong>andong> increasingdemong>andong> from consumers who wish ong>toong> take ong>theong> lead in ong>theong>ir own health caredecisions, including treatment outside ong>ofong> traditional medicine.” 9In Canada, British Columbia is ong>theong> only province ong>toong> regulate both TCM ong>andong> acupuncture.Alberta ong>andong> Quebec regulate acupuncture. None ong>ofong> ong>theong> several schools ong>ofong>fering TCMtraining in Canada, including Ontario, are accredited.What is TCM?TCM views ong>theong> body as a whole ong>andong> addresses how illness manifests itself in a patient.TCM treatment methods include acupuncture, Chinese herbology, dietary ong>theong>rapies,ong>theong>rapeutic exercise ong>andong> tuina massage. 10Who practices TCM in Ontario?Current TCM practitioners in Ontario have diverse backgrounds. Many were trained inAsia or ong>theong> United States. Oong>theong>rs have been trained in Canada at one ong>ofong> ong>theong> many TCMschools which are generally private facilities. Some practitioners earned credentials bycompleting academic programs with clinical requirements, while oong>theong>rs have received inservicetraining from experienced practitioners in less formal environments. Some5 David M. Eisenberg, MD; Ronald C. Kessler, PhD; Maria I. Van Rompay, BA; Ted J. Kaptchuk, OMD;Sonja A. Wilkey, MD; Scott Appel, MS; ong>andong> Roger B. Davis, ScD Access To Conventional Medical ong>Careong>And The Complementary And Alternative Medicine, Annals ong>ofong> Internal Medicine Volume 135 • Number 5,Sep.4 , 2001.6 HPRAC Regulation ong>ofong> ong>Healthong> Prong>ofong>essions in Ontario: New Directions, April 2006.7 Ibid.8 McFarlong>andong>, B. et al, Complementary ong>andong> Alternative Medicine Use in Canada ong>andong> ong>theong> United States,iAmerican Journal ong>ofong> Public ong>Healthong>, 2002.9 HPRAC, Regulation ong>ofong> ong>Healthong> Prong>ofong>essions in Ontario: New Directions, April 2006.10 MOHLTC, “McGuinty Government Regulating Traditional Chinese Medicine”, December 7, 2005.5

practitioners have written a qualifying examination, while oong>theong>rs practice without havingpassed a competency examination.4. Use ong>ofong> ong>theong> “Docong>toong>r” TitleAs reported, almost all submissions agreed that TCM practitioners with ong>theong> appropriatequalifications ong>andong> experience should be allowed ong>toong> call ong>theong>mselves “docong>toong>r;” ong>andong> mostfavoured “Docong>toong>r ong>ofong> Traditional Chinese Medicine.” (Only seven ong>ofong> ong>theong> more than 50submissions received disagreed.) 11This is consistent with ong>theong> approach taken in British Columbia. Under B.C.’s TraditionalChinese Medicine Practitioners ong>andong> Acupuncturists Regulation, The College ong>ofong>Traditional Chinese Medicine ong>andong> Acupuncture (CTCMA) has ong>theong> authority ong>toong> grant ong>theong>designation ong>ofong> Docong>toong>r ong>ofong> Traditional Chinese Medicine (Dr. TCM), as well as ong>theong> titles ong>ofong>Registered TCM practitioner (R.TCM.P.), Registered TCM herbalist (R.TCM.H.) orRegistered Acupuncturist (R.Ac.). In all cases, an applicant must complete ong>theong>appropriate educational training ong>andong> pass ong>theong> associated licensing examinations ong>andong>safety courses. 12The licensing ong>ofong> acupuncturists, herbalists, practitioners ong>andong> docong>toong>rs ong>ofong> traditionalChinese ong>andong> oriental medicine is quite common throughout most Asian countries ong>andong>several American states. As shown in Table 1, ong>theong> title “docong>toong>r” is conferred only uponcompletion ong>ofong> ong>theong> highest levels ong>ofong> prong>ofong>ession-specific educational ong>andong> clinical trainingtypically covering five full-time years ong>ofong> study.11 Among those disagreeing were ong>theong> College ong>ofong> Physicians ong>andong> Surgeons ong>ofong> Ontario, ong>theong> Royal College ong>ofong>Dental Surgeons ong>ofong> Ontario, a physician prong>ofong>essor from ong>theong> Faculty ong>ofong> Medicine at ong>theong> University ong>ofong>Toronong>toong>, Registered Practical Nurses Association ong>ofong> Ontario ong>andong> ong>theong> Ontario Medical Association.12 Website ong>ofong> ong>theong> B.C. College ong>ofong> TCM ong>andong> Acupuncture www.ctcma.bc.ca – accessed on September 20,2006.6

TABLE 1Four Common Levels ong>ofong> Registrants ong>andong> Titles for TCM ong>andong> Acupuncture ong>andong> Respective Educational RequirementsRegisteredAcupuncturist(R.Ac.)Registered TCMHerbalist(R.TCM.H.)Registered TCMPractitioner(R.TCM.P.)Docong>toong>r ong>ofong> TCM(Dr. TCM)BC 13 ACOS 14 Alberta 15 CITCM 16 TSTCM 17 NCCAOM 18 China 193 years1900 hrs.(450 hrs.clinical)Diploma3 years1900 hrs.(450 hrs.clinical)Diploma4 years2600 hrs.(650 hrs.clinical)Diploma5 years3250 hrs.(1050 hrs.clinical)Docong>toong>r ong>ofong>TCM(primarycarepractitioner)3 years2400 hrs.Diploma3 years2205 hrs.Diploma4 years3405 hrs.Diploma5 years4020 hrs.Docong>toong>r ong>ofong> TCM(primary carepractitioner)3 years1750 hrs.(500 hrs.clinical)Diploma3 years2900 hrs.(600 hrs.clinical)Diploma3 years2260 hrs.(680 hrs.clinical)DiplomaN/A N/A 3 years2260 hrs.(680 hrs.Clinical)DiplomaN/A N/A 4 years2880 hrs.(920 hrs.clinical)DiplomaN/A4 years4007 hrs.(1200 hrs.clinical)Docong>toong>r ong>ofong> TCM(primary carepractitioner)5 years4220 hrs.(1340 hrs.clinical)Docong>toong>r ong>ofong> TCM(primary carepractitioner)1905 hrs.(600 hrs.clinical)2175hrs.(660 hrs.Clinical)2625 hrs.(870 hrs.clinical)4050 hrs.(1200 hrs.clinical)Docong>toong>r ong>ofong> TCM(primary carepractitioner)TCM Assistant:Secondaryschoollevel courses &exam5 years/5660Hours(2,000 Clinic),pre-requisite:high school +entrance exam,Docong>toong>r ong>ofong> TCM13 BC = College ong>ofong> Traditional Chinese Medicine, Acupuncturists ong>ofong> British Columbia (regulaong>toong>ry).14 ACOS (BC) – Academy ong>ofong> Classical Oriental Sciences, Nelson, British Columbia (educational).15 Alberta = Alberta ong>Healthong> ong>andong> Wellness (regulaong>toong>ry).16 CITCM (AB) = Canadian Institute ong>ofong> Traditional Chinese Medicine, Calgary, Alberta (educational).17 TSTCM = Toronong>toong> School ong>ofong> Traditional Chinese Medicine, Toronong>toong>, Ontario (educational).18 NCCAOM = National Certification Commission for Acupuncture ong>andong> Oriental Medicine, U.S.A (regulaong>toong>ry).19 Committee on ong>theong> ong>Healthong> ong>Careong> Complaints Commission (Parliament ong>ofong> New South Wales, Australia), ong>Reportong> inong>toong> TraditionalChinese Medicine (ong>Reportong> No. 10/53), 2005.7

PreparationDegreeUse ong>ofong> ong>theong> Docong>toong>r Title among Currently Regulated ong>Healthong> Prong>ofong>essionsStakeholders said that educational requirements leading ong>toong> ong>theong> docong>toong>r title in TCM shouldbe at least at ong>theong> same level as those for oong>theong>r health care prong>ofong>essionals that are permittedong>toong> use ong>theong> docong>toong>r title.In Ontario, ong>theong> five prong>ofong>essions that are currently permitted ong>toong> use ong>theong> title ong>ofong> “docong>toong>r” inong>theong> course ong>ofong> providing health care all require preparaong>toong>ry, post-secondary education,usually an undergraduate degree, preferably in ong>theong> sciences with prescribed prerequisitecourses. Physicians, dentists, chiropracong>toong>rs ong>andong> opong>toong>metrists also must complete a seconddegree specific ong>toong> ong>theong> prong>ofong>ession. Psychologists require a Ph.D. in psychology. Table 2sets out ong>theong>se requirements.TABLE 2Comparative Requirements for Certificates ong>ofong> Registration in OntarioExaminationsPracticalPhysicians Dentists Chiropracong>toong>rs Opong>toong>metristsPreferably an U/G degree insciences with prerequisitecoursesMedical degree from anaccredited Cdn/US medschool, or internationalequivalentParts 1 & 2 ong>ofong> MedicalCouncil ong>ofong> CanadaQualifying Exam ANDRCPSC or CFPC examafter residency in accreditedor recognized residencyprogram2 year residency for familymedicine; longer for mosong>toong>ong>theong>r specialtiesSame Same SameMin. 4 year universitydegree in dentistry fromCanada or USNational DentalExamining Board ong>ofong>Canada Exam; exam inethics ong>andong> jurisprudenceChiropractic degree fromprogram accredited byCouncil on ChiropracticEducation, or equivalentCdn. ChiropracticExamining BoardKnowledge-based Exam;CCEB ClinicalCompetency Exam; CCOethics ong>andong> legis. ExamInternship or residency inapproved program or nonhospitalposition in aCanadian universityfaculty ong>ofong> dentistrySame Same SameCitizenship Canadian or permanentresidentForeign Grads Medical Council ong>ofong> Canada Full-time, 2 yearEvaluating Exam before qualifying program beforePart 1 ong>ofong> ong>theong> MCC exams NDEBC examLanguage Fluent in English or French Same Same SameOong>theong>rNot guilty ong>ofong> a criminal SameSame plus evidence ong>ofong> Sameong>ofong>fence or any ong>ofong>fenceliability insurancerelevant ong>toong> ong>theong>ir suitabilityong>toong> practice, or an ong>ofong>fenceunder ong>theong> Narcotics ControlAct, ong>theong> Controlled Drugsong>andong> Substances Act, or ong>theong>Food ong>andong> Drug Act; nong>ofong>inding ong>ofong> misconduct,incompetence or incapacityin anoong>theong>r jurisdictionU. ong>ofong> Waterloo Schoolong>ofong> Opong>toong>metry degree, orequivalent from anaccredited North AmericanSchoolCOO prescribed examsCOO/UW bridgingprogram8

5. Educational Stong>andong>ardsThere are two challenges in calling for comparable stong>andong>ards between ong>theong> new TCMprong>ofong>ession ong>andong> currently regulated health prong>ofong>essions. The first is ensuring that ong>theong>education ong>andong> training programs available ong>toong> TCM students ong>andong> practitioners are ong>ofong> aconsistent ong>andong> high calibre. The second is that ong>theong> educational providers should also meetsimilar high stong>andong>ards.A 2003 academic inquiry inong>toong> TCM found “a very unevenly qualified TCM workforce.[Furong>theong>rmore] a proliferation ong>ofong> prong>ofong>essional groups…made it difficult ong>toong> achieveuniform practice stong>andong>ards...[However] practitioners graduating from extended TCMcourses experienced about half ong>theong> adverse event rate ong>ofong> graduates ong>ofong> shorter trainingprograms.” 20 This finding, that directly relates quality ong>ofong> care ong>toong> training ong>ofong> practitioners,underscores ong>theong> need for rigorous educational requirements ong>toong> ensure ong>theong> protection ong>ofong> ong>theong>public interest.The Wong Committee noted that despite differences in ong>theong>ir education ong>andong> training, mostcurrent practitioners agreed that high education ong>andong> training stong>andong>ards should be set forentry inong>toong> ong>theong> prong>ofong>ession, ong>andong> that ong>theong>se same stong>andong>ards should be applied ong>toong> current ong>andong>future practitioners. 21Overview ong>ofong> Programs leading ong>toong> a Dr. TCM designationIn considering ong>theong> issue ong>ofong> setting appropriate educational stong>andong>ards, HPRAC reviewededucational programs in oong>theong>r jurisdictions that lead ong>toong> ong>theong> Dr. TCM title.During its consultations, HPRAC heard that most stakeholders concur that TCMpractitioners who are permitted ong>toong> use ong>theong> docong>toong>r title should have completed an academicprogram with high stong>andong>ards. The Toronong>toong> School ong>ofong> Traditional Chinese Medicine’ssubmission captured ong>theong> salient points ong>ofong> many oong>theong>rs:Docong>toong>rs ong>ofong> TCM must possess ong>theong> knowledge ong>ofong> fundamental ong>theong>ory, ong>theong> skills ong>ofong>diagnostic methods ong>andong> differentiation ong>ofong> syndromes, master ong>theong> techniques ong>ofong>treatment remedies, be able ong>toong> diagnose ong>andong> treat a wide range ong>ofong> diseases ong>andong>conditions safely ong>andong> effectively using a comprehensive ong>andong> holistic approach, beable ong>toong> identify ong>andong> manage emergency ong>andong> complicated cases with an integratedapproach, ong>andong> be knowledgeable with legislation, regulation, ethics ong>andong> businessmanagement.Twelve core competencies were suggested. These include: fundamental ong>theong>ory;diagnostics ong>andong> differentiation; TCM classics; Western Medicine; TCM treatmentremedies (specifically acupuncture, Chinese herbal medicine, Tuina massage, TaijiQigong, ong>andong> TCM Nutrition ong>andong> diet); integrated medicine; TCM clinical diagnostics ong>andong>20 Parker, M Chinese Dragon or Toothless Tiger? Regulating ong>theong> Prong>ofong>essional Competence ong>ofong> TraditionalChinese Medicine Practitioners Journal ong>ofong> Law ong>andong> Medicine, Volume 10, February 2003.21 MPP Consultation Group on Traditional Chinese Medicine ong>andong> Acupuncture, ong>Reportong> ong>toong> ong>theong> ong>Ministerong> ong>ofong>ong>Healthong> ong>andong> ong>Longong>-ong>Termong> ong>Careong>, Summer 2005.9

treatments ong>ofong> diseases; research; emergency management; safety ong>andong> risk management;legislation ong>andong> regulation; ong>andong> ethics ong>andong> business management.Programs leading ong>toong> a Dr. TCM designation in ong>theong> United StatesIn ong>theong> United States where 41 states license Acupuncture ong>andong>/or TCM, many rely on ong>theong>stong>andong>ards developed by ong>theong> Accreditation Commission for Acupuncture ong>andong> OrientalMedicine (ACAOM). The ACAOM is ong>theong> only U.S. Department ong>ofong> Education (USDE)recognized accreditation agency for ong>theong> field ong>ofong> acupuncture ong>andong> Oriental medicine inNorth America. Essential elements ong>ofong> an ACAOM-endorsed docong>toong>ral program include:♦ A core curriculum. This includes competencies in ong>theong> area ong>ofong>: advanced patientassessment ong>andong> diagnosis; advanced clinical intervention ong>andong> treatment;consultation ong>andong> collaboration; clinical supervision ong>andong> practice management;clinical evaluation ong>andong> research. Furong>theong>r, ong>theong> core curriculum must includeinstruction necessary ong>toong> provide knowledge ong>andong> skill development in criticalthinking, problem solving ong>andong> communication skills.♦ Clinical training/specialties. The program must provide in-depth level ong>ofong> practicalong>andong> clinical training ong>andong> experience ong>toong> distinguish ong>theong> cong>andong>idate as havingadvanced expertise in acupuncture ong>andong> oriental medicine.♦ Clinical Research Projects. A clinically oriented research project must becompleted by docong>toong>ral cong>andong>idates. The products ong>ofong> ong>theong>se clinical projects must beong>ofong> such a nature that ong>theong>y meet academic form ong>andong> style stong>andong>ards suitable forpeer-reviewed prong>ofong>essional publications.♦ Prerequisites. The program must show evidence that it has developed appropriatecourse prerequisites, ong>andong> that students have completed all ong>ofong> ong>theong>se prerequisites.♦ Program Length/Maximum Time Frame. The minimum educational programlength is 4,000 hours for docong>toong>ral students. This includes ong>theong> trainingrequirements for ong>theong> Master’s level program ong>andong> a minimum ong>ofong> 1,200 hours atong>theong> docong>toong>ral level. 22 Advanced clinical training must constitute a minimum ong>ofong>650 hours. The docong>toong>ral portion ong>ofong> ong>theong> program must be completed within 4 yearsong>ofong> matriculation.♦ Residency. Docong>toong>ral study includes residence, which provides students access ong>toong>faculty committed ong>toong> ong>andong> responsible for ong>theong> docong>toong>ral program as well as oong>theong>rstudents.♦ Clock-ong>toong>-Credit Hour Conversion. One semester credit hour is granted for each15 hours ong>ofong> classroom contact plus appropriate outside preparation. One semestercredit hour is granted for each 30 hours ong>ofong> supervised laboraong>toong>ry or clinicalinstruction; one semester credit hour for each 45 hours ong>ofong> clinical externship orindependent study. To provide perspective, ong>theong> minimum length ong>ofong> ong>theong>prong>ofong>essional acupuncture program must be at least 105 semester credits, ong>andong> ong>theong>22 ACAOM, Accreditation Hong>andong>book, January 2005.10

minimum length ong>ofong> ong>theong> prong>ofong>essional Oriental medicine curriculum is 146semester credits.♦ Completion Designation. Successful completion ong>ofong> a docong>toong>ral program awardsong>theong> student with ong>theong> degree “Docong>toong>r ong>ofong> Acupuncture” (“D.Ac.”) or ong>theong> degreeDocong>toong>r ong>ofong> Acupuncture ong>andong> Oriental Medicine (“DAOM”). 23Master’s level curriculum requirements, as shown in Chart I, are comprehensive in ong>theong>ircoverage ong>ofong> subject matter. Additional details may be found in Appendix A ong>ofong> this report.CHART ICourse Curriculum Overview for ACAOM’s Master’s Level Program 24Major Fields ong>ofong> Study1) Hisong>toong>ry ong>ofong> Acupuncture ong>andong> Oriental Medicine 11) Oriental Herbal Studies2) Basic Theory • Basic Herbal Medicine Theory3) Acupuncture, Point Location ong>andong> Channel• Oriental Diagnostic And Treatment(meridian) TheoryParadigms As They Pertain To HerbalMedicine4) Diagnostic Skills • Materia Medica - Instruction in a minimumong>ofong> 300 different herbs5) Treatment Planning in Acupuncture ong>andong>• Herbal Formulas - Instruction in aOriental Medicineminimum ong>ofong> 150 formulas6) Treatment Techniques • Food Therapy/Nutrition7) Equipment ong>andong> Safety • Clinical Internship ong>andong> Herbal Dispensary8) Counseling ong>andong> Communication Skills • General principles ong>ofong> pharmacognosy9) Ethics ong>andong> Practice Management10) Biomedical Clinical Sciences 12) Oong>theong>r Oriental Medicine ModalitiesPerformance outcomes upon completion ong>ofong> a cong>andong>idate’s training are prong>ofong>iled below.Chart IIACAOM-Approved Program: Acquired Competencies1. Accurately collects data ong>andong> uses patient examinations ong>toong> make a diagnosis.2. Formulates a diagnosis by classifying ong>theong> data collected ong>andong> organizing it according ong>toong> traditionalong>theong>ories ong>ofong> physiology ong>andong> pathology.3. Determines a treatment strategy based on ong>theong> diagnosis formulated.4. Performs treatment by applying appropriate techniques, including needles, Moxa, manipulation,counseling, ong>andong> ong>theong> utilization ong>ofong> skills appropriate for ong>theong> preparation ong>ofong> ong>toong>ols ong>andong> instruments.5. Appropriately assesses ong>theong> effectiveness ong>ofong> ong>theong> treatment strategy ong>andong> its execution.6. Complies with practices as established by ong>theong> prong>ofong>ession ong>andong> society-at-large.7. Makes a Diagnosis/Energetic Evaluation by: identifying position, nature ong>andong> cause ong>ofong> ong>theong>dysfunction, disorder, disharmony, vitality ong>andong> constitution.23 In ong>theong> United States, four American universities now ong>ofong>fer postgraduate docong>toong>rates. Bastyr University inSeattle, WA, Oregon College ong>ofong> Oriental medicines in Portlong>andong>, OR, Emperor’s College in Los AngelesCA, ong>andong> Pacific College ong>ofong> Oriental Medicine in San Diego, CA. Each ong>ofong> ong>theong>se institutions is based in astate where TCM ong>andong> Acupuncture are regulated health prong>ofong>essions. The educational programs ong>theong>y ong>ofong>ferare based on stong>andong>ards developed for TCM postgraduate docong>toong>ral programs by ACAOM.24 ACAOM, Accreditation Hong>andong>book, January 2005.11

8. Plans ong>andong> executes an Herbal Treatment using acquired knowledge.9. Understong>andong>s prong>ofong>essional issues related ong>toong> oriental herbs.In addition, students must demonstrate an adequate understong>andong>ing ong>ofong> relevant biomedicalong>andong> clinical concepts ong>andong> terms; human anaong>toong>my ong>andong> physiological processes; conceptsrelated ong>toong> pathology ong>andong> ong>theong> biomedical disease model; pharmacological concepts ong>andong>terms including knowledge ong>ofong> relevant potential medication, herb ong>andong> nutritionalsupplement interactions, contraindications ong>andong> side effects. Furong>theong>r, ong>theong>y must understong>andong>ong>theong> nature ong>ofong> ong>theong> biomedical clinical process including hisong>toong>ry taking, diagnosis,treatment ong>andong> follow-up, as well as ong>theong> clinical relevance ong>ofong> laboraong>toong>ry ong>andong> diagnostictests ong>andong> procedures, as well as biomedical physical examination findings.This knowledge is vital in order ong>toong> be able ong>toong>:• Recognize situations where ong>theong> patient requires emergency or additional care orcare by practitioners ong>ofong> oong>theong>r health care (or medical) modalities, ong>andong> ong>toong> refer suchpatients ong>toong> whatever resources are appropriate ong>toong> ong>theong>ir care ong>andong> well-being.• Appropriately utilize relevant biomedical clinical science concepts ong>andong>understong>andong>ings ong>toong> enhance ong>theong> quality ong>ofong> Oriental medical care provided.• Protect ong>theong> health ong>andong> safety ong>ofong> ong>theong> patient ong>andong> ong>theong> health care provider related ong>toong>infectious diseases, sterilization procedures, needle hong>andong>ling ong>andong> disposal, ong>andong>oong>theong>r issues relevant ong>toong> blood borne ong>andong> surface pathogens.• Communicate effectively with ong>theong> biomedical community. 25A more detailed description ong>ofong> competencies appears in Appendix B ong>ofong> this report.Programs leading ong>toong> a Dr. TCM designation in ChinaIn 1985, ong>theong> Chinese government created four universities dedicated ong>toong> TCM educationalprograms. Since ong>theong>n, numerous oong>theong>r privately operated institutions have appeared.Wheong>theong>r public or private, all programs are government approved. Undergraduate coursesare five years in length. The first three years are devoted ong>toong> ong>theong> study ong>ofong> ong>theong> mostimportant aspects ong>ofong> pre-clinical Western medicine with subjects such as biochemistryong>andong> pharmacology as well as ong>theong> basic foundations ong>ofong> TCM. Between one ong>andong> two yearsong>ofong> clinical study follow.Students sit for three exams at ong>theong> conclusion ong>ofong> ong>theong>ir fifth year; ong>theong> first related ong>toong> basicclinical principles ong>ofong> Western medicine, ong>theong> second ong>theong>oretical principles ong>andong> ong>theong> third isa ong>theong>sis. Exams are set ong>andong> conducted by ong>theong> National Administration on TCM. After oneyear working in a hospital (without prescribing rights) practitioners must ong>theong>n pass alicensing exam. The following table provides an overview ong>ofong> a typical curriculum for ong>theong>five-year Undergraduate Medical Degree Program in TCM.25 ACAOM, Accreditation Hong>andong>book, January 2005.12

TABLE 3Overview ong>ofong> Sample Course CurriculumFive Year Undergraduate Medical Degree Program 26Requirement Hours YearsBiomedicine 1125+TCM 1920Oong>theong>r 660+Clinic 1800 1 yearTotal 5500+ 5 yearsGraduation ThesisGraduation ExaminationA more detailed overview ong>ofong> ong>theong> sample curriculum is found in Appendix C.Comparison ong>ofong> Educational Requirements for Use ong>ofong> Dr. TitleHPRAC’s consultations revealed a consensus that docong>toong>ral programs in Ontario should beequivalent ong>toong> those in oong>theong>r jurisdictions.Table 4 summarizes ong>andong> compares prerequisites, core curriculum ong>andong> hours ong>ofong> trainingrequired for programs leading ong>toong> a docong>toong>r ong>ofong> TCM designation in China, British Columbiaong>andong> ong>theong> United States. In all jurisdictions but China, two years ong>ofong> undergraduateschooling are required prior ong>toong> acceptance ong>toong> ong>theong> TCM programs. In China, applicants areaccepted upon graduation from high school if ong>theong>y can successfully complete an entryexam.TABLE 4Jurisdictional Comparison ong>ofong> Core Curriculum for Dr. TCM ProgramsJurisdiction China BC USModality Hours Years Hours Years Hours YearsBiomedicine 1000+ 250+TCM 1800+ 360Oong>theong>r 750+ 450Acupuncture 550Herbology 550Sub-Total 3600+ 2160+ 3350Clinic 2000 15 months 1050 650Prong>ofong>essional Education 5,600+ 5-6 years 3,210 5 years 4,000 5 yearsPrerequisitesHigh School+ entryexam2 yearsuniversityeducation2 yearsuniversityeducationTotal Post Secondary 5-6 years 7 years 7 years26 Heilongjiang University ong>ofong> TCM (1988). This leads ong>toong> an M.D. equivalent degree.13

As illustrated, programs leading ong>toong> a docong>toong>r TCM designation, typically consist ong>ofong> five ong>toong>seven years ong>ofong> study, with ong>toong>tal hours accumulated between 3,210 hours (B.C.) ong>toong> 5,600hours (China).Table 5 compares educational requirements for regulated health prong>ofong>essionals currentlyauthorized ong>toong> use ong>theong> docong>toong>r title in Ontario. HPRAC has previously recommended ong>toong> ong>theong>ong>Ministerong> that in addition ong>toong> those who are currently authorized ong>toong> use ong>theong> title, thoseprong>ofong>essionals with an earned docong>toong>ral degree in ong>theong> discipline ong>ofong> ong>theong>ir practice should beable ong>toong> use ong>theong> docong>toong>r title in ong>theong> course ong>ofong> providing health care. 27TABLE 5Comparison ong>ofong> Educational Requirements Leading ong>toong> Docong>toong>r Title forCurrently Regulated ong>Healthong> Prong>ofong>essions in OntarioOrganization Total Hours Clinical Hours PrerequisitesCanadian MemorialChiropractic College4634 hrs/4 yrs1603 hrs 3 years undergraduate universitystudy 28Medical Schools 4 years 1 year 3 years university study 29Dentistry 4 years 1 year 3 years university education 30Opong>toong>metry 4 years 1 year Currently 2 years, (soon ong>toong> be 3 years)in a university undergraduate bachelorong>ofong> science program 31In April 2006, HPRAC recommended Naturopaths for regulation under ong>theong> RHPA, ong>andong>that ong>theong>y be entitled ong>toong> use ong>theong> title “Naturopathic Docong>toong>r” or “Docong>toong>r ong>ofong> NaturopathicMedicine”. Similar ong>toong> ong>theong> regulated health care prong>ofong>essions reviewed in Table 5,Naturopaths must meet a high stong>andong>ard ong>ofong> educational preparation. Members ong>ofong> thisprong>ofong>ession attend ong>theong> Canadian College ong>ofong> Naturopathic Medicine for four years (or 4266hours) ong>ofong> which 1240 are clinical hours. As a prerequisite ong>toong> admission, students musthave completed three years university education (or its equivalent). 32Most participants in HPRAC’s consultations agreed that Ontario’s stong>andong>ards for programsleading ong>toong> ong>theong> designation ong>ofong> Dr. TCM should be at least equal ong>toong> that ong>ofong> jurisdictionswhere ong>theong> docong>toong>r title is authorized.Educational requirements should be set according ong>toong> ong>theong> core competencies ong>andong>ong>theong> scope ong>ofong> TCM practice at ong>theong> docong>toong>ral level in accordance with oong>theong>r healthcare prong>ofong>essions that [use] ong>theong> title ong>ofong> Docong>toong>r in Ontario, ong>andong> that ong>ofong> ong>theong> oong>theong>rjurisdictions where stong>andong>ards are established such as China, ong>theong> US ong>andong> BC.Toronong>toong> School ong>ofong> Traditional Chinese Medicine27 HPRAC Regulation ong>ofong> ong>Healthong> Prong>ofong>essions In Ontario: New Directions, , 2006, Recommendation 51.28 http://www.cmcc.ca/admissions/admission_requirements_for_can.htm, Accessed on September 20, 2006.29 http://www.facmed.uong>toong>ronong>toong>.ca/English/Admissions-Information.html, Accessed on September 20, 2006.30 http://www.uong>toong>ronong>toong>.ca/dentistry/admissions/DDSLIT2007.pdf, Accessed on September 20, 2006.31 http://www.opong>toong>metry.uwaterloo.ca/prospective/od/academicrequirments.html#studies, Accessed onSeptember 20, 2006.32 http://www.ccnm.edu/admiss.html, Accessed on September 20, 2006.14

[The] TCM Docong>toong>ral educational requirement should be set at 7 years postsecondary education: 2 years university education as entrance requirement, 4years TCM program, plus 1 year internship.Ontario Coalition for TCM RegulationIf Ontario wishes ong>toong> ensure that those prong>ofong>essionals who are granted ong>theong> title ong>ofong> Dr. TCMhave equivalent competencies, skills ong>andong> education ong>toong> those in oong>theong>r jurisdictions, it mustset comparable educational stong>andong>ards.Policy-makers ong>andong> ong>theong> new regulaong>toong>ry college will face two challenges in this regard.The first is determining which programs meet ong>theong> rigorous educational stong>andong>ardscontemplated for a prong>ofong>essional program leading ong>toong> a Dr. TCM degree, ong>andong> ong>theong>subsequent recognition ong>ofong> post-secondary educational institution(s) that ong>ofong>fer(s) anaccredited TCM curriculum leading ong>toong> a Dr. TCM degree. This could be eiong>theong>r a stong>andong>aloneprong>ofong>essional college, comparable ong>toong> ong>theong> Canadian Memorial Chiropractic Collegeor ong>theong> Canadian College ong>ofong> Naturopathic Medicine, or a prong>ofong>essional school set in auniversity, comparable ong>toong> faculties ong>ofong> Medicine or Dentistry.The second challenge is ong>toong> adopt an accreditation stong>andong>ard for educational facilitiesong>ofong>fering prong>ofong>essional docong>toong>ral programs in TCM. This is essential ong>toong> ensuring that ong>theong>facility or school meets recognized requirements for ong>theong> program, ong>andong> is comparable ong>toong>requirements for educational institutions ong>ofong>fering advanced degrees in oong>theong>r prong>ofong>essions.5.2 Educational Equivalencies for current TCM practitionersGiven ong>theong> vast number ong>ofong> TCM-related associations ong>andong> institutions that currently operatewithin Ontario, it should come as no surprise that ong>theong> issue ong>ofong> recognizing ong>theong> experienceong>andong> training ong>ofong> current TCM practitioners engenders much debate. The opinionsexpressed ranged from ‘waving-through’ all current practicing TCM ‘docong>toong>rs’ ong>toong> havingstrict criteria, that do not allow existing practitioners ong>toong> use ong>theong> Docong>toong>r title at all.B.C.’s College ong>ofong> Traditional Chinese Medicine Practitioners ong>andong> Acupuncturists ong>ofong>(CTCMA) completed its grong>andong>-parenting process in ong>theong> summer ong>ofong> 2006. Dr. TCMcong>andong>idates were assessed by a committee, ong>andong> some were required ong>toong> undertake ong>theong>practical portion ong>ofong> CTCMA’s herbology exam. Stan Nicol, former BC Registrar,recently ong>toong>ld HPRAC that he would recommend some form ong>ofong> examination, including awritten ong>andong> practical examination for all current TCM practitioner-applicants who seekong>theong> docong>toong>r title.A number ong>ofong> submissions suggested fairly rigorous stong>andong>ards including:• A minimum number ong>ofong> years ong>ofong> practice (i.e. 10-20 years).• A minimum number ong>ofong> hours ong>ofong> training ong>andong> experience (i.e. 2000 hours) inaddition ong>toong> formal education.• Passing ong>ofong> a qualifying or challenge exam (practical ong>andong> ong>theong>oretical).15

• Working knowledge ong>ofong> English.• Documentation/evidence that formal education ong>andong> training is comparable ong>toong> thatin China, with additional years ong>ofong> practice.• References, publications, affidavits from 100-500 patients, letters ong>ofong> referencefrom teachers ong>andong> colleagues.• Interview/consultation with examining Board.• Combination ong>ofong> ong>theong> above 33 .• No criminal conviction record ong>andong> no conviction for medical malpractice inCanada.A number ong>ofong> submissions suggest that a “challenge exam” is an appropriate method ong>ofong>verifying that TCM practitioners qualify for ong>theong> title ong>ofong> Docong>toong>r. One method ong>ofong> providingthis form ong>ofong> exam is through ong>theong> voluntary certifying association, ong>theong> NationalCertification Commission for Acupuncture ong>andong> Oriental Medicine (NCCAOM).NCCAOM is a member ong>ofong> ong>theong> National Organization for Competency Assurance ong>andong> isaccredited by ong>theong> National Commission for Certifying Agencies – an agency ong>ofong> ong>theong> U.S.Department ong>ofong> Education (USDE). NCCAOM has developed an examination system, ong>andong>has set stong>andong>ards ong>ofong> training ong>andong> established criteria for a docong>toong>ral program in OrientalMedicine.NCCAOM BackgroundNCCAOM's mission is ong>toong> establish, assess, ong>andong> promote recognized stong>andong>ards ong>ofong>competence ong>andong> safety in acupuncture ong>andong> Oriental medicine for ong>theong> protection ong>andong>benefit ong>ofong> ong>theong> public. 34 More than 13,000 individuals have been certified in Acupuncture,Chinese Herbology ong>andong> Asian Bodywork Therapy by ong>theong> NCCAOM since its inception.The first NCCAOM Comprehensive Written Examination (CWE) in Acupuncture (ACP)was given in March 1985. It was developed during a three-year period with ong>theong> help ong>ofong>leading acupuncturists across ong>theong> nation. Throughout this development period ong>theong>NCCAOM followed national guidelines for certification ong>andong> testing in order ong>toong> ensure afair, valid, ong>andong> reliable examination. The administration ong>ofong> ong>theong> exam was a milesong>toong>neevent in ong>theong> growth ong>ofong> ong>theong> prong>ofong>ession in ong>theong> United States.The Practical Examination ong>ofong> Point Location Skills (PEPLS) was added as a componenong>toong>f NCCAOM’s Acupuncture Examination in September 1989. The Clean NeedleTechnique (CNT) portion was added ong>toong> ong>theong> acupuncture written exam two years later.33 For example, proong>ofong> ong>ofong> ong>theong> equivalent ong>ofong> 3600 hours ong>ofong> instruction or an apprenticeship program ong>ofong> at least10 years, has passed written, oral ong>andong> practical examinations, holds an International Certificate or License,has 1500 hours ong>ofong> clinical internship, ong>andong> can provide confirmation ong>ofong> a minimum ong>ofong> 500 ong>ofong>fice visits peryear.34 NCCAOM web site http://www.nccaom.org/aboutus.htm.16

This separately-scored CNT exam was merged inong>toong> ong>theong> Comprehensive WrittenExamination in Acupunture in 1998.In 1989, ong>theong> prong>ofong>ession asked ong>theong> NCCAOM ong>toong> develop a certification programmeasuring entry-level competency in ong>theong> practice ong>ofong> Chinese herbology. After three yearsong>ofong> research, ong>theong> organization opened ong>theong> Credentials Documentation Review (CDR)period for Certification in Chinese Herbology. The first national Comprehensive WrittenExamination in Chinese Herbology was given in April, 1995.The NCCAOM ong>theong>n developed a third certification program in response ong>toong> requests fromong>theong> prong>ofong>ession. NCCAOM Certification in Asian Bodywork Therapy (ABT) was ong>ofong>feredin 1996 through Credentials Documentation Review. CDR for certification in AsianBodywork Therapy closed in December 1997. The first Comprehensive WrittenExamination in ABT was given in Ocong>toong>ber 2000.HPRAC’s information is that ong>theong> NCCAOM is currently developing stong>andong>ards forcredentialing docong>toong>rs ong>ofong> TCM.HPRAC considered a wide range ong>ofong> options available for granting current Ontario TCMpractitioners ong>theong> title ong>ofong> docong>toong>r including:• Granting ong>theong> docong>toong>r title ong>toong> all current practitioners who can provide reasonableproong>ofong> ong>ofong> qualifications that meet Ontario benchmarks.• Requiring practitioners seeking ong>theong> docong>toong>r title ong>toong> interview with a consultingBoard.• Creating a new Ontario-based TCM exam which all practitioners must passbefore being granted ong>theong> docong>toong>r title.• Adopting NCCAOM’s future stong>andong>ards for ong>theong> use ong>ofong> ong>theong> Docong>toong>r title.5.3 Educational Facilities ong>ofong>fering Programs leading ong>toong> Docong>toong>r ong>ofong> TCM DesignationAs HPRAC found in its 2001 review, ong>andong> confirmed in 2005-06, ong>theong>re is considerablevariability in ong>theong> curriculum, delivery ong>andong> duration ong>ofong> educational programs in ong>theong> fieldsong>ofong> TCM ong>andong> acupuncture currently ong>ofong>fered ong>toong> students in Ontario ong>andong> elsewhere.In Ontario, ong>theong> Ministry ong>ofong> Training, Colleges ong>andong> Universities (MTCU) administersseveral relevant Acts governing Ontario’s post-secondary educational system.• The Post-secondary Education Choice & Excellence Act, 2000 governs degreegrantingactivity by institutions that do not have degree granting authority in ong>theong>irown legislation (e.g. private institutions, out-ong>ofong>-province public institutions, ong>andong>colleges ong>ofong>fering applied degrees).• The Ontario Colleges ong>ofong> Applied Arts ong>andong> Technology Act, 2002 governs collegesong>ofong> applied arts ong>andong> technology (for diplomas ong>andong> certificates).17

• The Private ong>Careong>er Colleges Act (PCCA) governs private career colleges (fordiplomas ong>andong> certificates). 35To date, no private career colleges ong>ofong>fering TCM or acupuncture-related programsleading ong>toong> a certificate or diploma are registered with MTCU under ong>theong> PCCA. Similarly,no college ong>ofong> applied arts ong>andong> technology has been granted consent ong>toong> ong>ofong>fer an applieddegree or are approved by MTCU ong>toong> ong>ofong>fer a diploma or a certificate in TCM oracupuncture.There are also no TCM-related programs provided by universities that have beenapproved for funding by MTCU. 36HPRAC heard that a few privately operated schools in Ontario ong>ofong>fer four year full-timeprograms with over 3,000 hours ong>ofong> instruction leading ong>toong> a “Docong>toong>r ong>ofong> TCM diploma.” Aschool in Toronong>toong> reportedly follows ong>theong> ACAOM 37 stong>andong>ards referenced above althoughit has not applied for accreditation. 38 As well, Ryerson University has recently launcheda continuing education program in traditional Chinese medicine. 395.4 AccreditationAccreditation is a process which ensures that an educational institution or program meetsestablished stong>andong>ards ong>andong> requirements for quality education ong>andong> training. Accreditationstong>andong>ards usually cover curriculum, faculty qualifications, admissions requirements,finances, administration, facilities, learning resources, safety ong>andong> oong>theong>r important areas.Drawing from ong>theong> ACAOM, accreditation serves many purposes.Accreditation assures that an institution or program has a clearly articulatedmission ong>andong> set ong>ofong> educational objectives, has ong>theong> resources ong>toong> attain its objectives,ong>andong> has a process in place ong>toong> demonstrate that its objectives are being met.Generally…it provides reasonable assurance ong>ofong> ong>theong> overall quality ong>andong>competence ong>ofong> graduates, since ong>theong> education ong>ofong>fered by an accredited institutionor program meets or exceeds recognized stong>andong>ards…for entry inong>toong> ong>theong> field ong>andong>preparing graduates ong>toong> practice safely ong>andong> effectively. For ong>theong> process ong>ofong>prong>ofong>essional certification, registration or licensure - accreditation providesreasonable assurances ong>toong> regulaong>toong>ry bodies that certain educational credentialsreflect high quality prong>ofong>essional training. 4035 MPP Consultation Group on Traditional Chinese Medicine ong>andong> Acupuncture, ong>Reportong> ong>toong> ong>theong> ong>Ministerong> ong>ofong>ong>Healthong> ong>andong> ong>Longong>-ong>Termong> ong>Careong>, Summer 2005.36 Ibid.37 All ACAOM-recognized programs must be taught in an accredited educational institution.38 According ong>toong> ong>theong> Direcong>toong>r, graduates ong>ofong> this school are eligible ong>toong> write ong>theong> NCCAOM exams ong>andong>, in ong>theong>past, have passed ong>theong> exam with a 100 per cent success rate.39 The Ryerson program consists ong>ofong> eight modules: Foundations ong>ofong> Chinese Medicine; Integrative ong>Healthong>ong>Careong> – Challenges ong>andong> Issues; Diagnosis in Chinese Medicine – Basics; Herbal Treatment in TraditionalChinese Medicine – Basics; Acupuncture Treatment in Chinese Medicine – Basics; Risk Management inTraditional Chinese Medicine; Herbal Treatment in Chinese Medicine – Clinical; ong>andong> AcupunctureTreatment in Chinese Medicine – Clinical.40 ACAOM, Frequently Asked Questions, http://www.acaom.org/faq_q1.htm#2.18

Programs ong>ofong>fered by accredited institutions have some flexibility in educationalobjectives ong>andong> delivery methods. The institutions ong>theong>mselves conduct periodic reviews ong>ofong>ong>theong>ir educational mission, ong>theong> content ong>ofong> accredited educational programs, trainingdelivery methods ong>andong> supporting structures ong>toong> determine wheong>theong>r it meets or exceeds ong>theong>stong>andong>ards set by an accrediting body.Accreditation ong>ofong> Medical SchoolsIn North America, accreditation agencies commonly evaluate schools ong>andong> programs inboth Canada ong>andong> ong>theong> United States. For instance, ong>theong> Association ong>ofong> American MedicalColleges (AAMC) includes all 125 accredited medical schools in ong>theong> United States ong>andong>ong>theong> 17 accredited medical schools in Canada. The AAMC works ong>toong> ensure that ong>theong>structure, content, ong>andong> conduct ong>ofong> medical education meet ong>theong> highest stong>andong>ards ong>andong> keeppace with ong>theong> changing needs ong>ofong> patients ong>andong> ong>theong> health care system.In Canada, ong>theong> Association ong>ofong> Faculties ong>ofong> Medicine Canada (AFMC), ong>toong>geong>theong>r with ong>theong>Canadian Medical Association (CMA), carries out accreditation surveys ong>andong> rules on ong>theong>accreditation ong>ofong> all undergraduate medical programs in Canada. Through ong>theong> AAMC, ong>theong>Committee on Accreditation ong>ofong> Canadian Medical Schools (CACMS) serves as amechanism ong>toong> ensure high stong>andong>ards on a national basis as well as meeting accreditationstong>andong>ards ong>ofong> AFMC’s American counterpart, ong>theong> Liaison Committee on MedicalEducation ong>ofong> AAMC.Accreditation in ong>theong> Field ong>ofong> Naturopathic Schools in North AmericaSimilarly, in ong>theong> field ong>ofong> naturopathy, ong>theong> accrediting agency for naturopathic medicalschools ong>andong> programs in North America is ong>theong> Council on Naturopathic MedicalEducation (CNME). Currently ong>theong>re are four accredited schools in North Americaincluding one in Ontario.Accreditation in ong>theong> Field ong>ofong> Oriental MedicineThe United StatesAs mentioned previously, ACAOM is ong>theong> only U.S. Department ong>ofong> Education (USDE)recognized accreditation agency for ong>theong> field ong>ofong> acupuncture ong>andong> Oriental medicine inNorth America which has developed educational stong>andong>ards that reflect ong>theong> level ong>andong> depthong>ofong> training necessary ong>toong> practice safely ong>andong> effectively within ong>theong> field. States that useACAOM's accreditation process for licensure have demonstrated a superb safety recordfor ong>theong>ir licensed practitioners. Oriental medicine includes TCM, Japanese ong>andong> Koreanong>theong>rapies. 41Not all states recognize ong>theong> accreditation stong>andong>ards developed by ACAOM. InCalifornia, ong>theong> Acupuncture Board which regulates licensure, education stong>andong>ardsong>andong> enforcement ong>ofong> ong>theong> Acupuncture Licensure Act including Oriental Medicine,41 Founded in 1982, ACAOM was recently reviewed by ong>theong> USDE ong>andong> received its maximum 5-yearrecognition period.19

establishes educational stong>andong>ards ong>andong> approves training programs. To date, 31educational institutions have been approved by California’s board.CanadaIn 2004, ong>theong> ACAOM extended its scope ong>toong> include accreditation ong>ofong> programs ong>andong>institutions in Canada. 42 In Ontario, as far as HPRAC is aware, ong>theong>re are currently noschools ong>ofong>fering courses in TCM that are accredited by ACAOM, or that have applied ong>toong>be accredited by ACAOM.In December 2000, British Columbia passed regulations giving force ong>toong> ong>theong> creation ong>ofong>ong>theong> College ong>ofong> Traditional Chinese Medicine Practitioners ong>andong> Acupuncturists (CTCMA).The by-laws ong>ofong> ong>theong> CTCMA provide for ong>theong> establishment ong>ofong> approval guidelines for ong>theong>evaluation ong>ofong> educational programs, ong>andong> ong>theong> maintenance ong>ofong> a list ong>ofong> accreditededucational programs. To date, ong>theong> CTCMA has set out approval guidelines but has notmoved ong>toong> implement an accreditation system for educational ong>andong> training programs.Instead, it has posted a list ong>ofong> 18 TCM schools in British Columbia, most ong>ofong> which ong>ofong>ferTCM docong>toong>r programs, with ong>theong> following disclaimer: “The College ong>ofong> TraditionalChinese Medicine Practitioners ong>andong> Acupuncturists ong>ofong> B.C. currently does not have aprogram ong>toong> accredit acupuncture ong>andong> TCM schools. This list is provided for generalinformation purpose only.”HPRAC heard that ong>theong> lack ong>ofong> accreditation for TCM programs in British Columbia is acause for concern since some ong>ofong> ong>theong> listed schools’ websites give ong>theong> impression ong>ofong>having been accredited by virtue ong>ofong> meeting ong>theong> requirements ong>ofong> B.C.’s Private ong>Careong>erTraining Institutions Agency.By requiring accreditation as a basis for approving educational programs, regulaong>toong>rybodies have ong>theong> assurance that educational programs have undergone an external reviewong>andong> ong>ofong>fer programs that train competent, safe ong>andong> effective practitioners. This in turnhelps ong>toong> protect public safety ong>andong> ensures that high quality acupuncture ong>andong> TCMservices are available.6. Transition Issues6.1 Transition PeriodFor current practitioners seeking ong>theong> docong>toong>r title, a three-year transition period from ong>theong>date ong>ofong> ong>theong> new College’s call for applications appears ong>toong> be an appropriate timeframe ong>andong>is comparable ong>toong> that used in Australia. During this time, practitioners can take aqualifying exam, or go through ong>theong> administrative process ong>toong> have ong>theong>ir qualificationsrecognized, ong>andong> upgrade education ong>toong> meet competency stong>andong>ards for use ong>ofong> ong>theong> docong>toong>rtitle.42 The Accreditation Commission for Acupuncture ong>andong> Oriental Medicine www.acaom.org Accessed April22, 2006. HPRAC’s discussions with ACAOM lead us ong>toong> believe that ong>theong>y would be willing ong>toong> work withong>theong> Transitional Council ong>toong> establish stong>andong>ards.20

6.2 Mutual Recognition AgreementsBy announcing its intention ong>toong> regulate TCM, Ontario joins several jurisdictions that havetaken this step. The experience ong>ofong> those jurisdictions with respect ong>toong> title issues,educational requirements, accreditation stong>andong>ards ong>andong> methods for integrating existingpractitioners inong>toong> a new regime, has been useful in HPRAC’s consideration ong>ofong> ong>theong>ong>Ministerong>’s referral.Along with Canada’s oong>theong>r provincial ong>andong> terriong>toong>rial governments, Ontario is party ong>toong> ong>theong>Agreement on Internal Trade (AIT) ong>andong> its provisions on labour mobility. 43B.C.’s current Registrar for ong>theong> College ong>ofong> Traditional Chinese Medicine Practitionersong>andong> Acupuncturists, Mary Watterson, has suggested ong>toong> HPRAC that Ontario ong>andong> BritishColumbia could work ong>toong>geong>theong>r on a national stong>andong>ard for recognizing practitioners whohold a Dr. TCM designation when ong>theong> Ontario College is established.7. Non-Exemptible ong>andong> Oong>theong>r RequirementsA number ong>ofong> related issues were raised in ong>theong> submissions ong>toong> HPRAC.Language Prong>ofong>iciencyMost ong>ofong> Ontario’s TCM practitioners are from abroad. Upon arrival in this country, manymay build a patient roster from within ong>theong>ir ethnic community where prong>ofong>iciency inEnglish has been incidental. The majority ong>ofong> submissions ong>toong> HPRAC urged that aworking knowledge ong>ofong> English be a necessary requirement.No criminal recordA number ong>ofong> submissions suggested that a lack ong>ofong> criminal record should be a necessaryrequirement prior ong>toong> being granted ong>theong> title ong>ofong> Docong>toong>r ong>ofong> TCM.Continuing educationIt has been suggested that a program ong>ofong> continuing education should be instituted ong>andong> thatDocong>toong>rs ong>ofong> TCM be required ong>toong> attend a minimum number ong>ofong> hours (i.e. 25) ong>ofong> continuingeducation each year in order ong>toong> maintain ong>theong>ir qualification.8. Recommendations8.1 Educational ProgramHPRAC recommends that ong>theong> following requirements be considered as aminimum stong>andong>ard for an educational program leading ong>toong> ong>theong> Dr. TCM degree:43 With ong>theong> exception ong>ofong> Nunavut.21

a) Five years ong>ofong> study, including 4000 – 5000 hours ong>ofong> didactic training, ong>ofong> whicha minimum 1200 hours is at ong>theong> docong>toong>ral level, with an additional 1200 hours ong>ofong>clinical internship.b) A prerequisite ong>ofong> two ong>toong> three years undergraduate education in a relatedfield for entry inong>toong> ong>theong> educational program.c) A core curriculum including competencies in patient assessment ong>andong>diagnosis, clinical intervention ong>andong> treatment, consultation ong>andong> collaboration,clinical supervision ong>andong> practice management, fundamental TCM ong>theong>ory, ethicsong>andong> regulaong>toong>ry stong>andong>ards.d) A clinically-oriented research project suitable for peer-reviewed publication.8.2 Educational EquivalenciesHPRAC recommends that ong>theong> Transitional Council ong>ofong> ong>theong> College ong>ofong> TraditionalChinese Medicine Practitioners ong>ofong> Ontario:a) Establish a working relationship with NCCAOM ong>toong> develop a comprehensivewritten examination for current TCM practitioners in Ontario ong>toong> ascertain thatong>theong>y meet equivalent academic stong>andong>ards for registration in ong>theong> Dr. TCM class;b) Make accommodations during ong>theong> transition period so ong>theong> competencyexamination may be written in ong>theong> language in which ong>theong>y were trained. 44However, applicants must meet ong>theong> non-exemptible requirement proposed in 8.5D.;c) Establish bridging program requirements for individuals who requireeducational upgrades ong>toong> qualify for ong>theong> Dr. TCM title;d) Establish continuing competence requirements for Docong>toong>rs ong>ofong> TCM as afeature ong>ofong> quality programs ong>ofong> ong>theong> College;e) Establish mechanisms for ong>theong> assessment ong>ofong> credentials earned in oong>theong>rjurisdictions for applicants ong>toong> ong>theong> Dr. TCM class on an ongoing basis.8.3 Educational FacilitiesHPRAC recommends that ong>theong> Transitional Council ong>ofong> ong>theong> College ong>ofong> TraditionalChinese Medicine Practitioners ong>ofong> Ontario move quickly ong>toong> establish aneducation committee ong>toong>:a) Adopt an accreditation stong>andong>ard for educational institutions ong>ofong>feringprograms leading ong>toong> a Dr. TCM degree. Comparable ong>toong> ACAOM stong>andong>ards,44 HPRAC notes that NCCAOM ong>ofong>fers exams in English, Korean ong>andong> Mong>andong>arin.22

accreditation requirements should address training delivery stong>andong>ards, facultyqualifications, course content, ong>andong> educational outcomes ong>toong> ensure high qualityprong>ofong>essional training.b) Evaluate ong>theong> stong>andong>ards ong>ofong> existing educational facilities currently ong>ofong>feringTCM training programs leading ong>toong> a Dr. TCM designation ong>andong> those who havean interest in establishing a prong>ofong>essional school or college ong>ofong>fering prong>ofong>essionaldocong>toong>rate programs eiong>theong>r in a free-stong>andong>ing prong>ofong>essional college or aprong>ofong>essional school set in a university.c) Commence discussions with ACAOM concerning options for its accreditationong>ofong> a school (or schools) in Ontario that would ong>ofong>fer an academic program leadingong>toong> a Dr. TCM degree.8.4 CredentialingHPRAC recommends that ong>theong> College require all cong>andong>idates for registration inong>theong> TCM docong>toong>r class ong>toong>:a) pass an approved competency examination ong>andong> present credentials earned inCanada or anoong>theong>r jurisdiction ong>toong> ong>theong> College.b) successfully complete a course in ethics ong>andong> jurisprudence ong>andong> oong>theong>r suchexaminations as set or approved by ong>theong> College.8.5 Non-Exemptible ong>andong> Oong>theong>r RequirementsHPRAC recommends that non-exemptible requirements for a certificate ong>ofong>registration be comparable ong>toong> those established for oong>theong>r prong>ofong>essions, includingong>theong> requirement that:A. The applicant’s past ong>andong> present conduct affords reasonable grounds forbelief that ong>theong> applicant:1) Is mentally competent ong>toong> practise traditional Chinese medicine.2) Will practise traditional Chinese medicine with decency, integrity ong>andong> honestyong>andong> in accordance with ong>theong> law.3) Has sufficient knowledge, skill ong>andong> judgment ong>toong> engage in ong>theong> kind ong>ofong> practiceauthorized by ong>theong> certificate.B. If ong>theong> applicant has previously been or is registered or licensed ong>toong> practiceanoong>theong>r prong>ofong>ession in Ontario, or TCM, or anoong>theong>r prong>ofong>ession in any oong>theong>rjurisdiction, ong>theong> applicant must provide evidence that ong>theong>re has been no findingong>ofong>, ong>andong> that ong>theong>re is no current investigation or proceeding involving anallegation ong>ofong>, prong>ofong>essional misconduct, incompetence or incapacity or similarconduct.23

C. The applicant must not have been found guilty ong>ofong> an ong>ofong>fence that isrelevant ong>toong> ong>theong> applicant’s suitability ong>toong> practice.D. The applicant must be able ong>toong> speak ong>andong> write eiong>theong>r English orFrench with reasonable fluency.E. The applicant must be a Canadian citizen or a permanent resident ong>ofong>Canada or authorized under ong>theong> Immigration Act (Canada) ong>toong> engage inong>theong> practice ong>ofong> ong>theong> prong>ofong>ession.24

AcronymsThe following are acronyms are used in this report:HPRACAdvisory CouncilTCMSATCMACAOMNCCAOMong>Healthong> Prong>ofong>essions Regulaong>toong>ry Advisory Counciltraditional Chinese medicineState Administration ong>ofong> Traditional Chinese Medicine (China)Accreditation Commission for Acupuncture ong>andong> OrientalMedicineNational Certification Commission for Acupuncture ong>andong> OrientalMedicineRHPA Regulated ong>Healthong> Prong>ofong>essions Act, 1991CTCMAUSDECWEACPPEPLSCNTCDRABTMTCUCollege ong>ofong> Traditional Chinese Medicine ong>andong> Acupuncture (BritishColumbia)United States Department ong>ofong> EducationComprehensive Written ExaminationAcupuncturePractical Examination ong>ofong> Point Location SkillsClean Needle TechniqueCredential Documentation ReviewAsian Bodywork TherapyMinistry ong>ofong> Training, Colleges ong>andong> UniversitiesPCCA Private ong>Careong>er Colleges Act, 2005AAMCAFMCCMACACMSCNMEAITAssociation ong>ofong> American Medical CollegesAssociation ong>ofong> Faculties ong>ofong> Medicine CanadaCanadian Medical AssociationCommittee on Accreditation ong>ofong> Canadian Medical SchoolsCouncil on Naturopathic Medical EducationAgreement on Internal Trade25

APPENDIX ADetails ong>ofong> ong>theong> ACAOM Master’s Level Curriculum 45The prong>ofong>essional program in Oriental medicine must:• be at least four academic years in length;• be a resident program;• demonstrate attainment ong>ofong> prong>ofong>essional competence;• have an adequate clinical component; ong>andong>• include ong>theong> following minimum core curriculum designed ong>toong> train students ong>toong>achieve ong>theong> competencies ong>ofong> an independent Oriental medical provider.1. Hisong>toong>ry ong>ofong> Acupuncture ong>andong> Oriental Medicine• Discussion ong>ofong> different traditions in acupuncture ong>andong> Oriental Medicine ong>andong> howong>theong>y relate ong>toong> Chinese medical hisong>toong>ry.• Hisong>toong>ry ong>ofong> ong>theong> development ong>ofong> acupuncture ong>andong> Oriental medicine in ong>theong> U.S. ong>andong>ong>ofong> development ong>ofong> current prong>ofong>essional trends.• Discussion ong>ofong> hisong>toong>ry ong>andong> prong>ofong>essional trends in acupuncture ong>andong> Orientalmedicine outside ong>theong> U.S. ong>andong> China.2. Basic Theory• Qi• Tonification (supplementation) ong>andong> sedation (draining) ong>ofong> qi, creation ong>ofong> harmony• Dao• Yin Yang• Eight Parameters/Ba Gang• Five Elements (phases, correspondences)/Wu Xing ong>andong> ong>theong>ir laws ong>andong> cycles• Twelve Officials/Shi Er Guan• Viscera & Bowels/Zang Fu• Theory ong>ofong> channel vessels (Meridians)/Jing Luo• Internal ong>andong> External causes ong>ofong> disease such as Six External Evils/Liu Xie, SevenEmotions/Qi Qing ong>andong> Non-internal or External Reasons/bu nei wai yin• Oriental medicine pathology (bing ji)• Meaning (significance) ong>ofong> disease, sympong>toong>ms, signs• Fundamental Body Substances (e.g. shen, qi, blood, fluid, etc.)3. Acupuncture, Point Location ong>andong> Channel (meridian) Theory• Location systems: anaong>toong>mically, proportionally, by palpation, Anaong>toong>mical Chineseinch (cun), fen.• Systems ong>ofong> nomenclature ong>andong> knowledge ong>ofong> stong>andong>ards ong>ofong> ong>theong> WHO ScientificGroup ong>toong> Adopt a Stong>andong>ard International Acupuncture Nomenclature, 1991• Anaong>toong>mical locations• All points on ong>theong> twelve bilateral channels (meridians) ong>andong> ong>theong> Conception/Renong>andong> Governing/Du vessels45 As excerpted in full from ong>theong> ACAOM Accreditation Hong>andong>book, January 2005, pp 20-26.http://www.acaom.org/Downloads/hong>andong>book/RO%20Hndbk%20Pt%201%202005.pdf.26

• Forbidden points, contraindications ong>ofong> points• Classification ong>ofong> points• Functions ong>andong> Indications ong>ofong> acupuncture points• Extra Acupuncture Points• Oong>theong>r categories ong>andong> types ong>ofong> acupuncture points (e.g. auricular points, scalppoints, hong>andong> points)• Special groupings ong>ofong> acupuncture points (for example: transport points, painful ortender points (Ah Shi), local ong>andong> distal points, Associated Effect ong>andong> Alarmpoints, Windows ong>ofong> ong>theong> Sky, Internal ong>andong> External Dragons, Seas ong>andong> Oceans,thirteen ghost points), ong>andong> oong>theong>r recognized point combinations.• Traditions ong>ofong> acupuncture; respect for different traditions ong>ofong> evaluating ong>andong>diagnosing ong>andong> influencing ong>andong> correcting ong>theong> balance ong>ofong> Qi.4. Diagnostic Skills• Hisong>toong>ry Taking/Charting• Acupuncture ong>andong> Oriental Medicine: Methods: Observation/Wang, Audio-Olfaction/Wen, Inquiry/Wen, Palpation/qie, Differential diagnosis• Biomedical: Measuring ong>andong> recording vital signs, i.e., respiraong>toong>ry rate, pulse rate,temperature ong>andong> blood pressure• Referrals: Recognition ong>ofong> sympong>toong>ms requiring referrals, including infectiousdisease.5. Treatment Planning in Acupuncture ong>andong> Oriental Medicine• Methods ong>andong> systems for planning, carrying out ong>andong> evaluating a treatment• Prognosis• Contraindications ong>ofong> treatment• Making appropriate referrals• Consideration ong>ofong> special facong>toong>rs or sympong>toong>ms indicating: potential for increasedrisk ong>toong> ong>theong> patient (e.g., immune compromised patient, diabetic patient); ong>theong> needong>toong> modify stong>andong>ard ong>theong>rapeutic approach (e.g., infants ong>andong> children, pregnancy);ong>andong> apparently benign presentations that may have a more serious cause(hypertension, headaches).6. Treatment Techniques• Needle insertion: depth, duration, manipulation ong>andong> withdrawal• Moxa: application, direct & indirect. etc.• Oong>theong>r techniques (e.g., bleeding, moxibustion, cupping, gua sha, seven star)• Tonification (supplementation)/bu ong>andong> sedation (draining)/xie• Knowledge ong>ofong> methods ong>andong> application ong>ofong> acupuncture relating ong>toong> ong>theong> treatment ong>ofong>acute ong>andong> chronic conditions, first aid, analgesia, anesong>theong>sia, ong>andong> electricalstimulation• Safety issues• Oriental bodywork ong>theong>rapy (e.g., tui na, shiatsu, amma, acupressure etc.)27

7. Equipment ong>andong> Safety• Selection & maintenance ong>ofong> equipment:- Needles: gauge, types, selection, replacement, inspection- Oong>theong>r equipment: cups, moxa, seven star, etc.- Sterilization: necessity ong>andong> various methods- Electronic equipment: selection, maintenance, inspection for hazards- Relevant State ong>andong> Federal regulations concerning equipment- Safety ong>ofong> patient ong>andong> practitioner:-- Asepsis, Clean Needle Technique-- Avoiding harm from typical procedures: needling, moxa, cupping, bloodletting,etc.-- Fainting during treatment-- Relevant State ong>andong> Federal regulations concerning safety-- First Aid ong>andong> CPR-- Personal & ong>ofong>fice cleanliness ong>andong> hygiene8. Counseling ong>andong> Communication Skills• Communications skills: listening, counseling, explaining, ong>andong> teaching• Managing psychological reactions that may arise during ong>theong> course ong>ofong> treatmentong>andong> ong>theong> ability ong>toong> make appropriate referrals9. Ethics ong>andong> Practice Management• Confidentiality• Informed Consent• Understong>andong>ing ong>theong> scope ong>ofong> practice• Record Keeping: legal requirement, release ong>ofong> data• Ethical ong>andong> legal aspects ong>ofong> referring patients ong>toong> anoong>theong>r practitioner• Prong>ofong>essional conduct ong>andong> appropriate interpersonal behavior• Overview ong>ofong> ong>theong> status ong>ofong> acupuncture ong>andong> Oriental medicine in ong>theong> U.S.• Understong>andong>ing laws ong>andong> regulations governing ong>theong> practice ong>ofong> acupuncture ong>andong>Oriental medicine in ong>theong> state where ong>theong> program is ong>ofong>fered ong>andong> that laws ong>andong>regulations vary from state ong>toong> state• Recognition ong>andong> clarification ong>ofong> patient expectations• General liability insurance ong>andong> legal requirements• Prong>ofong>essional liability insurance: risk management ong>andong> quality assurance• Building ong>andong> managing a practice including ethical ong>andong> legal aspects ong>ofong> third partyreimbursement• Prong>ofong>essional development• Basic bookkeeping28

10. Biomedical Clinical Sciences• Relevant basic sciences that are directed ong>toong>ward attaining ong>theong> biomedical clinicalcompetencies• Biomedical ong>andong> clinical concepts ong>andong> terms• Human anaong>toong>my ong>andong> physiology• Pathology ong>andong> ong>theong> biomedical disease model• The nature ong>ofong> ong>theong> biomedical clinical process including hisong>toong>ry taking, diagnosis,treatment ong>andong> follow-up• The clinical relevance ong>ofong> laboraong>toong>ry ong>andong> diagnostic tests ong>andong> procedures as well asbiomedical physical examination findings• Infectious diseases, sterilization procedures, needle hong>andong>ling ong>andong> disposal, ong>andong>oong>theong>r issues relevant ong>toong> blood borne ong>andong> surface pathogens• Biomedical pharmacology including relevant aspects ong>ofong> potential medication,herb ong>andong> nutritional supplement interactions, contraindications ong>andong> side effectsong>andong> how ong>toong> access this information• The basis ong>andong> need for referral ong>andong>/or consultation• The range ong>ofong> biomedical referral resources ong>andong> ong>theong> modalities ong>theong>y employ11. Oriental Herbal StudiesThis component shall be included in any continuing education program in herbal ong>theong>rapyor any herbal component ong>ofong> any oong>theong>r type ong>ofong> program that provides students withsufficient knowledge ong>toong> enable ong>theong>m ong>toong> use Oriental herbs in ong>theong> practice ong>ofong> Orientalmedicine.• Introduction ong>toong> Oriental Herbal Medicine• Development ong>ofong> herbal medical systems throughout ong>theong> Orient• Hisong>toong>ry ong>ofong> ong>theong> development ong>ofong> Oriental herbal medicine in ong>theong> USA• Legal ong>andong> ethical considerations ong>ofong> herbal medicineBasic Herbal Medicine Theory• Plant-part terminology ong>andong> significance ong>toong> usage• Herbal properties, e.g., concepts ong>ofong> herbal categories, taste, temperature, enteringmeridians• Methods ong>ofong> preparation, i.e., dried, honey-baked.• Methods ong>ofong> delivery, e.g., decoction, ong>toong>pical, timing (before meals)• Laws ong>ofong> combining, including common contraindications, prohibitions,precautions• Methods ong>ofong> treatment, i.e., induce sweat, clearing, harmonizeOriental Diagnostic And Treatment Paradigms As They Pertain To Herbal Medicine, e.g.:• Shan Han/6 stages• Wen Bing/4 levels• Zang Fu• Chinese Internal ong>andong> External MedicineHerbal Treatment Strategies• Methods ong>andong> systems for planning, carrying out ong>andong> evaluating a treatment29

• Differentiation ong>andong> modifications ong>ofong> herb formula for various patterns ong>ofong>disharmony according ong>toong> Chinese medical principles• Chinese herbal medicine proong>toong>cols applied ong>toong> patients with a biomedical diagnosisMateria Medica - Instruction in a minimum ong>ofong> 300 different herbs• Categories: functions ong>andong> meaning• Visual identification including differing methods ong>ofong> cutting• Temperature, taste, ong>andong> entering meridians• Taxonomy ong>andong> nomenclature• Introduction ong>toong> Chinese names ong>ofong> herbs• Functions ong>andong> actions; classical ong>andong> new developments• Specific contraindications for each herb• Applications ong>ofong> herbal dosages• Current developments in individual herb research• Endangered species ong>andong> substitutions for ong>theong>mHerbal Formulas - Instruction in a minimum ong>ofong> 150 formulas• Traditional formula categories, functions ong>andong> meanings• Meanings ong>ofong> ong>theong> traditional Chinese formula names• Functions ong>andong> actions; classical ong>andong> new developments• Specific contraindications for each formula• Current developments in formula research• Composition ong>andong> proportion ong>ofong> individual herbs in each formula• Major modifications ong>ofong> formulations• Patient education regarding administration, potential side effects, preparation ong>andong>song>toong>rage ong>ofong> formulas• Prepared herbal formulations: modifications ong>andong> format ong>ofong> deliveryFood Therapy/Nutrition• Categorization ong>ofong> foods with regard ong>toong> temperature, taste, ong>andong> function• Dietary advice for various conditions• Preparation ong>ofong> common food/herbal recipesClinical Internship ong>andong> Herbal Dispensary• Clinical internship in which students interview, diagnose ong>andong> write appropriateherbal formulae moving from complete supervision ong>toong> independent formuladevelopment• Stong>andong>ards ong>ofong> cleanliness in a herbal dispensary• Song>toong>rage ong>ofong> herbs (both raw ong>andong> prepared formulas), covering issues ong>ofong> spoilageong>andong> bugs• Practice in ong>theong> filling ong>ofong> herbal formulas in an herbal dispensary settingWestern Science for Herbal Medicine• Botany, non-botanical ong>andong> horticulture (e.g., changes in ong>theong> characteristics ong>ofong>herbs due ong>toong> environmental facong>toong>rs) as ong>theong>y pertain ong>toong> herbal medicine30

• General principles ong>ofong> pharmacognosy:a) Biochemical components ong>ofong> herbs ong>andong> natural substancesb) Considerations ong>ofong> pharmaceutical interactions with reference ong>toong> currenttexts12. Oong>theong>r Oriental Medicine Modalities• Oriental manual ong>theong>rapy, including bodywork ong>andong> physioong>theong>rapies• Exercise/breathing ong>theong>rapy• Diet counselingThe above requirements may be satisfied by courses at a college or university accreditedby an agency recognized by ong>theong> U.S. Secretary ong>ofong> Education provided that ong>theong> corecontent is consistent with ong>theong> program's objectives. The program must ensure that ong>theong>sequencing, duration, nature ong>andong> content ong>ofong> all didactic, practical, ong>andong> clinical trainingcourses are appropriately integrated ong>andong> consistent with ong>theong> program's purposes ong>andong>educational objectives.31

Appendix BCompetencies for Successful Completion ong>ofong> ACAOM-approved Program 46CompetencyCollecting data ong>andong> using patientexaminations ong>toong> make a diagnosisFormulating a diagnosis by classifying ong>theong>data collected ong>andong> organizing it according ong>toong>traditional ong>theong>ories ong>ofong> physiology ong>andong>pathology.Determining Treatment Strategy Based on ong>theong>Diagnosis Formulated.Performing treatment by applying appropriatetechniques, including needles, Moxa,manipulation, counseling, ong>andong> ong>theong> utilization ong>ofong>skills appropriate for ong>theong> preparation ong>ofong> ong>toong>olsong>andong> instruments.Assessing ong>theong> effectiveness ong>ofong> ong>theong> treatmentstrategy ong>andong> its executionComplying with practices as established byong>theong> prong>ofong>ession ong>andong> society-at-large.Making a Diagnosis/Energetic Evaluation by:identifying position, nature ong>andong> cause ong>ofong> ong>theong>dysfunction, disorder, disharmony, vitality ong>andong>constitution.Planning ong>andong> Executing an Herbal Treatmentusing acquired knowledge.Planning ong>andong> Executing an Herbal TreatmentFoundation Skillsby: Observation, Olfacong>toong>ry examination, Audio examination,Palpation, Inquiry, ong>andong> Physical examination.This skill implies comprehensive understong>andong>ing ong>ofong> eightfundamental ong>theong>ories ong>andong> concepts, eg. Yin-Yang Theory,Channel Theory, ong>andong> Organ Theory etc.• The availability ong>ofong> additional appropriate modalities forpatient referral• The ability ong>toong> communicate with oong>theong>r health prong>ofong>essionalsregarding patient care, utilizing commonly undersong>toong>odmedical terminology• The functions ong>ofong> ong>theong> acupoints• Proper sterilization ong>andong> aseptic procedures• Preparation ong>ofong> ong>theong> patient, including proper positioningfor application ong>ofong> techniques• Effective communication with ong>theong> patient regarding ong>theong>nature ong>ofong> ong>theong> illness ong>andong> ong>theong> treatment plan• Accurate location ong>ofong> acupoints• Safe ong>andong> effective needle insertion techniques basedupon ong>theong> function ong>ofong> ong>theong> point, ong>theong> recommendedneedling depths, ong>theong> underlying anaong>toong>my at ong>theong> site, ong>theong>desired effect ong>ofong> needling, ong>andong> ong>theong> nature ong>ofong> ong>theong> illness• Accepted clean needle insertion practices, includingproong>toong>cols adequate ong>toong> allow compliance with NCCAOMguidelines on sanitation, asepsis, ong>andong> clean needlehong>andong>ling• Safe ong>andong> effective application ong>ofong> adjunctive techniques,including moxibustion, electrical stimulation ong>andong>manipulation• Effective control ong>ofong> emergency situations• By re-examination ong>ofong> ong>theong> patient• By comparison with previous conditions ong>andong>expectations• By modification ong>ofong> ong>theong> treatment plan, if required, basedupon that assessmentThrough: application ong>ofong> a code ong>ofong> ethics; practice ong>ofong>responsible record keeping ong>andong> patient confidentiality;maintenance ong>ofong> prong>ofong>essional development throughcontinuing education; ong>andong> maintenance ong>ofong> personaldevelopment by continued cultivation ong>ofong> compassion.This evaluation is based on ong>theong> 13 concepts below plusknowledge ong>ofong> distinctive patterns ong>ofong> herbal combinations ong>andong>recognition ong>ofong> medical emergencies.Identification ong>ofong> most commonly used raw ong>andong> preparedsubstances in Materia Medica; use ong>ofong> common foods ashealing modalities; properties ong>ofong> substances in Materia46 ACAOM, Accreditation Hong>andong>book, January 2005, pp 31-34.http://www.acaom.org/Downloads/hong>andong>book/RO%20Hndbk%20Pt%201%202005.pdf.32

using acquired knowledge.Understong>andong>ing Prong>ofong>essional Issues Related ong>toong>Oriental HerbsIn order ong>toong> be able ong>toong>:• Recognize situations where ong>theong>patient requires emergency oradditional care or care bypractitioners ong>ofong> oong>theong>r health care (ormedical) modalities, ong>andong> ong>toong> refer suchpatients ong>toong> whatever resources areappropriate ong>toong> ong>theong>ir care ong>andong> wellbeing• Appropriately utilize relevantbiomedical clinical science conceptsong>andong> understong>andong>ings ong>toong> enhance ong>theong>quality ong>ofong> Oriental medical careprovided• Protect ong>theong> health ong>andong> safety ong>ofong> ong>theong>patient ong>andong> ong>theong> health care providerrelated ong>toong> infectious diseases,sterilization procedures, needlehong>andong>ling ong>andong> disposal, ong>andong> oong>theong>rissues relevant ong>toong> blood borne ong>andong>surface pathogens• Communicate effectively with ong>theong>biomedical communityMedica; identification ong>ofong> common biochemical constituentsong>andong> common dosage guideline; contraindications ong>ofong>individual herbs ong>andong> possible side effects; traditionalstrategies ong>ofong> herbal formulation eg. sweating (sudorific) orsupplementing (ong>toong>nic); composition ong>ofong> formulas (hierarchy ong>ofong>ingredients, internal dynamics ong>ofong> ingredients, changes inhierarchy ong>ofong> ingredients by modification ong>ofong> ingredients ordosage); preparation ong>andong> administration ong>ofong> formulas(dosage, timing, frequency, duration, extraction times, etc);indications ong>andong> functions ong>ofong> representative herbal formulas;selection, modification ong>andong> development ong>ofong> appropriateformulas consistent with ong>theong> pattern ong>ofong> disharmony ong>andong>treatment plan; current types ong>ofong> prepared formulationsavailable (pills, powder, tincture, etc.); dosage variances,side effects ong>andong> ong>toong>xicity associated with usage, timing,frequency, duration, extraction times, etc; understong>andong>ing ong>theong>issues surrounding non-traditional additives ong>toong> prescriptions;selection ong>ofong> ong>theong> appropriate modality or modalities fortreatment; consultation with patient regarding treatmentplan, side effects, outcomes, ong>andong> healing process;biomedical considerations ong>ofong> herbal preparations(contraindications, drug interactions, etc).Specifically: ethical considerations with respect ong>toong>prescribing ong>andong> selling herbs ong>toong> patients; how/when ong>toong>consult ong>andong> refer with appropriate biomedical or allied healthpractitioners regarding drug interactions ong>andong> herbal ong>theong>rapy;appropriate management, care, ong>andong> song>toong>rage ong>ofong> herbs ong>andong>herbal products.The Student must have an adequate understong>andong>ing ong>ofong>:• Relevant biomedical ong>andong> clinical concepts ong>andong>terms• Relevant human anaong>toong>my ong>andong> physiologicalprocesses• Relevant concepts related ong>toong> pathology ong>andong> ong>theong>biomedical disease model• The nature ong>ofong> ong>theong> biomedical clinical processincluding hisong>toong>ry taking, diagnosis, treatment ong>andong>follow-up• The clinical relevance ong>ofong> laboraong>toong>ry ong>andong> diagnostictests ong>andong> procedures, as well as biomedicalphysical examination findings• Relevant pharmacological concepts ong>andong> termsincluding knowledge ong>ofong> relevant potentialmedication, herb ong>andong> nutritional supplementinteractions, contraindications ong>andong> side effects33

APPENDIX CDetails ong>ofong> Sample Curriculum: ChinaSummary Hours YearsBiomedicine 1127TCM 1920Oong>theong>r 662Clinic 1800 1 yearTotal 5509 5 yearsCourses Hours DepartmentScience ong>ofong> epidemic febrile disease 65 BiomedicinePhysiology 95 “Pathology 95 “Essentials ong>ofong> diagnostics 120 “Internal Medicine 133 “Surgery 76 “Anaong>toong>my, hisong>toong>logy & embryology 171 “Chemistry 84 “Biochemistry 60 “Microbiology 54 “Parasiong>toong>logy 22 “Sanitation ong>andong> entiepidemic 76 “Pharmacology 76 “Clinical Internship (1 year) 1800 ClinicLiberal Arts 662 Oong>theong>rNatural dialetics 60 TCMBasic ong>ofong> TCM science 152 “Diagnosis ong>ofong> TCM 90 “Chinese material 152 “Prescription ong>ofong> TCM 95 “Canon ong>ofong> Medicine 76 “Internal Medicine TCM 272 “Surgery ong>ofong> TCM 114 “Acupuncture ong>andong> moxibustion 114 “Medical articles or archaic Chinese 114 “Hisong>toong>ry ong>ofong> TCM 38 “Theories ong>ofong> Different Schools 114 “Treatise ong>ofong> febrile diseases 95 “Miscellaneous diseases 76 “Traumaong>toong>logy ong>ofong> TCM 95 “Pediatrics ong>ofong> TCM 73 “Ophthalmology ong>andong> laryngology ong>ofong> TCM 95 “Gynaecology ong>ofong> TCM 95 “Graduation ThesisGraduation Examination34

APPENDIX DApproaches ong>toong> Credentialing Existing PractitionersChinaThere are three channels through which TCM practitioners are trained. First, ong>theong>re arethose who receive no formal education but learn ong>theong> trade through family members (i.e.some form ong>ofong> apprenticeship). Second are students who graduate from TCM educationalinstitutions. Finally, ong>theong>re are physicians trained in Western medicine who transfer ong>toong> ong>theong>practice ong>ofong> TCM. There are also three tiers ong>ofong> practice: physicians, assistants, ong>andong>specialists - individuals examined ong>andong> ong>ofong>ficially recognized as prong>ofong>icient in a particularbranch ong>ofong> TCM. 47Unfortunately, ong>theong>re have been issues with ong>theong> specialists due ong>toong> ong>theong> lack ong>ofong> a uniformmethod ong>ofong> assessment, which consequently has led ong>toong> some unqualified individualsobtaining ong>ofong>ficial recognition. As a result ong>ofong> this, ong>theong> SATCM has introduced annualtesting for this tier ong>ofong> practitioners.SingaporeThe Traditional Chinese Medicine Practitioners Board was created by ong>theong> TraditionalChinese Medicine Practitioners Act (2000) with responsibilities for accrediting TCMschools ong>andong> courses, conducting examinations, ong>andong> registering ong>andong> issuing licenses ong>toong>TCM practitioners.To ease ong>theong> integration ong>ofong> existing practitioners inong>toong> its new regime, regulation wasphased in. Acupuncturists were registered first, followed by herbalists. Currently, ong>theong>Board is calling for voluntary listing ong>ofong> herbal dispensers prior ong>toong> registration beingundertaken. Eventually ong>theong>re will be a requirement that dispensers undertake a three ong>andong> ahalf year course for registration.With a view ong>toong> improving ong>theong> quality ong>ofong> trainees ong>andong> training, a government Committeeurged local TCM schools ong>toong> upgrade ong>theong>ir part-time courses ong>toong> a three-year full-timediploma course or a six-year part-time equivalent. The Board hopes ong>toong> move ong>toong> a degreecourse in ong>theong> future. The program is currently not a university degree course but ranksabove polytechnic status.Singapore now requires new practitioners ong>toong> undertake a six-year part time course whichis currently not a university degree course but ranks above polytechnic status. Thegovernment chose a part time format ong>toong> allow existing practitioners ong>andong> oong>theong>r students ong>theong>opportunity ong>toong> support ong>theong>mselves by working while studying.47 Cong>andong>idates who are not successful in passing ong>theong> examinations, or decide not ong>toong> take ong>theong>m, must pass aunified exam ong>ofong>fered by ong>theong> ong>Healthong> Department before ong>theong>ir qualifications ong>toong> practise as TCM assistants orphysicians are recognized.35

TaiwanThrough ong>theong> late 1980s ong>toong> ong>theong> present-day, ong>theong> Taiwanese government has expong>andong>ed ong>theong>responsibilities ong>ofong> ong>theong> Committee on Chinese Medicine ong>andong> Pharmacy. Among itsresponsibilities are clinical ong>andong> oong>theong>r training programs for Chinese medical personnel.TCM education in Taiwan is being gradually absorbed inong>toong> ong>theong> university educationsystem.Chinese medical education in Taiwan is being gradually absorbed inong>toong> ong>theong> universityeducation system. All traditional Chinese Medicine practitioners in Taiwan also learnWestern medicine. As a result ong>ofong> tension between Western ong>andong> Chinese medicalpractitioners, ong>theong> government requires that all individuals wishing ong>toong> practice TCMundertake continuing education at a university.36

APPENDIX ELetter from ong>Ministerong> ong>ofong> ong>Healthong> ong>andong> ong>Longong>-ong>Termong> ong>Careong> ong>toong> ong>theong> ong>Healthong> Prong>ofong>essionsRegulaong>toong>ry Advisory Council37

ong>Healthong> Prong>ofong>essions Regulaong>toong>ry Advisory Council55 St. Clair Avenue WestSuite 806, Box 18Toronong>toong>, Ontario, Canada M4V 2Y7Telephone: 416-326-1550Toll-Free: 1-888-377-7746Fax: 416-326-1549Website: www.hprac.orgE-mail: HPRACWebMaster@moh.gov.on.caEISBN 1-4249-2149-X (Print)© Copyright Queens Printer for Ontario, 2006.3M 09/06

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