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Teaching acupuncture to medical students: the experience of Rio Preto Medical School (FAMERP), Brazil
  1. João Bosco Guerreiro da Silva1,
  2. Rassen Saidah1,
  3. Cecília Baccili Cury Megid1,
  4. Neil Alvimar Ramos2
  1. 1Acupuncture Service - Department of Medicine II - Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
  2. 2Prefeitura Municipal de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
  1. Correspondence to Professor João Bosco Guerreiro da Silva, Rua Pernambuco, 3147 Redentora, São José do Rio Preto, São Paulo 15015-770, Brazil; jbgsilva{at}hotmail.com

Abstract

Complementary and alternative medicine, and in particular acupuncture, has been practised and taught in recent years in many universities in the Western world. Here, we relate our experiences since 1997 in teaching acupuncture to medical students at Rio Preto Medical School (Faculty of Medicine of São José do Rio Preto (FAMERP)), Brazil. Classes are given in the third and fifth years. The main goals of understanding the mechanisms of action and being able to recognise patients who may benefit from treatment and referring them have been well achieved, scoring 3.6 and 4.1, respectively, on a scale of 1–5. Also using that scale, medical students believe that acupuncture is important in the curriculum (4.6), course time is not sufficient (2.7) and they would like more information (4.6). To overcome these concerns, many students join an undergraduate study group (Acupuncture League) where they have more time to learn. We also describe the presence of foreign medical students who, since 2000, have enrolled in a course of 150 h in an exchange programme.

  • Acupuncture
  • Education & Training (see Medical Education & Training)
  • Medical Education & Training
  • Complementary Medicine

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Introduction

The clinical practice of acupuncture has increased substantially in Western countries over the past several decades. It has been introduced into many hospitals and outpatient clinics, and has been widely researched with promising results in some studies.1 The principles of acupuncture have also been taught in increasing numbers of universities and medical schools, but it is hard to isolate data on these curriculum enhancements because most of the research includes acupuncture in the broader context of complementary and alternative medicine (CAM).

Information collected since the turn of the century indicates that CAM is included in university curricula at a level of 64% in the USA,2 81% in Canada,3 40% in the European Union4 and 20% in Japan.5 While there is little information about acupuncture itself, it appears that most doctors’ training has been offered in a context outside of universities.

As a contribution to help fill this information gap this paper relates our experiences with several programmes designed to teach acupuncture to medical students at Rio Preto Medical School (Faculty of Medicine of São José do Rio Preto (FAMERP)), in the state of São Paulo, Brazil, over the last 16 years.

The undergraduate programmes

Third year

Since 1997, third year students receive acupuncture classes as a part of their formal curriculum. The classes take around 6 h and are intended as an overview of acupuncture, its origins in China and spread to neighbouring countries such as Korea, Japan and Vietnam, and its traditional explanatory model. Students also learn about the penetration of acupuncture in the West—where it received its Latin name—reaching south America and Brazil in the 1950s, the existence of an acupuncture service in their college since 1988 and what has occurred in Brazil over the past few decades to institutionalise its teaching and practice.

Emphasis is given to understanding the scientific approach to acupuncture, its possible mechanisms of action, and the extensive research and intrinsic difficulties of using a pharmacological methodology to investigate such a singular treatment. Students also learn about the most important pathologies treatable by acupuncture and the up-to-date literature that supports these treatments.

Fifth year

Since 2007, students in their fifth year have been welcomed into the college acupuncture outpatient clinic for four Wednesday afternoon sessions. Our initial focus was for students to achieve three aims: (1) an understanding of the relationship between acupuncture and modern medicine and how these medical systems could work together to enhance the construction of a truly integrative medicine; (2) to see with their own eyes the type of patients who benefit from acupuncture and become aware of the option of referring them for acupuncture treatment when the students become doctors, no matter what specialisation they practice; and (3) to see acupuncture as a practical tool for any specialisation and learn some ‘minor acupuncture’ to use with their future patients.

The experience has shown us that these aims were too ambitious to be achieved in such a relatively short time, and we temporarily dropped our third aim. For that we would need additional hours of practice, which could be attained only within the scope of the extracurricular ‘Acupuncture League’ (see below).

The last two classes of students (2011 and 2012) were asked to evaluate the acupuncture programme. From a total of 128 students, 95 (74%) responded to 5 questions, using a scale of 1–5: (1) how appropriate is to integrate acupuncture into the medical curriculum? = 4.6 (SD=0.7), (2) how much do you understand about the mechanisms of action of acupuncture? = 3.6 (SD=0.8), (3) can you identify patients who would benefit from acupuncture? =4.1 (SD=0.7), (4) was the time allotted for learning sufficient? =2.7 (SD=1.1) and (5) would you like to have more information about acupuncture? = 4.6 (SD=0.7)

The Acupuncture Academic League

Academic Leagues are organisations within medical schools, organised and led by students and supervised by a professor. They started in Brazil in the 1920s, are regulated by law, and are designed to supplement and enhance the curriculum. They are a complement that permits the student to attain a deeper understanding of some disciplines of particular interest.6 Each league is required to have three branches: learning, research and extension to the community. Although there are criticisms that the leagues can induce premature specialisation and distort the aims of general medical education, it is also arguable that they provide useful tools and opportunities for students approaching the reality of specialties.7 ,8

In 2012 there were 18 leagues at FAMERP, ranging from well-established specialties such as ophthalmology, orthopaedics and urology to interdisciplinary areas such as sports medicine, oncology, trauma and transplants. The League of Acupuncture, created in 1998 and transformed in 2004 into a League of Holistic Health, introduces students to other forms of healthcare that are not contained in the curriculum, including phytotherapy, homeopathy, meditation, functional food, tai chi, yoga and others.

Here we describe only the acupuncture portion, which comprises 24 h of theoretical classes covering the traditional basis of acupuncture, modern interpretation of this knowledge, scientific approach, foundations of acupuncture research and main pathologies treated by acupuncture. In the theoretical part of the League there is no limit to student enrolment. Up to 20 students (after a test, if needed) are then allowed to observe in the outpatient clinic and, in their free time, to practise among themselves the several procedures of acupuncture for a minimum of 15 h (figure 1). After completing this didactic and experiential training, students may attend normal service schedules to see real patients where they may assist with minor procedures such as removing needles, participate in patient interviews and help to develop research protocols. In addition, there is an annual League Fair, organised by the college but held outside its walls, commonly in malls and squares, where students can offer information to the community.

Figure 1

Students from the Acupuncture League practise among themselves.

The extra training provided by the League permits medical students to gather theoretical and practical knowledge that may be very useful in their future professional lives, and has stimulated many of them to continue their careers as doctors of acupuncture

Foreign student exchange programme

The International Federation of Medical Student Associations of Brazil is an organisation that promotes exchange programmes between students from Brazil and abroad. Every year since 2000 we have offered two to six positions for foreign students to undertake an internship covering 150 h of theoretical and practical experience in our outpatient acupuncture clinic, where they may practise with the students of the League and also observe regular care (figure 2). Most of the students are from Europe, but we have also received some from Asia and North America. From 2000 to 2012, we received 32 students (table 1), whose main goal was to obtain initial training that they did not have access to in their home countries. We even had a Taiwanese student from a conventional medical school—a daughter and sister of traditional doctors—who had no opportunity to learn acupuncture in her home country because this was only taught in traditional medicine schools.

Table 1

Foreign students from 2000 to 2012

Figure 2

Students from Poland ‘treat’ another student from Serbia.

We have no formal programme evaluations from these students but many returned to their home countries looking for courses in acupuncture to continue their studies.

Discussion

In many countries, medical students appreciate the importance of including CAM (with acupuncture as the best known of these treatments) within their conventional medical curriculum.9–12 This has been reported from countries such as Denmark where CAM is well known,13 as well from countries such as Israel where students report little initial knowledge of CAM.14 Our students in Brazil also agree that acupuncture should be integrated into their medical curriculum; on a scale from 1–5, their mean score was 4.6. This must be considered, as reported from Turkey15 and Korea,16 in the context of the need for a coordinated policy to integrate CAM (acupuncture) with a more consistent medical approach, as has been undertaken in Germany.17

Our main goal for a compulsory curriculum unit on acupuncture—for students to gain sufficient knowledge to advise patients about acupuncture as a medical option and to refer patients for such treatment—was achieved, as the mean score from students for this question was 4.1. This goal was also considered as achieved by students from the US18 and UK.19 That acupuncture's mechanisms of action are only relatively well understood is reflected in student scores of 3.6. This can be credited to the short period of time allotted to study and demonstrated by the score of 2.7 given to the time of learning and 4.6 to the willingness to receive more information.

To deal with the issue of the short time available, we decided to use evidence-based principles in the third and fifth years only,20 addressing some traditional knowledge only in the League and, of course, in the Medical Residency Programme, cited elsewhere.21 Many students, however, arrive very curious about the roots of traditional acupuncture, leading us to open a gap for this approach.

Conclusions

Our medical students are in strong agreement that acupuncture should be part of the curriculum, in particular to enable them to recognise what kind of patients could benefit from it. The short time of the course related to acupuncture makes it difficult for students to achieve sufficient understanding and they report that they would like to receive more information. This deficit has been addressed and overcome in part by the existence of the availability of extracurricular student groups (the aforementioned Leagues) that offer supplemental didactic and experiential training in acupuncture.

References

View Abstract

Footnotes

  • Contributors JBGS, RS, CBCM and NAR participated in the programme and helped to write the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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