8.1 Overview

This chapter presents a review of TCM education in China and Australia.

China has operated formal tertiary courses of study in TCM with government accreditation and financial support since 1956. Recent revisions to the delivery of tertiary education have resulted in the conversion of the larger well-established TCM teaching colleges into universities. Undergraduate university TCM programs in China are generally of five years duration, and represent the principal training for TCM practice in public hospitals. Formal TCM qualifications, however, can be also obtained through TCM secondary schools and external courses (known as the self-study examination system), but these generally serve a different practice environment.

Two levels of TCM education programs have been identified in Australia:

• Category A: There are 13 major programs containing 800 contact hours or more and acting as a primary TCM qualification. They are offered by both universities and private colleges.
• Category B: A further 10 programs have been identified in Australia that are recognised for the purposes of membership by various associations. They vary in duration from a few contact hours to 390 hours. They may or may not result in the award of a qualification.

Summary findings in this chapter relate to acupuncture and Chinese herbal medicine courses only.

8.2 Methodology

A bilingual researcher trained in TCM was commissioned to review TCM education in China. Important source documents were available in libraries and further information was collated through interviews with executive members of the <$iState Administration of TCM> (China), TCM institutions in China, Chinese-Australian TCM educators and other academics with relevant expertise. The Department of Human Services (Victoria) also initiated contact with the State Administration of TCM (China). The State Administration responded with substantial documentation to assist with this report.

The 13 Australian universities and private colleges known to be teaching programs in TCM were forwarded a survey instrument. Information was requested on:

• entry requirements;
• areas of instruction;
• total contact hours;
• research facilities;
• faculty qualifications; and
• external course review mechanisms.

The survey instrument is included as Appendix 19. Other non-award programs in TCM were contacted by telephone for basic information. The findings reported here are for current courses. Where programs have been transferred into university, only the university program is included here.

8.3 TCM Education in China

China has dual systems of traditional Chinese and western medical education. These are not mutually exclusive: students are trained primarily in one approach but elements of western medical sciences are incorporated in TCM programs, and western medicine students receive an overview of TCM:

• During undergraduate and internship training TCM students obtain clinical experience in hospitals in both TCM and western medicine departments. Graduates from TCM university courses are able to diagnose in western medical terms, prescribe western pharmaceuticals, and undertake minor surgical procedures. In effect, they practise TCM as a specialty within the broader organisation of Chinese health care.
• Western medical doctors undertake an introductory course in TCM (approximately 100 hours) to familiarise them to TCM treatment and theory. Practitioners trained in western medicine however, cannot practise acupuncture or Chinese herbal medicine without undertaking extensive additional training.

There is considerable homogeneity in formal educational requirements across China. Course specifications are determined by the central government, but regional flexibility is allowed. A variety of types and levels of education is available.

There are three principal streams of TCM education that lead to formal qualifications:

• TCM secondary schools;
• TCM tertiary institutions; and
• external courses (known as the self-study examination system).

Each stream prepares graduates in a different manner. Graduates are then qualified to work within certain contexts and under specific limitations. This is particularly the case in differentiating secondary and tertiary TCM education. However, self-study examinations and apprenticeships are still recognised, and many mechanisms exist for further training and upgrading of qualifications.

8.3.1 Secondary Education

The principal aim of this level of TCM education is to train personnel for primary health care activities in rural areas. This stands in contrast to the level of education required at tertiary level for employment and practice rights in large urban hospitals.

After completing junior high school (the equivalent of Year 9 level in Australia), students are able to do four years of secondary education for an associate diploma in TCM, Chinese herbal pharmacy, or TCM nursing. There are 71 secondary TCM schools and 98 departments of TCM in secondary medical schools1. The teaching weeks and subject hours determined by the Ministry of Health are distributed as shown in Tables 8.1 and 8.2.

Although the curriculum is designed by the Chinese Ministry of Health, individual schools are allowed some flexibility. Total teaching must not exceed 3200 hours. The ratio of lectures to clinical practice is 2:1.

Table 8.1: Teaching weeks: Associate Diploma of Herbal Medicine - Guangzhou, China

Table 8.2: Course subjects and hours: Associate Diploma of Herbal Medicine - Guangzhou, China. These hours exclude clinical practicum.

8.3.2 Tertiary Education

Training in TCM was established at the tertiary level in 1956 with government accreditation and financial support. Currently in the People's Republic of China there are 27 universities and colleges of TCM, and 15 faculties of TCM in medical universities and colleges1. Most of them offer postgraduate in addition to undergraduate studies and have the principal purpose of providing high quality education in TCM. Graduates have full practising rights within all public hospitals and are recognised by the State.

8.3.2.1 Undergraduate Studies

TCM tertiary institutions usually provide Bachelor of Medicine and Bachelor of Chinese Pharmacy programs, with specialties in the disciplines of herbal medicine, acupuncture, and herbal pharmacology. In recent years, higher education courses at diploma level have also become available. It is estimated there have been more than one hundred thousand Chinese graduates of TCM since 19621.

Undergraduate students are selected from amongst senior high school leavers (equivalent to Year 12 in Australia) who have passed the National University Entrance Examination and a health check. The curriculum and textbooks for universities of TCM are issued by the National Education Committee in conjunction with the State Administration of TCM.

Students undergo systematic training in TCM theories and practice with a focus on TCM diagnostic systems and methods of treatment. In modern medical science subjects emphasis is placed on:

• basic medical theory;
• the clinical treatment of common diseases; and
• first aid.2

Although curricula are designed by the national peak body, individual institutions do make variations, depending on their facilities.

By way of example, Tables 8.3 and 8.4 summarise the representative curricula for the Bachelor of Medicine with specialties in Chinese herbal medicine and in acupuncture and moxibustion offered by the Guangzhou University of TCM.3

The Bachelor of Medicine (TCM) programs run over five years full-time, with lectures, tutorials, laboratory work and clinical practice combined during the first four years. Students spend their fifth year in TCM teaching hospitals as interns. Table 8.5 summarises the distribution of course contact hours.

Major subjects are assessed by examinations combined with other forms of written and oral tests, presentations, case discussions, and laboratory reports. A comprehensive theory examination must be successfully completed before proceeding to the final clinical practice year during which clinical skills are the focus of assessment. Students must finally complete a graduation examination to be awarded the degree of Bachelor of Medicine, and to qualify to practise.

During the Cultural Revolution (1966-1976), there was a collapse in the tertiary education system, and graduates (popularly named worker, peasant or student soldiers) were trained for a maximum of three years in TCM. The quality of training during that period should not be compared with current programs. At the end of the Cultural Revolution, graduates from that period were offered further training.

Table 8.3: Bachelor of Medicine, Guangzhou University of TCM, (specialising in Chinese herbal medicine).

Table 8.4: Bachelor of Medicine, Guangzhou University of TCM, (specialising in acupuncture and moxibustion).

Table 8.5: Distribution of contact hours for the Bachelor of Medicine (TCM) program

8.3.2.2 Diploma Courses

In recent years, the Chinese government has encouraged TCM tertiary institutions to establish diploma courses (often involving four years of full-time study) in TCM, specialising in Chinese herbal medicine, acupuncture, therapeutic massage and Chinese herbal pharmacy. The establishment of these programs has spearheaded a national approach to meeting the demand for TCM practitioners.

8.3.2.3 Postgraduate Education

TCM tertiary institutions recommenced enrolment of postgraduate students in 1978 following the Cultural Revolution. It has been estimated that 2,500 postgraduate qualifications (Postgraduate Diploma, Master's and PhD) have been awarded since then.1

Postgraduate courses must be approved by the National Education Committee and the State Administration of TCM. Candidates are selected from amongst graduates of tertiary institutions of TCM or western medicine and on the basis of a National Postgraduate Courses Entrance Examination. Depending on the student's clinical orientation, candidates may be required to have substantial clinical experience to enter some postgraduate programs.

Postgraduate diploma courses consist of two years full-time study. Students are required to complete general and specific subjects depending on the course undertaken. Those who perform well are invited to proceed to the Master's degree. Students then complete another year or two on a specified research topic.

Doctor of Philosophy courses consist of four to five years full-time study. Candidates must pass an entrance examination, and are required to complete certain subjects and a doctoral dissertation.

8.3.2.4 TCM Self-study Examinations

External studies programs in TCM have been promoted at the national level in recent years. There are twenty-four TCM institutions providing State-recognised Diploma and Bachelor courses in TCM and Chinese herbal pharmacy.4 The courses use an 81-point credit system. Single subject certificates are also awarded.

The Diploma requires passes in twelve subjects (10 compulsory and 2 elective), and a six-month period of evaluated clinical practice (see Table 8.6).

Upon completion of the Diploma, students are entitled to proceed to the Bachelor's degree. The Bachelor's degree requires the accumulation of a total of 148 credit points, and clinical evaluation during a three month period under an authorised TCM tertiary institution (see Table 8.7).

Applicants must complete and be examined in all subjects within three years. Clinical practice evaluations are then held in TCM hospitals and conducted by Doctors in Charge or higher ranked doctors who are employed by the TCM Higher Education Self-study Examination Steering Committee and the Department of Health.

Table 8.6: TCM Diploma by external studiesSubject Credit points

Table 8.7: Additional subjects for TCM Bachelor degree by external studies

8.3.3 Non-Qualification Education

Traditional methods of apprenticeship are still undertaken in China.2 According to Gao from the State Administration of TCM (China), on-the-job training, advanced training, certificates for a single subjects, trade certificates, and apprenticeship training are different forms of non-qualification education that are available. Although not included in the formal education system, these have drawn some government attention.5 The State encourages TCM practitioners who have been trained by apprenticeship or informal education to participate in the TCM Self-study Examinations to gain formal recognition.

In 1992 the Ministry of Human Resources, along with the Ministry of Health, and the State Administration of TCM approved 500 TCM apprenticeships in order to inherit the experience of veteran TCM doctors. Completed in 1995, this effort was considered to be a success.6 It is understood that a second group of apprenticeships has recently commenced.

However, there are still concerns about the variability of adult education in TCM outside accredited institutions. A national examination for TCM practitioners has been proposed in order to ensure the standard of the profession.7 The State has also employed a ranking system, which has been used before and after the Cultural Revolution in China. This system is designed to assist in granting appropriate recognition to the varying levels of skills and training acquired by TCM practitioners. The system is described in Appendix 20.