The TCM workforce survey included a number of questions related to the educational background of TCM practitioners. The findings are summarised below.

8.5.1 Length and type of TCM training

The reported length of undergraduate or first TCM qualification for practitioners ranged from 50 hours to 8 years, with an average for primary TCM practitioners of 43.6 months, and for non-primary TCM practitioners, 8 months (Table 8.11).

Eleven percent of respondents (118 out of 1074) obtained a primary TCM qualification overseas. These are summarised in Table 8.12.

Thirty-five percent of primary TCM practitioners hold non-TCM qualifications predominantly in other health care disciplines. Table 8.13 summarises non-TCM qualifications (undergraduate or postgraduate) held by primary TCM practitioners.

Table 8.11: Average (mean) length in months of undergraduate (initial) TCM training by nature of practice (standard deviations in brackets)

Table 8.12: Country of undergraduate TCM study by nature of practice. Figures are numbers of practitioners with percentages of respective workforce in brackets.

Table 8.13: Non-TCM qualifications held by primary TCM practitioners (n=433). Figures are numbers with percentage of primary TCM practitioners in brackets.

8.5.2 Views on Australian TCM Programs

Practitioners were asked whether TCM courses offered by universities in their State were satisfactory. A sizeable proportion of primary (40%) and non-primary (64%) TCM practitioners were unsure of the standards of the TCM courses taught by universities, while 35% of primary TCM practitioners believe the current standard is satisfactory and 25% believe it is unsatisfactory.

8.5.3 Apprenticeships in TCM

Among primary TCM practitioners, 66 (15%) received an apprenticeship in TCM. Of these, 43 had not received any more formal TCM education. Hence, almost 10% of primary TCM practitioners practise on the basis of apprenticeship training alone. Apprenticeship was in various forms, but in some cases consisted of up to six years full-time work.

Among non-primary TCM practitioners, 52 (9%) received an apprenticeship in TCM. Of these, 49 had not received any more formal TCM education. Hence, almost 9% of non-primary TCM practitioners practice on the basis of an apprenticeship training alone. In some cases this apprenticeship was reported as training at national or international conferences.

8.5.4 Continuing Education

Continuing education in TCM in some form was reported by 45% of the TCM workforce overall. This could include seminar attendance. Table 8.14 summarises the findings.

Table 8.14: Continuing TCM education by nature of practice. Figures are numbers of practitioners with percentages of the primary/non-primary workforce component in brackets.

References

1. Zhang WK. Sum up its experience, develop its characteristic, cultivate the talented person of trans century in TCM. Education of Traditional Chinese Medicine 1995;14(4):1-3.

2. Zhu C. Medical education. In Chen H, Zhu C (eds) Chinese health care: a comprehensive review of the health services of the People's Republic of China. 1984:301-337 Lancaster: MTP Press.

3. Guangzhou University of TCM Curriculum for Bachelor of Medicine 1995.

4. Gao D. Education and structure of traditional Chinese medicine in China. Paper delivered at TCM seminar. Academy of Traditional Chinese Medicine in Australia (Melbourne) April 1996.

5. Gao S. Vice-director, Postgraduate studies, Academy of TCM, Beijing. Personal communication, Melbourne, April 1996.

6. Chen MZ. Masters cultured high quality apprentices and the work of inheriting veteran TCM doctors' experience gained great successes. Education of Traditional Chinese Medicine 1995;14(5):3-4.

7. Guo ZH. Urgency of putting into effect the examination for TCM doctors' qualification in China. Education of Traditional Chinese Medicine. 1994;13(6):10-11.

Chapter 8: TCM Education

Summary of Findings

China

• TCM and western medicine: China has dual systems and equivalent recognition of traditional Chinese and western medical education.
• Courses: The three principal streams of TCM education which lead to formal qualifications are TCM secondary schools, TCM tertiary institutions, and external courses (known as the self-study examination system). It is reported there are currently 27 universities and colleges of TCM, and 15 faculties of TCM in medical universities and colleges in the People's Republic of China.

The Bachelor of Medicine (TCM) program runs over five years full-time, with the fifth year as internship in a TCM teaching hospital.

• Student numbers: It is estimated that:
• • more than 100,000 Chinese students have graduated in TCM since 1962;
  • 2,500 postgraduate TCM qualifications have been awarded in China since the recommencement of tertiary education in 1978 after the Cultural Revolution.
• Graduates: Graduates have full practising rights within all public hospitals and are fully recognised by the State; that is, they have prescribing rights for medications and are on a State register.

Australia

• The institutions: There is significant variation in the delivery of TCM education in Australia between private colleges and universities, and award and non-award courses:
• • 12 institutions (including three universities) offer a total of 13 major primary qualifying courses in aspects of TCM (that is, more than 800 contact hours).
  • Most institutions report affiliations with Chinese teaching institutions and Chinese hospitals although in some cases the nature of these affiliations is unclear.
• The programs:
• • Primary training qualifications in TCM are offered at both undergraduate level (12 courses) and postgraduate level (one course). Ten of these are accredited by local education authorities or universities.
  • In addition, 10 short programs of study are offered to graduates of other health science disciplines, usually on a non-award basis and in acupuncture alone. The graduates receive limited recognition for membership by professional associations representing primary TCM practitioners.
• Course content: Primary qualifications in TCM in Australia have tended in the past to focus on acupuncture training. However, an increasing number of institutions, both universities and private colleges, are offering courses in Chinese herbal medicine and more courses are planned.
• Course requirements:
• • Undergraduate programs involve 3 to 5 years of full-time study. Standard 4 to 5 year programs are broadly recognised and favoured by professional associations.
  • All university-based undergradutate programs are offered on a full-time basis only. In all private colleges, studies may be undertaken part-time.
  • There is one postgraduate program offered as 3 years part-time with 845 contact hours.
  • There are no significant differences between private colleges and universities in terms of reported total course hours.
• Qualifications of workforce:
• • The average length of the first TCM qualification for primary TCM practitioners is 44 months, and for non-primary TCM practitioners, 8 months.
  • 10% of primary TCM practitioners practise on the basis of apprenticeship training alone.
• Student and graduate numbers:
• • Given the number of flexible part-time courses in private colleges, it is difficult to estimate the number of current effective full-time enrolments in TCM programs.
  • It is estimated that approximately 1,123 students will graduate from TCM qualifying programs and will enter the workforce by the year 2000. This would almost double the numbers of primary TCM practitioners in the workforce. It excludes migration effects or withdrawal from the workforce.
• Staff:
• • Academic staff qualifications vary considerably both between and within institutions. This reflects in part the difficulties of establishing a new profession in Australia.
  • With the exception of one university, the majority of TCM academic staff with postgraduate TCM qualifications accredited by an appropriate education authority are employed in private colleges.
  • The academic staff of private colleges have substantially more Chinese hospital experience than university appointed staff..
  • Conventional mechanisms of national advertising and competitive appointments for TCM academic staff are under-utilised by both private colleges and universities.
• Research: No external research grants have been awarded to TCM teaching institutions for TCM research.
• Course review:
• • External review of TCM programs and mechanisms to ensure broad professional input are poorly developed in the majority of institutions.
  • Representative members of the large professional associations are not sufficiently involved in course review and approval within either universities or private colleges.
• Continuing education: 45% of the total workforce claimed to be involved in continuing TCM education.
• Australia compared to China: It is difficult to compare the major teaching programs in Australia with those in China, because of:
• • the different points of entry of under-graduates into TCM courses;
  • the importance of Chinese language skills in accessing Chinese medical literature;
  • the different outcomes of training, specifically that Chinese students graduate with medical prescribing rights and employment in public hosptials.

The academic component of TCM training in Australia (with concurrent teaching in Chinese herbal medicine and acupuncture) offered at university or in private colleges appears similar to that in China. In comparison to China, clinical training in Australia is poorly provided for.

Chapter 8: TCM Education

Recommendations

• That a comprehensive review be undertaken of TCM educational provision in Australia, addressing the basic medical sciences, TCM content and clinical education. If occupational regulation proceeds, the review should be conducted by either the newly established registration or accreditation board or by other independent, non-partisan means.
• That basic medical and clinical sciences for non-medical TCM practitioners be reviewed and upgraded where necessary, to ensure adequate safety in practice. Appropriately qualified medical practitioners should be included in this review process.
• That major TCM professional associations closely examine the course requirements for all new courses prior to granting recognition to graduates.
• That private colleges and universities review the process of appointment to course advisory committees in order to ensure broader representation from the profession. Institutions are encouraged to include representatives from the largest associations representing TCM practitioners.
• That universities and colleges utilise open and competitive selection procedures (including national advertising and appropriate selection panels) to recruit academic staff in TCM.
• That professional associations representing practitioners of registered health occupations (including medicine, nursing, physiotherapy, chiropractic and osteopathy) who utilise TCM, review and upgrade the minimum qualifications required of their members for safe practice, particularly in acupuncture and Chinese herbal medicine.
• That the Health Insurance Commission re-examine its provision of Medicare rebates for acupuncture performed by those medical practitioners without identifiable and adequate qualifications in the area, and establish a minimum acceptable qualification for Medicare rebate.