Regulation

Core Competencies of Regulated

Acupuncture in Canada

Rev. 1

This document sets out the core, entry-level knowledge, skills and abilities that a candidate must be able to demonstrate in order to become an ACUPUNCTURIST, recognized by a REGULATORY AUTHORITY for ACUPUNCTURISTS in Canada. The document was reviewed and approved as APPENDIX A of the Mutual Recognition Agreement (MRA) developed by representatives of Regulatory Authorities from Quebec, Alberta and British Columbia in November 2001. Occupational Titles governed under the MRA are set out in Appendix B.

 

The document is based upon “Standards of Competency and Practice, November 1998”, developed by the Acupuncturist Regulatory Authority for the Province of Alberta, with revisions and additions reflecting review of comparable documentation from Quebec and British Columbia.

 

The competencies are described as “CORE” competencies because any Regulatory Authority may require additional competencies beyond those listed herein. Under the terms of the MRA, no Regulatory Authority will require less.

 

The competencies are described as “ENTRY LEVEL” because basic competence is the entry requirement. In every field of endeavour, proficiency (or exceptional or advanced skill) develops over time. It is not appropriate to demand proficiency of an entry-level practitioner. It is appropriate, and essential, to demand competence.

 

The outline includes required “KNOWLEDGE, SKILLS AND ABILITIES” because the regulatory acupuncturist requires foundation knowledge to perform safely and effectively as an acupuncturist. The required skills and abilities are demonstrated both in the application of judgement in investigation and diagnosis, and in the application of problem solving, practical skills and appropriate therapies.

 

Standards of Competency

 

This document describes the core entry-level competencies that regulated acupuncturists in Canada are expected to be able to demonstrate upon entry to practice and to maintain throughout their careers.

 

Competencies of Regulated Acupuncturists

 

SECTION ONE: FOUNDATIONS OF COMPETENCIES

 

(A)      FUNDAMENTAL THEORY OF TCM

 

Acupuncturists have knowledge of:

 

  1. The history and development of Traditional Chinese Medicine (TCM) in China, North America and worldwide, and of the development of professional trends.
     
  2. Basic theoretical concepts necessary to the practice of acupuncture, including:
    1. Yin/yang
    2. Five elements
    3. Fundamental body substances including:
      1. Shen
      2. Jing
      3. Qi
      4. Blood/xue
      5. Body fluids/jing ye
    4. Zang-xiang/zang-fu
    5. Channels and collaterals/jing-luo
    6. Etiology and pathogenesis/bing yin and bing ji, including:
      1. External pathogenic factors (six pernicious factors) & internal pathogenic factors
      2. Secondary pathogenic factors, including qi and blood stagnation & phlegm and water retention
      3. Miscellaneous factors
    7. Prevention of diseases and principles of treatment

 

(B)      BASIC THEORETICAL CONCEPTS OF BIOMEDICAL SCIENCES

 

Acupuncturists have knowledge of:

 

  1. Basic anatomy and physiology related to acupuncture
  2. Basic pathology related to acupuncture

 

SPECIFIC COMPETENCIES

 

SECTION TWO: ACUPUNCTURE POINTS (Shu Xue)

 

Acupuncturists have the knowledge and skills necessary to:

 

  1. Locate, identify and use acupuncture points according to function, indications, precautions and contraindications, including:
    1. Points of the 14 channels
    2. Extra channel points/jing wai qi xue
    3. World Health Organization (WHO) standard acupuncture nomenclature
    4. Special groupings of points including:
      1. Auricular points
      2. Scalp points
      3. Hand points
      4. Face points
      5. Ah shi points
      6. Five shu (five transporting) points
      7. Channel meeting points
      8. Lower he (sea) points
      9. Yuan (primary) points
      10. Luo (connecting) points
      11. Xi (cleft) points
      12. Eight confluent points
      13. Back-shu points
      14. Front-mu points
      15. Eight influential points
      16. Forbidden points
      17. Cautionary points
         
  2. Implement the principles of point selection and combination.

 

SECTION THREE: DIAGNOSTIC PROCESS

 

Acupuncturists have the knowledge and skills necessary to:

 

  1. Collect information from the patient using the four methods as follows:
    1. Inquiry (Wen Zhen) including:
      1. General information
      2. Family and personal medical history
      3. Current complaint(s)
      4. Sleep patterns
      5. Bowel movements (frequency, volume, colour, texture of stool, and accompanying symptoms)
      6. Urination (colour, volume, frequency, clarity, and accompany symptoms)
      7. Appetite and digestion (food cravings, length of digestion, and accompanying symptoms)
      8. Thirst (volume of fluid intake and frequency, and desire for temperature of fluid)
      9. Nutritional levels and patterns (eating or diet habits, body weight, and signs and symptoms associated with diet)
      10. Medications, including prescriptions, non-prescriptions, herbals and vitamins (type, dose, term of use, purpose and their reactions)
      11. Chills and fever
      12. Perspiration (frequency, onset and extent, as related to eating, drinking and exertion)
      13. Presence of pain (character, location, and frequency)
      14. Emotional state
      15. Use of alcohol, tobacco, caffeine and narcotics
      16. Exercise and physical activity
      17. Sexual activity and birth control methods
      18. Menstrual cycle and gynaecological symptoms
      19. Sensations of body extremities (hot, cold, numbness, pain, dizziness, tinnitus, palpitations or chest constriction)
      20. Condition of skin, hair, nails, teeth and sensory organs
    2. Inspection (Wang Zhen), including:
      1. Spirit (expression and general behaviour)
      2. Colour of face, skin and excretions
      3. Body structure (balance and movement)
      4. Condition of tongue (colour, swelling, alignment, coating, shape, geographical location, movement, and moistness)
      5. Symptom site (colour, swelling, alignment, sensation, shape, and location)
    3. Auscultation and olfaction (Wen Zhen), including:
      1. Sound of voice, including tonal qualities and volume
      2. Abdominal sounds
      3. Breathing and coughing sounds (quality and quantity)
    4. Palpitation (Qie Zhen), including:
      1. Qualities and positions of left and right radial pulse (rate, depth, rhythm, and strength)
      2. Comparisons of regional pulse sites (carotid, radial, femoral and dorsalis pedis)
    5. Temperature, moisture, texture, sensitivity, and tissue structure of the chest, abdomen, ear, along the channels, and at points and symptom sites
       
  2. Organize and summarize the collected information into groups of symptoms using TCM theories of physiology and pathology, including:
    1. Eight principles
    2. Zang-xiang (zang-fu) theories
    3. Five elements
    4. Sanjiao theory
    5. Qi, blood (xue), essence (jing), and body fluids (yie)
    6. Etiology and pathogenesis
    7. Meridians/channels/collaterals (jing-lou)
    8. Four phases of febrile disease
    9. Six stages (Tai Yang, Yang Ming, Shao Yang, Tai Yin, Jue Yin, and Shao Yin)
    10. Three burners (San jiao)
    11. Natural progression of illness and healing
       
  3. Determine the pathogenesis exhibited by analyzing the groups of symptoms and identifying patterns among them.
     
  4. Perform a differentiation of syndromes by comparing the patterns of symptoms against the patterns of known disorders and diseases.
     
  5. Make primary and secondary diagnoses based on the differentiation of syndromes.

 

SECTION FOUR: TREATMENT OBJECTIVES AND PLANNING (Zhi Zhe & Zhi Fa)

 

  1. Acupuncturists have the knowledge and skills necessary to select and formulate a treatment plan based on the diagnosis, including:

 

  1. Establishing appropriate treatment principles.
  2. Selecting specific treatment strategies to accomplish the treatment principles.
  3. Selecting appropriate points and point combinations (i.e. Confluent points of the Eight Extra Meridians, Meeting points, Entry and Exit points, Four Gates points, Xi-Cleft points, Source and Luo points, etc.).
  4. Considering the precautions and contraindication(s) of treatment and treatment modalities.
  5. Selecting appropriate therapeutic modalities (needles, moxa, cupping, and acupuncture).
  6. Modifying treatment when conditions warrant it (i.e. children, pregnant women, frail elderly, terminally ill, and acute emergency cases).
  7. Evaluating effectiveness of treatment.
  8. Executing new or revised treatment strategy/plan based on evaluation of treatment.
  9. Making referrals where appropriate.

 

  1. Acupuncturists have knowledge of related medical considerations:

 

  1. Basic pharmacology to determine how prescription drugs, non-prescription drugs, and vitamins interact with acupuncture treatment, and how such treatment can complement drug therapy.
  2. Basic medical orthopaedic assessment.
  3. Interpretation of results of medical imaging and medical laboratory tests.

 

Traditional Chinese Medicine (TCM) complements and enhances acupuncture, and general knowledge of the following elements of TCM is desirable and strongly recommended:

 

  1. Basic Chinese herbology to determine how herbs complement health and disease, and interact with acupuncture treatment.
  2. Basic tui-na techniques.

 

SECTION FIVE: TREATMENT TECHNIQUES

 

  1. Acupuncturists have the ability to:

 

  1. Position the patient appropriately based on the location(s) of selected points.
  2. Locate the selected points.
  3. Select and use appropriate therapeutic technique(s) according to the indications, contraindications and precautions, including:
    1. Using needling techniques appropriately by:
      1. Inserting acupuncture needles for:
        1. The appropriate depth
        2. The appropriate duration
      2. Withdrawing acupuncture needles.
      3. Using needle manipulation techniques, including:
        1. Tonifying
        2. Reducing
        3. Even method
    2. Using moxibustion techniques appropriately, including:
      1. Direct
      2. Indirect
  4. Using acupressure.
  5. Using electro-acupuncture techniques appropriately, including:
    1. Tonifying
    2. Reducing
    3. Even method
  6. Using cupping techniques appropriately.
  7. Using seven star needling technique appropriately.
  8. Using three edge needling technique appropriately.

 

  1. Acupuncturists have knowledge of:

 

  1. Gua Sha technique
  2. Basic tui-na techniques
  3. Acu-point injection
  4. Intra-dermal needles
  5. Intra-dermal tack needles

 

SECTION SIX: TREATMENT OF DISEASES

 

Acupuncturists have the knowledge and skills necessary to treat a broad range of internal and external diseases and disorders, including:

 

  1. Digestive disorders
  2. Urinary diseases
  3. Cardio-pulmonary diseases
  4. Infectious diseases
  5. Diseases of the eyes, ears, nose and throat
  6. Musculo-skeletal diseases
  7. Neurological diseases
  8. Psychiatric diseases
  9. Dermatological diseases
  10. Gynaecological diseases
  11. Pediatric diseases
  12. Geriatric diseases
  13. Addictions

 

Traditional Chinese Medicine (TCM) offers a perspective on the nature of illness and health that is uniquely different from and is complementary to the Western Medicine. Proper diagnosis in accordance with TCM theories is critical for planning and carrying out effective treatment with acupuncture techniques. As noted in section five above, a general knowledge of specific elements of TCM is strongly recommended. Acupuncture treatment relies upon correct identification of the pattern of the disorder according to TCM, and the application of appropriate treatment to correct the imbalance.

 

SECTION SEVEN: EQUIPMENT, SAFETY, AND INFECTION CONTROL

 

Acupuncturists have the knowledge and skills necessary to:

 

  1. Appropriately select and maintain acupuncture equipment, including initial assessment of types of equipment and quality of manufacturing, plus on-going inspection for safe operation, cleanliness, sterilization, and disposal.
  2. Manage adverse reactions to acupuncture treatment (fainting, needle bending/breaking, emergency medical conditions during therapy) including initiating emergency measures and referring to physician or emergency care provider as appropriate.
  3. Be aware of, respect, and follow all applicable local, provincial or other regulatory requirements/protocols pertaining to public health, infection control, office hygiene and protection of the environment.

 

SECTION EIGHT: COMMUNICATION SKILLS

 

Acupuncturists have the knowledge and skills necessary for:

 

  1. Listening to, explaining to, and educating the patient about health and illness as related to acupuncture.
  2. Educating the patient on his/her responsibility for prevention and for caring for one’s own health.
  3. Demonstrating compassion for and respect towards patients.

 

SECTION NINE: COLLABORATION WITH OTHER CAREGIVERS

 

  1. Acupuncturists have knowledge of:
  1. The roles and responsibilities of other health care providers, and of their standards of practice.
  1. Acupuncturists have the ability to:
  1. Communicate effectively with other caregivers, facilitating referral, consultation, and collaboration as appropriate.
  1. Acupuncturists demonstrate understanding:
  1. They shall not advise a patient to discontinue any treatment prescribed by a physician or other health care provider.
  2. They respect the confidentiality of patient information.
  3. They know the proper procedure to release a patient.

 

SECTION TEN: PROFESSIONAL, LEGAL, AND OTHER ASPECTS

 

Acupuncturists have knowledge of, respect, and follow:

 

  1. The standards of practice for acupuncture as defined by their regulatory authority.
  2. The standards of conduct as a professional as defined by their regulatory authority.
  3. Legislation and health agency policies and procedures pertaining to acupuncture.
  4. Legal responsibilities and obligations to clients and other health care providers.
  5. Requirements and standards of regulatory authority for documentation and reporting.