Clinical Impressions: Part I

Clinical Impressions: Part I

Welcome back everyone! I hope you enjoyed your Thanksgiving recesses. Here at Academy for Five Element Acupuncture, we welcome back our intern class, as well as the Class of 2015 who began their second intensive this week. The building is once again humming with energy. And, in Admissions, we’re in the final phases of putting together the Class of 2016. One more push to the end of the year for all of us!

In the meantime, it’s a good time to address one of the biggest sources of questions that I get from prospective students: the clinical residency in the third year of our master of acupuncture program. I’ve touched on the schedule slightly when I discussed the intensive structure, but this post will be the first of a series that provides greater detail on what to expect and how to prepare for the clinical year. Today, I’ll start generally by outlining how the structure of the program changes and what it means to be an intern in the student clinic. Subsequent posts will address clinic from the supervisors’ point of view, the interns’ point of view, and what the year means for an intern’s family.

So, let the demystification begin.

The clinical residency at AFEA, and other acupuncture schools, is the final stage of graduate training, where students treat patients under the guidance of licensed supervisors. The clinical residency is 12 months long, a full calendar year treating patients and continuing didactic work in the classroom. It is also a residential year, which means that those students who aren’t already living in the Gainesville, FL area, must relocate for the duration of the program.

One of the  questions I get a lot is whether the clinical year can be broken up and finished over a longer period of time. For many students, our intensive session structure attracts them because they can go back and forth between school and home more easily. The relocation for the third year becomes the sticking point because they might not be able to conceive of how to be away from home for a full year. Every student handles this issue differently (and we’ll talk about that in a later post). But, for these students, it would be easier if they could continue commuting. Some want to know if they can complete their clinical training elsewhere, at another school* or through an apprenticeship-like arrangement with a local private practitioner. The short answer to each of these proposals is: No. The clinical year must be done on-site and cannot be broken up over a longer period of time.

While there are several reasons as to why, one the most compelling is patient rapport. Five Element practitioners focus heavily on developing rapport with their patients as it’s essential in being able to treat them on the deepest levels. This  relationship of trust and acceptance is built over the treatment cycle. If an intern were to be in Gainesville for a month of clinic, go home and come back several months later for another month, or some other such schedule, this would cause an insurmountable disruption to the patient/practitioner relationship.  Not to mention the loss of focus and skill in the intervening time periods. So, no, the residency is one, continuous year-long period of training that must be done in the Academy’s student clinic.

Before I wear anyone out with the details of the clinical year schedule, let me also say our schedule is typical of any acupuncture program. To learn the skills required to become a safe and effective practitioner, to pass one’s national exams, and to have the confidence necessary for starting one’s own practice, many, many hours must be dedicated to study. While daunting, the year is also one of the most rewarding. At no other time in a practitioner’s career will they be surrounded with the knowledge, love, and support of their classmates and their supervisors and teachers. That’s an immense amount of wisdom and experience to draw on throughout the learning process. This is important to keep in mind.

Students don’t arrive for the start of the year and jump into the clinic immediately. They go through several weeks of Internship Preparation. This includes everything from patient paperwork to how the clinic actually runs. The students are responsible for running the clinic- they greet patients, check on supplies, and keep the patient flow moving throughout the day. It’s the best way to give them a foundation to draw from when they’re in their own practices. So, rather than throwing students right into this, the first few weeks of the residency are spent learning the processes and procedures of the clinic. They also see their first patient in the Grand Rounds Style of observation, where supervisors join them in the treatment room for the first TD (traditional diagnosis). That first treatment is nerve-wracking enough, so it’s helpful to have as much support as possible. We give the students time to get their feet underneath them before they start seeing their own patients.

So once Internship Prep is complete, the interns do jump into scheduling their own patients, assisting their classmates, and treating. The clinic is open three days a week with the first appointment starting at 9 am and the last appointment ending at 8 pm. This is a long day with a lot of movement. Treating patients requires absolute focus and can be draining energetically in the beginning as interns learn the best ways to interact with each individual. This is one reason that we require students to live in Gainesville.  Even the students who come from the Jacksonville area of Florida, which is only an hour and a half away, move. Going home after a clinical day, only to return for class at 9 am the next morning is tough enough without adding on a lengthy commute.

I should note that interns are not required to be in clinic from 9 am to 8 pm. In fact, it’s not recommended at all. But over the years, we’ve noticed a tendency for interns to hang around longer and longer. Sometimes, it’s easier to catch up on paperwork and updating files by just staying at school when they’re not treating. Interns must complete a certain number of treatments where they are the primary practitioner, and they also must complete a number of treatments where they are the assist for a classmate. If they stay on campus for the entirety of a clinical day, an assist slot might open, or a primary slot might become available and they can get in an extra treatment. While this demonstrates dedication and initiative, it also means less time to recuperate. So, with our most recent intern class we’ve instituted a policy where they have set days and times to sign up for primary treatments and set days and times when they can sign up for assists. We’re building in rest periods this way.

You might have noticed that I mentioned class as well as clinic. The clinic provides the hands-on experience of diagnosis, treatment planning, and needling. But in conjunction with that experiential learning is the processing of that experience. Every week the interns attend clinical seminar in which they can discuss their patients’ response to treatment and possibilities for future treatment. When an intern has a difficult patient (and difficult can mean many different things), they can work through strategies with their classmates and instructors. Instructors also teach more advanced concepts in clinical seminar that the interns are now able to consider and use in their treatments. And of course, every week brings more point location study. After all, you can never have enough point location practice.

So, with three days of clinic and a day of class, we’re already up to four days a week that the interns are on campus for some length of time. If the intern is also in the Chinese Herbal Studies program, they have a day of either class, or herbal clinic that they must attend each week. That’s a five day schedule right there, and to it, we can also add several weekend seminars that are scheduled throughout the year. We try to space the weekend classes out as much as possible to give students those much needed days to recharge. But no matter when they are scheduled, it still means being in class on a Saturday and Sunday, with clinic starting a new week on Monday. Being able to go home for lunch on these days is extremely helpful in being able to decompress for even an hour or so.

One last note: the administration has been scheduling the clinical year for many classes. They know what they’re doing and the teachers and supervisors have all been in the interns’ shoes. Our graduates look back on their clinical experience as the best part of their education.  I try to remind the interns to soak up the experience while they are going through it because there is immense wisdom and support surrounding them that they can use to their betterment.  It takes patience and perseverance, but in the end, their patients go home healthier and happier, and that is the best reward.

Stay Tuned for Part II: Clinical Impressions from the Intern Perspective.

2012-11-29T15:55:09+00:00