The Crisis of American TCM

Active TeachingAs the first cohort of students I taught embarks upon the final year of their master’s program, I wanted to offer them some words of encouragement. In thinking about what to say, I began to recognize a potential problem that not only affects them, but all current students, teachers, and practitioners of Chinese and East Asian medicine in the United States.

The Rise of the Disempowered Healer
Chinese medicine in America is stuck: the growing number of acupuncturists and practitioners of East Asian medicine has created a new economic market for postgraduate certification programs. Subsequently, we have begun to create a culture of secrecy and certification that is ultimately detrimental to our field. The most recent generation of practitioners is particularly susceptible—we don’t have the experience of our colleagues who have been practicing for 20+ years, so we often compensate for this perceived deficiency with workshops, seminars, and certifications. Let me take a moment to clarify my terms: I am not talking about CEUs required for licensure, I am talking about the myriad of certificated programs that do not adhere to the academic standards of other disciplines, and thusly confer unaccredited titles. We are continually being enticed by teachers who promise to unlock the secrets of Chinese medicine, as revealed to them through arcane lineages that were originally transmitted from the favorite pupil of the Yellow Emperor (or some such thing). In many cases, this leads to complacency: instead of educating ourselves, we rely on others to do it for us. We accept the myth of “secret knowledge.” Simply put, we voluntarily disempower ourselves. In so doing, we gain certifications and techniques, but not true knowledge of the medicine. As a practitioner who graduated within the last 10 years, and as a former teacher, I have witnessed my colleagues—and myself—succumb to this Faustian bargain.

In addition to holding MTCM and DAOM degrees from accredited institutions, I also have several unaccredited certifications, but out of respect for other practitioners and students of the medicine, I no longer list any of these certificated titles on my website or other marketing materials. Let me be clear: I am not suggesting that these certificates have no value—they represent hours of training and study in their respective subjects—they just don’t hold any weight with the greater academic community. When I joined the faculty at Five Branches University, I was not permitted to list any unaccredited certifications in my bio, and though I no longer teach there, I have chosen to follow the standard set by that institution (my master’s-level alma matter). It’s one thing to be proud of one’s accomplishments, but I believe it sends the wrong message about our field to current students, the biomedical community, and the general public when we list certifications obtained through non-accredited sources alongside legitimate degrees and credentials. We should be proud of our master’s degrees, doctoral degrees, and licenses. They are well deserved!

How did this happen?
Many of us are drawn to Chinese medicine because of the mysterious and mystical ideas it seems to hold, only to be frustrated as we wait in vain for the part about dragons and ancient sages who have unlocked the mysteries of the universe. In my experience, few teachers ask students to think critically, and students are often discouraged from doing so, both in the classroom and in the clinic. Seeking the magic within the medicine, students begin to look outside their schools for the “secret knowledge” that isn’t taught anymore. Many of us have entertained romantic notions of stumbling upon an old man with a white beard walking the Chinese countryside, or meditating on the subtleties of nature in a subterranean cave. Unfortunately, while a few of us may attain this fantasy, most won’t. As a community, we need to reject the fallacy of “secret knowledge” that is found somewhere outside of ourselves—a notion that is inherently disempowering. Instead, we must hold ourselves to a higher level of academic rigor and integrity. Only then will we see that there is no veil between ourselves and true understanding of this timeless medicine.

Pedagogy and the Failure of the TCM Educational Model
The first American schools of TCM inherited a model of education from China that did not truly meet the needs of American students. While we have largely adapted the clinical practice of Chinese medicine to meet the needs of the American patient population, we have not—for all intents and purposes—adapted our teaching model to meet the needs of the American student. As part of my doctoral research on pedagogy and ancient chinese medical literature, I referenced Bloom’s taxonomy of educational objectives when composing a curriculum for the Huáng Dì Nèi Jīng. Put simply, Bloom’s taxonomy is a method of grouping learning outcomes in the classroom: ranging from lower-order to higher-order cognitive processes (Bloom, 1956). Unfortunately, many teachers at American TCM and OM schools are basing their learning objectives on lower-order processes, like “remembering” or “understanding.”

Visual representation of Bloom’s taxonomy

Let me illustrate this concept using yīn-yáng theory as an example: a teacher outlines the basic concept of yīn-yáng theory, along with some general associations (yīn=dark, yáng=light; yīn=water, yáng=fire). The lowest-order cognitive process is simply “remembering,” so students are only asked to repeat back the previously mentioned yīn-yáng associations on a test or when questioned in class. The next level up is “understanding,” so students are asked a question like, “What is yīn-yáng theory?” and they are expected to answer something along the lines of, “An ancient Chinese theory about the dynamic polarity of opposites,” and then give a few examples. These lower-order processes are important at the beginning stages of any subject, but they must evolve throughout the semester (and the program) as the students’ understanding of the subject matter deepens.

Ideally, someone who is teaching at the foundational level should begin with lower-order objectives, and as the semester progresses, gradually incorporate higher-order objectives into their lesson plans. Using the same example of yīn-yáng theory, higher-order questions would sound something like, “Analyze how yīn and yáng affect your life,” “Compare yīn-yáng theory with Five Phase theory,” or “Some Chinese scholars believe the full moon is maximum yīn, while others believe it is maximum yáng: what do you think, and why?” How many teachers, even in the final year of a four-year master’s program, ask students to employ these higher-order cognitive processes in the classroom? Not many, in my experience. Even in the final year, most learning objectives seem to be geared toward the memorization of disease patterns and the rote repetition of point and/or herbal prescriptions. The model employed in many American master’s programs is utilitarian in this regard: these programs doggedly prepare students to take State and/or National Board exams, which are largely based on lower-order cognitive processes (specifically recall of information). Unfortunately, this also means that many master’s students graduate without ever really thinking critically about Chinese medicine and the theories thereof. These graduates then go on to teach, and the cycle repeats…and the cylce repeats…a d  t e  c c e  r p a s…until the knowledge is obscured and thus appears secret.

So What?
The lack of higher-order learning objectives in most TCM and OM classrooms does two things: it creates a surface understanding of the practice and theory of the medicine, and it drives students toward external sources of information. In my case, it did the latter. I wasn’t getting the answers or understanding I sought, so I spent most of my free time reading books about the medical classics, ancient Chinese philosophy, or the history of Chinese medicine. By graduation, I had read more than 50 books on these subjects—none of which were required reading! Most of my colleagues thought I was crazy for reading this much in addition to the required texts, but I enjoyed finding answers to my lingering questions. Other colleagues attempted to rectify their academic frustration by becoming involved in outside classes and school-sanctioned electives, or by obtaining certification in some other modality related to Chinese or East Asian medicine. As mentioned above, I took this approach, too. I mention it merely to underscore a point: teachers should give more to their students, and students should expect more of their teachers.

Students should be encouraged to find answers to the questions that intrigue them, and teachers at American schools of East Asian medicine should foster this curiosity in both the classroom and the clinic. Schools need to prepare students for the boards, but also need to challenge them to do more than repeat and regurgitate TCM banalities like, “The Liver is associated with the color green.” American students are hungry for knowledge, and no matter how many times the administration or their teachers tell them: “Just focus on passing the boards for now, and then you can study the things that interest you,” they are going to seek it out!  Furthermore, the students at American TCM and OM schools are being yoked with a crushing amount of student-loan debt, so they should not be forced to look outside of their schools to find the knowledge they are seeking; consequently, the teachers at these schools should not be satisfied with relying on lower-order learning objectives in the classroom or in the clinic.  Weas a communityneed to up our game, or we will never be taken seriously by the greater world of academia.

Integration of Knowledge from Other Disciplines
Most American TCM schools do an admirable job of teaching students how to interface with MDs and other biomedical professionals. Unfortunately, Chinese medicine is a complex discipline and—to accurately articulate its theoretical underpinnings—an understanding of the history, philosophy, and culture of China is required. As teachers, we need to incorporate knowledge from these other disciplines into our classrooms, so that our students can dialogue intelligently with academics in these other fields as well. We also need to do a better job of citing our sources. As a scholar of the Huáng Dì Nèi Jīng, I find it incredibly frustrating when I see a post or an article by a member of our community that says, “According the Nèi Jīng…” without specifically citing from which of the 162 potential chapters the statement originated!

Speaking of the Nèi Jīng: how many students are graduating from their program without even a cursory understanding of this foundational text? How many students know basic Five Phase theory, but have never heard of Zuo Yan, who popularized it (Wang, p. 6)? How many of our colleagues create articles, blog posts, and websites that make statements about acupuncture or East Asian medicine without citing their sources? And how many of us rely on the statement, “According to my teacher…”? That phrase is fine when we are repeating personal insights a teacher has shared with us based on their clinical experience, but it is not acceptable when making specific claims about the medicine. If a teacher makes a statement that is anything but experiential, they should be able to cite a source. That is the accepted standard in all academic disciplines: why should we be any different?

The Remedy
Fortunately, there are literally hundreds of journal articles and books available in English encompassing topics as esoteric as the Magic Square and Nine-star Feng Shui. I know they exist: I read and incorporated many of them into my DAOM research. It’s simultaneously humbling and inspiring to see all the questions that university professors and academics have answered already! And on the flip-side, for those who long for a more modern approach to Chinese medicine, there are scientific articles on biophotons, Bonghan ducts, and fMRI imaging of the brain during acupuncture treatment.

Few teachers or practitioners have time to read these articles, however, because they are working to pay off student loans, and need downtime between managing their practices and attending to worldly responsibilities. This scenario is precisely why I started Dr. Phil’s Chinese Medicine Blog. In the coming weeks and months, I am pledging my free time to the advancement of our field through the dissemination of accurate and reputable information. Whether you want to know more about the translation of Chinese medical terms into English, or are interested in the latest research on acupuncture and PTSD, I’m going to share it with you or tell you where to look. Whether you are a teacher, a student, or a member of the general public who is interested in Chinese medicine, I hope you will find something inspiring, and go in your own direction with whatever you are passionate about. You don’t need an arcane lineage or a certificate to be a great practitioner. You need to believe in yourself. You need to believe in the medicine. Teachers need to believe in their students. Practitioners need to believe in their patients. You hold the secret of Chinese medicine: find your own Dao.

References
Aihe Wang, Cosmology and Political Culture in Early China

Benjamin Bloom, Taxonomy and Educational Objectives Book 1: Cognitive Domain

Bloom’s Taxonomy

Bloom’s Taxonomy Action Verbs

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

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9 thoughts on “The Crisis of American TCM

  1. Hi Phil! Thanks for sharing this with us (students of FBU). I am happy to read this because I am frustrated and since I have no other TCM education to compare it to, I am just “putting up with it”. I thought about doing one or two of the certification programs at the school but decided against it because of time and money. I feel FBU does have an incredible program, in comparison to other TCM schools yet as graduation creeps up, I feel I am receiving somewhat of a “cookie-cutter” education. We have some amazing teachers and doctors at our school but there is only so much time they can stray off the syllabus. I do feel happy in the clinic, as I get to pick and choose the supervisors… Pick their brain for the most part and go beyond “liver is associated with the color green”, etc. But even here, time is minimal. I would love to know what books you recommend and I can make some time to read through them. Or even articles. Keep sharing!

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    • Sonal,

      I agree that FBU has a great program…probably one of the best in the country in terms of the breadth and scope of what is taught. Having interacted with practitioners from other schools both in the DAOM program and as an herbal consultant at Kan Herb, I feel very comfortable making that statement. I am grateful that I had the opportunity to study the classics at the master’s level, and I’m obviously a big fan of the herb program.

      My critique is not necessarily focused on what is being taught, as much as how it is being taught. Even at a school like FBU that has a great program, the learning objectives are fairly low-level in most classes. As I mention in the article, the main concern I have is that students at the master’s level—and here I’m speaking generally, not just about FBU—are not being challenged to think deeply about Chinese medicine. I’d like to see our profession rise to a higher standard of academia en masse. We need to be better about citing sources, doing research, and understanding the evolution of Chinese medicine from a philosophical/historical/cultural context. I think this shift must begin at the master’s level. With still so many vocal opponents of Chinese medicine in both the biomedical field and on the internet, I think we must be conscious of how we appear as a community. Personally, I’d like to see the CM community appear as erudite as possible, in terms of the material we publish and our ability to speak about the medicine. If a practitioner wants to publish something about acupuncture or CM from a biomedical view, it should be well researched and contain appropriate citations from biomedical journals; and if a practitioner wants to publish something about acupuncture or CM from a classical perspective, it should be equally well researched and contain appropriate citations from historical/philosophical journals.

      I appreciate that you took the time to read my article and comment on it. I am going to continue to do my best to educate and (hopefully) inspire current students and practitioners. I will share books and research articles through my posts, so keep an eye out! 🙂

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  2. Pingback: Ancient Chinese Medical Theory 101: Why Study Ancient Chinese Medical Literature? | Ancient Chinese Medical Theory

  3. Dr. Garrison,

    Wow, thanks for this poignant and succinct article. In the most basic sense, i totally agree that the strategy of ‘lowest order cognition’ is an important idea to seriously consider as it positively affects some dimensions of education and negatively affects others. And the farther i progress through my education, the more I believe that how Chinese Medicine is taught, is becoming the Key factor in broadening our profession in terms of state and national institutions, government, insurance companies & buisness, and also in terms of medical efficacy, knowledge, value.

    I am curious what you think about the tremendous pressure to create strong and consistent systems to produce students to pass state and national licensing exams? That perhaps if a schools buisness model depends on this, could the current didactic system be the best strategy to meet these ends? Do these questions of education really come down to the economics of it?

    I am a Masters student in San Francisco and struggle with pedagogy of Chinese Medicine.

    best!
    stan

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  4. Pingback: The Crisis of American TCM | Logos And Tao

  5. I am very pleased to see that have taken the time to create this website; you are voicing many of the same concerns I have as to the nature of our TCM training. I’ve railed against my instructors favoring rote memorization over understanding and have stopped my TCM education once in protest. I think the reasons we are forced to memorize are many: (1) “that’s how this is taught in China”, (2) “this is too complicated to understand at the first stage of learning” and (3) the instructors don’t know the background and the theory and hence are unable to go beyond ‘memorize this’. Number 3 is my guess.

    An instructor I greatly admire once noted that he’d had to figure out how to deal with the Western students in his class who clamored for “understanding the reasons for what he taught” vice just demanding that we keep quiet and memorize.

    Right now I see no pathway to learning this material deeply until I graduate and that is just a shame.

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