Tuesday, June 26, 2018

Review: How to Get Your Foot in the Door of Hospital Practice #9

keywords: hospital practice for integrative health practitioners, hospital practice acupuncture, hospital-based practice for acupuncturists, integrative medicine hospital practice, hospital-based practice for East Asian Medicine practitioners, how to get started in hospital practice

What's in this post?
  • summary of the how-to-get-your-foot-in-the-door-of-hospital-practice series
  • related blogposts
  • resources

This is the last post in the series answering the question, "How do I get my foot in the door of hospital practice?"  If you would like a copy of the download-able pdf of this series, pre-order it here.   To continue to follow our resources as we build them, sign up on our email list. You can help build resources for the community like this by sponsoring a newsletter, a project, or as simple as buying me a cup of coffee.


Summary:  How You Get Your Foot in the Door of Hospital Practice
  1. Complete the Basics (education and licensing requirements)
  2. Prepare your foundation as a gardener enriches the soil before spring
  3. Find your Trail Guide (mentors) and Pack Your Trail Bag
  4. Plan some expeditions with these Trail Guides (shadowing): one, two
  5. Learn about hospital culture and make positive connections through volunteering
  6. Keep learning and honing skills for your trail pack: 
    1. Shadowing, volunteering, short-course certifications, regular biomedicine reviews as well as TCM reviews 
  7. Connect to your hospital-practice community (HH Project)
  8. Regularly renew/enrich your clinical work by repeating steps 1-6.

Related Blogposts

Are you a New Hospital Employee?
Stay connected to the Handbook via our blog, website, and email list and send your questions via the website contact page or the "message" feature on the public Facebook page.
More posts relevant to questions we receive from the new hospital employee coming soon.

Want to pre-order a pdf of this entire blogpost series?  Order here.

Was this blogpost useful?
 You can support this work for as little as a coffee.  
If you want to support one of the Projects, like the Webinar Series, or sponsor a newsletter, contact me via the website

Thank you!

Do you want to follow our work at the Hospital Handbook Project?  Just sign up for the newslettersubscribe to the blog, and like our Facebook page.


Sunday, June 24, 2018

What is the National Databank for Healthcare Providers and How is it Relevant to Hospital-based Practice?

keywords:  resources, basics, the national provider database for health care practitioners, hospital-based practice, credentialing process

NPDB = national practitioner data bank
This gets queried by the credentialing department when you have applied to a job and your paperwork is "processing".  Along with a state criminal background check, the NPDB data bank is also checked.  As a practitioner, you can do a self-query so you understand what data is being reported about you in this national data bank.

Learn more at the U.S. government website, run by the Department of Health and Human Services (HHS).

For more about the credentialing process for integrative health practitioners, check out these related posts:



Thursday, June 21, 2018

The Hospital Volunteering Adventure: Foot-in-the-Door Series #8

keywords: hospital-based practice, volunteering, volunteering in healthcare facilities, non-clinical hospital volunteer work, clinical volunteer work in hospitals

"Volunteering is a valuable way to learn about hospital culture, generally, and specifically for your clinic (volunteering location).   When volunteering, you provide value to your clinic and the larger organization."  
"Volunteering is a useful way to meet potential future hospital sponsors and advocates.  It is a healthy way to make connections.  You have heard the saying 'It’s not what you know, it’s who you know'.  For L.Ac. s in hospital practice, it is both what you know and who you know.  You need both."

HIPAA = federal law on sharing of health information.  "health information portability and accountability act"
TB = tuberculosis
PPD = skin test for exposure for TB; done annually for all health care workers, paid and unpaid, at a facility.
BMI = body mass index
PRT = physical readiness training, a program unique to active duty military facilities (U.S.)

  • intro--what do I mean by volunteering?
  • non-clinical volunteer work
  • clinical volunteer work
  • review:  the volunteering adventure

This is the 8th post in the series answering the question, "How do I get my foot in the door of hospital practice?"  If you would like a copy of the download-able pdf of this series, pre-order it here.   To continue to follow our resources as we build them, sign up on our email list. You can help build resources for the community like this by sponsoring a newsletter, a project, or as simple as buying me a cup of coffee.

Volunteering in a Hospital Setting 
Volunteer work is usually more consistent than shadowing.  Time spent in volunteering is balanced on what you can give in time vs. what the facility or program needs.  This can be as intense as one 8-hour shift a week or as little as one 2-4 hour shift a month.  Less consistent volunteering (less than once a month) at a facility is usually discouraged because the volunteer coordinator needs to track all her current volunteers and that is easier to do when she knows when and where you usually report so she can help you stay consistent on your paperwork.
Such paperwork often includes, but is not limited to: HIPAA and privacy policy training, in-house policy training, flu shots, and TB skin test/PPD.

Non-Clinical Volunteer Work
Note: For the purpose of this post, "work" is short for "volunteer work".  

You can be the hospitality volunteer who brings the coffee cart around to the inpatient rooms, which might be every Thursday at 1000 with your volunteer partner Joyce.

You may do non-clinical work in your favorite specialty:  mother-baby unit, pain management, behavioral health, physical medicine and rehabilitation, sleep clinic, cancer care, pediatrics, etc. Or, you can work in department or clinic related to your field, such as wellness or health-promotion.

When I was a Red Cross volunteer at Portsmouth Naval Medical Center, I started out helping wherever they could use me.  Nurse educators are awesome, by the way.  What they understand about health and wellness and decreasing the overall cost of healthcare by creating wellness and care management programs and promoting self-care is very much aligned with philosophies of care in East Asian Medicine.  

In the Wellness and Health Promotion department I started by sorting files and education materials and eventually was tasked to run a small walking program while the lead was deployed.  

Megan, Red Cross volunteer, staffing the StepWell Walking Program
 table at a health promotion fair at Portsmouth Naval Medical Center, 
Portsmouth, Virginia
When I worked in the walking program, we did a lunchtime lecture series for the program participants where we coordinated speakers from several departments to talk about a subject related to health around walking.  Topics varied and included:  proper shoe wear, nutrition, weight management/BMI check, and stress management and speakers came from backgrounds of nutrition/dietetics, physical medicine and rehabilitation, behavioral health, diabetes management, tobacco cessation, physical readiness (PRT), and wellness/health promotion.  

I volunteered one full day a week for about 3 years.  I loved what I did and the people I volunteered for have been lifelong contacts and sources for great future job recommendations.  And, this was work in my field of “wellness and health promotion” without doing clinical work.


Clinical Volunteer Work
Volunteering as a clinician is possible, but not the first step I would try.  I recommend volunteering in a different capacity, non-clinical, and getting to know the local hospital culture and making contacts and understanding where your skills are most needed before jumping into volunteering as a clinician.  Also, as a clinician, remember your clinical skills are very valuable, so I don’t recommend volunteering full-time.  Keep it to once a month or, at most, just one short shift a week.  As part of the hospital-practice community, I have seen volunteering clinical skills work in these ways:
1.   Too much is given, and the hospital sponsor/department head does not value your work, practitioner burns out, and no L.Ac. is ever hired
2.    Just enough is given and well-executed with a team of advocates for your work in the hospital and they begin the long process of creating a paid part-time or full-time clinical position.  You apply and are hired.
3.    Same as #2, except when the position is announced, the volunteer applies, and someone else is hired
4.    Same as #2, and the in-house advocates obtain a stellar grant to hire you and 2 more L.Ac. positions into the program

So, while I recommend volunteering, when it comes to volunteering clinical skills:
  • I urge caution—pace yourself and don’t over-give
  • Develop a set of advocates in-house for what you are doing
  • Have a well-executed clinic plan, working with your advocates
  • Collect metrics—from as simple as patient satisfaction scores to adding in objective measurements or research-validated survey tools
    • Review your metrics data--feedback and outcomes 
    • Pass this data on to your advocates --> market your good work
    • For more about metrics and clinical outcomes for our field, see our growing resources under the tag/search item "metrics" in this blog, the website, and new courses
  • Be connected to the larger (national and international) hospital practice EAMP community to help you avoid re-inventing the wheel and learn from the mistakes of others.  
  • Don’t put all your eggs in one basket—when things don’t work out, be willing to adapt and/or move elsewhere

Review:  The Volunteering Adventure

Volunteering is a valuable way to learn about hospital culture, generally, and specifically for your clinic (volunteering location).   When volunteering, you provide value to your clinic and the larger organization.  Volunteering is a useful way to meet potential future hospital sponsors and advocates.  It is a healthy way to make connections.  You have heard the saying “It’s not what you know, it’s who you know”.  For L.Ac. s in hospital practice, it is both what you know and who you know.  You need both.
Balance volunteer work with your other responsibilities.  Your volunteer work is valuable.  If you consistently feel your volunteer work is not valued, and on self-reflection, you are sure you are not being over-sensitive, it is time to stop, go back to your organization’s volunteer coordinator and request a new assignment.  Try a different clinic or supervisor or department if what you are in is not working.  Volunteering is about love (caritas, agape).  If it feels terrible, stop and change it up.

copyright Megan Kingsley Gale.  all rights reserved.
Do not reproduce without author's written permission

Thank you
Thank you for following this special series, answering the most common question I receive, "How do I get my foot in the door of hospital practice?".  You can catch up on the past posts here and pre-order the download-able pdf, which is a summary of all the posts in the series.  There is only one post left, the Summary and Resources.

Other Posts in this Special "How to Get Your Foot in the Door of Hospital Practice" series

  1. Basic Education and Licensing requirements  
  2. Enrich Your Foundation
  3. Pack Your Trail Bag
  4. Find Your Trail Guide
  5. What to Expect on Your Shadow Day
  6. As a New Employee, Shadow Your Clinical Team
  7. Shadow Physicians

Want to pre-order a pdf of this entire blogpost series?  Order here.

Was this blogpost useful or interesting to you?
 You can support this work for as little as a coffee.  
If you want to support one of the Projects, like the Webinar Series, or sponsor a newsletter, contact me via the website

Thank you!

Do you want to follow our work at the Hospital Handbook Project?  Just sign up for the newslettersubscribe to the blog, and like our Facebook page.


Wednesday, June 13, 2018

ACIH Announced Hospital-based Massage Practice Standards, June 2018

keywords: national integrative health organizations, practice standards, competencies for hospital-based practice, massage therapy

ACIH = Academic Collaborative for Integrative Health, the "Collaborative"
HBMT = hospital-based massage therapy
MT = massage therapy

The Collaborative (ACIH) has announced hospital-based massage practice standards this week. ACIH represents national integrative health and medicine organizations, universities, colleges and programs.  ACIH's mission is to "enhance health by cultivating partnerships and advancing inter-professional education and collaborative practice".

What is the Collaborative's definition of Hospital-based massage therapy competencies?
"competencies define what a massage therapist should know and be able to do to practice safely and effectively in a hospital setting."

Why develop these competencies?
"HBMT competencies was led by an ...ACIH task force [which was] formed because its members saw first-hand what could happen when hospitals aren't informed about how to practice in hospital settings."
"HBMT specific competencies developed by the ACIH HBMT task force with input from approximately 40 individuals associated with HBMT programs.  These competencies include some of the ACIH Competencies most relevant to HBMT and additional competencies that specifically address practical issues relevant to HBMT practice."  

Who benefits from these competencies?
"The HBMT competencies are designed to be useful to hospitals, massage therapists, and MT educators."
The facility:  "HBMT specific competencies help with hiring, working with, and evaluating MT staff."
The practitioner:  these "competencies can serve as a tool to inform you of the skills needed to practice in the hospital environment and inform your scope of practice."
The MT educator:  "competencies serve as guidelines for curriculum development and can provide topics for CE courses about working in a hospital environment."

Share the HBMT Competencies
The ACIH HBMT Task Force requests these competencies are shared broadly and that you let them know how you are using them or how you envision using them in the future.
"We are tracking how and where the HBMT competencies are being used, and would greatly appreciate hearing about your experiences with them."

Who are the ACIH HBMT Task Force Members?  

MK Brennan, RN, MS, LMBT
Dale Healey DC, PhD
Carolyn Tague, MA, CMT
Beth Rosenthal, MPH, MBA, PhD
contact:  brosenthal@integrativehealth.org

Where you can find the HBMT competencies 

Massage Therapy Evidence Map article, 2019


Other ACIH publications you may be familiar with:

Learn more about ACIH at their website.

Monday, June 11, 2018

Resource: Project ECHO

keywords: resources, primary care, specialty care, hospital-based practice sharing wisdom with rural practice providers, connecting teaching hospitals to small practices and solo practices


Project ECHO®, I love the idea behind it, how it goes beyond the basic telehealth consult, and enjoyed my time participating in it.

ECHO® = extended community healthcare option, created by the University of New Mexico.

I mentioned Project ECHO® in the resource section of the May post on Shadow Physicians.

When I participated as part of a "hub", I felt the innovators of Project ECHO® truly believed in the value each discipline in the allied health provider fields brought to the table as important and essential, not auxillary, pieces to the whole-person health equation for the patient and the primary care provider.

If you work in primary care, I highly recommend connecting to an ECHO®.
If you work at a larger health center and could be a "hub", I highly recommend you connect to an ECHO®.  The program benefits the hub and the spokes.

FAQ sheet for Healthcare Admin about ECHO® from benefits to challenges.

ECHO® videos
What is ECHO? video, 1 minute, 20 seconds:

An October 2014 talk by COL (retired) Kevin Galloway about the ECHO model I participated in as an LAc in the Madigan Army Interdisciplinary Pain Management Clinic (IPMC):

Example of ECHO® in rheumatology 5 1/2 minutes:

Interested in the Hospital-practice Handbook Project?


Thursday, June 7, 2018

Research Review: Cellular Reorganization and Acupuncture--a 2018 Literature Review of Acupuncture and Fascia Research

Keywords:  fascia, matrix rearrangement, connective tissue, acupuncture, literature review, research, Dr. Helene Langevin, fascia research and acupuncture, mechanotransduction, mechanisms of action


EA = electroacupuncture
SAR = Society of Acupuncture Research
SIO = Society of Integrative Oncology
FRS = Fascia Research Society

Reference:  Liddle, C.E., and Harris R.E. (2018).  Cellular Reorganization Plays a Vital role in Acupuncture Analgesia.  Medical Acupuncture, 30(1), 15-20.  doi:  10.1089/acu.2017.1258
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799886/

Type of research:  literature review
subcategory of acupuncture research:  mechanisms of action

As acupuncturists, we are all well aware of its effects on analgesia.  The benefits of acupuncture utilizing endogenous opioids activated via descending pain pathway have been well documented.  The article, though, is focused on something entirely different.  It outlines the benefits of needle technique in manual manipulation versus electro-acupuncture (EA).  In "Cellular Reorganization Play a Vital Role in Acupuncture Analgesia", Liddle and Harris review recent development of fascia, mechanotransduction, extracellular matrix rearrangements, and inflammation response in the body in relationship to acupuncture.  They suggest long term benefits of acupuncture analgesia may be attributed to cellular reorganization by lowering the "mechanical stress state of the tissue's mechanical receptors".

Reviewer's Take-away:
The paper largely cites Langevin and her research in fascia.  If you have been living under a rock and not heard of Helene Langevin (or, like me, already have a fan girl brain crush on her) read the article now.  As one would expect from Harris, the article demonstrates profundity in fascia and interweaves the great mass of research spanning over 40 years into a single paper (pun intended).  Interestingly, the paper differentiates needle technique.  It radically details the importance of achieving de qi in treatment.  This is a fairly simple concept to an acupuncturist.  The paper's strength lies in what is not spoken.  I believe it can be used to demonstrate the importance of seeking an acupuncturist versus a provider who dry needles and would not know "setting fire on the mountain" to an "eye of the tiger".  The paper clearly uses TCM terminology.  I also believe this paper can be used to strengthen distal acupuncture styles like Balance Method or Japanese style compared to a more direct local musculoskeletal style.  So, it goes without saying, further studies are needed.

Hi, my name is Liz Dart BS, MSAOM, EAMP, LMP.  After 15 years in the healing arts, I am currently in the final stretches of earning my DAOM at Bastyr University while participating in clinical rounds at Harborview Medical Center.

Biomedicine Review Resources 

Dr. Helene Langevin's Research on connective tissue and the 
fascia-acupuncture connection
September 2017, Acutalks interviews Helene Langevin, PhD on her Acupuncture Research, 9.5 minutes.  Published by Osher Center for Integrative Medicine.

May 2016.  "Stretching, Connective Tissue, Chronic Pain and Cancer" talk by Helene Langevin.  Helene begins the talk at about minute 9.  length of presentation is 58 minutes.

November 2015, Helene Langevin, PhD's talk on Acupuncture, Oncology and Fascia at Joint Conference (SAR, SIO, FRS).  35 minutes.

More on fascia and mechanotransduction
September 2016, Robert Schliep, PhD and "Fascia as Internal Sensor".  34 minutes.

Related Posts

Was this blogpost useful or interesting to you?
 You can support at the cost of a coffee while I blog at a coffee shop or 
support operating costs for a day.

If you want to support one of the Projects, like the Webinar Series, or sponsor a newsletter, contact me via the website

Thank you!

Do you want to follow our work at the Hospital Handbook Project?  Just sign up for the newsletter on the website, subscribe to the blog, and like our Facebook page.

Check out our new Metrics short course on how to successfully use and chart a pain scale in your patient-centered clinical work.  100% of the proceeds from this course
help to support the Hospital Handbook Project work.  Thank you.

Monday, June 4, 2018

The National Academy of Medicine's Clinician Well-being Series

keywords: lunchtime listen recommendation, clinician burnout, teamwork, resilience, quadruple aim

Lunchtime Listen Recommendation (a series of lunches, really):
The National Academy of Medicine's Clinician Well-Being Series
updated 12.18.2019 
How full is your wellness bucket?
Your resilience bucket?
Are you making time for regular self-care and wellness activities that build your resilience?  

For health care providers, especially those in hospital-based practice, the burn-out rate is very high.

The National Academy of Medicine is running a series of open meetings on "Clinician Well-Being".  These 2018 meeting sessions were webcast and recorded.  You can view the recordings on YouTube and read the related discussion papers on their website.

Remember, in integrative health, a core tenet of the practice, whichever your specific discipline, follows this basic idea, "Physician, heal thyself."


The May meeting webcast recordings.

NAM Clinician Well-being website

The Clinician Well-Being Knowledge Hub

The NAM YouTube Playlist for these webcast recordings


More about the Action Collaborative on Clinician Well-Being and Resilience
"In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience, a network of more than 60 organizations committed to reversing trends in clinician burnout.  The Collaborative has three goals:
1.  Improve baseline understanding of challenges to clinician well-being;
2.  Raise the visibility of clinician stress and burnout; and
3.  Elevate evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver"

On Teams and Teamwork: Implementing Optimal Team-Based Care to Reduce Clinician Burnout, by Cynthia Smith et al. NAM discussion paper published 9.17.2018.  https://doi.org/10.31478/201809c

2019--NAM added these Clinician Well-Being Series Resources in Spring 2019
2019 October-December New NAM Publication
The National Academy of Medicine has a new publication on clinician burnout, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. **This is a consensus study report. The pdf download is free and available as of late October 2019. It will be available in paperback December 1st.
For more information and the pdf download, go to this NAM webpage.

Quotes from the NAM webpage:
"Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care." 
"Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being and recommendations for the field."  -NAM webpage
National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.

What is a NAM consensus study report?
Any "Consensus Study Report" from the National Academies of Sciences, Engineering, and Medicine is the documentation of the "evidence-based consensus on the study's statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee's deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task."

Related Hospital Handbook Project Resources and Recommendations for further perusal