A source of information for Hospital-practice Acupuncturists and their Hospital Sponsors. This blog is part of the Hospital Handbook project which also includes social network sites to start or continue topic discussion.
Goals: to share collective wisdom of hospital practice
to create community
to encourage each other
to improve our knowledge and practice standards together
Self-care and teaching self-care to patients is integral and necessary to the integrative health care paradigm.
For the best individualized self-care routine to fit you and your condition, you must work with your Integrative Health care provider, such as your East Asian Medicine Practitioner (acupuncturist). To find a nationally board certified practitioner, go to the NCCAOM® Practitioner Directory and search by name, city, or your zip code.
The following are self-care resources, intended for an audience of practitioners, from the "Self-care Saturday" theme I started on the public Facebook page in March.
4 self-care tips to thrive this spring from Dr. Roger Jahnke and the IIQTC:
(1) keep moving and stretching such as Tai Chi, Qi Gong, or Yoga
(2) Eat your greens (vegetables, leafy greens, etc)
(3) Be outdoors. Walk, garden, go barefoot in your yard.
(4) Practice gratitude.
Try this short breathing exercise with Dr. Jahnke to move your qi in a healthful way today. This breathing exercise, Xi Xi Hu, is a useful way to move out irritated and stagnant energy (a common issue for everyone in the spring time).
keywords: hospital practice, prospective hospital-practice integrative health practitioners, students of East Asian Medicine (acupuncture), integrative health students, shadowing health care practitioners Acronyms EAM = East Asian Medicine. Broad term that includes Traditional Chinese Medicine (TCM) and related disciplines. EAMP, and L.Ac. = terms for a practitioner who has completed an ACAOM-accredited master's or doctorate program and has a current state license. EAMP = East Asian Medicine Practitioner. L.Ac. = Licensed Acupuncturist. L.Ac. is the most common state license title in the U.S. MD = medical doctor, physician
This is the second of the blogpost series answering the question
"how do I get my foot in the door of hospital practice?"
Stay tuned as posts will be published over the course of the next 4-5 weeks.
This information comes from my upcoming book on the basics of hospital practice for integrative health practitioners. If you are interested in following this work, please subscribe to this blog, the public Facebook page, and subscribe to the email newsletter.
Your first expeditions are to develop the basic stepping stones into successful hospital practice, shadowing and volunteering.
These stepping stones are used throughout your hospital practice career to learn and grow. So, become familiar with these stones and do not neglect how much easier they make crossing streams or rivers vs. wading in without a trail guide or path to follow.
Prepare Your Foundation as a Gardener
The gardener prepares the soil in autumn and spring for successful harvests in the summer and fall and future years.
To be more competitive and prepared to work in hospital practice, I recommend volunteering and shadowing as the easiest resources to access in any area of the country you live.
For more formal competitive training, consider a fellowship or residency and related certifications, such as those discussed in the "Specialties and Fellowships" book chapter.
The following short-course certifications for L.Ac.s support the integrative medicine/integrative health paradigm of teaching patients self-care in a standardized format (and are within our scope of practice):
Making Connections with Shadowing and Volunteering
The two main ways to make strides toward hospital practice that are accessible to any practitioner are shadowing and volunteering. There are no locality restrictions on shadowing and volunteering. No matter where you live in the country, you are only as far as your nearest hospital, medical center, or outpatient clinic.
While it is theoretically possible to take a "shot in the dark" and apply cold to a position, you still need the "tried and tested" skill sets that come from shadowing and volunteering to be successful in hospital practice.
I recommend doing some preparation first, like a gardener prepares for the growing season by tilling the ground and working in soil additives before planting seeds. The seeds are more likely to take root when the soil is prepared.
What is Shadowing?
Shadowing is following a healthcare provider for a set period of time, agreed to by you and the provider. You follow the provider through the clinic day, politely and respectfully (and usually silently), observing. Like a shadow, you silently following the practitioner throughout the set period.
Benefits of Shadowing
Shadowing helps you learn what a typical work day is for a specific healthcare provider. It helps you have a better idea of what their work and challenges are.
You learn more about this specialty, and see a sampling of the case load. You get a glimpse into this provider's typical clinic day.
You make a basic connection with this provider
You learn more about nuances of the specialty, and, importantly, how this provider practices specifically and interacts with her team.
copyright Megan Kingsley Gale
Do not reproduce without author's written permission
keywords: hospital practice, prospective hospital-practice integrative health practitioners, students of East Asian Medicine (acupuncture), integrative health students, basic requirements, licensing and certifications Acronyms EAM = East Asian Medicine. Broad term that includes Traditional Chinese Medicine (TCM) and related disciplines. EAMP, and L.Ac. = terms for a practitioner who has completed an ACAOM-accredited master's or doctorate program and has a current state license. EAMP = East Asian Medicine Practitioner. L.Ac. = Licensed Acupuncturist. L.Ac. is the most common state license title in the U.S. MD = medical doctor, physician
This is the first of a long-awaited blogpost series answering the question "how do I get my foot in the door of hospital practice?" Stay tuned as posts will be published over the course of the next 4-5 weeks. This information comes from my upcoming book on the basics of hospital practice for integrative health practitioners. If you are interested in following this work, please subscribe to this blog, the public Facebook page, and subscribe to the email newsletter.
Quick overview
First, make sure you have the basic requirements covered
Your first expeditions are to develop the basic stepping stones into successful hospital practice, shadowing and volunteering.
These stepping stones are used throughout your hospital practice career to learn and grow. So, become familiar with these stones and do not neglect how much easier they make crossing streams or rivers vs. wading in without a trail guide or path to follow.
Introduction to Hospital Practice: Getting Your Foot in the Door
First, you must meet the minimum requirements for practicing in a hospital setting.
What are the basic education and licensing requirements you need before applying for any job (paid or unpaid) in hospital practice?
A master's or doctorate degree in East Asian Medicine (formerly referred to as the acupuncture and Oriental medicine field) from an ACAOM-accredited program
Current, unrestricted state license in the state you work/volunteer
If your state or territory does not have licensing for your profession yet, join your state professional organization to get the ball rolling on this. In the meantime, get and maintain a state license from a state that does have licensing
key words: electro-acupuncture, ischemia reperfusion, pain gateway theory, COX-2-dependent mechanism, randomized controlled crossover trial, pilot study, celecoxib, guest post, research review, pain management, STRICT-A review, biomedicine review, biomedical pharmacology review
Bonuses (near end of post):
STRICT-A compliant review of article
Links to resources for reviewing the biochemical inflammation response, focus on the COX pathways, and the related drugs used to treat inflammation via these pathways, pharmacology review
Acronyms COX-2 = cyclo-oxygenase 2. A biochemical cell-signalling mechanism related to inflammation and pain. IR = ischemia reperfusion EA = electro-acupuncture NSAID(s) = non-steroidal anti-inflammatory drug(s)
Reference
Lee S.M. et al. (2017). Electroacupuncture prevents endothelial dysfunction induced by ischemia-reperfusion injury via a cyclooxygenase-2-dependent mechanism: A randomized controlled crossover trial. Plos One, 12(6). doi: 10.1371/journal.pone.0178838
link: https://www.ncbi.nlm.nih.gov/pubmed/28591155
Introduction
The researchers are focusing on endothelial dysfunction as neutrophils and other inflammatory cytokines have been linked to ischemia reperfusion (IR). By focusing on IR, the authors are studying the pain gateway theory albeit in a more cost-effective manner. In the paper, the authors discuss pain control theory.
Study type: randomized controlled crossover trial, pilot study
Category of research: Pilot study
Summary of the article
One can tell the researchers took time with the study as it follows the pain gate way theory. The first protocol demonstrates the benefits of EA by inhibiting COX-2 found in the spinal dorsal horn by decreasing inflammation and reducing neuropathic pain. The 2nd protocol demonstrates how NSAIDs may inhibit EA full potential.
Reviewer's interpretation
The authors are interested in the reduction of tissue damage post periods of ischemia, i.e. lack of oxygen.
By definition, ischemia reperfusion may cause injury to the endothelial tissue after a time of no oxygen. The researchers made medical assumptions in an effort to study EA in a cost effective and more independent review board (IRB) approved manner due to working with humans.
The inflammatory markers for pain are similar to the inflammatory markers in ischemic tissue. The authors used the healthy volunteers to study blood vessel response after being constricted via a pressure cuff, no blood flow, no oxygen. Reducing the pressure, the researchers used an ultrasound machine to see the difference of rebound in the vessel with EA vs. sham EA.
So, technically, with medical terminology and the pressure cuff, there is no blood flow nor oxygen to the artery.
The study is looking at how to slow or decrease the problem of tissue damage, particularly tissue damage due to lack of tissue oxygenation.
The researchers hypothesize that the electro-acupuncture would be beneficial due to the pain gateway theory in COX-2 dependent mechanism. As it is the first study on humans using this theory, this is a Pilot Study.
The study shows that electro-acupuncture is beneficial to decrease inflammation
It also suggests that NSAIDs and other pharmaceutical medication may inhibit the full benefits of electro-acupuncture.
Therefore, acupuncture and the treatment will be more effective when the patient is not on medication.
Please give a warm welcome to our guest blog post author today, Liz D!
Hi, my name is Liz D. 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 along with participating in clinical rounds at Harborview Medical Center.
Bonus: A STRICTA Review of this article
Apparently, I went a little overboard for the first blog and did a quick recap of the research via STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) oops. If you're still reading, enjoy...
The article is a pilot randomized crossover trial. The hypothesis involves the response and mechanism of electro-acupuncture (EA) in ischemia-reperfusion (IR) induced endothelial dysfunction in humans compared to the effect and mechanism of COX 2-dependent medication. The 2-part study involved twenty "healthy volunteers" in either EA or sham EA followed by 7 of twenty non-randomized/non-blinded volunteers taking a 15-day wash out from acupuncture then ingesting COX-2 inhibitor, celecoxib 200mg 2x/day for 5 days. The original inclusion factors involved non-smoking and between the ages of twenty-five to forty years old. The researchers excluded volunteers who had hypertension, diabetes, hepatic renal, thyroid, cerebrovascular disease, pregnancy, BMI greater than 25 kg/m and later excluded volunteers taking supplements or enrolled in another clinical trial. The volunteers in the first protocol were blinded via computerized random allocation sequence with permutable block design.
Protocol 1 involved unilateral EA treatment at P5, P6, ST 36, ST37 (0.25mm x 40mm) low frequency ES-160, ITO at 1 cm depth at anterior forearm and 2 cm depth at anterior leg. The practitioner rotated the filiform a few times before achieving "de qi" then connecting to ITO at 2 Hz continuous. The non-EA points were located 10-20 mm lateral to P5, P6, St 36, St 37 but not above the median line at a depth of 0.5 cm and did not achieve de qi. The ES machine made similar sounds to ITO but did not stimulate frequency.
Ischemia-reperfusion (IR) and flow-mediated dilation (FMD) were used as measurement. The volunteers rested 10 minutes in supine position prior to protocol. IR and FMD were measured after receiving EA or sham EA. In the sham EA as well as the active EA group, BA diameter and blood flow values were not different from baseline value before and after IR. Instead, sham EA had a decrease in FMD after IR. EA prevented the impairment in endothelium-dependent vasodilation induced by IR injury. FMD was significantly shortened after IR, showing COX-2-inhibitor prevented EA induced endothelial protection against IR. This is the first human study showing the response of EA on "endothelial pharmacological preconditioning" and further theorizes the mediation of COX-2-dependent mechanism.
PLOS ONE is a peer-reviewed non-profit 501c3 journal. It has over 6000 academic experts on editorial board.
Limitations to the study involve small sample size, single center and the volunteers were considerably healthy.
Biomedicine Review Resources: Inflammation Process (COX pathways) and Pharmacology of NSAIDs
Got 7 minutes? Speed Pharmacology's YouTube video on how NSAIDs work with audiovisual and cartoons, the first 7 minutes. "Pharmacology--NSAIDs & Prostaglandin Analogs (made easy)". Topics include: role of COX-1 and COX-2, mechanisms of action, therapeutic uses and side effects of NSAIDs, aspirin, non-selective COX inhibitors, naproxen, ibuprofren; selective COX-2 inhibitors including celecoxib.
For a more thorough audiovisual review, check out Dr. Matt & Dr. Mike's Medical YouTube presentation. 24 minutes. Reviews the inflammatory process, prostaglandins, leukotrienes, NSAIDs and steroids, COX-1, COX-2, and acetaminophen. Corticosteroids: cortisol, cortisone, gluco-corticoids. Australian, so some minor drug name variations.
keywords: leadership skills, skills for successful leadership, build a team and team-cohesiveness, skill-building, team leadership, leadership and mindfulness, leadership and selflessness, leadership and compassion
links updated February 2019
The foundation of leadership is to understand yourself--Rasmus Hougard
This week's Lunchtime Listen recommendation is a keynote address,
"The foundation of leadership is to understand yourself" --minute 6.55
Notes on the Presentation
The Potential Project did a 2-year research project, working with the Harvard Business Review, about leadership. The results are published in the book, Mind of the Leader, which was released in March 2018.
Presentation Overview
The presentation will be a "crash course" in
(1) mindfulness
(2) selflessness, and
(3) compassion. [minute 8.30]
"selflessness is the most important leadership quality in the 21st century"--Dominic Barton
"Selflessness helps us to see the inter-connected-ness of organizations and make us understand our modest contribution. The only sound response is humility and gratitude."
When you develop humility, it is easier to practice gratitude.
Research has shown that "gratitude is [the most] empowering leadership skill."
Jeff Weiner: "compassion without wisdom is folly; wisdom without compassion, ruthless." [minute 40]
minute 43: compassion is also about giving tough feedback so [your employee/colleague] can grow and improve.
Compassion can be difficult.
Compassion is valuable leadership skill.
Do you know how to develop your compassion?
minute 44-48 short 3-minute "practice of compassion"
be aware of your intention throughout your day. Intention is directly related to acts of compassion.
When leaders are (1) mindful, (2) selfless, and (3) compassionate, this creates trust and social cohesion. So, when hard times arise, the organization will be ready and resilient.
Did you find this information useful? If so, please support this community resource through the website todayand watch these resources grow by following the blog and Facebook page.
key words: advocacy, integrative health, opioid crisis, non-pharm options in healthcare, patient-centered care models, Congressional Integrative Health and Wellness Caucus
When our politicians learn more about the integrative health and wellness movement as part of mainstream U.S. healthcare from recognized experts, they can make better informed decisions when voting on health-care related legislation.
What Invite your U.S. House Representative to the March 15th, 2018, D.C. luncheon, Congressional Integrative Health and Wellness Caucus to learn more about Integrative Health during lunch.
Share a brief personal reason why this issue is important to
you (constituent/voter).
"Hello, I am ___(name)__ and my zip code is ___. As your constituent, I urge you to attend the Congressional
Integrative Health and Wellness Caucus on Thursday, March 15th.
This is an introductory educational briefing with lunch.
Health care and access to integrative health as part
of my health care team is important to me and my family.I hope you are able to attend this briefing
or meet with one or several of the speakers."
If it is after March 15th, you can still contact your representative and connect them to some of the resources that were available at the luncheon. Here are the published contact details:
What is the Integrative Health and Wellness Caucus?
The Integrative Health and Wellness Caucus is a bipartisan Congressional effort.
Published Schedule and Speaker Panel for the 2-hour luncheon, March 15th, 2018:
It is a national policy and advocacy voice of integrative health and wellness healthcare professionals. It represents 24 health professional organizations and 600,000+ healthcare providers.
keywords: hospital practice, integrative health in medical centers, making integrative health available to those who need it
How did I get started on this work? Why am I passionate about making hospital-practice work available to East Asian Medicine Practitioners/Licensed Acupuncturists? Why do I want EAMPs/L.Ac.s to be available in hospitals and medical centers?
Well, it's personal. And, personal stories are hard to share. So, while I recorded this video for our spring fundraiser at much prompting from colleagues and some family, I never wrote a blogpost to accompany this video. Until now.
With the community growing the past several months and several major steps for hospital practice work being announced in the past 60 days, it seems like a good time. These major steps that have taken years of work from members of the profession and their advocates--the BLS occupational code (Jan. 1st, 2018), the Joint Commission Pain Standard (Jan 2018), and the VA Handbook Occupational/Staffing Code (Feb 2018).
When I was in grad school, there was the troop surge in
the Iraq war. And my brother was one of those soldiers.
As I sat in class
learning about Traditional Chinese medicine, I was thinking about how what I was
learning could help my family and friends who were deployed.
And, I learned that East Asian medicine is a non-drug non-surgery option for pain management.
And, it decreases stress. And, it improves sleep. So, thereby, it helps increase
resiliency.
As it turns out, if you can improve sleep quality, decrease stress,
and decrease pain you can decrease the probability of post-traumatic stress
from becoming PTSD.
East Asian medicine complements conventional medical care.
So, how do we get East Asian medicine into the hospital
system?How do we get East Asian medicine to those who need it?
By working in the conventional medical system. By having Acupuncturists work in hospitals, medical centers, VAs, and military treatment
facilities.
There have been barriers to working in hospitals, the
first of which is that we are new to the system.
So, often, each time an Acupuncturist is hired into a
system, they are the first or one of the first for that facility. So, the
problem of reinventing the wheel is common.
Instead of existing in silos, this Project endeavors to
create connections community, and share wisdom.
The hospital handbook project provides a ladder over the
barrier and makes landing on the other side with your hospital sponsor a
little softer. You still need to get up and get moving; and I believe your
clinic and your program will be better poised for success because you have
learned from the wisdom of others.
This is what the Hospital Practice Handbook Project
living resource aims to do.
I wish these resources had been available to me when
I started hospital practice. And I hope, by getting these resources published
and collaborative projects funded, that this resource will be available to
hospital practice acupuncturists and their sponsors.
