Phase 4 Internship Policy - Midwest College
Phase 4 and 5 must be completed on campus.
The purpose of Phase 4 internship is to help the student gradually build skills in determining the choice of therapy; including continuing acu / moxa treatments, and additionally selecting herbs and formulas with the help of the supervisor.
When you are a Phase 4 or 5 intern, you are adding herbs and nutrition to your acupuncture treatment.
Students will continue to conduct pulse and tongue examination and take patient histories, but there is a new emphasis on the identification of conditions where herbal therapy is most appropriate, and on the development of the special refinements in Oriental medical diagnosis that are specifically designed for herbal administration.
The student and the supervisor will work out the main formula together, with increasing emphasis on the student’s role as Phase 4 progresses. Interns learn to accurately identify and compound herbs according to written prescribed formulas. The student’s work will be monitored carefully by the supervisor and observed as directly as possible, in order to ensure accuracy in prescription and administration.
Some students have had the misunderstanding that the College is a sales rep for the brands of herbs and supplements in the clinics. This is not true. They are chosen for quality and efficacy.
Phase 4 Performance objectives:
· Demonstrates the clinical decision-making process in the acu/moxa treatments, as well as, the selection of the appropriate herbal formulas for the TCM diagnosis.
· Demonstrates development of skill and accuracy in the interpretation of Oriental diagnostic examinations, and gathering of symptoms and signs.
· Demonstrates ability to record a detailed patient history and record accurate and thorough soap notes, including the proper recording of nutraceuticals, formulas, their modifications, and their administration.
· Demonstrates ability to identify and select individual herbs in the pharmacy according to their name in a written formula.
· Demonstrates ability to use scales and other equipment in herbal pharmacy.
· Demonstrates ability to compound formulas in dosages according to a written formula.
· Demonstrates ability to select Chinese prepared herbal formulas (patents) based on traditional indications and contemporary data.
· Demonstrates ability to recommend nutraceutical products and make healthy eating recommendations based upon TCM diagnosis and contemporary data.
· Demonstrates sensitivity and attentiveness to the patient’s needs, including patient education on the preparation and administration of prescribed herbal products.
· Demonstrates knowledge of herbal practice management skills, including cleanliness, storage, and organization.
Phase 4 Evaluation and Grading Process:
1. Passing turned in each quarter.
2. Sufficient attendance.
3. Completion of the Phase 4 Workbook; showing 108 hours and 50 treatments and a minimum of 10 nutrition intakes with computerized recommendations.
4. Book turned in when completed.
Assessing Quality of Life (QoL) A new measurement added to all intern workbooks in 2007
Many patients present with conditions which have dramatically decreased the quality of their life. For example, arthritis patients may not be able to put on jewelry; they may have difficulty opening bottles. Diabetic patients with neuropathy may no longer be able to mow their lawns. Each patient, regardless of their physical condition, may have their activities of daily living (ADL) adversely affected by their illness.
Assessing ADL and quality of life is a common medical practice. It is another way to assess and prove patient progress and improvement in their condition. These numbers will be expected when writing letters of medical necessity to insurance companies and as part of clinical narratives which may be requested by attorneys on behalf of their patients.
Interns will now be required to ask the patient about improvement in the quality of their life as a result of treatment in the clinic. First is an initial quality of life evaluation taken at the first visit. This is measured, like the pain scale, on a 1 to 10 rating. 1 means my quality of life is poor as a result of my condition, 10 means the quality of my life is excellent and could not be better.
During each visit, the intern will remind the patient of their initial number and their last visits number and ask for a new rating. At each visit, the intern will re-record the number from the first visit and the new number in their workbook and on the Intrak computer record.
Most simply, 5 domains are considered when deciding on a number:
1. Mobility / lack of mobility
2. Ability to care for themselves / assistance needed
3. Usual activities / limitation of these activities
4. Pain / discomfort (use the separate line for pain score if it is a pain related problem)
5. Anxiety / depression
Impact of disease on QoL
A 31 year old man who developed ankylosing spondylitis said it totally changed his life. ‘My plans for a career were stifled. I couldn’t move around my house. I became dependent on my parents. I have since become depressed and have stopped my hobbies. The patient rates themselves a 3.
Indications of Improvement in QoL
After receiving acupuncture, my ability to walk improved. While I can no longer play sports, I again am enjoying my hobbies. I can now take short walks and am less depressed. The patient rates themselves a 6.
You may need to help the patient
select a number through discussion.
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