Phase 5 Internship Policy - Midwest College
The goal of Phase 5 of internship is to allow the student to progressively master the skills and attain the competence needed to practice Oriental Medicine independently. During Phase 5, interns are expected to have well developed skill in acu/moxa therapy, to be able to choose an herbal formula, including its modification, with only minimal input from the supervisor, and make nutritional recommendations that complement the treatment plan. Although prescriptions and treatment plans must still be approved by the supervisor, the student is nevertheless responsible for accurately arriving at correct conclusions and assigning of appropriate therapy based on diagnostic examination and knowledge of herbal principles.
Students are expected to be able to write formulas, including dosage, preparation, and parts of individual herbs, accurately and professionally.
Students must learn to handle adverse reactions that might occur as part of the herbal course of treatment, and to minimize these reactions with appropriate modifications in the prescriptions.
During Phase 5, interns must integrate TCM nutrition as part of their scope and activity.
Phase 5 Treatment Requirements
Students are required to make a nutritional evaluation of each patient where food recommendations could enhance the therapeutic outcome. During Phase 5, in addition to food recommendations, interns must compound a minimum of 35 crude herb formulas and dispense herbs, whether crude or prepared, to 100 patients.
Interns document 100 treatments using Acu/moxa, tui na, herbs, nutrition and supplements in this book. Another focus of this last phase of internship is documentation of pre and post treatment physical examination and evaluation. This is the time to demonstrate continuity of care and the ability to carry a treatment regimen through to the resolution of the presenting complaint. This workbook must be turned in to the office prior to graduation.
Phase 5 Performance Objectives
· Demonstrates independence in the clinical decision-making process in the selection and modification of acu/moxa therapy, accessory techniques, tui na, herbal formulas and nutraceutical products.
· Demonstrates ability to independently collect information from TCM examinations and to arrive at an accurate diagnosis suitable for the prescription of herbs.
· Demonstrates ability to accurately and independently identify and select individual herbs in the pharmacy according to their name in a written formula.
· Demonstrates ability to manage adverse reactions, including appropriate modification of the formula if necessary, and to inform patients of potential side effects.
· Demonstrates ability to record a detailed patient history and record accurate and thorough soap notes, including the proper recording of formulas, their modifications, and their administration.
· Demonstrates sensitivity and attentiveness to the patient’s needs, including patient education on the preparation and administration of herbal products, including adverse combinations with standard Western medications.
· Demonstrates ability to manage the inventory, storage, and legal standards (e.g., endangered species, possibility of contamination with pharmacological products, etc.) needed to operate an independent herbal pharmacy in future private practice.
· Demonstrates
awareness of the lexicon of nutrition, and ability to communicate with
nutrition professionals in an informed 
manner.
· Demonstrates awareness of the scope of nutrition in the maintenance of health, enhancement of vitality, resistance to illness and intervention into disease states.
· Demonstrates the ability to confidently design and implement an Interventive Medical ™ response for both the prevention and/or treatment of illness.
· Demonstrates the ability to integrate nutrition and other TCM modalities into a comprehensive treatment plan.
· Demonstrates the ability to make appropriate referrals to allied health professionals.
· Demonstrates the ability to evaluate claims in the scientific and popular literature relating to the eight branches of Traditional Chinese Medicine.
· Demonstrates the ability to take responsibility for evaluating their own clinical performance in the student clinic and their own future practice.
· Demonstrates the ability to obtain up to date professional information in the field of TCM in order to implement their own future continuing education.
Phase 5 Completion requirements:
1. Passing score turned in each quarter.
2. Sufficient attendance.
3. Completion of the Phase 5 Workbook; showing 150 hours and 100 herbal/nutrition/acupuncture treatments.
4. Book turned in when completed.
Total, over all five phases of internship; a minimum of:
1. 918 hours (a maximum of 150 hrs from observation)
2. 400 treatments (excluding observation) (including at least 150 Herbal treatments).
3. 75 different patients treated (recorded on the ICD-9s)
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:
- Mobility / lack of mobility
- Ability to care for themselves / assistance needed
- Usual activities / limitation of these activities
- Pain / discomfort (use the separate line for pain score if it is a pain related problem)
- 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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