99645 Clinic Level 4 and Acupuncture Techniques 3

Warning: The information on this page is indicative. The subject outline for a particular session, location and mode of offering is the authoritative source of all information about the subject for that offering. Required texts, recommended texts and references in particular are likely to change. Students will be provided with a subject outline once they enrol in the subject.

Subject handbook information prior to 2024 is available in the Archives.

UTS: Science: Life Sciences
Credit points: 6 cp
Result type: Grade and marks

Requisite(s): 99644 Clinic Level 3 and Acupuncture Techniques 2
Anti-requisite(s): 94680 Entering Professional Life (6cp) AND 94681 Entering Professional Life (8cp)

Description

Approximately 30 per cent of the undergraduate training program is devoted to gaining clinical experience in preparation for becoming a qualified traditional Chinese medicine (TCM) practitioner. This subject builds upon the basic diagnostic concepts already covered, especially the four methods of diagnosis (si zhen), and combines them with the biomedical principles involved in orthopaedic assessment. The subject includes the program's Stage 4 clinical learning, experience and preparation, which comprises the following.

• TCM orthopaedic assessment, which builds on the introduction to Chinese remedial massage (tuina) practiced in Clinic Level 3. In Clinic Level 4, the focus on orthopaedic assessment develops diagnostic skills and allows the student to identify regional musculoskeletal dysfunction. In the practical workshops, students apply their diagnostic findings to plan and carry out integrative treatment approaches using a range of external Chinese medicine modalities, including tuina.
• Acupuncture Techniques lll, which extends and applies the basic theoretical constructs introduced in Clinic Level 3 and Acupuncture Techniques II to the practice of various acupuncture techniques.
• Clinical placement hours, which develop the skills and duties required of a student practitioner working in the University's outpatient clinics. All students must satisfactorily complete the required clinical hours, case reports and competency assessments.

Upon completion of the subject, students have the basic knowledge necessary to undertake supervised clinical practice in the UTS Chinese Medicine Remedial Massage (Tuina) Clinic in Stages 5 and 6. Knowledge gained in Clinic Level 4 is necessary for further development of a clinical application of an integrative practice scope.

Subject learning objectives (SLOs)

1.	Recognise specific situations, in both scenario-based workshop activities and during clinical placements, that require and demonstrate the use of professional therapeutic communication skills when dealing with patients, peers and clinical supervisors.
2.	Communicate and contribute effectively as a team member while engaging in learning that enhances professional competence.
3.	Identify and act upon risk factors within the clinic environment.
4.	Perform a primary problem-focused physical examination.
5.	Demonstrate the ability to recognise pathological conditions, distinguish between relevant and irrelevant patient cues, interpret diagnostic information and apply TCM disease and pattern differentiation (bianbing bianzheng).
6.	Accurately locate acupuncture points, further develop the understanding of their clinical functions, and describe and perform basic and intermediate needling manipulation techniques required for safe and effective acupuncture practice.
7.	Describe, perform and correctly apply orthopaedic assessment methods and TCM external therapies, including tuina techniques, to different body regions.

Course intended learning outcomes (CILOs)

This subject also contributes specifically to the development of following course intended learning outcomes:

• Apply: Demonstrate expertise in Chinese medicine’s classical and contemporary theories, research, and clinical health practices to support patient health and wellbeing. (1.1)
• Analyse: Contextualize knowledge in clinical practice, including an integrated biomedical and Chinese medical understanding of pharmacology, human physiology, pathophysiology and differential diagnosis to inform health management strategies, as well as treatment construction and delivery. (1.2)
• Apply: Develop effective problem-focused assessment skills to differentiate diseases and patterns, and apply clinical reasoning to make diagnostic and therapeutic judgements. (2.1)
• Apply: Demonstrate the integration and application of professional health care knowledge and clinical skills to safely and ethically practise Chinese medicine. (3.1)
• Apply: Demonstrate a high level of writing, reading and speaking in English and an ability to engage constructively in conversation with health stakeholders, including community, other health disciplines, and policy makers. (5.1)
• Analyse: Integrate information from patients, community, and other health disciplines to support patient care models and quality health care practice. (5.2)

Contribution to the development of graduate attributes

1. Disciplinary knowledge

Information on the classical manipulation techniques and points covered in Clinic Level 2 and 3 are extended and applied in the clinical practice workshops. Emphasis is placed on the main acupuncture point groups, their clinical applications, and on acupuncture manipulation techniques to develop professional competence in the area of acupuncture and other manual therapies. You will build on previous knowledge gained from CM Manual Therapies 1 (Tuina) and continue to develop skills in identifying musculoskeletal and myofascial pain. You will explore various concepts of pain and dysfunction and how these relate to similar concepts in CM. The opportunities to practice and demonstrate these skills in a simulated practice-based environment focuses your learning on treatment planning and integration.

2. Research, inquiry and creative thinking

Critical thinking and clinical reasoning skills are developed as part of the assessment structures and are vital to your development as you enter clinical practice. The problem-based case history task requires that you further explore and research the topics under consideration and critically think about relevant information and its application in treatment. To assimilate biomedical and CM knowledge, the subject encourages you to have an open mind and to use inquiry to achieve the best possible clinical outcomes for your simulated patients in the subject workshops and for the clients you encounter during your clinic placement.

3. Professional, ethical, and social reponsibility

Your participation in weekly workshops develops your understanding and application of manual therapies within the CM professional scope of practice. During your clinical placements you will assist and observe registered practitioners and are required to adhere to CMBA and UTS policies and procedures. Your knowledge of and adherence to these policies and procedures will ensure that you maintain the highest possible standards in patient care and ethical behaviour in your practical workshops and when attending clinic placements.

Workshop exercises and assessments will require that you practice, demonstrate and explain the location and dynamics of acupuncture points, channel pathways, needling techniques and other manual therapy skills for a range of commonly presenting clinical conditions. The workshop exercises require that you safely and competently needle specified points, and carry out orthopaedic assessment methods. They require that you demonstrate the application of intermediate needling techniques and adjunct therapies such as electro-acupuncture and CM remedial massage – ensuring this is done in a safe and ethical manner. Classes will continue to develop your diagnostic skills and procedures so that you are able to correctly identify a range of trauma and dysfunction and determine appropriate application of manual therapies as part of your treatment practice scope. You are required to actively demonstrate and ensure your clinical practices do not cause harm to your patients (simulated or real).

As you participate in clinics and undertake treatment of your fellow students in practical workshops, a sense of your professional and humanitarian responsibilities will develop over time. You are encouraged to foster professional attitudes as you encounter and treat patients (simulated and real). As your clinical skills and competence grows, you will be able to take your place within the professional community.

4. Reflection, innovation and creativity

For the CM practitioner, a key principle for lifelong learning is the ability to research and reference knowledge, and to critically analyse and incorporate that knowledge into clinical practice. In Clinic Level 4, therefore, the student will be required to reference and process material on treatment systems and then incorporate the knowledge gained into the case history assignment and practical needling workshops. The subject requires that you constantly revise your studies to date and observe and question how practitioners in clinics justify their Chinese medicine manual therapies treatment prescriptions.

Over time, this approach helps you to build a structure upon which you can develop your own treatment protocols.

The subject requires that you assess your fellow students in a simulated role play clinical environment using orthopaedic neuromuscular assessment techniques and interpret the results diagnostically. You are actively encouraged to use the literature and other information sources in your learning and for undertaking practical and paper-based assessment tasks. This continues the process of skill and knowledge acquisition necessary for your development as a lifelong learner. This is especially necessary for clinical practice where currency of knowledge is of most importance in ensuring best practices in the care and treatment of your patients.

5. Communication

You have the opportunity to engage in a number of activities that develop varying communications styles and techniques. In practical workshops you obtain necessary data to develop your treatment protocols and must inform and seek feedback from your peers when treating each other. Written assessment tasks require you to clearly articulate case history details and the clinical reasoning behind the development of treatment protocols.

In clinical placements, you interact directly with patients to obtain case history data and communicate that information to the practitioners. You also observe your practitioners’ professional communications with their patients and must interpret and record these data. These activities help build your knowledge of both biomedicine and CM, as patient communication will often require a translation of CM terminology and concepts into biomedical models that are more familiar to patients. The case reports provide a tool for you to document and reflect on these processes and observed communications.

Teaching and learning strategies

The subject is delivered through clinics, lectures and workshops, through which students are incrementally introduced to the responsibilities of Chinese medicine practice. Communication regarding the subject takes place largely via Canvas, especially through its announcements and email facilities. It is your responsibility to check these regularly.

You will undertake 40 hours of clinical placements assisting registered Chinese medicine practitioners. This part of the subject requires that your attitude and behaviour with clinic clients, your supervisors and peers are responsible, cooperative and professional at all times.

You will have 11 x 4-hours of class time per week. Classes are in lecture and workshop practicum format, and are supported by Canvas where you will find Clinic Level 4 subject information, learning materials and pre-class activities. Each week you are required to complete pre-class activities prior to the workshop session. The subject allows students to receive regular formative feedback from your peers and teaching staff during the practice-based classes, which gradually develop your confidence in preparation for the UTS internship clinics during your final year.

You will confirm and extend your understanding of the locations, functions and applications of acupuncture points within various theoretical and contextual frameworks. Clinic Level 4 assumes that you have by now acquired sufficient knowledge of anatomy, physiology and point location to accurately select and locate the points to which you will apply various needle manipulation techniques to develop your needling skills.

The subject learning objectives emphasise the integration of diagnostic and manual therapy (acupuncture and tuina) skills and safe clinical practices, and the subject assessments will evaluate your performance against relevant competency criteria. Your workshop teachers will observe your practice throughout the semester and match your performance against these same criteria. Lack of attendance for your Clinic Level 4 classes therefore will adversely affect your clinical competencies, assessment performance and subject result.

The Course Notes: Section 1 is for your own self-directed learning and includes a number of supplementary readings that will benefit your understanding of Chinese medicine, case management planning and its application to a CM treatment scope encountered in a clinic. Section 2 contains several segments that cover information and activities for specific anatomical regions of the body. These are to be completed during your practical classes. You will want to read the notes prior to attending class however, to prepare for the workshop activities. A hard-copy of the Course Notes will be provided during the first class.

This subject includes experiential learning undertaken within a clinical learning environment. Students will have the opportunity to engage in both the practise of the techniques as well as receiving them in the patient practitioner role play scenario. This may involve exposure of appropriately draped body regions, physical practice including palpation, and interventions related to manual therapies such as massage, cupping, gua sha, and needling. Third party observation from class and teaching participants may occur. Teaching activities are designed carefully with consideration to clinical practice and procedure guidelines but there may remain possible risks and inconvenience. Consequently, consent is always required in these situations and sufficient detail must be provided outlining the benefits, purpose and potential risks of harm so that individuals may freely accept or decline participation. Consent is a continuous process and changes to expected participation during the course of the learning activity requires further consent. You must always obtain informed consent from anyone you are working with for these techniques, and participation always remains voluntary. No student will ever be required to participate in these activities, there will always be opt in participation, and there will be no effect on your relationship with staff, UTS or study opportunities. If you wish to withdraw from the learning activity once it has started, you can do so at any time without having to give a reason. Should participation become uncomfortable or the participant become distressed while engaging in learning activities, they continue to have the right to withdraw consent.

Content (topics)

Clinic placements

Students will assist practitioners as directed including:

• Cleaning clinic equipment and carrying out sterilisation procedures as required
• preparing and maintaining needle and equipment trays
• assisting in dispensing herbal prescriptions and maintaining the herbal dispensary
• recording patient reports, practitioner’s diagnosis and treatment details
• assuming responsibility for general patient care and comfort during treatment
• monitoring the patient’s pulse and noting other diagnostic criteria of significance
• arranging appointments for patients as requested
• assisting the supervisor or practitioner as otherwise requested
• assisting in general clinical management

Acupuncture Techniques III and Orthopaedic Assessment Classes

To broaden and enrich your awareness of the Chinese medicine scope of practice, necessary for treatment planning and for the management of chronic conditions presenting in the different regions of the body, you will engage in:

• revision of musculature, anatomical landmarks, point location and clinical functions, channel theory, diagnostics and treatment techniques
• intermediate filiform needle insertion and manipulation techniques
• further development of acupuncture theory and its applications regarding
  • the eight extraordinary vessels
  • special point groupings
  • the five shu-transport points
  • electro acupuncture
  • time theory
  • other treatment application theories as advised
• identification, assessment and treatment of
  • common injuries (including sprains, bruises, cramps, spasms, strains, bursitis and adhesions)
  • traumatological disease and dysfunction (affecting the limbs, pelvis, thorax, vertebral column and head)
  • pain (including neurogenic, vascular, bone and soft-tissue, acute / chronic and trigger points)
• demonstration and application of orthopaedic assessment for Chinese medicine (including range of movement testing, resistance testing, neuromuscular testing, reflex testing, observation, palpation, questioning and listening, radiographic and pathological test information)
• application and integration of appropriate TCM manual treatment techniques (principally acupuncture and tuina, including EA, guasha, moxibustion, cupping)

Assessment

Assessment task 1: In-class theory and practical tests

Intent:	This assessment task contributes to the development of the following graduate attributes: 1. Disciplinary Knowledge 3. Professional, ethical and social responsibility 5. Communication
Objective(s):	This assessment task addresses subject learning objective(s): 2, 5, 6 and 7 This assessment task contributes to the development of course intended learning outcome(s): 1.2, 3.1 and 5.2
Type:	Quiz/test
Groupwork:	Individual
Weight:	50%
Criteria:	Referenced against competency criteria. Further details will be available in class.

Assessment task 2: Threshold task - Practice Workshops Weekly Worksheets

Intent:	This assessment task contributes to the development of the following graduate attributes: 1. Disciplinary Knowledge 2. Research, inquiry and critical thinking 5. Communication
Objective(s):	This assessment task addresses subject learning objective(s): 2, 3 and 7 This assessment task contributes to the development of course intended learning outcome(s): 1.1, 2.1 and 5.1
Type:	Exercises
Groupwork:	Individual
Weight:	30%
Criteria:	For your participation in the weekly workshops, you will be assessed on your 1. Knowledge and application of Chinese medicine manual therapies: orthopaedic testing, acupuncture points and needling techniques, tuina and other external modalities, that are contextualised and applied in clinical practice

Assessment task 3: Case History

Intent:	This assessment task contributes to the development of the following graduate attributes: 1. Disciplinary Knowledge 3. Professional, ethical and social responsibility 4. Reflection, Innovation, Creativity 5. Communication
Objective(s):	This assessment task addresses subject learning objective(s): 1, 4, 5 and 6 This assessment task contributes to the development of course intended learning outcome(s): .0, .0, .0, .0 and .0
Type:	Case study
Groupwork:	Individual
Weight:	20%
Length:	There is no formal upper limit, but students should aim for around 1500 words
Criteria:	Assessment marking criteria can be downloaded from Canvas. Students are assessed on the comprehensiveness of their case, critical thinking and clinical reasoning, formatting and referencing

Minimum requirements

To successfully complete this subject you must complete all assessment tasks, clinic hours and case reports.

The standard UTS Minimum Requirements apply, whereby you must obtain a minimum of 50% in the overall subject mark.

In addition, for the Chinese Medicine Program’s ongoing clinical placement attendance and case reports competency tasks, you are required to meet subject thresholds to the satisfaction of your clinical supervising practitioners and subject coordinator.

Threshold task – Clinical Placements and Clinic Case Reports

Task: Clinical Assistant, Clinic Level 4

The Clinical Assistant task requires that you fulfil your rostered hours in the acupuncture and CHM clinics, and submit 6 clinic case reports. In addition, you are required to maintain your log book for the clinical hours you have accrued.

In Stage 4, the required clinic placement hours and clinic case reports are as follows:

• clinic placement hours:
  • herb clinic hours – 2 shifts
  • acupuncture clinic hours – 5 shifts

= total clinic placement hours – 40 hours

• clinic case reports:
  • 2 herbal case reports
  • 5 acupuncture case reports

Check your clinic rosters regularly, make sure each of your placement sessions has been signed off by your supervising practitioner, and that you submit each of your clinic case reports within one week of completing the relevant clinical shift. Over the duration of the program you will develop a personalised portfolio of clinical learning experience. Proformas and instructions are available in Canvas.

Failure to attend a rostered clinic will result in the loss of clinical hours. In such circumstances, UTS is under no obligation to provide extend clinical shifts to accommodate a shortage of mandatory semester hours. Students may be required to complete any additional or missing hours externally. In such cases, application for the completion of external hours should be made through the clinical managers.

A rostered shift may be swapped prior to its commencement. Such swaps should be notified, well in advance, to the clinical managers, using the appropriate forms available from the clinic.

Failure to meet this subject’s required threshold tasks before the end of the teaching session will result in an ‘X grade’ fail. An X grade may be due to incomplete clinic placement hours, clinic case reports, or both.

If you fail to satisfy the subject’s prescribed clinic attendance and clinic case report requirements, you may within 10 working days, submit an online Application for Special Consideration in line with the requirements and in the manner prescribed in the online Special Consideration Student Guide (http://www.uts.edu.au/current-students/managing-your-course/classes-and-assessment/special-circumstances/special ). It is your responsibility to demonstrate that you have been prevented from meeting prescribed threshold requirements as a result of illness or other circumstances beyond your reasonable control (Rule 3.8.3).

In such cases, where outstanding clinic hours or clinic case reports remain, a ‘Q result’ may be awarded. A ‘Q result’ may also be awarded in cases where your clinic hours and clinic case report submission were not confirmed in time for the official release of results.

Q result means the result is pending. In this case the result cannot be awarded until the satisfactory completion of clinical practicum hours and/or clinic case reports.

X grade (X > 45) denotes unsatisfactory performance in a compulsory component of the subject. This grade is applied by the Results Ratification Committee in cases where the student has gained a mark of 45 or more but failed a subject overall. There is no formal upper limit for this grade.

Recommended texts

Course Notes: Clinic Level 4 and Acupuncture Techniques III, (current) UTS, Sydney

TCM Clinical Procedures and Safe Clinical Practice, (current) UTS, Sydney

CMBA Codes and Guidelines, (current) https://www.chinesemedicineboard.gov.au/Codes-Guidelines.aspx

References

Chen, E. (1995). Cross-sectional Anatomy of Acupoints. Edinburgh: Churchill Livingstone.

Deadman, P., Al-Khafaji, M. and Baker, K. (2007). A Manual of Acupuncture. Hove (UK), Journal of Chinese Medicine Publications

Rogers C. and C. (1996), Point Location and Point Dynamics Manual, Sydney: Acupuncture Colleges Publishing.

Shi, X. M. (2007). Shi Xue-min’s Comprehensive Textbook of Acupuncture and Moxibustion. Beijing, People’s Medical Publishing House

Wang, Q. (1990). Chinese Massage Therapy. Shandong Science and Technology Press: Shandong, China.

Other resources

Baldry P. Acupuncture, trigger points and musculoskeletal pain. 2nd ed. Edinburgh: Churchill Livingstone; 1993.

Baldry P. Myofascial pain and fibromyalgia syndromes: A clinical guide to diagnosis and treatment. London: Churchill Livingstone; 2001.

Batavia M. ‘Contraindications for therapeutic massage: do sources agree?’, Journal of Bodywork and Movement Therapies. 2004;8:48-57.

Beeton K. Manual therapy masterclasses – the peripheral joints. Edinburgh: Churchill Livingstone; 2003.

Brukner P, Khan K. Clinical sports medicine. 2nd ed. Sydney: McGraw Hill; 2000.

Chaitow L., DeLany, J.W. Clinical applications of neuromuscular techniques. Volume 1 – the upper body. Edinburgh: Churchill Livingstone; 2000.

Charman, R. Complementary therapies for physical therapists. London: Butterworth Heinemann; 2000.

Deng, T. T. (1999). Practical Diagnosis In Traditional Chinese Medicine. Edinburgh, Churchill Livingstone.

Field, D. Anatomy: palpation and surface markings. 3rd ed. London: Butterworth-Heinemann.; 2001.

Field, T. ‘Chapter 3: Massage therapy for immune disorders’, in Massage therapy: the evidence for practice. Rich G., Edinburgh: Mosby; 2002.

Gardner-Abbate S. The art of palpatory diagnosis in Oriental medicine. Edinburgh: Churchill Livingstone; 2001.

Garvey, M. A Clinical Guide to the Body in Chinese Medicine: History and Contemporary Practice. Taos NM, Paradigm Publications; 2015.

Holey, E. Evidence Based Therapeutic Massage. 2nd ed. Edinburgh: Churchill Livingstone; 2003.

Loo, M. Pediatric Acupuncture. Edinburgh: Churchill Livingstone; 2002.

Low, R. Acupuncture: techniques for successful point selection. London: Butterworth- Heinemann; 2000.

Lowe, W. Orthopaedic Massage. Edinburgh: Mosby; 2003.

Lyttleton, J. Treatment of Infertility with Chinese Medicine. Edinburgh: Churchill Livingstone; 2004.

Jarrett, L. The Clinical Practice of Chinese Medicine. Stockbridge: Spirit Path Press; 2003.

Maclean, W. and Taylor, K. Chinese Herbal Patent Medicines. Sydney: Pangolin Press; 2000.

Travell, J. and Simons, D. Myofascial pain and dysfunction: the trigger point manual – lower extremities. Baltimore: Williams and Wilkins, 1992.

Travell, J. and Simons, D. Myofascial pain and dysfunction: the trigger point manual – upper extremities. Baltimore: Williams and Wilkins, 1992.

Wang, J. Y. and J. Robertson Applied Channel Theory in Chinese Medicine: Wang Ju-Yi's Lectures on Channel Therapeutics. Seattle, Eastland Press, 2008

Weintraub W. Tendon and Ligament Healing: a new approach to sports and overuse injury. Brookline: Paradigm Publications, 2003.

West Z. Acupuncture in Pregnancy and Childbirth. London: Churchill Livingstone; 2000.

Wolfe H, Strand E, Allen M. Points for Profit: the Essential Guide to Practice Success for Acupuncturists. Boulder: Blue Poppy Press Boulder, 2004.

Yin G, Fu D. Three Needle Technique. Fort Lauderdale: Atlantic Institute of Oriental Medicine, 2002.