Victorian Chinese medicine workforce and practitioner capability

Zhou, W 2008, Victorian Chinese medicine workforce and practitioner capability, Doctor of Philosophy (PhD), Health Sciences, RMIT University.

Document type: Thesis
Collection: Theses

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Title Victorian Chinese medicine workforce and practitioner capability
Author(s) Zhou, W
Year 2008
Abstract Chinese medicine (CM), a popular form of complementary and alternative medicine (CAM), has been increasingly used in the Western world over the last three decades. Quality, safety and efficacy of CAM therapies including CM have been major public concerns associated with the use of these interventions, for example, the variability of quality of herbal medicines, potential herb-drug interactions, organ injuries due to poor acupuncture practice, inadequate aseptic techniques, and the overall lack of high level clinical evidence of efficacy. Consequently, significant resources have been allocated to the generation of the new scientific evidence concerning quality, safety and efficacy of CAM therapies to address the public concerns and to support the clinical application of validated CAM therapies. Acupuncture and herbal medicines have been amongst the most popular CAM research areas. While the importance of such original research is well argued and supported, there has been a general negligence of the role of education in protecting public safety, promoting CM as a form of evidence-based healthcare and improving the quality of clinical CM services.

This study aimed to determine the essential practitioner capabilities to ensure the safe, competent and contemporary CM clinical practice in complex healthcare systems such that of Australia. The specific objectives of this study are: a. to understand the utilisation of CM in Australia, China and a number of developed countries; b. to review issues related capabilitybased curriculum development and to compare the similarities and differences of CM education in China and Australia; c. to provide a comprehensive profile of the Victorian CM workforce based on reliable and authoritative source of data; d. to investigate registered practitioners’ views on the desired capabilities for CM practice; and e. to identify knowledge and skill gaps of practitioners who were registered under the transitional arrangements (between 1 January 2002 and 31 December 2004) which will provide the basis for 15 determining the needs of continuing professional education. Based on outcomes from the two literature reviews (addressing objectives a and b, see Chapters 2 and 4, publications 1, 6, 7, and 9), this research involves a workforce study (addressing objective c, see Chapter 3, publications 3, 4, 5, and 10) and a capability survey (addressing objective d, see Chapter 5, publications 2, and 8). Ethics approvals were obtained for both studies.

For the workforce study, a specific instrument with a coding system was developed and approved by the Chinese Medicine Registration Board of Victoria (CMRBVic) prior to the commencement of the data collection based on registration forms submitted by all practitioners registered with CMRBVic during the transitional (also known as grandparenting) period. There were 639 Registered CM practitioners in Victoria as of December 2004. Acupuncture was practiced by almost all practitioners while Chinese herbal medicine was practised by about 60% of them. The mean age of the Victorian CM workforce was 44 years and 55% of them were male. Over 60% of CM practitioners had completed at least a bachelor degree with another one-third of them holding a diploma in CM. Furthermore, over half of the practitioners spoke English as their first language and over one-third (38%) spoke Chinese as their first language. The vast majority of the CM practitioners (90%) worked in the metropolitan areas of Melbourne. These findings provide comprehensive data on the current state of the Victorian CM workforce concerning their educational background, clinical experience and their current practice of CM. They are of significant value to educational institutions, professional associations, healthcare practitioners, government agencies, policymakers, and human resources and workforce managements for future planning.

The capability survey was divided into three stages: the literature review stage, a pilot stage and a survey that was sent to all registered CM practitioners. The literature review 16 stage resulted in a draft capabilities chart that was initially developed for the curriculum development of a Master of Applied Science (Chinese Herbal Medicine) at the Division of Chinese Medicine, RMIT University between 2001 and 2003. This draft capabilities chart was piloted through interviews with CM academic staff, regulators and CM practitioners in Victoria prior to the finalisation of the chart.

In October 2005, the main postal survey was sent to all (701) eligible practitioners. The response rate was 32.5% with a total of 228 participants completing and returning the bilingual (English and Chinese) questionnaire. In addition, to seek their views on the importance of the individual items of the capabilities, demographic data were also gathered. The demography of the survey respondents did not differ appreciably from that of the Victorian CM workforce.

Findings of the survey indicated that of the four categories of capabilities (28 items in total), technical capabilities were considered to be the most important aspects of clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In relation to very important capabilities, seven technical capabilities and three capabilities concerning responsible and sustainable practice were ranked the highest of importance, while none of the research and information management capabilities were given the same scores. In addition, communication capabilities were considered to be important, but not to the extent of being very important. New graduates considered the capabilities of identifying key business issues as important while this was not the case for existing practitioners. Furthermore, over one-third of male participants considered patient referral capability to be less important. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. The 17 educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications compared with practitioners trained overseas valued communication as an important capability.

These findings represent a major step in the development of a capability-based curriculum that meets the needs of the Chinese medicine workforce. In the short-term, the findings of this study provide the basis for developing specific continuing professional educational programs that address knowledge and skill gaps such as communication, referral, research training and for some practitioners, basic biomedical sciences. These are particularly relevant and important for those who had not completed a qualification in Australia.

The limitations of these studies were a relatively low (32.5%) response rate and the lack of clarity of specific terminologies used in the survey and application for registration form, such as postgraduate education, highest qualification in CM versus highest qualification that may be in another academic discipline. It is unlikely that these issues would have an impact on the validity of the key data, findings of these studies need to be interpreted in the context that these findings represented the state of the CM workforce in a specific point in time.

In conclusion, this study, for the first time, provided the comprehensive data on the state of the Victorian CM workforce and CM practitioners’ views on desired practitioner capabilities. A number of continuing professional education needs were identified and the successful implementation of these programs will contribute to the safe and competent CM practice and thus protect the public safety.
Degree Doctor of Philosophy (PhD)
Institution RMIT University
School, Department or Centre Health Sciences
Keyword(s) Medicine, Chinese -- Victoria
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