Finding and Recommendation 4
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
Finding 4:
The examination of candidates for licensure is a critical quality control measure for assuring competency of providers and is an essential mechanism for ensuring that evolving public policy goals are met.
California's regulator has had difficulties with the acupuncture examination, including documented fraud and criminal charges during the 1980s that spawned security improvements that require continuous refinement. In debating improvements to the examination, policy-makers also have considered replacing the California test with the examination offered by the National Certification Commission for Acupuncture and Oriental Medicine.
Most other California health professionals are licensed based on a national examination. However, the acupuncture profession is still relatively new in its evolution within the United States and the profession in California has evolved somewhat differently than it has developed nationally. Just as different nations take different regulatory approaches to acupuncture, herbs and other modalities of traditional Oriental medicine, so do different states. As the profession evolves in America, a national examination may become the norm.
However, at this juncture, the independent psychometric analysis of the two examinations determined that while both the California and national examinations are statistically sound and meet all other measures of quality, the California examination was somewhat more robust. In addition, by controlling its own examination, California can directly control the evolution of policies and priorities. California has been able to achieve this goal even though the exam is administered by a private firm under contract.
The California examination does need to be refined to ensure that critical knowledge is tested and passed. Further, when the practical component of the examination was canceled in 1999, regulators lost the means to ensure that candidates possess the physical skills necessary for safe practice. Finally, ongoing concerns regarding exam security plague all professional examinations, requiring sophisticated and continuous vigilance.
Recommendation 4:
The California Acupuncture Board should continue to control its examination to ensure that the State's policy goals are met. Among the policy goals that the State should ensure:
- Demonstrate knowledge of critical components of safe practice. "Must-pass" modules should be required for areas of particular concern, including herb-drug interactions, exclusive use of single-use disposable needles, additional infection control measures, understanding of emerging infectious diseases, "red flag" conditions, first aid procedures, and knowing when and how to refer to physicians.
- Competitive examination administration. The board should continue to contract out for the secure administration of the California-designed and controlled examination.
- Develop strategy for implementing internship. This time-tested strategy for proving the practical skills necessary to be successful in many health professions should replace the discontinued practical portion of the examination.