The NCCAOM vs. POCA Tech
a guest post by Jennifer Kehl, RN, L.Ac.
A brief introduction for non-acupuncturists and anyone who’s new here (welcome, new subscribers!):
Jennifer Kehl is a recent graduate (Cohort 8) who passed her exams and got her Oregon acupuncture license in record time. She’ll start work at Acupuncture for the People next month. She has 27 years of experience as a registered nurse, 20 of them in the ER. I asked her to write about her learning experience at POCA Tech; she chose to start at the end and work backwards.
The NCCAOM is the national credentialing organization for acupuncturists. In most states, getting credentialed by the NCCAOM is a requirement for getting a state acupuncture license. Here are Jen’s thoughts on that.
Does POCA Tech prepare students to pass the NCCAOM exams?
Fresh from the arduous process of studying, navigating POCA Tech’s 2023 re-accreditation, sitting for my board exams, and being really frustrated with all of it, my answer is “yes, but there’s a lot more to say”.
After reading the exam content outlines on this NCCAOM website, I can say my school covered all these topics at some point during my three years. If there wasn’t a class particularly dedicated to it, we were directed to appropriate resources for self study. A better question, in my opinion, is:
Do the NCCAOM exams accurately reflect the readiness of a graduate student to enter the profession?
I’d have to report a resounding “No!”, and I’ll tell you why. I’ll start with how POCA Tech did prepare me to enter the profession.
In addition to the required material, the school includes classes on how to do the difficult job of creating and/or maintaining a clinic, and how to do the actual work of caring for human beings in a professional and compassionate way. My teachers are witness to the multitude of times I blurted out in class “I wish I would have learned this in nursing school!”
Liberation acupuncture is a thread that weaves through everything POCA Tech does. To support that mission, there are multiple classes on trauma informed acupuncture, cultural competence, pain management, and how to build rapport during intakes. There is even a class called “Touch and How to Do It”.
I remember a teacher reminding us to lead with Heart, then Hands, then Head.
One of my most challenging classes in the beginning turned out to be the one that had the most impact. It was a series of leadership classes that followed us through all three years. My takeaway was “Leadership isn’t rocket science! It can be learned!” I didn’t need to dread it like I had all these years. I’m glad I attended a technical school. Techniques can be learned and mastered. Leadership techniques are no different.
Looking back over the curriculum, it’s even more clear to me how I got to the place I am now. I feel completely comfortable stepping into any community acupuncture clinic and treating virtually anyone with any complaint. I know there are still things to learn, things only my patients will be able to teach me, but the school absolutely prepared me to enter this new profession with confidence.
OK, so back to the evaluation process. How does POCA Tech evaluate the readiness of students to enter the profession?
There are two things students need to complete before graduation. A paper and presentation on their “11th Method” and successful completion of the clinic exit exam.
One of the things that is unique to POCA Tech is that they teach 10 different methods, or clinical approaches, for acupuncture. Although there are dozens of methods which have evolved over the centuries, the school chooses those that are easily adapted to a community style setting. During our final year, several of our teachers presented to us their “11th Method”, or how they have integrated their knowledge and experience into their own individual way of practicing.
The students’ task is to consider how they themselves have taken what they’ve learned in class and clinic and are starting to build their own style. I remember our teacher telling us “Just write down what you think about when you sit down next to a patient.” We took into consideration not only the 10 theories/methods we learned, but all the other things in those classes I spoke about above, things like how we are with people, or our “punk persona”.
I could only have created my 11th method by being given the freedom to explore these things on my own. I don’t want to be a carbon copy of all the punks that have come before me, and POCA Tech doesn’t want that either. There is an authenticity and genuineness that’s found when we’re allowed to be creative and open, and we’re encouraged to let the patients show us what works and what doesn’t.
Approaching my final few days of school, I was not cramming facts and figures into my brain and stressing about multiple choice tests. I was finding ways to explain to my fellow students and teachers what I’d learned by doing the actual work of treating human beings. I was honored to be able to share how I was integrating everything I’d learned, and what kind of acupuncturist I want to be. At the same time, I was excited to hear how my classmates had interpreted the material for themselves. My 11th method is not only my guidebook for point prescriptions, but my very first mission statement.
Excerpt from my 11th Method paper:
I imagine things will morph and reinvent themselves over time, and therein lies the beauty of this profession. It’s technical. It’s art. It’s humanity. It has it all.
The biggest test of our readiness for graduation lies with the clinic exit exam.
For one festively charged afternoon, the 11 students in my cohort treated 67 patients in the span of three hours. Walking in wearing our “For the most part…professionally qualified” T-shirts, we were ready. It was time to show the teachers that we could put all of our newfound skills into practice. You would think I’d have been nervous, this was our final exam! But I wasn’t at all. After doing nearly 800 treatments during my internship, I was fully prepared.
The exam included a trauma-informed intake, gentle and safe needling with a point prescription that reflected our 11th method, blanketing, and thorough SOAP charting. We also needed to show leadership skills, both as an individual providing compassionate care for our patients, and as a team member managing our time and “holding the room”, which meant rounding not only on our own patients, but our classmates’ as well. This included pulling needles, cleaning chairs, and keeping the clinic running smoothly.
The teachers were milling about, making sure we were following the rules of the exam, but it was easy to lose them in the busyness of the clinic. It brought back memories of my ER nurse days when I was part of a well-oiled machine, although this felt more like a well-oiled dance. We drifted in and out, helping each other. Each of us may have had our own style, but we had a common goal.
Then things went sideways.
In stark contrast to these accomplishments stood the looming NCCAOM board exams. I was prepared for sitting on a rolling stool in any community acupuncture clinic and treating people with virtually any complaint. I was not prepared for taking the exams. This wasn’t because POCA Tech didn’t prepare me, but because NCCAOM needs you to do more than graduate from an accredited acupuncture school. Speaking to several acupuncturists who have graduated from more traditional TCM schools, they weren’t ready at graduation to take the exams either. Additional studying is necessary. For some, months of study are required before they feel ready for the three exams required for certification and then licensure.
I could write another 1,000 words on how no multiple choice test is going to evaluate how good anyone is going to be at their job. I’m thinking about my nursing career now. I understand that there were lots of things I needed to know to practice, and I’m glad I learned those things. I understand that when it comes to facts and figures, multiple choice tests are a good way to make sure the material has been downloaded into my brain, but I’ve met nurses who barely passed their boards and are excellent nurses and mentors of mine. On the other hand, I’ve met nurses who could recite the textbooks, but I wouldn’t let them anywhere near me or my loved ones.
So, yes, NCCAOM exams can evaluate the ability of someone to download information into their brain and critically think their way through a multiple choice test. But much like the nursing boards, they cannot evaluate if someone is ready to do the actual job.
My NCCAOM exam experience looked something like this: After showing two forms of ID and placing my hand on a machine that read the pattern of my palm veins, I was shown to a cubicle in a room with other people in other cubicles. A little time clock in the upper right corner of the screen reminded me that I not only need to read the questions thoroughly, but do it fast. A rule peculiar to NCCAOM is that you do not have scheduled breaks at all during your 2.5 hour exam, if you do take a break, the time clock keeps ticking.
I just don’t see how putting people through all this test anxiety, and weeks or months of studying makes anyone a better acupuncturist, nor should it be the deciding factor in who deserves to practice. I think back to 1997 when I took my nursing boards, I studied maybe a week for my one nursing board exam and I wasn’t too worried about passing. I was prepared because I had just graduated from an accredited nursing school. Minimal studying was needed. It blew my mind that so much studying would be required for the NCCAOM exams after I’d already met all the requirements for graduation.
This whole NCCAOM experience felt very… western medicine to me. Although I’m new to the profession, I get the feeling that the acupuncture world outside of POCA Tech really wants validation from the western medical community. I imagine it’s because that’s where all the insurance dollars are. Trying to break into the Medical Industrial Complex shouldn’t be anything that anyone would want to do.
DO YOU NOT SEE ALL THE PEOPLE TRYING TO BREAK OUT?!
I have to admit that after climbing out of the Medical Industrial Complex with my limbs barely attached, I was very disappointed that there were areas of my future profession that have those same undertones.
I understand there are necessary evils. I understand that this is how things are done. I even understand that oversight agencies can be very important in keeping practitioners and patients safe. I even support their existence. What I don’t understand is why it needs to be so painful, and so expensive.
Ripping a page out of the Medical Industrial Complex bible, the NCCAOM proceeds to financially gouge students fresh from graduation, some already drowning in student loan debt.
Here is the breakdown of what I’ve paid post-graduation in order to get my license:
NCCAOM application fee: $525
Testing fees: $975
Exam results sent to state: $50
In addition, licensing fees:
OMB application fee: $293
Fingerprinting: $12
OMB licensing fee: $402
Total: $2,257
I felt ready to be an acupuncturist about six months ago. The accredited school I went to thought I was ready a month before graduation. This all seems excessive, borderline punitive, and everything that is wrong with health care capitalism.
Maybe the thing that disturbs me most about the NCCAOM exams is that in that list of exam content, no mention is made of actually doing the hard work of caring for humans. There is no mention of the skills needed to create therapeutic relationships with patients, or how to sit with someone in unbearable pain and give people hope. No mention was made of the importance of being a leader within our profession, of taking responsibility for its future, or even just how to work with others and run a successful clinic.
We can approach our profession like those in western medicine and break things down into diagnoses and abstract disease entities, but where is the heart?
Maybe that’s just my nursing background peeking through. Nursing is a very technical job, but a technical job with a heart. I remember getting acupuncture years ago at my local community clinic and thinking that if there was ever another job like that, it was in community acupuncture.
YES!