Introduction To The College
The Early Years
The NCA was founded in 1988 and in its early years offered a three-year professional diploma course in acupuncture. This course was validated as an MSc in Acupuncture by the University of Wales in 1995, making it the UK’s first degree-course in the subject. The College became a registered charity in 2000.
A second professional diploma course, in Chinese herbal medicine, began in 1994 and was validated by the University of Wales in 2004 as an MSc in Chinese Herbal Medicine (the first postgraduate degree in this subject in the UK). The University of Wales also validated our MSc in Nutritional Therapy in 2008.
The College had an early commitment to research. We set up a research charity, the Foundation for Research into Traditional Chinese Medicine, in the second year of the College’s life and we also initiated the British Acupuncture Council’s Acupuncture Research Resource Centre, which was based at the College in its early years. This involvement in research, combined with the level of qualifications of our staff, were key reasons for our first degree-courses to be validated as MScs.
We have a strong track record of developing and running courses leading to both professional and academic qualifications, and we have always been pioneers working with our professional bodies to promote the processes of professionalisation. As part of this, we were the first teaching institution to achieve professional accreditation for our acupuncture, Chinese herbal medicine and nutritional therapy courses (in 1996, 2003 and 2010 respectively).
Further University Partnerships
We had a positive and developmental relationship with the University of Wales. However, following devolution of powers to the Welsh assembly we were unable to gain assistance with student finance for our students, so we transferred validation of our courses to a new partner, the University of Central Lancashire (UCLan), in 2008. We also developed our BSc in Acupuncture and this was also validated by UCLan in 2008. The interim review of the acupuncture courses by UCLan, conducted after the first year of running them, was extremely positive and identified several areas of good practice. However, in June 2009 UCLan’s Academic Board decided to reverse its previous policy and cease its support for the provision of degrees in our subject areas pending statutory regulation. As a result, we sought a new partner and were pleased to be able to form a partnership with Middlesex University, which validated all our courses. Middlesex University’s Pro Vice Chancellor and Director of Academic Partnerships, stated “We have always held NCA in great esteem and have been very impressed with your engagement with the Quality Code, Middlesex University quality procedures and your own very high standards of delivery and quality assurance”. After Middlesex University closed their courses in our subject areas, we partnered with London South Bank University (LSBU) in 2018. Most recently, in 2020 we formed a new partnership with the Health Sciences University (HSU). This partnership is beneficial to the College in a number of ways. HSU’s values and standards mirror our own; our subject areas are aligned, so there is a high level of mutual understanding and potential for collaboration; we share a common focus on high quality education for practitioners; and the partnership provides organisational and financial stability for the College.
E-learning and Online MScs
In 2011 we made a strategic decision to move to a blended learning model by developing e-learning provision, initially on the BSc and MSc in Acupuncture, but soon after on all of our courses. Our e-learning provision was identified as good practice in the Review for Specific Course Designation by the Higher Education Quality Assurance Agency (QAA) in 2014.
Building on our successes in this area, in 2014 we successfully validated our first two entirely online courses, the MSc in Advanced Oriental Medicine (Research and Practice) and the MSc in Advanced Complementary Medicine (Research and Practice). These courses share modules, and were joined in 2016 by a third course, the MSc in Advanced Nutrition (Research and Practice).
Research Activity
As described above in the section on the History of the College, back in 1990 we established our research wing, the Foundation for Research into Traditional Chinese Medicine (FRTCM), having foreseen the need to carry out robust research into the value of our therapies. The Foundation was originally established as a separate charity and later, in 2011, was incorporated into the College, which by that time was itself a charity. The Foundation brought with it a small fund which is used to support research work by students which has the potential to lead to publication.
The FRTCM undertook two key studies on the safety of acupuncture (MacPherson et al 2001; MacPherson et al 2004), following which the FRTCM collaborated with the College's teaching clinic and Sheffield University on a large pragmatic controlled trial into the provision of an acupuncture service for low back pain. This was at that time the UK's largest ever research study into acupuncture, with major funding from the Department of Health. Patients were followed up for two years after treatment and the results of the trial were published in the British Medical Journal (Thomas et al, 2006; Ratcliffe et al, 2006). This research means that acupuncture is now one of the best evidenced interventions for back pain, and in 2017 the American College of Physicians in their evidence-based practice guideline recommended acupuncture for the treatment of low back pain (Qaseem et al, 2017).
Since the back pain trial the FRTCM was involved in collaboration with the acupuncture research effort at the University of York. This work was led by former College Principal and founder Hugh MacPherson, who became Chair of the Board of Directors/Trustees of the College and Professor of Acupuncture Research at the University of York. His work led to a wide range of publications including research into acupuncture for irritable bowel syndrome (MacPherson et al, 2012) and osteo-arthritis of the knee (e.g. Corbett et al, 2013), and MRI studies of the brain’s response to acupuncture (e.g. Asghar et al, 2012). An important meta-analysis of the specific effects of acupuncture combined 29 high quality trials of acupuncture for painful conditions in a single database of 18,000 patients and concluded that “significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo” (Vickers et al 2012). A major recent project explored the benefits of an acupuncture service or a counselling service for patients with moderate to severe depression (MacPherson et al, 2013), and another recently published trial explored the benefits of acupuncture or Alexander lessons for chronic neck pain (MacPherson et al., 2015).
Hugh sadly died in 2020. You can find here a pdf of a book capturing 200 tributes about his wide-ranging contributions to clinical practice, education and research.
We also undertake clinical outcomes research in all our teaching clinics. Each patient completes a Measure Your Own Medical Outcomes Profile (MYMOP) at commencement of treatment and at several stages during and after treatment. MYMOP is a validated outcomes measure which allows patients to define for themselves the symptoms/issues for which it is most important to them to see improvements from their treatment (see http://www.bris.ac.uk/primaryhealthcare/resources/mymop/ ). We are now involved with other teaching clinics in a collaborative effort to pool MYMOP data in relation to acupuncture, which was organised by the British Acupuncture Council working with the Council of Heads of Acupuncture Courses, with data collection and analysis being undertaken by a team of staff from the College.
We are keen to continue to contribute to the already strong and growing evidence base for our areas of practice. This includes nutrition and Chinese herbal medicine as well as acupuncture, and we are developing areas of research interest in all these areas. Of course, in all healthcare fields the evidence base is incomplete and is therefore a work in progress. The British Medical Journal’s online resource “Clinical Evidence” analysed around 3,000 treatments of all kinds used in the NHS and concluded that only 11% are known to be beneficial, with 24% likely to be beneficial and 50% of unknown effectiveness (BMJ Clinical Evidence, 2016). We encourage our students and staff to work with research-based evidence bearing in mind this broader context.
Students
Our total number of registered students is typically around 175-200, all of them studying on HE courses at FHEQ level 6 (BSc Hons) or 7 (MSc). We have regularly recruited up to 40 students every year to our acupuncture course(s) since the College's inception. Also, we now typically recruit up to 25 students every year to our nutrition course. Our acupuncture and nutrition students are drawn from a wide geographical area, mostly from between the north Midlands and the south of Scotland. Our Chinese herbal medicine courses have had smaller intakes – up to 12 – as they are open to qualified acupuncturists only, and we only recruit a new intake every other year. Our herbs students have been drawn from an even wider geographical area and a small number have even commuted from other European countries. We are particularly excited about our new suite of three online MSc courses for practitioners, which have recruited students from nine different countries around the world. Typical intakes in the first five years have averaged ten students a year.
The vast majority of our students are mature students, ranging in age from early twenties to sixties. This is perhaps less surprising for our Masters courses, but in fact is also true of the BSc in Acupuncture, which attracts an occasional school leaver but mostly appeals to adults seeking a change of career or an addition to a current healthcare career.
We also run a small number of post-registration courses such as open seminars and summer schools, providing continuous professional development options for practitioners.
Excellence And Quality In Education
Over the years, the College has come to be recognised nationally for its work in the field of Chinese medicine, and more recently nutrition. Our educational courses are designed to meet high standards of excellence and quality. They have a focus not just on acquiring knowledge and understanding, and learning techniques of practice, but also on the development of the practitioner. Our aim is to help our students to become balanced and well-rounded practitioners as well as educating them to a high academic level. We recognise and value the complexity and diversity of professional practice. Our courses follow a structured and critical approach to theory and practice but at the same time we are eclectic in our approaches to diagnosis and treatment and our tutors have diverse backgrounds in their own training. By this means our students are enabled to construct a wide-ranging personal repertoire, drawing on personal, propositional and process knowledge (Eraut, 1985), from which they can draw creatively and flexibly to best meet their patients’ or clients’ needs.
All of our students are taught to appraise information and literature critically and with an appropriate toolkit of analytical and comparative skills, and to understand a range of methodological approaches. This encourages the development of habitual criticality as an essential aspect of the research-literate practitioner’s repertoire. Masters students develop further skills in critical appraisal of literature, designing an appropriate research question, exploring the hierarchy of evidence, critiquing methodological approaches, and the interpretation of research data, practising and sharing formal intellectual engagement with extant theories and arguments surrounding their course of study and developing the ability to contribute materially to the published record.
All of our practitioner training courses also critically explore clinically important issues such as realistic scope of practice and prognosis, limits to competence and recognising need to refer, and integration of acupuncture, Chinese medicine and nutrition with biomedical treatment options.
Chinese medicine and nutrition are fields of knowledge where theory and practice remain closely linked. Their rich bodies of theory and research evidence are applied in practice, but also theory is continually informed and modified by direct clinical experience. We therefore put considerable emphasis on the importance of clinical experience, and early exposure to clinical practice and self-critical reflection is a key feature of our practitioner training courses. We have a thriving and well respected teaching clinic and dispensary at the College, which is open every week of the year and serves our local communities offering acupuncture, Chinese herbal medicine, and nutritional consultations. This provides a great clinical learning environment for our students at the heart of the College.
A Cohesive Self-Critical Academic Community
Nearly all of our teaching staff are part-time tutors who are also working in clinical practice. This is attractive for students, who are very aware of the real-world clinical experience that directly informs their teaching. It is also attractive for the tutors, for whom the College provides a focus for communication, discussion and professional development. The sense of community among the teaching staff is palpable, and the friendly, supportive and focussed atmosphere at the College is often remarked upon.
We think that a key factor in the cohesion of the College as an academic community is our twin focus on:
(1) Educating the best possible healthcare practitioners
(2) Promoting and participating in research, with a particular focus on clinical effectiveness
The challenge of how best to educate to produce great healthcare practitioners is substantial. Eraut (1994) described the ways in which professional knowledge is formed from a complex interplay between theory and practice knowledge and the development of personal theory. Practice knowledge is built up within the profession over generations of clinical experience, and it develops and evolves through its interactions with theory and with the research-derived evidence base, and with the clinical experience and developing personal theory of practitioners. We aim for our students to acquire a critical grounding in the practice knowledge of their profession combined with learning about research and the evidence base.
We see disciplines such as Chinese medicine and nutrition as offering practice knowledge in the form of clinical methods combined with a range of models which help practitioners to move from an overall evaluation of the patient/client (including their clinical signs and symptoms) to a choice of treatment which draws on prior clinical experience/evidence. In principle these models help us to make the most effective “complex intervention” – a claim which is of course itself accessible to critique and research. We are very clear that we do not encourage reliance on a single model, and we encourage an acceptance that all models underpinning clinical expertise are an approximation at best, and all methods can be improved. Practice knowledge has to continually evolve in response to changing circumstances, so practitioners need to critique the models and traditions of practice that they learn.
A good practitioner is able to respond flexibly to the unique clinical challenges presented by each individual patient. Both the evidence base and the practice knowledge available to practitioners are diverse and disputed, and it is by exposing students to this and encouraging their own critical thinking that we develop good practitioners who are capable of context-specific clinical reasoning.
Our disciplines are known for their patient-centred nature, and this is borne out by research – for example Cassidy (2002) found that patients of US acupuncturists attached a high value to the empowering and egalitarian nature of their relationships with their practitioners, which enabled increased self-efficacy. Research by NCA tutor Sarah Price et al (2006) found that the empathy of acupuncturists, as perceived by patients, had a direct impact on patient enablement and health outcome. All of our courses aim to develop students’ communication skills and ability to critically self-reflect, so that they are best able to meet patients’ needs and make clinical judgements.
The research-based evidence base is also important, and our QAA review of 2014 identified as good practice our use of the outcomes of significant research projects to inform our curricula. All of our curricula involve students in exploring and critiquing the research evidence base underlying their practice. We are also committed to playing our part in the active development of the evidence base. We do this by:
1. Pursuing our Research Strategy.
2. Educating all our students to be “research literate”, and in particular by providing courses which educate practitioners to Masters level.
3. Engaging in clinical outcomes research ourselves in our teaching clinics.
4. Collaborating with others on larger scale research projects (as described in the section on the History of the College).
5. Running an annual Research Conference.
We also engage in scholarly work and critical debate about education, particularly at the Staff Development Days, which focus on educational issues and have included presentations from staff based on their PGCert HE projects.
Acupuncture, Chinese medicine and nutrition are all characterised by a substantial research evidence base, and acupuncture and Chinese medicine are also rooted in two millennia of scholarly endeavour (Buck C, 2015), all of which provides fertile ground for further research, critical debate and scholarly activity among staff and students. The arena of healthcare is characterised by diversity and best practice is informed by patient needs, clinical experience and research evidence. In this context, our educational approach is to provide a supportive environment for debate and exploration which both challenges and develops our staff and students. We aim to develop the necessary skills of criticality and self-reflection which enable practitioners to combine their learning of practice knowledge and clinical skills with information from the research evidence base to achieve the best possible outcomes for their patients.
