Multidisciplinary Group of Integrative/CAM Educators Publishes Competencies for Optimal Practice in Integrated Environments

Summary: A team of educators led by chiropractic doctors, acupuncture and Oriental medicine practitioners, naturopathic physicians, massage therapists began a collaboration in September 2009. Their goal was to create a map to guide work that would foster optimal integration. In May 2011, the group, the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), sent out a press release announcing the publication of Competencies for Optimal Practice in Integrated Environments. Here are descriptions of the work from ACCAHC leaders Mike Wiles, DC, MEd, Marcia Prenguber, ND, Jan Schwartz, MA, and Jason Wright, MS, LAc. Their goal is to use these as a cornerstone for a major web portal and organizing site called the Center for Optimal Integration.

On May 11, 2011, as noted in this Integrator article, 6 national academic organizations published a joint set of Care Competencies for Interprofessional Collaborative Practice. The collaborators were organizations of academic institutions for MDs, nursing, public health, dentistry, osteopathy and pharmacy. Their publication reflected work begun in late 2009.

In that same week, an academic consortium led by 5 other health professions filed a media release on a set of competencies they collaborated since September 2009 to develop. These 5 disciplines are chiropractic, acupuncture and Oriental medicine, naturopathic medicine, massage therapy and direct-entry midwifery. Their document is entitled Competencies for Optimal Practice in Integrated Environments. Below are the release and competencies. (Alignment of interest note: I participated with these educators and organization leaders in developing these competencies.)



Multidisciplinary Consortium of Integrative Practice
Educators Responds to Integration Era with
Competencies for
Optimal Practice in Integrated Environments


Project Supports Educators, Students, Clinicians and
Administrators toward “Optimal Integration”

– DC, ND, LAc and Massage Educators Lead Effort





Mike Wiles, DC, MEd

a lengthy collaborative process involving academic leaders from 8 disciplines*,
the Academic Consortium for Complementary and Alternative Health Care (ACCAHC)
has endorsed what it calls the Competencies
for Optimal Practice in Integrated Environments.
ACCAHC is presently
focused on aggregating and creating content to develop a rich web-portal, the Center for Optimal Integration, to
assist educators, practitioners and organizations of all types to move toward
such competencies.

Wiles, DC, MEd
, Vice President and Provost at Minnesota-based Northwestern
Health Sciences University
, is among those leading the ACCAHC process. Wiles, co-chair
of ACCAHC’s Education Working Group, explains the importance of the initiative:
“The era of integration is here. Yet the
educational standards and clinical models of the licensed integrative
healthcare disciplines are generally not emphasizing integrative models of care.
These competencies focus us all on the current and future needs of providers.” 


Marcia Prenguber, ND

ACCAHC Competencies consist of 28 competency
elements in 5 distinct fields:

  • Healthcare

  • Institutional
    healthcare culture and practice

  • Interprofessional

  • Communication
    and interprofessional relationships, and

  • Evidence-based
    health care and evidence-informed practice.

multidisciplinary group of over 50 professionals from ACCAHC’s Education
Working Group, Clinical Care Working Group, Research Working Group, Council of
Advisers, Board of Directors and member organizations participated in the
multiple stages of the process that began in September 2009. 

Marcia Prenguber, ND, is co-chair of the ACCAHC Clinical
Working Group
and director of integrative care for Indiana University Health
, in Goshen, Indiana, where she also heads a residency program for
naturopathic doctors. Prenguber, the past president of the Council on
Naturopathic Medical Education
, underscores that the focus is on “optimal”
competencies rather than the minimal competencies in typical accreditation

Prenguber states: “Our work on the Competencies is energized by the knowledge – which I see daily here
in my health system – that creating optimal health care teams while at the same
time honoring the diverse contributions of our practices amidst the challenges of
healthcare delivery asks all of us to perform at our best. The document
represents our identification of the kinds of knowledge, skills and attitudes
that would do that.”


The vehicle for bringing the competencies to life

Next steps –
toward a web portal

ACCAHC executive committee member Jan Schwartz, MA, who also
serves as Wiles’ co-chair of the Education Working Group, notes that ACCAHC’s
Board has chosen as its central focus from 2010 forward the development and
hosting of an extensive body of resources that will assist educators, students,
clinicians and administrators toward bettering patient care through the
identified competencies.

Schwartz, a massage therapist and Past-Chair of the Commission on
Massage Therapy Accreditation, is also an online education specialist with Education and Training Solutions. She
states: “We are developing plans and looking for the resources to create what
will be an extraordinary web portal. We will have more to report on this
soon.”  The site, in development, will be
called the Center for Optimal Integration.


Jan Schwartz, MA

Prenguber’s co-chair of the clinical group, Jason Wright,
, Dean of the Finger Lakes School of Acupuncture and Oriental Medicine
of the multidisciplinary New York Chiropractic College, clarifies that “these
competencies are not about the skills of current graduates to provide quality
clinical services – our practitioners are well trained for that in our
accredited programs.”

Wright, a member of the executive committee of the Council
of Colleges of Acupuncture and Oriental Medicine
, explains: “Our work with the
competencies and providing web-based resources is at the heart of ACCAHC’s
mission. This work supports our ongoing commitment to promote mutual
understanding, collaborative activities, interdisciplinary health care
education, and the delivery of optimal patient care.”


Jason Wright, MS, LAc

ACCAHC urges any institutions and organizations that share
this mission to post, circulate and publish the competencies to their
educators, students, clinicians and administrators. (Contact for a separate PDF and

*About the Academic Consortium for Complementary and
Alternative Health Care (ACCAHC)
:  ACCAHC is a 501c3 organization the mission of
which is to enhance patient care through fostering mutual respect and
understanding among diverse healthcare professionals and disciplines. ACCAHC’s basic
work is funded 2/3 through philanthropic contributions and publications, with
the remaining third from dues of core members: councils of colleges,
accrediting agencies and certification and testing organizations from the 5
complementary healthcare professions with a US Department of
Education-recognized accrediting body (DC, ND, AOM, massage therapy,
direct-entry midwifery) plus some traditional world medicines and emerging
professions that are engaging self-regulatory actions (Yoga therapy, Ayurvedic
medicine, yoga teaching, homeopathic medicine).


Optimal Practice
Integrated Environments

Development initiated: September 2009

Approved by the ACCAHC Board of Directors: August 17,

Preamble: Skills in team
care are essential for all healthcare practitioners. Knowledge of other health
care systems and the practices of colleagues in other fields provides a
necessary beginning. Inter-and intra-professional education (IPE) that occurs
in classes, clinics and research projects, for health care students and
faculty, enhance the ability to collaborate. For members of the licensed
integrative practice disciplines, education in these areas gains importance as
patients form their own teams and as health systems open their doors to
practice opportunities in interdisciplinary, inpatient and outpatient
environments. These competencies and related knowledge areas are guides for
collaborative efforts toward better patient care through enhancing mutual
respect and understanding across healthcare professions. This document, which assumes
that all practitioners are equipped with their own, discipline-specific
clinical competencies, is meant to serve as a resource to all parties to these
emerging healthcare teams.


Describe policy issues,
structures, emerging clinical and economic models, and other factors that may
impact clinical and financial decisions; discuss
how cost, compensation models and incentive structures influence care decisions;
summarize recent history of integrated care, including varieties of integrated
care models; describe best practices, opportunities and challenges. 

Healthcare Culture and Practice

Explain inpatient and outpatient health system accreditation
standards and protocols; describe authority structures and decision processes;
explain credentialing and privileging mechanisms; identify and discuss
liability issues; contrast provider payment models; describe the clinical
services and processes of care for other disciplines in a facility; identify
and apply common medical terminology; appraise a medical record; select appropriate
medical codes; define relevant short-hand and abbreviations; evaluate standard
charting and documentation in both paper and electronic medical record formats.

Inter-Professional Education (IPE)

Describe the various health
care systems in common practice including both conventional and the licensed complementary
and alternative healthcare fields, as well as the emerging fields and traditional
world medicines; discuss the emphasis each places on disease prevention,
wellness and the therapeutic strategies engaged for health creation.


and Inter-professional Relationships

Discuss concepts of one’s own discipline in terms appropriate
for administrators and practitioners in other disciplines; role-play strategies
useful for building appropriate consultation, referral and co-management
relationships; identify decision processes in complex institutions; demonstrate
public speaking and presentation skills to represent your discipline and
practice to larger groups; produce written and presentation materials suitable
for both consumer and professional audiences; identify leadership strategies
useful in fostering institutional change; and integrate the knowledge, skills and values described in the
practitioner-to-practitioner section of Health
Professions Education and Relationship-Centered Care
(Pew Health
Commission, 1994, page 36; attached).

Health Care and Evidence-informed Practice


basic research principles and methodologies within the context of both clinical
and mechanistic research; evaluate research; explain the role of scientific evidence
in healthcare in the context of practitioner experience and patient preferences
and apply evidence-informed decision making; describe and discuss the research
base within one’s own discipline; relate contemporary issues in integrative
practice research, including those relative to measuring whole practices, whole
systems and health outcomes; identify and appraise the positive and negative
interactions and contraindications for one’s own modalities and agents; and
identify standard research methods and tools appropriate for assessing one’s
field in a clinical setting.

Copyright ©
2010 Academic Consortium for Complementary and Alternative Health Care



Practitioner to Practitioner Relationships in Relationship-Centered Care

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Written by John Weeks

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