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Abstract

I. Development of licensing and education systems for acupuncturists
The business licensing and education system of Japanese acupuncturists (and moxibustionists) began in 1911. After 1911, licensed schools were established, but for a time both the licensed schools and apprentice system existed simultaneously. The law of license for practicing acupuncture began in 1947. In 1947, following World War II, the law was revised and has persisted until the present day.
II. Two recent important turning points in the field of education of acupuncture and moxibustion
A recent turning point in the education system included the addition of a four-year university program in 1983. In 1994, a graduate school program was also added, awarding doctorates in acupuncture.Vocational schools for acupuncture for people with no visual impairment increased from 24 to 76 schools by 2006.
III. Activity of the Japan College Association of Oriental Medicine
As of 2006, 41 of the 76 vocational schools for acupuncture for people with no visual impairments became members of the Japan College Association of Oriental Medicine. The activity of the association is manifold, and includes holding seminars for instructors, performance of the academic congress, publication of textbooks and bulletins.
IV. Proposal of refinements to the licensing and education system in the field of Japanese acupuncture and moxibustion
For acupuncturists, a discussion of the refinements to the licensing and education system is necessary to gain even more trust from society. It is essential that this discussion include the academic congress and occupational group, according to results of a research survey conducted by the Japan College Association of Oriental Medicine.

Key words: words:licence, education, acupuncturist, moxibustionist

I. Introduction

Recently, complementary and alternative medicine (CAM) including acupuncture and moxibustion has been noticed in the world. Although there is the article introduced Japanese situation about CAM 1), the article that introduced in detail licensing and education system about Japanese acupuncturist and moxibustionist is few.
Therefore, we reported regarding development from the foundation to the present as to licensing and education systems of Acupuncturists and Moxibustionists in Japan. Simultaneously, we propose the refinements to licensing and education system in the field of Japanese acupuncture and moxibustion.
Furthermore, this paper is the report as standpoint of the Japan College Association of Oriental Medicine organized by vocational schools for training acupuncturists, moxibustionists and anma-massage-shiatsu therapists in all Japan.

II. Development of licensing and education systems for acupuncturists and moxibustionists

The licensing and education system of Japanese acupuncturists and moxibustionists began approximately 95 years ago.
The regulations of business for acupuncturists and moxibustionists were enforced in 1911 and training in school by the appointment of the local director for the first time was began (Table 1).
Namely, licensed school system was introduced while maintaining partly education by an apprentice system, and two licensing and education systems of acupuncturists and moxibustionists in Japan were started (One was an apprentice system that was able to acquire business license of acupuncture and moxibustion, if they passed examinations after four years training. The other was licensed school system that was able to start business of acupuncture and moxibustion without examinations, if students graduated the school.).
Afterwards, the regulations of business for acupuncturists and moxibustionists were changed to the business law of anma, acupuncture, moxibustion and judotherapy in 1947, and an apprentice system disappeared and licensed school system only continued.
The term of study to become acupuncturist and moxibustionist was four years in a junior high-school graduate and two years in a high-school graduate. If the students passed the examinations that a governor executed after graduating from licensed school, it was changed to the system that they could start business of acupuncture and moxibustion.
A name of law was changed from the business law of anma, acupuncture, moxibustion and judotherapy to the law of anma therapist, acupuncturist, moxibustionist and judotherapist in 1951 and the term of study was extended from two years after a high-school graduate to two and a half years after a high-school graduate.
Moreover, a name of anma therapist was changed to a name of anma-massage-shiatsu therapist by including business of massage and finger pressure (shiatsu) that had been recognized as business of anma therapist. Because anma-massage-shiatsu therapist, acupuncturist and moxibustionist are qualification that is based on the same law, there are licensed schools that educate to become acupuncturist, moxibustionist and anma-massage-shiatsu therapist.
Afterwards, the law for acupuncturists and moxibustionists was revised any number of times. In 1988, authority of licensing changed from the governor to the Minister of Health and Welfare (the Minister of Health, Labor and Welfare at the present) and the term of study became over three years after a high-school graduate (Table 2).
At the same time, although the contents of the curriculum in each licensed school of the whole country was a time system and was almost unified into the same contents until that, the curriculum become an outlined system and was changed from a time system to a credit unit system. As a result, each licensed school could have individuality of the curriculum.

III. Two recent important turning points in the field of education of acupuncture and moxibustion

The first of recent two important turning points in the field of education of acupuncture and moxibustion is the beginning of a university education.
The only source of formal acupuncture and moxibustion education was at vocational schools until the beginning of a university education. For that reason, it is considered that a university education necessarily needs to increase the quality of education, and three-year junior college program (the term of study is over three years after a high-school graduate) was started for the first time in Kyoto, Japan (Meiji University of Integrative Medicine at the present) in 1978 (Table 2). Afterwards, a four-year acupuncture and moxibustion university program was started (the junior college was raised to the university at the present).
However, each graduate of vocational school, junior college and university as licensing system of Japan takes same examination of each prefecture, and the license that each graduate can acquire is same among vocational school, junior college and university.
Furthermore, master course program (acupuncture and moxibustion) in graduate school of the same university was added in 1991. Following, doctor course program (Ph.D.) in acupuncture and moxibustion was established in 1994, and Ph.D. in acupuncture and moxibustion for the first time in Japan was born in 1997. As a result of these changes, research in the field developed dramatically.
The second important turning point in the field of education of acupuncture and moxibustion is the sudden increase of licensed school. New licensed school for acupuncturists and moxibustionists was not approved after 1977. But new licensed schools were approved after government of Japan lost by a judgment at Fukuoka in 1998 and increased in the whole country.

IV. Education system of acupuncture and moxibustion at the present (as of April, 2006)

From the standpoint of the Japan College Association of Oriental Medicine, author summarized the present educational system for training acupuncturists and moxibustionists in a sighted person below.
The requirements for admission are graduating from high school as a general rule (Fig. 1). Private vocational schools for sighted persons (approval by the Minister of Health, Labor and Welfare) are 76 schools in the whole country as of April, 2006, and the fixed number of admission is 5, 893.
The number of private university (approval by the Minister of Education, Culture, Sports, Science and Technology) is 4 as of 2006, and the fixed number of admission is 349. There are schools for persons with impaired vision as licensed school except such vocational schools and universities for sighted persons.
When students receive the education in these licensed schools and fill the standards decided by government, students take the qualifications of candidacy for national examination. If the candidates pass the examination, the Minister of Health, Labor and Welfare give the license of acupuncturist and moxibustionist to them. Although acupuncturist and moxibustionist are originally different license, almost students acquire both license, accordingly it is generally called acupuncturist and moxibustionist shin-kyu-shi in Japanese. When students acquire the license, they can start business independently in every region. Further, acupuncturist and moxibustionist can serve in hospital and clinic.

V. Standards for the establishment of vocational school in acupuncture and moxibustion (approval by the Minister of Health, Labor and Welfare)

Table 3 shows an outline of standards for the establishment of vocational school of acupuncturists and moxibustionists in Japan. Vocational school has to establish the subjects of classes over 86 units for three years in the contents of the curriculum (Table 4).
When students learn in vocational school that filled such the terms, the students take the qualifications of candidacy for national examination. The number of university approved by the Minister of Education, Culture, Sports, Science and Technology is very few in comparison to vocational school, because standards for the establishment of university in acupuncture and moxibustion is very severe about the number of faculty and facilities.

VI. National examination of acupuncturists and moxibustionists

The national examination of Japanese acupuncturists and moxibustionists is conducted in spring once a year, and the examination is only Japanese language. The examination is a computer-scored test, and the number of the question is 80 in the morning and 80 in the afternoon for a day (Table 5).
Although acupuncturist and moxibustionist are different license, the overlap of the subjects when students take both examinations at the same time is exempted. Fig.2 shows the national examination pass rate of acupuncturist and moxibustionist in sighted persons for five years from 2001 to 2005.

VII. The number of licensed school of acupuncturist and moxibustionist and the change of the fixed number of admission

The fixed number of admission in licensed school of acupuncturists and moxibustionists was 1, 558 until new licensed schools were approved after government of Japan lost by a judgment at Fukuoka (in 1998) after 1977. Afterwards, the fixed number of admission increased to 2,188 in 2000 and 5,893 in April, 2006 according as the increase of new licensed school. The number increased to 3.8 times as many as the number in 1999 (Fig.3).
Although the number of licensed school was 24 schools (there were 2 schools for a specialized anma-massage-shiatsu therapists except above 24 schools) until 1999, the number of licensed school also increased to 76 schools (except university) by 2006 (Fig.4). 41 schools of 76 schools (approximately 54 %) are the member of the Japan College Association of Oriental Medicine.

VIII. Activity of the Japan College Association of Oriental Medicine

The Japan College Association of Oriental Medicine started as an association including licensed school of judotherapists in 1956, and the name of association changed and the association became corporation in 1985.
Activity of the Japan College Association of Oriental Medicine is to hold a congress for presentation of research performed by students of the member schools once a year, publish the journal of the congress and textbooks, hold seminars (a theme such as objective structured clinical examination is annually established) for instructors of the member school, and issue bulletins for exchanging each information.

IX. Proposal of refinements to the licensing and education system in the field of Japanese acupuncture and moxibustion

Author proposes refinements to the field of Japanese acupuncture and moxibustion in the future from the three fields such as license (national examination), educational institution (the Japan College Association of Oriental Medicine), and academic society (and occupational group).

1. Proposal of refinements (license and national examination)
Although acupuncturist and moxibustionist are different license at the present, there is a proposal to be one license as shin-kyu-shi in Japanese by integrating acupuncturist with moxibustionist. Namely, it is proposal to separate the law of anma-massage-shiatsu therapist, acupuncturist and moxibustionist into the law of acupuncturist and moxibustionist and the law of anma-massage-shiatsu therapist. Author considers that is immediately separated, because anma-massage-shiatsu and acupuncture or moxibustion are different treatment method.
There is a proposal that revive skill test again regarding the national examination. However, author considers that more enough discussion including the other objective examination is important than revive simply skill test. Finally, because acupuncturists and moxibustionists have responsibility to national medical care, author would like to propose renewal system of medical license at California in USA, in addition to the proposal of the independent law of acupuncturist and moxibustionist.

2. Proposal of refinements (educational institution)
There was no new entry for a long time in the Japan College Association of Oriental Medicine, and applicant increased in proportion to recognition rising, and accordingly management of licensed school was steady very well. However, the number of licensed school suddenly increased after 2000.
Although licensed school is slightly increase in 2005, we have to make a plan for long -term by estimating when management of licensed school is steady period again (Fig.5). It is thought that need to review education for acupuncturists and moxibustionists from each viewpoint of manager, instructor, faculty, student and society in each licensed school.
Author considers that it is the time to consider how guarantee quality of students that is worried about decrease of academic ability of students by sudden increase of vocational school. Furthermore, although there are partly new licensed schools that aim to train therapists very hard, the other side, there are also partly new licensed schools that only target the national examination pass rate. Accordingly, the Japan College Association of Oriental Medicine has to make a plan to increase quality of member school and continuously has to train acupuncturists and moxibustionists that have good skill and knowledge. Furthermore, author considers the Japan College Association of Oriental Medicine builds up a closer connection with the member schools and has to train the therapists that answer the needs of the times, because there is the change of constitution of disease with sudden change of society.
To be guaranteed as learning from admission to graduation in peace by discriminating between the member schools of the Japan College Association of Oriental Medicine and non-member school needs. For that purpose, each member schools make effort with conducting self-study and self-inspection, and conduct estimation of each member school by third party as the Japan College Association of Oriental Medicine, and author considers that it is important to form as the organization can make certification of the Japan College Association of Oriental Medicine.

3. Proposal of refinements (cooperation academic society and occupational group 1)
The Japan College Association of Oriental Medicine conducted twice questionnaire surveys in 1997 and 2002 for 17,069 persons of the member school graduates of successful applicants from the first national examination in acupuncturist and moxibustionist to the ninth examination. Answerers were 5,691 persons and the collection rate was 33.3 % (Table 6).
Fig.6 shows the course of the graduates, the experience in business, and the ratio of men to women in the results of the questionnaire surveys. Graduates that start business independently in answerers was 25.4% from the first national examination to the fourth examination, and was 27.4% from the fifth examination to ninth examination (Table 7).
Next, the rate of admission to occupational group in graduates that start business independently was 23.3% in Japan Acupuncture and Moxibustion Association and was 24.0% in All Japan Acupuncture, Moxibustion and Massage Association from the first examination to the fourth, and was 21.6% in Japan Acupuncture and Moxibustion Association and was 28.5% in All Japan Acupuncture, Moxibustion and Massage Association from the fifth to the ninth.
The number of graduates that start business independently from the fifth examination to the ninth increased by 186 persons than graduates from the first to fourth. However new members only increased by 111 persons between Japan Acupuncture and Moxibustion Association and All Japan Acupuncture, Moxibustion and Massage Association, and licensed therapists of 82.4% in average from the first to the ninth were not the members of the occupational group (Fig.7).
The rate of admission to the Japan Society of Acupuncture and Moxibustion was 5.1% (133 persons) from the first examination to the fourth and was 6.8% (210 persons) from the fifth to the ninth. Although answerers from the fifth examination to the ninth in comparison with answerers from the first examination to the fourth increased by 489 persons, the new members only increased by 77 persons.
Accordingly, the number of new member to the academic society and occupational group is very few. It is clear that we have to be anxious about this situation when we consider about the field of Japanese acupuncture and moxinustion in the future, that increase of the number of new licensed therapists for a year by the increase of new licensed school suddenly is realized. Therefore, author considers that more need to cooperate among the educational institution of acupuncture and moxibustion, academic society, and occupational group and need the step for the next period.

4. Proposal of refinements (cooperation academic society and occupational group 2)
The Society for the study and propulsion of medical treatment of acupuncture and moxibustion was started in 2006 as cooperation of the Japan College Association of Oriental Medicine, the Japan Society of Acupuncture and Moxibustion and each occupational group. The purpose is the establishment of scientific evidence in acupuncture and moxibustion, preparing of guidelines in acupuncture and moxibustion treatment, and activity of spread and education in medical treatment of acupuncture and moxibustion. The activities were started by the foundation of four groups.
Furthermore, the Safety Commission of Acupuncture and Moxibustion also was held, and the activity of conference and enlightenment on safety in medical treatment of acupuncture and moxibustion in Japan and preparing of guidelines on safety in medical treatment of acupuncture and moxibustion was started (published in January, 2007). Author considers that more cooperation among the Japan College Association of Oriental Medicine, the Japan Society of Acupuncture and Moxibustion, Japan Acupuncture and Moxibustion Association and All Japan Acupuncture, Moxibustion and Massage Association necessarily need for development of Japanese acupuncture and moxibustion.

Further, the questionnaire surveys in this paper were performed by funding from the Japan College Association of Oriental Medicine.

Reference

1) Suzuki N. Complementary and alternative medicine:aJapanese perspective. eCAM 2004;1:113-8.