applying it as a therapeutic technique for a limited number of conditions for which it has been shown to be effective, without having to reconcile the underlying theories of modern and traditional medicine. In this type of situation, lengthy periods of instruction in traditional medicine as a background to acupuncture are neither feasible nor necessary, and shorter training must suffice. Furthermore, in many countries, acupuncture is not yet officially recognized and regulations and registration requirements, where they exist, vary considerably. In some, only qualified physicians may practice acupuncture, while in others, practitioners trained in traditional medicine may also do so. It seems useful, therefore, to provide guidelines for relatively short periods of theoretical and practical training in acupuncture which, with well designed curricula and skilled instructors, would be sufficient to ensure the safety and competence of those so trained. In recent decades, the theoretical and practical aspects of acupuncture have been developed in various countries, particularly in those where modern Western medical perspectives and research methodologies have been applied to studies of this traditional therapy. The achievements of these studies should be included in the training. However, since a new theoretical system has not yet been established, traditional Chinese medical theory is still taken as the basis of the Core Syllabus. Guidelines on basic training and safety in acupuncture 4 1. Purpose of the guidelines These guidelines will, it is hoped, assist national health authorities in countries where modern Western medicine forms the basis of health care to establish regulations concerning: · general requirements for basic training in and the practice of acupuncture; · the knowledge and experience of modern Western medicine required of acupuncture practitioners employed as such in the national health care system; and the knowledge and experience of acupuncture required of physicians and other health staff wishing to include acupuncture in their professional work in modern Western medicine. 2. Use of acupuncture in national health systems A decision by the Ministry of Health to incorporate acupuncture in primary health care (or at any other level of government health services) in a system based on modern Western medicine raises a number of important issues which would need to be taken into account. 2.1 Administrative and academic considerations The training of health personnel in acupuncture involves certain administrative and academic considerations, for example: · Which types of personnel should be trained? · What would be their functions and responsibilities? · What would be the content of training, in each case? · Where would such training be given and by whom? · Are suitably qualified instructors available or would they also have to be trained? · What would be the mechanisms for official recognition of training courses, instructors and institutions? 2.2 Examinations and licensing A system of examination and licensing would be needed to ensure the competence of those trained, and to prevent unauthorized practice of acupuncture. Section I: Basic training in acupuncture 5 This would bring under control the situation, current in certain industrialized and developing countries, where commercial exploitation of acupuncture training and practice is not uncommon, with all the harmful consequences that may ensue. 2.3 Supervision, monitoring and evaluation The introduction of one or more new categories of personnel in the health system would probably make it necessary to provide for: · a period of supervised practice after training; · monitoring of performance of the trainees individually and as a group; and · evaluation of the benefits (or otherwise) of including acupuncture in primary health care (and at other levels) where it was not previously available, and of its cost-effectiveness compared with other forms of treatment for common conditions. 2.4 Further education and career possibilities Possibilities to be envisaged, and perhaps encouraged, are that some acupuncture practitioners may wish to increase their knowledge of modern Western medicine, while other health personnel who have not received the basic training may wish to acquire a knowledge of acupuncture and later apply it. Ultimately, a blending of the two disciplines must, to some extent, take place. 3. Levels of training The guidelines address four levels of training in acupuncture, namely: · full training for those with little or no prior medical education or experience, who wish to qualify as recognized acupuncture practitioners licensed to practise independently, subject to the limitations imposed by the Ministry of Health; · full training of qualified physicians (modern Western medicine) in acupuncture; · training of qualified physicians (and certain other medical graduates) from schools of modern Western medicine, who wish to include acupuncture as a technique in their clinical work; and · limited training of other health personnel (modern Western medicine) working in the primary health care system of their country. Guidelines on basic training and safety in acupuncture 6 4. Training programmes The basic training of the four groups is different. For traditional acupuncture practitioners, a complete course extending over two years is