The Seitai Shinpo Apprenticeship Model
Many acupuncture schools offer exceptional didactic education and supervised clinical experience prior to commencing private practice. Few, however, provide an opportunity to learn to think like a doctor by observing a senior acupuncturist evaluate, diagnose, and treat patients directly. When selecting acupuncture schools, my chief concern was finding a program that offered great clinical experience. I heard of a 4-year apprenticeship-based elective program at the Traditional Chinese Medical College of Hawaii (TCMCH), which offered something different from traditional education models.
I first met Dr. Chieko J. Maekawa in September 2009 at the freshman orientation for prospective Seitai Shinpo students hosted at her clinic in Kailua-Kona, Hawaii. In her first lecture, entitled “Digging One Well” she explained that if we wished to study in her clinic, we had to make a full commitment to the program.
She explained: “All people are thirsty for knowledge and start digging wells in order to attain wisdom. Most stop when they don’t see immediate results and move on to another well. Their level of attainment is shallow and their thirst is never satisfied. Those who persevere and keep digging eventually reach the purest water, and when they look up they understand how all wells lead them there. All styles of acupuncture work. If you understand how one works, it will be easy for you to understand how all of them work. Being a dancer, a painter or a martial artist is no different. All you need is dedication and hard work”.
In return for our commitment, she promised we’d achieve exceptional clinical results, without the usual struggle new graduates face in private practice. I had never heard any teacher promise anything like that before, so I knew I had to experience this for myself.
The Shortcomings of the Western Didactic Education Model
To understand Dr. Maekawa’s teaching philosophy we need to look at the journey that brought her to where she is today. Dr. Maekawa’s journey began in fall, 1971 at the New England School of Acupuncture (NESA) in Boston, Massachusetts.
She observed that while a few graduates succeeded, the majority failed to generate positive clinical results early on in clinical practice. The cited reason is confusion over the variety of styles and techniques taught at an insufficient level of clinical depth, and a lack of transmission of best practices from master to student in a clinical setting. This commonly results in many new graduates abandoning full time practice due to a lack of confidence in technique and difficulty achieving clinical results.
While still in Boston, spring 1972, Dr. Maekawa met Dr. Daiichi Sorimachi who’d been heavily influenced by Sawada style and Dr. Keizo Hashimoto. She was so impressed by his unique style and technique that she made arrangements to pursue an apprenticeship with him in Tokyo, Japan. Upon completing her training, she moved to the Big Island of Hawaii in 1975 and opened her private practice.
Inadequacy of the Seminar Education Model
Dr. Maekawa recalls how amazed she was at the results she was able to obtain immediately in her clinic and sought to bring Dr. Sorimachi and Seitai Shinpo, as well as other exceptional teachers of other Japanese styles to teach in the United States. Together with her good friend Dr. Jeffrey Dann, she created the Traditional Japanese Acupuncture Foundation and began hosting seminars with Dr. Sorimachi. After four years of running the seminar program Dr. Sorimachi noticed that the same students would come but would have made little progress from the prior year’s seminar and reported poor clinical results.
He had to spend most of his time teaching the basics rather than introducing new material. He found this disappointing and ineffective and he stopped offering seminars. Perhaps the seminar format itself wasn’t working?
Apart from lack of time, one of the main problems with the seminar format was that the attendees were already licensed acupuncturists. This made it hard to offer rigorous instruction to people who are immersed in prior training. If seminars weren’t going to work, then something new had to be invented.
An apprenticeship path is usually only available to a small number of students, and the education is not organized to maximize the number of students who could benefit from such training.
Inventing a New Educational Model
Till that time, Dr. Maekawa, like most Japanese acupuncturists had never taken on apprentices, but in 2001 she was approached by the Traditional Chinese Medical College of Hawaii to teach Seitai Shinpo at the school. She began teaching a didactic-only curriculum, having no intention to open her clinic to observers. After almost two years, she found she had no choice. The results from a didactic model simply weren’t good enough. With great reluctance she opened her clinic in 2002 under the condition that students remained completely transparent. Initially some patients complained at the change but soon became comfortable, and the new Seitai Shinpo apprenticeship program was born.
After the program’s initial clinical success, Dr. Sorimachi started returning to Hawaii to present seminars to its graduates, finding the education model was successfully preparing students for post-graduate content. Dr. Sorimachi still continues to come, whenever possible.
I joined the apprenticeship program in 2009, in its 7th year of operation. Over the past three years I’ve watched the program evolve and reach maturity. The curriculum is organized as a 1,000-hour graduate certificate in Seitai Shinpo and is comprised of 600 observation and internship hours, as well as 400 didactic hours. Classes are offered as a full time elective program taken alongside the Masters program.
Dr. Maekawa opens her teaching clinic three days a week, allowing up to three simultaneous apprentices. Students use an online booking system to schedule clinic time. Students answer client questions, perform the initial intake, track patient progress and teach the patient applicable So Tai Ho and breathing techniques. After showing competency in moxibustion, apprentices begin applying moxa on points marked by the doctor. When deemed competent under classroom settings, students mark out points on Dr. Maekawa’s patients. Additionally, all students perform full charting, noting each needle insertion, method of manipulation, and moxa directions for in-class case review.
Monthly classes are attended by an average of 20-25 current and former students who arrive early to set up the classroom. The day starts with an opening meditation and So Tai Ho exercises, followed by a lecture presented by Dr. Maekawa.
Upper classmen teach lower classmen with content divided into material appropriate for each level of competency. Students present previous lecture topics in front of peers, create handouts, solicit feedback, and practice public speaking. The program seeks to develop skills in educating patients, public relations, community building, curriculum development and teaching so as to prepare the next generation of teacher-practitioners.
The second half of the class day for 3rd and 4th year students is dedicated to community clinic. Students completing their Traditional Chinese Medicine (TCM) internships hours bring two of their most difficult patients and perform treatments while graduate apprentices and Dr. Maekawa observe performance, providing feedback and additional clinical direction. The day ends with group case review. This format boost student confidence while providing full time supervision and refinement of technique.
Practitioner Excellence Curriculum
During the first four years Dr. Maekawa’s educational focus was purely technical. Developing technical excellence in diagnosis, moxibustion, point location, and needling technique did not ensure clinical success, however. She concluded that it was insufficient to have a good hand without embodying the spirit of the medicine in one’s practice. First and foremost, we must treat the spirit.
The curriculum began to include topics related to practitioner excellence, compassionate listening and speaking, and eliminating the ego from the treatment room. This training has been invaluable in graduates creating a clinical atmosphere that not only attracts clients, but also establishes rapport, patient compliance, client retention, increased referrals, better results and overall satisfaction for the client as well as the practitioner.
Preparing for the Future
To date, the program has graduated 18 students, with 10 students in the pipeline and a substantial list of new applicants. Graduates of the four-year curriculum continue on the optional teacher-training track and dedicate many hours to the educational vision and refinement of teaching technique, manuals, and audio-visual methods of lineage preservation.
Dr. Maekawa’s dedication to her students’ success is unparalleled and this shows in her students’ enthusiasm for continuing the legacy of this training at TCMCH and its replication at other institutions in years to come.
What’s so unique about this program is that it allows us to contribute our own individual talents to its success and to develop not just as practitioners, but leaders in the community at large and I feel excited to be a part of its continuing evolution.
Michael Dabrowski, 3rd Year Student
Article published in North American Journal of Oriental Medicine August 2011