Empowering Acupuncture Students Through an Education in Research: Using Case Reports to Enhance Learning and Clinical Practice

1. Increasing research education

Research education can enhance a student’s understanding of acupuncture and Traditional Chinese Medicine (TCM) by stimulating critical thinking. Students of TCM learn how to assess the quality of studies, interpret results, and how to apply relevant findings to the clinic. In the USA and Canada, TCM students have endorsed the view that research is relevant not only for clinical practice but also for mainstreaming of the profession [10–12]. However, a substantial gap in acupuncture research education persists. This is perpetuated by a lack of education on the interpretation and application of research [13]. In a commendable initiative in the USA in 2008 which aimed to close this gap, grants were awarded to acupuncture schools to enhance research education [14]. This enterprise enabled the training of students, faculty members, and alumni in the foundations of clinical research design and implementation [15]. The goal was to stimulate interest in both participating in research and receiving in depth research training [15]. Analysis of the outcome of this initiative suggested that whilst interest in research was high among 1^st-year undergraduate students it was not sustained [12]. These findings on attitudes and interests towards research in acupuncture and Traditional, Complementary and Integrative medicine students become particularly relevant when the course structure is examined in terms of research modules, when they are introduced, and when specialization occurs in the curriculum.

A comparison of acupuncture and TCM education between China and other countries (Australia, Canada, Italy, UK, and USA) showed that whilst programs in the USA emphasize clinical practice, students in China complete a research module in their 1^st year, even before being introduced to clinical practice in following years [16]. In the UK, degree programs include research education, in view of equipping students with empowering knowledge on how to identify, understand, and interpret the vast and valuable evidence base for acupuncture [16]. Countries where universities offer postgraduate research degrees e.g., Australia, allow students to perform laboratory studies or clinical trials on acupuncture and Chinese herbal medicine [16]. Therefore, it seems important to consider that along with the type of research training offered to students, the timing of such engagement is also of crucial relevance.

2. Fostering inter-professional collaboration

Besides students and practitioners of acupuncture and TCM extending education to other healthcare professionals regarding evidence-informed acupuncture in the clinical setting, this could also lead to an increase in knowledge and understanding of its efficacy [17]. Thus, potentially increasing provision and furthering integrative medicine and collaborative practice. This is particularly relevant since despite the increase in acupuncture research and clinical guidelines advocating for its use, and along with its popularity amongst the general public, acupuncture’s integration into healthcare systems still remains low [18]. A few, though encouraging, examples of collaborative and integrative use of acupuncture in healthcare settings have exposed a considerable gap between evidence-based recommendations for acupuncture and its implementation [19]. Education and dissemination of acupuncture research are the foundation of bridging the implementation gap [19], and given how the use of a scientific evidence approach can facilitate communication within healthcare professionals, confidence in acupuncture will grow [20].

3. Closing the dissemination gap and bridging clinical practice and research

Increasing student awareness of effective dissemination of research findings in acupuncture and TCM clinical applications is an empowering communication tool. Non-profit organizations such as Evidence Based Acupuncture [21] and the Society for Acupuncture Research [22] highlight innovative research topics such as artificial intelligence and digital health [23,24] in special interest groups [25] and online journal clubs [21]. One such initiative focuses on Practice-Based Research [25], with the goal of optimizing data collection from acupuncture and TCM clinics, including teaching clinics. Acupuncture schools can educate students on evidence-based practice whilst simultaneously contributing towards the body of research and research-informed practice by publishing case reports originating from teaching clinics.

Case reports serve as an essential bridge between theoretical knowledge and practical application. In acupuncture education, students often learn complex theories and principles that can be challenging to apply in real-world settings. Well-written case reports demonstrate how these theories translate into practice, provide examples of how diagnostic principles are applied, reason why specific acupuncture points or techniques were applied, and how treatments were adjusted based on patient response [26].

4. Applications in acupuncture education and professional development

Case reports can be used in a variety of ways to enhance acupuncture education. They can form the basis for discussions, be incorporated into clinical training to promote thorough observation and critical thinking, and serve as a tool in continued education (including PhD, and MSc courses).

Preparing cases of significance for a case report, collating data, describing diagnostic methods, and discussing key observations introduces students to basic research skills and helps them communicate effectively on acupuncture treatments, and publication facilitates access for other healthcare professionals [27,28] (it is important to differentiate between “case histories” - often gathered in the short-term, taught as a technique-based training program in acupuncture schools - and properly structured “case reports” which are articles published in a journal for medical, scientific, and educational purposes. These terms are often used interchangeably. Here we refer to a “case report” as used across medical, and complementary medicine fields, which has clear guidelines [27,28], and requires a high level of academic rigor and data collection).

5. Case reports in acupuncture education, research, and practice

Case reports have long been a cornerstone of medical communication, serving multiple purposes from documenting new or rare conditions to reporting adverse events [27]. In the field of acupuncture and TCM, case reports take on additional significance due to their historical importance and capacity to allow an accurate diagnosis for the multifactorial nature of holistic health interventions [28]. One of the primary educational benefits of case reports lies in their capacity to sharpen clinical reasoning and diagnostic skills. By documenting the detailed process of patient assessments, treatment planning, and outcome evaluations, case reports provide a valuable tool for student practitioners to learn from real-world clinical scenarios. This process encourages them to meticulously observe and record patient symptoms, critically analyze the effectiveness of interventions, and reflect on their decision-making process throughout the course of treatment [26]. Whilst randomized controlled trials are considered the gold standard in medical research, case reports build the foundation for practice-based research in acupuncture. They introduce students to systematic documentation and reporting, encourage critical evaluation of treatment outcomes, and familiarize them with research methodologies and reporting standards such as the internationally recognized CAse REport (CARE) guidelines and the specialized CHM (Chinese Herbal Medicine)-CARE guidelines, which are guidelines for writing case reports that ensure accuracy, transparency, and usefulness [27,28].

6. Secondary analyses – tools to bridge theory and practice

When combined with other pragmatic data sets, such as those from clinical registries, secondary analysis can also provide a research model that more closely reflects actual practice than randomized controlled trials. Due to the inherent limitations of individual data sources including generalizability and selection bias [29], secondary analyses of combined case reports and clinical registry data offer a promising approach to mitigate these potential pitfalls. By aggregating data from multiple sources, researchers can increase the sample size and produce a large amount of clinical data (at a relatively low cost) [30–32]. This approach works for traditional medicine best when data are standardized across sources such as when International Classification of Primary Care-2 codes for health complaints and International Classification of Diseases-11 codes for diagnoses are used [33,34], and this facilitates a more reliable and valid comparison.

The use of concurrent triangulation mixed method design allows for corroboration of findings from different data sources and analytical methods, and enhances the reliability and validity of results [35,36]. This approach is particularly valuable in acupuncture and TCM research where interventions often involve multiple components and nonlinear changes that may not be apparent in simpler study designs [37–39]. By combining data from a broader context (for example including private medicine with public health medicine data) provided by clinical registry data, detailed information from case reports can provide enough data for quantitative and qualitative analyses to balance generalizability with in-depth understanding [40–42]. This synthesis of data sources and research methods can, more specifically, help identify diagnostic patterns, treatments, outcomes, and inform the design of future clinical trials [43,44].