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Notes for 8011 Clinical Observation I (Comprehensive Summary)

8011 Clinical Observation I — Comprehensive Notes

Course overview and administrative essentials

  • Course ID and name: 8011, Clinical Observation I.
  • Total hours: 60 ext{ h}. Schedule: Thursdays, 6:00pm–10:00pm. Instructor: Maria Virginia Florentin, BSPharm, M.D., M.Sc., R.Ac. Term: 2025 ext{ FALL} (Sept 11–Dec 18, 2025).
  • Prerequisites: TCM I & II; Acupuncture I & II or simultaneous I.
  • Course objectives: introduce safe, effective, and ethical TCM practice; enable observation and practice of basic clinical procedures including communication, data collection via the four diagnostic methods, organization/summarization/analysis of information, TC M disease diagnosis and syndrome differentiation; establish treatment principles and acupuncture point selection; cover general procedures: history taking, record-keeping, case reporting.
  • Learning outcomes: by completion, students will deepen knowledge of TCM profession, theory, and clinical practice; collect patient data via the four diagnostic methods; organize/summarize/analyze main symptoms/signs; provide preliminary diagnoses and syndrome differentiation; create treatment plans; apply theory to clinical practice through hands-on practice.
  • Course requirements (summary):
    • 100% attendance as described in clinical procedure. 100 ext{%}
    • Write a Purpose and Plan for becoming a successful and ethical TCM professional.
    • Submit 6 new patients and 12 follow-up visits (or as arranged by supervisor).
    • Participate and record all procedures and treatments demonstrated/performed by instructor/students.
    • Actively engage and practice clinical procedures.
    • Complete and submit all cases/forms before the end of the last class.
  • Evaluation and grading: this is a PASS/FAIL course. Components include:
    • Attendance: 10 ext{%}
    • Assignments and Case Studies: 30 ext{%}
    • Class Participation and Contribution: 10 ext{%}
    • Midterm: 20 ext{%}
    • Final Exam: 30 ext{%}
  • Methods of teaching: □ Lecture; □ Demonstration; □ Hands-on practice; □ Group study; □ Discussion; □ Presentation.
  • Course materials: TSTCM Clinical Handbook, Course Notes, and Handouts.
  • Lecture plan: provided in Course Schedule (see course schedule for week-by-week topics).

Course schedule and class plan (2025 FALL)

  • Guideline: schedule runs from Sept 11 to Dec 18; each class is 4 hours; contents may be modified.
  • Week-by-week highlights (high-level):
    • Week 1 (Sept 11): Why Study TCM; Your Plan; introduction to the TCM profession; planning long-term goals.
    • Week 2 (Sept 18): Plan for Success; define/plan for success; competency requirements.
    • Week 3 (Sept 25): Goals and Objectives; Individual/Group presentations; TSTCM Education goals.
    • Week 4 (Oct 2): Understand TCM Practice; apply knowledge to clinical practice; theory, diagnostics, treatments, ethics.
    • Week 5 (Oct 9): Case 1-1; History taking and medical record; Case Study 1.
    • Week 6 (Oct 16): Case 1-2; Reading Week; Case 1 continuation.
    • Week 7 (Oct 23): Case 2; Putting the pieces together; symptom/sign summary; Case Study 2; Discussion.
    • Week 8 (Oct 30): Putting the pieces together; symptom/sign summary ongoing.
    • Week 9 (Nov 6): Midterm; Case Study Case Study MIDTERM.
    • Week 10–14 (Nov 13–Dec 11): Case 3–6; TCMDiagnosis and Treatment Practice; Case Study discussions.
    • Week 15 (Dec 18): FINAL EXAM.

Mission, commitments, objectives and core values

  • Mission: The Toronto School of Traditional Chinese Medicine is dedicated to excellent education, service, and promotion of Traditional Chinese Medicine.
  • Commitments: Support student success; establish, recognize, develop the profession; promote TCM in Canada and worldwide; leadership in standards of education and practice.
  • Core values: Integrity; Trust; Respect; Caring and Compassion; Harmony and Balance.
  • Context: 8011 serves as the Clinical Observation I course (P1–P4 in the Program Goals and Objectives document).

The Oath (curriculum-wide professional commitments)

  • Commitment to education and peers: esteem TCM wisdom; treat teachers with respect; support peers; maintain a clean, organized, and supportive learning environment; complete duties on time.
  • Commitment to the profession: uphold highest ethical/professional standards; comply with regulation/licensure; continual knowledge/skill improvement for the community; view service to humanity as a gift.
  • Commitment to the patient: promote health, maintain patient dignity and confidentiality; provide timely referrals as appropriate; ensure informed consent; safeguard patient privacy; practice with patient welfare first.

Goals and objectives for professional programs (TCM education)

  • The overarching goal: graduates will meet CARB-TCMPA entry-level occupational competencies for registered acupuncturists and TCM practitioners in Canada.
  • Core framework: the curriculum aligns with CARB competencies and fosters leadership in integrating TCM into the health system.
  • Graduates should be able to embody six professional roles: 1) Traditional Chinese Medicine Expert; 2) Communicator; 3) Manager; 4) Collaborator; 5) Professional; 6) Educator and Leader.
  • The competency descriptors emphasize safe, effective, and ethical care along with capabilities in patient communication, interprofessional collaboration, records management, and ongoing professional development.
  • The program recognizes that graduates are qualified for Pan-Canadian Examinations and registration as TCM practitioners and/or acupuncturists.

CARB-TCMPA: The nine Entry-Level Occupational Competencies (areas)

  • Practice areas (with the nine areas):
    • Interpersonal Skills
    • Professionalism
    • Practice Management
    • Traditional Chinese Medicine Foundations
    • Fundamentals of Biomedicine
    • Diagnostics and Treatment
    • Acupuncture Techniques
    • Herbal Therapy and Management (Herbology)
    • Safety
  • These competencies are shared across acupuncture and herbology; some items are common to both, while some are unique to acupuncture or herbology.
  • The competencies are designed to reflect entry-level proficiency in line with CARB-TCMPA standards and are used to guide curriculum outcomes, assessments, and licensure readiness.

Regulated health professions framework (Ontario)

  • RHPA (Regulated Health Professions Act, 1991): governs regulated health professions in Ontario; aims to protect the public, ensure accountability, support self-governance, enable public choice, and enhance quality of care.
  • Key RHPA features relevant to TCM in Ontario:
    • Scope of practice: defines what the profession does.
    • Controlled acts: procedures/activities that carry risk if done by unqualified individuals.
    • Health Regulatory Colleges: professional bodies that regulate practice and membership.
    • Health Professions Regulatory Advisory Council (HPRAC): provides ministerial advice on regulation and quality programs.
    • Health Professions Appeal and Review Board (HPARB): independent review of registration/complaint decisions.
  • The RHPA framework provides the regulatory context for Ontario TCM practice and for institutions like TSTCM to align its policies.

Traditional Chinese Medicine Act, 2006 (Ontario) – key provisions

  • Definitions and scope:
    • The practice of traditional Chinese medicine is defined as assessment of body system disorders through traditional Chinese medicine techniques and therapies to promote/maintain/restore health.
  • Authorized acts:
    1) Acupuncture: performing a tissue-level procedure for acupuncture; and 2) communicating a traditional Chinese medicine diagnosis identifying a body-system disorder as a TC M diagnosis.
  • College establishment and governance: The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO) is established; Council composition includes elected members and gubernatorial appointees; governance includes President and Vice-President.
  • Restricted titles: Only registered members may use titles such as “traditional Chinese medicine practitioner” and “acupuncturist” in Ontario.
  • Notices and regulatory processes: provisions for advisory input from government; penalties for contravention; broad regulation authority to set standards, therapies, and titles.
  • Penalties: offences with fines (e.g., up to $25,000 first offence; up to $50,000 subsequent offences).
  • Regulations: the Council may regulate practice standards, referral patterns, therapies, and use/registration requirements; further rules around use of the title “doctor” and related certificate categories.
  • Transitional provisions and governance: transitional Council provisions and the ability to appoint a Registrar and operate until a fully constituted Council is in place.

Registration Regulation under the TCM Act (Ontario) – key elements

  • Regulation: Ontario Regulation 27/13 (Registration) governs the classes of certificates, registration requirements, terms/conditions, labour mobility, and suspensions/reinstatements.
  • Definition of full-time education: an education program with at least 480 hours classroom theory or 620 hours practical, or a combination with a corresponding ratio between theory and practice.
  • Classes of certificates:
    • General
    • Student
    • Temporary
    • Inactive
    • (Some previously listed classes revoked/modified by amendments.)
  • Application for certificate: complete an application, pay fees, provide supporting documents; false statements may lead to revocation.
  • Issuance prerequisites (Summary):
    1) Post-secondary program in traditional Chinese medicine and/or acupuncture with specified durations;
    2) Structured clinical experience of at least 500 direct patient contact hours over at least 45 weeks;
    3) Completion of safety program approved by the Council;
    4) Completion of jurisprudence course;
    5) Passing a competency assessment; and
    6) Passing registration examinations.
  • General certificate terms/conditions: mandatory reporting of certain events (e.g., professional misconduct findings, ongoing investigations, lapses in insurance) within 30 days; must maintain professional liability insurance; display of certificate/badge; contribute to patient safety and practice integrity; limit to areas of education/experience; etc.
  • Labour mobility: for applicable applicants, must demonstrate good standing in other jurisdictions and may be required to undertake additional training/exams to meet in-province standards; language proficiency requirements apply; etc.
  • Additional certificate classes (Inactive/Temporary): specific terms about practice restrictions, supervision, and eligibility.
  • Suspension/Revocation: various circumstances may lead to suspension or revocation; processes for reinstatement; and related timelines.
  • Administrative rules: transition provisions and ministerial oversight allow the government to direct changes as needed.

Entry-Level Occupational Competencies (CARB-TCMPA) – practical integration into the curriculum

  • The nine competency areas (as previously listed) are used to structure curriculum, teaching, and assessment.
  • Example integration points:
    • Interpersonal Skills: emphasis on professional communication, patient relationships, and team collaboration.
    • Professionalism: adherence to law, ethics, patient rights, self-care, and ongoing professional development.
    • Practice Management: record-keeping, office procedures, and staff supervision.
    • TCM Foundations: core principles such as yin/yang, five elements, channels, constitution, etiology, prevention, and treatment principles.
    • Fundamentals of Biomedicine: anatomy, physiology, pharmacology, infection control, etc., and their relation to TC M practice.
    • Diagnostics and Treatment: chief complaint prioritization, data collection via wang wen qie (inspection, inquiry, palpation, tongue/pulse), syndrome differentiation, and treatment planning.
    • Acupuncture Techniques: needling, moxibustion, cupping, tui na, and adjunct devices.
    • Herbal Therapy and Management: herb properties, formulas, interactions, dosing, preparation, safety, and administration.
    • Safety: risk assessment, infection control, emergency response, and equipment safety.
  • The CARB-TCMPA documents provide the explicit competencies for entry-level practitioners and are used to drive outcomes, case studies, and clinical performance evaluation.

Clinical Training Policies and Procedures (TSTCM) – essential practice norms

  • Essential requirements for clinical training:
    • 100% attendance and direct patient contact.
    • Interns must perform diagnosis and treatment and participate in case studies.
    • Accurate record-keeping and timely submission of all clinical forms and documents.
    • Completion of forms and case studies; performance evaluated against program standards.
  • General requirements include: compliance with laws, patient safety, professionalism, and confidentiality; adherence to dress and clinic policies; and awareness of boundaries.
  • Attendance and makeup policies:
    • Maximum absences: typically 3 per clinical course; misses must be made up in holiday clinics or events; holiday clinics provide continued patient care and opportunities to make up hours.
    • Absence due to emergencies must be reported promptly with makeup arrangements.
    • Missed hours must be completed within the defined makeup windows; excessive absences may result in course failure.
  • Event participation and patient recruitment: students are encouraged to participate in public events to promote TCM, recruit patients, and gain experience; hours may count toward makeup or clinical experience if approved.
  • Record-keeping and confidentiality: patient records and student notes must be kept in secure, bound formats; confidentiality is mandatory; patient information is shared only for educational or clinical purposes with proper permissions.
  • Non-competition covenant: students may not compete in TCM-related businesses in the GTA without approval from TSTCM.
  • Clinic incidents: all incidents must be reported and documented; incident reports are available for minor and major events.
  • Forms and documentation: a consolidated set of 12 forms supports the clinical training process (e.g., Total Summary Form; Individual Course Forms; Direct Patient Contact; Make Up/Holiday Clinic; Case Studies and Clinical Notes Review; Self/Supervisor Evaluation; Events Participation; Incident Reports; etc.). The due date for all forms is the last holiday clinic before the next term; failure to submit on time can affect pass status.

Clinic structures, responsibilities and governance

  • Teaching clinic hierarchy and roles: Clinical Director; Administration; Chief Clinician; Faculty; Supervisor; Class Leader; Group Leader; Primary Intern; Secondary Intern; Assistant; Observer.
  • Responsibilities (highlights):
    • All students: positive, responsible, compassionate care; protect personal safety; uphold the clinic's image and the profession; come prepared; document thoroughly; maintain a clean learning environment.
    • Class Leader: oversees room readiness; assigns patients; records absences; facilitates group comments and improvement.
    • Group Leader: ensures group professionalism; assigns patients; conducts peer evaluation; coordinates group communication.
    • Primary Intern: responsible for a patient from check-in to follow-up; coordinates with supervisor for approvals; ensures complete patient records; leads procedures within supervision.
    • Secondary Intern: supports primary intern; records own notes; participates in treatments; assists in group discussions and case reviews.
    • Assistant/Observer: supporting role; maintains own notes; may conduct basic tasks under supervision; may progress to more advanced duties as experience increases.
    • Supervisor responsibilities: ensure malpractice insurance and professional certification; supervise patient care and clinic operation; reject student participation if necessary for safety or ethical concerns; provide feedback and evaluation.
  • Administrative duties include patient assignment, ensuring rooms and equipment are prepared, monitoring timing, supervising group discussions, and ensuring compliance with policies.

Dress code and clinic supplies

  • Dress code: lab coat with TSTCM T-shirt and nametag; professional attire; restrictions on casual wear; no strong scents; hair tied back; keep nails short; modest jewelry; covered tattoos; remove visible piercings; no perfumes in clinic.
  • Supplies: school-provided items (bed sheets, cushions, sanitizers, etc.); students may bring their own equipment for other modalities; travel kit supplies include needles of various sizes, alcohol swabs, cotton, gauze, gloves, sharps containers, etc.; ensure proper storage and disposal; ensure patient safety and infection control standards; 15-minute pre-visit preparation guidelines; 4-hour clinic setting typical; post-clinic cleanup procedures.

Clinical procedures for patient management (high-level workflow)

  • Getting ready: arrive 15 minutes early in clinic dress; sign in; check absences; review patient appointments; prepare rooms and supplies.
  • Greeting the patient: introduce yourself; assist new patients with forms; explain TCM and modalities; obtain informed consent (Exemption of Liability Clause) on the Application for Acupuncture/TCM Services.
  • History and data collection: use new patient format for new cases; follow-up questions for existing patients; clarify current medications; confirm the chief complaint and history; verify prior treatments and responses; determine if new condition.
  • Examinations: observation, auscultation/olfaction, palpation; primary intern performs examinations with supervision; pulse/tongue inspection by intern with oversight.
  • Prepare for treatment: adjust patient position and exposure; ensure draping to maintain modesty and warmth; explain treatment plan to patient; obtain consent for treatment modalities; prepare points and equipment; maintain a clean field.
  • Diagnosis and treatment planning: synthesize information from history/exam with TCM theory; establish main diagnosis and syndrome differentiation; propose a TC M treatment plan including needle points, herbal formulas, Tuina, etc.; discuss prognosis and expected outcomes.
  • Supervisor approval and patient communication: present plan to supervisor; obtain approval; communicate diagnosis and plan to patient with lay terms; discuss treatment frequency, duration, and costs; obtain consent.
  • Treatment delivery and monitoring: conduct acupuncture (needling, technique, point selection, safety); monitor patient response during retention (time typically ~20 minutes); withdraw needles with careful technique; post-treatment observations (lightheadedness, relaxation, bruising potential).
  • Documentation and case follow-up: complete patient records; summarize response and plan; document herbs’ preparation and follow-up needs; organize case studies; maintain confidentiality.
  • After-treatment and ongoing care: discuss potential side effects; provide follow-up schedule and pricing; encourage maintenance and preventive care.
  • Case studies and record-keeping: every 60-hour clinic requires 6 case studies; each course requires 6 cases, 3 due by week 6 and 3 by week 12; case study formats include New Patient and Follow-Up formats; submit electronically and as hard copies; ensure patient confidentiality; supervise-case reviews with weekly or bi-weekly reviews; ensure alignment with Clinical Training Record.

Patient records and informed consent materials

  • Informed Consent and Exemption of Liability Clause: standard consent form for acupuncture/herbal medicine/tuina etc.; patient and practitioner signatures; explicit acknowledgement of potential risks and need for ongoing consent.
  • Initial Visit Record and Follow-Up Records: detailed forms capturing chief complaint, current symptoms, history, tongue/pulse diagnosis, treatment plan, and outcomes; structured for new and follow-up visits; follow-up forms include treatment responses and ongoing plans.
  • Case studies: six cases per course; includes sections on history, syndrome differentiation, acupuncture points, herbs, tuina, and outcomes; submission guidelines for electronic and hard copies; documentation of references and supervisor feedback.
  • Confidentiality: patient data kept strictly confidential; use of de-identified data for teaching purposes; non-disclosure agreements for sensitive information.
  • Incident reporting: if anything goes wrong, file a Clinic Incident Report; incidents can be minor or major; proper documentation and supervision are required.
  • Records management: black ink; no white-out; double-cross line for deletions; signatures required on all forms; patient files accessible only during clinic shifts; complete and accurate record-keeping is essential for program progression.

Fees, hours and clinic hours

  • Teaching clinic hours and prices: clinic schedules include Monday and Thursday afternoon/evening slots; Saturdays as well; initial visit typically 2 hours (including one acupuncture treatment); subsequent visits around 1 hour.
  • Fees (clinic services): Initial consultation or acupuncture or Tuina treatment: 35; herbal patent remedies vary; looser herbs priced separately; family consultations may have different rates for students.
  • Access and payments: OHIP does not cover TC M services; some extended plans may provide coverage; patients pay at front desk; sign-in and scheduling policies in place; cancellations require 24 hours notice with a $35 fee for missed appointments.

Course requirements for documentation and casework

  • Clinical training forms (12 forms total):
    1) Total Summary of Clinical Training Form
    2) Each Clinic Course Summary Form
    3) Direct Patient Contact Record
    4) Make Up and Holiday Clinic Form
    5) Case Study and Clinical Notes Review Form
    6) Self-Supervisor Evaluation Form
    7) Event Participation Form
    8) Evaluation Form for Clinical Supervisor
    9) Absence, Lateness, Early Leave Report Form
    10) Patient Recruitment Records Form
    11) Clinic Incident Report Form
    12) Summary of All 12 Forms
  • Submission: all forms due by the last holiday clinic before the next term; late submissions may result in a FAIL; students must keep copies; separate forms for each clinic course.
  • Case study submissions: 6 cases per clinic; format and submission instructions provided; the supervisor will review 3 cases in weeks 6–7 and the other 3 in weeks 12–13; all cases must be submitted electronically and as hard copies.

Teaching Clinic structure: responsibilities and governance (expanded)

  • The clinic hierarchy emphasizes teamwork, leadership development, and patient safety.
  • Daily and class procedures emphasize punctuality, patient care quality, and professional conduct.
  • Emphasis on case reviews, feedback, and continuous improvement; supervisors provide guidance, assess performance, and approve/modify treatment plans.

Appendices and supporting materials in CARB-TCMPA Pan-Canadian Examinations Candidate Handbook (overview)

  • The Pan-Canadian Examinations: three exams (TCM Practitioners; Acupuncturists; TCM Herbalists). All candidates must pass the appropriate exam for registration in a province.
  • Exam format:
    • Each exam consists of two components: Multiple-Choice (MC) and Clinical Case (CC). Each component contributes 50% to the total score.
    • MC: 125–175 questions (depending on exam) with single answers; CC: 40–55 case-based and MC/multiple-select questions.
    • Passing score: total scaled score of at least 400.
  • Computer-based delivery in secure testing centers (in-person since Aug 2024). Languages: English; French available in some provinces; Chinese options available at certain administrations.
  • Security, ethics, and Code of Conduct: stringent rules around exam content, confidentiality, and integrity; penalties for misconduct, including potential invalidation of results and regulatory action.
  • Preparation resources:
    • Access to practice questions (Appendix A) and reference materials (Appendices D–K).
    • Exam blueprints map competencies to exam content; recommended study plans refer to the National Competency Profile and藍prints.
  • Administrative and regulatory resources: contact details for CARB-TCMPA and provincial regulatory bodies (e.g., CTCMPAO in Ontario, CCA in BC, etc.).
  • Appendices provide terminologies for Tongue and Pulse diagnosis, standard acupuncture nomenclature, channel and point systems, and a vast list of formulae, herbs, and Biomedicine references (Appendices D–K).

Selected practical implications and connections

  • Regulatory alignment: The program aligns TSTCM policies with Ontario RHPA/TCM Act frameworks and CARB-TCMPA competencies, ensuring students graduate with regulatory readiness and a clear path to licensure.
  • Ethical and professional development: The Oath and core values emphasize integrity, patient-centered care, professional boundaries, and social responsibility, echoing CARB-TCMPA expectations for entry-level practice.
  • Real-world relevance: The Clinical Observation I course lays the foundation for clinical competence, including patient communication, data collection, diagnosis/differential reasoning, and treatment planning, plus the administrative duties of clinical practice (record-keeping, consent, and professional conduct).
  • Emphasis on documentation and accountability: A rigorous set of forms and checklists ensures traceable clinical learning experiences and alignment with licensure requirements; this supports quality assurance and patient safety.
  • Ethical considerations in special cases: The documentation includes sensitive areas (e.g., consent to treat sensitive regions) and strong confidentiality clauses, reflecting ethical standards in clinical education and TCM practice.
  • Integration of TCM with biomedicine: The curriculum emphasizes integrating TCM foundations with biomedicine concepts, enabling better communication with other health professionals and comprehensive patient care.

Key LaTeX-formatted references and numbers to remember

  • Total course hours: 60h
  • Attendance requirement: 100 ext{%}
  • Course evaluation breakdown: ext{Attendance }=10 ext{%}, ext{Assignments/Case Studies }=30 ext{%}, ext{Participation }=10 ext{%}, ext{Midterm }=20 ext{%}, ext{Final }=30 ext{%}
  • General certificate requirements (Ontario): at least 4 years of traditional Chinese medicine education (full program) or 3 years (acupuncture program); at least 500 direct patient contact hours; at least 45 weeks of clinical experience; and passing registrations/examinations.
  • Hours/duration rules (Registration Regulation):
    • Full-time educational hours: 480 classroom hours or 620 practical hours; partials require a proportional adjustment (1.3-hour supplemental practical per missing hour of classroom time).
  • Fee and policy figures: Missed appointment fee: 35 ext{ CAD}; exam passmark: 400 (Pan-Canadian Examinations).
  • Terminal exam structure: MC component length and CC component length vary by exam; each contributes 50 ext{%} to final score; passing is a total score of at least 400$$.

Quick reference to key contacts and resources

  • Ontario regulator: College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO)

  • CARB-TCMPA: Pan-Canadian Examinations framework and national competency standards

  • Website and contact: info@tstcm.com; tstcm.com; CARB-TCMPA contact: admin@carb-tcmpa.org

  • Note: The material above is a condensed, structured synthesis of the Clinical Observation I (8011) transcript you provided. It preserves major and minor points, regulatory context, competencies, policy details, and procedural guidelines to serve as a comprehensive study aid that can stand in for the original document for exam preparation.