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Comparison of acupuncture education, policies and regulations in South Africa and mainland China


Comparison of acupuncture education, policies and regulations in South Africa and mainland
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Complementary Medicine: Education and Research

Vol.1, No. 1, pp. 1-13, Feb 2024

Received August 15, 2023; Revised Dec 12, 2023; Accepted Jan 5, 2024

3006-273X / © 2024 by CMER

Published by Chinese Medicine and Acupuncture Association of Africa. This is an open-access article under the CC BY-NC-ND license.


Comparison of acupuncture education, policies and regulations in South Africa and mainland China


Yi Peng[1]  Zijing Hu[2]

1. Associate Professor, PhD in Law. Nanjing Tech University, China. Former Project Executor of China-Africa Cooperation, China Association of Higher Education.


[1] Corresponding author: Associate Professor, Department of XXXX, Nanjing Tech University, China. Former Project Executor of China-Africa Cooperation, China Association of Higher Education. Email: pengyi@njtech.edu.cn Postal address: Law Faculty, Pukou District, Nanjing Tech University, Nanjing, China.  

[2] PhD, Senior Lecturer, Department of Complementary Medicine, University of Johannesburg, South Africa. Email: zhu@uj.ac.za ORCID: 0000-0002-9752-4163


To cite this article:

Peng, Y. & Hu, Z. (2024). Comparison of acupuncture education, policies and regulations in South Africa and mainland China. Complementary Medicine: Education and Research, 1(1), 1-13. https://doi.org/10.62415/LCHZ6669


ABSTRACT

This review compares the landscape of acupuncture higher education in South Africa and mainland China, addressing the question of whether South African acupuncture programs meet international standards, particularly in comparison to their Chinese counterparts. The study explores critical aspects such as the position of acupuncture in the national higher education system, board examinations, core curricula, degree awards, and the integration of acupuncture into national healthcare systems. Divergences are noted in board examinations and continuing professional development, with China requiring comprehensive assessments for registration and imposing annual continuing education credits. The study reveals differences in the scope of practice, influenced by regulatory frameworks and curricula structures. While South Africa faces challenges in establishing acupuncture as a mainstream profession, China has a well-established system with widespread recognition, research funding, and integration into the national healthcare system. The review concludes with recommendations for international collaboration, increased research funding, quality assurance, integration into public healthcare, ongoing professional development, diversification of programs, advocacy for recognition, collaborative conferences, public awareness campaigns, and long-term planning to further elevate acupuncture education in both South Africa and the broader global context.

Keywords: acupuncture; curriculum; higher education; Chinese Medicine.


1. Introduction

Traditional Chinese Medicine (TCM) has gained increased attention in many countries, owing to scientific evidence regarding its clinical effectiveness (Li et al., 2019). TCM is a medical system that originated in ancient China over two thousand years ago (Hu, 2022). Due to its significant contributions to global healthcare, member states of the World Health Organization (WHO) adopted the eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) on May 25, 2019, incorporating TCM into the ICD-11 system (Lam, Lyu & Bian, 2019). This initiative aligns with the WHO Traditional Medicine Strategy (2014–2023), illustrating the WHO's recognition of TCM's historical contributions to global healthcare and its responsiveness to the current needs of member states (Hu & Venketsamy, 2022; Lam et al., 2019). The World Health Organization emphasises the necessity to establish a knowledge base that actively manages traditional and complementary medicine through appropriate national policies, understanding and recognizing its role and potential values in public health (Burton, Smith & Falkenberg, 2015). This review aims to provide an overview of acupuncture training in South Africa (SA) in comparison to equivalent programs in mainland China. In this study, the research question posed is, 'What are the differences between acupuncture higher education in South Africa and mainland China?'

It is essential that professional training for acupuncturists, especially in higher education institutions (HEIs), facilitates students' competency, enabling them to transition from students to independent practitioners. Consequently, HEIs should offer quality educational programs designed for the professional training of acupuncturists (Hu, 2023). This is particularly crucial for HEIs outside China. Nevertheless, there is a notable absence of cross-national comparative research in this field, particularly when examining the broader context of education in South Africa and mainland China. In this study, the authors aimed to broaden the analytic frame by comparing acupuncture training for a bachelor's degree program in SA and mainland China, considering various vital aspects, including the position in the higher education system, registration, and core curricula.

Acupuncture involves stimulating specific points on the body by inserting thin needles through the skin (Hu, 2022). It has been demonstrated to be both cost-effective and safe, adopting a natural and holistic approach to treat diseases (Kwon, 2014). Acupuncture and moxibustion are TCM modalities that share the same philosophy and theories. They are more extensively integrated into the Chinese healthcare system compared to the national healthcare systems of other countries (Lim et al., 2015). Consequently, the examination of the development of acupuncture and moxibustion in China holds significant importance, as it shapes the overall dynamics and progress of this field globally (Hu & Venketsamy, 2022).

2 Methodology

The review was conducted by consulting relevant accredited documentation on acupuncture higher education in SA and mainland China. Data were analysed according to the six-step thematic analysis proposed by Creswell (2014). According to Hu, Venketsamy, and Razlog (2022) and Venketsamy et al. (2022), thematic analysis is a crucial approach to identifying similarities and dissimilarities in data. It further assists in clarifying important aspects of the findings. The data were analysed inductively (Venketsamy et al., 2021). The authors reviewed the raw data several times to become familiar with the data (Step 1). Thereafter, the authors started to code the data (Step 2) and recognised initial themes (Step 3). The authors conducted a review of the initial themes (Step 4) and subsequently refined them (Step 5). Ultimately, the authors utilised these codes and themes to address the research question. To enhance the trustworthiness of this study, multiple techniques were employed to improve the credibility, confirmability, dependability, and transferability of the findings. These techniques encompassed a meticulously planned research design and methods, comprehensive descriptions of data, and an audit trail that underwent scrutiny by a second coder.

3 Results

3.1 Position of acupuncture in the national higher education system

South Africa

There is no historical record of when acupuncture was first introduced to SA. However, it is believed that acupuncture was brought to SA when the first Chinese individuals landed on this continent around 1660, although there were not many Chinese in the region until the late 19th century (Yap & Man, 1996). In SA,

acupuncture has been classified as complementary or alternative to biomedicine. Due to a historical lack of regulation, tertiary education was not a prerequisite for practice in complementary medicine (CM) for many years. According to WHO (2019), CM encompasses a broad range of medicines that neither originated from the country nor integrated into the mainstream medicine of the country. The marginal status of CM was also reflected in healthcare-related legislation. The Allied Health Professions Act 63 of 1982 governs the registration of several CM modalities, including Chinese medicine and acupuncture. Acupuncturists have been regulated according to clear standards and requirements by the Allied Professions Council of South Africa (AHPCSA) since the year 2000 (South Africa, 2000; 2001).

In SA, the introduction of Chinese medicine and acupuncture education occurred initially at the School of Natural Medicine, University of Western Cape (UWC), in the year 2003 (UWC’s school, 2018). It offered a five-year training course divided into two separate degrees: the Bachelor of Science in Complementary Health Sciences, completed over 3 years, followed by the Bachelor of Complementary Medicine (BCM), completed over 2 years. However, this institution ceased all new enrollments as of 2019 as part of a curriculum restructuring (UWC, 2020).

Currently, the University of Johannesburg (UJ) is the only higher education institute in SA that provides acupuncture training programmes under the Bachelor of Health Sciences in Complementary Medicine (BHScCM) and Postgraduate Diploma (PGDip) in Acupuncture. The BHScCM is a four-year, full-time course with a total of 480 credits (one credit equals 10 notional hours), offering training in acupuncture therapeutics with the choice of electives in homeopathy or phytotherapy. There are 90 credits that are directly related to acupuncture content knowledge. It was first offered in 2020 and admitted a cohort of about 50 students (UJ, 2021). The PGDip in Acupuncture is a two-year, part-time programme with a total of 120 credits. This programme was designed to offer acupuncture training for qualified healthcare practitioners, such as medical doctors, homeopaths, chiropractors, phytotherapists, naturopaths and Unani-Tibb practitioners (UJ, 2021). The PGDip is formally launched from the year 2021.

Mainland China

Acupuncture has been practiced continuously for more than 2000 years in China (Hu, 2022). It has been included in HEIs and the healthcare system for more than 70 years since the 1950s (Griffiths, Chung & Tang, 2010). The Nanjing Traditional Chinese Medicine School (NJTCMS), which traces its roots back to the establishment of the Jiangsu Province Advanced School of Chinese Medicine in 1954, stands as the earliest tertiary institution of TCM (Xue et al., 2015). In 1956, four colleges of Chinese Medicine were established in the cities of Beijing, Shanghai, Chengdu, and Guangzhou, and the NJTCMS was transformed into the Nanjing Traditional Chinese Medicine College. These five colleges were subsequently upgraded to TCM universities between 1993 and 1995 (Chang, 2008).

Currently, there are 43 tertiary TCM universities in China, the majority of which offer acupuncture and moxibustion programmes, with a total enrollment of 858,000 students (Chinese Net of TCM, 2019). The tertiary education program for acupuncture and moxibustion has evolved into a comprehensive system, providing courses of varying durations leading to associate, bachelor's, master's, and PhD degrees, addressing the health needs of the country. The predominant educational pathway involves a sequential approach, where students dedicate five years to earn a bachelor’s degree, accumulating a total of 200 credits (with one credit equaling 16 notional hours), followed by three years each for master's and PhD degrees. Alternatively, a seven-year master's program, totaling 250 credits (with one credit equaling 18 notional hours), is available, integrating both undergraduate and master's courses. Recent years have witnessed the introduction of specialised fields of study in acupuncture and moxibustion at the undergraduate level, such as cosmetology and rehabilitation (Lim et al., 2015). Table 1 provides a comparison of acupuncture-related credits for bachelor’s degree programs in SA and mainland China.


Table 1: Comparison of Acupuncture-Related Credits in Bachelor’s Degree Programme in SA and mainland China (FJTCM, 2018; UJ, 2021)


3.2 Board examination and registration

South Africa

An acupuncturist registered under the Allied Health Professions Act 63 of 1982, in respect of the profession of Chinese Medicine and Acupuncture, is licensed to diagnose, treat, or prevent physical and mental diseases, illnesses, or deficiencies in humans. They are also authorised to prescribe or dispense medicine and provide or prescribe treatment for such diseases, illnesses, or deficiencies in humans (South Africa, 2000). Initially, students graduating from UWC or with a relevant foreign qualification are allowed to be registered as practitioners of Chinese Medicine and Acupuncture or as acupuncturists, provided that the qualification allows the applicant to practice the profession in the country where the qualification was obtained. Additionally, the applicant must be registered with the relevant statutory body in their country of origin at the time of the application (AHPCSA, 2024a).

To become a registered acupuncturist under the Regulations of the Allied Health Professions Act, 1982, individuals must complete a minimum three-year Acupuncture Diploma programme at an educational institution. The diploma curriculum should encompass major subjects such as anatomy, biochemistry, botany, chemistry, electro-stimulation, evaluation and treatment of myofascial pain syndromes, moxibustion, needling techniques, neuroscience, pathology, pain research, physics, physiology, psychology, theory of myofascial pain syndromes, and zoology. Additionally, the program should cover ancillary subjects, including emergency care, ethics and jurisprudence, and practice management, as outlined in the regulations of the Allied Health Professions Act of 2001 (South Africa, 2001). Starting from September 1, 2018, it became mandatory for UWC graduates with a relevant Chinese Medicine and acupuncture qualification to undergo board examinations for successful registration with the Chinese Medicine and Acupuncture Professional Board of the AHPCSA. These examinations are conducted bi-annually in March and September of each year (AHPCSA, 2018).

Mainland China

Board examinations are mandatory for registration with relevant professional boards. Candidates are required to hold a bachelor’s (or higher) degree in medicine from a tertiary institution and must have undergone at least one year of probation under supervision in a medical institute. Assistant physicians are also eligible to participate in the examination if they possess a diploma from a medical institution and have completed at least two years of probation in a medical institute (People's Republic of China [PRC], 1999). Moreover, individuals lacking professional medical qualifications, but who have undergone a three-year apprenticeship under a mentor possessing over 15 years of TCM clinical experience, may be eligible for the Apprenticeship Assessment. Those demonstrating recognised expertise or exceptional skills, and who have engaged in lawful clinical practice of TCM for more than five years, qualify for the Recognised Competence Assessment, enabling them to obtain a physician’s practicing license (Lim et al., 2015).

The board examination for licensing purposes comprises two components: theoretical and practical assessments. Practical assessment includes needling techniques such as needling, moxibustion technique, cupping, and scalp and auricular acupuncture (Zou & Huang, 2013). The theoretical component spans two days, covering four categories. Each category includes 150 multiple-choice questions, totalling 600 questions (K, 2013).

3.3 Continuing Professional Development

South Africa

Continuing Professional Development (CPD) involves participating in educational activities that enhance the existing medical knowledge, skills, and attitudes of a healthcare provider. CPD activities were introduced by the AHPCSA to strengthen the competency of practitioners. Registered acupuncturists are mandated to accrue a minimum of 40 continuing education units (CEUs) per two-year cycle. These units can be earned through various means, including case studies, attendance at registered meetings or courses, publication of medical literature, work in educational institutions, and doctoral studies, among other options (AHPCSA, 2024b).

Mainland China

Established in 2002 under the management of the National Administration of Traditional Chinese Medicine and coordinated by TCM institutions, Continuing Medical Education (CME) aims to enhance the competency of practitioners and facilitate the transmission of knowledge. All registered physicians, including acupuncture practitioners, must accrue a minimum of 25 CME credits annually. These credits can be earned through various means, including mentorship learning, distance learning, participation in registered meetings or courses, and the publication of medical literature. Mentorship learning serves the purpose of transferring TCM clinical experience from senior to junior physicians (Lim et al., 2015). Acupuncturists in China can specialise in different fields of study after a certain number of years in clinical practice, provided they pass the examinations for these specialties. Table 2 illustrates a comparison of Continuing Professional Education (CPE) in SA and mainland China.


Table 2: Comparison of Continuing Professional Education in SA and mainland China


3.4 Core curricula on acupuncture in higher education institutions

Traditional Chinese Medicine universities in mainland China typically offer programmes in Chinese Medicine, Chinese Materia medica, acupuncture, moxibustion, and tuina. Most undergraduate programmes take five years to complete, while master’s and doctoral programs are each three years in duration (Xue et al., 2015). As a specialised field of study, the undergraduate curriculum focuses solely on the content of the discipline to ensure a basic level of core competency among students (Lim et al., 2015). For postgraduate programmes, students are required to attend both professional courses and clinical training. The professional courses encompass theories, clinical fundamentals, and research modules. The core curricula vary slightly between China and South Africa. Table 3 presents a comparison of the core curricula in bachelor’s acupuncture programmes in SA and mainland China.


Table 3: Comparison of the core curricula of acupuncture programmes at FJTCM, China, and UJ, SA


As seen in the above table, there are differences in the modules between these two universities that reflect disparities in policy and regulations regarding healthcare education. The design of these programmes invariably shows a reference to the TCM curricula in mainland China, where 60%-70% of the content is focused on TCM, and the remaining curriculum is centered around biomedicine (Brosnan et al., 2016).

3.5 Degrees

South Africa

Upon successful completion of the programme at UJ, individuals will be conferred the degree of Bachelor of Health Sciences in Complementary Medicine (UJ, 2021). Those holding this certificate are eligible to pursue further studies in various postgraduate programmes.

Mainland China

Upon successful completion of the programme, graduates will be conferred with the Bachelor of Medicine degree in accordance with the Regulations of the People’s Republic of China on Academic Degrees. Holders of this certificate are eligible to pursue further studies by either taking the National Graduate Entrance Examination to enroll in a master’s degree program or, alternatively, they may be directly admitted to a doctoral program if they possess six years of working experience and successfully pass the National Doctoral Entrance Examination.

3.6 Position of acupuncture in the national health care system 

South Africa

Acupuncture practitioners in South Africa continue to be excluded from publicly funded healthcare and hospitals, despite their inclusion on the list of registered professions with the AHPCSA. The majority of acupuncture practitioners operate as solo practitioners. Due to the limited number of practitioners, Chinese Medicine and acupuncture are categorised as 'scarce skills' in SA.

Mainland China

The Chinese health prevention and delivery system, established in the 1950s, operates on a three-tier framework comprising hospitals, health centres, and clinics (Xu & Yang, 2009). Since 1999, the government has actively advocated for the development of Community Health Services Centres as primary healthcare providers, incorporating modalities such as acupuncture and moxibustion (China Association for Acupuncture and Moxibustion, 2012). In 1999, legislation for Chinese Medicine physicians was enacted to prohibit unqualified and unreasonable practice (PRC, 1999). Presently, it falls under the jurisdiction of the State Administration of Traditional Chinese Medicine (SATCM).As of now, there are 4,939 TCM hospitals in China, including integrated TCM and Western medicine hospitals, along with 55,757 CM clinics. Additionally, there are 575,000 practitioners registered under the category of Chinese Medicine (Chinese Net of Traditional Chinese Medicine, 2020). The Chinese Medicine Act of the People's Republic of China was adopted on December 25, 2016, and it was formally implemented on July 1, 2017 (National Administration of Traditional Chinese Medicine, 2016).

3.6 Scope of practice

The scope of practice varies significantly from  SA and mainland China. The reason cited for this difference is the distinct curriculum structure and policy attitudes toward acupuncture in these two countries.

South Africa

The scope of practice for an acupuncturist includes the following: taking a case history, performing a physical examination, and making a diagnosis according to the principles and philosophies of acupuncture (SA, 2001). Additionally, the scope of practice of an acupuncturist may include moxibustion therapy, electro-acupuncture, laser acupuncture, magnetic therapy, cupping therapy, medical Qigong therapy, Tai Ji Quan Therapy, and needling. The use of a blade needle is prohibited and considered unprofessional conduct (AHPCSA, 2017).

Mainland China

Apart from practicing within the scope of Chinese medicine and acupuncture, which is Chinese Medicine and Acupuncture-related, doctors registered under the category of Chinese Medicine are allowed to work in emergency departments and general hospitals within their scope of practice. They are also granted the right to prescribe both Chinese herbal medicine and Western medicine (PRC, 2012).

4. Discussion

The comparison of acupuncture education and policy has revealed differences between these two countries due to varying understandings and attitudes toward acupuncture. This disparity is evident in their positions within the education system and public healthcare. Acupuncture was integrated into higher education much earlier in China than in SA (Griffiths et al., 2010; Xue et al., 2015). China has a higher number of universities offering acupuncture and moxibustion training, while in SA, there is only one university that enrolls about 40 students each year (Chinese Net of TCM, 2019; Hu, 2022). Higher education provides greater access to front-line research in the specific field. Acupuncture higher education in China has matured over a longer period, and SA can benchmark with TCM universities in China across various fields. Additionally, the opportunity for collaboration with TCM universities in China may offer excellent chances for students to gain more clinical exposure and experience. Mainland China remains a common clinical training destination for SA.

In China, graduates are required to pass board examinations before they can be registered with professional boards (PRC, 1999). The board examination in China comprises practical and written components (K, 2013). Conversely, in SA, board examinations are not compulsory for graduates to be registered in specific fields, as long as the HEIs are accredited by the AHPCSA. Continuing Professional Development requires ongoing study and lifelong learning for practitioners, benefiting both patients and the professions themselves. In terms of CPD, there are similarities in both countries, albeit with different criteria. Different curriculum structures are noted to meet distinct requirements in both countries, particularly concerning the different scopes of practice. As observed in the comparison, qualified acupuncturists in China have a broader range of scope of practice due to the different policies and training systems in these two countries.

The National Natural Science Foundation of China (NSFC), directly affiliated with the State Council, is dedicated to funding and promoting both basic and applied research in China (Lim et al., 2015). In 2013, the NSFC allocated funding for 109 acupuncture and moxibustion projects, amounting to 57 million CNY, and in 2017, it supported 121 projects in this field (Lim et al., 2015; Wei & Wu, 2018). Currently, South African public organisations do not sponsor any research projects in this domain. The utilisation of acupuncture and moxibustion significantly contributes to reducing healthcare costs, as these treatments are generally cost-effective and more accessible compared to other modalities for disease prevention, health promotion, and managing chronic non-communicable diseases (Hu, 2022). The adoption of TCM in public health holds potential benefits for the overall well-being of the public.

Despite that acupuncture has been included into South African higher education, there is a significant variation in the training hours between China and SA (FJTCM, 2018; UJ, 2021). The authors are of the opinion that there is an urgent need to ensure professional training for acupuncturists in SA benchmarks international standards, such as China or other recommendations proposed by the WHO. The challenges of acupuncture higher education in SA remain critical, as the factors involved are intertwined with no easy solution (Brosnan et al., 2016). The relatively low profile of acupuncture in SA means that the scale of acupuncture education has remained small, being represented in only two universities initially, and currently, only one institution still enrolls students (UWC, 2018; UJ, 2021). As a university discipline, acupuncture lacks the critical mass within SA that is needed to develop a strong professional field, such as holding local conferences and establishing cross-institutional collaborations.

Furthermore, the authors believe that these challenges can be resolved by seeking collaborations between China and SA. This is of particular significance since TCM has been included in the ‘China-Africa Talent Training Cooperation Plan’ proposed by the Chinese government during the BRICS Summit in Johannesburg in 2023 (PRC, 2023). The ‘China-Africa 100 Universities Cooperation Plan’, which is being actively promoted by the China Association of Higher Education and the Association of African Universities, has been included in the ‘China-Africa Talent Cultivation Cooperation Plan’. The China Association of Higher Education and the Association of African Universities formally signed a partnership in November 2022 and establish the China-Africa Consortium of Universities Exchange Mechanism. To promote and facilitate the implementation of the above-mentioned plans, the ‘China-Africa Higher Education Exchange and Cooperation Symposium’ co-sponsored by the Association of China Higher Education, the Association of African Universities, and Xiamen University was held during the 2023 Annual International Forum on Higher Education (PRC, 2023). The authors articulate the necessity of cooperation between China and Africa in the field of traditional medicine, such as TCM. The reason cited is that the promotion of traditional medicine in Africa will not only profoundly improve the economy on the African continent but also promote public health (Hu & Venketsamy, 2022).

5. Conclusion and recommendations

Acupuncture has gained increased recognition globally due to its crucial role in promoting public health. The acupuncture higher education has special criteria to meet the requirements and needs in each country. This study reveals the similarities and differences between SA and mainland China. International collaborations with TCM universities in China are great opportunities to benchmark with the matured higher education system and get more clinical exposure for students in SA. The demand of the quality acupuncture education indicates the necessity for future research into the development and evaluation on acupuncture training in SA. Based on the findings and discussion, the author recommends

Acupuncture has gained increased recognition globally due to its crucial role in promoting public health. Acupuncture higher education has specific criteria to meet the requirements and needs of each country. This study reveals the similarities and differences between SA and mainland China. International collaborations with TCM universities in China present great opportunities to benchmark with a matured higher education system and provide more clinical exposure for students in SA. The demand for quality acupuncture education indicates the necessity for future research into the development and evaluation of acupuncture training in South Africa. Based on the findings and discussion, the authors recommend

  • International Collaboration: Encourage and facilitate international collaborations between South African HEIs and TCM universities in China. These collaborations can provide South African students with more diverse clinical exposure and enrich their educational experience. Facilitate the organization of local and international conferences on acupuncture and traditional medicine. These conferences can serve as platforms for knowledge exchange, collaboration, and the establishment of a professional network within SA.

  • Research Funding: Advocate for increased research funding for acupuncture and moxibustion projects in SA. The establishment of research projects supported by public organizations, similar to the National Natural Science Foundation of China (NSFC), can contribute to the advancement of acupuncture research and its integration into public health practices.

  • Quality Assurance: Establish mechanisms for ongoing quality assurance in acupuncture higher education. Regular evaluation of curriculum, faculty qualifications, and adherence to international standards can ensure that South African acupuncture programmes maintain high educational standards.

  • Public Healthcare Integration: Advocate for the integration of acupuncture into publicly funded healthcare systems in SA. The recognition of acupuncture as a valuable healthcare modality can enhance accessibility and affordability for the public, aligning with global trends in the integration of traditional and complementary medicine.

  • Professional Development: Emphasise the importance of continuing professional development (CPD) for acupuncturists in SA. Encourage practitioners to actively engage in CPD activities to stay updated with advancements in the field and enhance their competency.

  • Long-Term Planning: Develop long-term plans for the growth and sustainability of acupuncture higher education in SA. This includes strategic planning, resource allocation, and collaboration with relevant stakeholders to ensure the continued development of the field.

By implementing these recommendations, SA can enhance the quality of acupuncture education, foster collaboration with international counterparts, and promote the integration of acupuncture into mainstream healthcare practices for the benefit of the public.

Limitations

One central limitation lies in the study's confined scope, primarily concentrating on the comparative analysis between South African and Chinese acupuncture programmes. While this focus allows for an in-depth examination of specific contexts, it may restrict the generalisability of the findings to a broader global perspective. The study fails to consider other international contexts that might offer valuable insights into acupuncture education. Another critical limitation stems from the reliance on existing documentation from accredited sources in both countries. The accuracy and depth of the study's insights are contingent upon the reliability of these sources, which may, in turn, be subject to biases or present incomplete information. The study recognises the potential limitations associated with thematic analysis, which introduces subjectivity in data interpretation and categorization. The trustworthiness of the study hinges on the robustness of the research design, and potential biases in coding and theme identification processes could affect the validity of the results. Future studies are recommended to be conducted with different approaches, such as quantitative or mixed methods research designs.

 

Acknowledgement

N/A.


Author’s Disclosure Statement

The study wasn’t funded by any organization or institution. The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.


Declaration

The authors declared no conflicts of interest.


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