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9-11-01
naturopathic education

clearaLicensed naturopathic physician (N.D.) attends a four-year graduate level naturopathic medical school and is educated in all of the same basic sciences as an M.D. but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology, and counseling (to encourage people to make lifestyle changes in support of their personal health). A naturopathic physician takes rigorous professional board exams so that he or she may be licensed by a state or jurisdiction as a primary care general practice physician.

     There are presently five C.N.M.E. recognized naturopathic medical colleges in the U.S. and Canada (Click here for more info on the colleges):
      Bastyr University - Seattle, Washington also accredited by the Northwest Association of Schools and Colleges and offers both undergraduate and graduate studies, but undergraduate students may enter Bastyr only as juniors. NCNM and SCNM offer only graduate studies.
      National College of Naturopathic Medicine - Portland, Oregon
      Southwest College of Naturopathic Medicine - Tempe, Arizona
      University of Bridgeport College of Naturopathic Medicine - Bridgeport, Connecticut
      The curriculum of UBCNM is modeled after the curriculum at professionally accredited schools
      Canadian College of Naturopathic Medicine, Ontario, Canada

     BU, SCNM, NCNM, CCNM, and UBCNM each offer a professional doctorate degree for completion of studies in naturopathic medicine. A minimum of three years of undergraduate premedical study is prerequisite for entry to a naturopathic medical school. The first two years of naturopathic school emphasize the basic sciences: anatomy, physiology, pathology, biochemistry, organic chemistry, neurology, radiology, minor surgery, microbiology, obstetrics, immunology, gynecology, pharmacology, pediatrics, dermatology, lab diagnosis, clinical and physical diagnosis, and other clinical sciences. Study of the bodily systems takes in gastroenterology, pulmonary system cardiology, neurology, gynecology, and dermatology.
      The second two years focus on clinic skills and the range of natural therapeutics. NDs receive training in naturopathic therapeutics including botanical medicine, homeopathy, natural childbirth, acupuncture, hydrotherapy, naturopathic manipulative therapy, therapeutic nutrition, and other therapies. Because coursework in natural therapeutics is added to a standard medical curriculum, naturopathic doctors receive significantly more hours of classroom education in these areas than the graduates of many leading medical schools, including Yale, Stanford andJohns Hopkins schools (Comparative Curricula). Pharmacology and minor surgery are examples of other conventional training recieved by NDs.
      Clinical Internship consist of 1500 hours of treating patients under the supervision of licensed naturopathic and conventional medical physicians.
      After graduating from a college of naturopathic medicine and passing the exam (NPLEX) required by the accrediting agency for naturopathic medical programs; the Council of Naturopathic Medical Education (CNME) and other state tests, most NDs go into private or group practice treating people with acute and chronic disease. NDs do not specialize in the treatment of any one organ system (such as dermatology) or any individual disease because they treat the body as an integrated whole. This is what is meant by whole person health care.

Mail Order Schools

     There are two primary reasons to license a profession. The first reason is to protect the public from potential harm. Obviously, in medicine, potential harm is a real concern. A second reason is to protect the integrity of a profession against charlatans and unqualified persons. When states license naturopathic doctors, they require practitioners to have graduated from an accredited program and to have completed all appropriate tests and clinical training.
      Without licensure, anyone can "hang out a shingle" and practice with nothing more than a "mail-order" degree or a home study course.
      Because naturopathic medicine is not regulated in 38 states, some individuals call themselves "naturopaths" who do not meet the historical standards of the profession. Such individuals sometimes have degrees or diplomas from correspondence schools, weekend seminar programs without supervised clinical training, extremely abbreviated courses, "certifying" agencies that confer naturopathic credentials based on other kinds of health education, poor "home study" schools without state authority to grant degrees, and/or schools without naturopathic programs or faculty. None of these programs qualify a candidate to sit for board exams or to receive licensure in any state. In some states, individuals call themselves "naturopaths" simply by paying a fee for a business license requiring no evidence of education at all.  This license is not a license to be a Naturopath  but simply a license to sell products and services of any kind.
      How to Get the Degree You Want by John Bear differentiates between traditional education; off-campus, life-experience and correspondence courses; and outright diploma mills. Regarding alternative medicine, Bear says: ". . . There are no legitimate alternative schools of "near-medicine" . . . The good schools in this category require three or four years of study in residence, and cannot be considered non-traditional."
      Diploma mills and mail order degrees (witch are fraudulent and not legal) mislead, endanger, and actually harm consumers as well as being damaging to trained and professional naturopathic physicians who find themselves sharing the same title. The Council of Naturopathic Medical Education (CNME) accreditation helps state authorities to distinguish between such degrees and legitimate medical education.
      Consumers should know what they are getting when they seek the services of a naturopathic physician. Only licensure can guarantee the training and safety to which consumers are entitled.
      All physicians listed in our database have been checked out by one of our editors to ensure they are qualified naturopathic physicians.

Scientific Basis for Naturopathic Medicine

     When expert and objective scientists, educators, or regulators have examined the scientific basis of naturopathic medicine, they have concluded that naturopathic medicine as practiced by the licensable professionals in the U.S. is well grounded in modern scientific method and practice.
      Scientific studies of methods utilized by naturopathic physicians not only validate naturopathic treatments, but leads to their improvement.
      The Textbook of Natural Medicine includes over 10,000 citations of scientific studies on naturopathic methods. Scientific studies and observations have not only held up the validity of diet, herbal medicines, manipulation, and massage, but also treatments including acupuncture, biofeedback, and homeopathy. In many instances, the scientific investigation has not only validated the natural method, but also led to significant improvements.
      In herbal medicine, improved equipment and techniques for chemical analysis have led to increased understanding of how best to grow and harvest a plant, and how to extract and concentrate the medicinal components of a plant for maximum benefit.
      In each of the three main areas of medicine - diagnosis, prevention, and treatment - naturopathic medicine rests on a scientific foundation.

Diagnosis Using the Same Science

     Naturopathic physicians use the same methods of clinical, physical and laboratory diagnosis as conventional general practitioners. These may be supplemented by quantifiable naturopathic methods, which attempt to assess areas such as the patient's vitality, the underlying susceptibility to disease, or sub clinical weaknesses in systems.

Prevention

     In the area of prevention, naturopathic physicians utilize the body of knowledge an MD uses in judging the course a disease may be expected to take. They are trained to give individual immunizations as needed with fully informed consent when allowed by law.
      Most important, naturopathic physicians are highly trained in clinical nutrition and lifestyle modification for the prevention of disease. In these areas, all thoroughly supported by science, naturopathic physicians are better trained than MD general practitioners (the majority of whom have not taken a single course in nutrition), family practice specialists, or registered dietitians. Naturopathic physicians are the only primary care medical professionals in the U.S. meeting and exceeding the recommendations of the U.S. Surgeon General for medical education in nutrition and dietary counseling.

Treatment

     Each of the major therapies used by naturopathic physicians is rooted in scientific literature and long traditions of clinical use. Modern naturopathic medicine incorporates advances in science into its traditional body of knowledge.

Clinical Nutrition

     The dietary approach to prevention and treatment of chronic degenerative disease, championed for more than a century by naturopathic physicians, has recently gained the attention of orthodox medicine. Each of the seven dietary guidelines in the 1988 U.S. Surgeon General's report on nutrition and health is a traditional part of naturopathic practice. More than 40 scientific journals worldwide are devoted to clinical nutrition, and articles on the therapeutic use of diet or supplements also appear regularly in conventional medical journals.

Botanical Medicine

     Most European countries recognize the effectiveness of medicinal plants, include them in their official pharmacopoeias and regulate them as drugs or over-the-counter remedies. At least 14 scientific journals worldwide are devoted to the study of botanical medicine.

Homeopathy

     Homeopathy is a system of medicine more than two hundred years old and there aremore than one hundred homeopathic medical colleges worldwide. A recent review article in the British Medical Journal performed a meta-analysis of 107 controlled clinical trials of homeopathic substances, and found positive evidence supporting their effectiveness (Kleijnen; see also: Alibeu; Ferley; Gassinger; Gibson; Maiwald; Reilly; Vozianov; Weisenauer). Various other in vitro or animal studies have also demonstrated the effectiveness of homeopathic preparations (Bildet; Poitevin; Sukul; Wagner).

Hydrotherapy

     The value of water treatments, fasting and rest in treatment for chronic disease is recognized throughout the developed countries in Europe. About half million French citizens each year receive insurance reimbursement for medically prescribed spa therapy (Payer).

Physical Medicine

     Naturopathic manipulation of the muscles, bones and soft tissues is collectively known as Naturopathic Manipulative Therapy (NMT). Physical medicine also includes exercise therapy, physiotherapy using heat and cold, electrical pulsation, ultrasound, diathermy and hydrotherapy. Such techniques are regularly evaluated in journals such as the Journal of Manipulative and Physiological Therapies. A recent study in England found manipulative treatment to be more effective than orthodox medical treatment for certain kinds of back injuries (Meade). The value of such treatments is recognized in other licensed professions such as physical therapy, osteopathy, chiropractic, and massage therapy.

Behavioral Medicine

     Naturopathic physicians are trained in various psychological techniques, including basic counseling, stress management, hypnotherapy, biofeedback, and methods of lifestyle modification. A large body of scientific literature points to the importance of treatment for psychological and somatic factors and coping mechanisms in many illnesses and complaints.

Oriental Medicine

     All naturopathic physicians are trained at an introductory level in the basics of Oriental medicine, and about one in five receives further training and specializes in it. Oriental medicine has been developed continuously for more than three thousand years in Asia and coexists along with conventional medicine today in China and Japan as a primary form of medicine. Dozens of peer reviewed journals are devoted to the scientific evaluation of Oriental methods, including both acupuncture and botanical medicine.
      Certain naturopathic treatment methods are well supported by conventional science. However, naturopathic physicians typically administer several treatments simultaneously, on the principle that treatments acting through different mechanisms may be more effective than any one of them used alone. They tailor groups of treatments to fit the individual needs of the patient. These complex protocols have only rarely been formally tested, although many of the individual treatments have been subjected to controlled trials. The orthodox approach of only testing single agents and the need for controlled conditions comes into conflict with the naturopathic practice of using protocols and adapting them to the patients' needs. Financial constraints also make the costs of evaluation of complex protocols prohibitive in some cases. The naturopathic profession continues to develop appropriate modes for outcomes analyses which include methodology acceptable to biomedical scientists.

NPLEX: Your Naturopathic Doctor IS Tested!

     NPLEX (Naturopathic Physicians Licensing Examinations) is an independent, nonprofit organization whose purpose is to provide a sound examination that would be nationally recognized and of such high quality and reliability that authorities regulating the practice of naturopathic medicine may grant a license without requiring further testing. Some jurisdictions require jurisprudence and other exams in addition to the NPLEX.

Purpose of NPLEX

     The purpose of the NPLEX exam is to ensure that the candidate has the knowledge necessary to practice safely. The NPLEX exam follows a blueprint based on a job analysis of the profession. The job analysis was created based on the results of a nationwide survey of naturopathic physicians to determine the conditions they were seeing and the treatments used in their practices.

     Licensing exams are meant to do considerably more than test what candidates learned in the classroom. Because they are based on blueprints of what takes place in actual clinical working conditions, NPLEX assesses what the candidate needs to know to practice safely. Research by NPLEX into the practices of the National Board of Medical Examiners (United States Medical Licensing Examination for MDs), the National Board of Chiropractic Examiners, and the National Council of State Boards of Nursing indicates that NPLEX observes every national standard in the development and scoring of health care licensing examinations.

Who is eligible to take the NPLEX exam?

     NPLEX consists of three sections, the Basic Science exams, the Clinical Science exams, and the Add-on exams. The requirements for eligibility to take the Basic Science exams typically include completion of the second year of naturopathic medical school. Requirements for eligibility to take the Clinical NPLEX typically include completion of requirements for graduation from an accredited naturopathic medical college. No candidate will be permitted to sit for the NPLEX exams who has not been approved by a licensing authority. To complete all 12 to 14 exams takes four days. Failing to pass even one exam means a postponement of practicing until the exam is successfully completed.

NPLEX study guide and tests

     The NPLEX blueprint is available at naturopathic medical school bookstores and is available for test candidates' use. The NPLEX blueprint is a study guide. However, the NPLEX exams test knowledge gained over a two to four-year period and it would be impossible to specify all the information needed to practice safely as a naturopathic physician. Therefore, the exams may test for knowledge that is not specified in the blueprints.

     The NPLEX Basic Science exams are designed to test the student's knowledge of anatomy, biochemistry, microbiology, pathology, and physiology. Of the 11 states that license naturopathic physicians, only CT and HI have elected not to require the Basic Science exam. If a candidate is initially licensed in one of these jurisdictions and later wants to become licensed in a jurisdiction that does require them, s/he will be required to successfully complete the Basic Science exams before being licensed.

     The NPLEX Clinical exams are designed to test the candidate's knowledge of the clinical sciences needed to be a safe and effective naturopathic physician. The clinical tests are required by every jurisdiction that provides for licensure of naturopathic physicians.

     Add-on exams (Homeopathy, Acupuncture, Obstetrics, and Minor surgery) are not required by every licensing authority. Different jurisdictions allow different specific physician practices, and some jurisdictions require a state test to cover these practices. The NPLEX exams are national exams and so candidates are required to have the general knowledge to practice in any jurisdiction, not just knowledge of the procedures which are allowed in one particular jurisdiction.

Establish the Passing Score

     Because NPLEX is a criterion-referenced exam series, each exam has a passing score that is independent of the passing scores of the other exams. The Angoff method is used to establish the minimum passing score.

     Naturopathic physicians rate the difficulty of each item by answering the question, "What percentage of minimally competent, entry level physicians would be expected to answer this item correctly?" (for Clinical items) or "What percentage of minimally competent students ready to enter the clinical phase of training would be expected to answer this item correctly?" (for Basic Sciences). This step is the key element for setting the passing standard. Thus, substandard education should not bring down exam standards as scoring on a curve would do, and variation in item difficulty is controlled for, rather than causing erratic passing rates as might be seen with an arbitrary passing score. The ratings from the physicians are averaged to get a cut score for an item. The cut scores for every item on the exam are averaged to determine the cut score for that exam.

Score Reports

     Scores are sent to the licensing authority through which the applicant is taking the exams approximately six weeks after administration of the exams.

Who Makes Up the NPLEX Board?

     The NPLEX Board is comprised of one representative from each jurisdiction giving the exams, one representative from each of the colleges graduating physicians eligible for licensing, one representative from the AANP, one from the Canadian Naturopathic Association, and two unaffiliated members. The NPLEX Board oversees the exam development process and provides input regarding jurisdictional and constituent needs.

How Is the Exam Assembled?

     Items for the exams are written by NDs in the United States and Canada and by other qualified professionals. These items are submitted on special forms detailing the source of the items, the references for the correct answer, and information about the item writer. Submitted items are added to a computerized item bank, and the exams are assembled. A Central Exam Committee reviews these assembled exams, substituting items as it deems appropriate, and finalizing the content. The exams are then sent to selected physicians for final proofreading. After corrections are made, the exams are produced as test booklets and sent to the exam sites for administration.

For further NPLEX information contact:

Christa Louise- Executive Director
PO Box 69657
Portland, OR 97201

Phone: (503)250-9141

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