title: Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training.
abstract: OBJECTIVE
  To investigate whether a training process that focused on consensus on Traditional Chinese Medicine (TCM) diagnostic criteria will improve the agreement of TCM diagnosis on patients with rheumatoid arthritis (RA).
  
  
  METHODS
  The design was a prospective survey.
  
  
  METHODS
  The study was conducted at the General Clinical Research Center, University of Maryland Hospital System, Baltimore, MD.
  
  
  METHODS
  The participants were 42 patients with RA. PRACTITIONERS: The practitioners included 3 licensed acupuncturists with a minimum of 5 years' licensure and education in Chinese herbs.
  
  
  METHODS
  A training session of TCM diagnostic procedures was conducted with an open case discussion and "real time" practice. After the training, 3 TCM practitioners examined the same 42 patients with RA separately. Patients filled out a questionnaire to serve as the data for the "Inquiry" component while physical examinations, including observations of tongue and palpation of radial pulse, were conducted by the 3 practitioners. Each practitioner provided a TCM diagnosis based upon the examination results. These diagnoses were then examined with respect to the rate of agreement among the 3 practitioners.
  
  
  RESULTS
  The average agreement with respect to the TCM diagnoses among the 3 pairs of TCM practitioners was 73% (64.3%-85.7%). Statistically significant differences were found between this study and the two previous studies (p < 0.001).
  
  
  CONCLUSIONS
  After training focused on consensus on TCM diagnostic criteria, we found that these 3 same TCM practitioners who were used in phase II of the study produced a significantly higher agreement when compared to study phase I or phase II. Our study suggests that improved consensus on TCM diagnostic criteria results in increased agreement of diagnosis.
authors.affiliation: Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD 21207, USA. gzhang@compmed.umm.edu
authors.forename: Grant G
authors.initials: GG
authors.lastname: Zhang
authors.forename: Betsy
authors.initials: B
authors.lastname: Singh
authors.forename: Wenlin
authors.initials: W
authors.lastname: Lee
authors.forename: Barry
authors.initials: B
authors.lastname: Handwerger
authors.forename: Lixing
authors.initials: L
authors.lastname: Lao
authors.forename: Brian
authors.initials: B
authors.lastname: Berman
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D008396:Maryland; D008516:Medicine, Chinese Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D010808:Physical Examination / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012107:Research Design; D014481:United States
chemical_list: D004365:Drugs, Chinese Herbal