David J. Schleich, PhD
The competition for skilled, numerate, literate, compassionate students for naturopathic medical programs is brisk. Not only are these students sought after for our own ND programs, but medical and allied health programs that attract students interested in careers as primary care practitioners and healers often find them earlier than we do. Even though our applicant pool is growing, we need strategies to make it grow faster and to reach potential students who are curious about natural medicine but cannot easily find their ways to us.
One tool that can seamlessly deliver more information and awareness to potential students earlier and more often is the “articulation agreement.” Well-known in higher education, particularly in the continuum between community colleges and baccalaureate completion programs, there are successful articulation models we can adopt and adapt to disseminate our health career and natural healer message to many more students than we currently reach. The challenge is that articulation agreements are labor-intensive and usually require the nod of accreditors, thus stretching out the time it takes and the cost in staff time to establish partnerships that work effectively. They also require not only being savvy about how to negotiate an articulated continuum between a feeder program and the target ND program, but also about what it takes to provide protracted stewardship for the arrangement.
Currently, applicant pools tend to be demarcated by the well-known factors of geography, price, reputation, facilities, and referrals. Some NDs fear that new programs will inevitably emerge in California, New York, and Florida, which will attract the usual applicant pool pathways faster than the aggregate will grow. Others are worried that the cluster of so-called “integrated medicine” programs at universities (soon amounting to four dozen) will confuse the feeder market and stall or derail growth in our pool. The time to pay closer attention to developing a network of articulation agreements, therefore, is now. The Association of Accredited Naturopathic Medical Colleges (AANMC) could lead this initiative.
An articulation agreement is an officially approved (by a faculty, board, administration, or accreditor) agreement that pre-assesses prerequisite coursework and aligns particular schools with Council on Naturopathic Medical Education-accredited ND programs. These pathways can be designed to help students make a smooth transition when transferring from secondary school to associate or baccalaureate degree programs, all the way to orientation in an ND program. Such agreements are formal, systematic, written collaborations between two institutions designed to identify equivalent courses and clarify requirements so that students can more easily transfer between the two institutions. Completing these agreements can be a lengthy process that involves the faculty and administration at both institutions. These agreements must also be periodically updated to reflect any changes in curriculum or requirements at the institutions, as well as changes that programmatic and regional accreditors may determine to be necessary, although this latter consideration is historically more reactive than proactive. There are many types of articulation agreements, ranging from institutional transfer agreements to pre-medical articulation programs.
For example, at its discretion and within its institutional framework, an accredited ND program may want to accept transfer credit from accredited institutions or foreign universities, U.S. military credit, credit by examination, or credit from miscellaneous sources, such as internships and nontraditional learning experiences. In all cases, notwithstanding prevailing practice, which would exclude some sources because they are not contemplated within the existing language of the programmatic accreditor or regional accreditor standards language, federal access legislation, federal and state equity legislation, and the common sense decisions and experience of the faculty of the specific institution whose teachers are central to describing, delineating, and assessing the academic record of individuals during the admission process are all relevant variables in an articulation policy for an institution.
In Canada, the United States, the United Kingdom, New Zealand, and Australia, articulation or, more specifically, “course articulation,” refers to the process of comparing the content of courses that are transferred between post-secondary institutions of various types. The challenge is that all such institutions are not always mutually understood. For example, how do the academic credits of the Australian Technical and Further Education institutes compare with the associate degree credits of an American community college or the diploma credits of a Canadian community college? To what extent is the academic credit of an American 4-year state college equivalent to the academic credit of a British undergraduate “honors” degree program?
Essentially, despite these variations in higher education structure among jurisdictions, articulation agreements are the process by which one institution matches its courses or requirements to course work completed at another institution. Students use course articulation to ensure that the courses they complete will not have to be repeated at the institution to which they are transferring. This is especially important for a “long view” articulation agreement, which tracks a student throughout his or her undergraduate, pre-ND school preparation. Course articulation is distinct from the process of acceptance of earned credit from one institution by another, as applicable toward its degree requirements, that is, “transferring credit.”
Course articulation may be done on an ad hoc basis when a student actually wishes to transfer. It may also be done pursuant to existing course-to-course comparison data, or it may be based on formal articulation agreements. In the last case, representatives of each institution compare their respective course curricula to determine which courses are comparable and which are not. Their consensus is then formalized in a written agreement that is used by students and advisors and is regularly updated according to a mutual schedule.
Although credit transfer can be conducted between educational bodies in separate countries or within the same country but between differing institutions (e.g., state colleges and community colleges), the process of articulation can become very complicated when students transfer courses that have been earned at multiple or international campuses, have been earned more than 5 to 10 years earlier, or represent alternative credit experiences, such as examination or military credit.
For our purposes in the ND world, a transfer articulation agreement process needs to be conceived, developed, and executed with precision and consensus among all the stakeholders, including the programmatic and regional accreditors. The agreements amount to academic partnerships between similar or even dissimilar institutions. They provide students with the opportunity to advance toward a place in an ND program by transferring more courses, completing coursework sooner, and, most important of all, becoming familiar with an articulated pathway that exposes them to what is expected in the ND program ahead of them.
The best agreements for ND programs are both comprehensive and bilateral. They are comprehensive in that they build into an undergraduate program not only the necessary prerequisites, but also familiarization activities for potential ND students as far back as possible. For example, a student in an associate degree science program would also be exposed to information sessions, preadmission materials, orientation sessions about the career path of NDs in his or her state or provincial jurisdiction, and frequent one-to-one mentoring during the relationship. The bilateral nature of such a comprehensive agreement strengthens not only its utility for the student, but the “stewardship” for the pathway, in that mentors with full information about the steps, requirements, challenges, and timing exist in both institutions. Both institutions have ongoing communication about the students in the articulated pathways, and both institutions are committed to facilitating a trajectory that encourages and supports the student toward the career goal.
There are numerous outstanding examples of articulation models from which we can learn. For example, the Albany Medical College program in science, humanities, and medicine offered at Siena College is positioned early in the education continuum, jointly accepting more than two dozen students directly out of high school into what amounts to an 8-year pathway leading to the doctor of allopathic medicine (MD) degree. With the right proposal and information platform, there is no reason why a pathway leading to bona fide ND programs could not also work.
Essentially, students in the top tier (10%) of their class, with a 1300 Scholastic Aptitude Test (SAT) score, are eligible to apply to the Albany program. But the trappings of eligibility do not stop with SAT scores. Other factors, such as what the Albany Medical College program calls “altruism” (community service), leadership, communication skills (written and spoken), and demonstrated “contributions to the Siena community” are part of the equation. Because applicants (high school seniors) would have to indicate very early on (at the freshman application stage, in fact) that they are applying for the program, the need for adequate stewardship (admissions officers of ND programs in substantial communication with guidance counselors in the feeder high schools) would be critical. At Siena, finalists for the program are invited to campus for a formal interview early in the spring semester. This kind of articulation pathway takes a lot of work, but the payoff in the form of skilled, numerate, literate, compassionate students for naturopathic medical programs could be powerful.
Assumption College in Worcester, Massachusetts, has an equally impressive articulation structure in place. Their bachelor of arts (BA)/MD program is structured such that Assumption students who fulfill the terms of the agreement are seamlessly accepted at the American University of Antigua (AUA) College of Medicine, an accredited program preparing students for medical practice in the United States and Canada. The agreement requires students to have a grade point average of 3.25 or higher, but at least 3.0 in the prerequisite courses required by AUA. Further, students in the pathway need a score of 24 or higher on the Medical College Admission Test, coupled with a favorable recommendation from an AUA admission officer who has interviewed the applicant in person (bilateral stewardship).
Another articulation program example is the partnership between Assumption College and Des Moines University College of Osteopathic Medicine. This accelerated 7-year continuum includes both undergraduate and professional education curricula leading to a BA degree in Biology from Assumption College and a Doctor of Osteopathic Medicine (DO) degree from Des Moines University. In 3 years, the Assumption students can complete their general education requirements and most of their major requirements and be eligible to enter medical school. Part of this dynamic relationship between schools and programs includes two courses that Assumption students actually take at Des Moines and apply toward their Assumption College major, which are determined case by case with their Health Professions Advisor. After year 1 at Des Moines, the students can receive a BA degree in biology from Assumption. After year 4 at Des Moines, the students can obtain a DO degree.
There are many outstanding articulation models such as these, which the AANMC can study and use to create “action templates” for its members. Hawaii Pacific University (HPU), for example, has a pre-medical studies program that has a track record of meeting requirements for medical, dental, and veterinary schools all over North America. Pre-medical students at HPU are plugged into volunteer work and internships that contemplate later medical careers. HPU has an enviable reputation for guiding students through articulation agreements for transfer programs into the Doctor of Physical Therapy program at Caroll College in Wisconsin, the Doctor of Chiropractic program at Los Angeles College of Chiropractic, and the Doctor of Physical Therapy program at Creighton University in Nebraska. It would be entirely possible to create a pathway to a Doctor of Naturopathic Medicine program that could capture the interest of HPU’s highly diverse and energetic graduates.
Let us convene a planning meeting of the admissions officers of our programs and the leaders of the AANMC to create not only templates for articulation agreements, but a strategic plan to generate two dozen such agreements in the next 5 years.
David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd), and the University of Toronto (PhD).
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