Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the conventional diagnosis of rheumatoid arthritis: effect of training. 
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).  The design was a prospective survey.  The study was conducted at the General Clinical Research Center, University of Maryland Hospital System, Baltimore, MD.  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.  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.  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).  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.