For students, the Seattle Institute of East Asian Medicine, which was established in 1994, provides an active, clinically-based graduate program in acupuncture and Chinese herbal medicine. A small instructor-to-student ratio ensures purposeful training and frequent skill assessments in patient care and varied treatments. At the end of their apprentice-style studies, 90 percent of alumni become active in clinical practice. For patients, SIEAM has long been a provider of affordable alternative healthcare, including herbal consultations, shiatsu massage, and tui na, a form of Chinese manipulative therapy often used in conjunction with acupuncture and t'ai chi. Services are explained and executed by interns with help from the faculty—all have a minimum of ten years experience treating patients.