The accreditation role of Councils on Chiropractic Education; The educational journey from craft to profession

Stanley I. Innes

Introduction Economies require healthcare practitioners, such as chiropractors, to assist in providing safe, effective and economical care for lower back pain, globally the leading cause of disability-adjusted life years. A minority of chiropractors have been shown to have highly undesirable practice behaviours that have implications for public health and patient safety. These practice patterns appear to be associated, to some extent, with the chiropractic program they were trained at. This indicates a need for scrutiny of international chiropractic educational and practice standards. For chiropractic the establishment and monitoring of educational standards is the responsibility of Councils on Chiropractic Education (CCEs). Methods This scrutiny required gaining an understanding of the complex system in which CCEs function. To this end our objectives were to comprehend the "language" of the system by comparing internationally, CCE graduating chiropractic student competency lists and educational / accreditation standards and processes. In addition, we sought to explore the relationship of unsuitable chiropractic practice profiles and various intrinsic and extrinsic factors such as personality, beliefs and attitudes with the clinical decisions of chiropractic students and practitioners. Results By comparing all the CCEs accreditation standards and processes we found they became increasingly dissimilar as our research drilled down to describe the various domains and subdomains. Definitions are urgently needed for clarity around key terms. We were able to make recommendations for quality improvements in CCE standards and processes as well as develop an outcome measure to assist Australian chiropractic accreditation processes. We also learned that CCEs have enabled a "big tent" approach that allows dichotomous "traditional" and "evidence-based" approaches to clinical care to co-exist. This, combined with the view that chiropractic is "unique", highly valued, best understood by other chiropractors, explains how students and practitioners can cling to 'traditional' thinking and this has implications for public safety. Conclusion We conclude that CCEs are in need of re-vitalising and make recommendations to this end. We argue that the "raison d'être" of CCEs is to take a more forthright stand and better serve the patients' best interests.

The accreditation role of Councils on Chiropractic Education; The educational journey from craft to profession

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