The modern chiropractic education demands a high level of competency. Each school must abide by the standards set by the Council on Chiropractic Education (CCE). Below is an explanation of the CCE's role:
The Council on Chiropractic Education (CCE) is the agency recognized by the U.S. Secretary of Education for accreditation of programs and institutions offering the doctor of chiropractic degree. CCE seeks to insure the quality of chiropractic education in the United States by means of accreditation, educational improvement and public information. CCE develops accreditation criteria to assess how effectively programs or institutions plan, implement and evaluate their mission and goals, program objectives, inputs, resources and outcomes of their chiropractic programs. The CCE is also recognized by the Council for Higher Education Accreditation (CHEA) and is a member of the Association of Specialized and Professional Accreditors (ASPA).In the world of physical therapy, the CAPTE program exists which accredits graduate programs and in the world of medicine, the ACGME program exists for medical schools and COCA is the program that accredits osteopathic schools. Each school seeking accreditation must meet a certain criteria that satisfies each council's objectives for education.
In medicine and physical therapy, there are exams in place that measure each students clinical and critical thinking skills. These exams are called OSCE's. OSCE stands for: Objective Structured Clinical Examination which can be found here: http://www.oscehome.com/OSCEs_Formats.html. These exams are very good at weeding out weaknesses in each individual's clinical development. The school then holds workshops and further evaluation for those students who did not meet the required level of competency. Eventually, each student reaches a similar level of competency.
Only a few chiropractic schools have OSCE's in their programs. The University of Western States is one school that has OSCE's. Students take two parts, one is held in their 9th term and the other is in their 11th term. The first involves a 3 hour skill/critical thinking and medical history evaluation. Students go room to room with new patients in every other room. On the door outside the room, a prompt is given which helps the student formulate a strategy for the patient encounter. In the non-patient rooms, there is a set of 15-20 questions to answer about the particular patient encounter in the previous room. The second OSCE involves 3 patient encounters involving a medical history, a physical examination and writing up a treatment plan. The student is evaluated on their medical history skill, their appropriate selection and application of orthopedic, medical and neurological tests and their ability to write a solid management plan.
On top of the OSCE evaluations, the National Board of Chiropractic Examiners (NBCE) has board exams that must be passed to obtain a national license. These exams consist of four parts and a physiotherapy exam which is optional for some states. All states require Doctors of Chiropractic to pass all four parts of the boards. Some states require an additional state examination to obtain a license. The national boards are difficult to prepare for and are similar to medical licensing board exams and physical therapy boards. Once passed, there is a set amount of continuing education that must be maintained each year for continued licensure.
Beyond evaluation at the national, state and college level, each student must get through the rigorous 4 year doctorate program. Clinical requirements must also be met starting in the students 3rd year. Including, 265 patient visits, complex cases (management of health conditions beyond musculoskeletal disease), laboratory analyses (CBC, blood chemistry etc.) and narrative reports, progress reports and of course, many treatment plans. The attending chiropractic physician evaluates each student on their development in all aspects of patient care.
My hope is that this explanation of the clinical competency's used in the world of chiropractic, will help people understand the rigor of our education and further develop professional respect.
