Joseph Brimhall, D.C. President, University of Western States

Review of Clinical Competencies Required by CCEsWORLD FEDERATION OF CHIROPRACTIC CONSORTIUM OF EUROPEAN CHIROPRACTIC EDUCATORSASSOCIATION OF CHIROPRACTIC COLLEGESEDUCATION CONFERENCERoyal University Center Maria Cristina, San Lorenzo, Madrid, SpainOctober 14, 2010 Joseph Brimhall, D.C. President, University of Western States President, Councils on Chiropractic Education International

CCE International (CCEI) • Australasia – CCEA • Europe – ECCE • Canada – CFCREAB • United States - CCE

CCE International • Not an accrediting agency • Association of accrediting agencies • Mutual endorsement and recognition based on equivalence of the accreditation standards • International Accreditation Standards

Role of Accrediting Bodies in Chiropractic Education • Establish and promulgate high standards to assure quality in the education of chiropractors • Work with the educational programs to assist them in adhering to the established standards • Utilize a standard process to evaluate how well an educational program adheres to the standards • Public disclosure regarding those educational programs that undergo such evaluation

What is accreditation? Certification of the quality of education by: • Development of valid criteria (Standards) • Self-study and assessment (self analysis) • Peer review evaluation (site-visit and report) • Accreditation decisions • On-going monitoring of compliance (interim reports, complaint process, data collection)

What is not accreditation? • Notscope of practice (jurisdictional law) • Notthe philosophy of chiropractic (trade organizations, schools, individual practitioners) • Notthe identity of the profession (trade organizations) • Notthe definition of chiropractic (jurisdictional law) • Notproscriptive—does not prohibit or restrict education

Outcome-based Accreditation • Less prescriptive—more autonomy for the educational program • Establishes expected results from the program, including the competencies of its graduates • “Begin with the end in mind”

Outcome-basedChiropractic Accreditation • Relies on an understanding of practicing chiropractic as a primary health care provider: • Primary contact (access, gate-keeper) • Primary ability to evaluate and diagnose • Primary ability to managethe patient’s health care (including direct care, recommendations, and/or referral)

Clinical Competencies • Defines what the graduate should be able to do • Attributes of an entry-level chiropractor • Relies on input from: • Jurisdictional licensing authorities • Professional trade organizations • Accredited educational programs • Practitioners • Public

Clinical Competencies • Attitudes, awareness • Skills, abilities • Knowledge, understanding • Characteristics, attributes

Clinical Competencies • Patient assessment or evaluation • Diagnosis, decision-making • Patient Management, planning • Implementation of care • Record keeping • Patient relationship • Public health – health advocacy – disease prevention • Information literacy • Ethics and professionalism

Patient Assessment • History • Physical examination • Psychological/psychosocial assessment • Radiology, imaging • Laboratory, specialized tests • Spinal examination • Neuromusculoskeletalexamination

Diagnosis • Consistent with history and examination • Working diagnosis • Differential diagnosis • Refer or collaborate as necessary for other expert opinions

Patient Management • Planning and implementation of care • Coordination of care • Lifestyle and healthy living • Evaluates progress; manages accordingly • Referral, collaboration, co-management

Chiropractic care • Spinal manipulation/adjustment • Extremity manipulation/adjustment • Soft tissue therapy • Physiotherapy modalities • Nutritional therapy – dietary counseling • Exercise and rehabilitation

Record keeping • “Legible, accurate, complete and current” • Accepted procedures and protocols • Legal requirements, release and request • Coding • Electronic health records?

Patient relationship • Maintain professional attitudes and behaviors • Partnership with patient • Appropriate boundaries, imbalance of power • Trust • Fiduciary duty to the patient

Public health – WellnessDisease Prevention • Health promotion; health screening • Leading health indicators • Community health issues, chiropractic role • Environmental issues • Social determinants of health • Hygiene • Disease prevention • Immunization? • Maintenance care?

Information Literacy • Ability to access and critically appraise research information • Research methods • Life-long learning – continuing education • Integrate new information

Ethics and Professionalism • Integrity – personal and professional • Jurisprudence • Ethical standards and conduct • Professional communication • “Moral character” • Licensure and regulation • Substance abuse; addictive behaviors • Financial dealings with patients • Dual relationships

“In a time of drastic change, it is the learners who inherit the future. The learned usually find themselves equipped to live in a world that no longer exists.”- Eric Hoffer

The End Thank you.

Joseph Brimhall, D.C. President, University of Western States