The Chiropractic Education Position and Implementation Statement

Statement 1

Chiropractic education and training must  acknowledge the biopsychosocial model of health care and be underpinned by biologically plausible theories and peer-reviewed research. It should embrace the value of clinical experience, shared decision-making and a patient-centered approach to care.

Position on Implementation

• The content of chiropractic education is founded on biologically plausible theories and research
• Evidence-based practice according to Sackett et al.¹   should be identifiable and embedded in appropriate curriculum content
• The biopsychosocial model underpins clinical training and is identifiable and embedded in appropriate curriculum content

Teachings outside the above should either be removed as part of the core curriculum or alternatively be taught in a historical context.

 Statement 2

Upon graduation, chiropractic students should be equipped to work effectively and collaboratively to deliver improved quality of life outcomes for patients with musculoskeletal disorders. This will, of necessity, incorporate:

• An evidence-based approach to the case history, physical examination, diagnostic imaging, diagnosis, report of findings and management plan that may include a range of clinical  interventions
• Effective communication in a language that is clearly understood by all stakeholders in healthcare, thereby facilitating interprofessional practice and promoting effective collaboration between health care teams
• Knowledge of preventative measures including but not limited to musculoskeletal care, encompassing wider public health and health promotion initiatives

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• Understanding their responsibility to put the health interests of their patients first
• Being able to identify the health needs of patients using appropriate enquiry and assessment
• Having a thorough and detailed knowledge of musculoskeletal disorders and pain syndromes, and other pathologies that may mimic them or co-exist with them
• Being competent to understand and critically appraise scientific and clinical evidence to inform clinical practice
• Understanding clinical practice guidelines and the challenges of implementing them
• Understanding and being able to apply evidence-based care by incorporating the best available evidence from research, their own clinical experience, and the preferences of the patient
• Offering patient-centred care by engaging, enabling, and supporting patients in an objective based plan of management
• Understanding the actions, complications, and side-effects of commonly used medications in musculoskeletal conditions
• Understanding key concepts surrounding good nutritional advice
• Having a basic understanding of musculoskeletal conditions in distinct populations such as older adults, athletes, pregnant patients, and children
• Playing an active role in promoting disease prevention supporting national public health initiatives at a local level
• Being competent in recognising and applying appropriate procedures in an emergency situation
• Understanding the importance of working within the limits of their skills and competencies
• Participating in interdisciplinary collaboration

 Statement 3

Wherever possible, chiropractic educational programs should form or develop affiliations with established public and private universities preferably within a medical or health science faculty.  Such links may develop opportunities for interprofessional education and collaborative practice.

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• Training in collaborative clinical practice
• A working knowledge of both primary and secondary care and the and engage in a multidisciplinary setting
• Knowledge concerning the structure and processes involved in national health systems where they impact interdisciplinary communication and care approaches

 Statement 4

Chiropractic educational institutions should support their faculties in the provision of innovative models for the development of knowledge, learning and skills. These should focus on facilitating scholarly activity including research, interprofessional education and teaching within the context of emerging health care models.

 Position on Implementation

Chiropractic faculty should have clearly identifiable opportunities to upgrade their:

• Qualifications in paedagogical teaching skills
• Qualifications with contemporary evidence-based trends in the area of musculoskeletal medicine and other relevant areas as defined in statement 2
• Research skills and research career opportunities (eg. Academic staff should be encouraged to register in a Prof Doctorate/ PhD programme)

 Statement 5

The teaching of vertebral subluxation complex as a vitalistic² construct that claims or implies that it is the cause of or contributes to disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary.

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• An evidence-based approach to a wide range of manual clinical interventions
• An understanding of the therapeutic encounter as a  ‘package of care’ when articulating the active components of chiropractic management
• An understanding of the best evidence available regarding the nature and clinical effects of spinal manipulative therapy

Teaching of non-evidence-based theoretical explanatory models underpinning the manual clinical interventions should be removed from the curriculum or be taught in a historical context.

 Statement 6

Chiropractic education should reflect ethical practice and professional standards throughout the curriculum. Upon graduation, students must understand their responsibilities to their patients, their communities and to the profession.

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• Evidence-based patient-centred ethical practice which adheres to current clinical guidelines and aligning to professional values.

Teachings outside the above should either be removed as part of the core curriculum or alternatively be taught in a historical context.

 Statement 7

Practice styles³, which may contribute to inappropriate patient dependence, compromise patient confidentiality or require repeated exposure to ionising radiation are not part of an undergraduate chiropractic curriculum. Students should be taught to recognise that such approaches are not acceptable in terms of the best interests of patients or the chiropractic profession.

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• Evidence-based and patient-centred musculoskeletal management plans which adhere to current best practice clinical guidelines.
• A clinical guideline aligned  approach to radiology and radiography which focuses on clinical justified, appropriate referrals and report interpretation.

Teachings outside the above should either be removed as part of the core curriculum or alternatively be taught in a historical context.

 Statement 8

Immunization. The chiropractic programs below support the World Health Organization ‘WHO’s vision and mission in immunization and vaccines - 2015-2030⁴.

 Position on Implementation

The curriculum must clearly identify opportunities for students to demonstrate:

• An understanding of current public health and health promotion initiatives according to the recommendations of WHO, national and local government initiatives.

Teachings outside the above should either be removed as part of  the current curriculum or alternatively be taught in a historical context.