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Chiropractic education trains future chiropractic practitioners. The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world.

Chiropractic practice is currently formally regulated in approximately 60 countries although chiropractors are also practicing in several other countries where there is no formal legal recognition of the profession.. To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published guidelines for basic training and safety in chiropractic [1] Chiropractors usually obtain a first professional, second entry, degree in Chiropractic. Typically a four year university undergraduate education is required to apply for the chiropractic degree.[2][3] In general, the World Health Organization lists three potential educational paths involving full‐time chiropractic education across the globe. This includes: 1 – 4 years of pre-requisite training in basic sciences at university level followed by a 4 year full‐time program; DC. A 5 year integrated bachelor degree; BSc (Chiro). A 2 - 3 year Masters program following the completion of a bachelor degree; MSc (Chiro).[4] These are considered "basic guidelines", however, and in countries where the practice of chiropractic is well established, the standards are frequently much higher.

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training.[4] Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy.[1] Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

All Chiropractic Examining Board requires all candidates to complete a 12 month clinical intership to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the chiropractor maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. Chiropractic medicine is regulated in North America by state/provincial statute. The regulatory boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[5]

Contents

Chiropractic degree

Doctor of Chiropractic (D.C. or DC) is an academic degree for chiropractic providers. All degrees in chiropractic are considered to be first professional degrees.[6] A D.C. is considered a "primary health care" provider in the United States and Canada.[7][8] This implies that a patient does not require a referral to seek treatment from a chiropractor. In this sense they are considered a "portal of entry" to the healthcare system.

Also known as a "chiropractic doctor" or "chiropractor", or "chiropractic physician" [9] , a Doctor of Chiropractic degree differs from a Doctor of Medicine degree "medical doctor" in scope and practice. In chiropractic, the practitioner health care provider seeks to diagnose, treat, correct, and prevent neurological, skeletal, or soft tissue dysfunction by primarily employing manual and conservative therapies; the most frequent being spinal and other articular adjustments and manipulations.[10]

The United States Department of Education currently states:

Chiropractic--Doctor of Chiropractic (D.C. or B.Chiro or M.Chiro), a curriculum divided into "straight" or "progressive" chiropractic depending upon the philosophy of the institution, generally requiring 4 academic years of full-time study after 2-4 years or more of study at the associate or bachelor's degree level.[11]

Although the U.S. Department of Education lists the D.C.M. (Doctor of Chiropractic Medicine) as a type of degree granted to chiropractors, the degree has never actually been conferred by any academic institution. The D.C.M. degree was first proposed by Western States Chiropractic College in 1994. Western States Chiropractic College had announced at the time its intentions of developing a post graduate D.C.M. training program that would prepare chiropractors to prescribe pharmaceuticals and perform minor surgery. [12]

Some New Zealand chiropractors appeared to have used the title 'Doctor' in a New Zealand Yellow pages telephone directory in a way that implied they are registered medical practitioners, when no evidence was presented it was true. This happened more often among chiropractors than acupuncturists or osteopaths.[13] In New Zealand, chiropractors are allowed to use the title ‘doctor’ when it is qualified to show that the title refers to their chiropractic role. A representative from the NZ Chiropractic Board says that entries in the Yellow Pages under the heading of 'Chiropractors' fulfills this obligation when suitably qualified.[14] The NZ Chiropractic Board noted that it publishes specific directions in its Code of Ethics and Standards of Practice as follows to using the title ‘doctor’: "The use of the title ‘Doctor’ must be qualified, for example, John Doe, Dr of Chiropractic or Dr John Doe, Chiropractor. Failure to qualify the use of the title ‘Doctor’ may contravene the provisions of the Medical Practitioners Act 1995 and he or she may be committing an offence under that Act.".[14] If a chiropractor is not a registered medical practitioner, then the misuse of the title 'Doctor' while working in healthcare will not comply with the Health Practitioners Competence Assurance Act 2003.[13]

Chiropractic education, licensure, and regulation

The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world, and their curricula, paradigms and scope of practice differ accordingly to the dominant belief structures within chiropractic.

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Australia

In Australia, a minimum of five-years worth of chiropractic education is needed before one may register as a practising chiropractor. Chiropractic is taught at three public universities: RMIT in Melbourne, Murdoch University in Perth and Macquarie University in Sydney. The RMIT and Macquarie programs graduate chiropractors with a bachelors degree followed by a masters degree while Murdoch University graduates attain a double bachelors degree, any of which is necessary for registration with state registration boards.[4]

A graduate of RMIT will have attained a Bachelor of Applied Science (Complementary Medicine - Chiropractic) and a Master of Clinical Chiropractic.[15] Similarly, a typical graduate of Macquarie University will have a Bachelor of Chiropractic Science followed by a Master of Chiropractic.[16] Murdoch University graduates possess the double-degree of Bachelor of Science (Chiropractic Science) / Bachelor of Chiropractic.[17]

The Council on Chiropractic Education Australasia undertakes accreditations of Australasian chiropractic courses [5]

The use of honorifics by chiropractors is under the jurisdiction of each state government. For example, NSW law states "A registered chiropractor must not use the title “doctor” in the course of the practice of chiropractic unless the chiropractor is the holder of a qualification conferred by a university that entitles the chiropractor to use that title"[18]

Canada

There are currently 2 schools of chiropractic in Canada: Canadian Memorial Chiropractic College, in Toronto, Ontario and the Universite du Quebec a Trois Rivieres, in Trois Rivieres, Quebec. Both programs are fully accredited by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards.[19] Canadian Chiropractic students undergo a course of study similar to that of other doctoral-level health care professionals, including medicine, optometry and dentistry and have similar entrance requirements. Students are required to complete a minimum of three years of university before they are eligible for admission to the CMCC Doctorate of Chiropractic Degree program. The majority of students entering the CMCC program have completed a baccalaureate university degree, and approximately 7% have a graduate degree.[20] The CMCC program is a privately funded institution and requires four years of full-time study, including a 12-month clinical internship.[21] The UQTR and CMCC programs both include courses in anatomy, biochemistry, embryology, immunology, microbiology, neurology, clinical nutrition, pathology, physiology, principles of chiropractic, radiology, and other basic and clinical medical sciences.[22] In terms of manual therapy skills, the technique department of CMCC teaches the diversified technique for spinal manipulative therapy, and have formally introduced soft tissue techniques in 2006.

Canadian chiropractic schools teach an evidence-based medicine paradigm as opposed to the traditional vertebral subluxation model. The chiropractic schools state that the role of the doctor of chiropractic is primary care for neuromusculoskeletal conditions.

Four Canadian public universities currently have government-funded Canada Research Chairs in Chiropractic, with plans to have at least one in each of Canada's 10 provinces in the near future. Pilot projects involving doctors of chiropractic in hospitals in the province of Ontario are underway.[23]

In August 2005, CMCC became the first private institution in Ontario to be granted the privilege of offering a professional health care degree under the Post-secondary Education Choice and Excellence Act. It sets the program within the hierarchy of education in Ontario as comparable to that of other primary contact health care professions, such as medicine, dentistry, and optometry.[24] As of 2005, graduates of CMCC are formally recognized to have at least 7–8 years of university level education which will facilitate the acceptance of credits if they choose to further their education at the post graduate level.[24] Additionally, CMCC offers chiropractic graduate studies in sport sciences, clinical sciences, and radiology following the 4 year Doctor of Chiropractic Degree [25]. CMCC also offers a 1 year continuing education programme in acupuncture. In contrast, the doctorate of chiropractic degree in Quebec is within a publicly funded university (UQTR) and is a five-year program following graduation from CÉGEP, a system of education that is unique to the province of Quebec.

In addition to the academic program, chiropractic education requires hands-on clinical experience under faculity supervision. This experience includes clinical assessment, diagnosis, treatment, and referral protocols. The multi-disciplinary faculty at both CMCC and UQTR have diverse backgrounds including MD's and PhD's that offer students a wide range of expertise in the medical and clinical sciences. Both the CMCC and the UQTR programs include courses in anatomy, neuroanatomy, neurodiagnosis, neuroscience, biochemistry, physiology, orthopaedics, diagnosis and symptomotalogy, laboratory diagnosis, embryology, principles of chiropractic, radiology, immunology, microbiology, pathology, clinical nutrition and other basic and clinical medical sciences. Additionally, four Canadian public universities currently have government-funded Canada Research Chairs in Chiropractic, with plans to have at least one in each of Canada's 10 provinces in the near future.

Canadian Chiropractic Examining Board requires all candidates to complete a 12 month clinical internship to obtain licensure, as well as write a total of 3 exams in their 4th year of study. Candidates must successfully pass Components A and B (Written Cognitive Skills Examination) to be eligible for the Clinical Skills Examination.[26] Canadian accrediting standards are higher than the United States, and admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America.[27]

South Africa

In SA (South Africa) there are two schools of chiropractic: the Durban Institute of Technology and the University of Johannesburg.[28] They are both 6 year full-time courses leading to an MTECH or Masters of technology in Chiropractic.

It's a legal requirement that chiropractors must be registered with the Allied Health Professions Council of SA (AHPCSA) the governmental statutory body in order to practice Chiropractic in SA. Being a member of the Chiropractic Association of SA (CASA) is voluntary. CASA is the only voluntary national association in the country and aims to promote the profession through publications in newspaper, interviews, internet and public enquires over the phone.

Currently continuing education is not compulsory in order to stay registered with the AHPCSA.

United Kingdom

In 1993 HRH Princess Diana visited the Anglo-European College of Chiropractic and became its patron. She also appeared at a news conference that launched a report calling for legislation to prevent unqualified individuals from practising Chiropractic in the UK.[29] In 1994, Parliament passed legislation regulating the practice of Chiropractic, like other health care professions, and creating the General Chiropractic Council as the regulatory board. Since that time, it is illegal to practice Chiropractic in the UK without a license.[30] There are three UK chiropractic colleges with chiropractic courses recognised by the General Chiropractic Council (GCC), the statutory governmental body responsible for the regulation of chiropractic in the UK.[31]

The McTimoney College of Chiropractic offers an Undergraduate Master Degree in human Chiropractic and 2 Post graduate Masters programmes in Animal Manipulation, plus a masters in Paediatric Chiropractic.[32] The Anglo-European College of Chiropractic graduates chiropractors with an undergraduate Masters degree (MChiro). The WIOC has also recently changed from a Bsc to an Mchiro programme.

It is a legal requirement that all chiropractors in the UK register with the GCC to practice. A minimum of 30 hrs per annum Continuing Professional Development is required to retain registration.[33]

United States

Graduates of chiropractic schools receive the degree Doctor of Chiropractic (DC), are referred to as "doctor", and are eligible to seek licensure in all jurisdictions. The Council on Chiropractic Education (CCE) sets minimum guidelines for chiropractic colleges, but additional requirements may be needed for a license depending on the jurisdiction where a chiropractor chooses to practice. All 19 chiropractic institutions are accredited by the CCE. In 1991, the University of Bridgeport established its College of Chiropractic, becoming the first chiropractic school in the USA to be affiliated with a university.[6]

Students often enter chiropractic school with a Bachelor's degree, but, in 2005, only one chiropractic college required this as an admission requirement.[34] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCE is 90 semester hours, and the minimum cumulative GPA for a student entering is 2.50. Commonly required classes include: psychology, biology, organic and inorganic chemistry, and physics. Other common medical classes are: anatomy or embryology, physiology, and microbiology. Chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, orthopedics, neurology, geriatrics, and nutrition.

To qualify for licensure, graduates must pass at least 4 (NBCE parts I - IV) and in some juristdictions 5 (NBCE Physiotherapy) examinations from the National Board of Chiropractic Examiners and complete State specific requirements; most State boards require at least 2 years of undergraduate education, and an increasing number require a 4-year bachelor’s degree. All licensing boards in the US require the completion of a 4-year program at an accredited college leading to the DC degree. Once licensed, most States require chiropractors to attend 12–50 hours of continuing education annually. Chiropractic colleges also offer postdoctoral training in Chiropractic Neurology, orthopedics, sports injuries, nutrition, industrial consulting, rehabilitation, radiology, family practice, pediatrics, and applied chiropractic sciences. After such training, chiropractors may take exams leading to "diplomate" status in a given specialty including orthopedics, neurology and radiology.

Other governing bodies and associations

Councils on Chiropractic Education International (CCEI)[7]

As the genesis of chiropractic and the major development of the profession occurred in the United States of America, chiropractic education was nurtured and developed in the US throughout the 20th century. Emulating that success in recent decades, chiropractors in other regions of the world have promoted this model for chiropractic education in their countries. As a natural consequence of these educational efforts and the establishment of effective accreditation practices, the US Council on Chiropractic Education has been joined by CCEs in Australia, Canada and Europe in efforts to assure excellence in chiropractic education and quality in the profession through accreditation. The success of this work has become evident in the solid development of chiropractic in their respective regions/countries.

While this quality assurance model and the CCEs themselves have taken hold in English speaking countries and across Europe where English can be used in professional circles, the same has not been true in other regions, some of which are showing tremendous interest and potential growth in chiropractic. Educational ventures in some of these locations seem to indicate endeavors of high quality. However, others are questionable and some seem to be cause for considerable concern with regard to inadequacy in the scope, thoroughness and quality of the education expected for practice of chiropractic. Unfortunately, but not unexpectedly, government, regulatory, and social acceptance of less than professional chiropractic sometimes seems to accompany instances of insufficient rigor and completeness in chiropractic education.

In recognition of these conditions and the need to assure quality in the further growth and development of the profession across the world, the four established CCEs have founded and developed CCEI as the means to address the educational aspects of this concern. CCEI recognizes that differing cultural, social/traditional, governmental and regulatory factors influence many situations, and CCEI endeavors to work and cooperate with related agencies and groups in the profession to address those challenges as well.

Council on Chiropractic Education (USA)

The Council on Chiropractic Education - USA (CCE-USA) is an agency for accreditation of programs and institutions offering the doctor of chiropractic degree. Its accreditations are recognized by the U.S. Department of Education. It seeks to insure the quality of chiropractic education in the United States by developing accreditation standards, encouraging educational improvement and providing public information.

Federation of Chiropractic Licensing Boards

The FCLB is a conglomeration of all 50 US state licensing boards and the District of Columbia. It also includes several Canadian provinces and US territories. Its stated purpose is to protect the public and to serve the member boards by promoting excellence in chiropractic regulation.[35]

See also

References

  1. ^ a b http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf
  2. ^ http://www.ac-fpeh.com/PDF/academic/Chiropractic.pdf
  3. ^ Chiropractic Education
  4. ^ a b World Health Organization (2005) (PDF). WHO guidelines on basic training and safety in chiropractic. http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf. Retrieved 2008-03-03.  
  5. ^ Facts & FAQs
  6. ^ Universities.com, First-Professional degree in Chiropractic (DC).online
  7. ^ The International Chiropractic Association, Chiropractic Quick Facts.available online
  8. ^ The Canadian Chiropractic Association, The Chiropractic Profession - Within the Health Care Framework.available online
  9. ^ [1] List of US States and the Fed. Gov't that recognize DC's as "Physicians"
  10. ^ Chiropractors U.S. Department of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-09 Edition.
  11. ^ First-Professional Studies: Degrees awarded
  12. ^ "Western States to offer 'Doctor of Chiropractic Medicine' degree". http://www.worldchiropracticalliance.org/tcj/1994/sep/sep1994b.htm. Retrieved 2008-01-27.  
  13. ^ a b Gilbey A (2008). "Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy". N Z Med J 121 (1278): 15–20. PMID 18670471.  
  14. ^ a b Karl Bale (2008). "Chiropractic Board New Zealand response to "Dr Who?" editorial". N Z Med J 121 (1280): 78–9. PMID 18791634. http://www.nzma.org.nz/journal/121-1280/3224/.  
  15. ^ RMIT Chiropractic
  16. ^ Macquarie University Department of Chiropractic
  17. ^ Murdoch University Chiropractic
  18. ^ Chiropractors Act 2001 No 15 Part 3 Division 1 Section 18
  19. ^ "Accreditation of Educational Programmes". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. http://www.chirofed.ca/english/accreditation.html. Retrieved 2009-10-16.  
  20. ^ "President's Message". Canadian Memorial Chiropractic College. http://www.cmcc.ca/ABOUTCMCC/WhoWeAre/PresidentsMessage/tabid/263/Default.aspx. Retrieved 2009-10-16.  
  21. ^ "Year IV (Clinical Education)". Canadian Memorial Chiropractic College. http://www.cmcc.ca/ACADEMICPROGRAMS/UndergraduateEducation/YearIV/tabid/144/Default.aspx. Retrieved 2009-10-16.  
  22. ^ "Becoming a Chiropractor". Ontario Chiropractic Association. http://www.chiropractic.on.ca/ChiropracticCare/WhoareChiropractors/BecomingaChiropractor.aspx. Retrieved 2009-10-16.  
  23. ^ Chiropractic Services - St. Michael's Hospital
  24. ^ a b Canadian Memorial Chiropractic College - Media Room
  25. ^ CMCC Division of Graduate Studies
  26. ^ [2]
  27. ^ [3]
  28. ^ "CASA : Student Info". http://www.chiropractic.co.za/index.html?lf=1;pg=14. Retrieved 2009-10-19.  
  29. ^ Staff (June 18, 1993). "Chiropractic Report Calls for Registry of DCs in United Kingdom". Dynamic Chiropractic 11 (13). http://www.chiroweb.com/mpacms/dc/article.php?id=42352.  
  30. ^ "Regulation of chiropractic". http://www.chiropractic-uk.co.uk/default.aspx?m=3&mi=19&ms=8&title=Regulation+of+chiropractic. Retrieved 12/02/2009.  
  31. ^ GCC Criteria for Recognition of Degrees in Chiropractic
  32. ^ McTimoney College Prospectus
  33. ^ GCC Continuing Professional Development
  34. ^ Wyatt, Lawrence H; Stephen M Perle, Donald R Murphy, and Thomas E Hyde (2005-07-07). "The necessary future of chiropractic education: a North American perspective". Chiropractic & Osteopathy 13 (10): 10. doi:10.1186/1746-1340-13-10. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1181629.  
  35. ^ Federation of Chiropractic Licensing Boards Mission statement

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