What Should Be the Goal of Chiropractic Education?

At my first CCE meeting in April, there was a great deal of discussion about entrance requirements for chiropractic students. The push in the profession from organizations such as the Federation of Chiropractic Licensing Boards (FCLB), National Board of Chiropractic Examiners (NBCE) and most of the chiropractic colleges is for higher entrance requirements. But the higher entrance requirements being discussed focus only on academics, specifically science courses and GPAs.

The prevailing attitude is to require more science courses and higher GPAs to get into chiropractic colleges. "This would allow students to be more successful in chiropractic programs and in taking national boards, since a high GPA in science courses usually indicates success in chiropractic school and on the national boards," we're told.

There is also a misconception in the health care arena, often perpetuated by chiropractic organizations such as the FCLB and NBCE, that there are too many chiropractors in practice. And of course, higher entrance requirements for chiropractic colleges may limit the number of students and eventually chiropractors in practice.

This way of thinking is wrong on several levels. The real issue is not oversaturation, but rather a need to increase our market share. If chiropractors are to be viewed by the general public as providers of preventive health care and lifetime wellness care, then fewer than 50,000 chiropractors will never fill the need. After all, there are 600,000 medical doctors in the United States today, and still many parts of the country are underserved. Certainly, if we see people for a greater scope of care than just treating disease (the medical model) as we should, then we will need many more chiropractors to fill the need. That need is even greater outside the United States. In Brazil, for example, there are 171 million people and only eight chiropractors.

To graduate more chiropractors who are educated to be successful in practice, those of us in chiropractic colleges must take charge of the educational process. We must cease deferring to trade, political or government organizations.

At chiropractic colleges, we need to ask the logical followup question to this discussion. Do proposed higher entrance equirements ensure that students will be successful in practice?

That's a question only a few people are beginning to ask. At Palmer, we put together an educational task force to answer it. The task force is actually addressing several questions: 1) What are the attributes of a successful chiropractor? 2) What kind of a curriculum would you design to produce that kind of a chiropractor? 3) What entrance requirements would you need to best assure someone would be successful in that curriculum?

"What are the attributes of a well-rounded, successful chiropractor?" the group came up with four attributes: 1) ability to integrate chiropractic philosophy into the science and practice of chiropractic; 2) highly developed interpersonal skills; 3) ability to manage a business in a manner that allows them to deliver optimal patient care; and 4) possessing life skills in the areas of values, personal growth and professional development that would support continued growth in these areas.

At Palmer, we now offer practice management courses two years into the life of a chiropractor after graduation. We will soon be teaching students courses in personal developmental skills (like integrity, commitment and values) during the first third of their education. In the middle trimesters, we'll teach professional development; in the latter trimesters, we'll emphasize the values of practice management and business management.

An additional change, basically a modification of our current curriculum, is the integration of chiropractic philosophy into the curriculum. Chiropractic curricula has traditionally focused on one subject area, such as anatomy or philosophy, and taught classes until the student has mastered the subject, then moved on to the next subject area. National board examinations are also designed this way. We've taken one subject, chiropractic philosophy, and integrated it into all phases of the curriculum. This integration ensures that students learn how philosophy relates to all subjects they study, from basic sciences to clinical practice.

Another modification of the current system we've already implemented at Palmer is to restructure our curriculum into year-one, year-two and year-three groups. The faculty will work together to ensure that all classes are integrated within the three groups, so that students have a better understanding of how each class relates to another.

This is only the beginning. To ensure we produce successful chiropractors, we will need to make more sweeping changes. One of the four curriculum designs the task force researched and brought forward for consideration is called a "threaded curriculum." In this type of system, a student in the first year, for example, wouldn't have individual classes in CNS, PNS and spinal anatomy, but one class called "chiropractic." A series of instructors would discuss chiropractic principles, the central nervous system and spinal anatomy. So instead of having individual classes, you would present the information in a pragmatic sequence, then test the student's competencies at the end of year one on everything they should have mastered.

The goal of chiropractic education should be to produce chiropractors who have the life skills to be successful on many levels. A high GPA upon graduation does not necessarily translate into practice success. In terms of entrance requirements, this means that we should not only look at a prospective student's academic qualifications, but also their interpersonal communication skills, their willingness to work hard, and their passion for being a chiropractor. Our curriculum should also hone these basic skills so that the doctors of chiropractic we graduate are fully capable of success at every level.