There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders. However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.
Purpose: In 2008, the European Academy of Chiropractic decided to develop a competency-based model for graduate education in Europe. The CanMEDS (Canadian Medical Education Directives for Specialists) framework describes seven competency roles (fields) and key competencies identified as fundamental to all specialist doctors. It was not known how these fields are perceived by chiropractors in Europe. The purpose of this study was to compare perception scores of senior chiropractic as well as medical students with perception scores of licensed chiropractors and to analyze practitioners' remembered confidence in these competency fields. Methods: An anonymous 5-point Likert scale electronic questionnaire was sent to senior students of two chiropractic schools and licensed chiropractors of five European nations. Age and gender differences as well as differences in appraisal of the competencies in respect to importance and remembered confidence were analyzed. Results: Response rates were low to moderate. Agreement of importance of the seven competencies was not different between chiropractic and medical students as well as licensed chiropractors. Chiropractic students and chiropractors regarded all key competencies as important (averages ½4.0). The importance versus remembered confidence was consistently judged higher by about 1/2 point on the 5-point scale, significant for all competency fields (p < .001). Conclusion: The seven competency fields seem to be of the same importance for chiropractic senior students and licensed chiropractors and might be considered as a base for future graduate training in chiropractic. The survey should be replicated with additional samples and further information should be gathered to reflect reality. (J Chiropr Educ 2009;23(2):123-133)
BackgroundIn 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU) and the European Academy of Chiropractic (EAC) involved in the European Committee for Standardization (CEN) process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations.ObjectiveTo introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems.DiscussionProviding health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care.ConclusionsBefore a reporting and learning system can be established it has to be clear what the objectives of the system are, what resources will be required and whether the implementing organisation has the capacity to operate the system to its full advantage. Responding to adverse event reports requires the availability of experts to analyse the incidents and to provide feedback in a timely fashion. A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.
BackgroundThe literature on chiropractic safety tends to focus on adverse events and little is known about how chiropractors ensure safety and manage risk in the course of their daily practice. The purpose of this study was to investigate how chiropractors manage potentially risky clinical scenarios. We also sought to establish how chiropractors perceive the safety climate in their workplace and thus whether there is an observable culture of safety within the profession.MethodsAn online questionnaire was designed to determine which of nine management options would be chosen by the respondent in response to four defined clinical case scenarios. Safety climate within the respondent’s practice setting was measured by seeking the level of agreement with 23 statements relating to six different safety dimensions. 260 licensed chiropractors in Switzerland and 1258 UK members of The Royal College of Chiropractors were invited to complete the questionnaire. Questionnaire responses were analysed quantitatively in respect of the four clinical scenarios and the nine management options to determine the likelihood of each option being undertaken, with results recorded in terms of % likelihood. Gender differences in response to the management options for each scenario were evaluated using the Mann–Whitney U (MWU) test. Positive agreement with elements comprising each of the six safety dimensions contributed to a composite ‘% positive agreement’ score calculated for each dimension.ResultsQuestionnaire responses were received from 76% (200/260) of Swiss participants and 31% (393/1258) of UK members of The Royal College of Chiropractors. There was a general trend for Swiss and UK chiropractors to manage clinical scenarios where treatment appears not to be successful, not indicated, possibly harmful or where a patient is apparently getting worse, by re-evaluating their care. Stopping treatment and/or incident reporting to a safety incident reporting and learning system were generally found to be unlikely courses of action. Gender differences were observed with female chiropractors appearing to be more risk averse.ConclusionsSwiss and UK chiropractors tend to manage potentially risky clinical scenarios by re-evaluating the case. The unlikeliness of safety incident reporting is probably due to a range of recognised barriers, although Swiss and UK chiropractors are positive about local communication and openness which are important tenets for safety incident reporting. The observed positivity towards key aspects of clinic safety indicates a developing safety culture within the Swiss and UK chiropractic professions.
was chosen because the organizers wanted a venue in Europe and because this European university has a chiropractic educational program and had outstanding facilities to house delegates and the conference. CLINICAL TRAINING IN CHIROPRACTIC EDUCATION: MEETING THE DEMANDS OF A NEW ERA Are graduates well prepared for independent clinical practice? Are they prepared for the evolving health care world, characterized by collaboration, integration, evidence-informed best practices, patient safety, accountability, and a variety of practice environments and career choices? Do they know how to manage lifelong learning and apply scholarship to practice? How should chiropractic educators and organizations address these challenges? 1 The subject matter of the conference was undergraduate and postgraduate chiropractic clinical training, including faculty and clinician scholarship, and
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