A perspective on Councils on Chiropractic Education accreditation standards and processes from the inside: a narrative description of expert opinion, part 2: Analyses of particular responses to research findings

Abstract

Background This is the second article reporting on a study that sought the views of people with extensive experience in Councils on Chiropractic Education (CCEs) on research that has raised concerns about variability in accreditation standards and processes for chiropractic programs (CPs) and chiropractic practice in general. Methods This qualitative study employed in-depth semi-structured interviews that consisted of open-ended questions asking experts about their thoughts and views on a range of issues surrounding accreditation, graduate competency standards and processes. The interviews were audio-recorded, and transcribed verbatim in June and July of 2018. The transcripts were reviewed to develop codes and themes. The study followed the COREQ guidelines for qualitative studies. Results The interviews revealed that these CCE experts were able to discern positive and negative elements of the accreditation standards and processes. They were, in general, satisfied with CCEs accreditation standards, graduating competencies, and site inspection processes. Most respondents believed that it was not possible to implement an identical set of international accreditation standards because of cultural and jurisdictional differences. This was thought more likely to be achieved if based on the notion of equivalence. Also, they expressed positive views toward an evidence-based CP curriculum and an outcomes-based assessment of student learning. However, they expressed concerns that an evidence-based approach may result in the overlooking of the clinician’s experience. Diverse views were found on the presence of vitalism in CPs. These ranged from thinking vitalism should only be taught in an historical context, it was only a minority who held this view and therefore an insignificant issue. Finally, that CCEs should not regulate these personal beliefs, as this was potentially censorship. The notable absence was that the participants omitted any mention of the implications for patient safety, values and outcomes. Conclusions Expert opinions lead us to conclude that CCEs should embrace and pursue the widely accepted mainstream healthcare standards of an evidence-based approach and place the interests of the patient above that of the profession. Recommendations are made to this end with the intent of improving CCE standards and processes of accreditation.

The accreditation role of Councils on Chiropractic Education as part of the profession's journey from craft to allied health profession: a commentary

“…This concern is not unique to chiropractic educational institutions [33,34]. Also, experts worried about the possible public safety implications resulting from students unable to master the complexity and volume of information required to practice competently [25]. It is during the undergraduate years that the future chiropractor will assimilate the contents of the course.…”

“…As previously discussed, not all CCEs belong to an international body, which works towards accepted minimum standards for chiropractic education. However, when asked, CCE experts did not believe it was possible for there to be an identical set of homogeneous international high-quality standards [25]. It was recognised that CCEs must function within their own regulatory and cultural environments and these are not uniform internationally.…”

“…A recent qualitative study seeking the views of key informants, who had extensive experience working within CCEs, offers insights that need to be considered when making recommendations for change [24,25]. The picture that emerged was of a group of accreditation experts who perceived the chiropractic profession to be a collection of health care providers with diverse and strongly held views on the nature of chiropractic care [24].…”

“…This has included, among other strategies, a lack of clear definitions for key terms such as "chiropractor", "diagnosis", and "competency", a lack of a whole-hearted acceptance of an evidence-based approach to standard educational development and clinical practice [29], and silence on known historically important traditional beliefs that have consequences for unwanted practitioner behaviours (subluxation / vitalism) [27,31]. Also incorporated are a lack of transparency around CP inspections [53], negotiated settlements on accreditation standards with disparate and vocal interest groups, and seemingly placing the perceived specialness or preservation of chiropractic above the interests of the patient [25].…”

“…Some of the CCE experts expressed the view that 'traditional' conservative and vitalist views are a personal belief and therefore outside the scope of the CCE standards and that any such regulation would be censorship of a CPs academic freedom [25]. It is true that academic freedom is "a system of complementary rights and obligations entitled to teachers and students as free enquirers" [61] and a fundamental right for CPs.…”