Comparing the old to the new: A comparison of similarities and differences of the accreditation standards of the chiropractic council on education-international from 2010 to 2016

Abstract

BackgroundChiropractic programs are accredited and monitored by regional Councils on Chiropractic Education (CCE). The CCE-International has historically been a federation of regional CCEs charged with harmonising world standards to produce quality chiropractic educational programs. The standards for accreditation periodically undergo revision. We conducted a comparison of the CCE-International 2016 Accreditation Standards with the previous version, looking for similarities and differences, expecting to see some improvements.MethodThe CCE-International current (2016) and previous versions (2010) were located and downloaded. Word counts were conducted for words thought to reflect content and differences between standards. These were tabulated to identify similarities and differences. Interpretation was made independently followed by discussion between two researchers.ResultsThe 2016 standards were nearly 3 times larger than the previous standards. The 2016 standards were created by mapping and selection of common themes from member CCEs’ accreditation standards and not through an evidence-based approach to the development and trialling of accreditation standards before implementation. In 2010 chiropractors were expected to provide attention to the relationship between the structural and neurological aspects of the body in health and disease. In 2016 they should manage mechanical disorders of the musculoskeletal system. Many similarities between the old and the new standards were found. Additions in 2016 included a hybrid model of accreditation founded on outcomes-based assessment of education and quality improvement. Both include comprehensive competencies for a broader role in public health. Omissions included minimal faculty qualifications and the requirement that students should be able to critically appraise scientific and clinical knowledge. Another omission was the requirement for chiropractic programs to be part of a not-for-profit educational entity. There was no mention of evidence-based practice in either standards but the word ‘evidence-informed’ appeared once in the 2016 standards.ConclusionsSome positive changes have taken place, such as having bravely moved towards the musculoskeletal model, but on the negative side, the requirement to produce graduates skilled at dealing with scientific texts has been removed. A more robust development approach including better transparency is needed before implementation of CCE standards and evidence-based concepts should be integrated in the programs. The CCE-International should consider the creation of a recognition of excellence in educational programs and not merely propose minimal standards.

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

“…Papers in this series have again revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession [13,19,20], as well as disagreements and variation in relation to education of chiropractors [14,15] and chiropractic clinical practice [11]. In our opinion, it is ironic that while chiropractic has a strong presence in large parts of the world [3], is taking on increasingly important roles in disability prevention [6,7,17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved.…”

“…Two papers reported on issues relating to education of chiropractors. Innes et al compared accreditation standards from the Councils of Chiropractic Education between 2010 and 2016 and found that while there had been a move towards a focus on musculoskeletal care, mention of competencies in appraising scientific evidence and evidence-based practice had been removed from the criteria [14]. Funk et al searched websites of 46 chiropractic educational programs in order to identify and count the mention of the term subluxation, and found that it is much more prevalent in descriptions of US-based educational institutions, and in fact the mention of subluxation had increased between 2011 and 2017 [15].…”

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

“…Not surprisingly, the views of CCE experts were that accreditation standards were a result of compromises made to reconcile diverse and strongly held opinions about the scope of chiropractic practice in order to accommodate all practitioners' perspectives [25]. This view is reinforced by the knowledge that subsequent revisions of standards have shown few signs of addressing undesirable consequential graduate practices and an unwillingness to adopt key standards accepted by other mainstream allied health care providers [29,30]. 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].…”

“…These include matters involving CP staff, chiropractic registration and licensing boards, chiropractic associations, government departments, health consumer groups, and the public at large. Until recently there has been a paucity of research exploring chiropractic education standards, however recent studies have begun to critically review those making the standards (CCEs) [24,25], chiropractic students who are engaged in the learning (as dictated by the standards) [23,26,27] and the standards themselves [28][29][30][31].…”

Are Councils on Chiropractic Education expectations of chiropractic graduates changing for the better: a comparison of similarities and differences of the graduate competencies of the Chiropractic Council on Education-Australasia from 2009 to 2017

“…While revisions of the CCE-International accreditation standards for chiropractic programs have been reviewed for changes over time [22] no study has explored expectations for graduating chiropractors. Consequently, we chose to investigate the graduate competencies of one CCE, namely the CCE-A for such changes.…”