Chiropractic education

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Founded in 1945, the Canadian Memorial Chiropractic College, in Toronto, Ontario, Canada.

Chiropractic education trains future chiropractors. The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the worldcitation needed. To help standardize chiropractic education, in 2005 the World Health Organization published guidelines for basic training in chiropractic.1 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 Doctorate 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).2

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.2 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.

Contents

Chiropractic career

Realistic median annual wage of chiropractors was $67,200 in May 2010.3 According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively.4 Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

Components

Basic sciences

Recognized programmes either require essential basic science components as prerequisites, or include necessary units of chemistry, physics and biology within the first‐year curriculum.

Pre-clinical sciences

The preclinical science components within chiropractic programmes generally include: anatomy, physiology, biochemistry, pathology, microbiology, pharmacology and toxicology, psychology, dietetics and nutrition, and public health.

Clinical sciences

Clinical science components would include or cover: history‐taking skills, general physical examination, laboratory diagnosis, differential diagnosis, radiology, neurology, rheumatology, eyes, ears, nose and throat, orthopaedics, basic paediatrics, basic geriatrics, basic gynaecology and obstetrics, and basic dermatology.2

International degrees in Chiropractic

Degree Full Name Country in which it is awarded
B.App.Sc. (clin). & B.C.Sc. Bachelor of Applied Science (Clinical Science) & Bachelor of Chiropractic Science Japan
B.Sc. (chiro) & B.C. Bachelor of Science (Chiropractic) & Bachelor of Chiropractic Australia, Japan
B.App.Sc. (Compl) & M.Clin.Chiro. Bachelor of Applied Science (Complementary Medicine) & Master of Clinical Chiropractic Australia
B.Chiro. Bachelor of Chiropractic New Zealand
B.Chiro. & M.Chiro Bachelor of Chiropractic & Master of Chiropractic Australia
B.Sc. (Hons) Chiro Bachelor of Science (Hons) Chiropractic Malaysia
B.Tech. (chiro) and M.Tech. (chiro) Bachelor in Technology (Chiropractic) & Master in Technology (Chiropractic) South Africa
D.C. Doctor of Chiropractic Brazil, Canada, France, Japan, Mexico, South Korea, Spain, Sweden
M.C. or M.Chiro. Master of Chiropractic or Master in Chiropractic Australia, Switzerland, UK
M.C.B. Master in Clinical Biomechanics Denmark
M.Tech. (chiro) Master in Technology, Chiropractic South Africa

Investigations

Spinal dysfunction/subluxation

Main article: Spinal dysfunction

Spinal dysfunction, dubbed subluxation by chiropractors, is hypothesized to interfere with optimal biomechanics, thereby altering proper neurological function. Chiropractic theory suggests spinal dysfunction/subluxation may contribute to neuromusculoskeletal and visceral disorders via aberrant spinal segmental and suprasegmental reflexes. While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial.5 Chiropractors suggest spinal manipulation normalizes spine biomechanics, and as a consequence, normalizes afferent input to the central nervous system resulting in optimized neurological function and improved health outcomes.6

Manual and manipulative therapy

A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.7 It describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.8 Spinal manipulation gained mainstream recognition9 and acceptance during the 1980s,9 which has led to increased collaboration between chiropractors and medical doctors. Currently they are developing inter-professional pathways of care for manual and conservative treatment of neuromusculoskeletal disorders.101112 It is the most common intervention used in chiropractic care.13 In North America, chiropractors perform over 90% of all manipulative treatments14 with the balance provided by osteopathic medicine and physical therapy. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.15 Typically, it is performed on patients who have failed to respond to other forms of treatment.16 There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.17 Although serious injuries and fatal consequences can occur and are likely to be under-reported,18 these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.2

Safety

The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manipulative therapists, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindication apply only to the manipulation of the affected region.19

Adverse events in spinal manipulation studies are believed to be under-reported 20 and appear to be more common following HVLA manipulation than mobilization.21 Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.17 These events typically dissipates within 24–48 hours 22 Serious injuries and fatal consequences, especially to SM in the upper cervical region, can occur.23 but are regarded as rare when spinal manipulation is employed skillfully and appropriately.19

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.242526 Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.27 A 2012 systematic review determined that there is insufficient evidence to support a strong association or no association between cervical manipulation and stroke.28

Evidence-based practice guidelines

The 1990s resulted in a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines. In the current advent of the evidence-based medicine era, chiropractic scholars have generated evidence-based systematic reviews and practice guidelines with respect to the management of acute and chronic low back pain,2930 thoracic pain, neck pain,31 headache,32 radiography,333435 as well as extremity conditions;3637 tendinopathy38 myofascial pain/trigger points,39 and non-musculoskeletal conditions.40

Licensure and regulation

See also: List of chiropractic schools

Regulations for chiropractic practice vary considerably from country to country. In some countries, such as. the United States of America, Canada and some European countries, chiropractic has been legally recognized and formal university degrees have been established. In these countries, the profession is regulated and the prescribed educational qualifications are generally consistent, satisfying the requirements of the respective accrediting agencies. However, many countries have not yet developed chiropractic education or established laws to regulate the qualified practice of chiropractic. In addition, in some countries, other qualified health professionals and lay practitioners may use techniques of spinal manipulation and claim to provide chiropractic services, although they may not have received chiropractic training in an accredited programme.

United States

Graduates of chiropractic schools receive the degree Doctor of Chiropractic (DC), and are eligible to seek licensure in all jurisdictions. The Council on Chiropractic Education (CCE) sets minimum guidelines for chiropractic colleges,41 All 18 chiropractic institutions are accredited by the CCE. 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 3.0 on a 4.0 scale.42verification needed Common prerequisite classes include those of the biological, chemical, & physical sciences, including: human anatomy and physiology, embryology, genetics, microbiology, immunology, cellular biology, exercise physiology, kinesiology, general chemistry, organic chemistry, analytical chemistry, biochemistry, toxicology/pharmacology, nutrition, nuclear medicine, physics, biomechanics, and statistics.43 American chiropractic schools tend to have lower entry requirements than medical or dental schools.44 In 2005, only one chiropractic college required a bachelors degree as an admission requirement.45

Australia

In Australia, a minimum of five-years worth of chiropractic education is needed before one may register as a practicing chiropractor. Chiropractic is taught at four public universities: RMIT in Melbourne, Murdoch University in Perth, Macquarie University in Sydney and new in 2012 Central Queensland University in Mackay. The RMIT, UCQ 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.46

A graduate of RMIT will have attained a Bachelor of Applied Science (Chiropractic) and a Master of Clinical Chiropractic.47 Similarly, a typical graduate of Macquarie University will have a Bachelor of Chiropractic Science followed by a Master of Chiropractic.48 Murdoch University graduates possess the double-degree of Bachelor of Science (Chiropractic Science) / Bachelor of Chiropractic.49 Students at University of Central Queensland graduate with a Bachelor of Science (Chiropractic) followed by a Master of Chiropractic Science.50

Canada

There are currently two 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.51 In 2010, the majority of students (87%) entering the CMCC program had completed a baccalaureate university degree, and approximately 3% have a graduate degree.52 The CMCC program is a privately funded institution and requires four years of full-time study, including a 12-month clinical internship.53 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.54

Pilot projects involving doctors of chiropractic in hospital emergency rooms in the province of Ontario are underway.55 Canadian Chiropractic Examining Board requires all candidates to complete a 12 month clinical internship to obtain licensure, as well as write a total of three exams in their fourth year of study. Candidates must successfully pass Components A and B (Written Cognitive Skills Examination) to be eligible for the Clinical Skills Examination.56 Canadian accrediting standards are higher than the United States, and admission requirements into the Doctorate of Chiropractic Degree program are the strictest in North America.57

South Africa

In SA (South Africa) there are two schools of chiropractic: the Durban Institute of Technology and the University of Johannesburg.58 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.

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 practicing Chiropractic in the UK.59 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 call oneself a Chiropractor in the UK without being registered with the General Chiropractic Council.60 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.61

The McTimoney College of Chiropractic offers an Undergraduate Master Degree in human Chiropractic and two post-graduate Masters programmes in Animal Manipulation, plus a masters in Paediatric Chiropractic.62 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.citation needed

It is a legal requirement that all chiropractors in the UK register with the GCC to practice. A minimum of 30 hours per annum Continuing Professional Development is required to retain registration.63

New Zealand

The College was formed in 1994 by the New Zealand Chiropractors’ Association (NZCA) to address the demand created by a shortage of chiropractors in New Zealand. Its first location was in Auckland city and its founding President was Dr Jim Stinear. By the end of 1999 New Zealand Qualifications Authority (NZQA) approval of the BSc (Chiropractic) /BSc qualification had been gained and College ownership was transferred to the NZCA Chiropractic Education Trust, a not-for-profit organisation. In 2002 the College was renamed the New Zealand College of Chiropractic. In 2005 the College obtained its first accreditation by the CCEA (Council on Chiropractic Education Australasia). The College was re-accredited in 2007 and in the same year moved to its new campus in Mount Wellington.

Fellowships and scholarly designations

Chiropractors, like other health care professionals, can pursue post-graduate education in various chiropractic specialties such as animal chiropractic, sports chiropractic as well as clinical sciences, radiology and others. There are some other chiropractic credentials, however, that are not recognized by the major health care organizations, medical or chiropractic communities. The following is a comprehensive list of the various designations that chiropractors can attain with further continuing and post-graduate education programmes.

Accreditation

Main article: Councils on Chiropractic Education International

Chiropractic is governed internationally by the Councils on Chiropractic Education International (CCEI). This body is officially recognized by the World Federation of Chiropractic and the World Health Organization as the accrediting agency for schools of chiropractic across the world. In 2005, in efforts to improving the consistency and equivalency in chiropractic schools, the basic training and safety were developed.64

See also

References

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  47. ^ RMIT Chiropractic
  48. ^ Macquarie University Department of Chiropractic
  49. ^ Murdoch University Chiropractic
  50. ^ CQU - Bachelor of Science (Chiropractic)
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  53. ^ "Undergraduate education". Canadian Memorial Chiropractic College. Retrieved 2011-08-21. 
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  61. ^ GCC Criteria for Recognition of Degrees in Chiropractic
  62. ^ McTimoney College Prospectus
  63. ^ GCC Continuing Professional Development
  64. ^ "Basic training and safety in chiropractic". World Health Organization. Retrieved 16 February 2013.