Chiropractic Education

An interesting take on chiropractic education from another blog I read. However, lest we be disingenuous, we can find find plenty of examples throughout physical therapist educational programs where the academic credibility of their faculty is far less than desirable. Using the late Steven J. Rose's analogy, much works remains convincing some physical therapist program faculty that they should strive for much more than being a 'school teacher'.

John

Download ChiroEducationSlidesver9.ppt

Comments

[JD Garbrecht]

John,

It is interesting that this posted the exact day I had a conversation on this matter with a young man finishing his Bachelor’s in Exercise Science and looking at going to Chiropractic School, specifically Life University. I will have to copy this presentation and give it to him. I spent about a ½ hour explaining to him about chiropractic and the different schools and then also spent some time talking to him about Physical Therapy schools that had good manual medicine clinicians as part of their faculty. Additionally, I focused on Vision 2020 for the Physical Therapy. Unfortunately, he had some false impressions in my view about both chiropractic and physical therapy. I did tell him there are different schools of thought in chiropractic and the traditional or straight view versus the mixer or orthopractic approach. I informed also, that the majority of evidence based research on the benefits of manipulation had actually been performed by physical/physio therapists. It was amazing to me that this man had spent time observing both professions and came away with the impression that if he wanted to perform manipulation and actually “treat” the patient with hands on techniques versus a wholly modality or exercise based approach that he needed to pursue chiropractic. I think John is right that we can point our finger at some problems or fallacies in chiropractic education, but from a biblical perspective those without sin throw the first stone. Therefore, we need to take a hard look at the education in our own PT programs.
At this point, Regis University, U Pittsburgh, USC, Baylor, and others received plugs for having good manual medicine practitioners on faculty. I am a University of Wisconsin guy, but unfortunately Bill Boissonnault was not teaching Ortho there at that time. I think this goes back to Rob Wainner’s comments on “where are the goods.” There is not the emphasis on the psychomotor skills to actually develop good entry level practitioners. In fact, at the time of my attendance there seemed to be an actual de-emphasis on these skills but then a frustration when students were unable to perform as expected. We had myriad classes where we talked about things, but very few classes where we actually did things. So when PT’s go out into practice they are not secure in their skills and consequently resort to exercises, modalities, and protocols instead of an integrative approach encompassing manual medicine skills. We need to have a good science background and this can be provided by the PhD’s who have not seen a patient in 25 years and working in the rabbit lab. However, just as importantly we need clinical professors who are board certified in their respective practice areas teaching the clinical classes. We must also identify a basic skill set (Flynn et al CD) of manual medicine practice in our programs where one of the faculty is a Fellow in the academy and teaches and practices manual medicine.
It is interesting to note that many athletic training programs look at delivering the goods and set up their curriculum based on developing those psychomotor skills through many hours of practice and mentorship. All too often I heard “you will be shown that on your clinical.” I am not always so sure my clinical instructors received that “word.”

One only has to look at the continuing education circuit:

A sure way to sell out a course is to advertise “this is a lab course” if we are really delivering the goods in our programs would clinicians be so starved to go somewhere and pay hundreds of dollars to work on their psychomotor skills. I am not bashing the educational circuit. I just think it demonstrates that we are not delivering the good to PT students. It is now almost 8 years since I graduated and I am board certified in one area and sitting for a board exam in another, but I still feel that I have a long way to go to deliver the goods to my patients.
I think John mentioned this awhile back about how continuing education units are done and the variability between states. I think this is where we need to come up with a minimum national standard divided into content areas and courses need to be approved for credit through the APTA. The state boards could increase the number of hours, but the courses would still need to have received approval from the APTA. I think the free exchange of information, such as this blog helps start us on the right pathway for providing and ensuring physical therapists are the best qualified providers for musculoskeletal care.

JD

[Louie Puentedura]

John,

Thanks for posting such a timely topic. I am currently reading "Spin Doctors" written by Paul Benedetti and Wayne MacPhail (http://www.amazon.com/gp/product/155002406X/qid=1133641847/sr=8-21/ref=sr_8_xs_ap_i7_xgl14/102-0276380-9404933?n=507846&s=books&v=glance)
and it is a very eye-opening and informative read. The book was recommended to me by Bill Kinsinger, MD from Oklahoma City, OK, who I had the distinct pleasure to meet recently when we presented on Spinal Manipulative Therapy at an evening lecture series in Kansas City, MO. Mike Teston, PT from Arkansas, who was successfully sued by the Arkansas Chiropractic Board for practicing 'chiropractic' without a license and fined $10,000 was also there. See http://www.defendphysicaltherapy.com/

JD, I couldn't agree with you more. I also believe we need to do more to ensure entry-level physical therapists are provided the necessary skill set to provide "hands on" techniques that "actually treat" the patient. I've been using spinal manipulative therapy as a part of my clinical practice since graduating from PT school in Melbourne, Australia in 1980, and then completing a Post Graduate Diploma in Manipulative Therapy at the same university in Australia in 1983. I started taking students on clinical placements as soon as I arrived here in the USA in 1995, and I've never looked back. I've done the best I could to ensure that those students were "shown that on your clinical" and then some. But I believe that I'm not doing enough and I want to do more to pass on my clinical skills and manipulative therapy experience. I've offered to teach courses at PT Programs close to me in Southwest Arizona, but have never been taken up on the offer. I guess all we can do is be role models and continue to offer our services, and one day, hopefully, we'll make a difference.

Thanks again for the great post. I hope it generates plenty of comments and discussion.

[Britt Smith]

John, JD & Louie,
Great points all the way around. The DOD paper, Shekelle et al 2000, on should the VA system allow chiros full primary care priveleges (direct access) was illuminating. I believe Shekelle et al conducted the random review of 80 patient charts (small n) and found:
33% had a review of systems
37% had vital signs
23% had evidence of a posture/gait analysis
53% had an orthopaedic exam
80% recorded a diagnosis

Again, I also agree with stones & sinners and stones & glass houses...I would probably be frightened by what I would see in 80 random PT chart reviews!!! Let's keep working on our cleaning up our own mess. Onward and upward.

Louie,
Here, Here....you have great hands (and mind to boot!) and long experience in manual therapy, so keep on keeping on with the teaching efforts. I recommend you continue with the neurodynamics class in the t-DPT program at NAU and integrate information (and manipulations) as appropriate within the course. I agree that you have a lot to offer all levels of learners. Have a very Merry Christmas
Britt

[Rob Landel]

Not much time to post a cogent reply to this (I’m continually impressed by the level of discourse and command of the English language on this site), except to repeat a saying we have here WRT acquiring psychomotor skills:

“You can talk all you want about how to hit a Randy Johnson fastball, but sooner or later you’re going to have to step up to the plate and take a few swings.” -- Jim Harrison, DPT, OCS

[Aiyna]

The chiropractic approach to health care stresses the patient’s overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body’s inherent recuperative abilities. They also recognize that many factors affect health, including exercise, diet, rest, environment, and heredity. Chiropractors recommend changes in lifestyle that affect those factors. In some situations, chiropractors refer patients to or consult with other health practitioners.
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Aiyna

http://www.addictionlink.org/drug-rehab-center/arkansas