Chiropractic education

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

Chiropractic education trains future people in chiropractic, a form of alternative medicine concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine, under the belief that such a disorder affects general health via the nervous system. Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results.^[1] Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.^[1] Throughout its history chiropractic has been the subject of internal and external controversy and criticism.

The entry criteria, structure, teaching methodology and nature of chiropractic programs offered at chiropractic schools vary considerably around the world.^[2]

According to a 2005 guideline by the World Health Organization (WHO), 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.^[3]

Occupation

Chiropractic education trains people in chiropractic, a form of alternative medicine^[4] concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine, under the belief that such a disorder affects general health via the nervous system.^[5] The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.^[6] The "specific focus of chiropractic practice" is chiropractic subluxation.^[7]

Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results.^[1] Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain.^[1] A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition.^[8]

Throughout its history chiropractic has been the subject of internal and external controversy and criticism.^[9][10]

It is the largest alternative medical occupation,^[9] and UK chiropractors often aspire to become primary care providers, though they lack the medical and diagnostic skills necessary to fulfil this role.^[11] The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling.^[6] The "specific focus of chiropractic practice" is chiropractic subluxation.^[7] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence.^[12] Some chiropractors fear that if they do not separate themselves from the traditional vitalistic concept of innate intelligence, chiropractic will continue to be seen as fringe profession.^[9]

The median annual wage of chiropractors in the United States was $66,160 in May 2012.^[13]

Training

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

Regardless of the model of education utilized, prospective chiropractors without 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 calculates out to 21 hours per week, using a standard 50 week year. This includes a minimum of 1000 hours of supervised clinical training.^[3] Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed. All Chiropractic Examining Boards require candidates to complete a 12-month clinical internship to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the chiropractor maintains malpractice insurance. Nonetheless, there are still some variations in educational standards internationally, depending on admission and graduation requirements. Chiropractic is regulated in North America by state/provincial statute, and also—to some extent—by the Business and Professions Code (e.g., in the state of California)--and the Case Law. Further, it has been argued that, at least in some states (in the USA), that this license subsumed the previous "drugless practitioner" license, and includes—within its scope of practice—that of the previous discipline.

In some countries, like the United States, chiropractors earn a professional doctorate where training is entered after obtaining between 90 and 120 credit hours of university level work (see second entry degree) and in most cases after obtaining a bachelor's degree. The World Health Organization lists three potential educational paths involving full‐time chiropractic education around 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 Master's degree following the completion of a bachelor's degree leads to the MSc (Chiro).^[3] In South Africa the Masters of Technology in Chiropractic (M.Tech Chiro) is granted following 6 years of university.

International degrees in chiropractic

Various degree designations for the chiropractic field exist in different countries. They generally follow the Bachelor's, Master's, Doctorate scheme.^[14]

Licensure and regulation

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 program.

Chiropractic is governed internationally by the Councils on Chiropractic Education International (CCEI). This body is recognized by the World Federation of Chiropractic and the World Health Organization as the accrediting agency for schools of chiropractic around the world.^[2] The minimum prerequisite for enrollment in a chiropractic college set forth by the CCEI is 90 semester hours, and the minimum cumulative GPA for a student entering is 3.0 on a 4.0 scale. 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.^[15] Chiropractic programs require at least 4,200 hours of combined classroom, laboratory, and clinical experience.

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 bachelor's degree followed by a master's degree while Murdoch University graduates attain a double bachelor's degree, any of which is necessary for registration with state registration boards.

A graduate of RMIT will have attained a Bachelor of Applied Science (Chiropractic) and a Master of Clinical Chiropractic.^[16] Similarly, a typical graduate of Macquarie University will have a Bachelor of Chiropractic Science followed by a Master of Chiropractic.^[17] Murdoch University graduates possess the double-degree of Bachelor of Science (Chiropractic Science) / Bachelor of Chiropractic.^[18] Students at University of Central Queensland graduate with a Bachelor of Science (Chiropractic) followed by a Master of Chiropractic Science.^[19]

Canada

There are currently two schools of chiropractic in Canada: Canadian Memorial Chiropractic College, in Toronto, Ontario and the Université du Québec à Trois-Rivières, in Trois-Rivieres, Quebec. Both programs are fully accredited by the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards.^[20] In 2010, the majority of students (87%) entering the CMCC program had completed a baccalaureate university degree, and approximately 3% have a graduate degree.^[21] The CMCC program is a privately funded institution and requires four years of full-time study, including a 12-month clinical internship.^[22] 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.^[23]

Pilot projects involving doctors of chiropractic in hospital emergency rooms in the province of Ontario are underway.^[24] 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.^[25] 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.^[26]

Germany

There are no accredited chiropractic schools in Germany. Chiropractors that are qualified abroad need a license as physician or healing practitioner "Heilpraktiker". In the past the authorities demanded a general examination to obtain the license as Heilpraktiker. In recent rulings German courts decided that the graduation of an accredited school of chiropractic and professional experience abroad has to be recognized to obtain the license as Heilpraktiker limited to the field of chiropractic.^[27]

South Africa

In South Africa (SA) there are two schools offering chiropractic: the Durban Institute of Technology and the University of Johannesburg.^[28] Both offer a 6-year full-time course leading to a Masters of Technology (M.Tech) in Chiropractic; the course comprises two years of basic sciences followed by four years specialising in chiropractic, and incorporates a research dissertation. In order to practice in SA chiropractors are required to complete an internship, and must be registered with the Allied Health Professions Council of SA (AHPCSA) the relevant governmental statutory body. Membership of the Chiropractic Association of SA (CASA) is voluntary; CASA is the profession's sole national association and aims to promote Chiropractic through publications in newspaper, interviews, internet and other public inquiries.

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.^[29] 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.^[30] 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.^[31]

The McTimoney College of Chiropractic offers an Undergraduate master's degree in human Chiropractic and two post-graduate Masters programmes in Animal Manipulation, plus a masters in Paediatric Chiropractic^[32] The Anglo-European College of Chiropractic graduates chiropractors with an undergraduate master's degree (MChiro). The WIOC has also recently changed from a Bsc to an Mchiro programme.

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.^[33]

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;^[34] 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 2.8 on a 4.0 scale.^[35] Common prerequisite classes include those of the biological, chemical, and 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.^[36] In 1997, American chiropractic schools tended to have lower entry requirements than medical or dental schools.^[37] In 2005, only one chiropractic college required a bachelor's degree as an admission requirement.^[38]

Accreditation

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 around the world.

In 2005, in efforts to improve consistency and equivalency in chiropractic training, the WHO published basic training and safety guidelines to provide international minimum requirements for chiropractic education and to serve as a reference for national authorities in establishing an examination and licensing system for the qualified practice of chiropractic.^[2]

See also

• Medical school

References