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Issue 10 - July2004 Educators look at the past and ponder the future Education plays a critical role in how a profession forms, develops and becomes recognized and accepted by the public as something more than a career, but a calling that requires considerable training and specialized study. Chiropractic Economics asked the presidents of the nation’s chiropractic colleges to look back on chiropractic education and tell us how it has changed during the last 50 years, what changes they see for the future and how their institutions will cope with these changes. The presidents were: • Carl Cleveland III, DC, Cleveland Chiropractic College (CCC); • Gerard Clum, DC, Life Chiropractic College West (LCCW); • Guy F. Riekeman, DC, Life University (LU); • George A. Goodman, DC, FICC, Logan College of Chiropractic (LCC); • Reed B. Phillips, DC, PhD, University of Health Sciences/Los Angeles College of Chiropractic (LACC); • James Winterstein, DC, National University of Health Sciences (NUHS); • Frank J. Nicchi, MS, DC, New York Chiropractic College (NYCC); • Alfred D. Traina, DC, FACO, Northwestern Health Sciences University/Northwestern College of Chiropractic (NWCC); • Donald Kern (interim president), DC, Palmer College of Chiropractic (PCC, Davenport and Florida); • Peter Martin, DC (interim president), Palmer College of Chiropractic West (PCCW); • Fabrizio Mancini, DC, FICC, FACC, Parker College of Chiropractic (Parker); • Jerry L. Hardee, EdD, Sherman College of Straight Chiropractic (SCSC); • Richard G. Brassard, DC, Texas Chiropractic College (chief administrative officer), (TCC); • Frank Zolli, DC, University of Bridgeport College of Chiropractic (UBCC); • Joseph Brimhall, DC, Western States Chiropractic College (WSCC); We’ve compiled their answers reflecting similarities and differences into a “virtual round table” discussion.
Changes in chiropractic education Dr. Cleveland (CCC): The CCE (Council on Chiropractic Education) served to bring the chiropractic educational community to the table to collectively develop educational standards and to foster cooperation and collegiality within the diversity of chiropractic education. The ACC (Association of Chiropractic Colleges) has served as a unifying influence within chiropractic education. Dr. Clum (LCCW): The movement of educational prerequisites for admission to three years of undergraduate study has served in part to reduce the number of second-career persons who are seeking to become chiropractors. This, in turn, has reduced the valuable input that second-career and more mature students bring to a campus. Dr. Riekeman (LU): The two most significant events [changing chiropractic education] were the creation of the Council on Chiropractic Education and the access to student loans. These two factors caused a change not only in content and delivery of education, but also to facilities and research unimagined and unrealized even 30 years ago. Dr. Traina (NWCC): Accreditation was essential to establishing uniform standards, which in turn allowed access to federal loan programs. The National Board of Chiropractic Examiners has been able to set national standards guaranteeing minimum competency and defining the knowledge base required in clinical science, basic science and in practice. Dr. Mancini (Parker): Accreditation by the CCE as well as regional accrediting agencies has brought acceptable educational parameters and defined outcomes with focus. Dr. Goodman (LCC): Chiropractic education has incorporated research and service into its mission and probably the most striking development is the strength of curricular development and emphasis on the clinical aspects of the delivery system.
Dr. Kern (PCC): We’ve seen the addition of pre-professional education as a requirement for entrance into a chiropractic college. Some states require a bachelor’s degree (in science in some instances), either as an entrance requirement or as a graduation requirement. School days have been lengthened by many institutions to include seven classes per day in some terms. Some institutions have added additional quarters or trimesters. Dr. Martin (PCCW): Over the last 50 years, we’ve become a learned discipline, with a valuable body of accumulated knowledge and a commitment to scholarship. We have a faculty engaged in active research paralleling that of medical education. Dr. Phillips (LACC): Today there is more science and less dogma. Joseph Brimhall, DC (WSCC): The profession has moved toward evidence-based practice, has improved scientific inquiry of the practice of chiropractic and has enjoyed increased credibility and acceptance. Dr. Hardee (SCSC): [Education has been] strengthened in academic quality and interaction with the academic community but it is not as well focused on the chiropractic mission itself. Dr. Brassard (TCC): There has been a greater emphasis on research and scientific validation of chiropractic.
Dr. Zolli (UBCC): The ACC has helped to move major legislation for the profession. In the process, the member institutions of the ACC have been able to focus our efforts on providing quality education to the future practitioners of chiropractic. Chiropractic in the future Dr. Goodman (LCC): The future dictates that ethical paradigmatic examples determine the curriculum as compared to the present. Chiropractic education will integrate into the professional healthcare educational mainstream. This does not mean that our profession must become homogenized from an identifiable viewpoint, but if our system of education is to remain viable we must meet the standards of the future.
Dr. Winterstein (NUHS): Chiropractic medicine must attain a more integrated role with the total healthcare delivery system or it will gradually cease to exist. I also think the profession will undergo significant changes as we see a tiering of its practitioners through advanced educational processes and through hospital-based credentialing systems. Dr. Nicchi (NYCC): Chiropractic will become more mainstream over the coming years, yet it will remain a distinct profession by adhering to traditional chiropractic tenets and through the continued administration of the chiropractic adjustment. Dr. Phillips (LACC): Integration with other CAM [complementary and alternative medicine] professions will be significant. Dr. Traina (NWCC): Chiropractic will be fully incorporated into every major healthcare arena, from the Veterans Administration to local hospitals and the military. Dr. Martin (PCCW): Our profession will continue to rise to the challenge of meeting expectations of both consumers and third-party payers. Dr. Mancini (Parker): I believe many of the philosophical principles regarding health and wellness will be given scientific credibility and the doctor of chiropractic will continue to be a very vital part of the healthcare delivery system. Dr. Hardee (SCSC): Mainstream chiropractic will retain a separate and distinct role while fringes will be more integrated within medicine. Accommodating the future Dr. Clum (LCCW): We will attempt to apply the Gretsky dictum of hockey — pay attention to where the puck is going as opposed to where it has been. Dr. Riekeman (LU): Life University will integrate fully into areas of chiropractic education, accreditation and research. Life has a commitment to developing new curricular delivery systems and world-class faculty. It will attach private funds to conduct research that is currently under-funded due to the government’s narrow interests. We are also committed to expand our undergraduate and postgraduate programs. Dr.Goodman (LCC): The process [of change] has already started. Our vision and focus are to fortify chiropractic and its education well into the future. The ability to articulate and develop strategic partnerships with institutions of higher learning and provide guidance to future students is essential. Dr. Nicchi (NYCC): NYCC will accommodate this focus by continuing to provide our students with the opportunity to participate in a wide range of unique experiences, including our own integrated clinics, hospitals, Department of Defense sites and other free-standing ambulatory-care centers. Dr.Winterstein (NUHS): National is currently engaging in a self-study for the Higher Learning Commission of the North Central Association of College and Schools, in which it is asking for the right to offer masters’ degrees in advanced practice and in radiology. It is going to offer the naturopathic medicine degree beginning in 2005. We believe it is our responsibility to embrace other members of the complementary and alternative medicine practitioners so that we become colleagues rather than competitors.
Dr.Traina (NWCC): Northwestern is in the midst of refining and refocusing the curriculum to enhance the clinical relevancy of what our students are taught. This includes both our classrooms and our clinics. Coupled with retaining strong basic sciences coursework and enhancing our practice management curriculum, we will be able to prepare our students to flourish in the new healthcare environment. Dr.Kern (PCC): We have and will continue to place primary emphasis on clinical studies within our Research Center and communicate the results of these studies to our faculty, students, alumni and communities. Dr.Hardee (SCSC): Sherman College will be the leader in bringing straight chiropractic to the world. Dr.Brassard (TCC): TCC has already incorporated many programs necessary to meet the new changes. Examples include the Moody Clinic with a multi-discipline approach to patient care and the American Col-lege of Integrative Medicine founded to promote collegiality and stimulate learning and research among the members of the healing professions. The trend toward specialization Dr. Cleveland (CCC): Specialty practice education will continue to be provided at the graduate level. Specialty practices in management of the aging patient will become an additional opportunity for service. Dr. Clum (LCCW): Chiropractic specialty will be along technique and skill lines, as opposed to condition-based lines. Specialty development in areas of direct support to the general practice of chiropractic will likely continue to develop. In the future these will be based within the institutional environment rather than the private practice environment. This will allow the collective resources of the institution to be brought to bear on the advanced training of the individual. Dr. Riekeman (LU): For those who wish to specialize, post-graduate work will be necessary. This is and can be accommodated through diplomate programs or, as in Life’s case, masters’ degrees, in addition to profession-wide certificate courses. Dr. Nicchi (NYCC): As chiropractic grows, so too will the trend towards specialization in various subcategories. In response to this trend, chiropractic colleges may wish to develop masters programs in a variety of subspecialties. NYCC, for example, has developed the first masters degree program in diagnostic imaging. Dr. Winterstein (NUHS): Specialization is naturally going to happen. We suspect that even at the first professional degree level we will begin offering several tracks so that, while all students have the core education, they could begin to differentiate their practices by concentrating in orthopedics, for example, or in primary care.
Dr. Kern (PCC): I envision chiropractic colleges offering more undergraduate elective courses for students and continuing education courses for graduates embracing the specialties. Dr. Martin (PCCW): Basic chiropractic education produces generalists, able to function effectively in a portal-of-entry role. We also have specialists in various fields, who become such with advanced education. This pattern will not change. Dr. Mancini (PCC): We will continue to provide the best vehicles for advanced education that are available; however, we additionally feel that greater sophistication of the general curriculum is additionally needed. After all, if everyone specializes then one day the generalist or average practitioner will in fact be a “specialist.” Dr. Hardee (SCSC): Vertebral subluxation centered chiropractic will continue to develop specializations in imaging, focus on care of children types of technique, research, and other endeavors relevant to vertebral subluxation.
Dr. Zolli (UBCC): The key to chiropractic’s success has been our ability to remain distinct in the healthcare delivery system. Our future success hinges on our ability to maintain the unique character and principles of chiropractic. While I am supportive of individual learning as much as possible in specific areas of care, that care will only help to serve patients if it is provided in the context of what makes chiropractic unique. Dr. Brimhall (WSCC): Chiropractic must emphasize its role in primary care first. WSCC has always held to the principle, “For the good of the patient.” The profession is well positioned to specialize in many different areas, but the overarching tenet of caring for the whole patient must never be overlooked. |
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