Introduction
Defining Competency
Problem
Aim
Objectives
Method
Eligibility criteria
Data extraction process and synthesis of results
Results
CCE-Aust | CCE-Canada | ECCE | CCE-USA | |
---|---|---|---|---|
Domains
| 11 | 14 | 3 | 7 |
Component statements
| 299 | 213 | 21 | 63 |
Component/Domain ratio
| 27.2 | 15.2 | 7.0 | 9.0 |
Objective 1: definitions of competency
Name of CCE | Definition of “competency” | Knowledge | Skills | Attitudes | Context | Other |
---|---|---|---|---|---|---|
CCE-Int | the practice of chiropractic requires the acquisition of relevant knowledge, understandings, attitudes, habits and psychomotor skills (pg 3, 2010) | X | X | X | Practice of chiropractic | Habits |
CCE-Aust | Competencies: Written statements describing the levels of knowledge, skills and attitudes expected of graduates (pg 18, 2009). | X | X | X | practitioner | |
ECC-Europe | a measurable set of skills, knowledge, problem solving abilities and attitudes in controlled representations of professional practice when performing at maximum levels of ability (pg 57, 2013). | X | X | X | Professional practice | Problem solving abilities |
CCE-Canada | a student’s knowledge, skills and attitudes with the goals of providing feedback to enhance the educational progress, rating performance, and determining the appropriateness of progression in the clinical phase of becoming a qualified chiropractor (pg 68, 2011). | X | X | X | Qualified chiropractor | |
CCE (USA) | Mandatory meta-competencies have been identified regarding the skills, attitudes, and knowledge that a doctor of chiropractic program provides so that graduates will be prepared to serve as primary care chiropractic physicians (pg 21, 2013) | X | X | X | Chiropractic physician | |
Aust. National Health Work Force | It refers to specific capabilities in applying particular knowledge, skills, decision-making attributes and values to perform tasks safely and effectively in a specific health workforce role (pg 5, 2011) | X | X | Health workforce role | Values, decision making attributes |
Objective 2: domains of competency
Major elements/ domains of competency
| CCE-USA | CCE-Aust | ECC-Europe | CCE-Canada |
---|---|---|---|---|
History taking | X | X | X | X |
Physical exam | X | X | X | X |
Neuromusculoskeletal exam | X | X | ||
Psychosocial assessment + cultural gender ethnic diversities | X | X | X | |
Diagnostic studies- interpret clinical laboratory findings and diagnostic imaging of NMSK | X | X | X | X |
Diagnosis & differential diagnosis | X | X | X | X |
Case management/Referral | X | X | X | X |
Chiropractic adjustment or manipulation skill, competent care | X | X | X | X |
Emergency care | X | X | ||
Case follow-up and review | X | X | X | |
Record keeping | X | X | X | |
Doctor-patient relationship/communication | X | X | X | X |
Professional issues/continuing education/Sound business practice/ethical practice | X | X | X | X |
Other therapeutic procedures | X | X | X | X |
Public health and community interaction* | X | X | X | |
Health care system interaction* | X | X | ||
Professional interaction* | X | X | X | |
Staff and financial management* | X | |||
Information and technology** | X |
Objective 3: analysis of three important domains
Competency dimension :assessment and diagnosis
| CCE-USA | CCE-Aust | ECC-Europe | CCE-Canada |
---|---|---|---|---|
Background clinical sciences | ||||
Understand the pathophysiology and history of NMSK conditions | X | X | ||
Understand the signs and symptoms of NMSK conditions | X | X | ||
Understand the prognosis of NMSK conditions | X | |||
Case history | ||||
Data gathering (CCE USA) | X | X | X | X |
Data recoding | X | X | X | X |
Take a comprehensive problem-focused or case-appropriate history | X | X | X | X |
Psychosocial factors considered in case history taking | X | X | X | X |
Cultural ethnic issues considered specific to case history taking | X | X | X | |
Patient centred/comfort when history taking | X | X | X | |
History taking subcomponents specified eg chief complaint, family, past, systems review | X | X | ||
Practitioner behaviours describe during the process | X | X | ||
Physical exam/assessment | ||||
Perform an appropriate general physical exam | X | X | X | X |
Perform an appropriate case appropriate/NMSK physical exam | X | X | X | X |
Description of physical exam components | X | |||
Incorporate psychosocial assessment | X | X | X | X |
Incorporate subluxation/neuro-biomechanical dysfunction | X | X | X | |
Reliability of data/tests/ examinations considered | X | X | ||
Patient-centered requirement, comfort, respect + psychosocial factors assessment | X | X | X | |
Doctor hygiene and patient safety | X | |||
Explanation of findings to patient | X | X | ||
Radiology – with specific requirements | ||||
Radiological Interpretation | X | X | ||
Radiographic technology | X | X | ||
Laboratory tests | ||||
General statement for requirement of utilization & interpretation competence | X | X | X | X |
Risk/cost benefit analysis | X | X | X | |
Within scope of practice | X | X | X | |
Ordered based on previously obtained clinical data | X | X | ||
Explained to patient | X | X | X | |
Diagnosis | ||||
Formulate a diagnosis(es) based on information gathered-general statement | X | X | X | X |
Documentation of diagnosis | X | X | X | |
All material considered in the diagnosis | X | X | X | X |
Use diagnosis for recognition of when condition exceeds capacity/referral | X | X | X | |
Explanation of diagnosis to patient | X | X | X | |
Within the context of clinical reasoning skills/problem-solving skills | X | X | X | X |
Competency dimension : professional ethics and jurisprudence
| CCE-USA | CCE-Aust | ECC-Europe | CCE-Canada |
Ethical principles & professional conduct | X | X | X | X |
Patient – practitioner boundaries: physical, communication (verbal, non-verbal) emotional | X | X | X | |
Knowledge of health care law | X | X | X | |
Professional conduct with peers | X | X | X | X |
Professional conduct with patients | X | X | X | X |
Professional conduct with staff | X | X | X | |
Compliance with ethical and legal dimensions | X | X | X | |
Patient records and patient billing meets state and federal law | X | X | X | |
Ethical business practices | X | X | ||
Professional participation/support | X | X | ||
Explain the importance of research participation | X | X | ||
Competency dimension : intellectual and professional development
| CCE-USA | CCE-Aust | ECC-Europe | CCE-Canada |
Seeking and application of new knowledge | X | X | X | X |
Ability to adapt to change | X | X | X | X |
Critical appraise literature and apply it to clinical practice/patient care | X | X | X | X |
Understanding of research methods and significance in modern health care | X | X | X | X |
Provide evidence of critical thinking skills | X | X | X | X |
Reflect on personal and professional learning skills | X | X | X | |
Application into patient care | X | X | X | X |
Demonstration of basic, social and clinical sciences sufficient to promote intellectual development and effective patient care | X |
First domain - assessment and diagnosis
Case history
Physical examination
Investigations/laboratory tests/imaging
Diagnosis
Domain 2: professional ethics and jurisprudence
Domain 3: intellectual and professional development
Discussion
Definitions of competence
Domain analysis
Component analysis of three representative domains
Recommendations
Recommendations in relation to competencies | Justifications | |
---|---|---|
1 | An internationally uniform definition of competence for chiropractic education and assessment is required. | There is increasing global workforce movement and there is evidence of variations in international standards. Common standards would ensure and safeguard patient safety and care and be good for global workforce standardization |
This may require agreement from all CCEs on the definition of common words and terms used in their documentation. | ||
2 | There should be separate definitions of competence at different stages of the course work; separating the undergraduate’s progress from readiness to graduate. | Chiropractic educators are better equipped to monitor and assess a student’s progress toward detailed graduating standards. |
3 | “Abilities” and “other categories” should be included in the definition of competence and their meanings clarified among CCEs. | This would create a clearer understanding of the required standards to be assessed and achieved by chiropractic educators. |
Recommendations in relation to domains | ||
4 | A clarification of the use of the terms and words used to describe the domains of competency should be undertaken so there is an established understanding of their meaning among CCEs. | High levels of descriptions reduce the capacity for ambiguity as they clearly state the expected behaviours and standards of graduates. |
5 | Adoption of these structures would also improve the likelihood of mainstream integration. | |
6. | Appropriate descriptive statements should be found that adequately define the domains, sub-domains and their components. These should be sufficiently prescriptive and unambiguous to establish high standards of practice and reduce the possibility of undesirable practice profiles. E.g., radiology competencies, physical examination, and pathophysiology expectations. | CCEs should consider the evidence for a more prescriptive approach to component descriptive statements that would set clearly defined quality graduation standards for educators to achieve and CCEs to enforce. |
7 | The term “evidence-based” should be used for improved research and knowledge application, such as patient safety and treatment improvements from other mainstream medical disciplines. Further it would facilitate communication and integration within the broader health field. Content taught should be required to be done in the context of the evidence that underpins it. | The adoption of an evidence-based approach would help facilitate integration into mainstream health care. |
8 | Increased description of ethical and professional practice and practitioner behaviours which are consistent across all CCEs. | Clarity would ensure and safeguard high professional standards. |
9 | Imaging competencies need to include contemporary modalities such as MRI, CT and diagnostic ultrasound | Health care technology is constantly changing and chiropractic education should keep pace with these changes, so that patients benefit from access to these emerging imaging technologies. |
10 | CCEs should guide and fund research into accreditation matters: suggested areas include, but not limited to; | This will develop, inform and improve regulatory standards |
10 (a). | A study comparing CCEs’ levels of enforcement of competency standards. | Identifying the opportunities for improving enforcement of standards may result in a uniform quality international standard of patient care and safety of practice. |
10 (b). | A study of factors that may be at odds with competency standards. | Identification of these factors may provide opportunities and mechanisms for chiropractic educators to improve competency levels. |
10 (c). | A study trialling interventions targeted at improving identified unwanted practitioner profiles which may alter practice behaviours. | This would improve the quality of patient care and safety |