Chiro Cleanup – Part 6: Solutions – Part 2: The Muck *Stops* Here…

Since there’s so much about the NBCE, the CCE (until it started to wake up and join at least the 20th century very recently), and chiropractic education that many of my colleagues and I would love to see changed, let’s address that topic next.

The first item I’d like to bring to the table is the education.  The admissions standards and school curricula need a complete and massive overhaul.  It starts with admission.

I’m of the firm belief that all schools should:

  • Require CCAT scores (and this CCAT should be a scientific, chiro-equivalent to the MCAT and remain every bit as respectable)
  • Require an essay and interview.  Are you a slacker who wears flip-flops and can barely spell or construct a sentence?  Do you type in “textspeak”?  Do you stammer and say “ummm” a lot?  Are you looking for the easy way out or a shortcut?  Can you think for yourself?  Can you follow directions?  Do you only do the minimum required to get by, or do you push yourself further for the sake of doing so?
  • Require a 3.0 GPA.  Apparently the CCE has already made this change.  Kudos to them.  It’s about time.  Considering the fact that these undergraduate classes and prerequisites can be obtained at a neighborhood community college, requiring an overall GPA of 3.0 is more than reasonable.
  • Require a 4-year degree?  Truthfully, this is not foolproof.  I watched several students with BS and BA degrees fail out of the program.  Others successfully graduated but did not end up in practice due to sheer laziness; these folks were those who did the bare minimum required and constantly sought a shortcut to boot.  Meanwhile, many without incoming 4-year degrees ended up completing school just fine and practicing successfully fresh out of school.  So, this option is worth a thought, but it’s not everything.

Currently, schools teach roughly a year of a mixture of basic sciences and philosophy/business and another year of a mixture of the same plus clinical sciences and adjusting.  The final year is spent in internship, with a few straggling clinical and adjusting classes here and there.  The sciences are generally good but antiquated and lack any contemporary functional knowledge, the philosophy courses are excessive and reek of brainwashing, and the adjusting and business classes barely scratch the surface.  The internship hardly bears any resemblance to real-life practices, nor does it provide any exposure to other disciplines (whether general info, working with, referring to, or receiving referrals from).  You’re severely limited in what you can and cannot do in clinic.  If it’s not taught in (out-of-touch, outdated) school, you can’t do it in clinic, and even if it IS taught in school, you can’t do it in clinic unless it’s somehow clinically approved.

So, I propose the following sample educational program (yes, it’s longer, and divided up into semesters – not that that’s a bad thing):

Year 1:  Basic Sciences (2 semesters)

  • Basic sciences only, mirroring that taught in med schools.  In fact, join up with conventional med schools for the first few years; this would give various fields cross-exposure and possible cross-camaraderie.
  • Do away with Systemic (pre-dissection) Anatomy and Research classes; require them in undergrad instead.  Start right off with dissection.  That way, you’re not learning about body parts you’ve never directly seen.
  • Do away with Philosophy; people can think for themselves and make up their own minds without indoctrination.
  • Cover cadaver dissection, basic Physiology, basic Neurology, Biochemistry, Embryology, and Normal Rad Anatomy at the same time, and in the same order.  For example, when you’re dissecting the chest and heart of a cadaver, you’re also learning about the cardiovascular system in Physiology, the neurological innervation to the heart and blood vessels in Neurology, the enzymes/nutrients/cofactors that drive this function in Biochemistry,  cardiovascular system formation in Embryology, and chest x-rays in Normal Rad.  This way, each class reinforces the others and information becomes jelled more cohesively.

Year 2: More Basic sciences (2 semesters)

  • Now’s the time to bring in more advanced Neurology, as well as advanced Physiology (that also includes Immunology and Endocrinology), and Pathology (which includes not only diseases of 50 years ago but also conditions such as spinal disorders, brain disorders, vestibular issues, and touching on the concept of autoimmune disorders).
  • This is also the time to take up Pathology Imaging.  Just as described above, the x-ray, CT, and MRI pathology discussed in imaging classes should mirror the subject matter currently being covered in Pathology class.  Other classes should also cover the same respective material.
  • This is also the time to bring in Basic Clinical Nutrition (of which “The China Study” should never be brought up, as it is not even endocrinologically correct).
  • And, this is where some diagnosis is introduced, now that students have a good basic understanding of pathology.  There would be 2 diagnostic classes – Physical Diagnosis and Lab Diagnosis.  Again, material from all classes would coincide as much as possible.
  • Pharmacology of a first-line or emergency crisis is also included, for basic scenarios such as infections, pain relief, excessive bleeding, blood clot busting, etc.  Side effects are discussed in depth.  Vaccination debate is balanced, with all sides brought to the table and given equal time.

Year 3: Functional Diagnostic Medicine

  • Immunology, Endocrinology, Biochemistry/Nutrition, Physical Diagnosis, and Lab Diagnosis are brought together to give special attention to contemporary complex disorders of today and study/address them specifically.  Pediatric FDM should also be addressed.
  • Certain previous basic classes would spawn functionally-oriented counterparts.  For example, Lab Diagnosis, which was mainly interested in screening for disease, would evolve into 2 classes of Functional Blood Chemistry, taken in order.  FBC 1 would cover just blood chemistry, but a hugely expanded, comprehensive functional panel.  FBC 2 would cover specialty testing, such as salivary cortisol, other salivary hormones, digestive stool analysis for microbes, urinary metabolites, heavy metal testing, and others.
  • Disciplines would begin to be tied together, as endocrine gland and digestive functions are correlated with autoimmune conditions and genetic mutations.  Then, nutritional and herbal combinations would be discussed to help these people.
  • Observation in clinic begins here, with Functional Medicine cases.  Learn to draw blood for blood testing, and learn to inject vitamin/herb preparations.
  • Case Management begins here (Functional Medicine cases only), with nuggets of practice management thrown in.  Pharmacology is also included, especially for endocrine disorders and blood sugar stabilization.  Side effects are covered thoroughly.

Year 4: Functional Neurology

  • Now Neurology gets its turn.  In fact, it gets its own year.  This is not the academic type of neurology that sits around memorizing conditions without ever discussing successful, clinically proven treatment methods.  This is also not the type of conventional neurology that thinks neurosurgery is the answer to all that ails.  No, this is where material from Carrick Institute and brain-based therapy come in.
  • Good, sound neurological exam protocols should piggyback on–and fully integrate with–a regular functional Physical Exam.
  • Special attention should be paid to the integration, cross-talk, and mutual influence the immune, endocrine, and nervous systems all share with each other.  Especially important is a thorough understanding of how problems in one system create problems in other systems.
  • Proper diagnosis and treatment should consist of determining the level/area of the dysfunction and the nature metabolic environment, and then rendering proper therapies that minimize, manage, improve, or resolve those issues.  Critical thinking is applied here, as natural therapies and neurological rehab, no matter how non-invasive and otherwise safe, can overdrive a nervous system and cause trans-neural degeneration.
  • Observation and case management continue (this time with most of the emphasis on Functional Neurology, observing real patients with MS, Autism spectrum, traumatic brain injuries, spinal injuries, polyneuropathy, stroke rehab, phantom pain, paralysis, stenosis, fibromyalgia, etc), with more nuggets of practice management here and there.
  • Pediatric Neurology should also be addressed.
  • Appropriate Pharmacology is also included, with side effects covered in depth.

Year 5:

  • Classes include Coupled Adjusting, Clinical Orthopedics, Biomechanical Stabilization/Neuromuscular Therapy, Physical Rehab Therapy, and Exercise Science.
  • Only non-protocol adjusting methods are allowed, and all must follow the idea of coupled adjusting.  Basically, everything becomes Diversified, because that is a widely-ranging catch-all term for all miscellaneous maneuvers that don’t fit under a trademarked protocol.  Techniques and concepts from Gonstead, SOT, Activator, Flexion-Distraction, etc, can be explored, but we got way too much of “walk around in a circle 3 times and wave a chicken bone over the patient’s abdomen” types of explanations while we were in school.  Those days should be finished.
  • Only industry-standard tools are allowed – Activator, Integrator, and standard Physical Therapy tools (e-stim, microcurrent, TENS, etc).  No Pro-adjuster, Substation, Myovision, or any other non-diagnostic toy.
  • Clinical Orthopedics classes should cover only relevant tests.  If the test isn’t clinically useful or has been disproven, it should not be taught.
  • Exercise Science should be centered not on turning patients into treadmill hamsters, but utilizing cutting-edge science such as the Tabata Protocol and other types of interval training to get the most out of their workouts and rehab.
  • Emergency care should also be included during this year.
  • Pediatrics and Geriatrics get their own classes during this year as well, instead of including special population material in other classes.
  • Clinical observation and case management work continues, this time in more of a Chiro/Ortho fashion, observing cases such as car wrecks, carpal tunnel, sprain/strain, sports injuries, whiplash, low back pain, frozen shoulder, migraines, chronic aches and pains, nerve impingement, etc.  Pharmacology coverage continues, including in-depth discussions of side-effects.

Year 6-7:  Residency, Mentorship, and Practice

  • These last two years are spent in *practice*.  The first year can be spent in either the school’s clinic or a hospital (the two should provide a relatively similar experience, so it shouldn’t matter too much which the student chooses).  Students with the best grades get first choice.  All notes are reviewed and signed off by the attending physician.  Integration and co-treatment with other fields is emphasized.
  • The second year is divided into 2 parts.  The first half is spent with a credentialed mentor.  Students with the best grades get first choice.  This mentorship could be an opportunity to practice abroad for 6 months.  All notes are reviewed and signed off by the mentor.  Co-treatment with other fields is emphasized.
  • The second half of the second year is spent *in* practice, seeing your own patients.  Students who choose to work in hospitals, clinics, or other established group practices may negotiate a salary, including benefits.
  • Students document their experiences, saving summary printouts of diagnoses rendered and treatments administered for each patient.
  • Students may split off into the specialty of their choice.  This allows them to gain hands-on experience in their desired field and make sure that field is right for them.
  • At no point is a student ever required to recruit new patients to any school, hospital, or clinic.

An educational overhaul of this nature requires a similar overhaul of the NBCE (the National Board of Chiropractic Examiners).

Rumor has it that it’s a private entity that operates completely independent of much government oversight or backing.  This makes me more than a little uneasy.  Not only does it conjure up images of inmates running asylums, but it also becomes possible that this entity can arbitrarily giveth and taketh away should they become aware of any ill-spirited mention from one of their licensees.  Rumor also has it that there are several “straights” stuck on philosophy and art, while woefully downplaying and/or lacking in the areas of diagnostic skills, scientific physiological or biochemical knowledge, and relevant, proven clinical application.  In addition, there were several instances where peers or instructors eluded to the idea that the NBCE is comprised of a collection of “old-timers” who operate based on data from “30 years ago”.

My solution is simple: give the NBCE a complete overhaul.  Out with the old, in with the new (and relevant).  Out with the dogma and indoctrination, in with the cutting-edge research and newly-established facts.  Only by understanding the most accurate information being discovered and presented through genuine research and fully utilizing the best that we have available can we hope to survive, lean and mean, through the chaos and upheaval we currently face and emerge smarter and stronger than we’ve ever been.

It’s time to base the questions on current knowledge.  It’s time to bring in even more physiology, pathology, biochemistry, differential diagnosis, lab diagnosis, and more.  It’s time to assess not just one’s prowess in “acting” and “setting up” for an adjustment, but to be able to competently demonstrate a grasp of the information outlined in the above sample curriculum and utilize a broad base of therapies to bring relief and hope to the patients out there who so desperately need the theoretical scenario above to become reality!

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