Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students
SOURCE: Chiropractic & Manual Therapies 2015 (Feb 2); 23 (1): 4
Jordan A Gliedt, Cheryl Hawk, Michelle Anderson,
Kashif Ahmad, Dinah Bunn, Jerrilyn Cambron,
Brian Gleberzon, John Hart, Anupama Kizhakkeveettil,
Stephen M Perle, Michael Ramcharan,
Stephanie Sullivan, and Liang Zhang
Logan University College of Chiropractic,
1851 Schoettler Rd,
Chesterfield, MO 63017 USA.
BACKGROUND: The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.
OBJECTIVE: The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.
METHODS: A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.
RESULTS: A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.
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CONCLUSION: The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.
KEYWORDS: Chiropractic; Cross-sectional survey
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Introduction
The last thirty years in health care have brought about many changes in thoughts and practice ideologies. One of these recent trends is an emphasis on cost-effective treatments and interprofessional collaboration. [1–3] Additional changes in health care over this time have included an increase in medical specialization and sub-specialization, the concept and implementation of evidence-based practice, and a greater acceptance of complementary and alternative medicine (CAM) therapies in mainstream medicine. Amid all of these transformations and shifts in the health care arena, a primary spine care specialist role has not been established. The current state of spinal care has been classified as a “supermarket approach” consisting of multiple practitioners including primary care providers, chiropractic physicians, acupuncturists, physical therapists, physiatrists, orthopedic surgeons, neurosurgeons, massage therapists, and naturopathic physicians with multiple treatment philosophies, high salesmanship and little interprofessional communication. [4] Chiropractic physicians possess many attributes that would be required of a primary spine care practitioner, and with specific modifications in education and practice, chiropractors may be in a position to make a relatively lateral transition to occupy this role. [4]
As factions of the chiropractic profession are establishing a pathway for chiropractors to assume an evidence-based primary spine care practitioner role integrated in mainstream health care, it has been asserted this may not be the route many field providers desire to pursue. [5] Although most professions may have internal factions with conflicting viewpoints, such factions within chiropractic are particularly contentious. [6] According to McGregor et al., progressing toward a collaborative focus will demand a more visible appreciation of the professional strata that exist, and the mutual goals that exist between them. [1] Because chiropractic students represent the future of the profession, examining their views on professional identity might provide insight into the future of the profession. However, to date, there has been little research done among this population, with only one related specifically to this topic; this study, in fact, served as the pilot study for the current project. [7] The aim of this investigation was to survey chiropractic students’ opinions about chiropractic identity, role and future. Results may yield an insight into future practitioners’ perspective about the future of the profession, thus aiding in chiropractic’s progression. This study may further act as a catalyst for future studies directed to current practicing chiropractors.
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