Perceptions and attitudes of University of Johannesburg chiropractic students toward a blended learning approach and a shift to an e-learning approach necessitated by the COVID-19 pandemic

ABSTRACT Objective This study aimed to explore and compare the perceptions and attitudes of chiropractic students on a blended learning offering in 2019 and a subsequent shift to an e-learning approach in 2020 owing to the COVID-19 pandemic. Methods This was an exploratory descriptive study of 4th-year BHSc chiropractic students enrolled in the Clinical and Applied Biomechanics IV module in 2019 (n = 31) and 2020 (n = 33). The survey used close-ended Likert scale questions collected from 29 July to 14 August 2020. Data were analyzed using frequencies and descriptions, exploratory factor analysis, and reliability. Trends and interrelationships of and between student attitude, satisfaction, social influences, ease of use, accessibility, and effectivity were investigated for each year and compared between successive years' cohorts. Results Students were mostly female (76.6%), aged 20 to 24 years (84.4%). Although both cohorts showed similar positive attitudes, accessibility, and satisfaction levels, the e-learning group showed increased effectivity (p = .016) and ease of use (p = .038) compared with the blended learning cohort. Face-to-face time with the lecturer was shown to be more important to the blended learning cohort (p = .006). Strong correlations were demonstrated in both cohorts between accessibility and satisfaction with attitude, effectivity, and ease of use. Conclusion Findings suggest that students were more receptive to an e-learning approach than they may have been in the past. This may be as a direct consequence of the response to COVID-19, and the adapted offerings of the curriculum.

Assessing attitudes of patient-centered care among chiropractic students at a South African university

Objective Patient-centered care (PCC) is acknowledged globally as a foundation of quality patient care and key to doctor–patient rapport. Student attitudes toward PCC have been assessed in some health professions and some international chiropractic institutions but is lacking in the South African chiropractic student context. This study explores this concept and compares these attitudes to other student groups. Methods A cross-sectional survey was conducted on chiropractic students (years 1, 3, 5, and 6) at a South African institution. The 18-item Patient–Practitioner Orientation Scale (PPOS), with scoring 1–6 on a Likert scale, was used to evaluate the attitude toward PCC by students. Higher scores were representative of more patient-centeredness. Variables were analyzed to assess for associations between variables. Mean PPOS scores were calculated, and reliability and validity were tested using Cronbach α and factor analysis. Results There were 100 respondents (68% response rate). The PPOS showed unsatisfactory reliability in our sample. The mean scores for the overall PPOS were 3.64 (SD = 0.46), the sharing subscale was 2.99 (SD = 0.61), and the caring subscale was 4.29 (SD = 0.58). There were small but suggestive trends noticed in PPOS scores based on age, sex, and year of study. Conclusions Chiropractic students from our university showed a general positive tendency toward PCC with no association between age and year of study. Sex showed some suggestive descriptive trends contrary to findings in other studies. The PPOS showed poor reliability in this study, warranting consideration with its use in similar contexts.

Online or onsite? Comparison of the relative merit of delivery format of Aboriginal cultural-awareness-training to undergraduate chiropractic students

Purpose The purpose of this paper is to work with Aboriginal and Torres Strait Islander people (ATSI), it is expected that non-ATSI health-care professionals become culturally aware; however, participants’ perceptions of the relative merit of cultural awareness training (CAT) formats is uncertain. Design/methodology/approach The authors compared undergraduate students’ perceptions of an asynchronous online format with onsite delivery formats of CAT using a mixed-method design. Students from five successive cohorts (n = 64) in an undergraduate programme were invited to complete a post-training survey which gathered quantitative and qualitative data. Findings Whilst feedback was positive regarding both formats, the onsite format was preferred qualitatively with several valuable learning outcome themes emerging from the results. These themes included; “perceived benefits of self-evaluation of students’ own culture whilst learning about Aboriginal culture”; “encouraging to be provided with scenarios, examples and exercises to enhance cultural awareness” and “engagement with the interactive facilitator approach”. There were differing views about the benefits of learning the history of oppression which warrant further research. Research limitations/implications Results may be applicable to undergraduate allied health students who participate in clinical immersion placements (CIPs) who participate in Aboriginal CAT. Practical implications Given the changing dynamic in education forced by the COVID-19 pandemic, more resources may need to be directed to improving online training and possibly combining formats in course delivery. Social implications The strength of the study is that the authors achieved a response rate of 100%, thus the results are highly significant for the sample. This sample represents 41.3% of chiropractic students who attended CAT and CIPs at this university over the course of 9 years, thus the results could be generalized to chiropractic students who participated in these types of placements. Originality/value To the best of the authors’ knowledge, this is the first study to compare student perceptions of different formats of Aboriginal CAT for final year chiropractic undergraduate students in Australia.

Experiences and perspectives of chiropractic students graduating from an alternate admission track plan

Objective This study explored self-reported experiences of alternate admission track plan (AATP) students who completed a chiropractic training program at a US chiropractic college. Methods Our institution conducted semistructured exit interviews with 16 graduating AATP students. Our consensus-drafted open-ended interview questions probed in-depth for these students' experience throughout the training program, with national board exams, their personal characteristics, their satisfaction with the training program generally, and with the AATP program specifically. We employed a content analysis to identify themes and patterns of responses across the blinded deidentified interview transcripts. We used a combination of deductive coding based on our interview guides, and inductive coding to identify newly emerging subthemes. Results Perceived facilitators of student success were strong commitment to chiropractic, cooperative, and supportive environment (eg, student study groups and a highly committed faculty), work ethic, and time management skills. Although many recommended that AATP entrants without science backgrounds take prerequisite courses in biology and chemistry, they also observed that a capable student could dedicate the time and effort to obtain the needed information via available college resources. Conclusion Graduating AATP students were positive about the AATP program overall, and their preparation for national board exams and for clinical practice. They greatly valued the opportunity to accelerate their entrance into chiropractic college. A major limitation of this study is that the perspectives of AATP students who did not complete the doctor of chiropractic program are not represented in these interviews of graduating students.

Perceptions of chiropractic students regarding interprofessional health care teams

Objective To describe perceptions of knowledge of interprofessional teams and value of interprofessional education (IPE) among 3 distinct years of chiropractic students at 1 chiropractic college. Methods A 24-item cross-sectional survey was administered to 247 chiropractic students in years 1–3 within a single institution. Surveys included 5 demographic questions and the 19-item Readiness for Interprofessional Learning Scale (RIPLS). The RIPLS collected information on perceptions and value of interprofessional health care in a health care training program. Each question is scored on a 1–5 scale, with 5 indicating a stronger agreement. Multivariable analysis was used for comparison. Results Out of a total 321 eligible students, 247 (148 male) students completed the survey from year 1 (n = 66), year 2 (n = 102), and year 3 (n = 79), respectively. Most students (68%) were 18–25 years old. The mean compiled score of all 3 years (n = 231) was 77.2 (SD = 9.1). Each individual's year scores were as follows: year 1 (n = 60, mean = 79.7, SD=7.4), year 2 (n = 95, mean = 76.9, SD = 9.1), and year 3 (n = 76, mean = 75.4, SD = 9.9). Of the 247 students who responded, 87% of participantsagreed with “shared learning with other health care students will increase my ability to understand clinical problems.” Conclusion Most participants demonstrated a positive response to IPE and collaborating with health care teams. Participants in earlier years demonstrated a more positive response compared to later years. While positive perceptions to IPE were demonstrated, chiropractic students lacked knowledge and understanding of their role within an interprofessional health care team.

Chiropractic students’ experiences on the use of virtual radiography simulation: a pilot observational study

Background Virtual radiography provides students with an opportunity to practise their clinical skills in patient positioning and evaluating radiographic images. The purpose of this pilot study was to introduce Projection VR™, a software radiography simulation program, into a student chiropractic program and evaluate its potential application as a teaching and learning tool. Methods Undergraduate chiropractic students, enrolled in a radiographic course (unit within the chiropractic program), were invited to attend a scheduled laboratory where they were introduced to, and undertook purposefully designed activities using the radiography simulation. At the end of this activity, students were asked to complete an online survey (see Virtual Radiography Survey) to describe their experiences of the educational value of the software program. Descriptive statistics were used to evaluate outcomes. Content analysis was performed for free-text comments provided by respondents with key themes provided by the predetermined quantitative categories of the questionnaire. Results Responses were received from 44 out of the 47 students who attended the scheduled laboratory (response rate 92%). Overall students were positive about this simulation identifying that it was easy to use (95%) and that they could control the equipment as needed (95%). The main reported benefits included students being enabled to repeat tasks until they were satisfied with the results (98%) and being able to quickly assess images and determine if changes needed to be made (98%). Participants reported improvement in their understanding of the effect of exposure factors on patient radiation dose (93%) as well as their technical image evaluation (84%) and problem-solving skills (80%). Conclusions The results of this study suggest that virtual radiography is a valuable complementary resource in providing chiropractic students with radiographic knowledge and skills.

Chiropractic student diagnosis and management of headache disorders: A survey examining self-perceived preparedness and clinical proficiency

Objective To explore the self-perceived preparedness and clinical proficiency in headache diagnosis and management of Australian chiropractic students in senior years of study. Methods Australian chiropractic students in the 4th (n = 134) and 5th year (n = 122) of 2 chiropractic university programs were invited to participate in an online cross-sectional survey. Descriptive analyses were conducted for all variables. Post hoc analyses were performed using simple linear regression to evaluate the relationship between self-perceived preparedness and correctness of headache diagnosis and management scores. Results Australian chiropractic students in senior years demonstrated moderate overall levels of self-perceived preparedness and proficiency in their ability to diagnose and manage headache disorders. Final-year students had a slightly higher self-perceived preparedness and proficiency in headache diagnosis and management compared to those students in the 4th year of study. There was no relationship between self-perceived preparedness and correctness of headache diagnosis and management for either 4th- or 5th-year chiropractic students. Conclusion Our findings suggest that there may be gaps in graduate chiropractic student confidence and proficiency in headache diagnosis and management. These findings call for further research to explore graduate chiropractic student preparedness and proficiency in the diagnosis and management of headache disorders.

Chiropractic students’ cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data

Background Chiropractic students demonstrate philosophically opposing views about the chiropractic profession. The primary aim was to describe chiropractic students’ responses to statements about chiropractic identity, role, setting, and future direction. A secondary aim was to describe the frequency of internally conflicting responses. Methods Three datasets from Europe, North America, and Australia/New Zealand were pooled in a secondary data analysis. Chiropractic students from 25 chiropractic training institutions completed interrelating surveys (combined response rate 21.9%) between 2013 and 2018. The survey instrument investigated student viewpoints about chiropractic professional identity, role, practice setting and future direction of chiropractic practice. Student attitudes about chiropractic were described using weighted proportions to adjust for unequal population sampling across the three geographical regions. The frequency of concordant and discordant student responses was described by combining identity items with items that explored responses about practice role, setting and future direction. The relationship between student characteristics (age, sex, education, association membership and geographical region) and ideologically conflicting responses were assessed using the Chi-squared test and Cramér’s V. Results Data from 2396 student chiropractors (50.8% female; from Europe 36.2%, North America 49.6% and Australia/New Zealand 14.5%) were analysed. For identity, nearly half of the chiropractic students (weighted 45.1%) agreed that it is important for chiropractors to hold strongly to the traditional chiropractic theory that adjusting the spine corrects “dis-ease” and agreed (weighted 55.5%) that contemporary and evolving scientific evidence is more important than traditional chiropractic principles. The frequency of discordant (ideologically conflicting) student responses ranged from 32.5% for statements about identity versus role, to 51.4% for statements about identity versus future. There was no association between student age, sex and internally conflicting responses. Chiropractic students’ professional association membership status, pre-chiropractic education and geographical region were associated with ideologically conflicting responses. Conclusions Chiropractic students in this analysis show traditional and progressive attitudes towards the chiropractic profession. Individual student responses frequently contradict in terms of professional ideology, but most (approximately half) students demonstrate concordant progressive and mainstream attitudes. Ideological conflict may raise concerns about some students’ ability to learn and make clinical judgements, and potential for disharmony in the chiropractic fraternity.