In memoriam of Alan H. Adams, DC, MS, MSEd:

In this paper we pay homage to Dr Alan H. Adams, who was born on November 3, 1945, and passed away on December 26, 2020. An early adopter of problem-based learning and evidence-based medicine, he contributed substantially to improving chiropractic education, research, and developing an evidence-based practice mindset for chiropractic practice. People who knew Al best recall that he was a fluent instigator of collaborative relationships, and he inspired and advanced many people in their academic and scientific careers. His curiosity, expertise, and mentorship were appreciated by many people and developed numerous interprofessional collaborations.

Making a case for genomics in chiropractic education

Objective To determine if an existing course in genetics should be revised to refocus on the topic of genomics and its impact on health and primary care, a survey of chiropractors was conducted regarding genomics and patient care. Methods A short survey was designed to ascertain chiropractors' knowledge and use of genomics in their practices, particularly regarding direct to consumer genetic testing. Nine closed-ended questions and 2 open-ended questions were included. Pearson correlation was used to evaluate relationships between close-ended responses. Content analysis was conducted on the final open-ended question that queried respondents for further comments. Results There were 181 completed surveys returned. Patients do ask chiropractors about their own direct to consumer genetic testing results—42% indicated that they are approached by patients 1–3 times per month to discuss genetics/genomics. Knowledge of genomics varies among chiropractors, yet 51% feel that teaching genomics is moderately (31%) or extremely (20%) important. Conclusion An introductory course in clinical genomics is necessary to prepare a chiropractor for patient care.

Harnessing the Web: How Chiropractic Education Survives and Thrives During the COVID-19 Pandemic: Chiropractic Educators Research Forum (CERF), December 5, 2020

ABSTRACT This conference was convened by the Chiropractic Educators Research Forum (CERF) on December 5, 2020. This meeting provided a forum for the presentation of scholarly works in chiropractic education theory and practice. This conference specifically focused on research related to chiropractic education during the COVID-19 pandemic. During the December 2020 CERF meeting, presenters and panelists took an in depth look at how programs worked to meet program objectives, graduation requirements, accreditation, and other activities during the COVID-19 pandemic.

Chiropractic program changes facilitated by the European Council on Chiropractic Education Accreditation reports:

Objective The European Council on Chiropractic Education (ECCE) currently accredits 10 programs throughout Europe and South Africa. It is assumed that ECCE evaluation activities lead to changes to the chiropractic programs but no systematic evaluation as to whether this is true, and the extent of changes has previously been done. The purpose of this study was to obtain feedback from program heads as to whether ECCE evaluation reports facilitated changes/improvements to their programs and to identify their reported changes. Methods This was a mixed methods audit study using questionnaires with 2 sections. Closed statements requesting the degree of change to each section of the “Standards” based on ECCE evaluation reports (substantial, some, none) were analyzed using frequencies. Written responses identifying the specific changes made based on previous evaluation reports were evaluated independently by 3 researchers using a modified “thematic analysis” approach. Results All 10 accredited programs responded. Seven of the 10 programs (70%) reported “some” or “substantial” changes to ≥ 6 sections of the ECCE Standards. The most common section with reported changes was “Educational Program” (8 of 10). “Educational Resources” had the largest number of programs reporting “substantial changes” (4) and was the second most common section to have reported changes. The main themes identified emphasized changes in “infrastructure, equipment and faculty,” “increasing evidence-based practice,” and “instilling a research culture in faculty and students.” Conclusion ECCE accreditation processes facilitate changes to the chiropractic programs, particularly in the areas of improved infrastructure and faculty, research, and evidence-based practice.

COVID-19: how has a global pandemic changed manual therapy technique education in chiropractic programs around the world?

Background Manual therapy is a cornerstone of chiropractic education, whereby students work towards a level of skill and expertise that is regarded as competent to work within the field of chiropractic. Due to the COVID-19 pandemic, chiropractic programs in every region around the world had to make rapid changes to the delivery of manual therapy technique education, however what those changes looked like was unknown. Aims The aims of this study were to describe the immediate actions made by chiropractic programs to deliver education for manual therapy techniques and to summarise the experience of academics who teach manual therapy techniques during the initial outbreak of COVID-19 pandemic. Methods A qualitative descriptive approach was used to describe the immediate actions made by chiropractic programs to deliver manual therapy technique education during the COVID-19 pandemic. Chiropractic programs were identified from the webpages of the Councils on Chiropractic Education International and the Council on Chiropractic Education – USA. Between May and June 2020, a convenience sample of academics who lead or teach in manual therapy technique in those programs were invited via email to participate in an online survey with open-ended questions. Responses were entered into the NVivo software program and analysed using a reflexive thematic analysis by a qualitative researcher independent to the data collection. Results Data from 16 academics in 13 separate chiropractic programs revealed five, interconnected themes: Immediate response; Move to online delivery; Impact on learning and teaching; Additional challenges faced by educators; and Ongoing challenges post lockdown. Conclusion This study used a qualitative descriptive approach to describe how some chiropractic programs immediately responded to the initial outbreak of the COVID-19 pandemic in their teaching of manual therapy techniques. Chiropractic programs around the world provided their students with rapid, innovative learning strategies, in an attempt to maintain high standards of chiropractic education; however, challenges included maintaining student engagement in an online teaching environment, psychomotor skills acquisition and staff workload.

Chiropractic conservatism among chiropractic students in Denmark: prevalence and consequences

Background The chiropractic profession is split between those practicing evidence-based and those whose practice is honed by vitalism. The latter has been coined ‘chiropractic conservatism’. In Denmark, the chiropractic education program is university-based in close collaboration with a medical faculty. We wanted to investigate if such conservative attitudes were present in this environment. Our objectives were to i) determine the level of chiropractic conservatism, ii) investigate if this was linked to academic year of study, iii) determine the level of clinical appropriateness, and iv) to investigate if this was affected by the level of conservatism among students in a chiropractic program, where the students are taught alongside medical students at the University of Southern Denmark (SDU). Methods A cross-sectional survey of 146 (response-rate 76%) 3rd to 5th year pre-graduate students and 1st year postgraduate clinical interns from the chiropractic degree course at the University of Southern Denmark was conducted during autumn of 2019. The students’ levels of conservatism were dichotomized into appropriate/inappropriate, summed up, and used in a linear regression model to determine the association with academic year of study. Thereafter, the conservatism score was categorized into four groups (from low -1- to high -4-). Conservatism groups were cross-tabulated with the ability to answer appropriately on nine cases concerning i) contra-indications, ii) non-indications, and iii) indications for spinal manipulation and analyzed using logistic regression. Results Generally, the Danish chiropractic students had low conservatism scores, decreasing with increasing academic year of study. Seventy percent of the students were placed in the two lowest conservative groups. The level of conservatism (categories 1–3) was moderately (but not statistically significantly) associated with an inability to recognize non-indications to treatment. Three outliers (category 4), however, revealed a highly inappropriate handling of the clinical cases. Conclusions Chiropractic students enrolled at a university-based course closely integrated with a medical teaching environment are not immune to chiropractic conservatism. However, the course appears to attenuate it and limit its effect on clinical decision-making compared to other educational institutions.

Perceptions of Ontario chiropractors on business education in chiropractic schools

Objective Chiropractic, as a business in the health care system, has a component of entrepreneurship. Therefore, it is important to have business education in chiropractic schools. This study examines perceptions of business education in chiropractic schools as evaluated by Ontario, Canada, practicing chiropractors. Methods We conducted a series of interviews with 16 chiropractors practicing in Ontario. Questions aimed at analyzing 2 levels of chiropractors' perceptions on the quality of business education they received. The questions were designed around 2 concepts: perceived level of business knowledge acquired and current level of knowledge for 6 business topics. The topics included accounting and finance, organizational behavior and human resources, legal and ethical issues, strategic management, managerial decision making, and operational management. Interview responses were analyzed by grouping significant statements into themes followed by descriptions of what and how the subjects experienced the phenomena. Results The interviews revealed that Ontario practicing chiropractors' requirements for education in business skills are both broad and essential, embracing most if not all major business domains. Many participants indicated that the status of business education in chiropractic schools is minimally contributing to business skills following graduation. Conclusion Producing chiropractors with entrepreneurship skills requires enhanced business education in chiropractic schools. Perceptions of Ontario chiropractors reveal a gap between skill-oriented business training in chiropractic education and the skills needed to practice within the profession.

Grit and chiropractic students' academic performance: a cross-sectional study

Objective Previous investigations have studied the relationship between grit and academic performance, and it has been reported that grittier students perform better academically. The objectives of this study are to measure chiropractic students' grittiness and to explore the correlation between grit and academic performance. Methods We distributed the Short Grit Scale (Grit-S) questionnaire to chiropractic students in electronic form. We included questions about their previous grade point average and the number of times they had retaken examinations. We scored the overall Grit-S scale and the Consistency of Interest and Perseverance of Effort subscales. A 2-tailed t test and 1-way analysis of variance were used to determine differences between groups. Results The response rate was 87% (n = 110). The mean grit score (3.44 ± 0.60) was similar to the general population and slightly lower than other healthcare professionals. The students who had a grade point average between <80% but less than 90% obtained significantly higher grit scores compared to those who had a grade point average <60% but less than 70%. Similarly, students who had no examination retakes had higher grit scores compared to those who took 4 or more exam retakes. We observed these differences in the overall and subscales scores. No other group showed any difference. Conclusion The results of this research showed that the grittier students performed better academically than the less gritty students. Grit scores can potentially be used to identify the students at risk of failing or dropping out. The role and potential application of grit in chiropractic education, student support, and admission procedures should be further evaluated.

A survey of chiropractic students' perceived business preparedness at graduation

Objective The objective of this study was to assess chiropractic college graduates' business experience, education, and need for further education at the time of graduation. Methods We conducted an anonymous survey of graduating chiropractic students in 2015 and 2016 regarding their prior business experience, business courses taken before and during chiropractic education, business abilities and needs, and practice plans. Results Eighty-one responded out of 114 surveyed (71% response rate). Less than half had taken college-level business courses or had business experience prior to entering chiropractic college. Almost 90% of respondents took 1 or more of 3 elective courses in business skills during their chiropractic education. Sixty-eight percent planned to work as an associate doctor and to be in private practice after 5 years. The respondents indicated that they were more prepared in the business abilities of ethics/risk management/jurisprudence, employee management, strategic planning, and marketing/advertising, and least prepared in business operations, accounting, and billing/reimbursement. In the areas of economics, finance, business taxes, and starting a practice, the respondents indicated a need for further education or experience. It was statistically significant (p < .001) that students who had prior business experience and/or college business education were more confident in operating a health care practice. Conclusion Chiropractic business education provides students with some of the practice management skills essential for operating a health care practice. Students with prior business experience and/or education reported more confidence in their ability to run a chiropractic practice immediately after graduation.