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Let's Make It Better

This is an article about the accreditation of chiropractic colleges and the developments currently taking place in that important arena. First, however, a comment or two directed at those who unfortunately continue to view our profession as one made up of either straights or mixers.

During nearly 100 years of our profession's history, the terms "straight" and "mixer" most often have been used in a pejorative way intended to put something or someone down. They have been used to describe differences in professional beliefs and to describe the nuances of various perceived practice behaviors. Depending upon which side one was on, both "mixer" and "straight" have been synonymous with being ethical or unethical, good or evil. Historically, these labels have, in one way or another, been at the heart of nearly every division of the profession. Is it any wonder the terms are considered by many as being divisive? The saga continues to this day. It is at the forefront of the current accreditation issue.

There are those who assert that the dichotomy of bad and good associated with the labels "mixer" and "straight" no longer exists. It is said that in our current, more moderate and loving world the two terms are simply semantic conveniences used to distinguish differences between acceptable professional belief structures. We are told that a "live and let live" theme should pervade the profession and that, if this were the case, all would be well. If only it could be so.

The fact is, however, extremes of the two sides continue the bitter rivalry, totally oblivious of the enormous cost to the profession. Yes, a few favor a practice model so broad as to be unrecognizable as chiropractic to most practitioners. And yes, some have a view of the profession so narrow they seem insensitive to the needs of patients as well as the aspirations of the majority of the profession. That both often justify their position by arguing how seldom they are sued for malpractice gives little comfort.

It is true, both extremes exist in the profession. However, it is also true that taken together, the total number of practitioners countable in these extremes represent an incredibly small minority of the over 40,000 licensed chiropractors in this country. Finally, it is also true that an overwhelming majority of chiropractors use reasoning models, procedures, and technologies daily that members of both extremes would identify as belonging to the bad guys of the other side. So, how do we discover who is right? Who is wrong?

The dilemma is not peculiar to the chiropractic profession. Widely divergent and passionately held professional opinions are found in virtually every profession, whether law, psychology, medicine, or even architecture. It is precisely here that a strong and credible educational community is essential.

Wise men have warned against trusting he who claims to know that which is singularly right. Were we to know the single "right answer" to all of our questions and the single "right way" to do things, the world would be a different place indeed. For instance, there would be no need for colleges in the sense that we know them. In such an unlikely world, there would only be need for training centers where the "right answers" and the "right ways" could be transplanted into the minds of customers. There would be no need for students. After all, students, especially good students, question the things they learn. They try new ways of answering questions. They try new ways of doing things. Sometimes, they even find better ways.

In such a world of "right answers and ways" we would not need, nor would we want educational institutions to develop an ambience of inquiry. We would no need, nor would we want questioning. There certainly would be no need for discovering new ways of doing things, for doing so might contaminate the body of "right answers" and "right ways."

Finally, there would be no need for an accreditation process to validate the quality of the educational process. The degree to which the "right things" had been implanted could simply be measured by some Orwellian testing committee. The process would entail ascertaining how many of the "right things" could be regurgitated or demonstrated by individuals who had endured the prescribed course of transplant programming.

Unfortunately, a set of "right answers" and "right ways" does not exist. Pointing fingers and repeating labels of right and wrong, mixer and straight, will not change this. Not surprisingly, participants in the real world do not expect absolute rightness. They do look for and have the right to expect discovery of better answers and better ways. And this is where a healthy and vibrant educational community plays perhaps its most important role.

The colleges provide new practitioners to replace those who leave and to assure growth in the profession. Equally important, indeed many feel more important, the colleges also must provide the environment in which better answers and ways are uncovered. This is the expectation that society in general has of its educational establishments. Why should it be different in the chiropractic profession?

What then is the role of accreditation?

First, what accreditation is not: Accreditation does not prescribe right answers and right ways, nor does the accreditation organization establish licensing laws.

The accreditation process is a peculiarly American phenomenon developed over the last century as an alternative to the more common governmental guardianship of education, characteristic of most parts of the world. In a very real sense it is, in fact, peer review. To an almost exclusive extent it deals, not with what things are to be taught, but rather with how things are to be taught. It is a method by which assurances of quality educational practice can be made to the various constituents who utilize education: to the students who experience it; to the chiropractic profession it represents; and to the patients effected by its decisions.

To do these things the CCE, as do all accrediting agencies, establishes standards. These standards are not the sole product of college people, but rather are arrived at as the result of deliberation and input from a wide number of sources. In the case of the CCE those sources include representation from chiropractic colleges, the American Chiropractic Association (ACA), the International Chiropractors Association (ICA), the Federation of Chiropractic Licensing Boards (FCLB), and the public.

Like laws, all accreditation standards are not universally popular. Almost all are objected to in some way, by someone, for some perceived good reason. Like laws, accreditation standards are not static; they are amenable to change and to do so to some extent virtually every year.

For myself, I do not like every CCE standard, nor does my institution. As a result, over my almost 17 years of involvement with CCE, I have worked to change those standards I do not like. That work has been rewarded with some successes and, of course, some failures. I shall continue to work for improvement.

To institutions who have been associated with the Straight Chiropractic Academic Standards Association (SCASA)

Let this stand as an invitation to stop the endless and fruitless cycles of division, divisiveness, and isolation that has characterized our profession during much of its first 100 years. The objective must be to win the war, not kill the enemy. A unified educational establishment dedicated to finding better answers and better ways can best serve that end. A unified educational community, not necessarily agreeing on all matters, but focused on producing competent practitioners, is essential.

It has been said that if the SCASA colleges join the CCE, the principles which they hold dear will be lost. I can only say that if they are that fragile, then perhaps they should be lost. But on the other hand, if they have the enduring qualities which are attributed to them, then they will not only survive, they will flourish. And they will do so, not just for a special few, but to the benefit of the entire profession and the public which it serves.

Come bring your wisdom to the entire profession. Don't limit it, or yourselves. Please let us end the senseless and destructive name calling. If the CCE standards need changing, then work toward changing them. From experience, I can tell you positive change comes only with great effort, but combined with energy and integrity, change is possible. Finally, neither the world nor the CCE will ever be perfect, but if we work together they can be better.

John L. Miller, D.C.
Sunnyvale, California

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