I had occasion to be in Phoenix, Arizona in January, 1997 to attend some very special meetings. I was intrigued and pleased with the discussions and decisions.I should like to summarize my impressions in this report.
The meetings attended were the annual meeting of the Council on Chiropractic Education (CCE) and a special meeting of the education committee of the World Federation of Chiropractic (WFC).
There were many dignitaries in attendance representing the chiropractic colleges on planet Earth, the various CCEs and a variety of what earthlings call political organizations.
I have previously attended CCE meetings, and this one was business as usual. Everyone had their oversized white agenda books filled with repetitious printings of material that seemed important. I wonder how much of it is ever thoroughly reviewed? So many dead trees. In other galaxies, trees are preserved and communication usually occurs via electronic or other means yet to be fully utilized on Earth.
It was hard to follow the step-by-step course of discussion over minor "housekeeping" changes in by-laws and standards. As expected, there was a lively debate regarding the desire to increase standards of admission to your colleges. It was quite a surprise to see the motion to increase entrance GPAs to a whopping 2.5 actually pass. It was a more startling surprise when one particular member of the Council (one known for his disdain of science because you haven't proven a bumble bee can fly), argued to delay any action on the motion until more scientific studies could be completed to lend validity to the proposed action.
One argument opposing the change to increase standards focused on imposing regulations upon the colleges. If some colleges wanted to raise their standards and others didn't, it should be a voluntary decision and not a regulation. As I listened, I pondered what would happen if the regulation was to move the GPA to less than what is required such as a 2.0., or eliminate it? Would the quality of entering students improve? In other galaxies public respect of chiropractic is high and applicants to colleges exceed available seats. Such respect seems to be related to public perception that doctors of chiropractic are highly educated, beginning with their preparatory education and extending through their professional education and their clinical training experience. Earthling logic amuses me.
The meeting ended with the usual accolades of appreciation and everyone shook hands and left to enjoy the Arizona sunshine. I wonder what they will argue about next year?
Internationalization of Chiropractic and the WFC
The following day was a diverse gathering of international representatives focused on setting standards for education. Many languages and cultures were represented. It is quite gratifying to see chiropractic take on a global perspective, much like it has throughout the universe. With diversity, however, comes several interesting challenges.
I will try to summarize my perspective of the meeting and suggest some issues and concerns that confront the World Federation of Chiropractic (WFC) and the chiropractic profession. The WFC is to be applauded for its efforts to address and solve some of these issues.
The absence of legal recognition has allowed for an uncontrolled growth of chiropractic in many countries. This proliferation of numbers has been without standards and thus chiropractic has become a collage of definitions and practice styles. Setting educational standards is a beginning step to improve this situation.
There are three areas where I see the WFC must make bold steps.
- Basic Definitions: The chiropractic profession continues to struggle with defining its role as a health care provider.
- The basic concept of a primary provider extends from the definitions provided by Western medicine (one who can treat all things with an unlimited scope of practice), to the concept of the WHO, where the primary provider is the village health advisor who teaches people how to wash their food, improve sanitation and avoid the unnecessary transmission of disease. Surely the WFC can assist chiropractic in finding a niche within this spectrum.
- Is chiropractic an alternative health care delivery system or is it part of the mainstream of health care? In the U.S., we seem to straddle the fence depending on who is providing the definition and how it best suits their interests. In the far East, chiropractic seems to be an additional modality used by a wide variety of practitioners. In several countries, other professions have shown an interest in learning to do what chiropractors claim to do. Is the profession separate and distinct in all countries? Can the WFC help to represent the interests of the profession to the World Health Organization?
- Basic Training, Credentialing, Reciprocity
- In the U.S., the requirements to obtain admittance into a chiropractic college are well defined and support the educational system designed to bring students into the program well-prepared. In other countries, many who already practice chiropractic receive far less training than those trained in the North America. In an attempt to bring standardization to this dilemma, proposals for "grandfathering" current practitioners and establishing multi-stage training programs leading to recognition levels less than the doctor of chiropractic are being implemented. This creates a double standard between North American and non-North American trained practitioners. The WFC needs to develop a plan to deal with this dilemma.
- There are requests from many countries for advanced placement and short courses leading to a DC degree from people with training in other health care fields (medicine, physical therapy, oriental medicine, acupuncture, etc.). There needs to be a method to determine equivalency of training and transference of credit between DC programs and other health professions.
- In the U.S., chiropractic colleges are nonprofit organizations. Outside the U.S., chiropractic colleges are either university-based or proprietary. If the WFC wishes to eliminate the proprietary schools and move everyone to a university-based system, should not the colleges in the U.S. be held to the same standard? What are the benefits and pitfalls of such a plan?
- With CCE-US, CCE-Canada, CCE-Europe, CCE-Austalasia, should the WFC become a super accrediting agency setting standards at an international level? From a galactical point of view, it is unfortunate that standards must be imposed by some authority. If the true sense of professionalism existed, wouldn't the drive towards excellence and the establishment of higher standards be a natural consequence? Ah, the downside of being mortal.
- Internationalization, Globalization, Technological-Based Learning
- It was reported in the WFC meeting that in many countries, table manufacturing companies, independent practitioners selling a variety of techniques, and weekend junkets sponsored by North American chiropractic colleges all contribute to the mass of poorly trained, unlicensed practitioners. All were asked to cease from such activities. The motivation for such activities appears to be economically driven on the surface. However, as one listens to many of these traveling sales people, several motivations are revealed. Some are politically driven. Others are philosophically driven. A few may actually be academically driven. Whatever the motivation, some sort of clearinghouse or standard-setting organization needs to define what is appropriate education for recognition of one's credentials. The WFC could fill this breach.
- While Earthlings struggle with boundaries and jurisdictions and the variation of standards, the world is speeding by. Soon, instruction in chiropractic will be on the Internet, on interactive TV and interactive CD-ROM. No sooner will people become accustomed to this type of crude communication than new technology will replace it. As communication improves, boundaries will become less significant in the transference of information. Soon, chiropractic will indeed become global. At such time, the WFC should be prepared to assume a leadership role in directing the future development of the chiropractic profession and its educational standards.
In closing, let it be said that the foundation of all such standards, guidelines and regulations parallels the quality and competency of the clinician. Until quality and competency are the prime motivators for our actions, regulations will be required to assure implementation. As we move toward implementation of regulations for assurance of quality and competency, the WFC should serve has a vehicle of communication, as a legitimization and recognition agency and as a broker of ideas and standards.
From the LA Galaxy, Good Luck Mr. David Chapman-Smith. The challenge of internationalization is in your future.
Reed Phillips, DC, PhD
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