Chiropractors' attitudes to, and perceptions of, the impact of continuing professional education on clinical practice

Continuing Professional Development in the Legal Profession

Continuing professional development is often seen as a means of protecting professional autonomy and maintaining privileged status. This article explores recent debates. A missing perspective on how professional learning occurs is explored using practice-based learning. The purposeful practice of professionals is considered with particular attention to instances of `hot' action, situations where professionals are required to make on-the-spot decisions with little time for deliberation. We demonstrate that it is at such moments that, through articulation and in dialogic relations, professionals can arrive at new understandings of their work; this we term `CPD-on-the-run'. Our research findings are from a collaborative study of lawyers and we report some of the significant ways in which these professionals learn and the context. Our findings suggest there is a need to shift policies away from the predominant focus on individuals towards a concern with informal and spontaneous collective interaction in practice.

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic

Background

Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor.

Methods

The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author.

Results

A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi.

Conclusion

Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia.

Increasing research capacity in the chiropractic profession: A case study and evaluation of an innovative research program in Norway

OBJECTIVE

The subject of research methods is not commonly covered in continuing professional development (CPD) courses in spite of its emphasis in undergraduate education. This initiative aimed to develop postgraduate research competency and recruit chiropractors to musculoskeletal research.

METHODS

The program was delivered as a university-based program with 20 credits over seven contact weekends covering topics of evidence-based practice, research methods, statistics, ethics, resources, and funding. Students were assessed through assignments showing competency in critical literature review, case report writing, and production of a research protocol as the final assessment. Non-student participation for CPD points was possible. A student evaluation survey was completed after the end of the academic year.

RESULTS

There were 26 participants: 16 as students handing in assignments, 10 as non-student participants for up to 94 CPD points. Three submitted a final protocol and two registered at a university PhD program. A network of research clinics was established for data collection for future multicenter studies.

CONCLUSIONS

The program was well received by the participants and gave them the tools and resources to perform research. The two-level attendance system afforded a basis for setting up a network of research clinics with a fundamental understanding of optimal data collection. This initiative has shown that research skills can be revisited through CPD programs as part of evidence-based lifelong learning.

The influence of continuing professional development portfolio records on pharmacy practice

Objectives

The aim of this study was to undertake an in-depth investigation of the influence of continuing professional development (CPD) portfolios on pharmacy practice in the hospital setting. The objectives were to explore the views of pharmacists regarding the contribution of CPD records to professional practice and examine the influence of time and experience on pharmacists' views of recording professional practice.

Method

A qualitative design was used to explore the views of pharmacists over 12 months. Pharmacists were stratified according to years of practice in the UK National Health Service (NHS). The methods used involved semi-structured in-depth face-to-face interviews. The interviews were undertaken at three time points. The pharmacists were gathered into three focus groups to test the consistency of the interviews. A purposive sampling method used nine NHS Teaching and Non-Teaching hospital pharmacists in the London area.

Key findings

The participants included four males and five females, who had been qualified for between 0.1 and 21 years. Three key themes emerged for how CPD records contribute to practice: (1) lack of contribution to practice, (2) tacit contribution and (3) mentality. Overall, the recording process made little if any change in professional practice. The more experienced participants were less likely to be able to explain any changes in practice and there were no consistent changes in the views expressed over time.

Conclusions

The contribution of CPD recording to enhancing practice in hospital pharmacists was difficult to demonstrate. This study has also illustrated the power relationships involving control mechanisms used by the NHS, and the UK pharmacists' regulatory body, which are discussed in the context of the Panopticon model of self-regulated behaviour. Further research is needed to establish the value of CPD recording.

Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach: introduction

PURPOSE

Imaging technology can improve patient outcomes by allowing greater precision in diagnosing and treating patients. However, there is evidence that overuse, underuse, and misuse of imaging services occur. The purpose of this project was to develop evidence-based diagnostic imaging practice guidelines for musculoskeletal complaints for use by doctors of chiropractic and other primary health care professionals.

METHODS

An electronic search of the English and French language literature (phase 1) was conducted on several databases. Cross references, and references provided by clinicians, were also used. Independent assessment of the quality of the citations used to support recommendations in the guidelines was performed using the QUADAS, the AGREE,and the SPREAD evaluation tools. A first draft of a diagnostic imaging practice guideline was produced, using the European Commission's Referral Guidelines for Imaging document as a template. Results were sent to 12 chiropractic specialists for a first external review. A modified Delphi process, including 149 international experts, was used to generate consensus on recommendations for diagnostic imaging studies. The reliability of proposed recommendations was further tested on field chiropractors and on a group of specialists both in chiropractic and in medicine in both Canada and the United States. All recommendations were graded according to the strength of the evidence.

RESULTS

The research procedure resulted in the recommendations for diagnostic imaging guidelines of adult extremity and spine disorders supported by more than 685 primary and secondary citations. High levels of agreement among Delphi panelists were reached for all proposed recommendations. Comments received by specialists were generally very favorable and reflected high levels of agreement with the proposed recommendations, perceived ease of use of guidelines, and implementation feasibility.

CONCLUSIONS

These evidence-based diagnostic imaging practice guidelines are intended to assist chiropractors and other primary care providers in decision making on the appropriate use of diagnostic imaging for specific clinical presentations. In all cases, the guidelines are intended to be used in conjunction with sound clinical judgment and experience. Application of these guidelines should help avoid unnecessary radiographs, increase examination precision,and decrease health care costs without compromising the quality of care. All guidelines are documents to be refined and modified regularly with new information and experience.

Canadian chiropractors' perception of educational preparation to counsel patients on immunization

OBJECTIVE

This study describes the prevalence and correlates of perceptions of Canadian doctors of chiropractic regarding the adequacy of their undergraduate (UG) and postgraduate (PG) educational preparation to counsel patients about immunization/vaccination and explores their preferences for continuing education (CE) in this area.

METHODS

A cross-sectional population-based postal survey of Alberta chiropractors was conducted in the summer of 2002.

RESULTS

The response rate was 78.2%. Forty-five percent perceived that their formal UG chiropractic education prepared them adequately to counsel people on immunization compared with 64% who agreed that their self-directed PG education prepared them adequately. College of graduation was significantly associated with perceptions related to UG but not PG education. Those who felt prepared to counsel on immunization by UG education used different immunization information sources than those who felt prepared by PG or both UG and PG education. Use of specific sources and perception of preparedness to counsel on immunization were both associated with antivaccination behaviors. Those who felt prepared by PG or both UG and PG education were more likely to engage in antivaccination behavior than others. Most respondents indicated interest in CE on immunization.

CONCLUSION

The proportion of doctors of chiropractic who perceive themselves adequately prepared to counsel on immunization varies by type of education considered and is related to vaccination behavior. Many are interested in some form of CE related to immunization/vaccination.

An online survey of chiropractors' opinions of Continuing Education

Background

Continuing Education (CE) for chiropractors is mandatory for licensure in most North American jurisdictions. Numerous chiropractic colleges have begun collaborating with universities to offer master's degree programs. Distance education master's degree programs may be desirable to allow full-time practicing doctors to further their post-graduate education. The present survey sought to answer three questions. First, what is the level of satisfaction of chiropractors with their continuing education? Second, what is the level of interest of chiropractors in online master's degree programs? Lastly, what is the response rate of chiropractors to an online survey?

Methods

An online survey consisting of 22 multiple choice questions was e-mailed to 1000 chiropractors randomly selected from the mailing list of an online chiropractic newsletter. Upon completion of the questionnaire, participants' answers were saved on a secure site. Data analysis included evaluation of the demographic characteristics of the respondents, their opinions of and patterns of taking CE including online education, preferred learning formats, and their interest in proposed online master's degree programs. A survey response rate was determined.

Results

Nearly 86% of respondents felt their previously completed CE courses were either somewhat or extremely satisfactory. Over ninety percent of respondents who had completed online or distance CE coursesfound them to be somewhat or extremelysatisfactory. Almost half the respondents indicated that they most preferred online distance learning, while 34.08% most preferred face-to-face interaction. Fifty-three percent of respondents indicated an interest in starting a master's degree program; however 70.46% of respondents were interested in an online master's degree program that would offer CE credit. A response rate of 35.8% was obtained.

Conclusion

Satisfaction among chiropractors with CE programs is high. The notion of completing a part-time online master's degree (or online combined with face-to-face interaction) appears to be popular among respondents, with a M.Sc. in Chiropractic Sciences being the most popular of those mentioned. Online surveys are a viable method of obtaining opinion in a cost and time efficient manner; there are some sources of bias involved in this type of research, and numerous steps need to be taken to obtain a suitable response rate.

Research Note: Continuing Education via Telemedicine: Analysis of Reasons for Attending or Not Attending

This study analyzed factors that influence the decision to attend or not attend tele-education broadcasts via a telemedicine network for continuing education (CE) credits. A questionnaire was developed and sent to all participating sites on our telemedicine network that have attended CE broadcasts. The majority of respondents attend specific types of broadcasts, receiving less than 25% of their CE credits from the tele-education broadcasts. Factors most influencing the decision to attend a broadcast include interest in the topic and perceived utility of the information. The most common reason influencing the decision not to attend is an explicit preference for attending conferences. Tele-education broadcasts may supplement other CE activities but may not replace them. The attraction of attending conferences in person is very high and may be especially so for health-care professionals in rural environments.