Redefining the Rules

The CCE changes its standards from quantitative to qualitative

Early next year, chiropractic colleges across the nation will adopt a new set of accreditation standards. Significantly, this will be the first wholesale rewriting of the standards in more than three decades.

Set by the Council on Chiropractic Education (CCE), these rules define what programs must do to gain or maintain CCE accreditation. In a marked departure from past years, the standards will now allow greater freedom in how D.C. programs admit and educate students, while requiring more accountability for producing competent professionals. “It’s a change in the way institutions go about delivering education,” says Dr. Brian McAulay, executive vice president and provost at Life University.

The new standards, which take effect in January 2012, are less prescriptive, with fewer demands that programs offer specific courses or use particular teaching methods such as requiring D.C. students to deliver 250 adjustments. Rather, the standards reflect an emerging focus on setting and measuring learning outcomes for students. It’s a trend that has become commonplace in higher education nationally, but is only now being adopted by the chiropractic profession, according to McAulay.

“Rather than focusing on credit hours and the amount of time a student spends in a seat, an outcomes approach asks ‘What has a student actually learned?’” he explains. “This approach is about holding institutions accountable for being very clear on what the student is expected to learn, and then being very good at measuring and assessing whether that learning has taken place.”

The U.S. Department of Education charges accrediting agencies such as the CCE with periodically reviewing standards to ensure they reflect best practices in the profession and in the broader field of education. A team comprising personnel from CCE-accredited programs began this process in the summer of 2006. Its mission was to look at every aspect of the agency’s accrediting standards, and then bring them more in line with current thinking and practices in higher education.

In past decades, the emphasis among colleges was centered simply on the teaching process. “You put people in class, they hear a lecture and they take an exam or write a paper,” says McAulay. “They do that for 48 courses over four years, and then you give them a degree.”

The philosophic shift to measuring outcomes, however, arose primarily from the realization that it was possible for a student to undergo an entire program and emerge without having mastered the skills necessary to function as a practicing professional. Sure, one might have completed the required number of adjustments, but were they a good adjuster? Were all these adjustments given to supportive family members, or given as a result of caring for patients who provided real feedback regarding the effect of chiropractic care on their health?

Under these new requirements, D.C. programs will be required to demonstrate that students have acquired the knowledge, skills and attitudes each college sets forth in its curriculum. As a result, they must do baseline testing to gauge what a student knows before beginning the course of study, and then follow up to see how much progress the student is making. These expectations will stem not only from the CCE’s Meta-Competencies Policy that sets forth basic skills that every chiropractor must possess, but also from the college’s own mission statement and philosophy.

“We wanted to give the educational programs more latitude and more flexibility in how they design and deliver their educational programs,” says Dr. David Wickes, executive vice president and provost at the University of Western States and CCE Council chair. “You can’t force everyone into a single box.”

One program might present its curriculum in a very linear fashion, moving from one set of courses to another. Other schools could create a more integrated program in which basic and clinical sciences are mixed together, he adds.

“Some people think they’re trying to change Chiropractic to a point where we can’t do the things we have always done,” said Dr. Tim Gross, assistant provost for institutional effectiveness and accreditation liason at Life University. “Part of the best practices in accreditation is that you have standards allowing you to set your mission, but then you have the policies, procedures and assessment practices to demonstrate you’re meeting your mission.”

After considerable debate regarding the best way of approaching the standards, the Task Force circulated two drafts for public comment—the first in 2009 and a second in 2010. Almost from the beginning, the process stoked controversy among many members of the profession.

“There was language in one of the drafts that referred to the CCE accrediting the ‘D.C. [degree] or its equivalent,’” says Wickes. “That immediately got seized upon by a fraction of the profession that the CCE was endorsing the Doctor of Chiropractic Medicine degree.”

According to Wickes though, non-U.S. programs often award a degree other than a Doctor of Chiropractic degree to their graduates. Eventually language was fashioned to clarify that the CCE was seeking a means to recognize these international chiropractic degree programs. And in a subsequent draft, these programs were described as “chiropractic educational programs offered outside the United States, in accordance with CCE’s Vision and Mission.”

One of the toughest and most controversial issues, however, revolved around a concept viewed by a large part of the profession as the central tenet defining Chiropractic as a separate and distinct healing art. To this end, the drafts omitted all mention of subluxation—causing an uproar among not just the colleges, but throughout the entire profession.

In a letter to the CCE regarding this point, Life University’s President, Guy Riekeman, D.C., spoke for many when he wrote, “This revision draft is an attempt to make the CCE Standards less prescriptive; however, this is not the same as making them completely non-specific to Chiropractic. It is possible to make them so generic and non-specific that we don’t even need a separate specific professional accrediting agency. The ACC chiropractic paradigm, along with virtually all of the laws defining Chiropractic as a separate and distinct healing arts profession, makes direct reference to the relationship between Chiropractic and spinal subluxation.”

After a long and often heated debate, the profession won what some see as a partial victory. While subluxation was not restored to the standards document, it was placed in CCE Policy 3, which governs the standards. “It was put back in along with another modifier [neuro-biomechanical dysfunction],” explains Wickes. “That way, it doesn’t require schools to use the term ‘subluxation’ if they don’t want to do so.” And despite the wording of these new regulations, students can rest assured LIFE will continue to be a subluxation-based institution.

Indeed, numerous members of the chiropractic educational community believe accreditation standards shouldn’t shape or define the profession. “That’s left to professional associations such as ICA and ACA, as well as the state licensing boards that, by legislation, define what it can and cannot do,” says McAulay. “An accreditation agency is about defining educational quality for a particular profession, but shouldn’t define the profession itself. For me, this is a significant step forward for the profession. The regulators and the associations can take that on as their rightful responsibility. The standards, as they’re supposed to be, are focused on educational quality and the quality of the graduate.”

Many chiropractic students are already starting to see methods of teaching that are quite different from those experienced by earlier generations. Instructors are moving away from just lecturing and toward more active forms of learning intended to create a greater degree of student engagement with the material. “So there will be more small-group learning and more dialogue, rather than just the lecture model where the teacher stands at the front of the class and delivers material,” says McAulay. “There will be more back-and-forth.”

And at LIFE, for instance, students have already begun using a Learner Response System device in some of their classes. Using this technology, they can provide real-time feedback on how well they’re grasping any particular point of instruction. “As the instructor facilitates a class, she can—at any time—stop the class and have the students respond to a topic she’s been discussing,” says McAulay. “[The instructor] can test in real time their level of mastery of it. [And instructors] can solicit [students’] opinions in real time.”

When all is said and done, the new standards are likely to encourage colleges to develop more innovative ways of educating students. In the future, that will mean better-educated and more skillful chiropractors entering the workforce, which can only be a good thing.