MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Have you ever wondered how good or bad the education of chiropractors and osteopaths is? Well, I have – and this new paper promises to provide an answer.

The aim of this study was to explore Australian chiropractic and osteopathic new graduates’ readiness for transition to practice concerning their clinical skills, professional behaviors, and interprofessional abilities. Phase 1 explored final-year students’ self-perceptions, and this part uncovered their opinions after 6 months or more in practice.

Interviews were conducted with a self-selecting sample of phase 1 participant graduates from 2 Australian chiropractic and 2 osteopathic programs. Results of the thematic content analysis of responses were compared to the Australian Chiropractic Standards and Osteopathic Capabilities, the authority documents at the time of the study.

Interviews from graduates of 2 chiropractic courses (n = 6) and 2 osteopathic courses (n = 8) revealed that the majority had positive comments about their readiness for practice. Most were satisfied with their level of clinical skills, verbal communication skills, and manual therapy skills. Gaps in competence were identified in written communications such as case notes and referrals to enable interprofessional practice, understanding of professional behaviors, and business skills. These identified gaps suggest that these graduates are not fully cognizant of what it means to manage their business practices in a manner expected of a health professional.

The authors concluded that this small study into clinical training for chiropractic and osteopathy suggests that graduates lack some necessary skills and that it is possible that the ideals and goals for clinical education, to prepare for the transition to practice, may not be fully realized or deliver all the desired prerequisites for graduate practice.

Their conclusions in the actual paper finish with these sentences, in the main, graduate participants and the final year students were unable to articulate what professional behaviors were expected of them. The identified gaps suggest these graduates are not fully cognizant of what it means to manage their business practices in a manner expected of a health professional.

In several ways, this is a remarkable paper – remarkably poor, I hasten to add. Apart from the fact that its sample size was tiny and the response rate was low, it has many further limitations. Most notably, the clinical skills, professional behaviors, and interprofessional abilities were not assessed. All the researchers did was ask the participants how good or bad they were at these skills. Is this method going to generate reliable evidence? I very much doubt it!

Imagine, these guys have just paid tidy sums for their ‘education’ and they have no experience to speak of. Are they going to be in a good position to critically evaluate their abilities? No, I fear not!

Considering these flaws and the fact that chiropractors and osteopaths are not exactly known for their skills of critical thinking, I find it amazing that important deficits in their abilities nevertheless emerge. If I had to formulate a conclusion from all this, I might therefore suggest this:

A dismal study seems to suggest that chiropractic and osteopathic schooling is dismal. 

PS

Come to think of it, there might be another fitting option:

Yet another team of chiro- and osteos demonstrate that they don’t know how to do science.

39 Responses to Chiropractic and osteopathic graduates’ unreadiness for practice

  • I saw “survey” and “n=“ a ridiculously small sample and thought “well this will be crap”.

    But it was even worse than I imagined. Dismal to more dismal indeed.

    • yes, indeed!

    • “Qualitative samples tend to be small because of the emphasis on intensive contact with participants and the findings are not expected to be generalizable.”

      Bradshaw C, Atkinson S, Doody O. Employing a Qualitative Description Approach in Health Care Research. Global Qualitative Nursing Research. 2017;4

  • Scandalous that chiro is offered in some universities on UK

    • Yes – it implies that chiro is a legitimate and serious branch of actual medicine, while at the same time diminishing the status of such universities, at least in my eyes!

  • I’m afraid that the problem is not just limited to chiropractic, but extends to all of SCAM.

    The following seems to apply:

    – As far as I can estimate, at most half of all SCAM practitioners receive at least some form of science-based medical training, usually basic medicine. However, a large proportion (most?) of SCAM practitioners appears to have no relevant education at all.
    – Best case (i.e. multi-year full-time programs), this medical training still only comprises a fraction of what real medical students receive – maybe 20%. The bulk of SCAM training is Tooth Fairy science and thus useless.

    So you could say that when you randomly select a SCAM practitioner, there is at best a 10% chance that their diagnosis of a problem is more or less in line with science-based medicine.
    Unfortunately, this does not translate to a 10% chance of receiving a science-based treatment, because even if a diagnosis is science-based and correct, there is still a significant chance that a non-science-based treatment will be selected by the practitioner.

    These problems with poor education are further compounded:
    – Most SCAM training programs have very little supervised hands-on training, and certainly not the 1500+ of hours of internships that a real medical curriculum demands. Students are thus not confronted by how very difficult real medicine actually is.
    – And of course then there’s the Dunning-Kruger effect: people with just a little education tend to have more confidence in their level of knowledge and skills than those with a far more extensive education (although I must admit that there are plenty of very arrogant real doctors as well …).

    Note that any figures above are rather coarse estimates, so corrections and criticism are welcome. If anyone has better data on what part of a SCAM curriculum is proper science-based medicine, I’d really like to hear.

  • Well, I make only a perfunctory apology for re-posting this lnik: https://youtu.be/qTtNFEMPktU

  • It’s tragic that universities should be involved in the teaching of any SCAM – I feel it lends an air of authenticity and academic (and therefore scientific) credibility which misleads the public further. But not surprising I suppose when theology is also offered at Universities and time can happily be spent debating if the Bible or Quran etc represent the word of a make believe creature.

    • Slightly different. Theology does not necessarily lead to a job opportunity where thousands are scammed out of money and led to believe that pain relief or body function is dependent on regular visits.

      Theology does not undermine health care. Pain is the crucial factor when talking about SCAM ?

  • Incredibly, chiropractors and osteopaths often try to suggest that their training is equivalent to that of doctors when it so very clearly isn’t. It’s particularly concerning that many of them still try to treat a wide range of health conditions when they lack the necessary training and experience to do so.

    • “…many of them still try to treat a wide range of health conditions…”

      Sounds like they are practicing outside their scope of practice. Do you have a percentage with supporting evidence?

      • ‘DC’ wrote “Sounds like they are practicing outside their scope of practice.”

        Scope of practice is generally defined as the activities that an individual healthcare provider performs in the delivery of patient care.
        ‘DC’

        • Does Pete need something more specific?

          “Scope of practice refers to those activities that a person licensed to practice as a health professional is permitted to perform, which is increasingly determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity.”. AMA May 25, 2022.

          • [my emphasis]

            Or, why would one go to a PT when one can go to an evidence based chiropractor, considering that a chiropractor has a broader scope of practice?
            — ‘DC’

            Which aspects of this “broader scope of practice” would be beneficial and why?
            (Scope of practice varies depending on geographical location so it would help if you could specify the geographical location you are referring to)
            — compandalt

            Indeed. There is no scope of practice for chiros in the UK, so the ‘regulator’ has allowed them to get away with making a wide range of bogus claims with impunity.
            — Alan Henness
            https://edzardernst.com/2019/01/is-chiropractic-proven-effective-for-a-long-list-of-conditions-no-i-really-dont-think-so/#comment-108985

            And of course one must not forget all the Palmarian platitudes, axioms, mantras and miracle-testimonials from the late ‘20s to 1960 were based entirely on the wonderfully science-based concoction that only the axis and atlas (HIO) can “subluxate”…and only realign with a head-torqued, knee chest “toggle-adjustment”. Not unexpectedly after BJs earlier-than-expected demise all his earth-shattering research and treatment protocols disappeared like a proverbial fart in the wind.

            Of course the hyper-modern DC surrounds themselves in full‑spine flying‑7 adjusting, kinesio‑tape, motion‑palpation, AK, short‑leg analysis and Woody Woodpecker–like adjusting “guns”.

            All would agree; monumental, science-based progress!
            https://edzardernst.com/2019/01/is-chiropractic-proven-effective-for-a-long-list-of-conditions-no-i-really-dont-think-so/#comment-109088

            There are crooks in chiropractic who overtreat patients and foster a toxic dependency in patient and practitioner and it is up to the profession to clean them up with the assistance of external critics. Friends of Science in Medicine here have become more and more supportive of the chiropractic critics and reformers and we get along well. In countries like Australia, UK, Canada and the Scandinavian countries this is achievable. In the US with competing state registration boards and wildly varying scope of practice between states I am pessimistic.
            — Critical_Chiro
            https://edzardernst.com/2017/11/be-aware-of-the-bs-called-chiropractic/#comment-97380

          • In my area, a few examples:

            Can a PT order imaging? No
            Can a PT do an official reading of imaging? No
            Can a PT do phlebotomy? No
            Can a PT do an official lab report? No
            Can a PT see a Medicare patient without a MD release? No
            Can a PT do HVLA manipulation? No

            Can a DC do all the above? Yes

            “Scope of practice refers to those activities that a person licensed to practice as a health professional is permitted to perform…”

            So what can a PT do that a DC can’t do within the DC’s scope of practice? I’ll wait.

          • In UK

            – chiro does not ‘order’ but undertakes imaging using own equipment at an extra charge
            – chiro officially reads an image- how do we know as when it is read there is no objective interpretation of image?
            –why would a chiro need to do phlebotomy?
            – UK has self referral both for private and nhs physio
            – what is ‘official’ – no hospital in UK would receive/act on this report this report so what is report for?
            -who needs a HLVA manipulation? If a good physio doesn’t do it then that is probably because it has no evidence of effectiveness. However I am told there are some physios who do do HLVA in UK

          • What on earth is ‘DC’ waffling on about. Let’s recap…

            compandalt on Thursday 06 October 2022 at 07:15
            Incredibly, chiropractors and osteopaths often try to suggest that their training is equivalent to that of doctors when it so very clearly isn’t. It’s particularly concerning that many of them still try to treat a wide range of health conditions when they lack the necessary training and experience to do so.

            DC on Thursday 06 October 2022 at 12:09
            “…many of them still try to treat a wide range of health conditions…”

            Sounds like they are practicing outside their scope of practice. Do you have a percentage with supporting evidence?

            Which health conditions would be outside a chiropractor’s scope of practice? As I quoted above: “There is no scope of practice for chiros in the UK, so the ‘regulator’ has allowed them to get away with making a wide range of bogus claims with impunity.”

          • Pete: Which health conditions would be outside a chiropractor’s scope of practice?

            this isn’t all that difficult. Anything that’s not within their scope is outside their scope.

          • burdle, I am not real familiar with what DCs in the UK can and cannot do.

            Note in my comment, I said in my area (USA).

          • ‘DC’ wrote:

            Pete: Which health conditions would be outside a chiropractor’s scope of practice?

            this isn’t all that difficult. Anything that’s not within their scope is outside their scope.

            ‘DC’, Thanks for confirming, yet again, that the entire field of chiropractic is nothing but smoke and mirrors. It goes hand in hand with your previous confirmation:

            QUOTE
            R. Daneel on Tuesday 04 October 2022 at 19:27

            DC says:

            what schools may or may not teach or have on their web page isn’t necessarily representative of what practicing chiropractors may or may not believe.

            DC, Thanks for confirming that the entire field of chiropractic is nothing but smoke and mirrors.

            https://edzardernst.com/2022/10/dont-let-me-stop-youwhile-we-actually-treat-patients/#comment-141246
            END OF QUOTE

          • Pete: Thanks for confirming, yet again, that the entire field of chiropractic is nothing but smoke and mirrors.

            Illogical conclusion but people do tend to see what they want to see.

  • Hello Christine. How perceptive of you to spot the “whataboutism”. You have excelled yourself!!! Prof. Ernst and his ilk put “medicine” at a pinnacle of excellence, and every other healthcare system should aspire to be like them. When it is pointed out to them some examples where they fall off their self-proclaimed pinnacle, suddenly it is people like you who resort to sarcasm and inane comments about “contributing things of value” etc. All I am asking Prof. Ernst to do is be consistent in his criticism of all healthcare provider groups. Don’t concentrate on the easy targets, get some mettle and discuss some of the absolute tragedies in health care, e.g., opioid abuse and contribution of “big pharma”, $8 Billion rort of the Australian Medicare system by medical providers, etc. (I wonder how many people got incorrect care and have suffered as a result of this). Show some courage and have a look at these things. I bet you don’t as you are too chicken.

    • “All I am asking Prof. Ernst to do is be consistent in his criticism of all healthcare provider groups.”
      Has it not occurred to you that my expertise is in alt med?

    • You’re actually going to attempt to defend appalling whataboutism? Wow.

      Tell you what, why don’t you gather together the evidence you think you have and attempt an intelligent commentary.

      How dare you tell other people where they should concentrate their efforts.

      • Looks like I struck a raw nerve with you, Christine, for you to resort to old skeptics’ ploy of “bait and switch”. All I am doing is asking Prof. Ernst to do is be consistent in his commentary and review other healthcare systems with appalling track records in healthcare. Perhaps a comparative analysis would be of some interest. He hides behind the comment that he is an expert in “Alt med.”, but that is a copout for being lazy and bias.

    • The irate GG’s inability to tell apart terms like ‘medicine’ and ‘healthcare systems’ says all about its level of insight and understanding of the subject.

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