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Better by Degrees

Enhancing the DCís role through advanced practice programs

Written by Dean Greenwood   
The chiropractic profession has evolved significantly over the past few decades and has gained support from the public, and from medical and other health-care practitioners. Research initiatives, improved standards of education and an emphasis on evidence-based practices are solidifying the role of the chiropractor as an integral part of the health-care team in Canada and in many other countries around the world. Current trends in health-care funding, and a limited supply of primary care medical physicians, have created both an opportunity and a dilemma for the practising chiropractor. The opportunity is the fact that patients are seeking alternatives to a family medical doctor; the dilemma is that, more often, they are presenting to a chiropractor with complex health complaints necessitating advanced diagnostic protocols, co-management with allopathic providers and referrals for secondary or tertiary care. 

 Greenwood3  
Dr. Greenwood receives his Masters of Science from Dr. James Winterstein,
immediate past-president of the National University of Health Sciences.


 
There have been recent changes in the legislation of the practice of chiropractic in British Columbia. To paraphrase, in B.C., chiropractic means “the health profession in which a person provides, for the purposes of promotion, maintenance and restoration of health, the services of . . . advice and counseling on matters related to the condition of the spine or other joints of the body and the associated tissue, the nervous system and the overall health of the individual.”

The emphasis clinically is still spine and related structures, but there is a theme of conservative, integrative care that must be considered in the management of patients during the delivery of chiropractic services. It is incumbent on the chiropractor to have a greater understanding of co-existing disease processes and evidence-based management to provide patients with effective, timely, safe and appropriate care or advice when confronted with a serious or complicated health complaint. An aging population compounds the challenges in primary care, as many conditions are interrelated with aging, further complicating diagnosis and treatment.

Advanced learning to better serve patients
In 2007, the National University of Health Sciences in Illinois initiated the Master of Science in Advanced Clinical Practice degree program, an advanced degree designed for health-care providers such as chiropractors and naturopaths. The two-year, part-time program was established with several purposes in mind: to enhance and improve diagnostic skills; to help students understand and manage a greater array of clinical conditions; to encourage students to seek to work with an integrative health-care team; to help students pursue professional leadership; to provide educational appointments or PhD-level programs; and to provide training in scientific writing and publication in peer-reviewed journals. The first class graduated in 2009 and the program is proving to be a success. 

The author’s experience with the program
I applied to this program in the spring of 2010 and was accepted into the program in the fall of that same year. The decision to enter into a Masters program after nearly 30 years in practice was not made without some hesitation. It would involve 18 trips from Vancouver to Chicago to attend intensive weekend lectures, along with several online course modules, examinations, a great deal of extra reading and research, a clinical competency exam based on the United States Medical Licensing Examination (USMLE) internal medicine model, as well as two original case reports formatted for journal submission. The first class in neurophysiology was a big wake-up call, and I nearly called it quits. Slowly, the information overload became easier to deal with, and month by month, I passed each course and was able to progress successfully through the program. 

The modules on nutrition were particularly beneficial, I found, as my province had recently expanded the chiropractic scope of practice to permit the sale of nutritional supplements. Other courses included, Clinical Skills for the Primary Care Physician, Research Methodology, Mechanisms of Pain, Clinical Laboratory Medicine, Diagnostic Imaging, Neurology, Pediatrics, Geriatrics, Men’s and Women’s Health, Psychology, Ethics, and Integrative Medicine. Course instructors were practising physicians with specialty training and academic background in their respective topics. 

Pharmacology – why DCs should study it
One of the most challenging parts of the program was Clinical Pharmacology. A great deal of time was spent on understanding the role of pharmaceuticals in primary care practice in the management of infectious disease, cardiovascular disease, pain and diabetes. Some students questioned the necessity of this part of the program as it did not pertain to the scope of chiropractic practice, and this caused some dissent. However, there is a requirement for this type of training in jurisdictions where limited prescription rights are being sought by chiropractors. Regardless of the individual practice philosophy of the participants, it was generally agreed that this knowledge makes for an improved doctor-patient experience.  Chiropractors must be aware of prescription medication use by their patients whether or not they agree in principle. Interactions with herbal supplements and drug side-effects were discussed. The reality in evidence-based practice is that there may be a set of circumstances where the use of prescription medication is in the patient’s best interest. The epidemic of diabetes and cardiovascular disease in America is primarily lifestyle related, but when confronted with a very sick patient who may not have the resources to deal with his or her condition naturally or expeditiously, medication may be the only reasonable solution in the short term to prevent serious complications or even death. 

Canadian DCs and advanced education programs
August 2012 marked the end of the program with a capstone defence of an original case report and a formal convocation at National along with the graduating chiropractic, naturopathic and oriental medicine classes. There was a great sense of accomplishment and relief upon completion of the final step by everyone in the class, especially for those of us who had been in practice for many years. 

Two of the students were from Brazil and hoped to advance the profession of chiropractic in their country through political and academic involvement. 
I was the sole Canadian in the class. The registrar of the program, Dr. Jonathon Soltys – who is originally from Canada – advised me that there had been only one other Canadian to complete the program. His goal and the goal of the school was to continue to expand the program to include practising chiropractors from all parts of the United States and Canada and doctors from other countries looking for an opportunity for academic, clinical and professional advancement. 

There are now programs available through other chiropractic institutions that lead to a Master of Science degree, some of which are offered online. It is the responsibility of every practising chiropractor in Canada to achieve a minimum continuing education requirement, and programs such as Advanced Clinical Practice provide doctors with a systematic, challenging and rewarding experience towards higher education, improved patient care, and personal and professional enrichment.

In my opinion, it is programs such as these that will firmly establish chiropractors as health-care leaders with equal input to national and provincial health delivery strategies that will serve the needs of patients now and in the years to come.

“A vision for a new kind of healthcare is emerging. It is patient-centered, healing oriented, and embraces conventional and complementary therapies. This medicine has become known as integrative medicine. Driven initially by consumer demand, it is now increasingly being accepted by healthcare providers and institutions. Definitions abound, but the commonalities are a reaffirmation of the importance of the therapeutic relationship, a focus on the whole person and lifestyle – not just the physical body, a renewed attention to healing, and a willingness to use all appropriate therapeutic approaches whether they originate in conventional or alternative medicine.” (This excerpt is taken from the original article Integrative Medicine and Patient Centered Care, EXPLORE  September/October 2009, Vol. 5, No. 5  277-289)

For information regarding the Master of Science in Advanced Clinical Practice at National University of Health Sciences, go to www.nuhs.edu .


Dr. Dean Greenwood is a co-owner of the Vancouver Spine Care Centre in Vancouver, B.C., a 1981 graduate of the Palmer College of Chiropractic, a Fellow of the Academy of Chiropractic Orthopedists (U.S.) and of the Canadian College of Chiropractic Orthopedists, and a graduate of the Master of Science in Advanced Clinical Practice program at National University of Health Sciences.

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