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Table 3 Core competencies and associated knowledge and skills

From: The development of a global chiropractic rehabilitation competency framework by the World Federation of Chiropractic

Domain 1 Basic concepts of disability and rehabilitation
 Competency 1.1 Demonstrate an understanding of the contemporary frameworks of rehabilitation and disability Knowledge
 • Describe the concept of rehabilitation
 • Describe the concept of disability (e.g. International Classification of Functioning, Disability and Health (ICF))
 • Identify the determinants of health within populations served
 • Explain the epidemiology of neuromusculoskeletal diseases and the factors that might prevent or delay their onset, and prognosis
Skills
 • Diagnose and care for patients within a biopsychosocial model
 • Apply contemporary concepts of rehabilitation and disability in the implementation of services
 Competency 1.2 Effective communication with patients and all/key stakeholders involved in rehabilitation services Knowledge
 • Recognize good communication is a core skill that fosters relationships and improves outcomes
 • Understand that disability encompasses physical, mental and sensory components
 • Understand the power of words in communication
Skills
 • Develop knowledge, attitudes and skills of effective communication
 • Recognize and interpret verbal and non-verbal communication
 • Utilize available information and communication technologies
 • Share resources and knowledge
 • Facilitate a structured, evidence-based rehabilitation encounter
Domain 2 Legal, regulatory and ethical components
 Competency 2.1 Apply in clinical practice the laws, regulations and policies that impact delivery of rehabilitation services Knowledge
 • Comprehend legal duties and responsibilities relating to rehabilitation and disability
 • Describe the basic regulations and policies of stakeholder organizations relating to rehabilitation, disability and return to regular activities
 • Explain the application of the professional duty of candour
 • Distinguish the professional and ethical boundaries expected of the chiropractor-patient relationship
 • Summarize the principles of risk management, safe practice and duty of care
 • Explain medico-legal processes and procedures, including vicarious liability
 • Describe the model of health care service provision across the different levels and sites of care at the local, regional and national level
Skills
 • Competent acquisition of informed consent from the patient or substitute decision maker
 • Integrate and respect the diversity of patients’ cultural and religious values and belief systems
 • Demonstrate respect for individual preferences and expressed needs
 • Recognize and manage threats to safety of people requiring rehabilitation
 • Operate a safe and accessible practice environment
 • Manage health risks and public health issues, including reporting
 • Practice in accordance with laws and principles of confidentiality
 • Work with a community or population to identify the determinants of health that affect them
 • Enable and support integration of chiropractic services within the health care system context
 Competency 2.2 Apply in clinical practice the ethical delivery of services Knowledge
 • Recognize persons entitlement to enjoyment of universal and indivisible rights and freedoms
 • Describe, promote and protect human rights and freedoms of persons
 • Recognize individual involvement in decision-making
Skills
 • Engage persons full participation in community, work and home environments
 • Engage persons active involvement in decision-making
 • Provide an accessible environment for rehabilitation services
 • Communicate clinical information with equipoise
 • Refer patients in need of accessible information about mobility aids, devices and assistive technology to appropriate providers
 • Evaluate and work within provider’s individual capacity of knowledge and skills
 • Develop rapport and trust with patients, and other stakeholders, colleagues and professionals, in compliance with privacy legislation
 • Apply ethical principles of autonomy, beneficence, non-malfeasance and justice
 Competency 2.3 Deliver rehabilitation services in line with regulatory standards Knowledge
 • Describe and apply evidence-based clinical guidelines and protocols required for clinical practice
 • Recognize and respect scope of practice of other health care professionals
 • Recognize and respect the policies and regulations governing key stakeholders
 • Acquire and incorporate advances in knowledge into clinical practice
 • Comprehend duties and responsibilities arising from statutory regulation
 • Describe the structure of the chiropractic profession and the purpose of representative bodies (including trade unions, chiropractic associations, colleges, societies and patients’ associations)
Skills
 • Complies with professional standards and legal requirements for creation, maintenance, storage and disposal of patient records and business documents
 • Allocate finite healthcare resources appropriately
 • Apply evidence-based and management processes to achieve cost-appropriate care
 • Work collaboratively to provide an interdisciplinary approach to care
 • Collaborate with community organizations, families, employers, and other stakeholders as required
 • Critically evaluate quantitative and qualitative research to inform evidence-based practice
 • Recuse self from practice when personal health and well-being makes it unsafe to do so
 Competency 2.4 Advocate for rehabilitation services as a means of achieving optimal outcomes, including return to work Knowledge
 • Define available rehabilitation services in individualized care plans.
 • Define key stakeholders that would facilitate return to activity and work
Skills
 • Communicate with stakeholders to facilitate return to activity and work
 • Engage stakeholders to improve rehabilitation services
 • Employ people centered care to support equitable and accessible rehabilitation services
Domain 3 Rehabilitation management of disability and other health conditions
 Competency 3.1 Clinical assessment—evaluate patients’ health status and related circumstances to develop a working diagnosis Knowledge
 • Describe normal structure and function of the human body
 • Identify and consider biopsychosocial determinants of health
 • Describe etiology, pathology, symptomatology, natural history and prognosis of neuromusculoskeletal complaints, pain syndromes and associated disorders
 • Interpret diagnostic procedures, including reliability, validity, uses and limitations
 • Identify and consider lifestyle, occupation or external factors that may influence health or well-being and return to activities/work
Skills
 • Conduct a patient history and physical examination using knowledge of pathophysiology, basic and clinical sciences
 • Identify the need for and availability of external health records
 • Perform and/or refer for diagnostic studies when indicated, e.g. diagnostic imaging, ultrasound, clinical laboratory tests
 • Interpret diagnostic study results
 • Explain outcomes and implications, using an appropriate comprehension level, of assessment, including working diagnosis and plan of management, to the patient, family and/or caregiver
 • Formulate a differential diagnosis, where appropriate
 Competency 3.2 Formulate a clinical plan of management Knowledge
 • Recognize need for emergency care, referral and/or collaborative care
 • Identify acute, subacute and chronic phases of conditions
 • Recognize indicators of persons psychosocial, environmental, and health behavioral factors that may be comorbid with neuromusculoskeletal conditions or associated with the risk of developing other physical and/or psychological conditions
 • Knowledge and understanding of evidence-based people-centered plan of management
 • Summarizes principles of health promotion and disease prevention
 • Critical appraisal, translation and application of health care knowledge
Skills
 • Develop therapeutic goals and prognoses based upon individual needs and strengths
 • Provide advice, explanations and reassurance related to working diagnosis and clinical plan of management
 • Employ evidence-based rehabilitation interventions for the purpose of optimizing function
 • Counsel patient, family and/or caregiver on preventive, supportive, concurrent and referral care
 • Engage and support patient, family, caregiver, employer, union and/or community stakeholders in shared decision-making of a plan of care, including identifying risks, benefits, natural history, alternative care and patient preferences
 Competency 3.3 Monitors and evaluates progress of care and health outcomes Knowledge
 • Describe and employ reliable and valid outcome measures
 • Identify patient expectations, experience and patient-reported outcome measures
 • Recognize indications for cessation or referral of care based upon patient outcomes
Skills
 • Monitor patient clinical status and modify diagnosis and care plan as indicated
 • Modify plan of care, including consideration of alternative options, based upon individual’s progress and external factors
 • Manage potential complications or adverse events arising from plan of care and have procedures in place to manage these circumstances effectively
 • Discharge from care based upon mutually agreed upon goals
 Competency 3.4 Participates in implementing the rehabilitation plan within the unique cultural and environmental context Knowledge
 • Explain the relevance of a history and assessment, taking into account home, school, work and community environments
 • Describe the environment and culture of the community
 • Recognize responsibility to protect, promote and advance the health and well-being of individuals, communities and populations
 • Discuss with stakeholders to facilitate optimal recovery, timely return to work (where appropriate) and restoration of agreed quality of life parameters
Skills
 • Support patient participation and inclusion in all aspects of the home, school, work and community environments
 • Deliver rehabilitation services that are congruent with the local cultural, sociodemographic, work and environmental context