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Table 2 Comparison of CCEA 2009 and 2017 graduate competencies

From: Are Councils on Chiropractic Education expectations of chiropractic graduates changing for the better: a comparison of similarities and differences of the graduate competencies of the Chiropractic Council on Education-Australasia from 2009 to 2017

CCE-A 2017 competency Description (Denotes only present in 2017) CCE-A 2009 Equivalent
1 PRACTICING PROFESSIONALLY Practises professionally, ethically and legally with safety and efficacy with the application of evidence-based practice as the primary consideration in all aspects of chiropractic practice. 1.1
1.1 Complies with legal and ethical requirements  
1.1.1 Adheres to relevant legislation, common law, codes, standards and other policy regulating chiropractic conduct and practice. 1.1/ 3.4/ 4.1/ 4.2 / 5.1
1.1.2 Applies the ethical principles of autonomy, beneficence, nonmalfeasance and justice. 1.1
1.1.3 Applies principles of confidentiality and privacy. 9.2/ 9.3
1.1.4 Establishes and maintains professional relationships and boundaries. 3.3/ 9.4
1.2 Applies a patient-centred approach to practice  
1.2.1 Recognises and responds to diversity in the population, including but not limited to gender, age, religion, race, disability, socioeconomic status and sexual orientation. 6.1/ 9.3/ 10.1
1.2.2 Recognises and responds to the impact of culture, values, beliefs, education levels and life experiences on health status, health and help-seeking behaviours and maintenance of health. 6.1/ 9.3/ 10.1
1.2.3 Recognises and responds to a patient’s emotional response to their health status. 6.3B
1.3 Applies an evidence-based approach to practice 11.1
1.3.1 Uses an evidence-based approach in planning, delivering and evaluating care. 11.1
1.3.2 Applies critical thinking and problem solving to all aspects of care. 11.1
1.4 Demonstrates professional integrity 3.2
1.4.1 Demonstrates commitment to continuing professional development and lifelong learning. 3.2
1.4.2 Applies research skills to support professional development and lifelong learning. 11.1
1.4.3 Works within the bounds of their professional expertise and competence and seeks professional support and peer review when necessary. 3.4/ 6.5/ 8.4
1.4.4 Accepts responsibility and accountability as a professional and member of the chiropractic profession. 3.4
1.4.5 Applies principles of risk management and quality improvement to practice. 6.4/ 8.4
1.5 Demonstrates capacity for self-reflection 3.2
1.5.1 Demonstrates skill in self-assessment and critical evaluation of personal knowledge, skills and expertise, including awareness of personal bias and beliefs and how these might influence patient care; has appropriate strategies in place to deal with this. 3.2/ 6.5/ 8.4
1.5.2 Demonstrates awareness of factors affecting their health and wellbeing, including fatigue, stress management, infection control and disease prevention, to mitigate health risks of professional practice  
2 COMMUNICATION, COLLABORATION AND LEADERSHIP Communicates and collaborates effectively at all times with patients and others 6.1/ 6.2/ 6.5/ 6.6/ 6.7/ 7.1/ 7.2/ 9.1/ 9.2/ 9.3/ 9.4/ 9.5
2.1 Communicates effectively with patients and others 9.1/ 9.2/ 9.3/ 9.4
2.1.1 Communicates effectively – verbally, non-verbally and in writing – providing clarity for safe and agreed care and treatment. 6.1/ 6.2/ 9.1/ 9.2
2.1.2 Meets language proficiency requirements established in regulation for the profession.  
2.1.3 Adapts communication style to acknowledge cultural safety, and cultural and linguistic diversity 6.1/ 9.4
2.1.4 Uses information and communications technology effectively to enhance communication  
2.2 Collaborates effectively with patients and others  
2.2.1 Demonstrates rapport, active listening, mutual respect and trust in developing professional relationships with patients and others. 9.4/ 9.5/ 6.1/ 6.2
2.2.2 Expresses professional opinions competently, confidently and respectfully, avoiding discipline specific language when necessary. 9.5
2.2.3 Gives timely, sensitive and instructive feedback to colleagues in the chiropractic profession and other professions and responds professionally to feedback from these colleagues. 3.3/ 9.4
2.2.4 Demonstrates ability to describe and respect the roles and expertise of other health care professionals. 2.1 / 3.2/ 3.3
2.2.5 Demonstrates ability to learn and work effectively as a member of an inter-professional team or other professional group, including through delegation, supervision, consultation and referrals. 2.1/ 3.3/ 9.4
2.2.6 Recognises potential for disagreement and conflict in relation to care and management, and responds to resolve issues  
2.3 Collaborates effectively with patients and others  
2.3.1 Recognises responsibility to protect and advance the health and wellbeing of individuals, communities and populations. 1.1/ 10.1
2.3.2 Participates in evidence-based health education and risk reduction programs to meet identified needs within the community. 1.2/ 11.1
2.3.3 Integrates prevention, early detection, health maintenance and chronic condition management, where relevant, into practice. 10.1
2.3.4 Places the needs and safety of patients at the centre of the care process, demonstrating safety skills including infection control, adverse event reporting and effective co-management and referral. 1.2/ 9.10/ 10.1
2.4 Manages information to meet legal obligations and professional standards  
2.4.1 Creates, maintains and manages accurate and complete records that comply with legal requirements, accepted professional standards and confidentiality 4.1
2.5 Supervises administrative and other staff  
2.5.1 Defines activities that can be delegated to administrative or other staff. 4.2
2.5.2 Explains responsibility for supervising and training administrative or other staff 4.2
3 CLINICAL ASSESSMENT Understands patients’ health status and related circumstances; critically analyses these and forms a clinical impression.  
3.1 Obtains and records a history  
   Obtains and records history of patients’ medical, social and health status. 6.1
   Evaluates individual patient risk factors. 6.1
   Maintains secure, accurate, consistent, legible and contemporaneous records of patient management— electronic and/or written. 4.1
3.2 Performs a clinical examination  
3.2.1 Explains need for and process of examination. 6.2
3.2.2 Performs examinations relevant to patients’ presentation. 6.2/ 6.3A,B/ 6.4
3.2.3 Obtains consent and conducts physical examination with appropriate rapport, respect and preservation of modesty. 6.2
3.3 Obtains the results of clinical, laboratory and other diagnostic procedures necessary to inform care  
3.3.1 Identifies existing investigation results and reports. 6.5
3.3.2 Determines clinical, laboratory and other diagnostic procedures relevant to patients’ presentation 6.4 / 6.5
3.3.3 Refers for or conducts imaging where clinically indicated. 6.4
3.3.4 Makes referrals or obtains further information, where indicated. 7.2
3.4 Recognises determinants of health  
3.4.1 Identifies and considers determinants of health, including psychological, biological, social, cultural, environmental, educational, and economic determinants, as well as health-care system factors. 1.2
3.4.2 Demonstrates knowledge of aetiology, pathology, clinical features, natural history and prognosis for common and important presentations. 1.2/7.1
3.4.3 Recognises and responds to public health priorities. 1.2
3.5 Critically analyses information available to generate a clinical impression 7.1
3.5.1 Demonstrates knowledge of diagnostic imaging techniques and procedures, including indications and limitations of available imaging modalities. 6.4
3.5.2 Interprets and integrates results of clinical, laboratory and diagnostic procedures into care planning. 6.2/ 6.6
3.5.3 Forms an understanding of patients’ health status and/or identifies possible diagnoses. 7.1
3.5.4 Identifies ‘red flags’ and manages and/or refers as appropriate. 7.2/ 9.8
4 PLANNING CARE Works in collaboration with patients, exploring the care options available and developing agreed, evidence-based care and management plans. 7.2
4.1 Identifies possible care and management options  
4.1.1 Integrates knowledge of chiropractic and other health sciences to inform decisions about care and management options. 8.1 / 8.2
4.1.2 Obtains, interprets and applies current evidence and information to inform decisions about care and management options.  
4.1.3 Identifies care and management options likely to be therapeutically effective and safe for patients 8.4/ 9.2
4.1.4 Adapts practice according to varying patient needs across the human lifespan, including need for care and management options to be tailored for patients. 1.2
4.1.5 Considers opportunities to enhance patients’ care and management through the involvement of other health professionals. 7.2/ 9.4/ 9.6
4.2 Discusses care and management options  
4.2.1 Explains and discusses the outcomes and implications of the clinical assessment with the patients. 6.5 / 9.1
4.2.2 Discusses purpose, nature, benefits, risks and expected outcomes of care and management with patients and others. 9.1/ 9.4/ 9.6
4.2.3 Discusses and seeks agreement with patients and others on patients’ goals and priorities. 9.3
4.2.4 Describes areas of practice of other health professions and explains interprofessional approaches to patients and others. 9.4
4.3 Formulates a care and management plan  
4.3.1 Formulates care plan in collaboration with patients, recognising personal and professional limitation 3.4/ 8.4/ 9.6
4.3.2 Reaches agreement on patient-centred, evidence-based care plan, including chiropractic care, co-management or referral.  
4.3.3 Establishes plans for review of care and management. 8.3/ 9.10
5 IMPLEMENTING, MONITORING AND EVALUATING CARE Coordinates the safe and effective implementation, monitoring and evaluation of patients’ care and management plans.  
5.1 Obtains and records patient-informed consent regarding care 4.1
5.1.1 Applies relevant legal requirements, professional standards & codes to obtain & record patients’ consents. 3.3
5.2 Implements interventions safely and effectively  
5.2.1 Performs safe and effective adjustive, manipulative, manual and other procedures. 9.6/ 9.8
5.2.2 Provides information and advice to patients for health promotion, self-management and lifestyle options for better health. 1.2/ 10.1
5.2.3 Adapts interventions accounting for factors such as age, condition, health status, response to care and patients’ preferences. 1.2/ 9.8
5.3 Monitors & evaluates progress of care and health outcomes  
5.3.1 Recognises possible complications/adverse events arising from patients’ management and has appropriate procedures in place in order to be able to effectively manage these including referral for emergency care when appropriate. 7.2/ 9.7
5.3.2 Monitors patients’ progress towards achieving planned health outcomes using valid and reliable measures where available. 7.2/ 9.10
5.3.3 Monitors management and care for adverse events and changes in patients’ lives that may affect care. 7.2/ 9.7/ 9.10
5.3.4 Considers alternative options when indicated. 9.9/ 9.10
5.4 Adapts plans based on monitoring and evaluation  
5.4.1 Collaborates with patients and other health professionals, where indicated, to address issues arising from monitoring and evaluation. 9.10