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Table 3 A summary of criteria found in the CCE-A 2017 graduate competencies but not in 2009, criteria not carried forward, and those omitted from both

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

Criteria present in CCE-A 2017 and not found in 2009 competency standards for graduating chiropractors
• Applies principles of confidentiality and privacy.
• Establishes and maintains professional relationships and boundaries.
• Recognises and responds to diversity in the population, including but not limited to gender, age, religion, race, disability, socioeconomic status and sexual orientation.
• Works within the bounds of their professional expertise and competence and seeks professional support and peer review when necessary.
• Applies principles of risk management and quality improvement to practice.
• 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.
• 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
• Meets language proficiency requirements established in regulation for the profession.
• Added use of information and communications technology effectively to enhance communications
• Expresses professional opinions competently, confidently and respectfully, avoiding discipline specific language when necessary.
• Gives timely, sensitive and instructive feedback to colleagues
• Recognises potential for disagreement and conflict in relation to care and management, and responds to resolve issues
• Integrates prevention, early detection, health maintenance and chronic condition management, where relevant, into practice.
• 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.
• Reaches agreement on patient-centred, evidence-based care plan, including chiropractic care, co-management or referral.
• Provides information and advice to patients for health promotion, self-management and lifestyle options for better health.
• Monitors patients’ progress towards achieving planned health outcomes using valid and reliable measures where available (previously used pre-determined decision points to re-evaluate).
• Identifies ‘red flags’ and manages and/or refers as appropriate.
Criteria not carried forward to CCE-A 2017 that are present in 2009 competency standards for graduating chiropractors.
• Awareness of professional special characteristics, aspirations and strengths (ethos), aware of local to international organisations and major historical mileposts (3.1).
• Discuss with patient (9.1)
 ◦ cost of care
 ◦ appropriate patient discharge,
• Understands relevant health care economies (2.2)
• Patient re-evaluation and monitoring time frame removed at each visit (9.10)
• Change in language from “differential diagnosis” to “clinical impression”
• Removal of chiropractic techniques and replaced with “adjustive, manipulative, manual and other therapies”
• Removal of must have a “rational for treatment”
• Removal of must know “contra / non / indications” for care. Replaced with “therapeutically effective”
• Competent in business, staff and financial management (4.1, 4.2)
• Requirement to adhere to major national professional organisation (ACA / CA?)
• An interim management plan is required (8.2)
• Managing the physical and psychological practice environment (5).
• Identifies & uses screening instruments for the most common mental health &/or psychological disorders (6.1)
• Discussion of radiographic technology (6.4)
• Abnormal physical findings are pursued & investigated in a deliberate, logical & appropriate manner (6.2)
• The reliability of the data obtained is assessed & appropriate correlation with that patient’s complaints is established where possible (6.2)
• Patients are appropriately referred to mental health professionals (7.2)
• Reference to practice furniture, colour coding, music, temperature training of staff “to maintain an environment of unconditional positive regard” (5.1)
• Financial management of practice (4.1)
• Ensures adequate, ongoing care for patients during times of absence (3.4)
• Demonstrates willingness & capacity for writing third party & medicolegal reports certificates & correspondence (3.4)
• Demonstrates the ability to measure impairment, disability & handicap (3.4)
Missing from both the CCE-A 2009 and 2017 graduate competency standards
Vitalism / subluxation discussion
A definition of chiropractic or chiropractor