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

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