Chiropractic student choices in relation to indications, non-indications and contra-indications of continued care
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RESEARCH
Open Access
Chiropractic student choices in relation to indications, non-indications and contraindications of continued care Stanley I. Innes1* , Charlotte Leboeuf-Yde1,2,3,4,5 and Bruce F. Walker1
Abstract Background: The quality of health care provider clinical decisions has long been recognized as variable. Research has focused on clinical decision making with the aim of improving patient outcomes. No studies have looked at chiropractic students´ abilities in this regard. Method: In 2016, advanced students from two Australian chiropractic programs (N = 444) answered a questionnaire on patient case scenarios for neck and low back pain (LBP). We selected 7 scenarios representing the three categories; continuing care, non-indicated care, and contraindicated care. This represented a total of 21 tested scores. Comparisons of correct answers were made a) for program years 3, 4 and 5, and b) between the three categories of care. Results: In almost 1/3 of scenarios, correct scores were 70% or greater. Best results were for two neck pain cases (simple and with spinal cord involvement). Continued care showed most improvements with study year. However, the scenarios that reflected non-indication for continued care had much worse results and did not improve in higher years. For the obvious contraindicated neck scenario, the results were good from the beginning and progressively improved and for a contraindicated LBP scenario the results started poorly in year 3 but improved over the program years. Conclusions: Although student responses were generally good, there is still room for improvement, especially for non-indicated care. The quality of students’ clinical decisions can be measured and thus has the potential to be used by chiropractic educators and regulatory bodies to identify student’s in need of assistance as well as to monitor chiropractic programs in relation to student competence. Trial registration: Not applicable. Keywords: Clinical decisions, Diagnosis, Chiropractic, Education
Background Quality care is a key aim for all healthcare systems [1, 2]. The most common domains used to measure healthcare performance are safety, effectiveness and access [3]. Undergraduate education for healthcare providers aims to produce competent graduates who can implement evidence-based and common sense care in order to meet expectations associated with safety and effectiveness [4]. Chiropractic students in Australia undergo programs which are 5 years in duration [5]. Like medical students, * Correspondence: [email protected] 1 School of Health Professions, Murdoch University, Murdoch, Australia Full list of author information is available at the end of the article
the early years are spent learning the basic sciences, after which they progress to the clinical sciences with the expectation that they will learn to apply this knowledge and make reasonable clinical decisions. Clinician judgment has been described as being notoriously fallible, irrational and difficult to comprehend [6, 7]. As a result medical resea
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