The challenges we face in obtaining and providing appropriate training for the chiropractic allied health professional are not unique to our profession. A study of the training of allied health professionals for the other professions revealed some surprising information. Some of the allied health professions require very extensive formal education. Others are hired off the street and receive no formal education at all. Phlebotomists are an example. They are usually trained to conduct venapuncture on the job. Similarly, physical therapy aides in some states are hired off the street and receive on the job training, most often from the physical therapy assistant who is responsible to the physical therapists.
A number of years ago, Maine's DCs assessed the challenge of how to increase the knowledge and level of training for the CA who regularly has clinical contact (hands on) with the patient. The challenge was how to develop and provide a CA training program that included didactic education as well as clinical training, for the CA who works in the clinical side of the practice either solely, or as a part of total duties. Obviously the number of Maine residents who are able to leave the state, and enroll in CA programs at chiropractic colleges is extremely limited and does not come close to meeting the number of CAs needed to serve Maine's DCs.
To continue to justify the public confidence and trust in the clinical staff, solutions were imperative. It was obvious that a creative alternative needed to be developed and instituted. Any such program, to have credibility, validity, and to be meaningful, would also need the approval, sponsorship, and support of an accredited chiropractic college.
The concept was to develop a campus without walls. The formal program and clinical training would be held in state, using postgraduate instructors from the New York College of Chiropractic.
The major challenges that faced the successful implementation of the certified clinical CA program were identified and dealt with. They included:
a. Develop a syllabus that would be approved by the college.
b. Provide didactic training that had direct relevance to the practical aspects of the CAs' clinical tasks. In other words, eliminate the useless information that so often is included in other educational programs to beef up the course and project the image of an intense, quality course. This needed to be a no nonsense, no frills course that provided training and competency in the 'real world' of chiropractic clinical practice.
c. Provide clinical training without requiring that the CAs leave their local geographic area to any great extent, thereby enabling the CA to continue to work without lost work time. DCs would not need to be concerned about finding temporary staff to replace the CAs while they were away from the office/clinic acquiring the education and training leading towards certification.
d. Minimize the associated financial costs for tuition, lodging, travel, etc., to either the CA, the doctor, or both.
The program has been in existence approximately four years, and was initially voluntary. At the present time, the certification program is required by state statute. The initial class consisted of 106 enrollees, which was a surprise to us because we had not realized that there was this type of a need (especially since it was voluntary at that time).
The course is divided into two sections:
a. didactic education: 106 hours
- classroom instruction: 36 hours
- extension study: 70 hours
total hours: 206The Didactic Education
The didactic education is divided into two parts:
- practical, clinical physiological therapeutics;
- spinal anatomy and related subjects for the CA in assisting the doctor in patient clinical care.
The classroom hours of the didactic portion of the course are presented in three modules on three separate weekends, and consist of a minimum of 12 hours per session at each weekend. Two of the weekends coincide with the Maine Chiropractic Association's semi-annual educational conventions (spring and fall). The third is presented in mid-winter between these two sessions. Students are required to check in at the registration desk prior to the starting time of each class, and following each break. In this way, attendance is very closely monitored.
The final four hours of the third weekend are dedicated to the examinations (physiological therapeutics and spinal anatomy, etc.), which are given in two parts. Both examinations are comprehensive. Students are required to obtain a passing grade of 75 in each section.
On the Job Clinical Experience
The on the job clinical experience hours are logged. Verification of the hours is the responsibility of the supervising doctor, who may be the CA's employer. The supervising doctor must attest that the hours were actually spent in clinical contact with the patients by signing the log sheet each day that the CA works in the clinical environment. The signature places the onus of meticulous accuracy on the doctor. Evidence of fraud is an offense and is reported to the Board of Chiropractic Examiners for further action.
The log sheets are reviewed for accuracy by an auditor (notary public) and for evidence of fraud. The logs are archived as a permanent record. Students must have attended all 12 hours of each of the three modules, fulfilled the 100 hours on the job clinical experience, and have passed both sections of the examination before receiving a certificate that attests to satisfactory completion of the program of study from the New York College of Chiropractic.
Registration per session is $75 per weekend. The course hours are 11-6 on Saturday, and 8-1 on Sunday. These hours eliminate the cost of a second overnight stay for most of the CAs, since most travel to class on Saturday a.m. and leave for home immediately after class on Sunday. The single night stay also reduces other out-of-pocket expenses.
All students receive comprehensive pre-printed notes as they are presented on each of the elements of physiological therapeutics, i.e., electrotherapy, ultrasound, interferential therapy, cryotherapy, heat. This eliminates a good deal of note taking and enables the students to concentrate on the presentation and visual aids. The reference textbook is Applied Physiotherapy by Schaeffer (ACA).
Further details of the program, the statutory language, the mechanism for state certification, etc., can be provided by contacting the author:
Moshe Myerowitz, DC
50 Broadway
Bangor, Maine 04401
Tel: 207/947-3333
Fax: 207/947-1008
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