In the July 31, 1992 issue of "DC", we printed an interview with James Winterstein, D.C., president of the Council on Chiropractic Education (CCE) and of National College of Chiropractic.
As promised, we now present an interview with the chairman of the CCE's Commission on Accreditation (COA), Dr. Marino A. Passero. Dr. Passero is a private practitioner in Norwalk, Connecticut.
"DC": Can you give us an historical perspective on how the accrediting powers developed in the chiropractic profession?
Dr. Passero: The field of medical education was the first professional group to feel the impact of non-governmental standards. The need to evaluate medical education came with the Carnegie Foundation's 1910 Flexner Report. Soon after that, giant strides were taken by the medical profession to achieve educational credibility as an important and legitimate means by which a profession could raise the standards of education of its future members, and at the same time exert further influence over the quality of that profession. The medical profession was followed by the legal profession, and subsequently by scores of other professions, to establish credibility through educational standards.
The primary purpose for specialized or professional accreditation is to provide some assurance to the public of the quality of the education of future practitioners. The level of education is considered to be one of the eight characteristics by which a profession may be identified.
More than 60 professions now have voluntary, recognized accrediting agencies which regularly check on the performance of their respective institutions. The CCE and COA are the chiropractic profession's assurance to the public that there is a reliable, recognized organization which sets standards and ascertains the quality of chiropractic education.
Since 1913, accrediting agencies have expanded their scope to include: 1) certifying that an institution or program have met established standards; 2) establishing educational criteria to meet professional certification, licensure, and for upgrading courses offering such preparation; 3) protecting an institution against harmful internal and external pressures; 4) stimulating self-assessment and improvement; 5) faculty and staff participation in institutional evaluation and planning; 6) assisting institutions in determining the acceptability of transfer of credits; and (7) providing one basis for determining eligibility for federal assistance.
"DC": From the perspective of the COA, what does "accredited" mean?
Dr. Passero: The Commission on Accreditation of the CCE grants accredited status to institutions determined to be in substantial compliance with the council's criteria and that are substantially meeting their own objectives. Initial accreditation or reaffirmation of accreditation are made with specific recommendations or conditions.
When an institution is awarded accredited status, it is publicly stating that its entire enterprise has been examined and found to be in substantial compliance with known, agreed upon criteria. One criterion is that the institution, based upon its mission statement, has set for itself certain goals and objectives and is meeting them. An accredited chiropractic institution is fulfilling the public need for credibility in education. No other means of assuring high quality educational delivery and public confidence can equal accreditation by a recognized, reliable authority.
"DC": When a chiropractic college seeks CCE accreditation, what is the process in determining the institution's status.
Dr. Passero: There is one category of institutional status: accreditation.
Accreditation is granted to institutions that upon completion of the full accrediting procedure are deemed, by the COA, to be in substantial compliance with the standards. To be eligible, an institution must comply with 10 eligibility requirements.
Institutions seeking accreditation are required to develop a self-study and undergo an on-site visit by a team of experts in education and the practice of chiropractic. The submission of the self-study report to the COA constitutes the formal application. When the institution is ready for an on-site team visit, a judgment is made concerning the status of the school, based on the visit and related factors.
A self-study must be all encompassing and provide a penetrating and critical self-analysis. It must start with the institutional objectives and penetrate every facet of policy, program, procedure, and personnel in terms of the objectives. Its scope must be quantitative and qualitative, comprehensive and intensive, and must reflect the mutual participation of students, faculty, administration and board of control and other appropriate constituencies.
When the COA approves a school's self-study document, a highly specialized and expert team of administrative, basic science, and chiropractic personnel is assigned to visit the institution. It is the team's purpose to report on their factual findings as they relate to the self-study and the CCE Standards. A written report is then submitted by the team to he COA, and the commission conducts a review meeting of the application. It renders one of three decisions: 1) confer accreditation; 2) defer accreditation; or 3) deny accreditation. In the event of an adverse decision, an institution may appeal to a special independent appeal panel.
"DC": Does accreditation require chiropractic institutions to teach specific courses and hours as well as specific programs?
Dr. Passero: No, the CCE Standards states that the chiropractic curriculum must be designed and implemented in a manner that will give the students the opportunities to become proficient in the variety of cognitive, effective, and psychomotor skills necessary to become a doctor of chiropractic. The curriculum must also be supportive of the mission, goals and distinctiveness of the institution and of the achievement of the program's outcomes.
The Standards state that the offerings of the institutions should address subjects such as anatomy; biochemistry; physiology; microbiology; pathology; public health; physical, clinical, and laboratory diagnosis; gynecology; obstetrics; pediatrics; geriatrics; dermatology; otolaryngology; diagnostic imaging procedures; psychology; nutrition/dietetics; biomechanics; orthopedics; physiological therapeutics; fist aid and emergency procedures; spinal analysis; principles and practice of chiropractic; adjustive techniques and other treatment procedures; research methods and procedures; professional practice ethics and other appropriate subjects.
Courses offered in the curriculum must comprise a minimum of 4,200 50-minute hours.
As a responsible accrediting organization, the CCE Standards must provide for the educational requirements of all licensing jurisdictions in the United States.
"DC": What differences do you see between "accredited" and "non-accredited" institutions?
Dr. Passero: Perhaps one of the best ways to answer this question would be to offer a list comparing various features of the two:
| CCE Status-Holding Institutions | Non-CCE Status Institutions |
| 1. Recognized by reliable | 1. The institution failed to |
| authority as an insti- | seek such recognition or |
| tution offering and | failed to achieve it. An |
| delivering high quality | institution may be too new |
| education. | to apply, since the insti- |
| tution must have complied | |
| with CCE admissions criteria | |
| for at least two years to be | |
| eligible to apply. | |
| 2. Eligible for federally | 2. Eligibility uncertain. |
| guaranteed student loans. | |
| 3. Eligible to apply for | 3. Eligibility uncertain. |
| federal interest payment | |
| assistance toward putting | |
| up new campus buildings. | |
| 4. Required to support | 4. Not required to support |
| chiropractic research. | chiropractic research. |
| 5. Public is assured that | 5. Claims of the unaccredited |
| graduates of accredited | institution are not subject |
| institutions have | to verification by recognized |
| completed a competent | reliable authority. |
| education for the practice | |
| of chiropractic. | |
| 6. Acceptance of academic | 6. Transferring credits is |
| credits by other institu- | uncertain. |
| tions and universities. | |
| 7. Confidence that adminis- | 7. Lack of such assurance and |
| tration and faculty of | confidence. Claims of un- |
| the institution are dedicat- | accredited institutions are |
| ed to the continuing search | not subject to verification |
| for truth, and the utilization | by a nationally recognized, |
| of the results of acceptable | reliable authority. |
| scientific research. |
"DC": Dr. Winterstein explained that there are nine members of the COA who carry out and decide upon institutions' status. But, what does the Executive Committee of the COA do?
Dr. Passero: This is a standing committee of the COA. Its members consists of the officers of the commission: the commission chairman, the vice chairman, and the secretary. The executive vice president of the CCE is also a non-voting, ex officio member. The executive committee's duties are to carry out the accreditation policies and procedures of the council, all commission business affairs, and any other procedures which are developed by the commission. In effect, the executive committee oversees the day-to-day operations of the commission's responsibilities as it pertains to the accreditation of chiropractic colleges.
The commission chair is responsible for establishing, with the assistance of the CCE executive office staff, site team visits when institutions submit self-studies for review, and establishes the content and location of workshops which may be needed for the council, the institutions, the site team visitors, and the commission itself. The COA's executive committee is responsible for initially dealing with complaints against institutions. These are then referred to the commission for consideration, review, and action.
The executive committee acts as the coordinator for the commission for major activities which must be carried out by the commission in light of chiropractic institutional review for the accreditation process and activities regarding continuing needs of the institutions.
Dr. Passero: Thank you for the opportunity to give, in detail, information on the Commission on Accreditation activities, actions and its role in the accreditation process.
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