Periodically I will respond to some of the numerous questions I get from students. Sometimes they ask more sensitive and harder hitting questions that will require me to blank out names and protect identities so that we can discuss issues that are important to students without repercussions. All responses are my own opinions. And I hold every right to change my opinions over time with further insight and education.
Speaking of education, this entry revolves around that same subject. Chiropractic college education. Question is long, so the response is long. All feedback is welcome.
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Question from Student:
“I have been listening to the (FTCA) podcast a lot (and I love it, thanks so much for doing it!) and the main thing I hear over and over is that students aren't being taught to think critically or clinically. They are either taught a ton of scientific facts, heavy philosophy, or a ton of techniques but not being a master of anything. I hear over and over that there is a lack of systems in school to clinically assess someone and that you and others believe that the profession needs to start becoming more systematic.
I agree with everything above. I am a XXXXX chiropractic college student and we definitely get a lot of science here and we do really well on our first boards test but we seem to struggle with our later boards that are more clinical.
I have had 3 teachers that work here tell me in a one on one conversation that they think XXXXX is drifting away from what chiropractic should be and that we are getting caught up in becoming primary care docs, PT's, and scientists rather than proficient adjustors. That is pretty disheartening to hear from the staff of a school that you thought was going to prepare you the best for your future career.
I have been struggling to know what I should do as a student to become a good chiropractor when and before I graduate. I struggle with this especially because one of those three teachers that I mentioned before told me that if they had to redo their education somewhere now-a-days that they would do it at another school that wasn't XXXXX.
I don't see the point in leaving XXXXX to go to another school because I am just now finishing my 1st year and I might as well finish the basic sciences here at XXXXX before I go somewhere else... but should I go somewhere else once I pass my 1st part of boards?
I met a student from ZZZZZ chiropractic college that says they see a patient every week starting at trimester 1. Another friend of mine is at YYYYY chiropractic college and seems to be much more clinically aware than I am and we have an equal amount of schooling.
I want to do something before it is too late but I don't really know what to do. To make this questions more difficult another 1 of the three teachers told me that a doc who jumps to learning clinical stuff before they have a solid foundation in the basic sciences won't be as good as they could be but if you are just a pure scientist who dabbles in clinic practice then you won't really be a good clinician because a lot of the job is just figuring it out as you go. So where is the balance and how/where do I get it?
I am not against learning science but if the science is not going to help me be a better clinician then I really don't care to learn it. This trimester we did Head and neck anatomy, neurophysiology and neuroanatomy and I really liked a lot of neurophys and neuroanatomy but I didn't find a lot of clinical pearls in Head and Neck anatomy. For instance, we just finished a lecture about the layers and names of TEETH OF ALL THINGS and during that lecture I was replaying the many times from the podcast that I hear you and others say that students just learn a bunch of facts that aren't really helpful and then they get thrown out into the job market and struggle.
I know I am going to struggle when I graduate either way, but I want to prepare for it now.
I also want to know if I am wanting to run before I can walk. If I have that attitude and I just need to chill out because everything will be okay in the end then I would like to hear that too.”
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Thank you for listening to the podcast. I started it to begin conversations out loud that I felt were going on quietly in the profession. So many of us tend to graduate and then go off and practice on islands. We do that for many reasons, and not all of them are good. And some of them are downright detrimental to ourselves, our professions, and most importantly our patients.
Systems, or having solid systems in place in your practice, was a very strong theme in season one of the podcast. Think of your practice system as a practice “philosophy”. In reality, that’s what chiropractic philosophy serves as; a system for how to deliver care to people. There is really no chiropractic philosophy. There is a philosophy of chiropractic, and if you want to break it down, in truth there are thousands of different philosophies of chiropractic. One for each and every disparate doctor on their own island doing their own thing.
We have to be very careful when criticizing our educational institutions. I for one am not an educator. I don’t and never have taught at a chiropractic college. Most of us haven’t. They are a completely different entity with completely different responsibilities to the world, compared to the boots on the ground patient care world most clinicians live in. They have different masters to answer to. They also have alumni to answer to, but that might be a completely different story in itself. So I am not always comfortable discussing what a chiropractic school “should” do, or how they “should” change. All things can improve though, and there’s no doubt room at our educational institutions for improvement as well.
We do know that there are some really good chiropractic colleges out there, there are quite a few in the middle, and then a few more at the end of the spectrum that just do not produce a quality product on the average. Not the product we would want as a whole representing the profession. Everyone seems to be afraid to say that. And then to add another layer to that, the great schools can also produce horrible clinicians, and the less than favorable colleges can also produce great clinicians.
So I say, it is not a correlation equals causation argument. The school you go to isn;t nearly as integral of an issue on the outcome of your future success. I say it’s much more dependent upon the person matriculating in the program. The student. They are responsible for their own success. Yes, a school can sort of nudge you one way or another, it does have some importance. But overall, if a student has the makeup to be a winner, all things being equal, they have a better chance of winning. And the opposite for a student who is not, regardless of the college.
Here’s the thing about chiropractic colleges: Their job isn’t to help you be successful in chiropractic practice. You are paying them to matriculate you through a program that will prepare you to pass your boards and make you legally competent to practice within the profession of chiropractic. Anything else is gravy. Hopefully they teach you how to operate in the profession. Introduce you to ideas. Stoke your passions. But they don’t make you successful It’s that simple. There’s no “Harvard of chiropractic” where everyone who graduates wins. Even Harvard has its “unsuccessful” graduates.
So when you see the colleges focusing on certain topics, it should be taken with reflection that those are the things that will be potentially tested on in a board environment. They teach the things that will keep you legal and keep you from harming the public. They by no means need to formally introduce the concept of clinical MASTERY into your education. And when you discuss systems, you are discussing steps towards mastery. That happens after school.
First of all, they cannot teach mastery. Mastery is a journey that takes time. It takes a long time. Experienced DCs, throughout the span of time, get a good chuckle out of the fresh DC graduate’s The ones who think that now they have a diploma and a license, that they know all there is to know and are completely as equal clinically as an experienced DC. Your college can only teach you competency, and then initiate you into the profession with a nice push out the door and hopes that you make the best of it you can.
So let’s talk about the adjustment. You would think that the college would have the impetus to make adjusting proficiency the most important topic in the education, since chiropractors bank on it so much as a therapy. But with the thought process laid out above in mind, the reality is that the colleges don’t need to do any such thing. They need you to pass the adjusting portion of the boards, AND not hurt anyone in the process. Mastery of the technique itself is up to you. And it will take time, a long time, to reach it. Some faster than others of course. And that goes for any technique or approach.
One thing that students may not consider is that colleges have to present a program that prepares all students from all states, provinces, and jurisdictions, to be able to practice in their states. So while some states may have pretty straightforward requirements for practice, preparing a student to practice in states like Oregon, for example, require extra focus on meeting those needs. Oregon has quite a wide scope of practice, compared to its neighbor Washington, which is relatively narrow. The school has to prepare both students equally.
How many of us perform pelvic or rectal exams in our daily practice? Seriously, it is practically no one (there are a few though). In chiropractic college, in oregon, they taught the requirement, because there was a requirement, that would meet the needs of all 50 states and canada. Except one, California. Asterisk for those students planning to practice in the golden state. Even though I am nearly positive absolutely zero california chiropractors perform rectal or pelvic examinations, that states requirement was DOUBLE everyone elses. So the school had to make those resources available to student to meet the requirement.
To you, and many students, what the college does can seem absurd. It seems that it has nothing to do with you. And it would seem absurd if it didn’t directly benefit you. Or directly benefit what you think are the most important things you need to know to succeed in practice.
So let’s break some of these down. Students are taught “a ton of scientific facts, heavy philosophy, or ton of techniques without being a master of anything.” Well, that’s right. The scientific facts are absolutely required. And if you are going to build a healthcare profession that gains respect, the clinicians are going to have to be built upon a foundation of science.
Heavy philosophy is a bone of contention. I think historically that has been the vehicle to help the student apply what they were learning. Should the colleges teach a philosophy? Well they have to because it’s on the boards for one. Second, students do need a system for interpreting the education and then to begin practicing to apply it. “Chiropractic philosophy” has been the vehicle for that. The debate is for many of us, is that necessary anymore? I don’t think that debate will fit this article.
The irony of chiropractic colleges I find is that in order to allow more “philosophical” content on their campuses, they cling to an idea some of them term “academic freedom”. They have to allow academic freedom on their campuses in order for students to explore different ideas as they form their professional journey towards mastery. The irony here is that when it comes to “chiropractic philosophy”, there is no academic freedom on that subject allowed. It is rigid, dogmatic, and not to be questioned or obfuscated. So yeah, there’s a big logical crevice that needs to be navigated there. It’s one of the elephants in the room.
The same idea applies to teaching tons of techniques without a mastery of any of them. It’s exploratory. Introductory. This is why I personally, PERSONALLY think that chiropractors on the whole should have nothing to say whatsoever when it comes to vaccinations. Just a cursory introductory course in immunology does not make one expert enough on a subject to guide health care and public health decision making. Your few courses in physiological therapeutics will not make you an expert in rehab. Your few courses in soft tissue work will not make you an expert manual therapist. Your few courses on history taking will not make you a master interviewer.
Your professors that say your school is “drifting away from what chiropractic should be”...
…”should be”... That is extremely subjective. The truth is they feel it is drifting away from what THEY THINK chiropractic should be. Chiropractic, like many professions, should be and is is liquid. It has to be open to change. Unfortunately it is not as liquid as other professions, which can leave it stuck in the mud of the past, feel outdated, and have difficulty with change. But it does change. If it didn’t, it wouldn’t be a profession, it would just be an application of a technique. And we’d be technicians. Not doctors. Your professors are giving personal opinions. Take them as that.
“I have had 3 teachers that work here tell me in a one on one conversation that they think National is drifting away from what Chiropractic should be and that we are getting caught up in becoming primary care docs, PT's, and scientists rather than proficient adjustors…” - GOOD!!! Good for your college. Chiropractic is a profession, not a procedure. The colleges should be educating the profession and all of its professionals. Not just clinicians. That means it has to cover a wide array of subjects. And yes, adjusting is still an important tool in the chiropractors tool bag, but it is not everything. And let’s be very very honest here, you aren’t going to learn to be a good adjuster in school. Just not going to happen. Not even proficient. Consistent practice and experience does that. Could the school provide experiences? Practice opportunities? Sure. But not the years it would take. Because it’s just a hard truth, some things take time.
Yes, you need a scientific foundation before applying clinical approaches. There is no way around that. Will you “use” every single aspect of your scientific education in your clinical life? No, of course not. But without a foundation to stand on, based on science and reason, it is quite possible you will fall for anything.
There are very few “pure scientists” in our profession. And that’s bad. But most of us should endeavor to be scientist-practitioners. Clinicians well studied in science and research based subjects, possibly even participating in research projects when possible, but primarily clinicians. For a professor to even intimate to a student that if you focus too much on the sciences you won't be a clinician, that should be a damned crime. It’s an opinion. But if I was a college president I’d be hauling that professor into my office for a discussion. It’s just not true.
However it is true that if you don’t come out of school well balanced and well actuated, you are going to have some challenges. But I know for a fact some professors say, in essence “don’t worry so much about that science stuff, just get through it.” Another elephant in the room. And usually a hint you might be at a school coming to struggle. The irony is, you and these professors seem to think you are at a bad school, based on what the school is teaching. I say from experience you might be at a bad school because of these professors. Let’s not make it because of you too.
“A lot of this job is figuring it out as you go.” Yeah, that’s called practice. That’s called pursuing mastery. And without a solid foundation you will be a lost ship without a rudder, ready to sign on to any guru’s program who can promise you easy success, just as long as you do exactly as they say and they do, and the credit card is on file.
“I am not against learning science, but if the science is not going to help me be a better clinician then I really don’t care to learn it.” I take it back, you might be part of the problem as well. The science WILL help you be a better clinician. There’s no way around that. Is it going to make you a better day 1 out of school adjuster? No. Is it going to fill your practice because it gives you an edge in marketing? No. But it will make you a better clinician far and above the fold.
I am getting the impression that there is an instant gratification element to how you are approaching your educational process. These are the most important 4 years of your career. And I’m not trying to get down on you, but once you started to question the importance of head and neck anatomy… Well im starting to get a little pissed. You aren’t supposed to get clinical pearls out of every aspect of your education. But how could you appreciate a clinical pearl, without a foundation to draw on it from? You are waaaaaay too early on this journey to understand how your education builds on itself and doubles back and revisits items in year 3, that you learned in year one.
Do you think if a medical center asked you to come to their docs and do a lecture on vertebral artery dissections, that an anatomical understanding of head and neck anatomy won’t be important? To digest what another professional says about the subject? To identify nonsense. You would have no clue as to what is or isn’t nonsense, without the understanding itself.
Yes, students learn a lot of facts. Teeth is somewhat absurd. But someone is going to get a teeth question on the boards somewhere. Also, someone somewhere who was paying attention on that day is going to invent a device that helps with neck and TMJ pain derived from tooth related dysfunction. Some of my peers have created new approaches and ideas, from the same program as me, and I didn’t even see it. It’s like I wasn’t there on that day when they talked about XXXXX. Now Dr. XXXXX has a million dollar XXXXX business. It’s not all for you and your clinical pearls.
Where the colleges fall short, and my main point in regards to the podcast, is the colleges do a poor job telling you, the student these things. Some of you are destined to be absolute brilliant minds in the profession. Let’s be honest here, some of you are mental potatoes and i’m shocked a few are in practice. And then there’s the middle. The huge middle. Colleges have to play to all of them. So there’s no place for the brilliant, of any subject, in chiropractic college. It will never be enough. The potatoes, they end up sort of taking care of themselves.
Professor Stu McGill endeavors to create MASTERS in the treatment of the low back through his course series. Stu will say one of the ironies of clinical science is the idea that the only way for a test to be valid is for it to be reliable/reproducible. But in order for a test to be reproducible, a master must be able to do it, as well as the middle, AND the potatoes. How valuable is that in giving outstanding feedback clinically? What if a test gave a master exceptional information, but the middle and the potatoes couldn’t generate equal result? Science would say that test is not valid… Mastery is not the subject matter of chiropractic colleges. You have to regress to the mean.
So it’s not about you, or me, or any of us individuals on the whole. Colleges have to educate everyone. The problem I have with the colleges is that they don’t tell you. They don’t say “hey guess what, you’re paying us to teach you to pass the boards, be legal, and maybe pique your interests in some various topics. But you’re not going to use all of it, you’re not going to like all of it, you’re not going to always see how any of it applies, and by the way it has nothing to do with making you successful in your actual career. You’re just here to get permission to have a career. Education is for a time period, mastery is for a lifetime.”
Students struggle because many of them think that what they learned in school was “it”. And then they stop. And then when the results are bad, they blame the school or the profession, but not themselves. And then they hire gurus to teach them easy ways to fix it.
Look, I’m not down on the profession. I love the profession. I think some people who choose it have some personality traits that attract them to the profession. Just like other professions. Except one of them is expedience. I think some people choose chiropractic as a profession out of expedience. We’ve been told its easy. Easy money. Easy schools to get into. Easy living. And then the real world walks up and kicks you in the shins. Nothing worth doing and doing well is easy. Potatoes are easy. Masters choose the hard road.
“I know I am going to struggle when I graduate either way, but I want to prepare for it now.” - Well you are prepared, by admitting it. And as well, you cant prepare for it, because you just have to experience it. You can read book after book about your first kiss, or anything that you don’t actually own until you do it. I suppose you can take a kissing class, practice kissing the back of your hand. But it’s not until you do it, fumble with it, realize you’re actually not very good, get feedback, and practice and practice… and have some PASSION for it (even the foundations), then you will approach mastery. Confidence.
“I also want to know if I am wanting to run before I can walk. If I have that attitude and I just need to chill out because everything will be okay in the end then I would like to hear that too.” - Yes. You need to chill out. That’s easy. Don’t go jumping schools and looking for greener grass elsewhere. You will find the same gripes no matter where you go. Each college does it a little different. They all have their shortcomings and their strengths. They all produce great DCs, and potatoes. It’s not the schools… It’s what you put in and get out of it. They will not complete you.
I’m sorry to say it, maybe i’m becoming an old fart. But sometimes you just have to sit down, listen, do your work, enroll yourself in being part of the process and not work outside it, and admit that some things take time. Patience grasshopper. You have a lot you have to learn, learn it and discover for yourself where your passions within that lie, and go after them vigorously…
Bobby Maybee DC