Not too long ago the medical profession criticized the numerous chiropractic schools around the country saying they were nothing more than diploma mills. Of course their viewpoint was less than objective. Apparently, however, the profession must have felt that the public perceived many schools in this light, for until the mid-seventies chiropractic schools were dwindling in number.
Recently a change has been noticed in chiropractic education. The curriculum in the schools is slowly evolving toward the primary objective of equipping students to pass state and national boards. At first glance this might not seem like such a bad idea. After all, the boards are invented to be a test of the graduate’s ability to practice chiropractic. However, in reality the vast majority of knowledge tested on state and national boards bears very little relationship to the day-to-day practice of chiropractic. Conversely, very little testing is done that actually determines a chiropractor’s competency and proficiency in day-to-day practice. The chiropractic colleges, by the nature of their curriculum and their emphasis, have a short range objective, that is, to enable the student to “pass the boards.” That is not how the system was intended to function, but that’s, in fact, how it does. Students become more concerned about their academic subjects (those they will not use in practice) than they are about those subjects that will be a part of their daily practice, i.e., technique, philosophy, and clinical experience. In addition to worrying over their academic subjects while in school, they spend great sums of money to take courses to help them pass the boards. We can see, then, why technique courses on the post-graduate level are extremely popular. A chiropractic college graduate may spend great sums of money taking a week-end course in order to learn technique and chiropractic related subjects which he should have learned during his four academic years. The obvious reason is that he did not learn technique because he was too busy studying to “pass the boards.”
There are just so many hours in a chiropractic course of education. The more competitive the examinations become, the more emphasis the schools must put on preparing the student to pass them. The more emphasis on passing the exams, which, as we said, are largely academic, the less emphasis on chiropractic subject matter. The greater emphasis on preparing the student for his clinical experience, the less students pass the board examinations. The state and national boards, with very few exceptions, do not view the purpose of chiropractic education as preparation for practice, but rather as preparation to pass their exams. The problem will inevitably get worse. The exams aren’t getting any easier. They are, in fact, becoming more difficult. The number or hours of the course of chiropractic education has increased very little. Something has to give. The student is not dumb. He knows that he can always learn to adjust, learn to analyze an X-ray, learn office procedure, patient education and whatever else is necessary to be a competent, successful chiropractor after he gets a license. He will spend his time and effort on biochemistry, pathology, and diagnosis and be satisfied to just get by in technique, philosophy, and clinical experience. Is that what we are trying to accomplish in chiropractic education? I think not.
Obviously the solution has to begin from above, that is, with the boards. The schools are forced to make their program reflect what the exams require. Graduating chiropractors, however competent, who cannot pass a state board, does not attract students. Those making the examinations must begin to make them relevant to the practice of chiropractic. Anyone can make a difficult test. Making a relevant one that tests useful knowledge and competency takes much more effort. Unless that is done one of the following will occur:
1. The schools will have to lengthen the program to adequately prepare students to pass the boards and teach them chiropractic. This would make a chiropractic education longer than a medical education and would make chiropractic less attractive as a career.
2. Less and less chiropractic will be taught until chiropractic procedures are taught strictly on the post-graduate level or as an elective. This is what happened to osteopathy.
Perhaps the time has come to question the need for state board examinations. They came about when chiropractic (and medical) schools were proprietary institutions. The schools were designed to make someone a profit. As a result, short easy programs were developed to attract less than competent students. That has changed. There are no longer proprietary schools. Regional and specialized accrediting agencies are designed to insure the competency of the chiropractic program. In addition, the state boards have become a political football over which opposing factions fight for control. It was never intended as such. Those that are on state boards are usually not educators and have very little knowledge of testing procedures. Can we do away with state board examinations? The possibility should be investigated. Unless we do, chiropractic colleges will increasingly become just “license mills” rather than educational institutions. v3n5