Developing chiropractic students clinical practice skills - elements of best practice : a qualitative exploratory descriptive study

Background Although chiropractic has 125 years as an established profession, scrutiny of the literature proves that few studies have examined the clinical education of chiropractic students with a call for research from academics. This thesis is significant as it develops knowledge that can inform chiropractic bodies and help them improve an essential component of chiropractic education: clinical skill development. Research Purpose and Aims The purpose of this study was to identify elements of best practices in clinical education by critically examining, exploring and describing the aspects of an exemplar chiropractic clinical program that develops students’ clinical practice skills for transition into practice. This study explored the innovative clinical program of a reputable American chiropractic institution providing a scaffolded clinical program across varied clinical settings, patient populations and amongst other health disciplines. Research Design A six-phase exploratory descriptive qualitative design (EDQD) study was conducted to explore and describe the phenomenon being examined (Flick, 2014). This design enabled the collection of information about perceptions and lived experiences of three stakeholder cohorts: clinical faculty members, students and new graduates. Methods Purposive sampling (of students and clinical faculty members) and snowball sampling techniques (of new graduates) were used to derive the sample. Data were collected in three cycles across a two-year period using in-depth, semi-structured interviews. Interviews were conducted with 15 clinical faculty members and eight new graduates, and semi-structured focus groups were conducted with 20 students. All data were audio recorded, transcribed and thematically analysed using an inductive approach. Findings Chiropractic clinical education programs ought to be developed within a framework that incorporates adult learner principles; situated, social and experiential learning theories. Valued was a student-centred learning experience that includes authentic and diverse clinical placements, supervision and mentoring from multiple clinical educators which enhances students’ access to varied perspectives of clinical practices that contributes to developing clinical skills and professional identity. Business knowledge and entrepreneurial skills was an area of deficiency, which is problematic when the objective is to build graduates’ independence in clinical practice and professional prospects are predominantly private practice (NBCE, 2020). Embedding evidence-based practice within curricula and clinical training for educators and students are necessary to ensure this becomes a part of clinical practice. Conclusion This thesis posits best practice in chiropractic clinical education consists of the following: (a) using a scaffolded longitudinal clinical program, (b) varying clinical placements and case mix, (c) supervision and mentoring from multiple clinical educators, (d) educating the clinical educator, (e) curricula designed around industry standards and desired graduate attributes and capabilities, (f) an evidence-based practice approach in the curricula and clinical context, (g) aligning business skills, knowledge and practices with the professional context and (h) interprofessional learning and practice opportunities. Although this study has made a contribution to scholarly discourse, there remain many gaps in our knowledge where further studies are needed.Doctor of Philosoph