Changes to Logan's Doctor of Chiropractic curriculum aim to make students better practitioners

Changes to Logan University’s Doctor of Chiropractic curriculum are providing students with an opportunity to have a deeper focus on clinical application and improve patient communications skills.

Vincent DeBono, DC, CSCS, dean of the College of Chiropractic, said one of the most significant changes for students is the implementation of a full day of clinic each week.

In January, Trimester 1 through 6 students shifted from a schedule of being in clinic for short periods of time throughout the week to either working with Standardized Patients in the Assessment Center or performing peer-to-peer treatment in the Foot Levelers, Inc. Clinic for one full day a week.

Dr. DeBono said the clinical day is designed to integrate early trimester students with more experienced students to provide both mentoring and education. The full day also provides the students bigger blocks of time to become more immersed in their practice.

“One of the things we always want to do is get in early clinical mentoring to help with making foundational science concepts applicable to chiropractic care. The clinical day accomplishes that,” he said. “Also, anytime an older trimester student can mentor a younger trimester student is a great learning opportunity. We always say, if you can teach it, you really know it.”

Dr. DeBono said the full day of clinic also provides students with vertical integration of the curriculum, allowing students to hear and see what they need to do to become successful DCs. Logan students will also see the expansion of off-campus field trips to put clinical skills into practice.

“It’s good for students to practice on each other, but also more complicated patients, where geriatric issues might come into play,” DeBono said. “We’re hoping to do these field trips with students two to three times a trimester.”

This past year students visited Paraquad to practice taking blood pressure and conduct orthopedic exams. A group of students also visited a nearby assisted living facility where they interviewed a handful of seniors on their medication history and vital signs. 

This year, in addition to visiting those facilities, Logan students will set up a clinic at Jefferson High School in Festus, Mo., to perform sports physicals. Lower trimester students will work with upper trimester students to gather information and conduct the physicals. Dr. DeBono hopes to connect with other high schools as well. 

“What we’re really seeing are changes to the organization of our program, rather than the content of our program, to allow both horizontal and vertical integration,” he said. “It’s all part of our goal to continuously improve the quality of our program.”

In 2015, Consumer Reports found that, of 1,200 patients surveyed about physician compassion and communication, one in four said they were not treated fairly and didn’t feel like they were being heard.

Over the last few decades, physician bedside manner, and even personal interaction has taken a backseat to technology. Despite that, patient satisfaction still plays an ever-important role in the delivery of quality health care.

Logan’s Director of Academic Assessment Martha Kaeser, DC, MEd, said developing communication skills is another component of the new clinical day at Logan. She said students are being taught the value of empathy in patient care—the impact of their words, how they communicate and connect with patients. 

“The biggest issue in medicine is training doctors who are caring for the patients,” Dr. Kaeser said. “Oftentimes, diagnoses are misunderstood or missed completely due to lack of communication. We are making sure those communication skills are in place early on.”

One of the tools Dr. Kaeser is using to explore empathy in chiropractic students is the Jefferson Scale of Empathy. While the scale has been adopted by schools of medicine, dentistry, osteopathy and nursing, it is relatively unknown among chiropractic schools.

“Research shows that by year three, empathy among students in medical and other health care programs begins to decline as they get more immersed in patient diagnosis and treatment. While on one hand they have the clinical knowledge, they lack the ability to demonstrate compassion,” she said. “What we want to do is collect baseline data before students start their coursework at Logan and then see where that level of empathy is by the end of their first year. Our thinking is if we immerse students immediately in opportunities to practice communication with patients in a clinical environment, we can maintain their level of excitement and empathy.”

Just as research suggests, Dr. Kaeser says lack of empathy results in lower satisfaction outcome, not only for the patients but also for the students. With the Jefferson Scale, students self-report their level of empathy, rating statements such as “Patients feel better when health care providers understand their feelings,” or “I believe emotions have no place in the treatment of medical illness.”

“We feel like we’re ahead of the game because this kind of training is just not being done in our profession,” Dr. Kaeser said.

In the next six to 12 months, Dr. Kaeser intends to delve into yet another area designed to improve the doctor-patient relationship: motivational interviewing and the concept of how to address diagnoses with patients.

“The thought of addressing things like obesity, tobacco cessation and alcohol moderation scares some students,” she said. “They think, ‘I don’t want to offend my patient,’ so we talk about how to open that dialogue in a way that makes the doctor and patient feel comfortable.

“Everything we do in the Assessment Center is designed to provide feedback to the students. We hope it has an impact on them, and more importantly, we hope it equates to greater patient satisfaction, successful outcomes and successful diagnoses.”

DC2017: A resident's perspective

Last week, Lacey Miller, DC, and Rebecca Skiljan, DC, MS, CCSP, both residents in Logan’s Human Performance Center, attended DC2017, a premier chiropractic conference in Washington D.C. featuring thought leaders on research, best practices and the future of the profession.

Each earned top awards for their research in sports chiropractic. Dr. Miller earned a FICS Original Research Award in the category of Best Student for “Sport-specific rehabilitation for a Paralympic rugby prospect: A case report.”

Dr. Skiljan received first place in the student poster presentation category for her research, “Chiropractic intervention and rehabilitative exercises in an adolescent with a recent incomplete spinal cord injury: A case report.” 

Here are their perspectives on attending the conference: 

Dr. Lacey Miller (pictured above): 

“My experience at the DC2017 conference in Washington D.C. was one to remember. Rubbing elbows with some of the most successful chiropractors in the world was remarkable. I sat in lectures from individuals who practice anywhere from Asia, to Australia. Seeing what our profession is doing worldwide is profound and amazing. 

For the first day in DC, I attended the FICS conference, where I did a platform presentation of my research, Sports-Specific Rehabilitation for a Paralympic Prospect: A Case Study. Not only was I nervous to be speaking at a conference, but I was speaking to a room of renowned sports chiropractors from all over the world. In the end I loved showing my passion for sports chiropractic and working with not only abled bodied athletes, but adapted athletes as well. The experience was one I will never forget, and walking away with the Outstanding Student Award for Original Research was the cherry on top. 

My second day in DC consisted of attending different lectures at the ACA conference, as well as presenting my poster for the previously mentioned research study. The poster presentation was a more relaxed environment, and I enjoyed answering questions and having conversations about my case study. It was amazing talking to other chiropractors who have worked with adapted athletes, as well as chiropractors who have not, and really showing them our growing role in the adapted sports world. Overall I had a blast in DC and look forward to other opportunities that come my way.”