Anatomical Sciences in Chiropractic Education: A Survey of Chiropractic Programs in Australia

Musculoskeletal anatomy core syllabus for Australian chiropractic programs: A pilot study

OBJECTIVE

The aim of this study is to conduct a pilot survey to determine core anatomy content for chiropractic curriculum based on the perception of chiropractors and anatomy educators involved in teaching in an Australian chiropractic program.

METHODS

A survey of anatomical structures previously used in a medical survey, with similar criteria for synthesizing responses, was used and classified according to whether the respondents rated an item as essential, important, acceptable, or not required in a chiropractic program. The item was scored as core if ≥60% of respondents rated it essential, recommended if 30%-59% rated it essential, not recommended if 20%-29% rated it essential, or not core if <20% rated it essential.

RESULTS

The respondents rated 81.6% of all musculoskeletal concepts as core and 18.4% as recommended, 88.8% of the vertebral column items as core, and 11.2% of the items as recommended, 69.4% upper limb and pectoral girdle items as core, 23.7% of items as recommended, 5.5% as not recommended and 1.3% as not core items for inclusion, 85.3% of all lower limb and pelvic girdle items as core, 14.4% as recommended and 0.3% not recommended.

CONCLUSION

Chiropractors and anatomists involved in teaching in an Australian chiropractic program rated most musculoskeletal items as essential for inclusion in a chiropractic teaching program to ensure adequate preparation for safe practice and to promote alignment with the standards of anatomy education delivered into the clinical professions.

Musculoskeletal anatomy knowledge in Australian chiropractors

Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.

Australian chiropractors' perception of the clinical relevance of anatomical sciences and adequacy of teaching in chiropractic curricula

Background

Human anatomy education is compulsory in the undergraduate curriculum in all Australian chiropractic education programs. There is very little data on clinicians’ perceptions of the adequacy of their anatomy training and its relevance to practice. The aims of this study were to evaluate Australian registered chiropractors’ perceptions on the relevance and adequacy of anatomy training for clinical practice and analyse their opinion on the usefulness of the teaching resources utilized during their preprofessional training.

Methods

A questionnaire-based survey was conducted on a sample of Australian registered chiropractors focussing on the adequacy of their anatomical science (gross anatomy, histology, neuroanatomy and embryology) training and the clinical relevance of each individual sub-discipline, and the perceived value of each of the different anatomy teaching resources utilized.

Results

A total of 128 completed surveys were returned from an estimated 387 attendees at two national chiropractic conferences (estimated 33% response rate). The respondents represent 2.6% of registered chiropractors in Australia in 2016 and were representative in terms of gender (66.4% male) but not age, with older generations being over-represented (peak age group 35–44 vs. 25–34). The majority of the survey respondents obtained their chiropractic qualification in Australia (89.1%) and graduated after 1990 with an average of 21.7 years (SD = 11.3, range = 1–44) in practice. Respondents were equally likely to have undertaken anatomy training in Medicine, Science, Health Science, or other faculties. The disciplines perceived most relevant for clinical practice were neuroanatomy (100% of respondents agreeing) and gross anatomy (99.2%), followed by histology (86.0%) and embryology (81.1%). Respondents also perceived their training to be most adequate in neuroanatomy (99.3%) and gross anatomy (99.2%) followed by histology (91.4%) and embryology (85%). Respondents confirmed exposure to a varied suite of anatomy teaching tools utilized during their pre-professional training and highly valued access to cadavers and prosected specimens.

Conclusions

The majority of respondents perceived anatomy as highly relevant to their clinical practice and noted that it was adequately taught within a wide range of educational approaches. These results will assist educators to refine content and delivery of anatomy course offerings to maximize relevance in chiropractic clinical practice.

Musculoskeletal Anatomy Knowledge Retention in the Macquarie University Chiropractic Program: A Cross-Sectional Study

Attrition of anatomy knowledge has been an area of concern in health professions curricula. To ensure safe and effective clinical practice, the study of chiropractic requires a good knowledge of musculoskeletal anatomy. In this study, musculoskeletal limb knowledge retention was investigated among students in the 5-year chiropractic program at Macquarie University, Australia. A test of 20 multiple-choice questions, categorized into low-order (LO) and high-order (HO) cognitive ability according to Bloom's Taxonomy, was developed. Students enrolled in the program were invited to participate with 257 of the 387 choosing to participate, (response rate ranging 56%-72% per year level). No attrition of knowledge across the years was observed, instead, a significant increase in knowledge, measured by total LO and HO scores (P < 0.0005), throughout the program. There were significant increases in both low and high cognitive scores which were not uniform, with high-order scores increasing significantly in the last two year levels. The increase of knowledge, may be explained, at least partially, by the vertical and horizontal integrated curriculum. Retrieval of knowledge, especially in clinically applied formats, may have led to an enhanced ability to apply anatomy knowledge and account for the increased scores in the high-order knowledge seen in the later clinical years. Evaluating anatomy knowledge retention at different cognitive levels seems to provide a better assessment and is worth considering in future anatomy educational research.