Relationship Between Techniques Taught
and Practice Behavior: Education
and Clinical Correlation

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Manipulative Physiol Ther. 1999 (Jan); 22 (1): 29-31 ~ FULL TEXT

Angela Leone, DC

4715 NW 31 Ave,
Gainesville, FL 32606

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OBJECTIVE:   This study was undertaken to determine the relationship between the time spent teaching various manual procedures in each of two different chiropractic colleges and the actual practice of those procedures in the graduate clinical environment of the doctors involved.

METHODS:   A simple questionnaire instrument was constructed to assess the frequency of use of 9 different manual evaluation treatment procedures. All graduates from the two chiropractic colleges in the state of Texas who obtained their license between 1988 and 1993 were polled. Reliability was studied by polling the first 30 qualified respondents twice and was found to be acceptable. The college curriculum with respect to the techniques studied was compared with the perceived use of the various techniques by the graduates surveyed.

RESULTS:   A total of 224 of 322 (70%) surveys were returned for consideration. Of these, 197 met all of the inclusion/exclusion criteria and were assessed as part of the sample. Significant differences were found between the colleges with respect to perceived practitioner use of Activator (chi 2 = 14.247, P = .004), Thompson technique (chi 2 = 57.702, P = .000), Gonstead (chi 2 = 52.173, P = .000), and flexion-distraction (chi 2 = 29.424, P = .000).

CONCLUSION:   Data from this research provide evidence that a relationship does exist between manual procedures taught in two different chiropractic colleges and the perceived use of those procedures in actual clinical practice. Implications of this relationship are discussed.

Keywords:   Chiropractic, Education, Practice Behavior

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From the Full-Text Article:

Introduction

A key question asked by educators in every academic clinical environment is how what is taught translates to active health care practice; that is, what is the impact on performance by doctors as a result of their initial training?

This question has been asked in many ways. For example, researchers involved in a study published in 1995 attempted to determine the sources of influence on drug prescription habits of Peruvian physicians. [1] They concluded that the knowledge gained in medical school was not a substantial influence on the prescribing habits of the doctors involved. On the other hand, studies have indicated that the effect of medical school training is so strong that even when change in prescribing habits would be useful, they are not considered or updated. [2, 3] For example, in a study of 80 family physicians in Canada one of the strongest predictors of treatment for hypertension was found to be the physician's year of graduation. [3] In a separate study the relationship between management knowledge of treating hypertension was strongly and inversely correlated with time since graduation; that is, the longer the time since graduation, the less knowledge about modern management techniques. [2]

Efforts to help focus clinician behavior toward updating and incorporating new, quality information into practice skills have resulted in attempts to expose health care students to information-gathering techniques. The impact of these processes has also been studied, with conflicting results. [4-6] Landry et al [6] concluded that an interactive seminar in critical appraisal of clinical literature increased student knowledge but did not translate into increased use of the literature with respect to actual patient care write-ups. Pao et al, [4, 5] however, found that increased exposure to MEDLINE searches increased the likelihood that those skills would continue to be used. Finally, increased exposure to actual laboratory facilities was found to result in a greater likelihood for cost-efficient use of laboratory services. [7]

The impact of professional learning of manual skills can be even more complex. Included in this educational milieu are the elements of logic and reasoned use contained in the examples cited earlier, as well as issues of manual dexterity and control acquired through practice. Essentially no information is currently available about how effective teaching methods of manual therapeutic skills are making an impact on clinical practice.

This study was undertaken to determine the relationship between the time spent teaching various manual procedures in each of two different chiropractic colleges and the actual practice of those procedures in the graduate clinical environment of the doctors involved.

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Discussion

Data from this research provide evidence that a relationship does exist between manual procedures taught in two different chiropractic colleges and the perceived use of those procedures in actual clinical practice. As indicated in Table 1, College 2 has historically required its students to obtain knowledge in a greater diversity of manual techniques than College 1. Data from field practitioners reared in these academic environments indicate that representatives from College 2 use significantly more techniques that include either mechanical force or mechanically assisted force. In addition, respondents from College 2 also reported significantly more use of one of the high-velocity, low-amplitude manipulation procedures. A trend was found toward greater use of the most common high-velocity, low-amplitude technique diversified [8, 9] by College 1; this trend correlates to the greater curriculum hour requirements for this technique by College 1. Because substantial use by most US chiropractors of diversified technique has been verified by a previous study, [8] graduates from College 1 appear to be consistent with most practitioners in the nation. It is interesting to note that upper cervical, Activator, and sacro-occipital techniques did not show significant differences. This may indicate that favorite techniques on the basis of other factors have not been studied. It is interesting to consider why some methods taught in professional health care institutes translate to active use in practice and others do not. For example, it is interesting to contrast the findings in this study with those of Zarate and Llosa1 and Landry et al. [6] It is possible that because manual procedures involve a great deal of hands-on exposure, these procedures are more easily retained for future use. This is certainly the suggestion of Pao et al [4, 5] for repeated exposure to MEDLINE searches.

As with the research done in hypertension dealing with use of outmoded techniques, [2, 3] the generalization of manual methods from college to field use brings with it a degree of caution. If the next generation of research brings with it a clear understanding of superiority of particular methods in achieving results for particular disorders, appropriate methods of dissemination will have to be considered for the field practitioner to update his or her knowledge to the benefit of patient care.

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Conclusion

This study has shown that a correlation exists between technique curricula and those techniques being used in the chiropractic setting. Results show that a college that teaches a more diverse technique curricula will produce graduates who use more diverse treatment measures. It is important to realize that study of different effects, and as a result patient outcomes, from various manual methods discussed in this article, has never been completed. From the information obtained here, it is not possible to say whether one college or another has produced more effective practitioners as a result of their education styles. What is important is to understand that what is taught of manual methods does appear to be related to what is used in practice. Those formulating curricula and considering changes will no doubt want to be aware of the data in this regard.

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