WFC Education Conference – London, England – October 2018

Below is the script (only slightly modified) for a presentation I delivered at the WFC’s Education Conference in London, England in October 2018.

The title of this 15-minute session was: “Carrot or Stick? Making postgraduate education accessible for all…” (the vegetable theme was Dr. Richard Brown’s idea!)

Bolded titles below are brief descriptions of the images on the slides.

In these brackets are [additions for clarity].

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I’ve never done a talk with a vegetable theme before – so thank you! I want to chat with you about some generalities in the current continuing-education ecosystem in chiropractic…

Winding Road

If we look at our profession in general for a moment, our road ahead is still a bit uncertain, but it is becoming a more pleasant and scenic ride in many ways – I’m sure you would agree. The chiropractic profession must now navigate the challenge of not only educating our students to foster both clinical acumen and business savvy, but also supporting and maintaining the skills, knowledge and involvement of our practicing doctors. We have to engage them! With a profession’s maturity comes great responsibility…

Overwhelmed

I have dedicated my career in chiropractic to this problem (visit: www.rrseducation.com)…information overload (or its exact and perhaps more concerning converse – underload!). I am talking about knowledge transfer – that is, how individuals deal with emerging scientific literature.  Meaningful knowledge transfer is not only our burden to bear of course – many other medical and allied science disciplines face similar challenges. I’m interested in how we merge contemporary science and clinical education for practicing chiropractors.  Since starting RRS Education 12 [now 14!] years ago, I have become a trusted source of information; a logical, ‘Monday morning’ conduit between the ever-increasing body of research pertaining to chiropractic and our colleagues in the field caring for patients. I do this via weekly Research Reviews, online courses and in-person seminars…a variety of methods – each of which has provided lessons I’ll share with you today. I am not a researcher, nor an administrator. However, I can speak to a room full of practicing doctors, or a room full of scientists or educators with equal comfort and consistency.

Because of my specific interest in research (and how it trickles down into actual patient care in many disciplines), I must admit my bias upfront: I conflate the idea of staying current on emerging evidence with the very nature and content of continuing education – in my opinion, EVIDENCE should be the backbone of our continuing-education content – this is one of my career goals and something I work on every day!

Papers cascading

The aim of my company 'RRS Education', is to help chiropractors become more aware about research, so they can apply it rationally to their patient care.

Did everyone get all that [~12 recent research papers]?  Just a few from the last year or so (all of which we’ve reviewed as part of our Research Review Service, by the way)…most in this room (I hope) know these papers, but do our colleagues in small, remote towns know about them?  What about those in big cities – they must be more connected and tuned in, right? I’m sure Facebook does a smashing job of keeping us informed, right? Do our colleagues as a collective grasp why these papers matter and how their findings fit into and support our approach to healthcare? How are they to put all this together while maintaining their day-to-day patient care responsibilities, never mind the rest of what happens in life these days.

Obligation

For most, but not all practicing chiropractors, obtaining continuing education credits or hours is an obligation of licensure.  Human nature intrudes on everything we know and understand, and I would argue that it is human nature to sometimes view such obligations as burdens, unfortunately.  For the record, I DO think continuing-education should be mandatory. I also feel that free continuing education is generally worth what one paid for it. So how can we make this obligation an opportunity for both personal and professional growth for our colleagues?  How do we make it valuable, dare I say enjoyable for them?  This is the challenge my company and other purveyors of continuing-education must face…one trick I’ve learned is that wine helps [come to one of our Seminars – there’s wine with lunch!]!

Requirements

In many jurisdictions (states, provinces, countries etc.), requirements vary in terms of total number of hours, the breakdown of practical versus theory-based programs, the proportion of online versus in person learning, education ‘with others’ versus by oneself, and so on. There is certainly geographic inconsistency and these varying requirements are often accompanied by some massive assumptions about the superiority of some types of education over others. As a result, fulfilling these requirements in many cases comes with choice, cost, confusion about what counts (or what is approved).

Approval does not equal quality?

From a regulation perspective there is also massive inconsistency regarding what ‘approval’ means – should we define and enforce this within our profession globally? Is that even possible? In my experience, ‘approval’ ranges from a regulatory body or association of some sort attempting an honest appraisal of my content from a clinical and scientific perspective, to a simple cash grab. Pay and play if you will.

I would also suggest in many regions that approval does not necessarily guarantee quality!

This can become problematic because the link between science and society is currently a tenuous one in the first place – in my opinion, this means we have to work even harder to strengthen the bond between clinicians and science in a meaningful way, and properly assessing content in continuing-education programs is but one step along the way.

Individuality

If we move outside regulation and administration considerations, we must be cognizant of our customer base…chiropractors (like all other humans) are beautiful individuals, varying significantly in their preferences for continued learning – online versus in person, evidence-based versus…well, not evidence-based, theory versus hands-on techniques, weekend events versus the flexibility of online courses or webinars on demand. They also vary in their learning styles…some of them haven’t, umm, been to school in a while and aren’t necessarily technological savants!  This is another challenge for continuing-education providers – how do we best-serve such a variable group that seek continuing education programs for vastly different reasons: from obtaining contemporary clinical information and sharpening their patient care acumen; to business support, strategies and advice; to new gadgets and gizmos for treating, assessing etc. Our job is to satisfy these ‘wants’ within the realm of scientific plausibility and rational healthcare integration.

Some of my insights and observations about our colleagues so far…

Experience breeds wisdom – or something like that! I’ve given this a lot of thought – I’ve spent months/years reading papers, preparing slide decks, writing multiple-choice questions and clinical vignettes, speaking at my own seminars and conferences like this one and dealing with all the other fun and fulfilling things that come along with owning and operating a growing business. Along the way, I’ve realized some things about our colleagues that are pertinent to how we keep them current – these are presented in no scientific order:

  • Isolated Tree: Many of our colleagues are in pure practice isolation, working alone as a sole chiropractor in a clinic or even as the only doctor in a rural or remote area – we have to include them via distance and online learning options, but also recognize the continued value of in-person conferences and meetings…as well as the stark reality that internet signal is not always awesome in some areas of the world where chiropractors practice!
  • Graph (value vs. cost): Clinicians look for value for their money – lots of information, something new they can use in practice, sharpen a skill, address a weakness or concern they may have
  • Party tricks: chiropractors also seem to highly value party tricks – clinical pearls unique to our skill set…take home points they can use Monday morning is a good way to think of it
  • Timing is everything: They are also very deadline sensitive – spikes in sales of online programs in my company correlate directly with regional deadlines
  • Now vs. later: People, not just chiropractors – procrastinate, so booking seminars in close proximity to deadlines is a must!
  • Tablet/phone/laptop: our colleagues vary in their technological savvy, which means we must create programs that are easy to use and available across multiple platforms and devices, while respecting and remembering that we are a hands-on profession!

These are all factors we must bear in mind when creating content and programs for our colleagues.  We do provide to a niche market, yet there is wide variability within it.

Moving forward…

I push myself to fulfill the following challenges and invite all others in this space to do so as well:

  • Let’s up-skill our colleagues’ capacity to understand and consume research – let’s remove their fear and increase their confidence – this will in turn allow them to upskill the public and our patients. Nothing but good things will come from this!
  • Let’s evolve away from a guru-culture…and try to learn from those who ask good questions with humility and understanding, rather than those who claim to have all the answers.
  • Let’s support our colleagues in remote areas by using technology – but continue to encourage them to join us in person sometimes!
  • Let’s create variety in our CE offerings yet keep a laser-focus on pertinent clinical topics, patient service and outcomes, rational research integration, fostering caring and humanity in our clinicians and supporting their day-to-day realities of patient care in a chiropractic context – this can include ethical business practices, by the way!
  • Let’s find the sweet spot! The confluence of in-demand, clinically-relevant content, scientific veracity, value for money and delivery methods that satisfy our colleagues’ needs while offering relevant thought and practical upgrades they can install in their practices.
  • Recognize that evidence-based educational content (regardless of format) has a shelf-life…courses and content must be updated prior to their expiry date and this requires consistent dedication and hard work. Our patients and doctors deserve it.

Evidence Informed Practice

So, a fundamental question we must address is: What does evidence-based/informed practice really look like on Monday morning? This is something both educators and scientists must more frequently ask themselves, in my opinion. How do we make research real and applicable for our colleagues?  It is my opinion that evidence is our currency of the future – it has and will continue to open doors for our profession, not only pertaining to effective patient care, but also fruitful collaboration with other disciplines, favour in the eyes of stakeholders and decision makers and so on…growing strong roots in evidence yields less low hanging fruit for our critics.  Having said that, our colleagues need help in understanding the research process and its relevance without being bogged down too much in the details.  The WFC wants us all to be EPIC (evidence-based, patient-centred, interprofessional and collaborative), an acronym that appropriately begins with evidence! Thank you for listening and for those education institutions who have not yet done so, I offer free access to our Research Reviews to your students and faculty – contact me for details: This email address is being protected from spambots. You need JavaScript enabled to view it.
 
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