Impacting public health by affecting individual health: A focus group study with chiropractic students after an international clinical experience.

PURPOSE: To describe chiropractic students' perceptions of their future role in public health following an international service-learning experience. METHODS: Four, 60-minute focus groups were held with 17 upper-level students from 1 U.S. chiropractic college after a mentored clinical experience in 4 international settings. Two investigators analyzed the transcribed focus group interviews. RESULTS: We identified 3 themes where chiropractic students emphasized the public health contributions of chiropractors, usually through one-on-one interactions with patients. The primary theme was the prevention and treatment of spine and musculoskeletal conditions through chiropractic care. Next, chiropractors might improve patients' access to health services through screenings, referrals, and monitoring acute and chronic conditions. Lastly, patient education could help patients manage spinal health and make lifestyle modifications. CONCLUSION: Incorporating service learning strategies within chiropractic curriculum may increase student awareness and participation in public health activities.

OBJECTIF: Décrire la façon dont les étudiants en chiropratique perçoivent leur futur rôle dans la santé publique suite à une expérience d'apprentissage par le service menée à l'échelle internationale. MÉTHODOLOGIE: À la suite d'une expérience clinique encadrée dans 4 établissements reconnus à l'échelle internationale, on a tenu quatre séances de discussion de 60 minutes avec 17 étudiants inscrits au programme d'études supérieures d'un collège de chiropratique des É-U. Deux investigateurs ont examiné les transcriptions des entrevues avec les groupes de discussion. RÉSULTATS: Voici les trois points sur lesquels les étudiants en chiropratique ont insisté en parlant de l'apport des chiropraticiens à la santé publique, habituellement au moyen de rencontres personnalisées avec les patients. Premier point : les soins chiropratiques contribuent à la prévention et le traitement des troubles de la colonne vertébrale et des affections musculosquelettiques. Deuxième point : les chiropraticiens facilitent l'accès aux services de santé en faisant des dépistages, en dirigeant des patients vers des ressources appropriées et en surveillant les troubles aigus et chroniques. Enfin, le troisième point : l'information au patient peut l'aider à prendre en charge sa santé vertébrale et à modifier son mode de vie. CONCLUSION: L'intégration de stratégies d'apprentissage par le service au programme d'études en chiropratique peut permettre de mieux sensibiliser l'étudiant et d'accroître sa participation à des activités de santé publique.

A graphical clinical decision aid for managing imaging report information.

OBJECTIVE: The purpose of this article is to propose a graphical decision aid for managing radiology report information to assist learners in developing clinical decision-making skills through a structured approach. METHODS: A graphical decision aid informed by learning theories was constructed to manage radiology report information by identifying an overall strategy, specific decision-making steps, and decision goals. A review of radiology reports was performed to demonstrate the rich source of complex information requiring clinical decision making. Radiology report data were descriptively analyzed, and findings were described as definite or indefinite, while recommendations were reported as required or optional. RESULTS: The graphical decision aid involves 4 stages. The 1st 2 stages interpret report information and consider data obtained during the clinical encounter. The following 2 stages guide decisions by answering questions to ensure patient safety and/or to confirm diagnosis and to address broader case management questions. The mean (SD) age of participants whose imaging reports were reviewed was 73.4 (7.0) years. Of 170 reports, common findings included degenerative disc disease (98%), soft tissue or vascular calcification (94%), bone demineralization (92%), and zygapophyseal joint degeneration (86%). Common indefinite findings were spinal stenosis (15%), compression fracture (12%), bony abnormality (12%), radiodensity (12%), and disc degeneration (10%). One hundred twenty-one recommendations suggested follow-up actions. CONCLUSIONS: Information within imaging reports requires identification and interpretation to inform complex clinical decisions. The graphical decision aid proposed in this article is designed to facilitate the development of decision-making skills by providing a structured and evidence-based information management process.

A focus group study of chiropractic students following international service learning experiences.

OBJECTIVE: One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. METHODS: Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. RESULTS: The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor-patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. CONCLUSION: Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.

Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications.

OBJECTIVE: The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP). METHODS: This retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software. RESULTS: Lumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range. CONCLUSIONS: Moderate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.