Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey.

Background: Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students' attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs. Objective: To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide. Methods: We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students' patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores. Results: There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17-58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals. Conclusion: This is the first international study assessing students' attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.

Commentary on a framework for multicultural education.

Today's changing demographics require that multicultural factors be considered in the delivery of quality patient-centred health care in chiropractic. Yet minimal training in cultural competency in chiropractic education leaves graduates ill-equipped to treat a diverse population. This commentary examines cultural competency training in current literature, demonstrates frameworks for curriculum integration, and suggests how cultural competency might be included in a chiropractic college curriculum. A database search yielded little evidence that cultural competency is integrated into curricula of chiropractic schools. Some journal articles note that promoting multicultural education and cultural sensitivity is an important goal. However, they provide no mechanisms as to how this can be achieved within training programs. Thus, although an undeniable need exists for all healthcare practitioners to develop cultural competency in the face of an increasingly diverse population, cultural competency education has not kept pace. Chiropractic schools must review their curricula to develop the cultural competencies of their graduates and a basic framework is suggested.

Les changements démographiques de nos jours exigent la prise en considération de facteurs multiculturels dans l'administration de soins chiropratiques de qualité axés sur les patients. Pourtant, la formation minimale en compétences culturelles que les diplômés reçoivent pendant leurs études en chiropratique les laisse mal préparés pour soigner une population culturellement diverse. Cet article examine la formation en compétences culturelles dans la documentation spécialisée, indique des structures pour son intégration dans les programmes d'études, et propose les étapes d'intégrer les compétences culturelles dans un cursus de collège de chiropratique. Une recherche des bases de données a révélé peu de preuves indiquant que les compétences culturelles fassent partie du programme des écoles de chiropratique. Certains articles de journaux font remarquer que la promotion d'une éducation multiculturelle et d'une sensibilité culturelle est un objectif important. Cependant, ils ne mentionnent aucun mécanisme pour réaliser cet objectif dans les programmes de formation. Donc, malgré le besoin incontestable de développement de compétences multiculturelles chez les praticiens de soins de santé devant la diversité croissante de la population, la formation en compétences culturelles n'a pas suivi. Les écoles de chiropratique doivent revoir leurs programmes d'études afin de développer les compétences culturelles de leurs étudiants. Pour accomplir ceci, un système élémentaire est proposé.

Did American social and economic events from 1865 to 1898 influence D.D. Palmer the chiropractor and entrepreneur?

This paper explores how the social landscape of the latter half of the nineteenth century influenced D. D. Palmer and the many occupations he pursued. It focuses on the geographical area where D. D. lived from 1865 to 1898. This paper will show how the American social and economic events of the time provided favourable circumstances for D.D.'s entrepreneurial successes.

Cet article examine les facteurs du paysage social de la seconde moitié du dix-neuvième siècle qui ont influencé D. D. Palmer et les nombreuses professions qu'il a exercées en mettant l'accent sur la région géographique où D. D. Palmer a vécu entre 1865 et 1898. L'article montre comment les événements socio-économiques américains de l'époque ont créé les circonstances favorables aux réussites entrepreneuriales de D. D. Palmer.