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Competencies

The CCEB examinations are based on a competency framework that defines the knowledge, skills, and professional behaviours expected of an entry-level chiropractor in Canada.

What You'll Be Assessed On

The Written Examination assesses all seven competency domains.

The Clinical Competency Examination assesses the four competency domains that are demonstrated through direct patient care: Neuromusculoskeletal Expert, Communicator, Collaborator, and Professional.

Select a competency below to learn what you’ll be expected to know and demonstrate.

The Neuromusculoskeletal Expert domain assesses your ability to diagnose, manage, and treat neuromusculoskeletal conditions safely and effectively. This includes conducting patient assessments, developing and managing care plans, delivering therapeutic interventions, and performing chiropractic adjustments and manipulations.

Differential Diagnosis

You’ll be expected to:

  • Conduct a comprehensive patient history.
  • Perform a thorough physical examination.
  • Determine the need for, and select or refer for, appropriate imaging and laboratory testing.
  • Interpret the results of diagnostic testing.
  • Apply clinical reasoning to formulate an appropriate differential diagnosis.

Care Plan Management

You’ll be expected to:

  • Prioritize issues that need to be addressed based on the patient’s presentation.
  • Apply risk management strategies that support patient safety.
  • Obtain informed consent from the patient.
  • Develop and implement a measurable, patient-centred management plan that supports ongoing care, follow-up, and further consultation when needed.
  • Adapt the management plan in response to unanticipated clinical findings.

Therapeutic Intervention
You’ll be expected to:

  • Implement safe and effective interventions consistent with the differential diagnosis and treatment goals.
  • Recognize and respond appropriately to adverse events.
  • Provide evidence-informed conservative care for neuromusculoskeletal conditions.

Chiropractic Adjustment and Manipulation
You’ll be expected to:

  • Identify segmental dysfunction of the spine and other articulations.
  • Analyze and interpret findings that indicate the need for adjustment or manipulation.
  • Identify indications, contraindications, and risk factors for adjustment or manipulation, and explain anticipated benefits, potential complications, and effects to patients.
  • Apply chiropractic adjustment and manipulation techniques safely.
  • Identify and evaluate the effects of the adjustment or manipulation following treatment.

The Communicator domain assesses your ability to build effective relationships with patients, families, caregivers, colleagues, and other healthcare professionals. This includes listening, sharing information clearly, documenting clinical information accurately, obtaining informed consent, and adapting your communication to meet the needs of each patient.

Building Therapeutic Relationships

You’ll be expected to:

  • Build respectful and trusting relationships with patients and other healthcare professionals.
  • Demonstrate active listening skills.
  • Communicate effectively using verbal, non-verbal, written, and electronic communication.
  • Recognize and respond respectfully to diverse backgrounds, cultures, and communication needs.
  • Create an environment that promotes patient comfort, privacy, confidentiality, and safety.
  • Recognize the physical and psychosocial needs of patients.
  • Encourage shared decision making and patient engagement in their care.

Clinical Documentation

You’ll be expected to:

  • Gather relevant information from patients, caregivers, colleagues, and other healthcare professionals.
  • Document clinical encounters accurately, completely, and in a timely manner.
  • Maintain clinical records that meet legal, regulatory, and professional requirements.
  • Use appropriate chiropractic, medical, and healthcare terminology.

Patient Communication

You’ll be expected to:

  • Communicate clearly using language appropriate for the patient or recipient.
  • Explain assessment findings, recommendations, prognosis, and management plans.
  • Obtain and maintain informed consent throughout patient care.
  • Adapt your communication style when patients have different needs or levels of understanding.
  • Help patients access and understand health information and communication technologies.
  • Promote the practical application of evidence-informed health information.
  • Communicate with empathy during difficult, sensitive, or emotionally charged situations.
  • Manage misunderstandings and conflicts professionally.
  • Recognize how personal values, beliefs, and biases may influence communication and adapt your approach accordingly.

Professional Communication

You’ll be expected to:

  • Communicate effectively with colleagues and other healthcare professionals.
  • Protect patient privacy and confidentiality when using electronic communication and health information.
  • Use technology responsibly and in accordance with professional, legal, and regulatory requirements.

The Collaborator domain assesses your ability to work effectively with patients, families, caregivers, chiropractors, and other healthcare professionals to support coordinated, patient-centred care. This includes understanding professional roles, engaging patients as partners in their care, and collaborating respectfully with other members of the healthcare team.

Understanding Professional Roles

You’ll be expected to:

  • Understand the role of chiropractors within the Canadian healthcare system.
  • Recognize the scope of practice of chiropractors and how it may vary across jurisdictions.
  • Understand the roles and scopes of practice of other healthcare professionals.
  • Recognize when referral or co-management is appropriate.
  • Understand the chiropractor’s role as a primary healthcare provider.

Partnering with Patients and Families

You’ll be expected to:

  • Engage patients, families, caregivers, and support persons as active partners in care planning.
  • Respect cultural, social, and personal values when providing patient care.
  • Adapt your approach to meet the needs of diverse patient populations.
  • Encourage collaborative decision-making throughout the patient’s care.

Working with Other Healthcare Professionals

You’ll be expected to:

  • Work collaboratively with chiropractors and other healthcare professionals.
  • Participate in shared decision making when coordinating patient care.
  • Understand the principles of teamwork and collaborative practice.
  • Negotiate shared responsibilities when co-managing patient care.
  • Provide constructive feedback that supports collaborative care.
  • Resolve differences and conflicts professionally.
  • Communicate effectively during referrals and co-management using appropriate verbal and written communication

The Health Advocate domain assesses your ability to promote health, prevent injury and disease, and support patients and communities in achieving better health outcomes. This includes recognizing the factors that influence health, encouraging healthy behaviours, and supporting evidence-informed public health initiatives.

Understanding Health and Wellness

You’ll be expected to:

  • Recognize the social and personal factors that influence health and well-being.
  • Understand how a patient’s environment, lifestyle, and circumstances may affect their health.
  • Consider these factors when developing patient care plans.

Promoting Healthy Behaviours

You’ll be expected to:

  • Encourage patients and their families to adopt healthy lifestyle behaviours.
  • Promote health, wellness, and injury prevention.
  • Support patients in making informed decisions about their health.
  • Identify barriers that may prevent patients from adopting healthy behaviours.
  • Recommend practical strategies to help patients overcome those barriers.

Supporting Public Health

You’ll be expected to:

  • Recognize the chiropractor’s role in supporting community health.
  • Understand and support evidence-informed public health practices and initiatives.
  • Promote health beyond the clinical setting when appropriate

The Scholar domain assesses your ability to apply evidence-informed practice, critically evaluate research, communicate health information, and continuously develop your professional knowledge and skills. It reflects the expectation that chiropractors remain lifelong learners who use the best available evidence to support patient care.

Evidence-Informed Practice

You’ll be expected to:

  • Apply evidence-informed decision making in clinical practice.
  • Integrate the best available evidence with clinical expertise and patient preferences.
  • Apply clinical and biomedical knowledge when assessing and managing patients.
  • Use evidence to support patient care decisions.

Research and Critical Appraisal

You’ll be expected to:

  • Understand the scientific principles of research.
  • Locate and retrieve relevant scientific literature.
  • Critically evaluate the quality and applicability of research.
  • Use reliable sources of chiropractic and healthcare evidence.
  • Communicate research findings clearly to both professional and non-professional audiences.
  • Apply ethical principles when using research and clinical information.

Lifelong Learning and Professional Development

You’ll be expected to:

  • Identify gaps in your knowledge and clinical practice.
  • Develop strategies to expand your professional knowledge and skills.
  • Demonstrate a commitment to lifelong learning.
  • Integrate new evidence into clinical practice.
  • Recognize your role as a knowledge broker by applying and sharing evidence-informed knowledge to improve patient care.

The Professional domain assesses your ability to demonstrate ethical behaviour, accountability, reflective practice, and responsible professional conduct. It also includes understanding ethical business practices and maintaining the standards expected of the chiropractic profession.

Professional and Ethical Practice

You’ll be expected to:

  • Demonstrate professional behaviour in all interactions with patients, colleagues, and other healthcare professionals.
  • Maintain appropriate professional boundaries.
  • Recognize and manage conflicts of interest.
  • Apply ethical decision making when providing patient care.
  • Understand chiropractic codes of ethics and how they may vary across jurisdictions.
  • Recognize situations where mandatory reporting may be required.
  • Demonstrate appropriate delegation within professional practice.
  • Recognize how power imbalances can affect professional relationships.

Practice Management

You’ll be expected to:

  • Understand ethical business practices.
  • Manage human and physical resources responsibly.
  • Promote workplace safety.
  • Apply effective time and workflow management.
  • Understand principles that support a sustainable chiropractic practice.
  • Apply quality improvement principles to business operations.

Reflective Practice and Professional Growth

You’ll be expected to:

  • Reflect on your own strengths, weaknesses, and biases.
  • Demonstrate a commitment to continuous professional development.
  • Identify learning opportunities to improve your knowledge and skills.
  • Implement appropriate learning or remediation strategies when needed.

The Leader domain assesses your understanding of leadership within the chiropractic profession and the Canadian healthcare system. It includes knowledge of the roles of regulatory and professional organizations, the importance of contributing to the profession, and opportunities to improve healthcare delivery.

Leadership in Professional Practice

You’ll be expected to:

  • Understand the leadership responsibilities of chiropractors within professional practice.
  • Recognize opportunities to contribute to the advancement of the chiropractic profession.
  • Participate in community, professional, volunteer, or other leadership activities.

Regulatory and Professional Organizations

You’ll be expected to:

  • Understand the role of federal legislation and regulations that apply to chiropractic practice.
  • Understand the role of provinces and territories in regulating the chiropractic profession.
  • Understand the purpose and responsibilities of chiropractic regulatory bodies.
  • Understand the role of professional chiropractic associations.
  • Recognize how regulation and professional organizations support safe, ethical, and effective patient care.

Improving Healthcare

You’ll be expected to:

  • Recognize opportunities to improve healthcare delivery within teams, organizations, and the broader healthcare system.
  • Understand the importance of collaboration in improving patient care.
  • Recognize how payment and reimbursement models may influence chiropractic practice.
  • Support initiatives that improve the quality, accessibility, and effectiveness of healthcare.

Candidate Handbook

The CCEB Examinations Candidate Handbook is the official reference for the written and clinical examinations.

It includes detailed information about:

  • Examination procedures
  • Written Examination sample items
  • Examination blueprints 
  • Examination format
  • Scoring overview
  • Written examination sample items
  • Clinical examination sample items
  • Clinical examination sample case
  • Assessable competency framework
  • Sample performance reports
  • Examination policies
  • Candidate responsibilities

Use the handbook whenever you need more detailed guidance about the examinations.

View the Handbook