Competencies

1. Neuromusculoskeletal Expert

1.1. Demonstrate proficiency in determining a differential diagnosis of the patient.

1.1.1. Demonstrate proficiency in conducting a history.

• Demonstrate knowledge of NMS and systemic conditions that relate to patient presentation
• Demonstrate knowledge of appropriate questioning to elicit comprehensive history
• Use systematic questioning to obtain comprehensive information
• Adapt line of questioning based upon patient response
• Demonstrate knowledge of common descriptions of symptomology
• Elicit chief complaint and patient expectations
• Identify secondary complaints
• Obtain complete information regarding symptoms and concerns
• Identify physical and behavioural characteristics of a patient that may assist in establishing an initial differential diagnosis

1.1.2. Demonstrate proficiency in performing an examination.

• Demonstrate knowledge of assessment techniques relevant to patient presentation
• Perform systematic assessment techniques relevant to patient presentation
• Identify components of an assessment plan to evaluate systems for abnormalities
• Communicate assessment techniques to patient
• Demonstrate knowledge of assessment strategies suitable for diverse populations
• Identify physical and behavioural characteristics of a patient that may assist in establishing an initial differential diagnosis

1.1.3. Demonstrate proficiency in determining the need for and selection of or referral for appropriate imaging modalities and laboratory analysis to order to arrive at an appropriate differential diagnosis.

• Identify and select appropriate imaging modalities and laboratory analysis when relevant
• Demonstrate knowledge of ancillary assessment methods to be used when standard procedures may not result in reliable results, or are inappropriate
• Demonstrate knowledge of assessment strategies suitable for diverse populations

1.1.4. Demonstrate proficiency in interpretation of results of diagnostic testing.

• Demonstrate knowledge of established norms for assessment results
• Relate assessment results to NMS and systemic conditions
• Interpret diagnostic testing results to determine differential diagnosis

1.1.5. Demonstrate clinical reasoning by considering the relative influence of all determinants in the formulation of a differential diagnosis.

• Interpret diagnostic testing results to determine differential diagnosis
• Refine and revise the differential diagnosis based on emerging information
• Explain differential diagnosis to patient
• Provide rationale for clinical thought process

1.2. Develop and manage an appropriate plan of patient care.

1.2.1. Prioritize issues that need to be addressed.

• Demonstrate knowledge of signs and symptoms of conditions requiring immediate attention, and action required
• Respond appropriately to situations requiring immediate attention
• Identify management options and anticipated outcomes based on a differential diagnosis

1.2.2. Consider risk management strategies that address patient safety.

• Demonstrate knowledge of principles for communicable disease prevention and infection control
• Demonstrate knowledge of methods to clean and disinfect office space and equipment
• Demonstrate awareness of procedures to safely handle hazardous materials
• Identify management options and anticipated outcomes based on a differential diagnosis

1.2.3. Obtain informed consent.

• Demonstrate understanding of the requirements for informed consent
• Obtain informed consent
• Establish agreement on management plan, taking into account patient values, priorities and expectations
• Demonstrate knowledge of factors contributing to uncertainties in diagnosis and treatment

1.2.4. Implement measurable and effective patient-centered management that supports ongoing care, follow up investigations, response to treatment and further consultation.

• Modify management options to incorporate patient situation
• Establish agreement on management plan, taking into account patient values, priorities and expectations
• Demonstrate knowledge of factors contributing to uncertainties in diagnosis and treatment
• Select and explain evidence-informed management

1.2.5. Adapt to unanticipated clinical findings.

• Modify management plan based on emerging information
• Respond appropriately to situations requiring immediate attention
• Modify management options to incorporate patient situation

1.3. Demonstrate the proficient delivery of therapeutic interventions.

1.3.1. Implement safe and effective interventions consistent with the established differential diagnosis and treatment goals and expectations.

• Demonstrate understanding of delivery of safe and effective, evidence-informed therapeutic interventions
• Demonstrate understanding of adaptation of interventions suitable for diverse populations
• Deliver safe and effective, evidence-informed therapeutic interventions

1.3.2. Recognize and respond to adverse events.

• Demonstrate knowledge of adverse events and appropriate responses
• Respond to adverse events

1.3.3. Provide evidence-informed conservative care for NMS conditions.

• Demonstrate understanding of delivery of safe and effective, evidence-informed therapeutic interventions
• Demonstrate understanding of adaptation of interventions suitable for diverse populations
• Deliver safe and effective, evidence-informed therapeutic interventions

1.4. Deliver appropriate chiropractic adjustments/manipulations as identified in the treatment plan.

1.4.1. Identify segmental dysfunction of the spine and/or other articulations.

• Demonstrate understanding of evidence-informed methods to identify and treat joint dysfunction
• Demonstrate methods to identify joint dysfunction

1.4.2. Analyze and interpret findings indicating the need for chiropractic adjustment/manipulation.

• Demonstrate understanding of evidence-informed methods to identify and treat joint dysfunction

1.4.3. Identify indications, contraindications, and risk factors for the chiropractic adjustment/manipulation, explain the anticipated benefits, potential complications and effects to patients.

• Demonstrate understanding of indications and benefits, contraindications and risk factors, for chiropractic adjustments/manipulations
• Communicate clearly and concisely, using language meaningful to the recipient
• Communicate in an empathetic manner

1.4.4. Apply chiropractic adjustment/manipulation to patients while ensuring patient safety.

• Demonstrate understanding of indications and benefits, contraindications and risk factors, for chiropractic adjustments/manipulations
• Demonstrate knowledge of adaptation of position for chiropractic adjustment/manipulation to ensure appropriate contact, patient comfort and safety

1.4.5. Identify the effects following the chiropractic adjustment/manipulation.

• Demonstrate understanding of indications and benefits, contraindications and risk factors, for chiropractic adjustments/manipulations
• Demonstrate understanding of evidence-informed outcome measures appropriate for assessing response to treatment
• Demonstrate understanding of the effects of adjustment/manipulation

2. Communicator

2.1. Establish rapport and trust with patients, their families and/or caregivers and/or support persons, colleagues and other health professionals.

2.1.1. Engage in responsive, non-judgmental and culturally respectful dialogue, during written (including electronic) communication, verbal, and non-verbal communication.

• Demonstrate knowledge of components of a respectful relationship
• Demonstrate knowledge of principles of active listening
• Apply principles of active listening
• Demonstrate knowledge of ways to address communication challenges inherent in dealing with persons of diverse backgrounds
• Demonstrate knowledge of ways to address challenges inherent in dealing with persons of diverse needs
• Apply strategies to address communication challenges
• Demonstrate knowledge of principles of confidentiality and privacy

2.1.2. Facilitate an environment which optimizes patient comfort, safety, confidentiality and privacy.

• Demonstrate knowledge of ways to address communication challenges inherent in dealing with persons of diverse backgrounds
• Demonstrate knowledge of ways to address challenges inherent in dealing with persons of diverse needs
• Apply strategies to address communication challenges
• Demonstrate knowledge of principles of confidentiality and privacy
• Apply principles of confidentiality and privacy

2.1.3. Share information in an empathic manner that respects patient privacy and confidentiality.

• Demonstrate knowledge of components of a respectful relationship
• Demonstrate knowledge of principles of active listening
• Apply principles of active listening
• Demonstrate knowledge of ways to address communication challenges inherent in dealing with persons of diverse backgrounds
• Demonstrate knowledge of ways to address challenges inherent in dealing with persons of diverse needs
• Apply strategies to address communication challenges
• Demonstrate knowledge of principles of confidentiality and privacy
• Apply principles of confidentiality and privacy
• Communicate in an empathetic manner

2.1.4. Recognize the physical and psychosocial needs of patients.

• Demonstrate knowledge of ways to address communication challenges inherent in dealing with persons of diverse backgrounds
• Demonstrate knowledge of ways to address challenges inherent in dealing with persons of diverse needs
• Apply strategies to address communication challenges

2.1.5. Identify barriers and adapt communication approaches that enable shared decision-making and promote patient engagement in their care.

• Apply strategies to address communication challenges
• Demonstrate understanding of communication strategies that enhance patient engagement in decision making

2.2. Synthesize relevant information and perspective of patients and families and/or caregivers and/or support persons, colleagues and other health professionals.

2.2.1. Gather and document relevant information and perspectives of patients and families, colleagues and other professionals.

• Demonstrate understanding of chiropractic, medical and health-related terminology
• Demonstrate understanding of how personal perspectives and biases impact health care beliefs and expectations

2.2.2. Document clinical information and encounters in an accurate, readable, complete, timely and accessible manner in compliance with regulatory and legal requirements.

• Demonstrate understanding of principles for record keeping in professional practice
• Demonstrate understanding of chiropractic, medical and health-related terminology

2.3. Communicate in a collaborative, responsive and responsible manner that is meaningful to the recipient.

2.3.1. Recognize when values, biases, or perspectives of patients, chiropractors or other health care professionals may have an impact on quality of care, and modify the approach to the patient accordingly.

• Demonstrate understanding of how personal perspectives and biases impact health care beliefs and expectations

2.3.2. Participate in a continuing dialogue (with patient and/or referrer) while maintaining informed consent as part of the evolving process of patient engagement.

• Demonstrate understanding of the requirements for informed consent
• Obtain informed consent

2.3.3. Assist patients, their families and/or caregivers and/or support persons to identify, access and make use of information and communication technologies to support their care and manage their health.

• Communicate clearly and concisely, using language meaningful to the recipient
• Demonstrate understanding of how personal perspectives and biases impact health care beliefs and expectations

2.3.4. Utilize communication skills and strategies that help the public to practically apply evidence-informed health information.

• Communicate clearly and concisely, using language meaningful to the recipient
• Demonstrate knowledge of strategies to adapt communication to enhance recipient’s understanding
• Apply strategies to address communication challenges

2.3.5. Manage conflicts, misunderstandings and sensitive conversations in a professional manner.

• Demonstrate knowledge of principles of negotiation and conflict management
• Demonstrate knowledge of strategies to adapt communication to enhance recipient’s understanding
• Apply strategies to address communication challenges
• Demonstrate understanding of how personal perspectives and biases impact health care beliefs and expectations

2.3.6. Address challenging communication issues effectively, such as obtaining informed consent and addressing anger, confusion and misunderstanding.

• Demonstrate knowledge of principles of negotiation and conflict management
• Modify interaction based upon recipient’s response
• Demonstrate knowledge of strategies to adapt communication to enhance recipient’s understanding
• Apply strategies to address communication challenges

2.3.7. Provide clear and accurate explanation about the plan of care, recommendations and prognosis for the goals of proposed interventions, as well as the risks and benefits of proposed interventions within a structured report of findings.

• Communicate clearly and concisely, using language meaningful to the recipient
• Demonstrate knowledge of strategies to adapt communication to enhance recipient’s understanding
• Communicate a structured report of findings, and care plan
• Apply strategies to address communication challenges

2.4. Demonstrate appropriate and responsible use of technology for communication.

2.4.1. Implement steps to comply with relevant regulation and acts that relates to security, confidentiality and privacy issues with the use of electronic communication and data collection.

• Demonstrate understanding of appropriate and responsible use of technology for professional communication and data management

3. Collaborator

3.1. Demonstrate an understanding of the chiropractic scope of practice and those of other health professions.

3.1.1. Demonstrate knowledge of relevant provider’s scopes of practice in order to best address the patients’ needs and health goals.

• Demonstrate knowledge of the Canadian health care system and the role of chiropractic within it
• Demonstrate understanding of the chiropractic scope of practice, and its variability by jurisdiction
• Demonstrate knowledge of the scopes of practice of other professionals relevant to patient care
• Recognize the role of the chiropractor as a primary care provider

3.1.2. Co-manage and/or refer to the appropriate health professionals when applicable.

• Demonstrate understanding of situations where referral or co-management is indicated

3.2. Value and engage the patient/family/support persons in patient care.

3.2.1. Actively engage patient/family/support persons as team members in planning patient care.

• Demonstrate understanding of the value of interested party engagement in care planning
• Demonstrate knowledge of approaches to enable interested party engagement

3.2.2. Demonstrate respect for patient, family and community cultural and social values in the provision of clinical care.

• Demonstrate understanding of the value of interested party engagement in care planning
• Demonstrate knowledge of approaches to enable interested party engagement

3.2.3. Adapt to a variety of patient types and populations.

• Demonstrate understanding of the value of interested party engagement in care planning
• Demonstrate knowledge of approaches to enable interested party engagement

3.3. Work effectively with chiropractors and other health professionals.

3.3.1. Engage in respectful, shared decision-making with chiropractors and other health professionals when required or when applicable.

• Demonstrate knowledge of the role of the chiropractor in a multidisciplinary health care setting
• Demonstrate knowledge of principles that facilitate teamwork and collaboration

3.3.2. Negotiate overlapping and shared responsibilities with chiropractors and other health professions when required or when applicable.

• Demonstrate knowledge of the role of the chiropractor in a multidisciplinary health care setting
• Demonstrate knowledge of principles that facilitate teamwork and collaboration
• Negotiate parameters for collaborative care

3.3.3. Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture.

• Demonstrate knowledge of principles that facilitate teamwork and collaboration
• Demonstrate knowledge of ways to provide constructive feedback within collaborative care
• Negotiate parameters for collaborative care
• Demonstrate knowledge of principles of negotiation and conflict management

3.3.4. Utilize both verbal and/or written communication in situations of referrals and co-management.

• Communicate clearly and concisely, using language meaningful to the recipient
• Demonstrate knowledge of strategies to adapt communication to enhance recipient’s understanding

4. Health Advocate

4.1. Advocate for health, healthy lifestyle at home/work/recreation, injury prevention, and quality of life for individual patients and communities within and beyond the clinical environment.

4.1.1. Explore relevant personal and social determinants of health with the patient.

• Demonstrate knowledge of social determinants of health

4.1.2. Encourage patients and their families to adopt healthy behaviours.

• Demonstrate knowledge of social determinants of health
• Demonstrate knowledge of ways the chiropractor may contribute to community health
• Demonstrate knowledge of barriers and facilitators to adopting healthy behaviours

4.1.3. Recognize, support and assist in implementing evidence-informed public health practices and initiatives.

• Demonstrate knowledge of social determinants of health
• Demonstrate knowledge of ways the chiropractor may contribute to community health
• Demonstrate knowledge of barriers and facilitators to adopting healthy behaviours

4.1.4. Identify and address barriers and facilitators to adopting healthy behaviours.

• Demonstrate knowledge of barriers and facilitators to adopting healthy behaviours

Additional indicator listed in the handbook but not mapped to an enabling competency:

• Demonstrate understanding of the importance of addressing patient health in the context of the patient’s environment

5. Scholar

5.1. Demonstrate skills as a knowledge broker that include contribution to the creation, critical appraisal, dissemination, application and/or translation of health care knowledge into practice.

5.1.1. Demonstrate an understanding of the scientific principles of research and evidence-informed practice for health care.

• Demonstrate understanding of the characteristics of evidence-informed clinical decision making
• Apply evidence-informed process to clinical decision making
• Demonstrate knowledge of methods used to appraise current published research information
• Demonstrate knowledge of sources of pre-appraised, current chiropractic research information
• Demonstrate knowledge of strategies to expand personal knowledge relevant to practice

5.1.2. Demonstrate the ability to identify and retrieve relevant scientific literature, and to critically appraise and evaluate the applicability of health-related literature and research.

• Demonstrate knowledge of methods used to appraise current published research information
• Demonstrate knowledge of sources of pre-appraised, current chiropractic research information

5.1.3. Summarize and communicate to professional and lay audiences the findings of relevant research and/or scholarly evidence.

• Demonstrate knowledge of methods used to appraise current published research information
• Demonstrate understanding of the role of a professional as knowledge broker

5.1.4. Identify ethical principles for research and incorporate them into obtaining informed consent, considering potential harms and benefits, and considering vulnerable populations.

• Apply evidence-informed process to clinical decision making
• Demonstrate knowledge of ethical limitations on use of clinical records for research purposes
• Demonstrate understanding of appropriate and responsible use of technology for professional communication and data management

5.1.5. Identify and develop strategies to address knowledge gaps in clinical care.

• Demonstrate knowledge of sources of pre-appraised, current chiropractic research information
• Demonstrate knowledge of strategies to expand personal knowledge relevant to practice
• Demonstrate knowledge of principles for reflective practice and professional development

5.1.6. Demonstrate attributes of a lifelong learner including strategies to integrate new evidence-informed knowledge into practice.

• Demonstrate knowledge of strategies to expand personal knowledge relevant to practice

5.2. Establish and maintain evidence-informed clinical knowledge, skills, and attitudes, appropriate for the practice of chiropractic.

5.2.1. Demonstrate the application of knowledge of the clinical and biomedical sciences.

• Demonstrate knowledge of sources of published information relevant to practice
• Apply evidence-informed process to clinical decision making

5.2.2. Execute the practice of chiropractic in an evidence-informed manner considering best current evidence, patient preference and clinician expertise.

• Demonstrate understanding of the characteristics of evidence-informed clinical decision making
• Apply evidence-informed process to clinical decision making

6. Professional

6.1. Demonstrate a commitment to the patient, profession and society through ethical behaviour.

6.1.1. Exhibit appropriate professional behaviours and relationships with colleagues, mentors, and other health professionals.

• Demonstrate knowledge of how personal boundaries may vary with diversity
• Demonstrate knowledge of essential elements of professional boundaries
• Maintain appropriate professional boundaries
• Demonstrate knowledge of the impact of power imbalance on relationships
• Demonstrate knowledge of situations in which mandatory reporting may be required
• Demonstrate understanding of chiropractic codes of ethics, and their variability by jurisdiction
• Demonstrate understanding of principles for ethical decision making
• Demonstrate knowledge of principles to manage conflicts of interest
• Demonstrate understanding of principles for delegation in professional practice

6.1.2. Respond appropriately to ethical issues and conflicts of interest.

• Demonstrate knowledge of how personal boundaries may vary with diversity
• Demonstrate knowledge of essential elements of professional boundaries
• Demonstrate understanding of chiropractic codes of ethics, and their variability by jurisdiction
• Demonstrate understanding of principles for ethical decision making
• Demonstrate knowledge of principles to manage conflicts of interest
• Demonstrate knowledge of ethical limitations on use of clinical records for research purposes

6.2. Identify and describe the elements of appropriate, ethical and healthy business practices that could help develop and sustain a successful chiropractic practice.

6.2.2. Understand ethical business skills and practices.

• Demonstrate knowledge of principles for managing human and physical resources
• Demonstrate knowledge of principles for workplace safety
• Demonstrate knowledge of principles for business sustainability

6.2.4. Understand quality improvement processes for business practices.

• Demonstrate knowledge of time and workflow management
• Demonstrate knowledge of principles for business sustainability
• Demonstrate knowledge of quality improvement principles for business
• Demonstrate knowledge of strategies to expand personal knowledge relevant to practice

6.3. Demonstrate elements of reflective practice.

6.3.1. Demonstrate an ongoing ability for critical self-appraisal, including an examination of one’s own strengths, weaknesses and biases.

• Demonstrate knowledge of principles for reflective practice and professional development
• Demonstrate understanding of how personal perspectives and biases impact health care beliefs and expectations

6.3.2. Implement appropriate learning opportunities and/or remediation strategies.

• Demonstrate knowledge of principles for reflective practice and professional development

7. Leader

7.1 Identify and describe the elements of leadership in professional practice.

7.1.1 Understand the roles and governance structures of regulatory and professional organizations relevant to the chiropractic profession.

• Demonstrate knowledge of federal legislation and regulations applicable to chiropractic practice
• Demonstrate knowledge of the role of a province/territory in governing chiropractic practice
• Demonstrate knowledge of the role and typical functions of a regulatory body
• Demonstrate knowledge of the typical role and functions of a professional association
• Demonstrate knowledge of the Canadian health care system and the role of chiropractic within it
• Demonstrate understanding of the chiropractic scope of practice, and its variability by jurisdiction

7.1.3 Demonstrate engagement through community, professional, volunteer or other activities.

• Demonstrate knowledge of the typical role and functions of a professional association
• Demonstrate awareness of opportunities to advocate for improvements in Canadian healthcare

7.1.4 Understand how to contribute to the improvement of health care delivery in teams, organizations and systems.

• Demonstrate knowledge of the typical role and functions of a professional association
• Demonstrate awareness of the influence of payment and reimbursement considerations on chiropractic practice
• Demonstrate knowledge of the Canadian health care system and the role of chiropractic within it
• Demonstrate understanding of the chiropractic scope of practice, and its variability by jurisdiction
• Demonstrate understanding of situations where referral or co-management is indicated
• Demonstrate knowledge of the role of the chiropractor in a multidisciplinary health care setting
• Demonstrate knowledge of principles that facilitate teamwork and collaboration