Comprehensive Training in All Facets of Integrated Clinical Chiropractic Practice

The Integrated Clinical Practice Chiropractic Residency Program consists of one year of clinical training.

The program provides the resident with clinical experience as a portal of entry provider in an integrated delivery health care system, including the full scope of diagnosis and treatment of patients with non-operative musculoskeletal and neuromuscular problems. The curriculum is organized into three main categories:

1. Patient care: The resident gains experience in managing complex conditions under the mentorship of faculty chiropractic doctors. Patient cases include inflammatory arthritis, radiculopathy, peripheral neuropathy, chronic pain syndrome, neuromuscular degenerative pathology, deformity, and complicated medical and psychosocial co- morbidity. Approximately 60% of the overall residency time is allotted to patient care.
2. Interprofessional education: The resident rotates through other services to gain exposure to a wider variety of cases, learn about the roles and approaches of other disciplines and foster interdisciplinary teamwork and collaboration. Learning objectives focus on providing residents a better understanding of clinical practice in various specialties and facilitating future communication and collaboration in team care settings. Approximately 30% of the overall residency time is spent in clinical rotations across the following locations and/or services (subject to change):
   1. Primary care / Family Medicine, Internal Medicine, Pediatrics
   2. Physical Medicine and Rehabilitation
   3. Interventional Pain
   4. Non-interventional Pain
   5. Physiatry
   6. Orthopedic Spine
   7. General Orthopedics
      
      
   1. Neurosurgery
   2. Radiology
   3. Physical Therapy / Occupational Therapy
   4. Integrative Medicine
   5. Acupuncture
   6. Neurology
   7. Rheumatology
3. Scholarship: The resident attends ongoing scholarly presentations, obtains and appraises literature relevant to clinical care, presents critically appraised topics and/or case reports and assists or participates in ongoing faculty research projects. Approximately 10% of the overall residency time consists of scholarly activities. Specific activities include:
   1. Attend online or, if available, in person training in Motivational Interviewing and Ethics training.
   2. Present a minimum of two formal critically appraised topics and/or case reports including in-person or online meetings, Journal Club sessions with the VA or AAH relevant venues.
   3. Attend case reports and scheduled multidisciplinary case conferences within AAH.

The Mission of the integrated clinical practice residency program is to provide advanced clinical training and educational experiences to enhance the knowledge, skills and behaviors of chiropractic clinicians. This training focuses on patient-centered, evidence-based diagnosis and management of musculoskeletal and neuromuscular cases and clinical practice in an academic healthcare clinic and affiliated clinics and facilities. Graduates of this program will be exceptionally well prepared to practice in fully integrated healthcare systems or to pursue careers in clinical education

The residency is a one-year program. The program is full-time (with 40 hours/week minimum). Daily schedules fluctuate depending on teaching, clinic and rotation duties. The resident’s time is allocated in 2-week periods of 80 hours each approximately as follows:

The core curriculum emphasizes courses and experiences specific to the skillset of integrated clinical practice that includes clinical practice, collaboration with other health care practitioners, scholarly activity, and collaboration with scientists, as well as system navigation skills. As the primary emphasis of the program is clinical expertise and patient-centered care, residents are involved in direct patient contact working as part of an integrated, multidisciplinary health care team at AAH medical facilities.

Curriculum

Clinical care with Faculty supervision and oversight  - 48 hours per 2-week period
Interdisciplinary Rotations in 8 Core and ≥ 2 Elective Rotations - 24 hours per 2-week period
Scholarly activities - 8 hours per 2-week period

Interdisciplinary Rotations:

The resident rotates through day-to-day functionality of specialty and primary care services to: 1) gain observational exposure to a wide variety of cases with complex presentations and comorbidities; 2) advance clinical decision making skills through the lens of other disciplines; 3) foster interdisciplinary teamwork and collaboration. Learning objectives focus on providing residents a better understanding of clinical practice in various specialties and facilitating future communication and collaboration in team care settings.

Approximately 30% of the overall residency time is spent in clinical rotations across the following locations and/or services (subject to change):

• Core Rotations consist of: Radiology, Neurosurgery, Physical Medicine & Rehabilitation or Physical/Occupational Therapy, General Orthopedics, Orthopedic Spine, Interventional Pain Management, Family Medicine, Internal Medicine.
• Elective Rotations may include, but are not limited to: Acupuncture, Non-Interventional Pain Management, Integrative Medicine, Pediatrics, Neurology, Sports Medicine, Urgent Care/Emergency Care.

Scholarly Activities:

• Scholarly Activities include: case studies, Quality Improvement projects, posters, and written requirements, including a literature review.
• Citi Training

Call Hours:

The resident does not have call responsibility outside of duty hours; however some additional weekly time will be needed for scholarly or other training activities.

Consistent with Council on Chiropractic Education (CCE) residency standards and Graduate Medical Education (GME) standards, the residency ensures competency in seven main areas, listed below along with select representative sub competencies (i.e. Milestones).

1. Patient Care and Procedural Skills: Residents must be able to effectively diagnose and manage complex, subtle, or infrequently encountered clinical presentations by using patient-centered, compassionate, equitable, and appropriate diagnostic and treatment approaches.
   • Patient Care 1: competency in review of the clinical record and taking a history commensurate with patient age, impairment, and case complexity.
   • Patient Care 2: competency in performing a physical examination commensurate with patient age, impairment, and case complexity.
   • Patient Care 3: competency in diagnostic assessment based on history, examination, and appropriate use and interpretation of imaging, laboratory, and special studies.
   • Patient Care 4: competency in case management including appropriate patient-centered treatment, education, and collaborative decisions commensurate with patient age, impairment, and case complexity.
2. Advanced or Focused Healthcare Knowledge: Residents must identify and synthesize current scientific information and integrate this knowledge into patient care through evidence-based clinical decision making. The resident must promote and disseminate knowledge through scholarly activities, such as lectures, presentations, publications, posters, or research.
   • Advanced or Focused Healthcare Knowledge 1: Demonstrates competency in accessing relevant scientific knowledge and applying this to inform patient care.
   • Advanced or Focused Healthcare Knowledge 2: The resident provides clinical management consistent with best practices and recognized clinical guidelines.
   • Advanced or Focused Healthcare Knowledge 3: The resident promotes and disseminates knowledge through attending and/or presenting material at scholarly activities/lectures, and/or through research activities.
3. Practice-Based Learning and Improvement: Residents must be able to investigate and evaluate their patient care practices; appraise and assimilate scientific evidence; and improve patient care through self-assessment and lifelong learning.
   • Practice-based Learning and Improvement: Demonstrates competence in analyzing their practice and performing practice-based improvement activities through self-assessment and documented quality assurance activities.
4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills appropriate and effective for the exchange of information with patients, their families, and health professionals..
   • Interpersonal and Communication Skills: Uses appropriate and culturally competent communication in all patient interactions including education and shared decision-making.
5. Professionalism: residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
   • Professionalism 1: The resident demonstrates compassion, integrity, and respect for others, as well as sensitivity and responsiveness to diverse patient populations.
   • Professionalism 2: Demonstrates a commitment to ethical principles pertaining to patient care decisions, confidentiality of patient information, informed consent, and business practices.
6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and collaborate with other professionals and community entities to assure that appropriate resources are utilized for well-coordinated patient care.
   • Systems-Based Practice: The resident demonstrates appropriate use of system resources in their own practice and with regard to ordering healthcare services and/or consultations.
7. Structural Fluency (GME competency): Ensures equitable health outcomes for patients across the life span and in all settings.