Towards a 21st Century paradigm of chiropractic education. Stage 2, Connecting assessment to attainment in practice-integrated learning

Purpose: To identify contemporary themes and best practice in student assessment within chiropractic practice-integrated learning (PIL), taken as being the institution-managed, supervised clinicalplacement of senior chiropractic students within the context of a first-professional tertiary qualification. Methods: Focus group methodology was applied to four main categories of participants being multiple groups of chiropractic students, chiropractic academics, and chiropractic clinical educators or ‘clinicians’ in three institutions in three countries. The fourth category, industry, was represented by 3 groups. There were 65 total individual participants. Results: The findings provide evidence that (i) the complexities of clinical learning are compounded by a lack of consistent assessment processes and clinician behaviours; (ii) student assessment within chiropractic PIL should shift more towards the quality of the patient interaction and management given that quantitative measurement by quota completion equates to neither competency nor capability; (iii) specific elements of chiropractic PIL, namely radiography and radiology, are thought to remain relevant in the university-managed PIL environment and a structured assessment of their perceived value should be undertaken; (iv) feedback to students is acknowledged as important if not critical to their growth and development as a learner and a strong desire is present to strengthen and improve feedback as an assessment tool in the PILenvironment; and (v) critical self reflection has value as an assessment tool in this environment and must be properly implemented with a pre-determined structure and training of both students and clinicians. Discussion: The results are congruent with contemporary educational theory and point to a range of changes that could be developed and implemented by chiropractic educational institutions to improve the learning experience of chiropractic students and the quality of patient care provided in the teaching clinics. Conclusion: The finding that the complexities of clinical learning are compounded by a lack of consistent assessment processes and clinician behaviours supports the recent observations of the authors. The evidence is strongly indicative of the need to shift clinical assessment and processes more towards the quality of the patient interaction and management. The findings also signal the need to shift to a more holistic view of the patient in which the roleof radiography and radiology may be refreshed and strengthened and the primacy of the patient becomes the key driver of the learning around clinical decision making.