Changes in health care and education
today are far outpacing anything experienced by past generations. Palmer
College faces a myriad of challenges in preparing its graduates to
successfully navigate future expectations and new environments. During
Saturday’s general session, five of Palmer’s vice chancellors presented
on imminent academic, clinical, co-curricular and research issues and
how the College is addressing new challenges to best prepare its
graduates.
“The Changing World of Chiropractic Education,” Robert Percuoco, D.C., Vice Chancellor for Academics
Dr.
Percuoco spoke about the educational trends of outcomes-based learning
and assessment, and how Palmer has laid the groundwork over the past
several years and is now “ahead of the curve” in its assessment of
learning. “The most significant change in education over the last 10
years has been the movement from teaching to learning, specifically
outcomes-based learning,” he said.
The College has received high
marks from both of its accrediting agencies: the Council on Chiropractic
Education (CCE) and the Higher Learning Commission of the North Central
Association of Colleges and Schools, having consistently demonstrated
competency assessment and learning assessment of its students. “For
example, our clinical competency evaluation has changed over the past
five years, he said. “We’ve moved from a supervisory to a mentorship
model of clinical education and we now measure 18 clinical competencies.
Both intern and clinician satisfaction has increased and clinic
patients now know their clinic doctor as well as their intern.”
The
challenges Palmer faces in the academic arena include enrollment,
especially competition from Doctor of Physical Therapy programs (there
were nine in 1999 and now there are 206), new CCE enrollment criteria,
and the rising cost of education. In addition, the millennial generation
students are adept at using technology and expect it in their college
classrooms. Laptops and internet have been in use for several years in
Palmer classrooms, and educational technologies such as electronic
health records are now being implemented in the Palmer clinics on all
three campuses, along with “clickers” for faculty to use in surveying
electronically during class. “The coming years will require not only new
technologies to be implemented on our campuses, but also educational
strategies to take advantage of these new technologies,” Dr. Percuoco
added.
“The Academic Program,” Dan Weinert, D.C., Davenport Campus Provost
“A
college’s curriculum can be viewed as an indicator of the strategic
direction of the institution,” said Dr. Weinert at the beginning of his
presentation.
He continued by highlighting several curricular
enhancements on the Davenport Campus that have recently been implemented
or will be implemented in the Fall 2011 trimester:
1) Diagnostic imaging has been incorporated into anatomy classes.
2)
A clinical nutrition class beginning this fall will prepare graduates
to provide sound nutritional counsel in their practices.
3) A
subluxation analysis class will be added to the third trimester
curriculum this fall; the palpation class will move from the third to
the second trimester.
4) The Business and Practice Management curriculum has been revamped, and a new faculty member was brought on board.
5)
A new course in evidence-based chiropractic began in the spring 2011
trimester, which complements the existing information literacy class.
“Through
our R25 grant to incorporate evidence-based practices in our
curriculum, we are training our faculty to implement it in our
curriculum, and they in turn are getting our students involved in a
conversation about evidence-based chiropractic,” Dr. Weinert said. “Our
graduates need to be information-literate, and they are getting it
starting in the first trimester. Palmer had 12 presentations on this
subject at the Spring 2011 ACC-RAC conference. We dominated—no question
about it.”
“The Davenport Campus is by no means a museum piece,”
Dr. Weinert concluded. “We are moving forward in earning the name of the
trusted leader in chiropractic education. In the end it’s about student
learning. We want to make sure we have the best system in place for our
graduates to be phenomenal.”
“Clinic Affairs,” Kurt Wood, D.C., Vice Chancellor for Clinic Affairs
Dr.
Wood began his presentation with the goal of the Palmer Chiropractic
Clinics on all three campuses: to have our graduates be prepared for the
challenges of contemporary practice. He then went on to talk about the
factors influencing this clinical education goal:
• Laws, regulations and compliance
• Educational standards
• Third-party payment systems
• Case management mentorship
• Evidence-informed practice
• Technology
Dr.
Wood described several of the federal laws that are impacting
chiropractors and other healthcare professionals, and how the Palmer
Chiropractic Clinics are responding. For instance, the Tax Relief &
Health Care Act of 2007 established the Physician Quality Reporting
System (PQRS), which is currently voluntary, but failure to participate
in PQRS by 2015 will result in reimbursement penalties. In response,
Palmer’s Davenport, Florida and West Campus clinics began participation
in CMS-PQRS in July 2011.
Another example is the American
Recovery & Reinvestment Act (ARRA) of 2009, which offers financial
incentives to providers for using federally certified electronic health
records (EHR), and meeting “meaningful use” requirements. The Palmer
Chiropractic Clinics’ response is to employ HER at all Palmer campus
clinics by the third quarter of 2011. “Meaningful use” will be
established during the College’s 2011/12 fiscal year.
The
Patient Protection & Affordable Care Act (PPACA) of 2010 (new
healthcare law) requires physicians to report and repay any overpayments
from Medicare within 60 days of the overpayment being identified. To
comply with this provision, the Palmer Chiropractic Clinics are
establishing means of identifying potential overpayments through
pre-submission claims review, and are continuing their record of
returning any “identified” overpayments to respective Medicare carriers.
Another
provision of the PPACA is to restructure the Medicare reimbursement
model to a Patient Centered Medical Home (PCMH) model. The PCMH is an
approach to providing comprehensive primary care that facilitates
partnerships between individual patients and their personal providers,
and when appropriate, the patient’s family. The provision of medical
homes may allow better access to health care, increase satisfaction with
care, and improve health.
In response to the PCMH provision,
Dr. Wood said that he serves on the Iowa Department of Public Health
Patient-Centered Medical Home Advisory Committee, and the Davenport
Campus clinics are working toward satisfying the NCQA (National
Committee for Quality Assurance)-PCMH standards to become credentialed
as a Patient Centered Medical Home.
“In conclusion, it’s best
to say, like Roseanne Rosannadanna on “Saturday Night Live,” that ‘it’s
always something,’” Dr. Wood said. “There’s always something we have to
respond and react to, and we never let the grass grow under our feet.”
“Student Engagement and Preparing to Enter Practice,” Kevin Cunningham, D.C., Ph.D., Vice Chancellor for Student Success
Palmer
has traditionally delivered the chiropractic education and clinical
competency aspects of its D.C. program well, and continually strives to
improve in these areas, Dr. Cunningham told the audience. But there is
another important aspect of a well-rounded graduate of a Doctor of
Chiropractic program, and that is the so-called “soft skills” of strong
communication skills and business acumen.
To improve its
education in these areas, the College opened the Palmer Center for
Business Development in 2008. This co-curricular program augments the
Business and Practice Management curriculum and is free of charge to
students and alumni. It is in addition to the already robust offerings
on the Palmer campuses that enhance student engagement outside of the
classroom.
“On the Davenport Campus alone we have 60 active
clubs, with one-third of them being technique-oriented,” Dr. Cunningham
said. “There are six professional organizations, and student leader
groups such as the Vogt Leadership Society and the Palmer Student Alumni
Foundation are involved in numerous community projects throughout the
year. In fact, 55% of our students have been involved in community
service while at Palmer. Our Student Council puts on a community race,
the Palmer N8K Charity Run that raises awareness of chiropractic in the
community and raises funds for a cause. We have three active
fraternities and one sorority. Nearly 700 students participate in one or
more intermural sports this past year, and we have nine club sports,
such as rugby and hockey.”
But Palmer administrators knew there
was more to be done to improve students’ preparation to enter private
practice, and the Palmer Center for Business Development was born of the
need to enhance that component of the educational process.
“Palmer
College needs you today more than ever,” Dr. Cunningham told the
alumni. “I want to talk about your time and talents today, not your
treasures. The students aren’t taking advantage of the Center the way I
want them to. The Center offers a co-curricular experience that is free.
We have two full-time staff members and we bring in the best people in
chiropractic and business to talk to them about preparing for the
future. We also have several alumni helping us with our program in a
consulting capacity. Any alumnus is able to participate in the ‘Ask the
Coach’ webinar series.”
Dr. Cunningham described the new Palmer
CareerNetwork launched on July 25 that features a “match.com” type
system matching students and alumni looking for positions with alumni
who have positions available, a video resume development program, a
practice location software program, an alumni mentoring program and
more. “Just go to our website and join the network. Alumni may utilize
any of these services free of charge.” To register, visit
https://palmer-csm.symplicity.com/employers.
“The
Palmer Center for Chiropractic Research: On the Leading Edge of
Chiropractic Science,” Christine Goertz, D.C., Ph.D., Vice Chancellor
for Research and Health Policy
The Palmer Center for Chiropractic
Research (PCCR) is “100% committed to making sure the research we do is
pragmatic and absolutely relevant to what chiropractors do,” stated Dr.
Christine Goertz in her presentation during Saturday morning’s general
session. The term describing the focus of the PCCR’s research initiative
is “translational research,” which means translating research to
clinical practice on several levels. For instance, translational
research encompasses translating basic science findings into clinical
applications, translation of results from clinical studies into everyday
clinical practice and healthcare decisions, a “bench to bedside and
back again” approach in science where researchers and practitioners work
together to achieve common research goals, and working in
multi-disciplinary teams.
This kind of research is critically
important to the chiropractic profession, Dr. Goertz said, because
“there are a lot of unanswered questions in chiropractic, such as:
• What techniques work best for which patients and/or conditions?
•
What is ‘optimal dosing’ for chiropractic care? (This is a
controversial area with many parameters to examine, and research is just
beginning.)
• What’s the best way to deliver a given technique?
•
How much are treatment effects due to the adjustment vs. other
therapies vs. non-specific effects (like office environment, demeanor of
the practitioner, staff, etc.)?
• How cost-effective is chiropractic care? (A lot more research is needed in this area.)
• What is the effect of chiropractic care when it’s compared to other forms of health care?
There
are challenges to research that will answer these kinds of questions,
Dr. Goertz said. “For instance, clinical trials tend to show only mild
to moderate positive results, while the results in clinical practice are
more dramatic. We’re aware of this dichotomy and are trying to find
ways to address this scientifically. In addition, funding agency
reviewers often demand that chiropractic studies include a sham or other
control group, which complicates research.”
She went on to
describe the pragmatic clinical trials being conducted at Palmer, which
feature experienced clinicians and a warm, inviting clinic atmosphere
that closely mirrors a regular chiropractic office. “Our study
participants treat us the way yours do you—by bringing us cakes and
telling us they'll miss coming to the clinic,” she said. “We have
protocols that emulate real practice, including full-spine adjusting,
flexibility in the number of patient visits, along with the scientific
rigor necessary for a clinical trial.”
Another challenge is
conducting research that translates into policy, she added. “We need to
recognize future healthcare delivery trends and make sure our science is
at the forefront, and this means asking the right research questions.
It will be critical to conduct more comparative effectiveness research
and look into issues of cost-effectiveness and collaborative care, since
the healthcare of the future must be more cost-effective and
collaborative in nature.”
And last but not least, there is the
challenge of the cost of doing research and diversifying funding
sources, Dr. Goertz said. “For example, we recently finished data
collection for a low-back pain study. There were 221 participants, but
we spoke with 1,688 people on the phone and had 734 baseline visits from
prospective participants. Forty-five people worked on this study for
six years from the grant submission to the article being published in a
peer-reviewed journal—at a total cost of $1.9 million. Our annual budget
of $7-8 million pays for about four clinical trials.”
Diversifying
funding sources, Dr. Goertz concluded, “will be about the people.”
Those people include the PCCR faculty and staff members “who dedicate
more time than you realize to conduct research; along with those people
who care enough about what we’re trying to do that they’re willing to
give us millions of dollars in funding; it’s about all of you making
sure we’re asking relevant questions; and it’s about the
patient—patient-centered research will continue to be our focus as we
continue to move forward.”