What Chiropractic Program Would You Refer To? - By Thomas Dube DC
A long time ago I posted a question to the FTCA. Some people had been talking about chiropractic schools and what they did and didn’t like and it got me thinking: What schools would evidence based chiropractors recommend? So, I posted the following question:
“What Chiro schools would you refer a student to?”
I’ve been told when it comes to research I’m pretty naïve, and honestly, he’s probably right. I lack experience, and I’m the kind of person that just finds things interesting—regardless of how practical or pragmatic they may be. That said, I think what school you choose to go to matters, and I posted this with the hopes I could gain some insight about what schools members of the FTCA consider good enough to refer someone to. I also left instructions that people should post why they would or wouldn’t refer a student to that school. I thought it could help me gain insight into what other schools are out there and their quality, because frankly I was aware that I am definitely ignorant on the subject. That and at the time I was under the impression that a lot of the people in the group were Cleveland alums and wanted to confirm my thoughts. Boy was I wrong.
Hey! Stop laughing! I educated myself and now know better.
I wanted to take this opportunity to review the findings of the poll and discuss some insights based on a couple conversations I’ve had and some other research. First I’ll cover my ‘methods’:
For the poll I listed up every school I could think of (allowing people to add schools I missed) and gave members unlimited votes for the schools they might recommend. I then compiled the names of every individual that voted and tallied which schools they voted for. Finally, I started asking people in private messages which schools they attended and checked if they voted for their alma mater. This yielded some different information:
First and most obvious was the most highly recommended schools.
Second, how many people voted for multiple schools and which ones.
Third and Fourth were the number of alumni that voted for their own school as well as the number of non-alum docs that could recommend it. I call the first of those the “Alumni Approval Rating” (AA) which is the percentage of Alumni that voted for their school and the second the “Reputation Rating” (RR), which is the percent of non-alum respondents that voted for a school. This data is a little skewed because I couldn’t find out the alma mater of every respondent (more detail on that in a minute). I deemed it “Reputation” because I figure most people would vote for a school based off what they’ve heard, docs they know from that school, etc. rather than actual personal experience.
Part I-Discussing the Poll
So, let’s talk a little about each of those points in detail.
Regarding the first, in combination with the third point: Obviously, given the fact that overall there was an alumni approval rating of 87.03% we must consider population bias in our sample. I graduated from Cleveland University-Kansas City and to be honest, while I know other schools exist, until I did this poll (and ESPECIALLY up until just a few months before I did it) I had always thought of there being a “Big 4” schools: Logan, Palmer, Cleveland, and Life. Again, stop with the laughing; however once you see my results (and hear some of the arguments I have to discuss) some of even you may be surprised. Suffice it to say I realized CUKC is a very small fish in a—still pretty small—pond!
But back to my point: as there seems to be in general a high AA, obviously then if the members voting on my poll were more from one school than another, that would affect results. I had no intent for this to actually be an ideally random sample. In fact, as I mentioned before part of my ulterior motive for the poll was that I specifically wanted to see where members of FTCA attended school, or in other words, what schools had a higher number of evidence-based progeny, and what schools those people think are better/more evidence based. Emphasis on think, which I’ll be discussing later.
I also want to mention that I only have Alum information on 322 (70.46%) respondents, and I never got around to even requesting the information from roughly half of those I don’t have responses for. Sorry but Facebook started temporarily restricting my private messaging privileges and frankly… I got bored of the tedious nature of the task…
While we’re at it, lets note the other population bias: geography and class size. Bobby Maybee, the man behind FTCA, hails from the area of UWS and attended there, too. So of course, a FB group he started is going to be filled with his closest peers! And what of the foreigners? If I remember correctly, Washington state is in the US, so obviously even in an online world reach to other countries is going to be limited. (accept maybe Canada—XOXO)
Additionally, schools that have smaller class sizes are obviously going to have less representation at all even in an evenly distributed group and given what we know that’s only going to skew the results more.
School Number of votes % of total votes # alum responders %alum responders AA RR
UWS 129 13.33% 45 12.16% 91% 21% NWHSU 112 11.57% 32 8.65% 94% 19% NUHS 103 10.64% 54 14.59% 82% 15% NYCC 95 9.81% 39 10.54% 100% 13% Logan 91 9.40% 46 12.43% 93% 12% CMCC 90 9.30% 21 5.68% 100% 16% UBCC 62 6.40% 15 4.05% 93% 11% AECC 41 4.24% 17 4.59% 100% 5% SCUHS 32 3.31% 2 0.54% 100% 7% PCC 27 2.79% 1 0.27% 100% 6% TCC 26 2.69% 12 3.24% 100% 3% PCC-W 23 2.38% 21 5.68% 81% 1.4% USD 20 2.07% 2 0.54% 100% 4% UZ 18 1.86% 0 0.00% 0% 4% CUKC 14 1.45% 16 4.32% 69% 1% WIC 11 1.14% 2 0.54% 100% 2% DYC 10 1.03% 4 1.08% 100% 1% Parker 10 1.03% 5 1.35% 60% 2% Murdoch 9 0.93% 1 0.27% 100% 2% PCC-F 8 0.83% 6 1.62% 33% 1%
(Editorial Note - We stopped publishing at the top 20 institutions, but there were many more on the list)
On the second set of findings: This was an interesting thing to see. Overall, we had 457 people cast 968 votes. That’s almost two per person, but when you look at the data, 64% of voters cast only 1 vote, which means that less than half of the people cast roughly 2/3rds of the votes. In fact, if you take out all the people that voted for 2 schools, you’re left with 22% of voters casting 56.5% of the votes. (Honorable mention to Stephen Perle, who voted for 15 schools, and the 4 others that voted for 14 schools.) Also, AA increased as the number of voted increased, generally.
And as far as the fourth point, RR, it’s maybe a bit more difficult to figure how this may be important, but I think what is important is very important. First, you ought to consider how many people only voted for one school. Essentially over half of us don’t know enough about other schools to recommend many of them, and when you consider the bias going both ways for those attending, it’s hard to say how many chiropractors can actually make a good, informed decisions about what school to refer a prospective student to. Then you consider that for those recommending other schools, how are they basing that decision? This is where the most important question comes into play: what makes a Chiropractic school (or any school, for that matter) worth going to?
The last thing to consider about this is how geographic bias, especially for the [relatively to an individual] foreign schools are obviously going to limit the reputation that a school can have.
Part II-What Makes a School a “Good” School?
So, what makes a school great? Before we consider anything, we must address the most important factor, personal preference. One critique I got from someone about my post was that most people didn’t even have feedback to give that mattered about certain schools. Well, sure while objectively having a nice fitness center at your school isn’t going to affect your success in practice as much as passing boards, it matters to people, and frankly, if you chalk it up to ignorance, well then don’t you know it’s those same ignorant fools looking at your school considering whether to put their loan dollars into your tuition buckets? What are you going to do, educate them about their choice? They’re already putting a bench press over passing Part I, so…
But for all my dogging on the logical conclusion, the logical conclusion is the best one. I don’t deny it. I’m just saying that the sad fact is it doesn’t matter like it should to most, and many doctors are referring students based on faulty reasoning.
Now let’s go through a list of Chiro school characteristics people can look at (maybe not that they should). I’ll start with the smaller stuff. For each of these, it’s also important to assess how one might measure each of these characteristics. For some it is easier to see, such as board scores, but others, like how well your school prepares people for starting a business, are far more difficult.
Amenities: What kinds of extras does your school offer? Does it have a gym? Cafeteria? What about clubs? Sports? Activities? These are the sweets that get the children into your van so you can take from them all that they’re worth.
Cost: This one is easy, so I won’t take more than another sentence to evaluate the concept as it applies to what makes a school great. You just must ask yourself: Am I getting what I pay for or am I getting good value for my future debt amount?
Philosophy: What kind of philosophy does a school tend to indoctrinate their students towards? And yes, I meant to use ‘indoctrinate’ there. Most students, open-minded or not, will be greatly influenced by the principles taught by the professors at the school and by the general views insinuated by the values of the institution as a whole. Some may not think this matters, and you may be largely correct, but ask yourself this: how much do you care if a doctor gets great results from his patients and sees a patient 12 times before releasing them from care vs one that sees them 48 times? How about if they tell their patients to direct immunization questions to their primary care doctor or tell them that vaccines cause autism? Or if they treat using evidence-based guidelines versus tell people they can cure cancer? Does it matter so long as they get great results? The amount that this matters to you is directly proportionate to how important it should then be that you consider the philosophy put forth in a given school.
Business Classes: How well does your school prepare its students for starting their own business? The best way I think to assess this is by seeing how many docs that decided to start a business right out of school feel after doing it for a couple years. This is hard information to get, though.
Retention: Ever since I had a friend transfer schools because he didn’t like Cleveland, this has been something important to consider for me. Of course, I understand that in schools this is reported it represents any number of things: Is the program to hard, or was the student too incapable? Is the student unreasonable, or is the program really that lacking? It’s hard to tell from just a number.
Program Efficiency and Options: How does your program operate? This can range from things such as whether you use a trimester vs semester method to the way your clinic internships are formatted. What requirements are there for students during their internships? What are your class attendance and testing policies? What kinds of classes do you offer, in general? While it is easy for two graduates to compare how many x-rays they needed to graduate, it isn’t so easy to compare the value when one school requires 30 yards of red tape to cut through for them and the other requires you do it on every patient at the beginning and end of treatment. What kinds of outside opportunities do you have to get experience, such as VA rotations?
Faculty and Class Quality: Simply put, how well do teachers teach their students? And does it make someone a bad teacher if they have a monotone voice? Or poorly organized slides? Or difficult tests? Or maybe more important is the relationships those faculty have with the students as mentors? Are your faculty approachable, instructive, insightful? One good way to see this objectively is to look at your class sizes and student: faculty ratios. If they’re high, developing those relationships and overseeing growth will become more difficult.
Board Scores: You can’t be a chiro without passing them, and the ability for a given school to prepare their students to pass boards is paramount to having any hope of practicing at all. Each school is supposed to keep available their pass rates for each part. This is probably the only purely objective information you can get on a school.
Clinical Preparedness: How well are students prepared for the practical application of what they’ve learned? And I’m talking more than just what it takes to pass part 4. The comprehensive nature of what it takes to be a clinician is so much more than what can be evaluated in a test. What kinds of results can new graduates get from their patients? How accurate are their diagnoses? Essentially, when a new doctor from your school walks into a treatment encounter each visit, how confidently and competently can they take care of that person?
And last but the opposite of least, Geography: From what I’ve heard, more and more people are moving farther away from family as they grow up, but nonetheless, the sweet beckoning of a school close to home is more often than not going to be the lure that grabs most students. Add in the perpetuation of graduates camping out close to their alma mater and influencing the local prospective students and you’ve got a recipe for predicting where a given individual will attend school. I didn’t put this last because it should be the most important when considering a school to attend, but because it likely is the most important to those making the decision.
For those that work in school administrations, these things are obviously under consideration when managing a school. In fact, I probably missed some important key points. The fact is, how many of those of the rest of us consider this when recommending a school to attend, or looking for recommendations?
Part III-What Does this Mean for Recommending Schools?
So, what does this mean for the students looking for advice on where to attend and the doctors hoping to help?
When considering the recommendation someone makes for chiropractic school, there are a number of things to consider about the recommendation itself, foremost being what qualifies their recommendation. Did they go to school there? If not, how did they hear about it, and what, and from whom? Perhaps they know a doc that graduated from that school; can you even consider them to be exemplary of what that school has to offer? How long ago did they graduate? If it’s been a while, how do you know the school hasn’t changed—drastically? And if not, many people leave school with extremely polar views that don’t settle until experience, hindsight, and insight level them out. Maybe the cafeteria staff were horrible, or maybe they just loved the club they were a part of. Those are fairly narrow reasons to approve or disapprove of a school for.
In the end, I believe that overall the best people to ask for input from are probably those close to graduating or that have recently done so, with the opinion of those that have attended more than one school being especially valuable. Despite the bias, this population likely has the most current, accurate, and comprehensive answers for you.
Also, teachers at those schools can probably answer your questions, too. While many of those teachers will likely recommend the school and/or are hoping to change the school for the better, their insights on the subjects above are nonetheless invaluable. The only thing you should remember is to compare. Get current information on multiple schools and compare it. Visit the campus and see for yourself. And always, always remember what matters most to you.
Interestingly after we look into all this information, we also should consider for yourself the following: if you know what other schools have to offer, would it change what you think of your school? Perspective is everything, my friend.
I additionally asked people to comment on my poll why they would or wouldn’t recommend a school and I got some meaningful feedback that if you go back and review, provides some—albeit minimal—insight about those individual schools. Just remember to keep it all in context or how qualified those people are and what their input says about how reliable the information is. (i.e. someone merely whining about stuff vs. meaningful commentary about curriculum). You may visit my post here.
So, in conclusion, apart from 8 respondents (honorably mentioned below) who attended two schools, very few that voted on my poll probably knew what they were talking about when they recommended a school. As a result of that and the huge quantity of bias, design flaws, etc. of the poll, the data is pretty much meaningless.
Austin S - NUHS/UWS
Chuck L - Life/UBCC
Cora B - NUHS/Logan
Emily R - TCC/SCC
Justin S - NUHS/UWS
Kyle S - NWHSU/NUHS
Lacey K - NUHS/ACU
Zac Y - NUHS/UWS
Actually, I’m going to make a case that this information IS valuable. The reason is because it has shown us that many of us have a whole lot more to consider before recommending a school to a prospective student. I’ll even go as far as to say that there are schools you can learn about from this poll. I kind of look at this as similar to a ‘specific’ test rather than a ‘sensitive’ one: few false positives, lots of false negatives.
I mean by this that if the school had a lot of votes and a high AA and RR rate, it’s probably safe to say it’s overall a decent college. I mean, come on, let’s consider just how cynical and critical we are as a group. If anyone would find something to nitpick at, it’d be us. Logically then, in addition to the people I mentioned above, I think it would be an awesome idea to ask people why they didn’t recommend their alma mater, and/or voted for another school. See how their reasons stack up to my reasons listed above. Are they being petty and is their information dated? Perhaps they don’t even know what they’re talking about? Or maybe it’s possible they indeed have something meaningful to say.
In the end, I have a feeling someone is going to say that there’s nothing meaningful here. We can’t rely on a bunch of biased input from a biased population. I however, don’t believe that a school’s board scores—probably being simultaneously the only and the most objective indicator of how good a school is—should be the only thing you base your decision off.
If you agree then that board scores aren’t the only thing you should base your decision off, it seems to me the only other option is to additionally talk with people or look at marketing information that is going to be biased in one way or another to find out about the characteristics I mentioned above. And if you won’t do that simply because the information is biased, and you won’t base your choice off board scores and/or geography alone either, how are your chances of choosing or recommending a good school going to be any better than picking a name out of a hat?
Thomas Dube DC