Chiropractors at McMaster University: the formation and direction of a university-based multidisciplinary chiropractic working group.
Subject: Chiropractors (Training)
Universities and colleges (Canada)
Universities and colleges (Training)
Authors: Passmore, Steven R.
Riva, John J.
Goldsmith, Charles H.
Pub Date: 01/01/2010
Publication: Name: Journal of the Canadian Chiropractic Association Publisher: Canadian Chiropractic Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Canadian Chiropractic Association ISSN: 0008-3194
Issue: Date: Jan, 2010 Source Volume: 54 Source Issue: 1
Topic: Event Code: 280 Personnel administration
Product: Product Code: 8041000 Chiropractors; 8220000 Colleges & Universities NAICS Code: 62131 Offices of Chiropractors; 61131 Colleges, Universities, and Professional Schools SIC Code: 8041 Offices and clinics of chiropractors; 8221 Colleges and universities
Organization: Organization: McMaster University
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 259589894
Full Text: At present globally there are rare examples of chiropractic training in publicly funded universities. (1) The absence of a university-style research tradition, coupled with a lack of access to government funding has acted as a barrier to the scientific development of the chiropractic profession. (2)

Within chiropractic educational facilities there are no formal programs cultivating chiropractic clinician researcher development. (3) In examining the development of clinician researchers, Coulter (1986) observed "to become a productive researcher the student requires prerequisite knowledge of the area, skills in research methodology, academic values and attitudes, a supportive environment, and advisors/mentors with specific responsibility for monitoring the students' progress." (4) It has also been recognized that research infrastructure, located outside of traditional chiropractic colleges is needed for the profession to develop productive clinical research programs. (3)

Professions of any health care discipline having faculty members at publicly funded universities are afforded academic freedom while maintaining the growth and development of their profession, with a focus on active scholarly publication thus fostering a strong research culture. (5) A university setting reduces barriers to interdisciplinary research and allows clinical collaboration that utilizes the most current technology. A university, or university hospital setting also allow for clinician training, incorporation of experimental treatment protocols and facilitate delivery of health care to the general public. (1) The chiropractic profession needs to remodel its present approach to clinical education and research to remain relevant in an era of evidence-based practice. (6)

Since January of2009, a group of chiropractors that also have an affiliation with McMaster University, have been meeting quarterly on the McMaster campus. These affiliations may be as graduate students (chiropractors who are currently in pursuit of a Masters or PhD, or are medical residents), full-time, part-time, or adjunct faculty, clinical faculty, research affiliates, academic committee members or those who supervise McMaster medical interns in their clinical environment. The group allows chiropractors that are operating at some capacity within the mainstream university system to become aware of their colleagues. It also assists to foster collaboration among these colleagues within such an environment to serve and enhance the chiropractic profession in improving patient care.

With the support of the Canadian Chiropractic Association and the Ontario Chiropractic Association, the group has been able to expand and thrive. Meetings consist of a member of the group presenting on a topic that relates to their McMaster University affiliation, followed by a round table discussion. At a recent meeting, a McMaster University Professor Emeritus, (Department of Clinical Epidemiology & Biostatistics) Dr. Charlie Goldsmith was present. He led the group through a workshop to identify

For the McMaster Chiropractic Working Group what specific priorities and collaborative goals the group should strive toward, to become productive.

The workshop focused on how the chiropractic working group could become a useful part of McMaster University. A workshop exercise was derived from a textbook called "The Quality Toolbox," (7) and was broken up into three distinct phases:

1 brainstorming

2 affinity diagrams

3 interrelationship digraphs

The process allowed for anonymous intellectual brainstorming, which prevents power imbalances in groups with diverse backgrounds, and individuals at various stages in their respective careers or positions by giving each person an equal voice. Having each group member write three ways to answer the question "How do we make ourselves a useful part of McMaster University?" on three separate pieces of paper was the first step. The pieces of paper were then passed to a neighbour, and again one more idea was added per person based on this new information.

An affinity diagram was created with the results of the brainstorming session, in which like ideas were grouped together. (8) This was achieved by posting all the ideas on a wall so that first, everyone could read them, and then second, people could freely move ideas around in attempt to group them. This was done in silence, and all pieces of paper were moved with the non-dominant hand of the person moving it. Once the ideas were grouped, a key-word summary of the concept from each grouping was created. The McMaster chiropractic working group came up with 7 concepts (see Table 1).

To interpret the meaningfulness of the concept summaries from Table 1, pair wise comparisons were performed to determine the relationship of concepts to each other. This is deemed an "interrelationship digraph." (8) Some concepts require input from other concepts to become reality. On the other hand, some concepts generate output used to fuel additional concepts. In the end it was revealed that, to prioritize goals for the working group, the concepts that need to be prioritized, are those that generate the most output to the other concepts. The high output generating activities will allow for the greater facilitation of the concepts that require the most input over the course of time.

The McMaster chiropractic working group came to the conclusion based on this exercise that it is through scholarly writing, that the greatest output can be achieved. This could take the form of grants, editorials, seed funds, and peer reviewed publications. The productivity of the group would be monitored by an internal group curriculum vitae and be an agenda item at each meeting. As such, the group has prioritized the various aspects of writing to proceed as a functional working group on collaborative projects. Balancing strategic interests, structured supports, technical knowledge and skill, and a culture of collaboration are crucial to the group's success over the long term. (9) Lastly, faculty members of the group must be able and willing to share, not own, curricular turf. (10)

This workshop and group development process offers to act a template for other university-based working groups. There are vast resources and opportunities within the publicly funded education system as evidenced by the chiropractic professions in other countries. (11) This manuscript also offers to inform other chiropractors presently operating in isolation (as clinicians, scientists, clinician scientists or clinician scientists in training) within other publicly funded universities of the practical application of group formation and interdepartmental collaboration.

Acknowledgements

McMaster Chiropractic Working Group members present for this workshop: Dr. Dan Avrahami, Dr. Craig Bauman, Dr. Steve Burnie, Dr. Charlie Goldsmith, Dr. Ryan Larson, Dr. Keshena Malik, Dr. Steven Passmore, Dr. John Riva.

Guests: Dr. Dave Brunarski (Ontario Chiropractic Association), Dr. John Tucker (Canadian Chiropractic Association).

We gratefully acknowledge the insight of Dr. Jason Busse, CIHR/CCRF Chiropractic Research Chair at McMaster University, during the development of this paper. Also, we extend our thanks to those working group members absent from the workshop but whose discourse at prior, and subsequent meetings aided in the formation of this manuscript.

References

(1) Myburgh C, Mouton J. The development of contemporary chiropractic education in Denmark: an exploratory study. J Manipulative Physiol Ther. 2008; 31:583-592.

(2) Cherkin DC, Mootz RD. Chiropractic in the United States: Training, Practice, and Research. Agency for Health Care Policy and Research, publication 98-N002, 1997.

(3) Haas M, Bronfort G, Evans RL. Chiropractic clinical research: progress and recommendations. J Manipulative Physiol Ther. 2006; 29:695-706.

(4) Coulter ID. Professional graduate studies in chiropractic. J Can Chiropr Assoc. 1986; 30:177-181.

(5) Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF. How can chiropractic become a respected mainstream profession? The example of podiatry. Chiropr & Osteopathy. 2007; 16:10.

(6) Wyatt LH, Perle SM, Murphy DR, Hyde TE. The necessary future of chiropractic education: a North American perspective. Chiropr & Osteopathy. 2005; 13:10.

(7) Tague NR, The Quality Toolbox. 2nd. ed. Milwaukee: ASQ Quality Press, 2005.

(8) Anjard RP. Management and planning tools. Training for Quality. 1995; 3:34-37.

(9) Mitchell PH, Belza B, Schaad DC, Robins LS, Gianola FJ, Odegard PS, Kartin D, Ballweg, RA. Working across the boundaries of health professions disciplines in education, research, and service: The University of Washington experience. Acad Med. 2006; 81:891-896.

(10) Muller J, Shore WB, Martin P, Levine M, Harvey H, Kelly P, McCarty S, Szarek J, Veitia, M. What did we learn about interdisciplinary collaboration in institutions? Acad Med. 2001; 76 (4 suppl): S55-S60.

(11) Myburge C, Hartvigsen J, Grunnet-Nilsson N. Secondary legitimacy: a key mainstream health care inclusion strategy for the Danish chiropractic profession? J Manipulative Physiol Ther. 2008: 31:392-395.

Steven R. Passmore, DC, MS ([dagger]) John J. Riva, BA, DC ([section]) Charles H. Goldsmith, PhD *

([dagger]) Graduate Student, Department of Kinesiology, McMaster University, Hamilton, ON & Fellow, Department of Research, New York Chiropractic College, Seneca Falls, NY.

([section]) Department of Family Medicine, McMaster University, Hamilton, ON.

* Professor Emeritus, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON. Funding: Dr. Passmore is funded by an Ontario Graduate Scholarship & New York Chiropractic College Fellowship. The McMaster Chiropractic Working Group is supported in part by the Canadian Chiropractic Association & the Ontario Chiropractic Association. Competing Interests: None.

Correspondence to: Dr. Steven Passmore, Department of Kinesiology, IWC AB131B, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1. Tel: (905)525-9140 x26086. Fax: (905)523-6011. email: passmosr@mcmaster.ca [c] JCCA 2010.
Table 1 Interrelationship Digraph Results *

                              Number       Number
                             Requiring   Generating
Concept                        Input       Output

Attract External Funding         3           1
Increase Awareness               2           3
University Integration           6           0
Public Education                 2           4
Contribute to Daily              2           2
  Operations of University
  Capacity and Function
Attract Prospective DC           3           2
  Graduate Students
Writing: Generate and            0           6
  Disseminate Original
  Grants/Research/Peer
  Reviewed Publications

* Input and Output do not all sum to 6 as some relationships
were considered to be equally an input and output, when

considered pairwise.
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