Table 3
Core competencies and associated knowledge and skills
| Domain 1 | Basic concepts of disability and rehabilitation |
Competency 1.1 Demonstrate an understanding of the contemporary frameworks of rehabilitation and disability | Knowledge |
| • Describe the concept of rehabilitation | |
| • Describe the concept of disability (e.g. International Classification of Functioning, Disability and Health (ICF)) | |
| • Identify the determinants of health within populations served | |
| • Explain the epidemiology of neuromusculoskeletal diseases and the factors that might prevent or delay their onset, and prognosis | |
| Skills | |
| • Diagnose and care for patients within a biopsychosocial model | |
| • Apply contemporary concepts of rehabilitation and disability in the implementation of services | |
Competency 1.2 Effective communication with patients and all/key stakeholders involved in rehabilitation services | Knowledge |
| • Recognize good communication is a core skill that fosters relationships and improves outcomes | |
| • Understand that disability encompasses physical, mental and sensory components | |
| • Understand the power of words in communication | |
| Skills | |
| • Develop knowledge, attitudes and skills of effective communication | |
| • Recognize and interpret verbal and non-verbal communication | |
| • Utilize available information and communication technologies | |
| • Share resources and knowledge | |
| • Facilitate a structured, evidence-based rehabilitation encounter | |
| Domain 2 | Legal, regulatory and ethical components |
Competency 2.1 Apply in clinical practice the laws, regulations and policies that impact delivery of rehabilitation services | Knowledge |
| • Comprehend legal duties and responsibilities relating to rehabilitation and disability | |
| • Describe the basic regulations and policies of stakeholder organizations relating to rehabilitation, disability and return to regular activities | |
| • Explain the application of the professional duty of candour | |
| • Distinguish the professional and ethical boundaries expected of the chiropractor-patient relationship | |
| • Summarize the principles of risk management, safe practice and duty of care | |
| • Explain medico-legal processes and procedures, including vicarious liability | |
| • Describe the model of health care service provision across the different levels and sites of care at the local, regional and national level | |
| Skills | |
| • Competent acquisition of informed consent from the patient or substitute decision maker | |
| • Integrate and respect the diversity of patients’ cultural and religious values and belief systems | |
| • Demonstrate respect for individual preferences and expressed needs | |
| • Recognize and manage threats to safety of people requiring rehabilitation | |
| • Operate a safe and accessible practice environment | |
| • Manage health risks and public health issues, including reporting | |
| • Practice in accordance with laws and principles of confidentiality | |
| • Work with a community or population to identify the determinants of health that affect them | |
| • Enable and support integration of chiropractic services within the health care system context | |
Competency 2.2 Apply in clinical practice the ethical delivery of services | Knowledge |
| • Recognize persons entitlement to enjoyment of universal and indivisible rights and freedoms | |
| • Describe, promote and protect human rights and freedoms of persons | |
| • Recognize individual involvement in decision-making | |
| Skills | |
| • Engage persons full participation in community, work and home environments | |
| • Engage persons active involvement in decision-making | |
| • Provide an accessible environment for rehabilitation services | |
| • Communicate clinical information with equipoise | |
| • Refer patients in need of accessible information about mobility aids, devices and assistive technology to appropriate providers | |
| • Evaluate and work within provider’s individual capacity of knowledge and skills | |
| • Develop rapport and trust with patients, and other stakeholders, colleagues and professionals, in compliance with privacy legislation | |
| • Apply ethical principles of autonomy, beneficence, non-malfeasance and justice | |
Competency 2.3 Deliver rehabilitation services in line with regulatory standards | Knowledge |
| • Describe and apply evidence-based clinical guidelines and protocols required for clinical practice | |
| • Recognize and respect scope of practice of other health care professionals | |
| • Recognize and respect the policies and regulations governing key stakeholders | |
| • Acquire and incorporate advances in knowledge into clinical practice | |
| • Comprehend duties and responsibilities arising from statutory regulation | |
| • Describe the structure of the chiropractic profession and the purpose of representative bodies (including trade unions, chiropractic associations, colleges, societies and patients’ associations) | |
| Skills | |
| • Complies with professional standards and legal requirements for creation, maintenance, storage and disposal of patient records and business documents | |
| • Allocate finite healthcare resources appropriately | |
| • Apply evidence-based and management processes to achieve cost-appropriate care | |
| • Work collaboratively to provide an interdisciplinary approach to care | |
| • Collaborate with community organizations, families, employers, and other stakeholders as required | |
| • Critically evaluate quantitative and qualitative research to inform evidence-based practice | |
| • Recuse self from practice when personal health and well-being makes it unsafe to do so | |
Competency 2.4 Advocate for rehabilitation services as a means of achieving optimal outcomes, including return to work | Knowledge |
| • Define available rehabilitation services in individualized care plans. | |
| • Define key stakeholders that would facilitate return to activity and work | |
| Skills | |
| • Communicate with stakeholders to facilitate return to activity and work | |
| • Engage stakeholders to improve rehabilitation services | |
| • Employ people centered care to support equitable and accessible rehabilitation services | |
| Domain 3 | Rehabilitation management of disability and other health conditions |
Competency 3.1 Clinical assessment—evaluate patients’ health status and related circumstances to develop a working diagnosis | Knowledge |
| • Describe normal structure and function of the human body | |
| • Identify and consider biopsychosocial determinants of health | |
| • Describe etiology, pathology, symptomatology, natural history and prognosis of neuromusculoskeletal complaints, pain syndromes and associated disorders | |
| • Interpret diagnostic procedures, including reliability, validity, uses and limitations | |
| • Identify and consider lifestyle, occupation or external factors that may influence health or well-being and return to activities/work | |
| Skills | |
| • Conduct a patient history and physical examination using knowledge of pathophysiology, basic and clinical sciences | |
| • Identify the need for and availability of external health records | |
| • Perform and/or refer for diagnostic studies when indicated, e.g. diagnostic imaging, ultrasound, clinical laboratory tests | |
| • Interpret diagnostic study results | |
| • Explain outcomes and implications, using an appropriate comprehension level, of assessment, including working diagnosis and plan of management, to the patient, family and/or caregiver | |
| • Formulate a differential diagnosis, where appropriate | |
Competency 3.2 Formulate a clinical plan of management | Knowledge |
| • Recognize need for emergency care, referral and/or collaborative care | |
| • Identify acute, subacute and chronic phases of conditions | |
| • Recognize indicators of persons psychosocial, environmental, and health behavioral factors that may be comorbid with neuromusculoskeletal conditions or associated with the risk of developing other physical and/or psychological conditions | |
| • Knowledge and understanding of evidence-based people-centered plan of management | |
| • Summarizes principles of health promotion and disease prevention | |
| • Critical appraisal, translation and application of health care knowledge | |
| Skills | |
| • Develop therapeutic goals and prognoses based upon individual needs and strengths | |
| • Provide advice, explanations and reassurance related to working diagnosis and clinical plan of management | |
| • Employ evidence-based rehabilitation interventions for the purpose of optimizing function | |
| • Counsel patient, family and/or caregiver on preventive, supportive, concurrent and referral care | |
| • Engage and support patient, family, caregiver, employer, union and/or community stakeholders in shared decision-making of a plan of care, including identifying risks, benefits, natural history, alternative care and patient preferences | |
Competency 3.3 Monitors and evaluates progress of care and health outcomes | Knowledge |
| • Describe and employ reliable and valid outcome measures | |
| • Identify patient expectations, experience and patient-reported outcome measures | |
| • Recognize indications for cessation or referral of care based upon patient outcomes | |
| Skills | |
| • Monitor patient clinical status and modify diagnosis and care plan as indicated | |
| • Modify plan of care, including consideration of alternative options, based upon individual’s progress and external factors | |
| • Manage potential complications or adverse events arising from plan of care and have procedures in place to manage these circumstances effectively | |
| • Discharge from care based upon mutually agreed upon goals | |
Competency 3.4 Participates in implementing the rehabilitation plan within the unique cultural and environmental context | Knowledge |
| • Explain the relevance of a history and assessment, taking into account home, school, work and community environments | |
| • Describe the environment and culture of the community | |
| • Recognize responsibility to protect, promote and advance the health and well-being of individuals, communities and populations | |
| • Discuss with stakeholders to facilitate optimal recovery, timely return to work (where appropriate) and restoration of agreed quality of life parameters | |
| Skills | |
| • Support patient participation and inclusion in all aspects of the home, school, work and community environments | |
| • Deliver rehabilitation services that are congruent with the local cultural, sociodemographic, work and environmental context |