2004:32 R

Follow-up of courses at the Foundation Scandinavian Chiropractors University College and the Naprapathy University College AB

The Swedish National Board of Health and Welfare regulations state that the professional remit of chiropractors and naprapaths is confined to pain therapy and the treatment of functional impairment. Due consideration has been given to this aspect when assessing the courses. Moreover the assessment group has taken a very close look at the quality aspects applied with regard to the regulations of the Swedish National Agency for Higher Education covering entitlement to have degree courses and national assessments of higher education.

The assessment group has consisted of four experts in medicine and one in economics, all active within higher education, as well as a legal expert from the Swedish National Board of Health and Welfare. The group opted to examine whether both the courses (chiropractic and naprapathy) can be said to meet the requirements for higher education. Since these courses are not subject to the statutes contained in the degree statutes stated in the Higher Education Ordinance, the regulations of the Swedish National Board of Health and Welfare were used instead to describe the knowledge and skills required of chiropractors and naprapaths.

The written assessment report was sourced from the following: assessments made by the Naprapath University College and the Chiropractor University College; written coverage of the courses from the respective student unions; a selection of degree projects, written examinations and patient case records kept by the students from both university colleges. The documentation was further augmented by written reports from both university colleges regarding the evidence that exists for the naprapathy and chiropractor treatment methods, a written report by the chairman of the science council, and both colleges’ annual reports for the fiscal years 2000/01 and 2002/03. The Naprapath University College was officially visited 1-2 April, 2004, and the Chiropractor University College 3-4 May, 2004. The assessment group has also paid a study visit to the chiropractor course in Odense, Denmark, where the course comes under the name of “clinical biomechanics” and is part of the curriculum at the Institut for Idrat og Biomekanik, Syddansk Universitet (Department for Sports and Biomechanics, University of Southern Denmark).

It is the conclusions of the assessors that neither of the courses comes up to university level. Both courses have major dissimilarities and suffer from the same shortcomings. The students leave the schools with a strong vocational identity and obvious student union affiliation, but this alone is not enough for a university education. Both courses lack the co-relationship between theory and practise necessary for the health care professions. The university colleges lack a research environment and the courses are not linked to any kind of research. The assessors are not convinced by the written submissions made by both the university colleges evincing the evidence for chiropractor and naprapath treatment. Nowhere do the courses mention the need to solidly embody the treatments in scientific and tested experience. Some courses are taught and instructed by teachers that lack proper competency. This applies particularly to the Chiropractor University College. In consequence of and among other things this, the degree projects and patient case records are at a level clearly below what one would expect of a proper university college. Extremely disquieting is the fact that some of the degree projects pertain to the treatment of specific patient groups or illnesses, something that is clearly in direct contravention of the regulations laid down by the National Swedish Board of Health and Welfare regarding chiropractors and naprapaths. There are also shortcomings in the teaching and examination methods.

Not formally assured is the right of students to participate in the workings of preparatory and decision-making bodies. There was little evidence of gender equality at the Chiropractor University College. Both courses lack genus perspective. Library resources are inadequate. The students have far too little contact with those exercising adjacent professions, in spite of the fact that many of them will be working with multi-professional rehabilitation teams. The reasons for these shortcomings are largely to be found in the organisation and power structure of the university colleges, this combined with the fact that most of the financing comes from student term fees.

The assessor group also notes that course presentation and formulation do not reflect the remit definitions and limitations stated in the regulations of the National Swedish Board of Health and Welfare. With their current formulation and contents, the courses cannot guarantee that the health service will be provided with chiropractors and naprapaths with an adequate grasp of the aforesaid regulations.
It is the view of the assessment group that there is only one way to rectify these shortcomings. Both courses must be developed in such a way that they are able to fulfil the higher education
requirements. The only possibility of achieving this is for both courses to be incorporated in the public higher education system. With their present structure and resources, the two schools will not be able to develop higher education environments. A critical, creative and academic environment will not see the light of day in isolation. The schools need to be incorporated in the medical faculty or corresponding. The necessary research into the efficiency and development of the treatment methods must take place in a qualified medical environment and in cooperation between representatives for medical research and representatives for these alternative treatment methods.

During the assessor group’s in-situ visits, everyone – students, teachers and management staff – expressed this view in different ways. The benefits to the students would be enormous. They would be allowed to study in multi-professional environments and acquire a research-linked education. This would give them regular university credits and they would get to study under the same economic and practical circumstances as the other students. As graduates they would be basically entitled to participate in post-graduate studies.

Finally – if the courses were to be incorporated in the medical faculty or corresponding - society would then have a tool for examining and, if necessary, for modifying two study-allowance entitled and registration-based courses.