Spain Chiropractic Continuing Education

• Determine how critical it is for us to take excellent are of ourselves
• Indicate the ways in which we can stay healthy physically, mentally and emotionally
• Examine the impact of stress on providers
• Recognize the issue of burnout
• Demonstrate the fiduciary duty that providers have

• Differentiate between assault and battery
• Outline various kinds of legal problems that may result from sexual impropriety claims
• Identify and describe distinctions between innocent flirtatious behavior and sexual misconduct
• Evaluate possible defenses to sexual misconduct Disciplinary complaints
• Discuss the applicability of the transference phenomenon to Doctors of Chiropractic

• Identify legal prohibitions against promising healthcare cures, guaranteeing treatment results, and deceptive patient communication.
• Distinguish between appropriate and inappropriate communication relating to patients' healthcare prognoses and progress.
• Explain scientific literature linking patients' mental states with healthcare outcomes.
• Demonstrate alignment between compliance with states' current patient communication restrictions and instances of patient encouragement that foster mental states favorable to desired healthcare outcomes.
• Explain office procedures and staff training which are likely to ensure ongoing ethical patient communication and the documentation thereof.

• Identify challenging/inappropriate patient requests and behaviors encountered by chiropractors.
• Explain prevention strategies, office procedures and effective responses to inappropriate patient activity.
• Describe safety concerns associated with a patient's inappropriate acts and communications, as well as ethical principles related thereto.
• Illustrate legal and ethical issues arising where the doctor/patient relationship is terminated due to inappropriate patient behavior.
• Analyze how aberrant patient behavior presents risks to staff, the treating doctor, and to fellow patients, and how proper documentation is important in such instances.

Hour 1

• Define Ethics
• Review various ethical issues recently reported on
• Identify ethics as related to the whistleblower
• Discuss Ethical standards specific to laws in various states

Hour 2

• Discuss Ethical standards specific to laws in various states (cont’d)
• Summarize awareness related to anti-discrimination
• Classify various aspects of professional boundaries and sexual misconduct

• Define anti-aging medicine
• Compare and contrast the differing opinions on anti-aging medicine
• List the moral questions associate with the anti-aging movement
• Describe how the anti-aging movement is viewed from a feminist perspective

• Describe the moral questions concerning home care for the elderly
• Identify the relationship between the cared for and the care giver
• Explain the focus of governmental programs for dependent elderly care
• List the values necessary to support elder care at home

• Outline the history of the nursing home
• Describe the evolution of bioethical thought on nursing home care
• List strategies for creating a more ethical nursing home environment
• Ways nursing homes can aid residents in addressing end-of-life concerns

• Give examples of the roots of an ageist attitude in the United States
• Describe the dynamics of the power relationship between care giver and cared for
• Explain the issues involved in setting boundaries in the institutional environment
• Describe the difference between independent and relational autonomy

• Define elder abuse, neglect and self-neglect
• Describe the “expressive – collaborative” model of approaching ethics
• Compare and contrast the classical definition of autonomy with “actual autonomy”
• Explain how remaining in an abusive / neglectful environment may constitute the best alternative for an individual

• Cite the historical perspective on senility
• Describe how the pervasive bioethical viewpoint affects the experience of people with dementia
• Explain the concepts of dignity
• Compare and contrast various definitions of dignity relative to those with dementia

• List the foundational assumptions that define advance care planning in the United States
• Differentiate hospice care from palliative care
• Describe the issues that arise when individual choice is the main focus of advance care planning
• Explain how the modern culture of medicine influences end – of – life care
• Compare and contrast the current approach towards end – of – life care with the authors. “bottom up,” approach

• Cite examples of how the elderly have been marginalized during disasters
• Define what is meant by the “axes of susceptibility”
• Identify the ethical obligation to the elderly during major disasters
• Describe how planning, communication and coordination is an ethical imperative in disasters
• Explain the concept of “place holding,” and how it fits into disaster planning

• Assess the current literature on outcomes assessment in chiropractic practice
• Describe the psychometric properties outcome measures
• Summarize the utility of patient related outcome measures
• Outline the various domains of outcome assessments
• Describe the clinical significance of common patient reported outcome measures
• Identify guidelines and recommendations for use of outcomes measures in daily practice
• Identify clinician driven outcome measures and discuss the strength of evidence supporting them along with their clinical significance and utility

• Define Evidence Based Practice (EBP)
• Identify problems/obstacles to EBP
• Outline the process of EBP
• Learn how to ask good clinical questions: PICO
• Describe how to search PubMed and learn how PubMed translates a search query
• Define MeSH terms and describe their use
• Illustrate how to limit or broaden your search to find the appropriate content
• Compare the results of boolean operators AND, OR and NOT

• Provide a rationale for the use of outcome assessments in practice
• Survey the recommended outcome assessment measures used by chiropractors and provide a copy or link to download them electronically
• Describe the recommended outcome measures and provide instruction on how to score them
• Detail the psychometric properties of the commonly used outcome measures to aid in determining clinically relevant change in patients
• Indicate which outcome measures to use and when to use them

• Evaluate the effectiveness of the influenza vaccine in healthy adults and children 
• Evaluate the effectiveness of the influenza vaccine in the elderly 
• Evaluate the importance of influenza vaccination in those with recent cardiac events 
• Explain the key elements in the "Tamiflu Controversy" 
• Discuss limitations to the Tamiflu research base 
• Discuss limitations to using zinc for the common cold 
• Evaluate strengths of study design for pragmatic trials 
• Discuss the effectiveness of using probiotics for the common cold 

• Recognize the initiation and growth of evidence-based  (EBP) or evidence informed practice (EIP)
• Interpret the need to utilize EBP
• Define EBP.
• Explain the levels of evidence and applications to practice
• Contrast EBP/EIP with what is not EBP/EIP and relate to your clinical expertise.
• Evaluate the research evidence for application to practice
• Locate the literature that applies to the doctor’s patient
• Integrate the literature research with their clinical expertise and the patient preferences
• Recognize patient preferences
• Distinguish your patients from the benchmarks of care
• Distinguish the different types of evidence
• Synthesize EBP/EIP into case studies
• Implement EBP/EIP procedures to your practice for increased patient compliance,
• Differentiate individual patient cases with similar diagnoses
• Identify actions contingent upon the level of evidence

• Hypothesize situations where being able to critically evaluate research on your own may be particularly important
• Recall the original definition of evidence-based medicine
• Identify point-of-care resources for high quality evidence
• Categorize the evidence-based resources into point-of-care, summaries, syntheses etc.
• Define “bias” in the context of research studies
• Discover risk of bias in randomized controlled trials as it relates to unmasking and blinding
• Paraphrase the meaning of a “straw man” in the context of study design
• Discover risk of bias in randomized controlled trials as it relates to industry sponsorship, specifically referencing spin, straw man design, selective outcome reporting
• Identify the aspects of ‘non-specific effects’
• Define minimal (clinically) important difference
•  Explain why minimal important differences may be more relevant than p values
• Apply research findings to the patient in front of you

• Explore contemporary healthcare issues from the perspective of Robert Lustig, MA and John Abramson, MD.
• Integrate the relevance of these issues to the chiropractic profession.
• Evaluate at the concept of evidence-based “medicine,” especially the “randomized controlled trial,” and describe how it applies to the chiropractic profession.
• Discriminate recent examples of “randomized controlled trials,” especially as related to pain syndromes and opioid drugs.Discusss the importance of the 2021 Nobel Prize for the chiropractic profession and mechanical-based care.
• Detail the physiology of the Piezo1 mechanical receptor.
• Introduce the concepts of mechanical function and mechanical neurology.
• Integrate the importance of the cerebellum to mechanical integrity and mechanical based care.
• Explain a randomized clinical trial that supports mechanical-based chiropractic care for visceral physiology.
• Distinguish the basic physiology of the neurotransmitter norepinephrine.
• State the basic physiology of the neurotransmitter dopamine.
• Outline the basic physiology of the neurotransmitter serotonin.
• Integrate the balance of the neurotransmitters dopamine and serotonin.
• Recite the relationship between the neurotransmitters dopamine, epinephrine and norepinephrine.
• Explore the concept of Heart Rate Variability (HRV).
• Integrate upper cervical chiropractic care, spinal chiropractic care, and HRV.

• Identify the relationship between an upper cervical - trigeminal cervical nucleus and headaches.
• Integrate headache, upper cervical spine, and the temporomandibular joint.
• Distinguish between the clinical management of compressive neuropathology v. supersensitivity nerve interference.
• Identify “red flags” associated with compressive neuropathology.
• Discuss the relationship between mechanoreceptors, the sympathetic nervous system, and neuroimmunology.
• Highlight the uniqueness of upper cervical spine mechanoreceptors and the vagus nerve.
• Describe mechanobiology and diseases of mechanotransduction.
• Explain connective tissue as a body-wide signaling network.
• Summarize some randomized controlled/clinical trials pertaining to chiropractic and/or manipulation care.
• Recall studies looking at the influence of chiropractic care on opioid use.
• Interpolate the importance of sagittal posture on pain and function.
• Examine the importance of sagittal posture on cognition.
• Integrate evolutionary biology, infection, and the existence of chiropractic subluxation.           
• Summarize studies showing the influence of joint adjusting on a variety of visceral syndromes.
• Detail the relationship between an infectious agent and host health.
• Recognize the basic details of neuroimmunology.

• Identify the differences between the deposition and trial
• Understand the fundamentals and subtleties of the discovery of evidence
• Distinguish between discovery and impeachment
• Describe the steps involved in a deposition and trial
• Discuss critical issues encountered in the deposition and trial

• Demonstrate how to get started in marketing new skill sets
• Recognize how to contract work
• Establish case preparation protocols
• Distinguish between oral and written reports
• Describe the steps involved in opinion forming

• Discuss demonstrative evidence and props
• Distinguish between discovery and impeachment
• Understand the steps involved in a deposition
• Recognize the worth of your knowledge as a forensic examiner
• Review the steps involved in civil and criminal cases

• Understand the steps involved in a trial
• Identify critical issues encountered in a trial
• Create a defensible curriculum vitae
• Explain the concept of work product
• Discuss critical issues encountered in discovery of work product

• Understand critical issues encountered in a forensic practice
• Recognize pertinent case law
• Explain the concept of absolute immunity
• Recognize risk management protocols for the forensic examiner
• Discuss the future challenges for the forensic examiner

• Develop a level of knowledge and understanding of the federal and state legal system
• Develop a level of knowledge, comprehension, and understanding of the deposition process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Integrate the Rules of Evidence
• Illustrate which Federal Rules of Evidence apply to the expert witness
• Explain discovery techniques
• Discuss that the expert witness may need to produce business records
• Emphasize that each chiropractic provider must keep informed as to the laws and their interpretation in their particular state of practice
• Assess Daubert criteria
• Explain what each chiropractic expert should look for when preparing for the opposing attorney relating to hearsay
• Develop a level of knowledge, comprehension, and understanding of the medicolegal system as it relates to Daubert challenges

• Discuss trick question posed on cross examination
• Assist judges in implementing effective management of expert evidence involving scientific issues
• Identify judicial notice, aggregation, and compensation schedules for specific injuries
• Develop a level of knowledge, comprehension, and understanding of the cross examination process as it relates to the practice of forensic chiropractic and testifying as an expert witness
• Develop a level of knowledge and understanding of the federal and state court appointed expert process
• Discuss evidentiary framework
• Identify which Federal Rules of Evidence apply to the expert witness
• Critique the nature of the claims, the theories of general and specific causation, the defenses, and in particular the bases for disagreement among experts
• Explore the use of reference guides