Methods: All 39 final year students in the RMIT chiropractic program self-selected then reviewed and summarised the health records of any 10 patients they had seen as a new patient within the University Chiropractic Teaching Clinics during the previous 6 months. The resulting 400 reports were then reviewed by the authors and the diagnostic categories identified and collapsed into themes.
Results: There were 355 patients with a spinal complaint for whom a working diagnosis of vertebral subluxation complex could have been appropriate, however this diagnostic term was used in only 13 cases. The more common diagnostic term was biomechanical joint dysfunction. In the vast majority of cases students diagnosed and managed patients attending the clinic with regard to mechanical joint pain and dysfunction only, and in the majority of cases did not address any health issues in patients beyond this clinical descriptor.
Discussion: Despite being provided with an extensive variety of diagnostic and management tools that enable them to assess and manage patients’ health issues beyond the reductionist diagnosis of mechanical joint pain, the greater majority of students within the RMIT teaching clinics do not appear to function beyond a limited, mechanical paradigm. It is argued that diagnostic reductionism to mechanical descriptors is counter-productive to the holistic attribute of chiropractic practice. One possible explanation for this disconnection may be the manner in which students are assessed in the clinical environment.
Conclusion: This apparent disconnection between the foundation clinical decision making skills taught in the classroom and the application of those skills in the clinical education environment is a cause of concern to chiropractic educators and deserves further investigation.
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