CANADIANCHIROPRACTICEXAMININGBOARD

ExamContent
CandidateInformation

July2013

CANADIANCHIROPRACTICEXAMININGBOARD TableofContents
I. IntroductionandExamContentBasis

II. ChiropracticCoreCompetenciesTestedForEntryLevelPractice 6 III. AllocationofItems 1. 2. 3. 4.

GeneralOverview 8 ComponentA 10 ComponentB 12 ComponentC 14

IV. Acknowledgements 16 AppendixI. ListofConditionsTestedbytheCCEB 17

Canadian Chiropractic Examining Board 2013

I.IntroductionandExamContentBasis
EveryprovinceandterritoryinCanadaisresponsibleforensuringthatchiropractorsapplyingto practiceinCanadameetanacceptablelevelofcompetency.Typicallycompetenceisdeterminedby education,thatis,successfulcompletionofbothanaccreditedDoctorofChiropracticprogramandan entrytopracticehighstakesexam.InCanada,theCanadianChiropracticExaminingBoard(CCEB)is responsibleforadministeringsuchexamsandhasbeeninexistencesince1961.Aspartofitsongoing worktodevelopandmaintaincurrent,psychometricallyvalidandlegallydefensibleexams,theCCEB conductedaBlueprintValidationStudyin20082009.Thisdocumentdescribestheexamcontentfor thethreeexams(ComponentsA,B,andC)administeredbytheCCEB.Theintentandpurposeisto provideinformationtothecandidatesandtootherstakeholdersregardingthecompositionofthe CCEBexams.

ExamContentBasis
ThebasisforthecurrentexamspecificationswasdevelopedusingaModifiedDelphiprocessin1994 andwasagainchangedin2004basedonajobanalysisoftheprofession.Thecurrentexamcontentis basedontheBlueprintValidationStudy(BVS)conductedin20082009.Thisstudyincludedthe following:

JobAnalysisSurvey RatingofConditionsandCoreCompetencySurvey CurriculumStudy BlueprintSurvey

TheJobAnalysissurveywascompletedbyhundredsofchiropractorsfromacrossCanada.Itprovided informationusedfordeterminingcorecompetenciesandprovidedthefrequencyofpatient presentationsanddiagnosesseenbyChiropractorsacrossCanada.Subjectmatterexpertswereused tofurtherdefinehowtoaddressthetestingofcorecompetenciesandtoratetheimportanceof conditions.TheCanadianChiropracticAssociation'sChiropracticClinicalPracticeGuideline(Glenerin Guidelines)1993werealsousedforhelpingtodeterminethechiropracticcorecompetenciestestedfor entrylevelpracticebytheCCEB.TheCurriculumStudyconsistedofananalysisofcurriculumsfrom accreditedchiropracticcollegesfromaroundtheworld.Itwasusedtohelpdefinethenamesandtypes ofcontentareasontheexams.Tofinalizetheblueprint,theBlueprintSurveywasconductedtoassign valuestothenumberofquestionstobeaskedpercomponentwherevaluescouldnotbeextracted fromthesurveyoftheprofession.Theweightingofcomponentswasultimatelydecidedbythe professiontorepresentwhatisusedinactivepracticeinCanada.Thechiropractorssurveyedwere fromacrossCanadaandrepresentativeofdifferentcollegesofgraduationanddifferentyearsof practiceexperience.Guidanceandfinalapprovalwasprovidedbyapsychometricconsultant,CAVES CONSULTINGSERVICES,INC.

Canadian Chiropractic Examining Board 2013

TheExams

Thefirstexam,ComponentA,consistsofmultiplechoiceitemseachwithfouralternatives,andis basedontheunderlyingcausesofpainanddiseases.Themajorityoftheitemsarepresentedina clinicalcontext(thatis,patientcentred).However,someitemsarepresentedinafactualcontext strippedofreferencetoapatient.TheComponentAexamconsistsofapproximately270itemswritten intwosectionswiththreehourstocompleteeachsection. Thesecondexam,ComponentBteststhecandidatesabilitytomakedecisionsanddiagnosesina clinicalcontext.ComponentBmainlyusesamultiplechoiceformatwithfouralternativesperitem. Theexamalsocontainsradiographicimageswiththreetofourquestionspertainingtoeachimage.It maycontainsomeradiographictheoryquestionsthatarepresentedinafactualcontextwithout referencetoapatient.TheComponentBexamconsistsoftwosectionswithatotalofapproximately 200itemsand3hoursforthecompletionofeachsection. Thethirdexam,ComponentC,isanObjectiveStructuredClinicalExam(OSCE)thattestsacandidates clinicalskillsinacliniclikeenvironment.TheComponentCexamconsistsof10,12minutestationsand upto23differentpatientpresentations.Itusesactorstoportraytheroleofapatientandusestrained examinerstoevaluateeachstation. ItisthroughthecombinationofthesethreeexamsthattheCCEBisabletoassessfortheminimal competenciesdefinedintheChiropracticCoreCompetenciesforEntryLevelPractice. RefertotheStudyGuidespostedonthewebsiteforfurtherproceduralandexamspecificinstructions notrelatedtoexamcontent.TheStudyGuidesalsocontainexampleitemsandstationexpectations.

Canadian Chiropractic Examining Board 2013

II.ChiropracticCoreCompetenciesTested ForEntryLevelPractice
ThesecompetenciesmaybetestedbytheCanadianChiropracticExaminingBoardasindicatedbytheXunder thedifferentcomponentsoftheexams.
Competencies ChiropracticKnowledge
Abilitytoexplaintheunderlyingpathophysiologicalandanatomicalbasisassociatedwithpatient assessmentandmanagement Differentiatepathologicalfromnonpathologicalconditions Differentiateneurologicalfromnonneurologicalconditions Diagnosisofconditionsbasedontheinterpretationandintegrationofpatientdataandphysicalfindings Identifyappropriateoutcomesoftreatmentsandphysicalexamprocedures Commonresearchpractices Thecourseofdiseasesandpublichealthrisks Radiologypracticesandinterpretation Component Component Component A B C

X X X

X X X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X GatheringofPatientDataObtainthefollowingPatientinformationanddisplaytheabilitytointerpretfindings: Medical/Surgicalhistory X Medications X Specialtestsordiagnosticproceduresandtheirresults X Establishsourceandhistoryofpain X Psychosocialhistoryandcurrentstatus X Laboratoryresults X X Recognizeirrelevantdata X InterpretHistoryfindingsandprovidediagnosis X X PhysicalExamSkillsPerformappropriatephysicalexamsandinterpretfindingsincludingthefollowing: Evaluate/assesspain X X
Selectandjustifyassessmentproceduresandapplicationsthatareappropriatetothepatient'sage, gender,functionalneeds,and/orothermedicalconditions Performreevaluations/reassessmentsbasedonchangestopatientsstatus ObservepatientsresponsetoChiropracticassessmentsandrespondaccordingly Measurerangeofmotionsofthepatient ConductGaitanalysis Performsensorytesting Performphysicalexamsthatdifferentiateandconfirmdiagnoses Performposturalevaluations Conductappropriateneurologicalexams ConductappropriateSoftTissueexams ConductappropriateOrthopedictesting Performphysicalexamsinanorganizedandmeaningfulmanner Interpretphysicalexamfindingsandprovidediagnosis

X X

Canadian Chiropractic Examining Board 2013

Competencies Treatments:InterpretandImplementappropriatetreatmentsbasedondiagnoses
Identifycomplicationsinimplementingcertaintreatmentsandadjusttreatmentaccordingly Determinepossiblecausesofpatient'sconditionandeducateasneeded Selectandjustifytreatmentsandprocedures Providerationaleandclearexplanationoftreatmentstothepatient Position,moveanddrapepatientforeffective,comfortabletreatmentandprivacy Identifymeasurableoutcomegoalsoftreatmentandestablishtimelines Participateinmultidisciplinaryplanningandfollowupcare Makereferralstootherhealthcareprofessionalswhenappropriate Recognizeandrespondtoconditionsrequiringemergencycare Performappropriateadjustmenttechniques Reviseordiscontinuetreatmentplansbasedonachievementofpatientgoals Facilitateprocurementofpatientaids Presentalternativeformsoftreatmentsalongwiththerisksassociatedwiththem Understandandexplainthegoalsofchiropracticadjustmentandothertreatments

Component Component Component A B C

X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

InterpersonalandCommunicationSkills
Askquestionsinanorganizedandconcisemanner Conveyactionsandproceduresinameaningfulwaytothepatient Conveyaccurateanddetailedinformationtothepatient Communicateinformationatanappropriatecomprehensionlevelforthepatient Appropriateuseofandrecognitionofpatient'snonverbalcommunicationandeyecontact Educatethepatientregardingselfmanagementandcopingstrategies Communicateresultsofevaluations/assessmentsaccuratelytootherhealthcareprofessionalswhenco managingorreferringpatients Demonstratecounselingskillswhenappropriate Respondandrecognizefeedback Summarizefindingsandtreatmentplans Drawaclosetoaconsultationappropriately Communicateallrisksassociatedwithtreatments

Professionalism
Documentallrelevantaspectsofcareincludingtreatmentplans,resultsofphysicalexams,progressnotes, anddiagnoses Optimizepatientcomfortandphysicalprivacy Respectpatientconfidentiality,knowledge,rightsanddignityofthepatientand/orfamily Bethoroughtoensureaccuracyofdiagnoses Berespectfulofcolleaguesandotherhealthcareprofessionals Conformtolegalrequirements Conformtothefollowingethicalrequirements: *demonstrateintegrityinprofessionalpractice *demonstrateempathy *maintainobjectivity *workinthebestinterestofthepatient *observeconflictofinterestguidelines Managetimeefficiently Presentfeesinanopenmanner

Canadian Chiropractic Examining Board 2013

III.AllocationofItems

1.GeneralOverview
Theallocationofthenumberofitemstocontentandcompetencies/behaviorsistypicallydisplayedin theformofatwodimensionalmatrixwithcontentdefiningoneaxis(usuallytheYaxis)and competencies/behaviorsdefiningtheotheraxis.Otherfactors,referredtoascontextualvariables,and whichimpactontherepresentativenessofanexamarealsoconsideredbutdonotconstitutea dimension.ForpurposesoftheCCEBexams,thecontextualvariablesareage,gender,patient presentation,andconditions. AllthreeCCEBexamssharegender,ageandfrequency/typeofpatientpresentationforthepurposes ofexamitemselection.Theyalsosharethesameblueprintforfrequencyofconditions(seeAppendix I).

Age AgeofPatientsSeen Frequencyofpatients Gender Gender Female Male Frequencyof patients 57%+/7% 43%+/7% 017 18%+/5% 18to64 50%+/5% 65+ 32%+/5%

PatientPresentations Presentation Lowback Neck Midback/Thoracic Dizziness/Headache/HeadTrauma Hip/Pelvis Shoulder Knee/Leg Foot Arm/Elbow Chest/Abdomen Hand Face/Jaw Other

Frequencyofpatients 22% 16% 12% 10% 8% 8% 5% 4% 4% 3% 3% 3% 2% +/3% +/3% +/3% +/3% +/2% +/2% +/2% +/2% +/2% +/2% +/2% +/2% +/2%

Canadian Chiropractic Examining Board 2013

DefinitionsofPatientPresentations
Patientpresentationsrefertothepresentingcomplaintofpain,dysfunction,discomfort,orinjuryfrom apatientcaseorscenario.Foritemswherenopatientscenarioispresent,itemsarecategorizedbythe underlyingconditionandthedirectareaofanatomyaffectedbythegivencondition.Alltheexamples belowarebasedonthepatientpresentationof'pain'butactualitemsmayincludedysfunction, discomfort,numbness,injury,ornoneoftheabove. PresentationExamples:

Lowbackpresentationsarespecifictocomplaintsofpaininthelowbackregionincludingthe coccyx.

Neckpresentationsarespecifictopatientpresentationsofneckpainrelatedtothemusclesand vertebrae.

Midback/Thoracicpainpresentationsarespecifictopainrelatedtothespine,ribsand/orgeneral musclepaininthemidbackarea.

Dizziness/Headache/Headtraumapresentationsmayincludepresentationsofheadache,brain lesions,braintumors,stroke,innereardysfunction,dizziness,and/orvisualdisturbances.

Hip/Pelvisincludespresentationsofpaininthehip,pelvisand/orgenitals.

Shoulderpresentationsarespecifictothepresentationofshoulderjointandmusclepain.

Knee/Legarepatientcomplaintsintheareaofthelegandknee.

Footpresentationsincludetheankle,footandtoes.

Arm/Elbowpresentationsarespecifictothearmandelbowonly.

Chest/Abdomenincludesallpresentationsofabdominalandchestpain.Thiscategorymayinclude presentationsrelatedtoliver,kidney,pancreas,lungs,heart,intestines,stomach,orappendix conditions(theexceptioniswhereanyoftheseconditionspresentasadifferentareaofpainsuch aslowback,thoracicorshoulderpain)

Handpresentationsincludethewrist,handandfingers.

Face/Jawpresentationsincludepatientcomplaintsofpainornumbnessintheface,jaw,throat, mouth,eyes,ears,and/ornose.

Otherpresentationsmayincludethefollowing:fever,bone/skeletalpresentations,skinconditions, generalizedcancer,rheumatologicalconditionsoranyotherpresentationthatisnonspecificto anyothercategory.

Canadian Chiropractic Examining Board 2013

2.ComponentAExam

ContentArea
Anatomy Biochemistry Biomechanics Embryology/Histology/ Immunology Microbiology Neurology Nutrition Pathology Physiology Psychology PublicHealth&Health Promotion ResearchMethods Toxicology& Pharmacology

TotalPercentage ofItems 23% +/2% 5% +/1% 11% +/2% 3% +/1% 4% +/1% 16% +/2% 7% +/2% 9% +/2% 10% +/2% 3% +/1% 4% +/1% 2% +/1% 3% +/1% 100%

(foreachcategory+/1%)

KnowledgeofFact 7% 1% 3% 1% 1% 5% 2% 3% 3% 1% 1% 1% 1% 30%+/5%

(foreachcategory+/1%)

Understanding 8% 2% 4% 1% 1% 5% 2% 3% 3% 1% 1% 1% 1% 34%+/5%

Application
(foreachcategory+/1%)

8% 2% 4% 1% 1% 6% 3% 3% 4% 1% 2% 1% 1% 36%+/5%

TOTAL

ThecontextualvariablesaspresentedinSectionII,Part1applytothisexam,howeverthecontextual variablesdonotapplytothoseitemsthatarenotpatientcentered.Approximately95%oftheexamis basedonpatientscenarios.

DefinitionsofBehaviouralAxis
KnowledgeofFactsreferstothosebehavioursthatemphasizeremembering,recognizing,or recallingofthefactsandinformationthatcomprisethedesignatedtopic.Specificexamplesinclude theknowledgeofterminology,specificfacts,procedures,trends,sequences,methodology, principles,andtheories.

UnderstandingoftheTopic(orComprehension)referstounderstandingdataandinformation. Comprehensionusuallyincludessuchbehaviorsastheabilitytotranslateapatientsprobleminto onesownwords,ortotranslatesymbolicinformationcontainedinreportsandchartstoaverbal form,ortoexplain,forexample,someaspectofresearchfindingstoapatient.Comprehensionalso includestheabilitytointerpretinformationintermsofdifferentiatingessentialinformationfrom nonessentialinformation,ortodistinguishcontradictedconclusionsdrawnfromabodyofdata. Comprehensionalsodealswiththeabilitytodrawconclusionsandtomakepredictions.

ApplicationofKnowledgereferstotheabilitytousebasiclearnedmaterialinnewandconcrete situations.ApplicationoverlapswithComprehensioninthatitbuildsonit.Thatis,tobeableto applyimpliesthatonecomprehendsorunderstands.

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DefinitionsofContentAreas

AnatomyThestudyofthestructuresofthehumanbody.Chiropractorsmustdemonstrate knowledgeoftheanatomyofthebodyinordertoconductpatientassessmentsandtreatments. Theymustbeabletodeterminewhichstructuresmayhaveinjuryordysfunction.

BiochemistryThestudyofchemicalprocessesthatoccurinthehumanbody.Chiropractorsmust demonstrateanunderstandingofthesenormalprocessesaswellastheclinicalimplicationsof dysfunctionofthoseprocesses.

BiomechanicsThestudyofmechanicalprocessesinthehumanbody,particularlyasitpertainsto movementofthebody.Chiropractorsmustdemonstrateanunderstandingofthemovementsof thehumanbodyandthestructuresthatproducethosemotionsandwhatdysfunctionorinjuryto thosestructuresordysfunctionalmovementsimply.

EmbryologyThestudyoftheprocessbywhichhumansdevelopinutero.Chiropractorsmust demonstrateknowledgeoftheoriginofdifferenttissuesandstructuresofthebody.

HistologyThestudyofthecellsandtissuesofthehumanbody.Chiropractorsmustdemonstrate knowledgeofhumantissuesandtheircomponentsandhowtheycanbeaffectedbyinjury.

ImmunologyThestudyoftheimmunesystemofthehumanbody.Chiropractorsmust demonstrateknowledgeoftheprocessesofinflammationandhealingandthewaythatthehuman bodyrespondstoinjuryandinfection.

MicrobiologyThestudyofmicroscopicorganismsincludingbacteria,viruses,fungi,andparasites. Chiropractorsmustdemonstrateanunderstandingoftheimplicationsofinfectionbythese organismsfromapathologicalperspective.

NeurologyThestudyofdysfunctionofthehumannervoussystem.Chiropractorsmust demonstrateknowledgeofthedifferentneurologicalstructuresthatareaffectedbyneurological conditionsandunderstandtheclinicalpresentations,diagnosisandmanagementofthose conditions.

NutritionThestudyofthecomponentsofhealthydietaryintake.Chiropractorsmust demonstrateknowledgeofnormalnutritionaswellastheclinicalimplicationsofinadequate nutritionandnutritionaldisorders.

PathologyThestudyofdiseaseinthehumanbody.Chiropractorsmustdemonstrateknowledge ofdiseasecausingprocessesaswellasthediagnosisandmanagementofpathologicalconditions.

PhysiologyThestudyofthefunctioningoftheorgansandsystemsofthehumanbody. Chiropractorsmustdemonstrateanunderstandingofallbodyorgansandsystemsastheyrelateto humanhealthanddiseaseprocesses.

PsychologyThestudyofhumanmentalfunctionandbehavior.Chiropractorsmustdemonstrate anunderstandingofmentalhealthandmentalhealthdisordersandhowtheycanimpacttheir patientsclinically.

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PublicHealthandHealthPromotionChiropractorsmustdemonstrateknowledgeofpublichealthprinciples,includingknowledgeof sexuallytransmittedinfections,preventivecareandeffectivepublichealthinterventions.Mustalsounderstandapproachesthat chiropractorscantaketopreventinjury,disease,andinfectionamongtheirpatientswhilepromotingpublicandpersonalhealthamong theirpatients.

ResearchMethodsChiropractorsmustdemonstrateknowledgeofdifferentmethodsofresearchinghealthconditionsandthewaysto treatandassessthem,aswellassignificantstudiesinthechiropracticliterature.

Toxicology&PharmacologyThestudyofadverseeffectsofchemicalsonthehumanbodyandthestudyofthemechanismsofactionsof drugsandotherchemicalcompounds.Chiropractorsmustdemonstrateanunderstandingofhowpharmaceuticalproductsandnutritional supplementsworkinthebodyandthesymptomsandmechanismsofadverseeffectsoftheseproducts.

3.ComponentBExam
Total Percentage ofItems
22% +/3% 16% +/3% 12% +/3% 10% +/3% 8% +/2% 8% +/2% 5% +/2% 4% +/2% 4% +/2% 3% +/2% 3% +/2% 3% +/2% 2% +/2% Administration, Ethics& Documentation
(eachcategory+/1%)

ContentArea*
Lowback Neck Midback/Thoracic Dizziness/Headache/HeadTrauma Hip/Pelvis Shoulder Knee/Leg Foot Arm/Elbow Chest/Abdomen Hand Face/Jaw Other TOTAL

Clinicaland Differential Diagnosis

(eachcategory+/1%)

Diagnostic Imaging
ImageInterpretation
(eachcategory+/1%)

Diagnostic Imaging
RadiographicTheory
(eachcategory+/1%)

Patient Assessment
PhysicalExamsand HistoryTaking
(eachcategory+/1%)

Treatment, Technique& Rehabilitation

(eachcategory+/1%)

2% 1% 1% 1% 1% 1%

1%

100%

5%+/3%

6% 4% 3% 3% 2% 2% 1% 1% 1% 1% 1% 1% 1% 27%+/5%

3% 2% 2% 1% 1% 1% 1% 1% 1% 1% 14%+/5%

2% 1% 1% 1% 1% 1%

1%

6% 4% 3% 3% 2% 2% 1% 1% 1% 1% 1%

4% 3% 2% 2% 2% 2% 1% 1% 1% 1% 1% 23%+/5%

8%+/3%

24%+/5%

*ThecontextualvariablesanddefinitionsaspresentedinSectionII,Part1alsoapplytothisexam.

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DefinitionsofBehaviouralAxis

Administration,Ethics&DocumentationChiropractorsmustunderstandandapplytheideaof

appropriatelydetailedandwellmaintainedpaperworkincludingtheconceptsofinformed consent,outcomemeasurement,anddailynotetaking.Theymustalsodemonstratean understandingofprofessionalconductandethicsindealingwithpatients. ClinicalandDifferentialDiagnosisChiropractorsmustdemonstrateanabilitytogenerate differentialdiagnosesforpatientswithdifferentclinicalpresentationsaswellasanabilityto integrateclinicalinformationinformulatingadiagnosisforpatients. DiagnosticImagingImageInterpretationChiropractorsmustbeabletoreadxrayimagesand recognizepathological,traumatic,anddegenerativesignsfromnormalradiographicanatomy andvariants.Theimageinterpretationitemsincludearadiographicimagewiththreeorfour questionsrelatedtotheimage. DiagnosticImagingRadiographicTheoryChiropractorsmustdemonstrateanunderstanding andabilitytoapplytheprinciplesofradiography,includingradiographyphysicsand determinationofwhendifferentformsofimagingareindicated.RadiographicTheoryitems maybeinpatientpresentationformatormaybeinabasicknowledgeformatwithasimple leadin. PatientAssessmentPhysicalExamsandHistoryTakingChiropractorsmustdemonstratean understandingandproperapplicationofthekeycomponentsofacomprehensivepatient historyandphysicalexam.Theymustbeabletointerpretthemeaningandimportanceof positiveandnegativefindingsofdifferentexammaneuversandpatientinterviewfindings. Treatment,Technique&RehabilitationChiropractorsmustunderstandhowtoapplydifferent treatmentandrehabilitationmodalitiesaswellastherationaleforsuchtreatmentsandwhen toapplythem.Theymustalsounderstandthecontraindicationsofsuchinterventionsand whentoapplyalternativetreatmentsorrefertoanotherhealthprofessional.

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Canadian Chiropractic Examining Board 2013

4.ComponentCExam
Station Behavioral Components
Total%of Exam

History Taking 14%

+/2%

Physical Exams 21%

+/2%

Plansof Rationale Technique Diagnosis Management (Explanation /Treatment ofProcesses) 8%

+/2%

Considerationof LegalEthicaland Commun Organizational ication aspectsofpractice 7%

+/2%

Professi onalism 5%
+/2%

ContentArea

9%
+/2%

16%
+/2%

5%
+/2%

14%
+/2%

Lowback Neck Midback/Thoracic Dizziness/Headache/ HeadTrauma Hip/Pelvis Shoulder Knee/Leg Foot Arm/Elbow Chest/Abdomen Hand Face/Jaw Other

22%+/3% 16%+/3% 12%+/3% 10%+/3% 8%+/2% 8%+/2% 5%+/2% 4%+/2% 4%+/2% 3%+/2% 3%+/2% 3%+/2% 2%+/2%

3.1% 2.2% 1.7% 1.4% 1.1% 1.1% 0.7% 0.6% 0.6% 0.4% 0.4% 0.4% 0.3%

4.6% 3.4% 2.5% 2.1% 1.7% 1.7% 1.1% 0.8% 0.8% 0.6% 0.6% 0.6% 0.4%

1.8% 1.3% 1.0% 0.8% 0.6% 0.6% 0.4% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2%

2.0% 1.4% 1.1% 0.9% 0.7% 0.7% 0.5% 0.4% 0.4% 0.3% 0.3% 0.3% 0.2%

3.3% 2.4% 1.8% 1.5% 1.2% 1.2% 0.8% 0.6% 0.6% 0.5% 0.5% 0.5% 0.3%

1.3% 1.0% 0.7% 0.6% 0.5% 0.5% 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.1%

1.5% 1.1% 0.8% 0.7% 0.6% 0.6% 0.4% 0.3% 0.3% 0.2% 0.2% 0.2% 0.1%

3.1% 2.2% 1.7% 1.4% 1.1% 1.1% 0.7% 0.6% 0.6% 0.4% 0.4% 0.4% 0.3%

1.1% 0.8% 0.6% 0.5% 0.4% 0.4% 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.1%

Notethatacandidate'ssuccessorfailureontheComponentCexammaybesubjecttoexaminerobservationsandislefttothediscretionof theCCEB.Candidateswhoinjureapatientinthecourseoftheexamorwhothrustandcompleteadjustmentsmaybeawardedanoverall'zero' onastationormayfacefailureontheentireexam.

Behavioralcomponentsareevaluatedacrossmultiplestationsontheexam.Forexample,aspectsofcommunicationandprofessionalismare foundoneverystationoftheexam.Componentssuchashistorytakingandphysicalexamshavespecificstationsdesignedtotestthese competencies.ReadtheComponentCstudyguideforstationspecificinstructions.

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DefinitionsofStationBehaviouralComponents

HistorytakingAbilitytoaskrelevanthistoryquestionsgivenapatientpresentation.Historytaking shouldbeorganizedandpertinenttothecase.

PhysicalExamsChiropractorsareexpectedtoperformrelevantphysicalexamsgivenapatient presentation.Physicalexamsareexpectedtobeperformedintheirentiretyandwithoutharmto thepatient.Theymayinclude,butarenotlimitedtotakingvitals,performingorthopedictests, neurologicalexams,softtissueexams,activeandpassiverangesofmotion,reflexes,gait/posture analysis,and/ortemperature.

ChiropractictechniqueChiropractorsareexpectedtodemonstratemanualadjustmentsetupson apatient.Adjustmentsmustbebroughttothepointoftensionandshouldbeintheappropriate contactpositionwhereifcompleted,theadjustmentwouldresultincavitation.Candidatesarenot tothrustonthepatients,doingsomayresultinfailureofthestation.Chiropractorsshouldbeable todemonstratemultipleadjustmentsonthespine,neck,andextremities.Theymustalsobeable torecognizewhenitisinappropriatetoadjustapatientandwhentorefertoothermedical professionals.

DiagnosisChiropractorsmustbeabletointerprethistoryand/orphysicalexamfindingsand provideanaccuratediagnosistothepatient.

PlansofManagement/TreatmentAbilitytocreateandcommunicateanappropriateplanof managementtoapatientbasedonadiagnosis.Plansofmanagementmayincludechiropractic treatments,referrals,alternative/complimentarycare,emergencyreferraland/orcomanagement withanotherhealthcareprofessional.

Rationale(ExplanationofProcesses)Chiropractorsmustbeabletoexplaintothepatientwhat theyareperformingandwhytheyareperformingitwhenitcomestophysicalexamsand chiropracticadjustments.Theymustalsobeabletoexplaintheirdiagnosestothepatientandwhy theycametotheconclusionsthattheydid.Whenrecommendingatreatmenttothepatient, chiropractorsmustbeabletoexplainwhythepatientneedssuchatreatmentorwhythepatient needstobereferred.Ifreferringapatient,chiropractorsareexpectedtobeabletoexplaintothe othermedicalprofessionalwhytheyaresendingtheirpatient.

ConsiderationofLegalEthicalandOrganizationalaspectsofpracticeChiropractorsmust conformtoethicalandlegalaspectsofpracticeandareexpectedtoanswerquestionsfromthe patientregardingsuchmatters.Thisincludesprovidinginformedconsentandaskingforconsentto performtreatmentoptionsandphysicalexams.

CommunicationChiropractorsareexpectedtocommunicatedetailedandaccurateinformationto patientsintermsthatthepatientcanunderstand.Theymustalsouseappropriatetoneandbody languagewhenspeaking.Casehistoriesshouldbecommunicatedinanorganizedmatterand physicalexamsshouldbeexplainedasthechiropractorperformsthem.

ProfessionalismChiropractorsmustdemonstrateprofessionalismandintegritybytreatingthe patientwithcareandcompassion.Thisincludesbutisnotlimitedtousingproperdraping techniques,listeningandrespondingtopatientconcerns,adjustingtechniquesandmovements accordingtopatientdiscomfort,andshowingrespectforpatientprivacyandquestions.

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V.Acknowledgements

TheblueprintrevisionteamconsistedofMs.KimberleyWittnerBSc.(ExamsManager),Dr.KentStuber D.C.,M.Sc(ChiropracticResourceOfficer)andDr.ErnestSkakunPh.D.(PsychometricConsultant,CAVES CONSULTINGSERVICES,INC.).TheBoardofGovernorsandMs.PatFrank,CAE(ChiefExecutiveOfficer) arealsoacknowledgedfortheirsupportandcontributionstothecompletionofthisproject.Wealso thankallthevolunteerswhoparticipatedinthemultiplecommitteesandsurveysconducted.

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APPENDIXI.ConditionsTestedbytheCCEB

Thefollowingisalistof267possibleconditionsthatmaybetestedbytheCCEB.Thislistisnot exhaustiveofconditionsthatmaybetestedbutcontainsthemostcommonconditionsseenby practicingchiropractorsfromacrossCanada. Theconditionswererankedaccordingtothefrequencyofpresentationoveraperiodofsixmonthsto chiropractorsacrossCanada.Conditionsthatwereseenby80%to100%ofchiropractorsweregivena rankingof1,conditionsseenby50%to79%weregivenarankingof2andconditionsseenbylessthan 50%ofchiropractorsweregivenarankingof3.Notethatnoconditionwasseenbylessthanthree chiropractorsinCanada,andthusitisdeemednecessarythatchiropractorshavesomeknowledgeof allofthebelowconditionsandknowtheunderlyingpathophysiologicalandanatomicalimplicationsof them. Sincerarelyseenconditionsmaystillbeimportantforchiropractorstorecognize,diagnose,treatand orrefer,theCCEBsurveyedachiropracticcommitteefromacrossCanadatodeterminetheimportance ofeachcondition.TheresultsofthissurveywereusedinconjunctionwiththeresultsoftheBlueprint ValidationStudytodeveloptheframeworkbelow. TheCCEBcannottestforalloftheconditionsateverysitting,ratherapercentagerangefromeach rankingofconditionsisselectedforeachexam.Theproportionisasfollows:
Rank 1 2 3 Total Veryfrequent Frequent Lessfrequent HighlyImportant(HI) 35%+/5% 25%+/5% 5%+/5% 65%+/10% Important(I) 25%+/5% 5%+/5% 5%+/5% 35%+/10% Total 60%+/5% 30%+/5% 10%+/5% 100%

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TableofConditionsthatmaybeTestedbytheCCEB
Conditions Grouping Conditions Frequency 1 1 1 1 1 1 1 2 2 2 3 3 3 1 1 1 1 1 1 1 2 2 2 2 3 3 3 1 1 1 1 1 1 2 3 3 3 1 1 1 1 1 1 2 2 2 3 3 3 Importance HI HI HI HI I HI HI HI I HI HI HI HI HI HI HI HI I HI HI HI HI I I HI HI HI HI HI HI HI I HI HI I HI I HI HI HI HI HI I I HI I I HI HI

lumbarfacetsyndrome/jointdysfunction lumbarsprain/straininjury sacroiliacjointdisfunction/sprain lumbardischerniation/lesion/derangement myofascialtriggerpointofthequadratuslumborum segmentalradiculopathy Lumbar/Sacral Spondylolisthesis Conditions spinalstenosis coccyxsubluxation/fixation lateralrecessstenosis Fracture vascularclaudication caudaequinasyndrome cervicalfacetsyndrome/jointdysfunction cervicalsprain/straininjury myofascialtriggerpointofthesuboccipitalmuscles whiplashassociateddisorders myofascialtriggerpointofthescalenemuscles segmentradiculopathy CervicalSpine/ cervicaldischerniation/lesion/derangement NeckConditions Torticollis spinalstenosis cervicalrib brachialplexustrauma Fracture Aneurysm vertebrobasilaraccident costovertebraljointfixation posturalstrain thoracicspinalsprain/straininjury thoracicfacetsyndrome/jointdysfunction ThoracicSpinal/ scoliosisfunctional Midback scoliosisstructural Conditions Fracture T4syndrome thoracicdischerniation/lesion/derangement Scheuermann'sdisease Cervicogenicheadache tensionheadache commonmigraine classicmigraine temporomandibularjointdysfunction Headache/Jaw sinusitis Conditions otitismedia hypertensionheadache clusterheadache trigeminalneuralgia glaucoma temporalarteritis

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Conditions Grouping

Conditions
cervicogenicvertigo benignparoxysmalpositionalvertigo concussion/postconcussivesyndrome Meniere'sdisease labyrinthitis obstructedexternalauditorycanal vestibularneuritis acousticneuroma myringitis iliopsoasstrain myofascialtriggerpointofthepiriformis/piriformissyndrome iliotibialbandcontracture hamstringstrain hipjointfixation quadricepsstrain bursitis adductorstrain snappinghipsyndrome inguinalhernia meralgiaparesthetica osteitispubis congenitalhipdysplasia myositisossificans avascularnecrosis avulsionfracture LeggCalvesPerthesdisease femoralneckfracture slippedcapitalfemoralepiphysis rotatorcuffstrain myofascialtriggerpointofthesupraspinatus myofascialtriggerpointoftheinfraspinatus bursitis bicipitaltendonitis myofascialtriggerpointofthepectoralismuscle myofascialtriggerpointofthesubscapularis impingementsyndrome acromioclavicularjointsprain/separation adhesivecapsulitis shoulderjointfixation thoracicoutletsyndrome myofascialtriggerpointoftheserratusanteriormuscle rotatorcufftear latissimusdorsistrain glenohumeralsubluxation fracture glenohumeraldislocation osteolysisofthedistalclavicle

Frequency 1 2 2 3 3 3 3 3 3 1 1 1 1 1 1 1 1 2 3 3 3 3 3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 3 3 3

Importance HI HI HI HI I I I I I HI HI I I HI I I I I HI I I HI I HI HI HI HI HI HI I I HI I I I HI HI HI I HI I HI I HI HI HI I

Dizziness/Inner EarConditions

HipConditions

Shoulder Conditions

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Canadian Chiropractic Examining Board 2013

Conditions Grouping

Conditions

Frequency 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 1 1 1 1 1 1 2 2 3 3 3 3 3 3 1 1 2 2 2 2 3 3 3 3 3 3

Importance I HI I I HI I I HI I HI I HI I I HI HI HI I I I I I I I HI HI I I HI HI HI I I I I I HI I HI HI HI

iliotibialbandfrictionsyndrome patellofemoralsyndrome kneejointfixation patellartendinitis meniscaltear bursitis Baker'scyst KneeConditions medialcollateralligamenttear popliteustendinitis anteriorcruciateligamenttear OsgoodSchlatterdisease lateralcollateralligamenttear plicasyndrome posteriorcruciateligamenttear fracture plantarfasciitis/heelspur anklesprain foot/anklejointfixation pesplanus Achillestendinitis shinsplints Foot/Ankle halluxvalgus Conditions metatarsalgia/Morton'sneuroma halluxlimitus compartmentsyndrome fracture tarsaltunnelsyndrome fatpadsyndrome deepveinthrombosis lateralepicondylitis medialepicondylitis elbowjointfixation radioulnarfixation pronatorteressyndrome Elbow tricepstendinitis Conditions olecranonbursitis mediannervepalsy Guyon'scanalcompression ulnarnervepalsy radialnervepalsy fracture

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Canadian Chiropractic Examining Board 2013

Conditions Grouping

Conditions
intercostalmusclestrain/myofascialtriggerpoint asthma bronchitis costochondritis intercostalneuritis pneumonia ribfracture chronicobstructivedysfunction anginapectoris congestiveheartfailure emphysema myocardialinfarction pericarditis pneumothorax pulmonaryembolism subacuteendocarditis wrist/carpaljointfixation carpaltunnelsyndrome deQuervain'stenosynovitis cubitaltunnelsyndrome radialtunnelsyndrome fracture anteriorinterosseousnervesyndrome dislocation diabetesmellitus irritablebowelsyndrome gastroesophagealreflux dysmenorrhea hypothyroid Crohn'sdisease urinarytractinfection colitis hiatalhernia prostatitis/benignprostatichypertrophy gastric/peptic/duodenalulcer hemorrhoids kidney/uretalstones diverticulitis hyperthyroid incontinence enuresis cholecystitis abdominalaorticaneurism pancreatitis appendicitis

Frequency 1 1 1 2 2 2 2 2 3 3 3 3 3 3 3 3 1 1 2 3 3 3 3 3 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3

Importance I HI I I I HI HI I HI HI I HI HI HI HI I HI HI I I I HI I HI HI I I I I I I I I I I I HI I I I I HI HI HI HI

Chest Conditions

Wrist/Hand Conditions

Abdominal/ Visceral/ Endocrine Conditions

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Canadian Chiropractic Examining Board 2013

Conditions Grouping

Conditions
degenerativediscdisease degenerativejointdisease/osteoarthritis osteoporosis fibromyalgia rheumatoidarthritis chronicfatiguesyndrome congenitalanomaly gout Raynaud'sphenomenon ankylosingspondylitis spinabifida polymyalgiarheumatica psoriaticspondyloarthropathy systemiclupuserythematosus diffuseidiopathicskeletalhyperostosis juvenilerheumatoidarthritis osteochondritisdissecans osteomalacia Reiter'ssyndrome Marfan'ssyndrome osteogenesisimperfecta breastcancer skincancer prostatecancer coloncancer benignbonetumor lungcancer cervical/uterinecancer lymphoma braintumor leukemia metastaticbonetumor thyroidcancer ovariancancer primarymalignantbonetumor(nonmetastatic) muscletumor multiplesclerosis Alzheimer'sdisease Parkinson'sdisease stroke Bell'spalsy epilepsy autism cerebralpalsy musculardystrophy Down'ssyndrome amyotrophiclateralsclerosis myastheniagravis syringomyelia encephalitis

Frequency 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3

Importance HI HI HI I HI I HI I I HI HI I HI HI HI HI I HI I HI HI HI HI HI HI HI HI HI HI HI HI HI I HI HI HI HI I I HI I I I I I I I I I HI

Rheumatologic/ Degenerative/ Skeletal Conditions

Malignant/ Cancerous Conditions

Neurological Conditions

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Conditions Grouping Conditions
shingles candidiasis/yeastinfections hepatitis(anykind) herpes childhoodinfectionssuchaschickenpox,measles,mumps mononucleosis HIV/AIDS Lymedisease infectiousarthritis/spondylitis osteomyelitis meningitis tuberculosis rheumaticfever pregnancy allergies depression anxiety normalpresentation(ie.awellpatient) obesity hypertension psoriasis sleepapnea restlesslegssyndrome medicationreactions(includingreboundheadaches) anemia bipolardisorder alcoholism dermatitis colic infertility severeacne drugabuse reflexsympatheticdystrophy/complexregionalpain syndromes anorexianervosa/bulimia/othereatingdisorders schizophrenia

Frequency 2 3 3 3 3 3 3 3 3 3 3 3 3 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3

Importance HI I I I I I I I HI HI HI I I HI I HI HI HI I HI I I I HI I I I I I I I I HI I I

Infectious Disease

PublicHealth

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