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J Can Chiropr Assoc. Mar 2006; 50(1): 14–17.
PMCID: PMC1839972

Continuing Health Education in Canada

Jaroslaw P. Grod, DC, FCCS(C), CAE*
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Jaroslaw P. Grod, DC, FCCS(C), CAE


Two questions arise when chiropractors consider issues surrounding Continuing Health Education (CHE):

  1. What are the goals of CHE?
  2. Why do chiropractors need CHE?

The answer to the both questions is relatively simple:

  • To ensure that health providers maintain and enhance their skills and competencies throughout their professional lives1
  • To change behaviours and improve patient outcomes 2

In order to change practice behaviour the chiropractor needs a source of clinical and scientific learning to update and alter accordingly the art and science of practice. A major challenge for all practicing chiropractors is determining how to improve quality of chiropractic care. CHE is basically about communication. Providers of CHE must identify the needs of the learner, determine the activity objectives, and structure an activity that can be demonstrated to achieve the objectives in the context of the learners. CHE consists of educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships of a health professional.

Continuing Education in Canada

It is important to note that of the approximately 6935 chiropractors in Canada (2004 data) only 3223 have mandatory CE requirements. These numbers are confirmed below in Table 1, taken from the Canadian Chiropractic Association website. At the present time Manitoba and Ontario do not have requirements for mandatory Continuing Education (CE) or Continuing Professional Development (CPD). Ontario has approximately 3500 chiropractors. The College of Chiropractors of Ontario alludes to CE in its mandatory professional portfolio but does not stipulate requirements for CE hours.

Does sitting for 8, 10 or 12 hours in a lecture format seminar change health provider behaviour in practice? The literature states that the didactic/lecture type format is least likely to change the practices and habits of a health provider. The workshop/hands-on session is more likely to affect health provider behaviour in treatment protocols. More and more CHE programs are now providing an outcome measure to ensure that there has been some retention of knowledge. This is often in the form of a pre-test/post-test. In most cases this outcome measure at least shows short term changes in knowledge and skills.

CMCC Continuing Education Programs

The Canadian Memorial Chiropractic College (CMCC) offers CHE in four distinct categories described as follows:

i) Fellowship Programs

Fellowship programs (College of Chiropractic Orthopedists and the College of Rehabilitation Sciences) are intensive three or four year programs offered through ongoing series of weekend seminars and workshops. By completion of a Fellowship program, a participant becomes eligible to pursue Fellowship status in a specialty college. The College of Clinical Sciences, the College of Radiologists and the College of Sports Sciences now only accept a completed residency program as eligibility for fellowship status.

ii) Certificate Programs

Certificate programs are an extended series of weekend programs, leading to advanced knowledge and training in a specific area. Currently, CE runs an Acupuncture Certificate Program and the Human Anatomy Certificate Program. Acupuncture has been newly restructured into a one year program from the former two-year format providing a better quality program with equivalent hours and quicker completion time.

iii) Weekend Seminars

Weekend seminars are the most accessible and practical option for the majority of chiropractors. CE sponsors seminars nation-wide, throughout the year in order to help chiropractors meet their CE requirements. A sample of specific topic seminars are Golf workshops, Recognizing Serious Disease, The Injured Worker, Nuts ‘n Bolts of Low Tech Rehab. These are run in major cities throughout Canada.

Over the past several years, CMCC Continuing Education has forged collaborative partnerships with external organizations in order to present weekend seminars. Examples of such collaborations include the provincial associations, Western States Chiropractic College, Palmer Institute for Professional Advancement, the Canadian Chiropractic Protective Association and the Canadian Society of Chiropractic Examiners. Some of these partnerships have developed into annual seminars.

iv) Distance Education

In the past 5 years, distance education has gradually become more important in the offerings of all Continuing Education providers. CMCC CE was at the forefront of this technology with the launch of Virtual Viewboxes CD-ROM format, an interactive radiology program that allowed practitioners to complete their hours in the comfort of their own homes. The second program offered in this genre was the Nutrition and Natural Medicine series, initially offered on videotape and now in CD-ROM format. Last year, the videotapes were sold and phased out, as that technology has become less popular.

The next progression was the development of web-based programs which are completed online. In 2004 CE launched two online case studies - Neck-Tongue Syndrome and Knee Pain with a Twist, which allow participants to complete a quiz online, and print their own certificate upon completion. Based on the success of these two online programs, CE is expanding the online catalogue to meet the growing demand for distance learning. Our newest web-based program (six-hour), Fibromyalgia, was launched in May 2005 and Chiropractic Evaluation and Management of Dizziness and Vertigo should be available in early 2006.

Using real-time, online payment services, chiropractors can purchase online programs any time, day or night, without communicating with the CE department. This provides learners instant access to online education, with ultimate flexibility, and allows CE to reach eager learners across the globe.

All of our online programs offer an outcome measure to ensure audiences are active learners and retain some knowledge of the topic.

Interest in Distance and Online CHE

In a recently published paper approximately 86% of chiropractic respondents felt their previously completed CE courses were satisfactory. Seventy-two percent of respondents felt that previously completed online or distance CE courses were satisfactory. Almost half the respondents indicated that they most preferred online distance learning, while 34.08% most preferred face-to-face interaction.4 A fascinating finding in this same study was that fifty-three percent of respondents indicated an interest in starting a master’s degree program; however 70.46% of respondents were interested in an online master’s degree program that would offer CE credit.


It should not be forgotten that the jury of the Lana Lewis Inquest, issued the following recommendation, found on the website of the Canadian Chiropractic Association (CCA), along with the response from the CCA.

Recommendation 13 from the jury of the Lewis Inquest submitted January 16, 2004

We the jury recommend, based on a review of the Clinical Guidelines for Chiropractic Practice in Canada, that the chiropractic professional associations, teaching facilities and regulatory colleges, ensure all of their members maintain their skills by taking mandatory upgrade courses.

Response from CCA on March 22, 2004

The chiropractic profession supports continuing education for all health professions as required by their respective regulatory colleges. The provincial chiropractic regulatory colleges are active in ensuring the provision of continuing education.

Continuing competency and professional growth are the responsibility of the individual practitioner. Self-directed learning is a program of learning activities, the structure, planning, implementation and evaluation of which are in the control of the learner.

How do health professional set goals for CHE and identify learning objectives?

  1. Critically review one’s practice and identify learning needs and interests of practice.
  2. Plan how to meet identified learning needs and interests by reflecting on one’s skills and knowledge.
  3. Develop one’s self by analyzing strengths and weaknesses.
  4. Evaluate effectiveness of CHE and the benefits it can bring to patient care.

To achieve its greatest potential, CHE must be truly continuing, not casual, sporadic, or opportunistic.5 Chiropractors have to recognize the ongoing chances to create important questions, interpret new knowledge, and judge how to apply that knowledge in clinical settings. Basically the literature indicates that CHE must be self-directed by the health provider. Opportunities for self-directed learning should improve the skills and knowledge required for critical reflection on practice and measurement of improvement. The responsibility for improving practice must rest with individual chiropractors.

Table 2
Outlines the CE requirements for provinces in Canada3


1. Bolton JE. Chiropractors’ attitudes to, and perceptions of, the impact of continuing professional education on clinical practice. Med Educ. 2002;36:317–324. [PubMed]
2. Mazmanian PE, Davis DA. Continuing Medical Education and the Physician as Learner: Guide to the Evidence. JAMA. 2002;288:1057–1060. [PubMed]
3. Federation of Chiropractic Licensing Boards. Official Directory 2005–2006, Greeley CO.
4. Stuber KJ, Grod JP, Powers P, Smith D. “An Online Survey of Chiropractors’ Opinions of Continuing Education.” BMC Chiropractic and Osteopathy. 2005;13:22. [PMC free article] [PubMed]
5. Houle CO. Continuing learning in the professions. San Francisco: Jossey-Bass, 1980.

Articles from The Journal of the Canadian Chiropractic Association are provided here courtesy of The Canadian Chiropractic Association
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