Chiropractic student choices in relation to indications, non-indications and contra-indications of continued care.
Background
The quality of health care provider clinical decisions has long been recognized as variable. Research has focused on clinical decision making with the aim of improving patient outcomes. No studies have looked at chiropractic students´ abilities in this regard.


Method
In 2016, advanced students from two Australian chiropractic programs (N = 444) answered a questionnaire on patient case scenarios for neck and low back pain (LBP). We selected 7 scenarios representing the three categories; continuing care, non-indicated care, and contraindicated care. This represented a total of 21 tested scores. Comparisons of correct answers were made a) for program years 3, 4 and 5, and b) between the three categories of care.


Results
In almost 1/3 of scenarios, correct scores were 70% or greater. Best results were for two neck pain cases (simple and with spinal cord involvement). Continued care showed most improvements with study year. However, the scenarios that reflected non-indication for continued care had much worse results and did not improve in higher years. For the obvious contraindicated neck scenario, the results were good from the beginning and progressively improved and for a contraindicated LBP scenario the results started poorly in year 3 but improved over the program years.


Conclusions
Although student responses were generally good, there is still room for improvement, especially for non-indicated care. The quality of students' clinical decisions can be measured and thus has the potential to be used by chiropractic educators and regulatory bodies to identify student's in need of assistance as well as to monitor chiropractic programs in relation to student competence.


Trial registration
Not applicable.
['Innes|Stanley I|SI|0000-0001-7783-8328', 'Leboeuf-Yde|Charlotte|C|', 'Walker|Bruce F|BF|']
D002684:Chiropractic D002983:Clinical Competence D000066491:Clinical Decision-Making D000072700:Conservative Treatment D000075204:Contraindications, Procedure D019538:Health Care Surveys D007722:Health Knowledge, Attitudes, Practice D006801:Humans D017116:Low Back Pain D026882:Manipulation, Chiropractic D019547:Neck Pain D058996:Quality Improvement D011787:Quality of Health Care D013337:Students, Medical
Chiropractic Clinical decisions Education Diagnosis