Commentary: Establishing an Accredited Master of Science in Diagnostic Imaging Degree at a Chiropractic College

Specialties in Other Professions 

Many health care professions have developed postdoctoral specialty education programs to educate and train consultants in supporting and assisting general practitioners in the areas of diagnosis, treatment, and quality assurance. Educational standards and criteria for specialists vary according to the specialty and the profession it serves. Regardless, two basic elements are essential for obtaining specialty status: postdoctoral education and successful completion of a certifying examination.

In the chiropractic profession in North America, the criteria for appropriate education and training are determined by specialty boards or subcommittees of professional organizations to qualify individuals to sit for board examinations. Most chiropractic specialty examining boards require postdoctoral education in the form of a series of weekend seminars or workshops offered by qualified individuals. Although this type of education provides the basics of specialty training, it lacks the day-to-day immersion in clinical activities and the experience, mentorship, and teaching opportunities available in full-time residencies.

North American chiropractic residencies and weekend postgraduate programs are not degree granting and therefore do not carry their own regional accreditation or fall under an umbrella organization requiring specialty accreditation within the profession. In the medical profession, the Accreditation Council for Graduate Medical Education is responsible for the accreditation of postdoctoral medical education programs within the United States. Accreditation is accomplished through a peer-review process and is based on established standards and guidelines.9 In turn, the American Board of Medical Specialties oversees the 24 approved medical specialty boards in the United States. The American Board of Medical Specialties serves to coordinate the activities of its member boards and provides information to the public, the government, the profession, and its members concerning issues involving medical specialization and certification. The American Board of Medical Specialties is to maintain and improve the quality of medical care in the United States by assisting the member boards in their efforts to develop and use professional as well as educational standards for the evaluation and certification of physician specialists.10

In the chiropractic profession, the American Board of Chiropractic Specialties currently functions as a subcommittee of the American Chiropractic Association (ACA) but has not evolved to the level of sophistication and authority of its medical counterparts. In fact, the American Board of Chiropractic Specialties currently does not serve as an accrediting body for chiropractic specialties but serves more in an advisory capacity to those specialties under the umbrella of the ACA. Most chiropractic specialty examining boards are not accredited by independent accrediting agencies. Some chiropractic specialties boards, including the ACBR, have independently sought accreditation through the National Organization for Competency Assurance, an organization independent of the chiropractic profession and the ACA. The main advantage of having National Organization for Competency Assurance accreditation is that examining boards would be independent of political and professional associations such as the ACA. The authors believe that such independence is essential for the natural evolution of high standards for specialties in chiropractic.

Other health care professions such as medicine, dentistry, and veterinary medicine have created academic degree-granting programs that are conducted concurrently with accredited specialty residency programs or, alternatively, have replaced traditional residency programs with academic degree-granting programs that qualify their graduates for professional certification (Fig 1).

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Fig 1. Academic degrees associated with health care specialties.

Our plan to develop a Master of Science in Diagnostic Imaging residency program is modeled largely after the programs in these other health professions. The chiropractic diagnostic imaging specialty is ideally suited for this model for several reasons: the program requires candidates to complete a full-time residency for certification eligibility; it is academically rigorous; it provides standardized postdoctoral training in diagnostic imaging; and, academically, it already resembles a master's-level graduate program. We consider it a natural progression to create a master's degree in this specialty.7

The NYCC Program 

In December 2002, the New York State Board of Regents approved a charter change for the NYCC to award master of science degrees and a bachelor of professional studies degree. The impetus for the charter change was to permit the college to offer maste's degree in acupuncture and oriental medicine. After this major shift from a single-purpose institution to a multipurpose institution, the college set out to develop academic degrees in chiropractic specialties. The process of developing new residency programs is complex.6 Any such program must be consistent with the mission of the institution and must have sufficient resource allocation. The program should also be generally accepted and embraced by the institution's general population and must serve to significantly advance the profession. In September 2003, after receiving the NYCC's proposal, the New York State Department of Education approved a Master of Science in Diagnostic Imaging (MSDI) degree program.

The NYCC MSDI residency program is a 43–semester-hour credit program (555 contact hours) that is administered concurrently with a full-time 4-year residency (∼8000 total hours of education and training). One resident per year will be accepted to the program, such that a maximum of 4 residents will be enrolled. Residents will be responsible for teaching, clinic rotation responsibilities in the college's Doctor of Chiropractic program, NYCC community service, and research-related activities that culminate in a defensible thesis (Table 1). Successful completion of the program will result in the award of the academic degree—MSDI—with eligibility to sit for the ACBR examination for professional certification.

Table 1. The NYCC MSDI courses and creditsa

	Course	Title	Contact	Credits
	RAD 5101	Hematopoietic Disturbances of Bone	22.5	1.5
	RAD 5102	Infectious Disorders of Bone	22.5	1.5
	RAD 5103	Congenital Anomalies and Skeletal Dysplasias	22.5	1.5
	RAD 5104	Arthritides	45	3
	RAD 5201	Principles of Diagnostic Imaging	22.5	1.5
	RAD 5105	Physical Injury of the Skeletal System	45	3
	RAD 5106	Internal Derangement of Joints	60	4
	RAD 5107	Neoplastic and Neoplastic-Like Lesions of Bone	22.5	1.5
	RAD 5108	Metabolic, Endocrine, and Nutritional Disorders of Bone	22.5	1.5
	RAD 5301	Chest Imaging	60	4
	RAD 5401	Gastrointestinal/Genitourinary Tract Imaging	60	4
	RAD 5501	Neuroimaging	60	4
	RES 5601	Experimental Design and Research Methodologies	45	3
	RES 5602	Experimental Analysis	45	3
	RES 5603	Thesis		6
	Total		555	43

a The MSDI program occurs concurrently with a full-time 4-year residency (∼8000 hours in total).

The MSDI residency program will serve the college's Doctor of Chiropractic program by providing masters-level education in an important specialty within chiropractic. Furthermore, it will promote and enhance scholarship and academic excellence, while remaining budget neutral. This postdoctoral program will resemble the postdoctoral programs of advanced training in other health professions, such as dentistry, veterinary medicine, and medicine.

The traditional model for diagnostic imaging residencies in chiropractic is that of a full-time 3-year program consisting of academic and clinical experiences. The NYCC's MSDI residency program consists of a more rigorous full-time 4-year program with emphasis placed on advanced imaging and masters-level research. Pretorius et al11 found that interest in a research track (an additional year) in medical radiology residencies was positively correlated with interest in a research academic career and negatively correlated with interest in private practice. It is our intent to develop successfully a diagnostic imaging residency that produces physician-academicians who can perform clinical duties and conduct research. Combining the conventional elements of traditional chiropractic imaging residencies with the research requirements, the NYCC MSDI residency program exceeds the eligibility requirements to sit for the ACBR examination. The NYCC's MSDI residents will be enrolled as graduate students. Their grades and transcripts will be generated in a similar manner as for students enrolled in the Doctor of Chiropractic program. Other diagnostic imaging residencies may offer grading opportunities, but grade point averages and transcripts are not provided currently in most programs. Because the NYCC's diagnostic imaging residency program grants an academic degree, its residents are entitled to the same benefits as those for other traditional graduate students. A major benefit of this program is the deferment of continuing education student loans and the opportunity for additional financial aid. In traditional diagnostic imaging residencies, it has been increasingly difficult, especially within the past 7 years, for residents to be granted student loan deferments because lending institutions typically do not recognize traditional chiropractic residency programs as qualifications for interest subsidization. Instead, most residents apply for either financial hardship deferment (in which case some interest payments are required) or forbearance (in which case the student loan payments are added to the principal of the loan during the time of nonpayment). With these financial realities and the increasing student loan debt of chiropractic students, many potential residents are discouraged from enrolling. Furthermore, diagnostic imaging residents' salaries have typically been at the lowest end of the salary scale in chiropractic colleges. It is our goal to offer residents free tuition, financial compensation, and employee benefits that would be equivalent to the average salary that a newly graduated Doctor of Chiropractic would earn as an associate in practice.