Improving preventive health services training in chiropractic colleges: A pilot impact evaluation of the introduction of a model public health curriculum

Objective: To investigate the impact of the dissemination of the model public curriculum at one US chiropractic college on chiropractic interns during their outpatient clinical internship. Methods: A retrospective pilot study was performed to evaluate the frequency of 9 patient clinical preventive health recommendations made by interns during their clinical training. The frequency of recommendations by interns completing their public health coursework after dissemination of the model curriculum was compared with those completing their coursework during the period immediately proceeding dissemination. A standardized data abstraction tool was developed to collect data from clinic charts that established a patient's need for any one of 9 preventive health services. Results: Of the 408 charts examined (204 from each group), there were only 4 documented instances (1%) of recommendations for any of the 9 preventive health service categories. Two recommendations occurred in the precurriculum change period. Conclusion: The results of this pilot study indicate that there has been no observable impact on intern behaviors toward educating patients in preventive health services since the dissemination of the model public health curriculum at one of the chiropractic colleges in the United States. The impact of this reform in public health education may have been limited by its minimal focus on clinical preventive services and by a focus on didactic rather than a clinically relevant learning exposure.