College of Chiropractic Intern’s Clinic Handbook

1.0 Introduction

Interns in their last 16 months at Northwestern Health Sciences University (Northwestern) will be engaged in an exciting and diverse range of unpaid clinical experiences. These may occur in one of the college’s own clinics, in one of the Community Based Internship (CBI) sites, in a T10 Preceptorship, or a combination of all of these. The Northwestern Clinic system is committed to providing quality whole-patient care while preparing interns to be Doctors of Chiropractic. The public clinics subscribe to the following principles of chiropractic care:

  1. The Doctor of Chiropractic is a generalist rather than a specialist. As generalists, we are concerned with the whole person and focus on the person primarily and symptoms secondarily.
  2. As primary health care providers, Doctors of Chiropractic serve as portals of entry into the health service system qualified to diagnose, treat, and refer when indicated.
  3. Doctors of Chiropractic emphasize spinal and extra-spinal manipulation in treatment but also utilize physiotherapeutics, nutritional therapy, acupuncture, life-style assessment, exercise, and other wellness concepts such as stress management.
  4. A good doctorpatient relationship is essential for therapeutic healing. Being patient-centered and understanding the power of the body to heal itself is essential to facilitating the healing process of the patient.
  5. We are interested in understanding the causes, nature, and prevention of disease, not just viewing symptoms, and strive to provide symptomatic relief while resolving underlying causes of our patients' ailments. The relationship between body structure and function and how it influences total health is our focus.
  6. Innate intelligence allows the body to strive toward equilibrium, or homeostasis, enhancing physiological and structural functioning.

Interns are encouraged to consult this handbook whenever a question arises regarding clinic procedures, policies, regulations, or general clinic operation. Interns are further encouraged to become familiar with Northwestern College of Chiropractic's Vision Statement and Health Care Model.

1.1 Northwestern Health Sciences University Mission Statement

Northwestern Health Sciences University prepares the next generation of healthcare professionals to deliver and advance health care.

1.2 Northwestern Health Sciences University Vision Statement

We are a premier health sciences university creating a healthier world. Live, Learn, Serve Healthy!

1.3 NWHSU College of Chiropractic Statement of Purpose

The College of Chiropractic Program provides a professional education comprised of the knowledge, skills and attributes necessary for one to practice chiropractic effectively, ethically and safely as a portal-of-entry, primary care chiropractic physician.

1.4 NWHSU College of Chiropractic’s Health Care Model

Chiropractic is a patient-centered form of care that serves to promote health and wellness, diagnose and manage disease, relieve pain and suffering, and improve quality of life.

The College of Chiropractic’s model of health care embraces the responsibility to respond to the health care needs of the patient, as they relate to clinical problems and promotion of optimal health. This model is based on the principle that the body’s innate recuperative power is affected by and integrated through the nervous system.

With this underlying philosophy, chiropractic’s patient-centered perspective incorporates both therapeutic and preventative approaches. The therapeutic approach promotes improved health through the diagnosis and management of clinical conditions. The preventive approach requires attention to the patient’s health behaviors, and the maintenance of optimum body structure and neural function.

Chiropractic recognizes and places particular attention on the adjustment, correction and prevention of the subluxation complex in the preservation and restoration of health.

Doctors of Chiropractic employ their knowledge, clinical skills and judgment necessary to render a diagnosis and determine the most appropriate course of care and management for the patient, in a competent, caring and ethical manner. The practice of chiropractic includes:

  1. Obtaining the necessary clinical information to establish an accurate impression of the person’s health status including diagnosis. This clinical information includes but is not limited to:
    • History
    • Physical examination
    • Biomechanical evaluation
    • Radiological and laboratory examinations
  2. Detecting the presence and significance of a subluxation, or other alterations in body structure, and determining their contribution to the clinical picture. Subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. Clinical recognition of a subluxation may involve:
    • Identification of spinal and other joint disrelationships;
    • Changes in joint motion;
    • Altered muscle tone, strength or length;
    • Changes in paraspinal or dermatome temperatures;
    • Altered sensation or reflexes;
    • Inflammatory processes;
    • Provoked pain or objective tenderness; or
    • Changes in skin texture
  3. Utilization of diagnostic and treatment procedures that are supported by the best available evidence, clinical experience or consensus-driven guidelines and are in accordance with legal standards of care.
  4. Facilitating neurological and biomechanical integrity through chiropractic adjustments, mobilization and adjunctive therapies. Chiropractic adjustments include, but are not limited to:
    • High velocity low amplitude
    • Traction/distraction
    • Mechanically assisted

      Adjunctive therapies include, but are not limited to:

    • Physiotherapeutic modalities
    • Soft tissue techniques
    • Physical rehabilitation
    • Bracing
    • Immobilization and orthoses
  5. Health and wellness promotion, including:
    • Advising and educating patients and the community about spinal health, healthful living practices, clinical preventative services and public health issues.
    • Nutritional recommendations
    • Exercise counseling
    • Psychosocial supports and identification of the need for counseling
  6. Cooperative patient management with, referral to, communication and collaboration with other health care providers to ultimately benefit the patient.

1.5 Clinical Education Mission Statement

Our Mission: to create competent and confident doctors of chiropractic prepared to practice successfully in the ever-evolving health care environment. Clinical Education dedicates itself to providing students with a nurturing, skill-building environment leading students to achieve clinical competency.

1.6 Statement on Chiropractic Scope and Practice

The Association of Chiropractic Colleges describes chiropractic practice as consisting of the following:

  1. Establishing a diagnosis
  2. Facilitating neurological and biomechanical integrity through appropriate chiropractic case management through adjustive and other procedures unique to the chiropractic discipline as well as other conservative patient care procedures
  3. Advising and educating patients and communities in structural and spinal hygiene and other healthful living practices

While spinal and extraspinal manipulation adjustment and equipment for spinal distraction and physiotherapy are in the forefront of our care, physiotherapy, nutritional counseling, exercise instruction, and lifestyle counseling are appropriately used as important elements of chiropractic health care and are available in the clinic for intern use.

1.7 Statement on Technique Policy

It is the policy of the clinic division that only those chiropractic treatment methods that are taught in the core curriculum may be used in the outpatient clinics. While it is recognized that occasionally some other technique may be useful, those methods cannot be used without the permission of the faculty clinician managing the patient. If authorized, this technique must be duly noted in the S.O.A.P. notes. Remember that each faculty clinician is legally and ethically responsible for the students' actions and that all faculty are not versed in all techniques. Some techniques require certification from the State Board to be used in clinic. If the supervising faculty clinician does not have this certification, and the intern is not enrolled in the course, the doctor or intern may not use the technique (ex. Acupuncture). Should a dispute regarding technique arise, the final decision will rest with the faculty clinician managing the patient.

1.8 Definition of Unpaid Internship

Individuals who participate in the clinical internship educational program must meet the following criteria:

  1. The internship, even though it includes actual operation of the facilities of the CBI/T10 clinic, is similar to training that would be given in an educational environment.
  2. The internship experience is for the benefit of the intern.
  3. The intern does not displace regular employees, but works under close supervision of a credentialed faculty clinician.
  4. The faculty clinician that provides the training derives minimal or no immediate advantage from the activities of the intern and on occasion its operations may be temporarily impeded.
  5. The intern is not necessarily entitled to a job at the conclusion of the internship.
  6. The faculty clinician and the intern understand that the intern is not entitled to wages for the time spent on the internship.
If all of the factors listed above are met, an employment relationship does not exist under the FLSA, and the Act's minimum wage and overtime provisions do not apply to the unpaid intern.
Further, the individual is not eligible for any benefits, including unemployment or workers' compensation.