9.2 Documenting Valid Adjustments

Definition of a Valid Adjustment

In order to graduate with a Doctor of Chiropractic degree, each intern must satisfy quantitative requirements in a number of different categories. This includes the physical performance of a minimum of 250 adjustments in 250 different patient encounters during the intern’s outpatient, clinical experience. A minimum of 75 of the 250 adjustments must be directly observed by the faculty clinician to whom the student is assigned. All T7 interns must be observed and assessed for each adjustment. T8-T10 interns may adjust if the faculty clinician is not in the room, but the clinician must be in the clinic at all times.

The required 250 adjustments are broken down as follows:

At least 80% (200) must be some form of spinal adjustment/manipulation;
No more than 20% (50) may be adjustments of extremities.

The faculty clinician is responsible for ensuring that the adjustment an intern claims on their monthly adjustment record truly meets these criteria. This will require some discretion on the part of the clinician, and the following guidelines should be used to determine what is and what is not a valid adjustment:

To be considered a valid adjustment, the following considerations must be present:

. . . A Doctor - Patient relationship must be established, in which the intern is perceived by the patient as a significant participant in the provision of their care for at least this particular interaction.

. . . The intern must be involved ACTIVELY with the patient's care, through assessment/diagnosis, treatment planning, and/or treatment delivery.

Examples of Valid Spinal and Non-Spinal Adjustments. . .

. . . The intern handles the entire patient visit, which includes an adjustment;

. . . The intern performs one or more of the adjustments on the patient, as directed by the faculty clinician. It is left to the faculty clinician’s discretion to determine whether to grant an adjustment credit for an intern's attempt, regardless of whether "it took", or not (this is allowable if the faculty clinician feels the intern's set-up and attempt was technically good and the lack of success is due more to the difficulty the patient/situation presents);

. . . The intern adjusts the faculty clinician, or adjusts a staff member while being directly supervised by the faculty clinician . To get credit, the intern must receive constructive feedback and document the interaction via S.O.A.P. notes just as they would with any other patient.

It is NOT a Valid Adjustment when:

an intern is simply applying a therapy, X-ray, or lab function as directed by the faculty clinician;
the intern's function is not directly involved with delivery of patient care (i.e. only documenting the DC's treatment and not actively sharing in the patient's care);
the intern is strictly observing;
an intern is adjusting his or her significant other, parent or child;