hiropractic continuing education has finally teamed up with the Internet. While the CE credits from Internet-based courses aren’t yet fully accepted by all state boards, this trend has all the ingredients needed to substantially change the world of continuing education for chiropractors.

At the end of a typical day, Dr. Randall Miller bids goodbye to the last patient of the evening and, after locking the door, heads back to his Chehalis, Wash., home. After dinner he settles in front of his computer, dials up an Internet connection, and logs onto the web site of ChiroCredit.com.

Within seconds the vivid picture of a knee appears on the screen. With a click of his mouse he begins to peel away muscles and nerves, displaying each layer in turn. The images of human anatomy are as close as you can get to the real thing—without the benefit of scalpels, scrubs and formaldehyde. For many doctors in need of continuing education for re-licensure it’s also better than sitting in a darkened auditorium watching overhead slides while an instructor drones on about anatomy or pathology.

“I can get more out of this than I do at the seminars,” says Miller, who has practiced in his community of 20,000 for the last 15 years. During that time he has always closed down his practice and climbed in his car for the 90-mile drive to Seattle and a class mandated by the state board.

Those trips ended last year when he learned about ChiroCredit and their online chiropractic education program. He was delighted to learn that his state allows doctors to earn all of their yearly credits in cyberspace.

A growing number of DCs have joined Miller in Internet-based continuing education. The trend is just beginning, as several chiropractic colleges and a smattering of private companies deliver courses in anatomy, radiology, philosophy and a host of other topics.

While mainstream academia—along with corporate trainers—jumped on the e-education bandwagon years ago, chiropractic has only recently adopted the technology. In many cases, state licensing boards were reluctant to accept credit for online learning, and those that now do—32 states so far—have created a hodgepodge of regulations.

In the state of Washington, you can earn all 25 of your required yearly credits online. In Virginia, on the other hand, Internet courses are classified as Type II credits—and can count for up to half of the 60 hours required every two years. In contrast to the Type I credits, which must be from hands-on seminars, Type II credits can include anything from online seminars to watching a video to chatting with another doctor about HIO. If you live in California, forget it. The Golden State doesn’t accept any online CEUs.

State boards question how online education can be of the same quality as face-to-face sessions. To combat that concern, online course providers have created technological tools that not only encourage participation, but, in many cases, require it.

“Once they’re in their (online) class it’s almost more interactive than a live seminar where doctors are able to kick back and just listen,” says Dr. Laurie Hogard, director of continuing education with the Palmer Institute for Professional Advancement.

Hogard contends that, unlike live classes that only verify attendance, online programs require active participation.

“The doctor has to work his way through the different elements of each unit in order to complete the class,” she explains. “So the doctor is being actively engaged, working through the material and assignments and answering questions that are posed to him. When live chats are scheduled, doctors are having structured discourse with other members in the class.”

Course material is divided into small timed units called modules. The student has to spend a minimum amount of time in each module before passing a multiple choice test, qualifying him to move on to the next section.

“One of the concerns that we’ve encountered in dealing with the various state licensing boards has been the issue of how do we know that the doc is actually spending an hour with the material,” observes Dr. Richard Saririto, continuing education director at the University of Bridgeport College of Chiropractic.

UBCC, which sponsors ChiroCredit’s programs, allayed those concerns by not only timing the material, but also by making sure it was of sufficient length and depth so that the students have to spend the required amount of time working on it, says Saririto.

Providers of online learning have also had to deal with another criticism—where’s the give and take of class discussions?

To make up for the lack of human interaction that many consider necessary for learning, online courses often facilitate communication between students and instructors. Nearly all allow the student to send email questions to the instructor. Some use “threaded” discussions in which participants can post comments that can be seen by all students, creating an on-going discussion that is often moderated by the teacher.

An increasingly popular innovation is the chat room that allows text communication between a group of people in real time—a sort of virtual hallway conversation.

“You can go in and ‘speak’ to the instructor at a set time,” says Dr. Patrece Frisbee, CEO of TheCEU.com. The Miami-based start-up plans to provide CE credit not just to DCs, but to other health professionals, including medical doctors, nurses and massage therapists. “The instructor will say that Wednesday night I’ll be available from 8 to 9 p.m. We’ll send emails to everybody who’s taking the course and they can go on and ‘speak’ to the instructor directly,” adds Frisbee.

The CEU.com and other providers such as The Palmer Institute and ChiroCredit do not limit their offerings to online courses alone. They are following the example of more traditional educational institutions that realize that not everything can be taught effectively in cyberspace.

“In most cases (college and universities) are redesigning their curriculums to have both in-class and face-to-face learning in combination with web-based learning,” says Karen Gage, vice president for marketing with WebCT, a Lynnfield, Mass.-based provider of online learning software. “They’re looking at hybrid models that take advantage of the web to enhance what they’re already doing.”

Examples of “blended learning” include Palmer’s Certified Chiropractic Sports Practitioner (CCSP) program. Formerly an in-person course that required 10 weekends, it has been redesigned to take advantage of web technology.

“With the online (programming) we’re able to cut the course down to five intensive hands-on live weekends, and put more of the academic material online,” explains Hogard.

Experts agree that courses which predominantly use lecture material can be easily presented online. Those that require feedback or hands-on practice are another matter.

“I can’t see it being used for learning a technique,” says Dr. Margaret Finn, a New York Chiropractic College faculty member and educational director for BrightCourse, a private firm that offers online courses in applied pharmacology and radiology. “You need the feedback of the patient and the feedback of the instructor,” she adds.

The concept of distance education is nothing new. A century ago the nation’s biggest colleges and universities started offering correspondence courses by mail. Most failed, but the concept didn’t disappear. In fact, Thomas Edison State College in New Jersey was founded as an exclusively distance learning institution, first using video and mail, and now the Internet.

One of its most popular programs is a degree program for nurses that shows just how accepting of the new technology the rest of healthcare has become. According to associate dean and director Dr. Susan O’Brien, “I can actually graduate a student that I’ve never seen.”

Today, virtually every profession—from doctors and lawyers to architects and engineers—offers online learning to its members. The big question for the critics is how good is it, really? Can professionals actually learn the skills needed to keep them up-to-date within their specialty?

BrightCourse’s Finn says they can. She divided a class into three segments. One group took the traditional classroom approach, while another did video teleconferencing. The remaining students were enrolled in an online version of the same program.

“I gave them the same exam,” she says. “Even though they had different delivery systems, they all had the same grades.”

Her limited experiment parallels those of other research studies that found that students in online courses did just as well, and sometimes better, than those in more traditional classrooms.
Some of those involved in online learning contend that results are determined by the quality of the instructor as much as by the medium used.

“It’s more a case of learners getting comfortable and teachers learning how to teach more effectively,” says Dr. Ed Laydon, manager of the eTeaching Institute at eCollege, the software provider for Palmer’s cyber education efforts. “Where you get learners who really want to learn, and you have really good teachers who really want to teach, then the technology is not the issue. The teacher is the one who really makes the difference.”

In fact, he maintains that courses using relatively simple tools can be quite effective.

“If you have a nicely organized course with good web links, good reading material, good threaded discussions groups with good questions, and a teacher who actively mentors people, you get rave reviews,” observes Laydon.

Chiropractic’s infant online learning ventures are finding success because of the novelty of their offerings and the ease of their use. Their long-term development will depend on the quality of their programs as users become more sophisticated.

Websites To learn more about online chiropractic continuing education, log on to these continuing education sites and learn about the CEUs (continuing education units) that they can provide for you. Brightcourse, LLC brightcourse.com Canadian Memorial Chiropractic College cmcc.cc Chirocredit chirocredit.com Northwestern Health Services University nwhealth.edu/conted/distlear/dlearn.html Seminar Innovations, Inc. onlinechirocredits.com TheCEU.com theceu.com The Palmer Institute for Professional Advancement palmerinstitute.org

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