Factors related to the resignation and migration of physicians in public health administration agencies using nationwide survey data in Japan.

BACKGROUND: Physicians in public health administration agencies (public health physicians: PHP) play important roles in public health; however, there are not enough such physicians in Japan. This study aimed to elucidate the factors related to the resignation and migration of PHPs using nationwide survey data. METHODS: Data from the Survey of Physicians, Dentists, and Pharmacists (2010, 2012, 2014, and 2016) were analyzed. The outcome was the resignation of PHPs or migration to public health administration agencies. The explanatory variables in the resignation analysis were age, sex, workplace, and board certification status. The type of work was added as an explanatory variable in the migration analysis, and clinical specialty was added to the clinical doctor-restricted analysis. The odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. RESULTS: In the resignation analysis among PHPs, women had a significantly lower OR, whereas younger PHPs and those with board certifications had significantly higher ORs. In the migration to public health administration agencies analysis among medical doctors, women and those aged between 35 and 39 years had significantly higher ORs, but those with board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff and 'others/not working' had significantly higher ORs. In the migration to public health administration agencies analysis among clinical physicians, those aged between 35 and 39 years had significantly higher ORs. Still, those with two or more board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff had significantly higher ORs. Clinical doctors specializing in surgery and other specialties had significantly lower ORs, but those specializing in pediatrics and psychiatry/psychosomatic medicine had significantly higher ORs. CONCLUSIONS: Having board certifications were significantly related to the resignation of PHPs and migration to public health administration agencies. Women migrated to public health administration agencies more than men and younger PHPs were more likely to resign. However, medical doctors aged between 35 and 39 years were more likely to migrate to public health administration agencies. Similarly, clinic staff, non-clinical physicians, and those whose specialties were pediatrics and psychiatry/psychosomatic medicine were more likely to migrate to public health administration agencies.

Adherence to interdisciplinary tumor board recommendations as an expression of quality-assured patient care: results of a bicentric German analysis.

PURPOSE: Interdisciplinary tumor boards (ITBs) represent a central part of standard cancer care defining a guidelines-guided treatment plan adapted to the patient's capabilities, comorbidities and wishes in a multi-professional team. The implementation rate of ITB recommendations can be monitored by structured adherence analyses. But (inter)national definitions how to measure the level of implementation are missing. Here, we present results of 4 years of ITB adherence analyses in a bicentric German Comprehensive Cancer Center (CCC). METHODS: Between 2018 and 2021, for at least 1 month, the implementation rate of recommendations of 8 different ITBs of 2 CCC sites was evaluated manually according to harmonized criteria between both sites regarding the degree of implementation of ITB's recommendations. RESULTS: In total, 1104 cases were analyzed (65% male, 35% female). Mean distance from patient's home to the CCC was 57 km (range 0.8-560.6 km). For 949 cases (86%) with known follow-up, the adherence rate was 91.9% (95% CI 0.9; 0.935). In 8.1%, ITB decisions were not implemented due to medical reasons (45.4%), patient's wish (35.1%) and unknown reasons (19.5%). Logistic regression revealed neither age (OR = 0.998, p = 0.90), nor gender (OR = 0.98, p = 0.92) or the distance from patient's home to the CCC (OR = 1.001, p = 0.54) were significantly associated with ITB adherence. CONCLUSION: ITB adherences analyses can serve as a quality management tool to monitor the implementation rate of ITB recommendations and to stay in contact with practitioners, other hospitals and state cancer registries to share data and resources in accordance with data protection requirements for continuously improvement of quality management and patient care.

Deforestation, certification, and transnational palm oil supply chains: Linking Guatemala to global consumer markets.

Although causal links between tropical deforestation and palm oil are well established, linking this land use change to where the palm oil is actually consumed remains a distinct challenge and research gap. Supply chains are notoriously difficult to track back to their origin (i.e., the 'first-mile'). This poses a conundrum for corporations and governments alike as they commit to deforestation-free sourcing and turn to instruments like certification to increase supply chain transparency and sustainability. The Roundtable on Sustainable Palm Oil (RSPO) offers the most influential certification system in the sector, but whether it actually reduces deforestation is still unclear. This study used remote sensing and spatial analysis to assess the deforestation (2009-2019) caused by oil palm plantation expansion in Guatemala, a major palm oil source for international consumer markets. Our results reveal that plantations are responsible for 28% of deforestation in the region and that more than 60% of these plantations encroach on Key Biodiversity Areas. RSPO-certified plantations, comprising 63% of the total cultivated area assessed, did not produce a statistically significant reduction in deforestation. Using trade statistics, the study linked this deforestation to the palm oil supply chains of three transnational conglomerates - Pepsico, Mondelez International, and Grupo Bimbo - all of whom rely on RSPO-certified supplies. Addressing this deforestation and supply chain sustainability challenge hinges on three measures: 1) reform of RSPO policies and practices; 2) robust corporate tracking of supply chains; and 3) strengthening forest governance in Guatemala. This study offers a replicable methodology for a wide-range of investigations that seek to understand the transnational linkages between environmental change (e.g. deforestation) and consumption.

Gaps and Challenges in Harnessing the Benefits and Opportunities of Indigenous Certification for a Sustainable Communal Commercial Lobster Fishery.

The Marshall Decision of Canada's Supreme Court inspired the Mi'kmaq in the 1700s regarding recognizing fishing rights to the Mi'kmaq communities. Despite this recognition, the Mi'kmaq communities did not have access to commercial fisheries due to the denial of absolute recognition of territories and rights and underrepresentation and participation in resource allocation, governance, and decision-making processes. A potential approach to these issues is the development of third-party Indigenous community-based sustainability certification standards for the American lobster (Homarus americanus) commercial fishery of Nova Scotia by Mi'kmaq communities. An Indigenous certification is a market-based tool that focuses on a holistic approach to the sustainability of the resource, followed by independent accreditations and standards. This study identifies the gaps, challenges, and opportunities of Indigenous-based certifications for the American lobster commercial fishery. We adopt a participatory approach to conventional policy analysis and perform a secondary analysis of existing legal and scientific resources to glean valuable information for supporting the establishment of an Indigenous certification for the American lobster. Certification could provide benefits such as increased control over fisheries management, governance, rights, and socioeconomic interest, building capacity for Mi'kmaq communities, and improving stakeholder relationships. However, there are issues with the entry points of certification for Indigenous peoples related primarily to the dominant actors in accreditation. This study will support further research and engagement of the Mi'kmaq people toward developing an Indigenous certification scheme.

Family Physicians with Certificates of Added Competence in Palliative Care Contribute to Comprehensive Care in Their Communities: A Qualitative Descriptive Study.

Background: Since 2015, the College of Family Physicians of Canada has certified enhanced skills in palliative care (PC) with a certificate of added competence. Aim: This study aimed to describe the ways family physicians with enhanced skills in PC contribute within their communities, the factors that influence ways of practicing, and the perceived impacts. Design: Secondary analysis of data from a multiple case study on the role and impacts of family physicians with enhanced skills (i.e., PC physicians) was undertaken. Setting/Participants: Interviews were conducted in 2018 to 2019 with PC and generalist family physicians and residents associated with six family medicine practice cases across Canada. An unconstrained qualitative content analysis was performed. Results: Twenty-one participants (nine PC physicians, five generalist family physicians, two residents, and five physicians with enhanced skills in other domains) contributed data. PC physicians worked by enhancing their own family practice or as focused PC physicians. Roles included collaborating with other physicians through consultations, comanaging patients (shared care), or assuming care of the patient as the main provider (takeover). PC physicians increased capacity among their colleagues, with some patient care and education activities not being remunerated. Funding models and other structures were perceived as incentivizing the takeover model. Conclusion: Family physicians with enhanced skills in PC contribute to comprehensive care through the end of life. Remuneration should support system capacity and relationships that enable family physicians to provide primary PC especially outside the takeover model.

Sustainability issues along the coffee chain: From the field to the cup.

The coffee industry is one of the most important commercial value chains worldwide. Nonetheless, it is also associated to several social, economic, and environmental concerns that impair its sustainability. The present review is focused on these main sustainability concerns from the field to the coffee cup, as well as on the strategies that are being developed and/or implemented to attain sustainability and circular economy principles in the different chain segments. In this context, distinct approaches have been applied, such as sustainable certifications (e.g., voluntary sustainability standards), corporate sustainability initiatives, direct trade, relationship coffee concepts, geographical indication, legislations, waste management, and byproducts valorization, among others. These strategies are addressed and discussed throughout this review, as well as their recognized advantages and limitations. Overall, there is still a long way to go to attain the much-desired sustainability in the coffee chain, being essential to join the efforts of all actors and entities directly or indirectly involved, namely, producers, retailers, roasters, governments, educational institutions (such as universities and scientific research institutes), and organizations.

Aboriginal Women Learning on Country: Lessons for Educators.

Introduction: This paper details the journey of eight Aboriginal women from Circular Head, a rural and remote area of North-West Tasmania, as they undertook an innovative 2-year program of tertiary studies in dementia to address a documented community need. The Chief Executive Officer of the Circular Head Aboriginal Corporation (CHAC) had identified difficulties being experienced by older members of the community. These difficulties included changes in behavior, memory, and communication, with profound consequences on social engagement and care needs from both individual and community perspectives. The community wished to know if a combined vocational and university program, completed on Country and in community, could serve as a culturally safe education pathway to empower Aboriginal members of a rural and remote area in providing community health and dementia education and care. Methods: The nationally funded program included a year-long face-to-face vocational Certificate III in Individual Support (Aging, Home, and Community) on Country, including within-community experience with adults with dementia. This face-to-face learning was combined with online study in the award-winning Bachelor of Dementia care offered by the University of Tasmania. Students received a PhD level stipend to support them in their studies and were guided by an Elder from their community. Results: All students completed their Certificate III. The number of units they completed toward the eight required for their Diploma of Dementia Care varied. Emergent themes from students' reflections were holistic and relational, highlighting achievements and challenges, the importance of on Country individual connections and community support, and the value of their current and future contributions to the community. Data from this mixed methods approach documented the impact of the innovative coupling of authentic, culturally appropriate experiential learning with broad and deep academic knowledge about dementia and evidence-based care. Conclusions: This program provided students with a work-related qualification embedded within a university education and increased the capacity and capability of this Aboriginal community to provide care for its members with dementia, a documented concern. The combination of vocational learning on Country with online university study established a pathway to improve students' access to and success in higher education and the professional workforce. This assisted in counteracting the negative influences of racism, stigma, rurality, and socio-economic marginalization on educational opportunity for Aboriginal people. Data showed the need for flexibility with this learning journey, and the strengths and resilience of these women as they learned.

A report of the AGCPD task force to evaluate associations between select admissions requirements, demographics, and performance on ABGC certification examination.

Graduation from a genetic counseling graduate program accredited by the Accreditation Council of Genetic Counseling and certification obtained by passing the American Board of Genetic Counseling (ABGC) certification examination are increasingly required to practice as a genetic counselor in the USA. Despite the ABGC certification examination serving as a gateway to the genetic counseling career, there have been no research studies to date that have examined what variables are associated with examination performance. Therefore, the Association of Genetic Counseling Program Directors established a Task Force to assess whether trainee demographics, Grade point average (GPA) and Graduate Record Exam (GRE®) percentile scores are associated with passing the ABGC certification examination on the first attempt. We surveyed accredited genetic counseling graduate programs in North America and gathered demographic data, admissions variables, and certification examination outcome data for 1,494 trainees from 24 training programs, representing approximately 60.5% of matriculants between 2007 and 2016. Univariable analysis was performed to assess associations between admissions variables and categorical outcome (pass vs. fail) on the certification examination using Wilcoxon rank-sum or Fisher's exact test. Variables significantly associated with the categorical board outcome were then entered in a stepwise model selection procedure. In stepwise logistic regression, trainees with higher GPA (OR = 3.41; 95% CI = 1.99, 5.83), higher verbal (OR = 1.02; 95% CI = 1.01, 1.03) and quantitative (OR = 1.02; 95% CI = 1.01, 1.03) GRE® scores, female trainees (OR = 2.95; 95% CI = 1.70, 5.12), and White trainees (OR 3.37; 95% CI = 2.14, 5.30) had higher odds of passing the certification examination on the first attempt. As programs move to a holistic approach to graduate admissions in order to improve access to the genetic counseling profession, our results may influence programs to provide additional preparation for the certification examination for all trainees. In addition, genetic counseling professional organizations should continue to work together to assess and eliminate outcome disparities in admissions, training, and certification processes.

[Management system and development strategy of quality Chinese medicine].

The development of quality Chinese medicine is an important way to improve the quality of Chinese medicine, and ensure the safety and effectiveness of Chinese medicine. This article systematically elaborates the definition, classification, standard and mana-gement certification strategy of quality Chinese medicine. We present the quality Chinese medicine which is higher quality than that of eligible Chinese medicine based on quality control standards. Quality Chinese medicine is strictly in accordance with management procedures, likely GAP and GMP et al, during the productive process, which quality indicators is higher than that of the current relevant national quality standards, such as Chinese Pharmacopoeia(ChP) et al; its limited indicators such as exogenous pollutants and endogenous toxic substances are lower than that of the current relevant national quality standards, likely ChP et al; meanwhile these Chinese herbal medicine, medicinal pieces, patent medicines, and health products and foods with Chinese medicine raw materials are been certificated by quality Chinese medicine. At the same time, this article systematically expounds the five major management systems of quality Chinese medicine, including technical training management for practitioners, productive process management, standard mana-gement, quality inspection and certification management, and product traceability management. And we put forward strategies to improve the supervision and management system, and promote the standardization and development of quality Chinese medicine by improving the technical management system of quality Chinese medicine, strengthening the quality management system and six sigma(6σ) management in the company. These strategies will provide a reliable basis and effective way to improve the quality of Chinese medicine.

El médico Homeópata y la Homeopatía. Reflexiones del Doctor Vicente Rosas Landa Lechuga / The Homeopathic physician and Homeopathy. Reflections of Doctor Vicente Rosas Landa Lechuga

La historia e identidad de toda profesión se construye a través de la experiencia de quienes la integran. La profesión médico homeopática y la Homeopatía mexicana cuentan, a lo largo de más de 127 años, con una amplia gama de hechos y situaciones acaecidas en nuestro país y que nos permiten caracterizarla. Tener la posibilidad de que los propios actores puedan compartir de viva voz su vida profesional, resulta invaluable para las futuras generaciones. A través de este documento se presenta una entrevista al doctor Vicente Rosas Landa Lechuga, personaje muy significativo para la comunidad médico homeopática, sobre diversos temas relevantes respecto a la profesión y al campo de la Homeopatía.

The history and identity of every profession is built through the experience of its members. "The homeopathic medical profession and Mexican Homeopathy, over more than one hundred and twenty-seven years, have undergone a wide range of events and situations that occured in Mexico and therfore, allow us to characterize it. Having the possibility of the actors themselves to share their professional lives, is invaluable for future generations. Through this document, an interview is conducted to Dr. Vicente Rosas Landa Lechuga, a very significant person for the homeopathic medical community, on various relevant topics about the profession and the field of Homeopathy.

Management system and development strategy of quality Chinese medicine / 中国中药杂志

The development of quality Chinese medicine is an important way to improve the quality of Chinese medicine, and ensure the safety and effectiveness of Chinese medicine. This article systematically elaborates the definition, classification, standard and mana-gement certification strategy of quality Chinese medicine. We present the quality Chinese medicine which is higher quality than that of eligible Chinese medicine based on quality control standards. Quality Chinese medicine is strictly in accordance with management procedures, likely GAP and GMP et al, during the productive process, which quality indicators is higher than that of the current relevant national quality standards, such as Chinese Pharmacopoeia(ChP) et al; its limited indicators such as exogenous pollutants and endogenous toxic substances are lower than that of the current relevant national quality standards, likely ChP et al; meanwhile these Chinese herbal medicine, medicinal pieces, patent medicines, and health products and foods with Chinese medicine raw materials are been certificated by quality Chinese medicine. At the same time, this article systematically expounds the five major management systems of quality Chinese medicine, including technical training management for practitioners, productive process management, standard mana-gement, quality inspection and certification management, and product traceability management. And we put forward strategies to improve the supervision and management system, and promote the standardization and development of quality Chinese medicine by improving the technical management system of quality Chinese medicine, strengthening the quality management system and six sigma(6σ) management in the company. These strategies will provide a reliable basis and effective way to improve the quality of Chinese medicine.

Certification as support for resilience? Behind the curtains of a certification body - a qualitative study.

BACKGROUND: Certification in healthcare often involves independent private sector bodies performing legally required or voluntary external assurance activities. These certification practices are embedded in international standards founded in traditional beliefs about rational and predictable processes for quality and safety improvement. Certification can affect organizational and cultural changes, support collaboration and encourage improvement that may be conducive to resilient performance. This study explores whether ISO 9001 quality management system certification can support resilience in healthcare, by looking at characteristics in the objectives, methods, and practice of certification from a certification body's perspective. METHODS: One of Norway's four certification bodies in healthcare was studied, using an explorative embedded single-case design. The study relies on document analysis of the international standards and associated guidances for the performance of certification bodies and thematic analyses of data from 60 h of observations of auditors in three certification processes and nine qualitative interviews with managers and personnel from the certification body. Results from the analyses were compared to identify discrepancies between the written and perceived certification approach and practice. RESULTS: Standards and guidances for certification embed an elasticity between formal and consistent assessments of nonconformities in organizations and emphasize holistic approaches that brings added value. Auditors were then left with the latitude to navigate their auditing strategy during interaction with the auditees. Members of the certification body perceived and practiced a holistic and flexible auditing approach using opportunities to share knowledge, empower and make guidance for improvement. CONCLUSIONS: ISO certification expects structures and systems to ensure consistent and objective certification processes. At the same time, it embodies a latitude to adopt flexible and context-specific certification approaches, as demonstrated by a certification body in this study, to give added value to the certified organizations. Such an ISO 9001 certification approach may support resilient performance in healthcare by nurturing the potential to respond and learn. These results are important for further development of methods that certification bodies use in the auditing encounter.

Corporate Characteristics and Adoption of Good Manufacturing Practice for Dietary Supplements in Japan.

Good manufacturing practice (GMP) is advocated and implemented as a standardized procedure for manufacturing dietary supplements. However, in Japan as a case, only half of the manufacturers in this field so far adopt it. To address this issue, the present study aims to explore the effect of key characteristics of a company on the adoption of and compliance with GMP for dietary supplements. The focus is on the effect of expertise in the pharmaceutical industry. The relationships between company characteristics and the adoption of GMP were analyzed for 90 manufacturers in the dietary supplement industry in Japan. A binomial logistic regression analysis showed that each of the following three factors had a positive and significant effect on the company's adoption of GMP: company size in terms of revenue (odds ratio = 1.04, p = 0.019), possession of a manufacturing license for pharmaceutical products (13.7, p = 0.003), and number of own product categories manufactured (3.93, p = 0.00009). These findings strongly suggest that the company's manufacturing capability of pharmaceutical products works as a key driver for the better adoption of a quality standard in the dietary supplement industry in Japan. Few considerations were made for conditions of the adoption and implementation of GMP. The present study empirically contributes by providing key clues for issues in the dietary supplement industry and by forming a theoretical base for policymakers and the regulatory authorities.

Certified "sustainable" palm oil took the place of endangered Bornean and Sumatran large mammals habitat and tropical forests in the last 30 years.

Tropical forests inhabited by endangered orangutans, rhinos, tigers, and elephants in South-east Asia are threatened by deforestation, including oil palm expansion. Certification has been proposed to label sustainable palm oil production. However, from a remotely sensed time-series and imagery analysis (1984-2020), we discovered that most of the currently certified grower supply bases and concessions in Sumatra and Borneo are located in the 1990s large mammals habitat and in areas that were biodiverse tropical forests less than 30 years ago. In light of this dramatic evidence, we suggest that certification schemes claim for the "sustainable" production of palm oil just because they neglect a very recent past of deforestation and habitat degradation.

[Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]. / Versorgungsabbild des benignen Prostatasyndroms ­ eine Analyse des Dachverbandes der Prostatazentren Deutschlands (DVPZ) e. V.

BACKGROUND: Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients. OBJECTIVES: Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies. MATERIALS AND METHODS: The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner. RESULTS: A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively). CONCLUSIONS: The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.

[Research and development of certified reference material of swertioside].

The standard sample of natural products is an essential standard reference to determine the quality of the product in the quality control of natural products. To develop a certified reference material(CRM) of swertioside according to the Work Guideline for Reference Materials(3): Reference Material-General Principles and Statistical Method for Certification(GB/T 15000.3-2008), swertioside was purified from whole plant of Swertia mussotii by extraction, isolation and Prep-HPLC to obtain certified reference material of swertioside. The structure of swertioside was identified by IR, UV, high-resolution MS, NMR. Thin layer chromatography, optical rotation, elemental analysis and melting point was carried out for the identification. The purity of the prepared sample was tested from different chromatographic elution conditions, thin layer chromatography and HPLC-MS. Swertioside was divided into 140 bottles, with 10 mg per bottle after homogeneity test, stability test and quantitative analysis. This CRM is 7-O-[α-L-rhamnopyranosyl-(1→2)-ß-D-xylopyranosyl]; the homogeneity of the 95% confidence interval was good; the certified purity value was 98.66%, with a relative expanded uncertainty of 0.38%; the storage period was 36 months at 0-8 ℃. Therefore, the CRM of sakuranetin reached the technical requirements of CRM, and was accepted by SAC. Swertioside is successfully developed and can be used for determining content, evaluating test methods, detecting relevant products and controlling quality.

Regulatory Issues of Voluntary Certification of Food Supplements in Russia.

When registering food supplements in Russia, restrictions on the labeling and consumer leaflet contents are tightly controlled by the regulatory agencies. Thus, misleading advertising is the most difficult problem with the turnover of these products if information in the commercials does not correspond to the information on indications for use that were agreed upon during state registration (or sanitary and epidemiologic control). An established procedure of voluntary certification enables additional health claims, thus expanding the information in the label and user leaflet. Voluntary certification is the evidence base for the specific characteristics of the products with regard to their efficacy represented by an independent party. This process allows the manufacturer to inform the consumer about the beneficial properties and efficacy of food supplements and enables the buyer to make an informed choice and to avoid buying counterfeit products by purchasing high-quality safe products with proven efficacy; therefore, the buyer can receive a product that is the best match for his needs and expectations. However, since the mid-2000s, several voluntary certification systems have been developed, approved, and included in the Unified Register of Voluntary Certification Systems maintained by the Federal Agency for Technical Regulation and Metrology, Rosstandart. Thus, manufacturers can choose an authority. In addition to the conventional approach to certification requirements and schemes, various outcomes of approved claims and subsequent certification maintenance are possible. The present article analyzes universal principles of voluntary certification, its legal basis, and authority-specific outcomes of the process.

Revised methodology for the examinations of the National Board of Chiropractic Examiners: Impact on institutions, faculty, and students.

For over 50 years, the National Board of Chiropractic Examiners (NBCE) has administered pre-licensure examinations to chiropractic students and graduates. During this time, the testing process has been continually refined and improved, consistent with the evolving science and practices of standardized testing. NBCE test results are provided to chiropractic program leaders who use these data to improve their curricula as part of their own ongoing efforts to refine and improve the academic programs. Finally, the Council on Chiropractic Education (CCE) requires accredited chiropractic programs to report their NBCE scores to ensure that benchmarks set by the CCE are met. With this symbiotic relationship between the NBCE, CCE, and chiropractic programs (as well as state licensing authorities), it is very important that these groups collaborate and communicate with transparency and diplomacy. In particular, the chiropractic program leaders-and their students as the end users-are vitally interested in monitoring changes at the NBCE and CCE levels that may impact their programs. Recent changes in testing methodology for the NBCE examinations need to be understood and monitored to ensure that they result in their intended outcome, which is greater validity of the testing process. This commentary reflects the views and concerns of 3 chiropractic educational leaders and is intended to facilitate further discussion among chiropractic program leaders toward strengthening the aforementioned symbiotic relationship.

An international stakeholder survey of the role of chiropractic qualifying examinations: A qualitative analysis.

OBJECTIVE: Many countries require examinations as a gateway to chiropractic licensure; however, the relevance of these exams to the profession has not been explored. The purposes of this study were to analyze perceptions of international stakeholders about chiropractic qualifying examinations (CQEs), observe if their beliefs were in alignment with those that society expects of professions, and suggest how this information may be used when making future decisions about CQEs. METHODS: We designed an electronic survey that included open-ended questions related to CQEs. In August 2019, the survey was distributed to 234 international stakeholders representing academic institutions, qualifying boards, students, practitioners, association officers, and others. Written comments were extracted, and concepts were categorized and collapsed into 4 categories (benefits, myths, concerns, solutions). Qualitative analysis was used to identify themes. RESULTS: The response rate was 56.4% representing 43 countries and yielding 775 comments. Perceived benefits included that CQEs certify a minimum standard of knowledge and competency and are part of the professionalization of chiropractic. Myths included that CQEs are able to screen for future quality of care or ethical practices. Concerns included a lack of standardization between jurisdictions and uncertainty about the cost/value of CQEs and what they measure. Solutions included suggestions to standardize exams across jurisdictions and focus on competencies. CONCLUSION: International stakeholders identified concepts about CQEs that may facilitate or hinder collaboration and efforts toward portability. Stakeholder beliefs were aligned with those expected of learned professions. This qualitative analysis identified 9 major themes that may be used when making future decisions about CQEs.

Current state and future directions of the National Board of Chiropractic Examiners.

The objective of this paper is to describe changes made to chiropractic national board examinations in the United States, including methodologies in test scoring, and to discuss future directions in test development and administration being considered by the National Board of Chiropractic Examiners (NBCE). Additionally, this paper serves as an introduction to the articles written by the NBCE staff and published in this issue of the journal. Statistical perspective on the properties of a test are presented, and reasons for the NBCE moving to item response theory for test scoring are described. NBCE consideration of on-demand testing and changes implemented in the Part IV practical examination are also discussed.