Journal of Chiropractic Education 2017 (Aug 2) [Epub]
~ FULL TEXT
Stephney Whillier, PhD, Kent Au, MChiroprac,
Louie Feng, MChiroprac, and
Helen Su, MChiroprac
Department of Chiropractic
OBJECTIVE: The shift toward evidence-based health care has reoriented tertiary clinical education in a way that necessitates and incorporates research. This study assesses the inclination and suitability of chiropractic students for research over a 5-year educational program.
METHODS: Research attributes of chiropractic students were assessed in this cross-sectional study using a validated and modified academic self-concept analysis scale. Students in first and final year were assessed in 4 domains: creativity, motivation, self-regulation, and general intellectual ability. Univariable differences were assessed using Welch 2-sample t tests, and multivariable analysis was carried out with multiple linear regression models.
RESULTS: The response rate was 71% (n = 165). First- and fifth-year students scored highly on all 4 domains (80% to 96%). Compared to first-year students, fifth-year students rated themselves significantly lower in 3 of the domains: general intellectual abilities (t = -2.01; p = 0.047), motivation (t = -4.82; p < 0.001), and creativity (t = -3.00; p = 0.003).
CONCLUSION: Research suitability is high in chiropractic students. Both cohorts scored high in all domains despite the disparity between first and fifth years. First-year students outperformed fifth-year students in 3 domains, indicating a potential decline in the inclination to do research over time. However, unaccounted factors, such as the Dunning-Kruger effect, life changes, and "burnout," may have contributed to these differences. Future studies should include questions about stress, fatigue, clinical orientation, and educational environment to inform the interpretation of findings.
KEYWORDS: Chiropractic; Cross-Sectional Survey; Education; Motivation; Research; Students
From the Full-Text Article:
Evidence-based medicine has best been described by
David Sackett as requiring the demonstrated use of the
most current best evidence in patient care. In its practice, it
requires integrating clinical experience and expertise with
patient values and systematic research. In order to practice
successfully within the health care professions, a practitioner
must apply self-directed learning toward tracking
down the best research evidence for clinical care and
appraise the quality of information for its validity and
The implications for evidence-based best practice
extend to private and government health funding. In
recent years, developed countries have seen a move toward
privatization of health care services away from what was
previously managed by the government.  Health care
services, including privatized health care services, paid by
insurance and/or government funding, expect quality
research to validate practice. Practitioners do not need to
necessarily conduct their own original research but do need
to be research literate and critical lifelong learners. It thus
behooves academic institutions to answer to the need to
produce research-literate graduates. It is also important
that students are receptive to this new and important
aspect of clinical teaching.
This study specifically investigates whether the students
attracted to the chiropractic program at Macquarie
University, Sydney, Australia, are oriented toward research
and what 5 years in the program does to their
orientation. In order to direct the development of future
chiropractic cohorts toward evidence-based practice,
quality education on research-intensive techniques and
treatment modalities is required. [5, 6] The Department of
Chiropractic at Macquarie University has over the past 10
years progressively incorporated research methods learning
outcomes into the 5–year program in the form of
critiquing papers and integrating the latest research into
every level of the curriculum plus a stand-alone research
methods unit for health sciences and a research project in
the final year. In 2016, we revised the program to include a
full stream of research methodology through the entire
program, building the learning outcomes to the goal of the
final year research project. While providing the foundations
for students to continue in the field of research, the
program also aims to produce critical thinkers and
evidence-based clinicians. But the question that will help
us to understand the outcomes of this extensive new
program is, are our students receptive to this type of
A study with a similar objective -- to evaluate the self concept
chiropractic students have of themselves as science
students -- was done by Robert Shields.  Shields astutely
pointed out that students attracted to medicine are likely
to be science oriented, but because chiropractic has
historically been philosophically rather than scientifically
underpinned, the same assumption cannot be made of
students entering this profession. However, this research
was done in 1993, and there is a need to investigate the
attitudes of students in 2016 given the increasing pressure
on the profession to leave its philosophical past and
embrace an evidence-based future.
The aim of this study is to compare the academic selfconcept
of chiropractic students at entry level and in the
final year of study in a cross-sectional study design using a
Ethics approval was obtained from the Macquarie
University Faculty of Science and Engineering Human
Research Ethics Subcommittee in 2016 to conduct a
questionnaire-based cross-sectional study on the firstand
fifth-year chiropractic program student cohorts (ethics
Students in the first year (145) and final year (80) of the
5–year chiropractic program at Macquarie University were
invited to participate in this study. Permission to use inclass
tutorial time was granted by conveners for the
completion and collection of the questionnaire in week 12
of the first semester. Students were assured that participation
was voluntary that the results would remain
anonymous with only deidentified grouped data being
used, and that the results of the questionnaire would not
affect their grades.
The academic self-concept in adolescents (ASCA)
questionnaire we used was first validated by OrdazVillegas
et al,  and we modified it by making it more
applicable to tertiary students (available from the authors).
In this modification, we changed "homework" to "work,"
withdrew reference to "school" and substituted "university,"
and removed some of the "school" information that
would not be applicable to university, such as middle
school grade-point average and a list of school-oriented
abilities. The original questionnaire was validated by a
panel of 10 professors in different schools of psychology,
each with a PhD in education. Their study was conducted
at the National Autonomous University of Mexico and
was administered to adolescents with the purpose of
identifying high and low levels of academic self-concept
within a secondary school.
Measurement of academic self-concept, or "personal
perception of self," and how this influences academic
achievement has been shown in a meta-analysis of
longitudinal studies to yield a high correlation between
self-concept and academic outcomes.  Thus, measuring
personal self-perception around science and research is
relevant in that the research suggests that this will influence
academic outcomes. More useful when measuring selfperception
is to have subjects judge their capabilities to
complete tasks rather than how they personally feel about
themselves.  Therefore, we sought to find a questionnaire
that asked task-oriented questions, as this has been shown
to be more predictive of ability. 
The questionnaire comprises 28 items that are rated on
a 5–point Likert scale, informing 4 task-oriented domains:
self-regulation, general intellectual ability, motivation, and
creativity. Self-regulation specifically measures "the positive
attitude students have to the acquisition of knowledge
and the learning process." General intellectual ability
emphasizes "the ability to process information; decompose
it into parts; analyses different aspects of the same reality
simultaneously; synthesize and incorporate experiences
adapted to new situations." Motivation measures "attraction
towards a particular task or objective that encourages
strategy search and analysis required to satisfy the
attraction within an established program." Finally, creativity
measures "the process that generates sensibility to
problems, deficiencies or gaps in knowledge leading to
identify difficulties, and find solutions and make decisions
strategically." The questionnaire also collected demographic
data.  The full survey, as modified for this study,
is available from the corresponding author.
The hard-copy questionnaires were distributed by hand,
completed and collected from the first- and final-year
chiropractic cohorts. Following protocol, the investigators
did not touch the questionnaires until the last student of
the cohort completed and sealed the envelope.
Descriptive statistics were produced for explanatory
variables by each group (year of study). Mean and
standard deviation were reported for continuous variables,
while frequencies and proportions were provided for
categorical variables. Baseline differences between groups
were assessed using Welch 2-sample t test for continuous
variables and Pearson’s chi-square test with Yates’s
continuity correction for categorical variables. Outcome
variables (i.e., factors of academic self-concept) were
described with mean and standard deviation by group.
For each outcome variable, differences between group
were assessed both univariably using Welch 2-sample t
tests and multivariably by fitting multiple linear regression
models. Regression model fitting was achieved by
(1) adding the explanatory variable and all potential confounders,
(2) checking potential collinearity with variance inflation factors,
(3) assessing effect modification by using backward elimination of nonsignificant interaction terms,
(4) removing nonconfounding explanatory variables.
All mean differences from univariable analyses and
regression coefficients from multivariable analyses were
reported with 95% confidence intervals and corresponding
p-values. The assumptions for all statistical tests were
checked as appropriate. All statistical analyses were
performed using the statistical computing software R
version 3.3.1 (R Foundation for Statistical Computing,
One hundred and sixty students completed this study,
representing 71% of possible respondents (92/145, or 63%
first-year students, and 68/80, or 85% fifth-year students).
Statistical evaluation of demographic data are shown in
Table 1. The 2 cohorts were similar in all respects
measured except for the education level of their father
(41% first-year and 65% fifth-year students had a father
with a university degree; χ2
 = 6.13; p = 0.013) and, as can
be expected, the age of the cohort (20.4 ± 3.3 years old for
first-year students and 26.5 ± 4.4 years old for fifth-year
students; t = –9.51, p<0.001).
The data revealed a high casual employment rate in
both cohorts (79% for first-year students and 70% for
fifth-year students; p = 0.262). The majority of both
cohorts also participated in extracurricular activities (69%
for first-year students and 80% for fifth-year students; p = 0.169).
First- and fifth-year students scored highly on all 4
domains, with mean values ranging from 12.0 to 14.4 out
of 15, a score of 80% to 96%. The first- and fifth-year
cohorts were different in 3 of the 4 domains investigated.
That is, first- and fifth-year cohorts were different in self-reported
general intellectual abilities (t = –2.01, p =
0.047), motivation (t = –4.82, p<0.001), and
creativity (t = –3.00, p = 0.003) but not self-regulation
(t = –1.03, p = 0.305) (see Table 2).
rated themselves significantly less able in these 3 domains
compared to first year students. The results of the multiple
linear regression analyses are shown in Table 3. The
regression coefficients represent the mean difference
between the 2 cohorts, controlling for all other variables
included in the model. In general, the results of multivariable
analyses are congruent with the univariable results
reported in Table 2. Although employment status and
engagement in extracurricular activities were found to be
confounders for some of the domains, neither resulted in
any major deviations from the unadjusted results (Table 3).
Many studies have been done on the attitudes that
medical and allied health students have toward research. [11–19]
Studies on chiropractic students’ attitudes specifically have
also been done. For example, Newell and Cunliffe 
conducted such a study on undergraduate students at
McTimoney Chiropractic College and found that 64% of
their 119 student respondents found research interesting,
54% thought it was difficult, and 75% considered chiropractic
research to be necessary. An earlier, smaller study on
70 randomly selected chiropractic students at Sherman
College conducted in 1994 showed a similar belief that
chiropractic research is necessary (71%), while only 51.6%
were interested in research in general, and, interestingly at
that much earlier time, only 19.4% thought research training
should be a part of their training. 
Our study was not so much interested in attitude as in the
attributes that students have that would suit the increasing
research orientation of our Macquarie University chiropractic
program. The ASCA is a validated questionnaire that measures
academic self-concept through the investigation of 4 defined
variables: self-regulation, general intellectual abilities, motivation,
and creativity. In the absence of definitively identified
attributes for being a researcher in the literature, the following
have been suggested: interest, motivation, inquisitiveness,
commitment, sacrifice, excelling, knowledge, recognition,
scholarly approach, and integration.  Universities also
identify attributes such as knowledge and intellectual ability,
personal effectiveness, research governance and organization,
engagement, influence, and impact.  The variables as they are
defined in ASCA and the questions asked in the ASCA
questionnaire align well with these suggested attributes.
The results of our study show that both first- and fifth-year
students do score highly on all 4 domains of self-regulation,
general intellectual abilities, motivation, and creativity, with
a score of 80% to 96%. This indicates that if we assume that
these domains are important attributes of a research-ready
student and that academic self-concept is a good way to
measure these attributes, then the students in both their first
year, recruited to the program, and the students in their final
year, leaving the program, are indeed suited to the evidencebased
chiropractic care that is essential today.
These results concur with those of Shields,  mentioned
in the introduction, who found that the majority of 158
chiropractic students in the first and eighth trimesters at
Los Angeles College of Chiropractic in 1993 (63.9%) had a
positive academic self-concept. He concluded that chiropractic
students show a readiness to "adopt the attitudes
and values of science students . . . such as questioning and
knowing the process of science itself." A study done at the
Palmer College of Chiropractic in Florida in 2008 on 303
students found that 99% of the students thought that
chiropractic research was necessary for growth in the
profession. Only 51% felt that they had the skills to
conduct good research, a self-determined assessment that
the authors felt was possibly inflated and perhaps could be
explained by a "disconnect in their understanding of
research skills and quality research". 
Extracurricular activities and current employment were
associated with higher ratings in all 4 domains across the
student sample. This is a correlation, not a cause-and-effect
relationship, and it would be conjecture to assume whether
having these extra interests improves the outcome or
whether the type of student who would have extra interests
would also perhaps score better in the outcome domains.
What is interesting is that the fifth year students, when
evaluating their personal academic self-concept of their
general intellectual abilities, motivation, and creativity, rated
themselves as less able in these domains compared to the selfrating
that first-year students had of these abilities. An
example would be question 21 of the questionnaire (available
from the authors), where fifth-year students reported less
likelihood of contributing their best efforts in group
activities compared to first-year students. An example of
lowered self-reported creativity in fifth-year students can be
demonstrated in question 25, where fifth-year students admit
to less tendency to generate new ideas without previous
knowledge of a topic compared to first-year students.
What would account for the differences between firstand
fifth-year students? The results are self-reported, so it
may be that the fifth-year students have a better grasp of
their abilities or, said differently, that the first-year
students suffer from the Dunning-Kruger effect. Kruger
and Dunning  first proposed this phenomenon as the dual
burden that people with limited knowledge bear: they jump
to mistaken conclusions, and, without sufficient knowledge,
they are unable to realize this. This was a similar
finding in a study done at the University of Western States
in Portland on 370 students in 2004  where they found
that students who were more exposed to evidence-based
practice in the curriculum did not feel more competent in
retrieving or understanding research literature. They
proposed the possibility of the evolution of an appreciation
of the "complexities of modern research reporting and
a better understanding of their own limitations."
However, a few alternative perspectives in the observation
of these trends must be considered. For example,
motivation and creativity in fifth- and therefore final-year
students may be significantly decreased due to study
fatigue. Or with a shift in focus toward a lifetime career,
academic work may lose priority for final-year students.
Thus, it is not easy to say whether we are dealing with fifth-year
burnout, a more clinical orientation in their thinking
as they move closer to graduating, or cautious and more
measured self-examination on the part of fifth-year
students. It may also be the case that this is an indictment
of the research-based teaching up to now (and prior to the
changes instituted) in the curriculum. A study done in 2015
on the challenges faced by chiropractic higher-degree
researchers using a modified Dundee Ready Education
Environment Measure conducted as an international
survey including high-degree research students at Macquarie
University did find that the students did not think
that undergraduate studies had been a good preparation
for high-degree research courses.  It may even the case
that the younger generation is actually more science/research oriented to begin with. In the absence of
longitudinal data, it is impossible to say for sure what
the reason for these differences could be, and repeated
research using the ASCA assessment tool is warranted.
It may have been beneficial therefore to also ask
questions around the education environment, levels of
energy, stress, and fatigue, as this could inform the
outcomes. It is interesting that Shields5 did find similar
but not significant differences between first- and eighthtrimester
students in his study, with 69% of first- and only
58% of eighth-trimester students reporting a positive
In addition, an analysis of the influence of some of the
demographics that could impact these outcomes could not
be made, as some of the data were incomplete and excluded
these demographics from further analysis. These included
personal interests, socioeconomic status, and birth order.
The questionnaire used a fairly indirect method to
ascertain research readiness. Additional, more direct
questions may actually have led to useful information
using simple questions such as "I would consider
conducting research in the future for chiropractic."
Further, the results of the questionnaire would have been
easier to interpret if such variables as the education
environment, fatigue, burnout, enthusiasm, optimism, and
so on had been addressed. A modified Dundee Ready
Education Environment Measure questionnaire may be a
necessary adjunct to the questions asked of students.
Our study is cross-sectional, which limits us to drawing
conclusions based on the respective cohorts at 1 point in
time. In the future, a longitudinal study may be conducted
as the current 2017 first-year cohort, which is now exposed
to the full research stream component of the program,
reaches final year. This result will be more accurate in
determining the state of the students’ mindfulness toward
research as well as determining whether the changes that
have been implemented to create a continuous research
stream in the program have beneficial effects with regard
to improved attributes for becoming lifelong researchers
during their professional lives.
This study found that the majority of chiropractic
students display the attributes of self-regulation, general
intellectual abilities, motivation, and creativity that would
be well suited and oriented to a research and evidence–based chiropractic curriculum. For reasons that require
further elucidation through research, the final-year students’
self-perception indicated a less oriented attitude toward
these domains compared to the entry-level students
Dr. Reidar P. Lystad is thanked for his assistance with
FUNDING AND CONFLICTS OF INTEREST
The authors report no conflict of interest in this
research. This research did not receive any specific grant
from funding agencies in the public, commercial, or notfor-profit
About the Authors
Stephney Whillier is a lecturer in the Department of
Chiropractic at Macquarie University (Department of Chiropractic,
Faculty of Science and Engineering, Macquarie University, Sydney, 2109; email@example.com).
Kent Au firstname.lastname@example.org, Louie Feng (louie.
email@example.com), and Helen Su (firstname.lastname@example.org)
are first-year graduates of the chiropractic program at
Macquarie University. Address correspondence to Stephney
Whillier, Department of Chiropractic, Faculty of Science and
Engineering, Macquarie University, Sydney, 2109; stephney.
email@example.com. This article was received January 13,
2017, revised March 18, 2017, and accepted March 23, 2017.
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