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General Chiropractic Council - Test of Competence – Evidence of Practice Questionnaire – June 2021

GCC Test of Competence Evidence of Practice Questionnaire

Your detailsName: Click or tap here to enter text.Email Address: Click or tap here to enter text.Country of Qualification: Click or tap here to enter text.Year of Qualification: Click or tap here to enter text.

IntroductionAll chiropractors wishing to practise in the United Kingdom must firstly register with the General Chiropractic Council (GCC). However, before you are eligible to register, you will need to show us that you meet the standards set out in The Code, Standards of Conduct, Performance and Ethics for Chiropractors (The Code).

Why are you asking me to fill in this questionnaire?This questionnaire forms a key part of your application and your responses will be considered by the TOC assessment panel (the panel) before the Test of Competence interview (the interview). You will be asked questions about it during the interview.

As the applicant it is your responsibility to include the information that we ask you for, we are not be seeking it on your behalf.

Before filling in the questionnaire, please familiarise yourself with The Code, Standards of Conduct, Performance and Ethics for Chiropractors. (June 2016) These are the standards all chiropractors must maintain while they are registered.

How do I fill in this questionnaire?The questionnaire is split into 8 sections, in sections 1 – 7 you are asked to give details on your practise as a chiropractor.

You can type your responses directly into the text boxes or click on the check box to select them.

In this questionnaire we ask you to demonstrate your understanding of The Code by linking aspects of your practice to the standards in it. You are also likely to be asked about The Code during your interview.

You will need to provide specific examples of what you have done in cases where you have taken clinical responsibility. We expect you to complete the questionnaire yourself and without help.

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What evidence must I send to back up the answers I give on the questionnaire?

To support your application, you must provide anonymised patient records to your answers to Sections 2, 3 and 4. Please make sure you clearly label each record so it’s clear which section it relates to. You do not need to provide records for all patients mentioned in Section 1.

All cases or examples must be no more than 24 months old.

We expect you to protect patient confidentiality by anonymising all patient information. If you do not, we will consider whether you have failed to fulfil the duty of confidentiality set out in The Code.

Please note that anonymised patient records will be used for the sole purpose of the Test of Competence. The GCC will not use them for any other purpose nor share them with third parties and they will be retained only in line with our data retention policy.

Please note that patient records are compulsory supporting evidence and must be complete, including case histories.

What if I can’t obtain and anonymise real patient records?If you are an educationist who does not treat patients, we will accept records from clinical cases of chiropractic students you have supervised. Please make sure your role and the actions you took in relation to the patient are made clear. If you are a recent graduate you may use patient notes taken as part of your supervised practical sessions within the course.

We recommend the use of real anonymised patient records where possible. We will accept patient records taken while observing or shadowing chiropractic care as long as this is made clear. Where you have exhausted all other options, you must create patient records based on real patients you have treated or cases you have observed. However, in this case you must ensure this is explicitly stated and provide us with an explanation as to why you have been unable to obtain these.

Please be aware that if you are unable to submit real patient records, your interview will be to longer and more intense to ensure that you meet the standards.

If you have questions or concerns about patient records, please contact the GCC for guidance by email at [email protected].

The maximum word counts given in each section of the questionnaire are mandatory. We are interested in the quality of your response not its quantity and will not consider any words beyond the maximum word count.

What happens when you receive my application and questionnaire?When we receive your completed questionnaire, we will check that you:

have completed all sections provided all required information, and kept within the word count.

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If you have, your application will go forward to the next interview.

It is in your own interest to check your questionnaire before you send it to us. Your application will be delayed, or you may miss the closing deadline, if we need to contact you for more information or ask you to resubmit the questionnaire and you may miss the closing date.

The panel will then consider your responses you have given in this questionnaire before you attend the interview. They will be looking to see how you have demonstrated an understanding of The Code and practising in the UK.

Please be aware that, if you need to resit the TOC, while we will do our best to ensure you are assessed by a different panel, this is dependent on availability and you may be assessed by one or more of the same panel members in your original interview.

What about the interview itself?The TOC assessment interview will focus on:

your responses to this questionnaire your attitude towards ethical issues requirements set out in The Code, specifically where we have

identified differences in content between our standards and those of other chiropractic regulatory authorities.

Also remember… the questionnaire must be typed and emailed to us. We do not accept

handwritten questionnaires or those submitted by post handwritten patient records must be accompanied by a typed transcript in

English to clearly label all diagrams and charts included in your response.

Standards of behaviour we expect from applicantsOur Student Fitness to Practise guidance sets out the standards of behaviour we expect of chiropractic students and prospective registrants. It also outlines the seriousness of behaviours such as plagiarism. If we find an applicant has submitted evidence that it is not their own work, this will raise serious questions about their fitness to register with us.

When you have filled in this questionnaire, please send it, together with your evidence, to:[email protected] g

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Section 1: profile of your caseload This section is designed to give us an insight into:

the scope and breadth of your clinical practice a profile of the patients you have provided chiropractic assessment and care to; and how you collect and analyse data about your professional practice.

Identify 10 patients in your caseload and then fill in the information in the table below about each of those patients. When identifying the patients’ health needs, remember we are interested in the individual’s main health needs which helped you to maintain your knowledge, skills and competence. Example

A 63-year-old overweight male presents to you with mid-thoracic pain and shortness of breath.

On questioning, you find that he has been diagnosed as type-2 diabetic and has been prescribed the appropriate medication. However, he is not compliant with his medication and has continued to over-indulge in both his food intake and his alcohol consumption.

On examination, you discover that he is hypertensive and has multi-level spinal joint dysfunctions.

His identified health needs would involve chiropractic care, a GP referral and possibly a dietician/counsellor.

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Patient Gender Age OccupationHealth needs

(All aspects of clinical and lifestyle care which should be considered in order to support a patient’s expectations, improve their prognosis and overall health.)

1. Male 63 Civil servant

This particular patient presented with mid –thoracic pain and reported that he had been suffering from shortness of breath. The patient’s history revealed that he had been diagnosed with type 2 diabetes and was taking medication for this. On examination the patient was found to have multi-level spinal joint dysfunctions and hypertension. The patient was also overweight.

The patient’s health needs included: chiropractic care and referral to a GP with advice to see a dietician and a counsellor.

You do not need to send patient records for all 10 of these cases.

Patient Gender Age Occupation

Health needs(Might include health problems/ conditions/ injuries you were presented with, what the patient reported to you, information on the symptoms presented, and any medication they were on. Information may also include any past treatments or tests.)

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here to enter text.

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enter text.

10. Choose an item.



Describe here how the above group of 10 patients you have selected, and their health needs have helped you to maintain your clinical and professional knowledge, skills and competence. Link this to our Code. (Maximum total number of words - 600)

Click here to enter text.

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Word count (max 600) = Click here to enter text.

Explain here how you identify your patients’ health needs (Maximum total number of words - 200)



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Section 2: a neuromusculoskeletal case presentation Describe a case in which a patient presented with neurological symptoms and where you suspected or found neurological involvement as a result of musculoskeletal dysfunction. This can be one of the patients you included in section 1 or another patient. You must respond to all aspects of this section from a – l, using a maximum number of 2,000 words for this whole section.

You must send us an anonymised copy of the complete patient record.

a) the case history including the patient profile, presenting complaint, and relevant medical, family and social history

Click here to enter text.b) the methods you used to physically examine the patient and why you chose these methods

Click here to enter text.c) how did you check for, identify and address any extremity conditions if relevant?

Click here to enter text.d) if you obtained further information or carried out further investigations (eg clinical imaging, laboratory tests) on the patient and

why you did this Click here to enter text.

e) your evaluation of the patient’s health and health needs, including any relevant physiological, psychological, and social factors Click here to enter text.

f) your differential diagnosis / rationale for care Click here to enter text.

g) whether the case was: i. suitable for chiropractic treatment, and if so your treatment and management plan based upon your working diagnosis /

rationale for care, the patient, and the likely effects and/or risks of treatmentii. not suitable for chiropractic treatment and the steps you took to ensure ongoing care for the patientClick here to enter text.

h) what you told the patient about the risks of the treatment and the management plan

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i) how you involved the patient in making informed decisions about their careClick here to enter text.

j) your ongoing management of the patient, including the frequency and duration of care, the frequency of patient review / re-evaluation, the evidence for the care used, any outcome measures you used, whether you changed your treatment approach through the course of the treatment and the reasons for thisClick here to enter text.

k) how you applied chiropractic principles and concepts in the assessment and care of the patient Click here to enter text.

l) Which specific, relevant sections of the Code does this refer to? Click here to enter text.

Total word count (max 2,000) = Click here to enter text.

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Section 3: a case presentation in which the patient was considered unsuitable for chiropractic treatment and/ or was referred to another healthcare practitionerDescribe a recent case in which, after clinical evaluation, you concluded that the patient was either unsuitable for chiropractic care or you referred them to another healthcare professional for co-management. This can be one of the patients you included in section 1 or another patient. It should be a different case to the ones you used in sections 2 and 4. Please ensure you complete all components below, using a maximum number of 2,500 words for this whole section.

You must send us an anonymised copy of the complete patient record, together with any referral letter(s).

a) the case history including the patient profile, presenting complaint, and relevant medical, family and social historyClick here to enter text.

b) the methods you used to physically examine the patient and why you chose these methodsClick here to enter text.

c) how did you check for, identify and address any extremity conditions if relevant?Click here to enter text.

d) if you obtained further information or carried out further investigations (eg clinical imaging, laboratory tests) on the patient and why you did this Click here to enter text.


f) your differential diagnosis / rationale for care Click here to enter text.

g) why you concluded that the case:a. was not suitable for chiropractic treatment b. required referral to another healthcare professional and how this would benefit the patient

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h) the actions that you took and your role in the patient’s ongoing careClick here to enter text.

i) how you involved the patient in making this decision and gained their consent


j) the mechanism you used for referring the patient – supply a copy with your questionnaire Click here to enter text.

k) the outcome of the referral and any ensuing modification of your treatment and management plan Click here to enter text.

l) the evidence that informed your practice Click here to enter text.

m) which specific, relevant sections of the Code does this refer to? Click here to enter text.

n) describe the benefits to your patient management of inter-disciplinary cooperationClick or tap here to enter text.


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Section 4: a case presentation in which you concluded that certain techniques were unsuitable(contra-indicated)

Describe a recent case in which, after clinical evaluation, you concluded that some chiropractic techniques should not be used with the patient because they were unsuitable (contra-indicated). This can be one of the patients you included in section 1 or another patient. It should be a different case from the ones you use in sections 2 and 3.Please ensure you complete all components below, using a maximum number of 2,000 words for this whole section.

You must send us an anonymised copy of the complete patient record.

a) the case history including the patient profile, presenting complaint, and relevant medical, family and social historyClick here to enter text.

b) the methods you used to physically examine the patient and why you chose these methodsClick here to enter text.

c) how did you check for, identify and address any extremity conditions if relevant?Click here to enter text.

d) if you obtained further information or carried out further investigations (e.g. clinical imaging, laboratory tests) on the patient and why you did thisClick here to enter text.


f) your differential diagnosis / rationale for care

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g) whether the case was suitable for chiropractic treatment and if so, your management plan based upon your working diagnosis / rationale for care, the patient, and the likely effects and/or risks of treatmentClick here to enter text.

h) why you concluded that the case:i. some chiropractic techniques were contraindicated for this patient ii. how you selected the techniques that you decided to use and how you explained this to the patient


i) how you involved the patient in making this decision and gained their consent to the treatment usedClick here to enter text.

j) your ongoing management of the patient, including the frequency and duration of care, the frequency of patient review / re-evaluation, the evidence for the care used, any outcome measures you used, whether you changed your treatment approach through the course of the treatment and the reasons for thisClick here to enter text.

k) how you applied chiropractic principles and concepts in the assessment and care of the patient Click here to enter text.

l) which specific, relevant sections of the Code does this refer to?Click here to enter text.


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Section 5: definition of acronyms and abbreviationsIn the table below please list all acronyms and abbreviations you have used in both your case presentations and in your supporting patient records.

(Information provided in this section will not be used to assess competence but will inform the review of your evidence.)

Abbreviation/Acronym

Definition Where in your application has this been used? (Please state the document and the particular page(s) it is used on.)





























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Abbreviation/Acronym

Definition Where in your application has this been used? (Please state the document and the particular page(s) it is used on.)





















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Section 6: application of patient management We wish to gain an understanding of the methods of chiropractic patient management you use and how these relate to those specified in our Education Standards. We will not assess this information directly, but it will be used it to inform the interview process. Check one box for column a – c in each row of the table below and give brief details of the contraindications and cross referencing in columns c) and d) to show the following:

a) your familiarity with the techniques/ elements of patient management.

b) how frequently you use them in practice

c) contra-indications to the use of the techniques (if applicable)

d) cross – referencing with your cases (i.e. When was this element of patient management used within the cases you have presented in sections 2 - 4)

e) the outcome measures you use (see final row of the table.)

Patient management (a) Familiarity (b) Frequency of use (c) Contra-indications (d) Cross-referencing

Very familiar

Partly familiar Unfamiliar Frequently Occasionally Never Give brief details Give brief details

Assessment

Case history ☐ ☐ ☐ ☐ ☐ ☐ Click here to enter text.


Physical examination methods

☐ ☐ ☐ ☐ ☐ ☐ Click here to enter text.


Laboratory tests ☐ ☐ ☐ ☐ ☐ ☐ Click here to enter text.


Plain film ☐ ☐ ☐ ☐ ☐ ☐ Click here to enter Click here to enter

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radiographs text. text.

Other forms of imaging (eg CT scans, MRI scans, Ultrasound, DXA scans)



Assessment of extremities



Chiropractic care - manipulation

Soft tissue techniques



Articulatory techniques



Thrust techniques ☐ ☐ ☐ ☐ ☐ ☐ Click here to enter text.


Management of extremity problems



Other chiropractic interventions

Advice, explanation and reassurance



Exercise and rehabilitation



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Multi-disciplinary approaches



Preventive measures ☐ ☐ ☐ ☐ ☐ ☐ Click here to enter text.


Supporting the patient’s health and wellbeing with others



Promoting health and wellbeing



Advising on medications



Advising on nutritional supplements and non-pharmaceutical medicines

☐ ☐ ☐ ☐ ☐ ☐ Click or tap here to enter text.

Click or tap here to enter text.

e) Do you use outcome measures for your chiropractic care? And if so, which outcome measures do you use?


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If you refer out for some methods of assessment (e.g. laboratory tests), please indicate this in your response in the table below.

For each of the three cases you discussed in sections 2 – 4, explain your rationale for choosing the forms of patient management that you used (for assessment and care) and demonstrate their relationship to the CodeMaximum 400 words for each part of this section

Case study referred to in section 2: A neuromusculoskeletal case presentation



Case study referred to in section 3: A case presentation in which the patient was considered unsuitable for chiropractic treatment / was referred to another healthcare practitioner



Case study referred to in section 4: A case presentation in which you concluded that certain techniques were unsuitable (contra-indicated)


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Provide either:

a. evidence of your interpretive notes after having received images or laboratory results; or

b. a reflective summary of the current procedures/protocol that you use when images, imaging reports or laboratory results are received



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Section 7: professional development undertaken in the last three years We are interested in understanding how you function as a self-directed learner. We are interested in any assessment and learning activities that you have undertaken in relation to chiropractic, including: peer review, patient feedback, self-reflection, professional networking, audit, lectures, seminars, conferences, case studies, online learning etc. Include any specific learning activities that you have undertaken in readiness for your potential move to the UK.

If you are a student / new graduate, then please relate the headings below to your development as a student. If you are an experienced practitioner, then relate your answers to your Continuing Professional Development (CPD).

You must respond to all aspects of this section from a – j. Please us no more than 2,000 words for a-h, with a 500 word maximum for both I and j.

a) how you have assessed your learning needs and interestsClick here to enter text.

b) how you have planned your learning Click here to enter text.

c) the learning and development you have undertaken to:i. keep your professional knowledge and skills up-to-date ii. monitor and enhance the quality of chiropractic assessment and care you provide


d) your evaluation of the learning and development you have undertaken

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e) how you have used your learning and development in your practice, and if not, why notClick here to enter text.

f) Give details of any first aid training have you completed (including dates) and the steps taken to ensure that you are competent to administer first aid should the need ariseClick here to enter text.

g) what are your current learning needs?Click here to enter text.

h) which specific, relevant sections of the Code does this refer to?Click here to enter text.

i) give an example and reflect upon how you have used current research to inform your practice. Please reference the research used and explain how you think that this example has benefited both your patient and you.

word count (max 500) = Click here to enter text.


j) give your thoughts on the differences in chiropractic practice in the country you currently practice, or trained if not in practice, and that of the UK. word count (max 500) = Click here to enter text.Click or tap here to enter text.


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Section 8: patient records

Have you submitted real anonymised records either taken when assessing and treating patients or through observing/shadowing chiropractic care?

Yes ☐ No☐

If you answered ‘No’ to the above, please give details of why you have chosen to submit records that you have fabricated and indicate whether these are based on real or hypothetical cases.


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Section 8: declarationSign and date the declaration below to confirm you have read and understood it. Caution: Should any entry on the Register be fraudulently procured or incorrectly made, action will be taken under the provisions of Section 10 of the Chiropractors Act 1994

☐ I declare that all information supplied by me in support of my application for registration with the General Chiropractic Council is, to the best of my knowledge and belief, complete, true and accurate

☐ I understand that the General Chiropractic Council may take steps to verify any such information supplied by me, and that in the event of any such steps being taken, I agree to cooperate fully

☐ I declare that I have read the current General Chiropractic Council’s Code: Standards of conduct, performance and ethics for chiropractors and understand that my actions may be judged against the standards and principles it contains.

Signed:

Date: Click here to enter a date.

If you have a disability within the scope of the Equality Act 2010, we may be able to make reasonable adjustments for the interview if, for example, you have dyslexia, or a visual or motor impairment. Please read our Reasonable Adjustments Policy.

Please provide details below if you need reasonable adjustments made. Please be aware we will need to inform the panel members who will interview you.


Your Evidence of Practice Questionnaire, along with your application, should be completed and returned to [email protected]

If you have any questions about your application or the Test of Competence process, please email using the address above, or phone the registration team on 020 7713 5155.

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Version history

Version Author Date Changes

April 2021 J Button 22/ 04/ 2021 Removal of phone numbers from first table

Added reference to possibility of seeing same panel member for resits. Also added qualification country and date to table at beginning of form

Declaration amended to tick box

Changed some font size to match house style

June 2021 J Button 8 June 2021 Addition of text field in Section 6

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