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QEP - Table of Contents

Chapter 1: Introduction and Description of Texas Chiropractic College

  • History of TCC    2
  • Mission, Vision, and Strategic Plan of TCC    3
  • Educational Environment    3
  • TCC Today    4

Chapter 2: History and Description of the QEP Topic Focus

  • Introduction    5
  • Process for Topic Identification    5
  • QEP Title and Definition    8
  • Delegation of Responsibilities    8
  • Anticipated Benefits of the QEP    9

Chapter 3: Literature Review

  • Introduction    10
  • Theories and Models of Clinical Reasoning    10
  • Curricular and Course Models of Clinical Reasoning    12
  • Instruction Strategies to Enhance Clinical Reasoning    15
  • Assessment Methods    16
  • Summary    18

Chapter 4: Developing the QEP

  • Introduction and Conceptual Model    19
  • Steps to Clinical Reasoning    20
  • QEP Design Plan    21
  • Programmatic Outcomes    21
  • Student Learning Outcomes    21
  • Table 4.1 Courses in the QEP Curriculum    23
  • Table 4.2 Teaching Strategies    24
  • Clinical Reasoning Design Plan for Pilot Courses    25
  • Spinal Anatomy    26
  • Clinical Case Applications    28
  • Clinic I    29
  • Orthopedics III    31
  • Implementation of the QEP Across the Curriculum    34
  • Implementation Timeline    44

Chapter 5: Assessment Methods

  • Introduction    46
  • Course Assessment    46
  • Written Examinations    46
  • Electronic Real-Time Student Feedback    49
  • Standardized Patient Encounters    49
  • Case-Based Discussion    49
  • Student Self-Evaluation    50
  • Global Rating Assessment    51
  • Objective Structured Clinical Evaluation    52
  • Programmatic Evaluatio    53
  • Student Course Evaluations    53
  • Diagnostic Thinking Inventory    54
  • Clinical Skills Competency Examinations I and II    54
  • Health Sciences Reasoning Test    55
  • National Board Examinations, Parts I, II, III and IV    55
  • Faculty Interviews    55
  • Core Concept Examinations (Capstone Examinations)    56
  • Knowledge-Based Inference Tool (KBIT)    56
  • Case-Based Discussion    56
  • Assessments and Criteria for Determination of Programmatic Success    57
  • Table 5.3 – Programmatic Outcome # 1    58
  • Table 5.4 – Programmatic Outcome # 2    59
  • Table 5.5 – Programmatic Outcome # 3    60
  • Programmatic Evaluation Schedule    61

Chapter 6: Faculty Development

  • Introduction    62
  • Table 6.1 - Faculty Development Outcomes    62
  • Faculty Development    63
  • Table 6.2 - Previous QEP Faculty Development Activities    63
  • Table 6.3 - Faculty Development of Teaching Strategies    64
  • Table 6.4 - Faculty Development of Assessment Strategies    66

Chapter 7: Institutional Capability for Initiation and Continuation of the QEP

  • Introduction    67
  • Management Structure    67
  • QEP Communications and Marketing    69
  • Project Timeline    69
  • QEP Budget    69

Conclusions 72

References 73


  • Appendix I – QEP Steering Committee    77
  • Appendix II – QEP Subcommittees    78
  • Appendix III – President’s Cabinet    79
  • Appendix IV – Promotional and Educational Materials    80
  • Appendix V – Communications Timeline    81
  • Appendix VI – Project Timeline    82



The goal of Texas Chiropractic College’s Quality Enhancement Plan is to improve teaching and student learning outcomes in clinical reasoning. The topic was chosen based on input from students, faculty, the President’s Cabinet, the Board of Regents and college alumni; institutional objectives set forth in the TCC Graduate document; and student performance on both internal and independent external examinations. The QEP title is “From Student to Clinician: Enhancing Clinical Reasoning Across the Curriculum.”

After the thorough review of the literature on clinical reasoning, a working definition was developed to guide the QEP process: “Clinical reasoning is a problem-solving process that enhances the development of clinical thinking and decision making in patient care. It involves the movement from accumulation of knowledge to the incorporation of skill, expertise and evidence leading to sound clinical judgment.”

Programmatic outcomes related to clinical reasoning focus on integration and application of basic science knowledge with the clinical presentation; introduction and application of clinical reasoning strategies in the pre-clinical setting; and application of clinical reasoning skills in the patient care setting. Evaluation methods were identified to monitor the programmatic outcomes. These methods include, but are not limited to, student course evaluations, Diagnostic Thinking Inventory, Clinical Skills Competency Exams I and II, Core Concept Exams, Health Sciences Reasoning Inventory, National Board Exams parts I, II, III and IV, and faculty interviews.

The full curriculum was reviewed and four pilot courses were selected. The pilot courses are Spinal Anatomy, Clinical Case Applications, Clinic I, and Orthopedics III. The pilot courses will be implemented during the Summer 2009 trimester.

For successful QEP implementation, new courses are being added to the curriculum.  The new courses are Clinical Case Applications I (trimester 3), Basic Communication and History-Taking Skills (trimester 3), Clinical Case Applications II (trimester 4), Advanced Communication and History-Taking Skills (trimester 4), and Clinical Case Applications III (trimester 5). Full implementation will be on a two-track basis.  The full track for incoming trimester one students begins in Fall 2009 and runs from trimesters one through ten.  The second track encompasses the clinical experience and continues through Clinic II, Clinic III and Clinic IV for those students enrolled in the pilot course, Clinic I, culminating in graduation from the Doctor of Chiropractic degree program.

Teaching strategies to enhance clinical reasoning are being integrated into courses by means of standardized patients, case-based learning, team-based learning, faculty modeling, SNAPPS, reflective practice and electronic real-time student feedback.

Assessment of clinical reasoning will be conducted through extended matching, key features and script concordance questions; electronic real-time student feedback; standardized patient encounters; case-based discussions; student self-evaluation; Intern Global Rating; objective structured clinical evaluation; and Diagnostic Thinking Inventory.


The TCC Graduate: An Educational Blueprint for the 21st Century


The complete document "The TCC Graduate: An Educational Blueprint for the 21st Century" is available here. (Updated Fall 2014).

In January, 2006, a task force of Texas Chiropractic College (TCC) faculty and administrators initiated the TCC Graduate Project in response to a charge by the TCC Curriculum Committee to identify the essential abilities of graduates to practice effectively in a changing health care environment.

An environmental scan and literature review was undertaken to identify important trends and drivers for change.

Outcomes-Based Education
An important educational trend is the emergence of outcomes-based education which is characterized by a focus on the product (competencies) and learning outcomes. A key driver is the accountability movement in education.

Evidence-Based Care
Another trend is evidence-based care. This approach to practice integrates clinical judgment and proficiency with the best available external clinical evidence from relevant research in the context of individual patient preferences, values, and predicaments. Drivers for evidence-based care includes the business community, government agencies, consumer groups, third party payers, and the academic community.

Patient-Centered Care
An additional trend is the focus on patient-centered care which emphasizes patients’ needs and feelings and provides for better understanding of the impact of health care decisions on patients’ lives. Drivers for patient-centered care include patient advocacy groups and health professions educators.

Health Care Informatics
A rapidly developing trend is health care informatics. This field deals with resources, devices and methods for optimizing the storage, retrieval and management of health information for problem solving and decision making. Drivers include technology advances, third party payers, the Federal Government, the academic community and consumer groups.

Integrative Health Care
There is an emerging trend toward integrative health care which fosters interprofessional collaboration, communication and respect between and among health professionals. Drivers for integrative health care include consumer demand, the military and Veteran’s Administration, and Complementary and Alternative Medicine (CAM) clinics.

Special Populations Care
Changing trends in population demographics have identified the need for special populations care for such groups as the elderly and the underserved.

Professionalism refers to the ability to carry out professional responsibilities, adhere to ethical principles and be sensitive to a diverse patient population. The topic of professionalism is generating a lot of discussion among regulatory boards and in the academic community.

Quality Improvement
The environmental scan and literature review identified the importance of quality improvement in health care. Drivers for quality improvement includes consumer groups, government agencies, the business community, and the academic community.

Professional Development and Practice-Based Learning
Finally, professional development and practice-based learning are increasingly being discussed by regulatory boards and the academic community as an important issue. This includes the ability to assess one’s own patient care to identify learning needs and to develop a learning plan for improvement.

Educational Outcomes

Goals for Student Achievement and Student Success

The focus of TCC’s mission is to educate practice-ready doctors of chiropractic. One way this is accomplished is by identifying the necessary student competencies in The TCC Graduate: An Educational Blueprint for the 21st Century which will lead to success. This report was initially developed in 2007 and expands on the competencies required by the Council on Chiropractic Education. There are currently nine meta-competencies that provide the framework for this document and the foundation for identifying student success.

Measures of student achievement, including the NBCE results expanded below, are available here.

National Board of Chiropractic Examiners Performance

As a part of the educational experience and as required by most states for jurisdictional licensure, TCC students participate in a series of examinations administered by the National Board of Chiropractic Examiners. These exams are divided into four parts beginning with knowledge in the basic sciences and ending with evaluation of practical clinical knowledge and skill.

TCC's Performance on NBCE Examination

TCC Data All
Date # Tested Pass % Pass
Fall 2014 18 13 72.22% 74.00%
Spr 2014 43 36 83.72% 74.33%
Fall 2013 17 14 82.35% 74.84%
Spr 2013 34 28 82.35% 72.79%
2-Yr Total 112 91 81.25% 73.95%



TCC Data All
Date # Tested Pass % Pass
Fall 2014 22 13 59.09% 73.04%
Spr 2014 39 32 82.05% 70.97%
Fall 2013 18 14 77.78% 72.71%
Spr 2013 28 19 67.86% 71.62%
2-Yr Total 107 78 72.90% 72.01%



TCC Data All
Date # Tested Pass % Pass
Fall 2014 16 14 87.50% 79.88%
Spr 2014 42 28 66.67% 81.72%
Fall 2013 18 15 83.33% 80.74%
Spr 2013 28 22 78.57% 81.37%
2-Yr Total 104 79 75.96% 81.02%



TCC Data All
Date # Tested Pass % Pass
Fall 2014 38 36 94.74% 90.63%
Spr 2014 18 16 88.89% 91.23%
Fall 2013 31 27 87.10% 88.50%
Spr 2013 18 14 77.78% 89.00%
2-Yr Total 105 93 88.57% 89.85%



TCC Data All
Date # Tested Pass % Pass
Fall 2014 14 12 85.71% 89.12%
Spr 2014 37 33 89.19% 85.71%
Fall 2013 21 18 85.71% 88.59%
Spr 2013 31 26 83.87% 89.23%
2-Yr Total 103 89 86.41% 88.03%

TCC Announces New “Center For Institutional Excellence”

(TCC News Release - 4/16/2012)

PASADENA, Texas -- Texas Chiropractic College is excited to announce the launch of its new Center for Institutional Excellence, which is set to begin operations Sept. 3, 2012.

The Center is charged with facilitating the development, monitoring and publication of the College’s Strategic Plan and organizational structure. It is additionally responsible for institutional assessment and accreditation, assessment of student learning, management of institutional policies and ongoing quality assurance. The new Center will absorb the role of the Office of Institutional Effectiveness and the program development responsibilities of Vice President Alan Adams, who is slated to retire from full-time status at the end of the current fiscal year.

"This is a great day for TCC as we announce our new Center for Institutional Excellence," said Dr. Richard G. Brassard, President of TCC. "This Center is the manifestation of the College’s commitment to creating the best experience in chiropractic for our students while also providing a rewarding environment for our employees."

The strategies behind the development of the Center have been based in the Baldrige Model for organizational success and planning strategies from the American Society for Quality.

"Our goal is for Texas Chiropractic College to ultimately be recognized as an international leader among single-purpose, professional schools," noted Dr. Clay McDonald, TCC Provost. "We also want every member of our community, from students to alumni to staff, to take pride in their affiliation with the College."

Dr. Steve Foster, the College’s current Director of Assessment, has accepted the new position of Executive Director of the Center for Institutional Excellence. In his new role, he will take over the monitoring, measuring and reporting of the strategic plan, which is currently managed by the Provost and the Institutional Effectiveness Committee. He will additionally lead the team of the Director of the Assessment Center, Director of Accreditation and Institutional Research, and the Program Coordinator for the Center.

Mrs. Pam Vise, current assistant to Dr. Adams, has accepted the position of Coordinator. She will be providing professional and administrative support to the Center while also sharing her coordinator experiences with the College’s most recent accreditation cycles.

Update: TCC is proud to welcome Dr. Lee Van Dusen as the Director of Accreditation and Institutional Research and Ms. Carla Kruger as the Director of the Assessment Center.

Dr. Van Dusen is a graduate of National College of Chiropractic and served as first Exectutive Director (September 2008 to May 2009) and then President (May 2009 to December 2011) of the Council on Chiropractic Education, the agency recognized by the U.S. Department of Education to accredit chiropractic degree programs. Prior to his work with the CCE, he spent 17 years moving up the ranks at New York Chiropractic College. He started as an assistant professor in 1991 and left in 2008 as the Assistant Vice President of Institutional Quality and Assessment.

Ms. Kruger was the standardized patient coordinator at the University of Texas Health Science Center Medical School for five years before joining the TCC team. Originally from South Africa, she brings a diversity of experiences to the Pasadena campus, including service to the South African Embassy in Belgium and Germany and international sales experience working from Cape Town and New Jersey.

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