For the Good of the Patient

Doctor of chiropractic students gain valuable professional experience through the robust clinical internship program at University of Western States.

At University of Western States (UWS), real-world experience is crucial for students—not only to put into practice what they learn in the classroom, but also to use their knowledge to benefit the community around them.

For doctor of chiropractic (DC) students, much of their out-of-classroom learning begins during clinical rotations in their eighth quarter—after they have completed two-thirds of their degree and have developed a variety of clinical skills and competencies.

All students begin these internships by providing care to patients in the Campus Health Center (CHC), caring for UWS and community members under the supervision and guidance of their attending physician. They practice performing physical exams, delivering adjustments and utilizing physical therapy modalities.

“At this stage, students are still spending most of their time in the classroom and commit to a small amount of time at the CHC—just six hours per week in the eighth quarter,” says Stanley Ewald, DC, MPH, associate dean of the clinical internship program.

Moving into the Community

As interns demonstrate additional clinical proficiencies, they become eligible for clinical rotations at other locations in their 10th quarter. In this stage, students work for 25 hours per week off campus with specialty populations at locations such as drug and alcohol treatment centers and homeless shelters.

Clinical rotation sites include everything from local health care affiliates like DePaul Treatment Center and Compassion Connect, to area hospitals like Oregon Health and Sciences University’s (OHSU) Comprehensive Pain Center, to out-of-state medical centers managed by Veterans Affairs all over the country—as close as Tacoma, Washington, and as far as Cincinnati, Ohio.

“Through sites like Portland Rescue Mission, which provides food, shelter and other care services to men, women and children affected by homelessness, addiction and abuse, residents have access to free treatment—sometimes for the first time in their lives,” says Dr. Ewald.

Darcy Ogloza, UWS DC student, had an internship at Outside In, a social services clinic focusing on helping homeless youth and other marginalized people.

“I was on site twice a week working with lower income and homeless patients,” says Ogloza. “Many of the patients are also asylum seekers and don’t speak English, so a big part of my assistance at Outside In was being able to communicate with them in Spanish.”

After Ogloza graduates, he intends to stay in Portland to work with a practitioner who has a sports background as he likes the rehabilitation aspect of chiropractic care.

“It’s important to provide patients with proper rehab techniques that they can do at home on their own,” says Ogloza. “That’s a more powerful form of healing for so many, since there’s only so much I or any other doctor can do in a 30-minute visit.”

Far-Reaching Value

The clinical rotations provide additional worth and importance to the DC program—not just for students, but for the university and the community as well.

“From an institutional perspective, UWS is able to remain an important collaborator in our community, working with others such as primary medical physicians, massage therapists, acupuncturists and more to provide holistic care,” says Joseph E. Pfeifer, DC, UWS chief clinical excellence officer.

“For patients, we help to improve value and quality of life by using multimodal ways to deal with a variety of health conditions. In the age of the opioid epidemic, this is especially important for the underserved populations to allow them access to healthier, safer and more effective means of managing pain.”

Cascadia Behavioral Healthcare, for example, became interested in partnering with the university’s clinical internship program to help them address a growing population of patients with mental illness—often severe—to try to minimize drug use for pain management.

From an educational standpoint, hands-on and varied experience through clinical rotations helps UWS focus on what is best for DC students. They can build their competencies, first in the controlled environment of the CHC with relatively uncomplicated issues, and progressing to a higher number of patients with more complex challenges, such as mental health concerns, homelessness and other comorbidities.

“Students need real experience with real patients,” says Dr. Ewald. “At the beginning, they get training on each other and other healthy students with little more physical issues than tight muscles. The internships expose them to patients with different and more realistic problems, from malnourishment in the under-insured to liver disease from alcohol abuse.”

Preparing for the Future

By the time DC students reach their 12th and final quarter, they are ready for their preceptorship, in which they cease taking classes and work at an external chiropractic practice, providing strong support for their attending physician. Preceptorships may be located in the Portland area, in another state, or even internationally.

“The preceptorship program gives students the chance to gain remote clinical experience in another facility as long as it meets certain requirements,” says Dr. Pfeifer. “Our students come from a variety of geographical locations, and some want to return to their hometowns to work with local chiropractors or begin preparations to set up their own practices.”

The preceptorship is another opportunity for students to explore another area of interest, such as pediatrics, geriatrics, sports medicine or the underserved. One example is the Returning Veterans Project, a nonprofit started by woman whose son served in Iraq. Through this service, doctors of all kinds sign up and open their schedule to take a certain number of veterans as patients who are treated for free.

“Our goal is to get every intern out into the community,” says Dr. Ewald. “We want them to experience what it’s like to give care to all people, especially those that need us the most. If every doctor out there did their small part to help the less fortunate and underserved, we could make a big difference in this world.”