Certification Update
In 1983, Dr. Gregory initiated the development of the NUCCA certification program. The purpose of the program was to qualify doctors in the NUCCA work and establish a set of standards for all NUCCA doctors to maintain. The certification was also developed to support inter-professional and public identification of quality of service. Its creation came in response to a request for a directory of doctors who had attended NUCCA seminars. Dr. Gregory believed it was important to understand or identify the specific skill levels of the attending doctors in order to have a reliable and safe referral network.
The first configuration of the certification program was solely as a testing process. It became evident that while some doctors had passed the examination, many had not. With little or no feedback provided to the participating doctors, there was increasing resentment when failures occurred. It became clear that there was an increase in the skills and performance of the doctors who participated, and a reduction in the ASC.
The next format or evolution of certification initiated the concept of the certification program serving as a coaching, mentoring, and proficiency testing system. This program was very successful in supporting the growth of NUCCA education. It attracted the largest number of participating doctors in the history of certification. Quality standards fundamental to the NUCCA procedure regarding x-ray imaging and accuracy in the analysis of the ASC were raised, and more consistent and complete reductions have become more effectively performed. Methods of instruction have improved as well as the certification process has become the backbone of our education.
The number of reviewing doctors increased from one to seven during this time. Certified doctors who have participated in the reviewing of candidates' films for levels one and two are Drs. Yardley, Hoeller, Dunn, Friedman, Read, Hasick, and Zabelin; only one doctor, Dr. Marshall Dickholtz Jr., was mentoring and testing at level 3.
During use of this certification program format, several aspects have become evident that require improvements, and specific changes have been requested by the NUCCA membership.
The proposed changes to the existing program are as follows.
- It has frequently been observed that if a candidate at any level is not actively participating in his or her growth and development within the NUCCA procedure, his or her skills are not growing but degenerating. Doctors who have had a particular distinction or level of completion in NUCCA certification will, over time, lose the rigors that were present at the time of the completion of their specific levels of skill or candidacy. Given the initial premise of certification—that is, the creation of a directory with specific distinctions reflecting particular qualities of work—it has become obvious that regular retesting at every level is necessary. Without this reevaluation, the listings on the NUCCA directory cannot accurately reflect current skill levels or capacities.
- Candidates who are not actively participating over a reasonable period of time will lose their candidate status. Merriam-Webster's dictionary defines a candidate as "a student in the process of meeting final requirements for a degree." A process is defined as "something going on." If there is nothing going on, meaning no movement or progress, there is no process and the doctor would not meet the criteria of being a candidate. Reapplication will be necessary for candidates renewing their participation in certification, with resubmissions and seminar participation necessary to regain past levels of completion.
- Certified doctors will also be required to demonstrate certain levels of proficiency and seminar attendance to maintain their NUCCA board certifications. Reapplication for certified doctors who failed to maintain their certifications will be managed with the appropriate logistics, and seminar participation will be necessary to regain their past NUCCA board certification levels.
- Requests for blinded testing will be provided to the membership. However, the logistics of blinded testing throughout all levels of certification within the current structure would make an effective mentoring or coaching relationship impossible. The new format will expand coaching and evaluation capabilities to every NUCCA board-certified doctor. Any certification candidate within this program can ask to work with any NUCCA board-certified doctor. If the candidate is accepted by that certified doctor, that doctor will be able to mentor and evaluate that candidate throughout his or her candidacy up until a final testing submission. The goal will be to prepare and support the learning in a positive environment, enabling the certification candidate to gain the skills and knowledge necessary to submit a final series of films to a review board consisting of up to three NUCCA board-certified doctors. The review would be a consensus of more than one examining doctor. The requirements of the final submission of x-rays will be a set of ten consecutive pre- and post-x-ray series in which seven out of ten will require a reduction of 80% or better. X-rays submitted for any one part as before, may not be used in any subsequent levels of testing and the last x-ray in the series must not be more than 30 days old. The quality of the submissions needs to be consistent with the standards of care reflected in previous levels of testing. This will be primarily a pass or fail submission not intended to be an integral aspect of a doctor's mentoring program.
- Currently, levels one and two of the written certification examinations are being rewritten to reflect both what is written in the NUCCA text book and what is taught in the classes. This rewrite should be completed prior to the next NUCCA conference.
With increasing public demands for the continuity of our finest efforts as well as expanding demands of consistency of research, NUCCA board certification is vital to our education today just as it was in its inception, and is still the finest education in the reduction of the ASC in the entire chiropractic profession. In the months to come as the specific aspects of these changes become implemented, further updates will be posted.
Dr. Marshall Dickholtz, Jr.
Head of Standards and Certification
The NUCCA Certification Program (Presented by Marshall Dickholtz, Jr., D.C.)
The NUCCA Certification Program is an integral part of chiropractic education, training, and development. Becoming proficient in all aspects of X-ray positioning, X-ray analysis, biomechanics, patient evaluation, set up, and adjusting are essential to the reduction of the Atlas Subluxation Complex (A.S.C.).
NUCCA seminars are correlatively designed to work in harmony with every aspect of the certification process and where a doctor's attendance is strongly recommended. By participating in NUCCA seminars and conferences, a doctor is educated and trained by Board Certified NUCCA doctors in the understanding and application of this technique. The Certification Program is designed to create a powerful and effective coaching environment for doctors and to help them further develop their skills in the "real world" of their practice. The certification process redefines the perception of the required accuracy and intricacies of the A.S.C., while honing skills in the performance of the adjustment.
The NUCCA technique and the Certification Program are often viewed as one of the most difficult and rigorous training programs in chiropractic. It requires a paradigm shift regarding techniques to understand that it is the complexity of the cervical biomechanics (including regional neurological mechanisms) that are unrelentingly demanding down to the last fraction of a degree. It is being able to effectively apply distinctions developed and taught by NUCCA to the A.S.C. that allow a doctor the easiest, most predictable, and consistent ability to reduce the C-1 subluxation complex.
The NUCCA Certification Program is volitional, requiring the doctor to generate their activity level with regard to the frequency of testing and submissions. While consistent participation is recommended, there is no fixed schedule that a doctor must adhere to while progressing through certification. The advantage to this is that doctors can grow individually and develop their skills at a pace that is appropriate for them and their practice. The disadvantage is that without imposed completion dates, doctors must be rigorous in establishing their own structure to maintain optimal progress and development.
Doctors who have completed this program and received Board Certification have gained an uncompromised skill in the understanding and correction of the A.S.C.. Through training, a Certified NUCCA Doctor is better able to address the many subtleties associated to the reduction of the A.S.C., versus the management of illusions based in errors and inaccuracies. The completion of the NUCCA Certification Program is time and effort well spent for the difference that it can make in the life of the doctor and their patients.
NUCCA Certification Board Requirements
Part I of Certification Candidate Requirements
Testing is required in written and practical formats. The standards of this part of certification are that the doctor has knowledge and applicable skills in the following areas:
- Understanding of X-ray alignment procedures
- Theory about distortion, magnification and collimation
- Structural identification on X-ray
- X-ray filtration
- Proper X-ray technique and exposures, image quality
- Patient adjusting steps and purpose of the individual steps
- NUCCA Historical perspective
- Use of NUCCA equipment for patient care
- Leg check and Anatometer procedures
- Neurological mechanisms of the cervical region
- Patients positioning for cervical X-rays
A passing grade of 80% is necessary for the written test and practical examination.
X-ray requirements for Candidates in Part I
- Four views of alignment films. Format can be found in the NUCCA text book and past monographs. X-ray equipment must be aligned to NUCCA standards to participate in all three levels of certification.
- Five pre-unanalyzed, consecutive sets of patient X-rays demonstrating necessary protocols for patient placement in all three views (Lateral, Nasium, Vertex).
- Two consecutive sets of both pre and post X-rays, demonstrating necessary protocols for patient placement.
Critical points of consideration include proper exposures, the use of the appropriate filters, proper views of structures, (i.e. posterior arch on the nasal view), and minimal distortions (i.e. rotation and location of structure on the X-ray film). Previously reviewed X-rays may not be resubmitted.
After the first set of five pre films have been approved, an additional requirement of two consecutive sets of both pre and post X-rays need to be submitted. This set of pre and post films is used exclusively for the criteria of patient placement used in the first five sets of films. These are not evaluated for analysis or reduction of the subluxation.
Once doctors have completed and passed the written and practical tests, alignment films, five consecutive pre X-rays, two consecutive pre and post films, they are eligible a candidates for the second part of the NUCCA Board Certification process.
*** All x-rays submitted for certification must be recently produced. The final set of the series (if more than one set of films is being submitted) must be taken within or no more than 30 days prior to the date of the candidate's submission.
*** The fee for candidates to participate in Part I of Certification is $300.00 (effective January 1, 2007), and must be submitted to NUCCA prior to taking the written test or submission of X-rays.
Part II of Certification Candidate Requirements
Testing is required in written and practical formats. The standards in Part II of Certification are that the doctor has knowledge and applicable skills in the following areas:
- Identifying anatomical structures on X-rays for analysis
- X-ray analysis
- Advanced adjusting steps
- Head piece placement
- Adjusting Biomechanics
- Understanding basic types
- Out of pattern subluxations
A passing grade of 80% is necessary for the written test and practical examination.
X-ray requirements for candidates in Part II
- Five consecutive sets of pre X-rays including all the necessary requirements of the Part I series including a complete and accurate analysis.
- Two consecutive sets of pre and post X-rays including all the necessary requirements of the Part I series including a complete and accurate analysis.
Critical points of consideration include identification of all cervical landmarks with appropriate markings, check lines, and listings as per NUCCA protocol. Previously reviewed X-rays may not be resubmitted.
Once doctors have passed the first set of five pre X-rays demonstrating consistently correct placement and analysis, an additional requirement of two consecutive pre and post X-rays are necessary. The pre and post X-ray sets are for positioning and analysis only. These X-rays will not be evaluated for the reduction of the subluxation.
After completing and passing the written and practical examinations, five consecutive sets of analyzed pre X-rays, two consecutive analyzed sets of pre and post films, doctors are eligible as candidates for the third part of the NUCCA Board Certification process. This is the requirement to start Part III Certification.
*** All x-rays submitted for certification must be recently produced. The final set of the series (if more than one set of films is being submitted) must be taken within or no more than 30 days prior to the date of the candidate's submission.
*** The fee for candidates to participate in Part II of Certification is $500.00 (effective January 1, 2007), and must be sent to NUCCA prior to taking the written test or submission of films.
Part III of Certification Candidate Requirements
The standards of this part of the certification are to bring together all the prior development through Parts I and II. Doctors have the opportunity to further refine their X-ray placement and analysis skills while applying this information toward the reduction of the patient's subluxation.
The X-ray submissions of Part III require the same high standard of X-ray positioning and analysis in Parts I and II. Additional requirements include demonstrating a reduction of the subluxation pattern by 80% or better on the post X-ray. The doctor is also responsible to provide biomechanical explanations about the X-rays that are being submitted.
Biomechanical Questions Regarding the Reduction of the C-1 Subluxation
- List the Basic Type of Subluxation and give the characteristics.
- How is it laterality produced and why that factor is significant?
- List the resistances encountered and how to overcome them.
- What frontal plain is the lower cervical angular rotation in?
- Explain the type of mastoid support to be used and why?
- What portion of the mastoid or skull (1) (2) (3) or (4): is placed on the mastoid support areas? (A) (B) (C) or (D). Explain why?
- Which headpiece angle will be used in each case?
- Did you change the adjusting vector, and if so why?
- What aspects of the adjustment do you feel you need to be more conscious of for this subluxation?
- Based on your pre and post X-ray findings would you expect the pattern to remain the same or change? Explain.
- Based on your pre and post X-ray findings would you change the headpiece placement or the adjusting vector in order to achieve a higher degree of correction?
- In comparing your pre and post X-rays, do you feel the patient X-ray placement was accurate? If not, explain.
- Based on the pre and post X-ray analysis and the objective findings, when do you think a re pre X-ray is necessary?
The requirements for the submission of consecutive pre and post X-rays for certification review are as follows:
Steps
- 1 set of pre and post X-rays.
- 2 consecutive sets of pre and post X-rays.
- 3 consecutive sets of pre and post X-rays.
- 4 consecutive sets of pre and post X-rays.
- 5 consecutive sets of pre and post X-rays.
At some point through this X-ray submission process, reductions of all four types of subluxation patterns must be demonstrated. Previously reviewed X-rays may not be resubmitted. At the completion of this series of X-ray review the doctor will achieve NUCCA Board Certification.
*** All x-rays submitted for certification must be recently produced. The final set of the series (if more than one set of films is being submitted) must be taken within or no more than 30 days prior to the date of the candidate's submission.
*** The fee for candidates to participate in Part III of Certification is $1000.00 (effective January 1, 2007), and must be sent to NUCCA prior to submitting films.
X-ray Submissions for Parts I and II are to be submitted to:
Certification candidates in Part I and Part II can choose one of four different review doctors to now send their x-rays in for review. Once films are submitted do not switch from one reviewer to another.
|
Dr. John Dunn |
Dr. Johanna Hoeller |
|
Dr. Russell Friedman |
Dr. Lee Yardley |
X-ray Submissions for Part III are to be sent to:
Dr. Marshall Dickholtz, Jr.
2565 Shermer Road
Northbrook, IL 60062
Phone: (847) 272-1000
For the purpose of clarity, efficiency, and courtesy, all X-ray submissions for any section of certification should include an enclosed letter indicating a request for review and the exact nature of the submission. Example, "enclosed are five sets of X-rays for part one review from É." Please do not assume because your X-rays show up in a reviewing doctor’s office they will know who they are from and what they are for. Also, please separate the individual sets; a piece of folded paper and a paperclip work well. The reviewing doctors are giving generously of their time, so remember a please and thank you can go a long way. Included with all submissions must be a self addressed, stamped return envelope.
Certification X-ray submission Deadlines: All X-rays must be in for review two weeks prior to a NUCCA conference. X-ray submissions will not be reviewed at the conference.
Note:
Only graduate doctors are eligible to participate in the certification program. In the event of failure of the examination, or any part thereof, the candidate is re examined on the part of the examination that is failed without paying an additional fee.
It is advised that a candidate doctor participating in any phase of certification attend a minimum of one NUCCA seminar per year. A doctor who completes a specific part or becomes certified must attend a NUCCA seminar at least once every 3 years to maintain certification in active status. After that time, they will be listed inactive. Doctors who successfully complete the program and are active, will be eligible to qualify as instructors in the NUCCA procedures.
Listing in the NUCCA directory will be as follows:
As doctors complete Parts I and II they will be listed as Certification Candidates having completed that specific level of the certification process. Upon completing the third part, the doctor will be listed as NUCCA Board Certified.
If you have completed Part I or Part II of the certification process or Board Certification prior to the conference, you will receive a certificate of completion at the upcoming conference. Doctors not attending the conference will receive their certification via mail.
Submit payment to:
NUCCA
1489 W. Warm Springs Rd., Suite 110
Henderson, NV 89014