american clinical board of nutrition (acbn) …table 7 - hours per week practicing chiropractic...

AMERICANCLINICALBOARDOFNUTRITION(ACBN)DiplomateoftheAmericanClinicalBoardofNutrition(DACBN)RoleDelineationAnalysisReportApril15,2016

TinaFreilicher,Ph.D.,ShorelinePsychometricServices,LLC.

ACBNRoleDelineationSurveyReport–April2016

ShorelinePsychometricServices,LLC. 2

TableofContents

Introduction............................................................................................................................................3

TheRoleDelineationSurvey.............................................................................................................3ResponseRate........................................................................................................................................4

SurveyRespondents’DemographicInformation.......................................................................4ValidityRatingScalesforthePerformanceDomainsandTaskStatements..................12

AnalysisoftheValidityRatingScaleData.................................................................................13PerformanceDomains................................................................................................................................13TaskStatements...........................................................................................................................................15

PreliminaryTestSpecifications....................................................................................................17

SummaryandRecommendations................................................................................................18ReviewofSurveyResultsandFinalizationofTestSpecifications.....................................19IndexofTablesTable1-PerformanceDomainsandNumberofTasks________________________________________________________________3Table2-Gender_________________________________________________________________________________________________________5Table3-Age_____________________________________________________________________________________________________________5Table4-Ethnicity_______________________________________________________________________________________________________5Table5-State___________________________________________________________________________________________________________5Table6-HoursperWeekPracticingChiropracticMedicine__________________________________________________________6Table7-HoursPerWeekPracticingChiropracticNutrition_________________________________________________________6Table8-DiplomateinNutrition________________________________________________________________________________________7Table9-DiplomatefromOtherOrganizations________________________________________________________________________7Table10-DiplomateFromOtherOrganizations-OtherResponses _________________________________________________8Table11-HowDidYouObtainPost-GraduateDiplomateStatus?___________________________________________________8Table12-OtherCertificationsinNutrition____________________________________________________________________________8Table13-OtherCertificationsinNutrition-OtherResponses _______________________________________________________9Table14-NumberofContinuingEducationHoursinNutrition-RelatedTopicsEarnedPerYear_________________9Table15-HighestLevelofNon-ChiropracticEducation______________________________________________________________9Table16-HighestLevelofNon-ChiropracticEducation-OtherResponses ________________________________________10Table17-School _______________________________________________________________________________________________________10Table18-DoYouHaveAGraduateDegreeinNutritionFromaRegionallyAccreditedCollegeorUniversity?__11Table19-TypeofDegreeinNutritionfromaRegionallyAccreditedCollegeorUniversity_______________________11Table20-IncomefromChiropracticNutritionEmployment________________________________________________________11Table21-ValidityRatingScalesforthePerformanceDomains_____________________________________________________12Table22-FrequencyQuestionforthePerformanceDomains_______________________________________________________13Table23-ValidityRatingScalesfortheTaskStatements___________________________________________________________13Table24-PerformanceDomainsDescriptiveStatistics-ImportanceandCriticalityRatings_____________________14Table25-PercentofTimeSpentinPerformanceDomain___________________________________________________________14Table26-TaskStatements-DescriptiveStatisticsofImportance,CriticalityandFrequencyRatings____________15Table27-TaskStatements-NumberandPercentageofImportance,Criticality,andFrequencyRatings_______16Table28-PreliminaryTestSpecifications____________________________________________________________________________18Table29-FinalTestSpecifications____________________________________________________________________________________20



IntroductionThisreportdescribestheanalysisofdatacollectedfromaRoleDelineationsurveythatwasdevelopedandadministeredbytheAmericanClinicalBoardofNutrition(ACBN)fortheDiplomateoftheAmericanClinicalBoardofNutrition(DACBN)ExaminationProgram.TheintentofthereportistoprovidetheACBNwithdatafromthesurveyforthepurposeofupdatingthecontentoutlineandtestspecificationstoreflectcurrentbestpractice.ThereportsummarizesdemographicdataofthesurveyrespondentsandvalidityratingscaledataassociatedwiththeperformancedomainsandtasksofaDACBN.PreliminarytestspecificationsbasedontheratingdataareproducedforreviewandconsiderationbytheACBN.TheShorelinePsychometricServices,LLCwasretainedbyACBNtoperformtheseanalysesandproducethisreport.ShorelinePsychometricServices,LLC.wasinformedbyACBNthataroledelineationstudywasconductedin2010,whichresultedinidentifyingsixperformancedomainsand15tasksdistributedamongtheperformancedomains.Thecontentoutlineandtestspecificationsresultingfromthestudyhavebeenusedforexaminationdevelopmentsince2010.In2015,ACBNdeterminedthatanewroledelineationstudybeperformedtoensurethattheexaminationprogramreflectscurrentbestpracticeinchiropracticnutrition.Therefore,inthefallof2015,theACBNadministeredtheroledelineationsurveytoindividualswithaDACBN.

TheRoleDelineationSurveyTheACBNadministeredapaper-basedsurveytocollectvaliditydataabouttheperformancedomainsandassociatedtasksfromthepopulationofindividualswhoholdaDACBN.Thesurveyincludedsixteen(16)demographicquestionsandthefollowingsixperformancedomainswith15taskstatementsdistributedamongtheperformancedomains(seeTable1):Table1-PerformanceDomainsandNumberofTasks

PerformanceDomains NumberofTasks1. HISTORY 22. EXAMINATION 53. ASSESSMENT 54. DIAGNOSIS 15. TREATMENT 16. FOLLOW-UP 1

TotalNumberofTasks 15



Thesurveyconsistedofthefollowingfoursections:SectionA–DemographicInformation,SectionB–DefinitionofTermsUsedintheRoleDelineationSurvey,SectionC–EvaluationoftheDomains,andSectionD–EvaluationoftheTaskStatements.ThequestionsinSectionAweremultiple-choicequestionsandsomeincluded“Other”asaresponseinwhichsurveyrespondentsweregivenopportunitytoindicate“Other.”SectionsCandDweredesignedtocollectvaliditydataontheperformancedomainsandtaskstatements.Validityratingscales,whicharedescribedlaterinthisreport,wereusedtocollectthesedata.SectionDalsoincludedopen-endedquestionsthataskedwhethertherewereanytasksthatwereoverlookedineachperformancedomain.AllsurveysreturnedtoACBNbythesurveyrespondentswereprovidedtoShorelinePsychometricServices,LLC.fordataentryandanalysis.

ResponseRateShorelinePsychometricServices,LLC.received107surveysfromACBNthatwerecompletedbythesurveyrespondents.ShorelinePsychometricServices,LLC.wasinformedbyACBNthatthesurveywasmailedto295individuals,whichweretheentirepopulationofDACBNsasoffall2015.Therefore,theresponseratewas36.27%.Themarginoferror,orconfidenceintervalatthe95%confidencelevelforthetotalnumberofsurveyrespondentswas+/-7.58.Thisconfidenceintervalisslightlyhigherthantheacceptablerangeof+/-5.00;however,itmaybeduetothesmallpopulationofDACBNs.

SurveyRespondents’DemographicInformationThesurveyincludedsixteen(16)demographicquestionsthatweredesignedtocollectdataaboutthesurveyrespondents’gender,agerange,ethnicity,geographicallocationoftheirpractice,amountoftimespentpracticingchiropracticmedicineandnutrition,credentials,education,continuingeducationandincome.AsindicatedinTable2,themajorityofsurveyrespondents(67%)aremaleand32%arefemale.Onesurveyrespondentselectedbothmaleandfemale.Table3showstheagerangesofsurveyrespondents.Approximatelyhalfofthoserespondingtothisquestion(51%)indicatedthattheyaremorethan55yearsofage.Thirty-ninepercent(39%)ofthesurveyrespondentsindicatedthattheyare46to55yearsold.Intermsofethnicity,themajorityofsurveyrespondentsindicatedCaucasian(78.5%),9.35%indicatedHispanic,and4.67%indicatedBlackorAfricanAmerican.Approximately8%didnotrespondtothissurveyquestion.Intermsofgeographiclocation,asshowninTable4,thesurveyrespondentsarelocatedamong25states,withthehighestnumberofsurveyrespondentsfromFlorida(i.e.,16.82%).



Table2-Gender

Gender Count PercentFemale 34 31.78Male 72 67.29Female&Male 1 0.93Total 107 100.00Table3-Age

Age Count PercentUnder25years 0 025-35years 1 0.9336-45years 8 7.4846-55years 42 39.25Morethan55years 54 50.47TotalNumberofRespondentstoQuestion 105 98.13Didnotrespond 2 1.87TotalNumberofSurveyRespondents 107 100.00Table4-Ethnicity

Ethnicity Count PercentAsianorPacificIslander 0 0BlackorAfricanAmerican 5 4.67Caucasian 84 78.50Hispanic 10 9.35NativeAmerican 0 0Other(Pleasespecify.) 0 0TotalNumberofResponsestoQuestion 99 92.52Didnotrespond 8 7.48TotalNumberofSurveyRespondents 107 100.00Table5-State

State Count Percent1. AR 1 0.932. CA 10 9.353. CO 6 5.614. CT 2 1.875. DE 1 0.936. FL 18 16.827. GA 3 2.808. IL 9 8.419. MA 3 2.8010. MD 3 2.8011. MI 1 0.9312. MN 5 4.6713. MO 1 0.9314. NC 1 0.93



State Count Percent15. NJ 8 7.4816. NM 1 0.9317. NY 10 9.3518. OH 2 1.8719. OR 2 1.8720. PA 4 3.7421. SC 1 0.9322. SD 1 0.9323. TX 9 8.4124. VA 2 1.8725. WI 3 2.80

Total 107 100.00Surveyrespondentswereaskedtoindicatethenumberofhoursperweekpracticingchiropracticmedicine.Approximately24%ofthesurveyrespondentspracticelessthan30hoursperweekinchiropracticmedicine,45%indicatedthattheypractice30to39hoursperweek,22.43%ofthesurveyrespondentspractice40to49hoursperweek,and7.48%ofthesurveyrespondentspractice50to60hoursperweekinchiropracticmedicine.SeeTable6forthesedata.Withrespecttothenumberofhoursperweekpracticingchiropracticnutrition,24.30%ofthesurveyrespondentspracticelessthan15hoursperweek,34.58%ofthesurveyrespondentpractice15to24hoursperweek,25.23%practice25to32hoursperweek,19.63%practice33to40hoursperweek,and4.67%practicemorethan40hoursperweek.SeeTable7forthesedata.Table6-HoursperWeekPracticingChiropracticMedicine

NumberofHoursPerWeekPracticingChiropracticMedicine Count PercentLessthan30hours 26 24.3030–39hours 48 44.8640–49hours 24 22.4350–60hours 8 7.48Morethan60hours 0 0.00Didnotrespond 1 0.93Total 107 100.00Table7-HoursPerWeekPracticingChiropracticNutrition

NumberofHoursPerWeekPracticingChiropracticNutrition Count PercentLessthan15hours 17 15.8915to24hours 37 34.5825–32hours 27 25.2333–40hours 21 19.63Morethan40hours 5 4.67Total 107 100.00



Table8indicatesthatthemajorityofsurveyrespondents(97.20%)haveaDiplomateinNutrition.Table9showsDiplomatestatusfromotherorganizations.Approximately37%indicated“none/doesnotapply,”andthecredentialsthathadthemostresponseswereDABCI(13%),andDACNB(8.51%).Theresponsestotheoption“Other”forthisquestionarepresentedinTable10.Themostcommon“Other”responsewasDABCN,asfive(5)respondentsindicatedthiscredential.NotethatalthoughTable9shows22respondentsindicating“Other,”only12respondentsprovidedaresponseto“Other”(SeeTable9).Intermsofhowsurveyrespondentsobtainedpost-graduatediplomatestatus,morethanhalfofthesurveyrespondents(58.88%)indicatedthatitwasobtainedthroughacouncil,academy,collegeorassociation.Approximately37%oftherespondentsindicatedthattheyobtainedpost-graduatediplomatestatus(orequivalent)throughanACAorICAspecialtyboard(seeTable11).Table8-DiplomateinNutrition

DiplomateinNutrition Count PercentYes 104 97.20No 1 0.93TotalNumberofResponsestoQuestion 105 98.13Didnotrespond 2 1.87TotalNumberofSurveyRespondents 107 100.00Table9-DiplomatefromOtherOrganizations

Diplomateinanyofthefollowingorganizations(Multipleresponses) Count PercentNone/doesnotapply 39 36.45DABCI 13 12.15DABCI&DACBSP 2 1.87DABCO 2 1.87DACAN 1 0.93DACBOH 0 0.00DACBR 1 0.93DACBSP 1 0.93DACNB 8 7.48DACNB&Other 1 0.93Other 22 20.56Didnotrespond 17 15.89Total 107 100.00



Table10-DiplomateFromOtherOrganizations-OtherResponses

Diplomateinanyofthefollowingorganizations-OtherResponses1. ACBN2. ACBN&CBCN3. CBCN4. CCN5. CNN6. DABCN7. DABCNneurology8. DACBN9. DACBN&DCBCN10. DACBN,DABCN11. DCBCN12. DIBAK

Table11-HowDidYouObtainPost-GraduateDiplomateStatus?

Howdidyouobtainpost-graduatediplomatestatus? Count Percent

1. Council,academy,college,orassociation 63 58.882. Council,academy,college,orassociation&Diplomatestatus(or

equivalent)throughanACAorICAspecialtyboard2 1.87

3. Diplomatestatus(orequivalent)throughanACAorICAspecialtyboard 39 36.454. Workingtowarddiplomatestatus(orequivalent)butnotcompleted 0 0.005. Didnotrespond 3 2.80

Total 107 100.00Withrespecttoothertypesofcertificationsheldbythesurveyrespondents,approximately41%indicatedthattheyhavetheCCN,andapproximately13%indicatedhavingtheCNS.Forty-threepercent(43%)ofthesurveyrespondentsdidnotrespondtothisquestion.SeeTable12forthesedata.Theresponsestotheoption“Other”forthisquestionarepresentedinTable13.NotethatalthoughTable12showsthree(3)respondentsindicating“Other,”six(6)respondentsprovidedaresponseto“Other”(SeeTable13).Table12-OtherCertificationsinNutrition

OtherCertificationsinNutrition Count PercentCCN 42 39.25CCN&CNS 2 1.87CCN&RD 1 0.93CNS 12 11.21RD 1 0.93Other 3 2.80Didnotrespond 46 42.99Total 107 100.00



Table13-OtherCertificationsinNutrition-OtherResponses

OtherCertificationsInNutrition-OtherResponses1. CGP2. LD/N3. M.S.4. M.S.BIO/NUTRITION5. MS,NUT.SCIENCE6. RN

AsindicatedinTable14below,42%ofthesurveyrespondentsearn13to20hoursofcontinuingeducationhoursinnutrition-relatedtopicsperyear,and48.6%oftherespondentsearnmorethan20hoursofcontinuingeducationhoursinnutrition-relatedtopicsperyear.Table14-NumberofContinuingEducationHoursinNutrition-RelatedTopicsEarnedPerYear

NumberofContinuingEducationHoursinNutrition-RelatedTopicsEarnedPerYear Count Percent0–6hours 0 0.007–12hours 9 8.417–12hours&13–20hours 1 0.9313–20hours 45 42.0621–30hours 28 26.1731–40hours 16 14.95Morethan40hours 8 7.48Total 107 100.00Withrespecttothehighestdegreeearnedinnon-chiropracticeducation,themajorityofthesurveyrespondents(79%)haveearnedabachelor’sorhigherdegreesinnon-chiropracticeducation,withabachelor’sdegreebeingthemostcommondegree(44.86%),followedbyamaster’sdegree(17.76%)andadoctorate(13.08%).SeeTable15forthesedata.Theresponsestotheoption“Other”forthisquestionarepresentedinTable16.NotethatalthoughTable15showsone(1)respondentindicating“Other,”two(2)respondentsprovidedaresponseto“Other”(seeTable16).Table15-HighestLevelofNon-ChiropracticEducation

HighestLevelofNon-ChiropracticEducation Count PercentHighSchoolDiploma 11 10.28AssociateDegree 8 7.48Bachelor’sDegree 48 44.86Bachelor’sDegree&Master’sDegree 1 0.93Master’sDegree 19 17.76Master’sDegree&Doctorate 1 0.93Doctorate 14 13.08



HighestLevelofNon-ChiropracticEducation Count PercentDoctorate&Other(Pleasespecify.) 1 0.93Other(Pleasespecify.) 1 0.93Didnotrespond 3 2.80Total 107 100.00Table16-HighestLevelofNon-ChiropracticEducation-OtherResponses

HighestLevelofNon-ChiropracticEducation–OtherResponses1. 2Yrs.College2. MD

Table17showstheschoolsinwhichsurveyrespondentsreceivedtheirdoctorofchiropracticdegree.Ofthe26institutionslisted,themostcommoninstitutionsindicatedbysurveyrespondentswere:NationalCollegeofChiropractic(NUHS)(16.82%),NewYorkChiropracticCollege(15.89%),andPalmerCollegeofChiropractic(13.08%).Table17-School

FromWhichSchoolDidYouReceiveYourDoctorofChiropracticDegree? Count Percent

1. Donotholdthedoctorofchiropracticdegree. 1 0.932. Anglo-EuropeanCollegeofChiropractic 0 0.003. CanadianMemorialChiropracticCollege 0 0.004. ClevelandChiropracticCollege,KansasCity 3 2.805. ClevelandChiropracticCollege,LosAngeles 4 3.746. InstituteFrancaisdeChiropractie 0 0.007. LifeChiropracticCollege,West 1 0.938. LifeUniversity,SchoolofChiropractic(LifeCollege) 9 8.419. LincolnCollegeofChiropractic 0 0.0010. LoganCollegeofChiropractic 3 2.8011. LosAngelesCollegeofChiropractic(SCUHS) 9 8.4112. NationalCollegeofChiropractic(NUHS) 18 16.8213. NationalCollegeofChiropractic(NUHS)&PalmerCollegeofChiropractic 1 0.9314. NewYorkChiropracticCollege 17 15.8915. NorthwesternCollegeofChiropractic(NWUHS) 6 5.6116. PalmerCollegeofChiropractic 14 13.0817. PalmerCollegeofChiropractic,West 4 3.7418. ParkerCollegeofChiropractic 3 2.8019. PennsylvaniaCollegeofStraightChiropractic 0 0.0020. QuantumUniversity(SouthernCaliforniaCollegeofChiropractic)(Pasadena

College)0 0.00

21. RoyalMelbourneInstituteofTechnology(PhilipInstituteofTechnology) 0 0.0022. ShermanCollegeofStraightChiropractic 1 0.9323. SydneyCollegeofChiropractic/MaquarieUniversity 0 0.0024. TexasChiropracticCollege 6 5.6125. UniversityofBridgeport 1 0.9326. WesternStatesChiropracticCollege 6 5.61

Total 107 100.00



Themajorityofsurveyrespondents(74.77%)indicatedthattheydonotholdagraduatedegreeinnutritionfromaregionallyaccreditedcollegeoruniversity(seeTable18).Forthosethatholdagraduatedegreeinnutritionfromaregionallyaccreditedcollegeoruniversity,14.95%haveaMasterofScienceand9.35%haveadoctorate(seeTable19).Table18-DoYouHaveAGraduateDegreeinNutritionFromaRegionallyAccreditedCollegeorUniversity?

Doyouhaveagraduatedegreeinnutritionfromaregionallyaccreditedcollegeoruniversity? Count PercentYes 26 24.30No 80 74.77TotalNumberofRespondentstothisQuestion 106 99.07Didnotrespond 1 0.93TotalNumberofSurveyRespondents 107 100.00Table19-TypeofDegreeinNutritionfromaRegionallyAccreditedCollegeorUniversity

Ifyouholdagraduatedegreeinnutritionfromaregionallyaccreditedcollegeoruniversity,whichofthefollowingdegreesdoyouhold?(Checkallthatapply.)

Count Percent

MasterofArts 0 0.00MasterofScience 16 14.95Doctorate 10 9.35Total 26 24.30Didnotrespond. 81 75.70Total 107 100.00Table20showstheincomerangesfromchiropracticnutritionemployment.Approximately24%ofthesurveyrespondents’incomeismorethan$100,000,andapproximately76%earnlessthan$100,000fromchiropracticnutritionemployment.Table20-IncomefromChiropracticNutritionEmployment

Whatisyourincomefromchiropracticnutritionemployment? Count PercentLessthan$10,00 6 5.61$10,000to$19,999 4 3.74$20,000to$29,999 9 8.41$30,000to$39,999 9 8.41$40,000to$49,999 5 4.67$50,000to$59,999 7 6.54$60,000to$69,999 11 10.28$70,000to$79,999 8 7.48$80,000to$89,999 11 10.28$90,000to$100,000 11 10.28Morethan$100,000 26 24.30Total 107 100.00



ValidityRatingScalesforthePerformanceDomainsandTaskStatements

TheimportanceandcriticalityratingscalesasshowninTable21andaquestiontoobtainfrequencydataasshowninTable22wereusedtocollectvalidityevidencefortheperformancedomains.Theimportance,criticalityandfrequencyratingscalestocollectvalidityevidenceforthetaskstatementsareshowninTable23.Priortoratingthedomains,thesurveypresentedthefollowingdefinitionsofimportanceandcriticalityandinstructionsforapplyingtheratings:Importance:

“Importanceisdefinedasthedegreetowhichknowledgeinthedomainisessentialtothejobperformanceofaminimallycompetentdiplomateinnutrition.Indicatehowimportanteachdomainistotheperformanceofaminimallycompetentdiplomateinnutrition.Rateeachofthesixdomainsbyusingthescalebelow.Pleaseassigneachdomainusingonlyonerating.DONOTRANKTHEDOMAINS.Selectthenumberofthedescriptionbelowthatbestexemplifiesyourratingforeachdomainandwritethatnumberinthespaceprovidednexttoeachdomain.”

Criticality:

“Criticalityisdefinedasthedegreetowhichadverseeffectscouldresultifthediplomateinnutritionisnotknowledgeableinthedomain.Indicatethedegreetowhichtheinabilitytoperformtasksineachdomainwouldbeseenascausingharmtoaclient,aco-worker,thepublic,etc.Harmmaybephysical,emotional,financial,etc.Rateeachofthesixdomainsbyusingthescalebelow.Pleaseassigneachdomainonlyonerating.DONOTRANKTHEDOMAINS.Selectthenumberofthedescriptionbelowthatbestexemplifiesyourratingforeachdomainandwritethatnumberinthespaceprovidednexttoeachdomain.”

Table21-ValidityRatingScalesforthePerformanceDomains

ValidityRatingScalesforPerformanceDomainsImportance Criticality

1=NotImportant.Performanceoftasksinthisdomainisnotessentialtothejobperformanceoftheminimallycompetentdiplomateinnutrition.

1=NoHarm.Inabilitytoperformtasksinthisdomainwouldhavenoadverseconsequences.

2=SomewhatImportant.Performanceoftasksinthisdomainisminimallyessentialtothejobperformanceoftheminimallycompetentdiplomateinnutrition.

2=MinimalHarm.Inabilitytoperformtasksinthisdomainwouldleadtoerrorwithminimaladverseconsequences.

3=Important.Performanceoftasksinthisdomainismoderatelyessentialtothejobperformanceoftheminimallycompetentdiplomateinnutrition.

3=ModerateHarm.Inabilitytoperformtasksinthisdomainwouldleadtoerrorwithmoderateadverseconsequences.



ValidityRatingScalesforPerformanceDomainsImportance Criticality

4=VeryImportant.Performanceoftasksinthisdomainisclearlyessentialtothejobperformanceoftheminimallycompetentdiplomateinnutrition.

4=SignificantHarm.Inabilitytoperformtasksinthisdomainwouldleadtoerrorwithmajoradverseconsequences.

5=ExtremelyImportant.Performanceoftasksinthisdomainisabsolutelyessentialtothejobperformanceoftheminimallycompetentdiplomateinnutrition.

5=ExtremeHarm.Inabilitytoperformtasksinthisdomainwoulddefinitelyleadtoerrorwithcatastrophicconsequences.

Table22-FrequencyQuestionforthePerformanceDomains

FrequencyQuestionforthePerformanceDomainsWhatpercentageoftimedoesthediplomateinnutritionspendperformingdutiesorusingtheprinciplesassociatedwitheachdomain?Table23-ValidityRatingScalesfortheTaskStatements

ValidityRatingScalesfortheTaskStatementsImportance Criticality Frequency

1–NotImportant2–SomewhatImportant3–Important4–VeryImportant5–ExtremelyImportant

1–Causingnoharm2–Causingminimalharm3–Causingmoderateharm4–Causingsignificantharm5–Causingextremeharm

1–Never2–Rarely3–Infrequently4–Frequently5–Repetitively

AnalysisoftheValidityRatingScaleData

PerformanceDomainsThesurveyrespondentswereaskedtoratetheimportanceandcriticalityofthesix(6)performancedomains.Thenumberofrespondentsforeachperformancedomain,theminimum(Min)andmaximum(Max)ratings,themeanrating(M),thestandarderrorofthemean,(SE)andthestandarddeviation(SD)oftheimportanceandcriticalityratingsareshowninTable22.TheSEisastatisticindicatingthestandarddeviationofthesamplemeans.TheSDisastatisticthatindicatestherangeordispersionofrawscoresaroundthemean.Fortheimportanceratingscale,theaveragemeanratingrangedfrom4.18for#4-Diagnosisto4.74for#5-Treatment.TheSErangedfrom0.05for#5-Treatmentto0.09for#4–Diagnosis.TheSDrangedfrom0.46for#5-Treatmentto0.93for#4–Diagnosis.Theinternalconsistencyestimateofthereliabilityoftheratings(i.e.,Cronbach’scoefficientalpha)is0.77(NofItems=6).Thisvalueofcoefficientalphasuggestsamoderate,acceptabledegreeofinternalconsistencyoftheratings.



Forthecriticalityratingscale,theaveragemeanratingrangedfrom3.44for#6-Follow-upto4.17for#5-Treatment.TheSErangedfrom0.08fortwooftheperformancedomains(i.e.,#3and#5)to0.10for#4–Diagnosis.TheSDrangedfrom0.82for#5-Treatmentto0.99for#4–Diagnosis.Theinternalconsistencyestimateofthereliabilityoftheratings(i.e.,Cronbach’scoefficientalpha)is0.81(NofItems=6).Thisvalueofcoefficientalphasuggestsamoderate,acceptabledegreeofinternalconsistencyoftheratings.Table24-PerformanceDomainsDescriptiveStatistics-ImportanceandCriticalityRatings

PerformanceDomainImportance Criticality

N Min Max M SE SD N Min Max M SE SD1. HISTORY 107 3 5 4.69 0.06 0.62 106 1 5 3.93 0.09 0.932. EXAMINATION 106 2 5 4.30 0.08 0.82 106 1 5 3.89 0.09 0.913. ASSESSMENT 106 2 5 4.28 0.08 0.78 106 1 5 3.87 0.08 0.854. DIAGNOSIS 106 1 5 4.18 0.09 0.93 106 1 5 3.88 0.10 0.995. TREATMENT 106 3 5 4.74 0.05 0.46 106 1 5 4.17 0.08 0.826. FOLLOW-UP 106 2 5 4.25 0.08 0.83 106 1 5 3.44 0.09 0.92

Intermsofthepercentageoftimespentperformingdutiesorusingtheprinciplesassociatedwiththeperformancedomains,asshowninTable24,approximately20.50%ofthetimeisspentin#1–History,19.42%ofthetimeisspentin#5–Treatment,18.30%ofthetimeisspentin#2–Examination,14.66%ofthetimeisspentin#3-Assessment,13.46%ofthetimeisspentin#4–Diagnosis,and12.56%isspentin#6-Follow-up.TheSErangedfrom0.65for#6-Follow-upto1.23for#1-History.TheSDrangedfrom6.67for#6-Follow-upto12.65for#1-History.Table25-PercentofTimeSpentinPerformanceDomain

PercentofTimeSpentPerformanceDomain M Median Mode SE SD Minimum Maximum1. HISTORY 20.50 20.00 20.00 1.23 12.65 4 702. EXAMINATION 18.30 20.00 20.00 0.81 8.38 2 603. ASSESSMENT 14.66 10.00 10.00 0.70 7.23 4 404. DIAGNOSIS 13.46 10.00 10.00 0.70 7.22 2 455. TREATMENT 19.42 20.00 20.00 0.89 9.12 2 706. FOLLOW-UP 12.56 10.00 10.00 0.65 6.67 1 50Total1 98.90 N=1061Thetotaldoesnotsumto100duetoroundingerror.ThesemeanratingsaremorethansufficienttojustifyretentionofallofthePerformanceDomainsinthedrafttestspecifications.



TaskStatements

Fortheimportanceratingscale,theaveragemeanratingrangedfrom2.90forTask3.4to4.62forTask1.2.TheSErangedfrom0.05forTask5.1to0.11forTask3.5.TheSDrangedfrom0.08forTask5.1to1.08forTask2.1.Theinternalconsistencyestimateofthereliabilityoftheimportanceratings(i.e.,Cronbach’scoefficientalpha)is0.84(NofItems=15).Thisvalueofcoefficientalphasuggestsanacceptabledegreeofinternalconsistencyoftheratings.Themajorityoftherespondentsratedthetaskstatementsasimportant,veryimportantorextremelyimportant.

Forthecriticalityratingscale,theaveragemeanratingrangedfrom2.71forTask3.1to4.22forTask5.1.TheSErangedfrom0.05forTask5.1to0.11forTask2.1,3.1,and3.5.TheSDrangedfrom0.87forTasks3.3and5.1to1.10forTask3.5.Theinternalconsistencyestimateofthereliabilityofthecriticalityratings(i.e.,Cronbach’scoefficientalpha)is0.92(NofItems=15).Thisvalueofcoefficientalphaishigh,suggestingahighdegreeofinternalconsistencyoftheratings.Themajorityoftherespondentsratedthetaskstatementsascausingmoderate,significant,orextremeharm.Forthefrequencyratingscale,theaveragemeanratingrangedfrom3.18forTask3.2to4.60forTask5.1.TheSErangedfrom0.06forTask5.1to0.11forTasks2.1and3.4.TheSDrangedfrom0.60forTask5.1to1.14forTask3.4.Theinternalconsistencyestimateofthereliabilityofthefrequencyratings(i.e.,Cronbach’scoefficientalpha)is0.85(NofItems=15).Thisvalueofcoefficientalphasuggestsanacceptabledegreeofinternalconsistencyoftheratings.Themajorityoftherespondentsratedmorethanhalfofthetaskstatementsasfrequentlyperformed.Notaskstatementreceivedameanratingindicatingthatitisneverorrarelyperformed.ItshouldbenotedthatSectionDofthesurveyincludedopen-endedquestionsthataskedwhethertherewereanytasksthatwereoverlookedineachperformancedomain.Therewerenoresponsestotheopen-endedquestions.

Table26-TaskStatements-DescriptiveStatisticsofImportance,CriticalityandFrequencyRatings

TaskImportance Criticality Frequency

N Min Max M SE SD N Min Max M SE SD N Min Max M SE SD1.1 107 2 5 4.52 0.07 0.73 107 1 5 3.85 0.10 1.05 106 2 5 4.42 0.08 0.781.2 105 2 5 4.62 0.07 0.76 105 1 5 4.15 0.09 0.96 105 2 5 4.28 0.09 0.892.1 107 1 5 3.53 0.10 1.08 107 1 5 3.17 0.10 1.03 107 1 5 3.73 0.11 1.092.2 105 2 5 4.10 0.08 0.78 105 1 5 3.69 0.10 1.01 105 2 5 4.10 0.08 0.852.3 106 2 5 3.99 0.08 0.81 106 1 5 3.54 0.10 1.03 106 2 5 4.11 0.08 0.852.4 106 2 5 4.25 0.08 0.78 106 1 5 3.90 0.10 0.98 106 2 5 4.19 0.07 0.772.5 106 1 5 3.58 0.09 0.95 106 1 5 3.27 0.10 1.00 106 1 5 3.35 0.09 0.933.1 107 1 5 3.26 0.10 1.02 106 1 5 2.71 0.10 1.06 107 1 5 3.39 0.10 1.073.2 107 1 5 3.36 0.09 0.88 107 1 5 3.16 0.09 0.88 107 1 5 3.18 0.09 0.93



TaskImportance Criticality Frequency

N Min Max M SE SD N Min Max M SE SD N Min Max M SE SD3.3 106 2 5 4.35 0.08 0.81 106 1 5 3.84 0.08 0.87 107 3 5 4.23 0.07 0.683.4 106 1 5 2.90 0.09 0.97 106 1 5 2.84 0.10 1.02 107 1 5 2.78 0.11 1.143.5 106 1 5 3.97 0.10 0.98 107 1 5 3.29 0.11 1.10 107 1 5 3.99 0.09 0.96

4.1 107 1 5 4.19 0.09 0.89 107 1 5 3.80 0.10 1.07 107 1 5 4.14 0.08 0.865.1 107 3 5 4.73 0.05 0.47 107 1 5 4.22 0.08 0.87 107 2 5 4.60 0.06 0.606.1 107 2 5 4.19 0.08 0.80 107 1 5 3.68 0.10 1.05 107 2 5 4.26 0.07 0.73

Table27showsthenumberandpercentageofrespondentsreplyingtoeachpointoftheimportance,criticalityandfrequencyratingscales.

Table27-TaskStatements-NumberandPercentageofImportance,Criticality,andFrequencyRatings

TaskStatements-NumberandPercentageofImportance,CriticalityandFrequencyRatings

Task Rating1 2 3 4 5

N Total%N % N % N % N % N %

1.1

Importance 0 0% 1 1% 12 11% 24 22% 70 65% 107 100%

Criticality 3 3% 8 7% 26 24% 35 33% 35 33% 107 100%

Frequency 0 0% 3 3% 10 9% 32 30% 61 58% 106 100%

1.2

Importance 0 0% 4 4% 6 6% 16 15% 79 75% 105 100%

Criticality 2 2% 5 5% 14 13% 38 36% 46 44% 105 100%

Frequency 0 0% 4 4% 19 18% 26 25% 56 53% 105 100%

2.1

Importance 2 2% 17 16% 36 34% 26 24% 26 24% 107 100%

Criticality 5 5% 20 19% 48 45% 20 19% 14 13% 107 100%

Frequency 3 3% 13 12% 24 22% 37 35% 30 28% 107 100%

2.2

Importance 0 0% 2 2% 21 20% 47 45% 35 33% 105 100%

Criticality 3 3% 8 8% 33 31% 36 34% 25 24% 105 100%

Frequency 0 0% 3 3% 24 23% 38 36% 40 38% 105 100%

2.3

Importance 0 0% 2 2% 29 27% 43 41% 32 30% 106 100%

Criticality 3 3% 11 10% 40 38% 30 28% 22 21% 106 100%

Frequency 0 0% 2 2% 27 25% 34 32% 43 41% 106 100%

2.4

Importance 0 0% 2 2% 16 15% 42 40% 46 43% 106 100%

Criticality 3 3% 5 5% 24 23% 42 40% 32 30% 106 100%

Frequency 0 0% 2 2% 17 16% 46 43% 41 39% 106 100%

2.5

Importance 1 1% 11 10% 40 38% 33 31% 21 20% 106 100%

Criticality 5 5% 15 14% 44 42% 30 28% 12 11% 106 100%

Frequency 2 2% 15 14% 45 42% 32 30% 12 11% 106 100%

3.1

Importance 4 4% 18 17% 46 43% 24 22% 15 14% 107 100%

Criticality 10 9% 42 40% 30 28% 17 16% 7 7% 106 100%

Frequency 5 5% 16 15% 35 33% 34 32% 17 16% 107 100%

3.2

Importance 1 1% 12 11% 56 52% 24 22% 14 13% 107 100%

Criticality 2 2% 20 19% 52 49% 25 23% 8 7% 107 100%

Frequency 4 4% 19 18% 45 42% 32 30% 7 7% 107 100%



TaskStatements-NumberandPercentageofImportance,CriticalityandFrequencyRatings

Task Rating1 2 3 4 5

N Total%N % N % N % N % N %

3.3

Importance 0 0% 3 3% 13 12% 34 32% 56 53% 106 100%

Criticality 1 1% 6 6% 26 25% 49 46% 24 23% 106 100%

Frequency 0 0% 0 0% 15 14% 52 49% 40 37% 107 100%

3.4

Importance 7 7% 29 27% 43 41% 22 21% 5 5% 106 100%

Criticality 10 9% 29 27% 40 38% 22 21% 5 5% 106 100%

Frequency 16 15% 26 24% 40 37% 16 15% 9 8% 107 100%

3.5

Importance 2 2% 4 4% 28 26% 33 31% 39 37% 106 100%

Criticality 5 5% 20 19% 39 36% 25 23% 18 17% 107 100%

Frequency 2 2% 6 6% 19 18% 44 41% 36 34% 107 100%

4.1

Importance 1 1% 3 3% 19 18% 36 34% 48 45% 107 100%

Criticality 3 3% 10 9% 25 23% 36 34% 33 31% 107 100%

Frequency 1 1% 2 2% 21 20% 40 37% 43 40% 107 100%

5.1

Importance 0 0% 0 0% 1 1% 27 25% 79 74% 107 100%

Criticality 1 1% 3 3% 16 15% 38 36% 49 46% 107 100%

Frequency 0 0% 1 1% 3 3% 34 32% 69 64% 107 100%

6.1

Importance 0 0% 1 1% 23 21% 38 36% 45 42% 107 100%

Criticality 4 4% 9 8% 30 28% 38 36% 26 24% 107 100%

Frequency 0 0% 1 1% 15 14% 46 43% 45 42% 107 100%

PreliminaryTestSpecificationsTable28showspreliminarytestweightsbydomainandtaskstatement.Toderivepreliminaryweights,theimportanceandcriticalityratings,andtimespentestimateswerecombinedtoproduceweightsforthedomains.Thesumsofeachofthesedataweretotaled,anddividingthesumofthedomainbythetotal,derivedtheweightforeachdomain.Toderivethepreliminarynumberoftestquestionsbydomain,thetotalnumberoftestquestionsonthecurrentexamination(i.e.,150)wasmultipliedbythedomainweight.Toderivethepreliminarynumberoftestquestionsbytaskstatementwithinadomain,theimportance,criticality,andfrequencyratingswerecombinedtoproduceweightsforthetaskstatements.Thetaskweightsweresummedwithinthedomain,andtheneachtaskweightwasdividedbythesum,andthenmultipliedbythedomainweight.Toderivethepreliminarynumberoftestquestionsbytaskstatement,thetotalnumberoftestquestionsonthecurrentexamination(i.e.,150)wasmultipliedbythetaskstatementweight.



Table28-PreliminaryTestSpecifications

PreliminaryTestSpecifications

DomainsandTaskStatements PreliminaryWeights

PreliminaryNumberof

TestQuestions

DomainI:History 19.61% 29.41Task1.1:Obtainthepatient’sreasonforseekingconsultationtodeterminewhyhe/sheisseekingcare/adviceusingwrittenandverbalintakes. 9.70% 14.56

Task1.2:Obtainthepatient’spasthistory(e.g.,medical,surgical,social,family)toevaluatethepatient’sproblemsusingwrittenandverbalintakedata. 9.90% 14.85

DomainII:Examination 17.84% 26.75

Task2.1:Evaluatepatienttodeterminehealthstatususinganthropometricmethods. 3.29% 4.94

Task2.2:Evaluatepatienttodeterminehealthstatususingphysicalmethods. 3.75% 5.63

Task2.3:Evaluatepatienttodeterminehealthstatususingobservationalmethods. 3.67% 5.51

Task2.4:Evaluatepatienttodeterminehealthstatususingbiochemicalmethods. 3.90% 5.84Task2.5:Evaluatepatienttodeterminehealthstatususingneuropsychologicalmethods. 3.22% 4.83

DomainIII:Assessment 15.36% 23.04

Task3.1:Assesshealthstatususinganthropometricstoevaluatebodycomposition. 2.80% 4.21Task3.2:Assesshealthstatususingimagingtoevaluatestructuralcomponents(e.g.,neuromuscular,visceral,functional). 2.91% 4.36

Task3.3:Assesshealthstatususinglaboratorymethodstoevaluatephysiologicalhomeodynamics(e.g.,blood,hair,tissue,urine,fecal,salivary). 3.72% 5.58

Task3.4:Assesshealthstatususingelectrodiagnosticmethodstoevaluateneurodynamics(e.g.,NCV,EMG,SEP,BAER,EEG). 2.55% 3.83

Task3.5:Assesshealthstatususingquestionnairestoevaluatepatient’sperceptionofcurrentcondition(s). 3.37% 5.06

DomainIV:Diagnosis 14.49% 21.73Task4.1:Describethepatient’sclinicalstatususingappropriatediagnosticorotherdescriptiveterminologytoclassifyconditionsandtodeterminetreatmentorreferral.

DomainV:Treatment 19.07% 28.61Task5.1:Recommendand/orapplyatherapeuticprotocoltoaddressthepatient’sdiagnosedcondition,usingappropriatemethodology(e.g.,alteringlifestyle,nutritionalintervention,stressreduction).

DomainVI:Follow-up 13.63% 20.45Task6.1:Documentandevaluateresponsetotreatmentusingserialtesting(e.g.,anthropometrics,imaging,physiologicalhomeodynamics,neurodynamics,andquestionnaires)todetermineeffectivenessoftreatmentandattainmentofpatient’sexpectations.

Total 99.99% 149.99

SummaryandRecommendationsThedemographicdataresultingfromthisroledelineationstudyshouldbereviewedbyACBNtoassesstherepresentativenessofthesurveyrespondentgrouptothepopulationofDACBNs.Acomparisonoftherespondents’demographic/backgrounddatatothepopulationofDACBNscouldbenotmadebecausethedemographic/backgrounddataon



thepopulationwereunavailable.Therefore,itisrecommendedthattheACBNconductthiscomparisontoassesstherepresentativenessoftherespondentgroup.Usingroledelineationdataasabasisforupdatingacontentoutlineandtestspecificationswillcontributetothevalidityoftheexamination.Asdescribedinthisreport,theroledelineationdatawereusedtoprovidevalidityevidenceforthecontentoutlineandproducepreliminarytestspecificationsbyperformancedomainandtaskstatement.Itisrecommendedthatthevalidityratingdatapresentedinthisreportbereviewedbyacommitteeofsubjectmatterexperts(i.e.,theroledelineationstudycommittee)tofinalizethecontentoutlineandtestspecifications.Besidesreviewingthedatatofinalizethecontentoutlineandtestspecifications,thecommitteeshouldalsotakeintoconsiderationthepracticalaspectoftestdevelopment.Forinstance,thescopeanddepthofthesubjectmattershouldbetakenintoconsiderationwhenfinalizingthetestweights.Forexample,sometasks,althoughratedhighontheimportanceand/orcriticalityratingscales,maybelimitedinscopeandtherefore,thenumberoftestquestionsmaybelimited.

ReviewofSurveyResultsandFinalizationofTestSpecificationsOnThursday,March24,2016,ameetingwasheldviawebconferencewithacommitteeofsubjectmatterexpertstoreviewtheresultsoftheroledelineationstudyandtofinalizethetestspecificationsfortheexamination.Thecommitteewasprovidedwithadraftcopyofthisreportfortheirreviewinadvanceofthemeeting.Thecommitteewasfirstorientedtothesurveystructure,theresponserate,andthedatadescribingthesurveyrespondents’backgroundanddemographics.Whenreviewingthebackgroundanddemographicdata,thecommitteeindicatedthatthesurveyrespondentgroupwasrepresentativeofthepopulationintermsofgender,ageranges,ethnicity/race,location(i.e.,state),highestlevelofnon-chiropracticeducation,highestlevelofchiropracticeducation,andothercredentials.ThecommitteedecidedthatthenextroledelineationsurveywillincludequestionsthatwillelicitadditionalinformationaboutDACBN’sroleasrelatedtonutrition.Thecommitteewasorientedtothevaliditydataforthedomainsandtaskstatements.Theydecidedtoretaintheperformancedomainsbecausethemeanvalidityratingsweremorethansufficienttojustifyretentionofalloftheperformancedomainsinthetestspecifications.Likewise,theydecidedtoretainalltaskstatementsbecausethemeanvalidityratingsweremorethansufficienttojustifyretentionofallofthetaskstatementsinthetestspecifications.Thecommitteereviewedthepreliminarytestspecificationsanddecidedtomakeminoradjustmentstothetestweightsforroundingpurposes.Table29presentsthefinaltestspecifications.



Table29-FinalTestSpecifications

FinalTestSpecifications

DomainsandTaskStatements FinalWeights

FinalNumberofTestQuestions

DomainI:History 19.00% 28.50

Task1.1:Obtainthepatient’sreasonforseekingconsultationtodeterminewhyhe/sheisseekingcare/adviceusingwrittenandverbalintakes. 9.00% 13.50

Task1.2:Obtainthepatient’spasthistory(e.g.,medical,surgical,social,family)toevaluatethepatient’sproblemsusingwrittenandverbalintakedata. 10.00% 15.00

DomainII:Examination 19.00% 28.50

Task2.1:Evaluatepatienttodeterminehealthstatususinganthropometricmethods. 3.50% 5.25

Task2.2:Evaluatepatienttodeterminehealthstatususingphysicalmethods. 4.00% 6.00

Task2.3:Evaluatepatienttodeterminehealthstatususingobservationalmethods. 4.00% 6.00

Task2.4:Evaluatepatienttodeterminehealthstatususingbiochemicalmethods. 4.00% 6.00

Task2.5:Evaluatepatienttodeterminehealthstatususingneuropsychologicalmethods. 3.50% 5.25

DomainIII:Assessment 15.00% 22.50

Task3.1:Assesshealthstatususinganthropometricstoevaluatebodycomposition. 3.00% 4.50

Task3.2:Assesshealthstatususingimagingtoevaluatestructuralcomponents(e.g.,neuromuscular,visceral,functional). 3.00% 4.50

Task3.3:Assesshealthstatususinglaboratorymethodstoevaluatephysiologicalhomeodynamics(e.g.,blood,hair,tissue,urine,fecal,salivary). 3.00% 4.50

Task3.4:Assesshealthstatususingelectrodiagnosticmethodstoevaluateneurodynamics(e.g.,NCV,EMG,SEP,BAER,EEG). 3.00% 4.50

Task3.5:Assesshealthstatususingquestionnairestoevaluatepatient’sperceptionofcurrentcondition(s). 3.00% 4.50

DomainIV:Diagnosis 15.00% 22.50

Task4.1:Describethepatient’sclinicalstatususingappropriatediagnosticorotherdescriptiveterminologytoclassifyconditionsandtodeterminetreatmentorreferral.

DomainV:Treatment 19.00% 28.50

Task5.1:Recommendand/orapplyatherapeuticprotocoltoaddressthepatient’sdiagnosedcondition,usingappropriatemethodology(e.g.,alteringlifestyle,nutritionalintervention,stressreduction).

DomainVI:Follow-up 13.00% 19.50



FinalTestSpecifications

DomainsandTaskStatements FinalWeights

FinalNumberofTestQuestions

Task6.1:Documentandevaluateresponsetotreatmentusingserialtesting(e.g.,anthropometrics,imaging,physiologicalhomeodynamics,neurodynamics,andquestionnaires)todetermineeffectivenessoftreatmentandattainmentofpatient’sexpectations.

Total 100.00% 150.00

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