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Freya Moran, Student

For my preceptorship, I was lucky enough to be placed at the VA hospital in Cincinnati. I've had a number of experiences to reflect on – primarily the state of chiropractic training and the very real and exceptional opportunity for growth within the primary care setting that the VA has offered our profession.

I have so far witnessed cardiac risk assessments, observed epidural steroid injections, attended grand rounds regarding brain injury and chronic fatigue, and worked side by side with MDs, psychologists, nurses, DOs, radiologists and physical therapists to assess and treat patients with multiple co-morbidities including chronic pain. Experiencing these types of patient interactions has been entirely different from my experience at the campus health center and even the downtown clinic. Here in the hospital, I don't just work with other chiropractors, but as a part of an integrative pain management team.

Every Wednesday is new patient intake day. In the morning, my supervisor and I sit down to collaborate on charts for our new patients. We look over their current conditions and medications, labs and radiographs (if present), and their reasons for consulting a pain management team. When they come in, these patients spend a half hour with the nurse to get a health history and vitals taken. We then conduct a regular diagnostic exam and add our notes to the chart. After their chiropractic consult, they move on to one of several MDs, a pain psychologist and finally a pharmacist. After all of the patients have consulted with each member of the pain team, the team gathers to go through the patient chart as a group. It's there that we share our analysis of the patient's condition with one another and create a strategy for the person's treatment plan.

As chiropractic continues to reach the primary care table, note that the VA has offered us a place, with integration of chiropractic as a part of their pain management teams in 51 VA hospitals.I feel very comfortable with the level of education I have received in preparation for this clerkship. But the opportunity doesn't stop at clerkship. In fact, the Council on Chiropractic Education recently accredited a one-year VA residency program for students of chiropractic.

Thorough investigation of the literature, specifically the Integration of Chiropractic Services in Military and Veteran Health Care Facilities: A Systematic Review of the Literature in the Journal of Evidence-Based Complementary and Alternative Medicine. 2016 by B.N. Green, et al., regarding this type of integration shows significant patient improvement when compared to other types of care. Could this be a prediction of the future success of a chiropractic residency?

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