Draft CCE Residency Accreditation Standards
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Foreword/Terminology and Definitions

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Foreword
 
This document presents the process and requirements for The Council on Chiropractic Education (CCE) accreditation of chiropractic residency programs (“residency”). CCE accreditation relies on a peer-review process that is mission driven, evidence informed and outcome based. The attainment of CCE accreditation provides a residency with expert evaluation and recommendations for improvement. Accreditation provides assurances of educational quality and institutional integrity to governments, jurisdictional licensing and regulatory bodies, institutions, professional organizations, residents, other accrediting agencies and the public at large.

The purpose of the accreditation of residencies is to improve health care by assessing and advancing the quality of chiropractic residency education and to accredit those residencies which meet the minimum requirements as outlined in the Residency Program Accreditation Standards and provide for training programs of good educational quality in each specialty.

Accreditation of residency programs is a voluntary process of evaluation and review performed by a non- governmental agency of peers. The goals of the process are to evaluate, improve and publicly recognize programs that are in compliance with standards of educational quality established by CCE. Accreditation of residencies was developed to benefit the public, protect the interests of residents, and improve the quality of teaching, learning, research and professional practice.

CCE publishes a list of accredited residencies and informs its stakeholders and the public regarding the accreditation requirements and process. Communications with the public regarding specific accreditation actions are appropriately transparent, taking into consideration applicable laws and practices (including rights to privacy) and the integrity of the accreditation process.

CCE policy references in these Standards are not all inclusive and may be delineated in other CCE publications. They are intended only to assist the reader for quick reference.
Terminology and Definitions
 
Affiliated Organization: an institution or organization that operates independently of the residency but is directly or indirectly involved with the residency. The affiliated institution or organization may provide guidance to the residency and/or formal services such as instruction, resident support services, library, information technology, etc. Formal services provided by the affiliated institution or organization are outlined in a contractual agreement.
 
Governing or Administrative Authority: a body or an administrative unit of the sponsoring organization that has ultimate responsibility for resources, policies, and quality of education provided by the residency.
 
Governing Official: the representative for the governing or administrative authority over the residency. For example, this could be a senior administrator of the sponsoring organization that oversees the residency Director and/or has ultimate responsibility for resources, policies, and quality of education provided by the residency.
 
Program Director: The program director is the person responsible for the direction, conduct and oversight of the residency.
 
Residency: A chiropractic residency is a post-doctoral education program centered on clinical training that results in the residents’ attainment of advance competencies. A residency must be a minimum of twelve months, full-time, and must be composed of appropriately supervised in-person clinical care. A residency should also include a well-designed mix of self-directed learning, seminar participation, instructional experiences, and scholarship. Specific to the area of training, the residency expands and builds on the competencies attained through completion of the doctor of chiropractic degree program.
 
Sponsoring Organization: An organization, institution or facility dedicated to health care or education that assumes ultimate responsibility for the residency. If more than one organization sponsors the residency, there must be a contractual agreement between the organizations that outlines specific responsibilities and ownership for the residency.
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Section 1

Section 1 - I

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I. Residency Accreditation by CCE

CCE accreditation of residencies is designed to promote the highest standards of educational program quality in preparing candidates for an advanced level of training, advocating best practices and excellence in patient care, while advancing and improving the profession and its practitioners. The Council takes steps to ensure that accreditation requirements are consistent with the realities of sound practices in residencies and currently accepted standards of good practice for chiropractic care. This reflects a recognition that residencies exist in different environments. These environments are distinguished by such differing factors as purpose of the program, jurisdictional regulations, demands placed on the profession in the areas served by the residencies, and the diversity of resident populations. CCE accreditation is granted to residencies deemed by the Council to comply with the eligibility requirements and requirements for accreditation.

1. The Council specifically reviews compliance with all accreditation requirements.

• It is dedicated to consistency while recognizing residency differences.
• It bases its decisions on a careful and objective analysis of all available evidence.
• It follows a process that is as transparent as possible, honoring the need for confidentiality when appropriate.
• It discloses its final decisions to the public, as well as to other appropriate authorities, in accordance with CCE Policy 111.

2. The Council provides information and assistance to any residency seeking accreditation, in accordance with CCE policies and procedures.
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Section 1 - II

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II. Process of Accreditation for a Residency

Any residency seeking to achieve or maintain CCE accredited status must apply for such status, and provide evidence that the residency meets the eligibility requirements and complies with the requirements for accreditation.
A. Application for Initial Accreditation
 
1. Letter of Intent
A residency seeking initial accreditation must send a letter of intent to the CCE Administrative Office stating its intention to pursue accredited status, and provide written evidence that it meets the eligibility requirements.

Since residencies may operate under different settings and systems, provide a description and organizational chart of the residency’s responsibilities and authority within the context of its sponsoring organization. Also include the name and title of the governing official. (The definitions for governing official, sponsoring organization, and governing or administrative authority are provided in the Terminology and Definitions section.)

2. Requirements for Eligibility
a. Sponsorship of a residency is under the administrative responsibility of a healthcare institution or doctor of chiropractic program, which develops, implements, and monitors the residency. The sponsoring organization also ensures the availability of appropriate facilities and resources for the residency.

b. Formal authorization to operate the residency from the appropriate governmental agency of the jurisdiction in which the residency legally resides, if applicable (e.g. state- level commission or board of higher education).
 
c. The residency and/or the sponsoring organization is legally incorporated as an educational corporation, if required by the state-level commission or board of higher education, in its jurisdictional residence.
 
d. A program director of the residency qualified by education and/or experience, as demonstrated by their Curriculum Vitae and position descriptions and minimum requirements. The program director and is provided authority from the sponsoring organization to manage the residency (e.g. contract or job description).
 
e. Formal action from the governing or administrative authority that commits the residency to comply with the CCE requirements for accreditation.
 
f. The residency’s mission/purpose, and program goals, and objectives, which are consistent with the CCE Residency Program Accreditation Standards and required core competencies.
 
g. A plan and process for the assessment of resident outcomes.
 
h. Disclosure of accreditation status with any agency other than CCE, to include the most recent action letter.

3. CCE Response
Upon application by the residency for accreditation:
a. The Council Chair, with assistance from the CCE Administrative Office staff, reviews the evidence of eligibility documents submitted by the residency. If further documentation is necessary, the Council Chair notifies the residency that such documentation must be submitted with the residency self-study report.

b. The Council establishes timelines regarding the self-study, site visit and Status Review Meeting in coordination with the CCE Administrative Office and the residency, according to CCE policies and procedures. If the residency’s sponsoring organization is a CCE accredited DC program, the CCE Administrative Office will make every effort to coordinate self-study, site visit and Status Review Meetings with the ongoing CCE accreditation cycle for the DC program. This effort is designed to maximize practical efficiencies and cost reduction efforts.
B. Application for ContinuedReaffirmation of Residency Accreditation

1. Letter of Intent
 
A residency seeking continuedreaffirmation of accreditation must send a letter of intent from the residency’s designated officer to the CCE Administrative Office stating its intention to pursue continuedreaffirmation of its accredited status. If the residency’s sponsoring organization is a CCE accredited DC program, this intent may be incorporated into the DC program application for continued accreditationreaffirmation letter.
 
2. Requirements for Eligibility
 
The residency need not submit evidence of eligibility documents required for initial accreditation unless eligibility requirements have changed sincefrom the last reaffirmationcomprehensive visit. However, the residency must maintain documentation that it complies with the eligibility requirements. This information must be available for review by appropriate representatives of CCE and/or the Council. Specifically related to the residency, the program must provide the following information to the Council:
 
a. A program director of the residency is qualified by education and/or experience; and is provided authority from the sponsoring organization to oversee the residency (e.g. contract and/or job description).
 
b. Formal action from the governing or administrative authority that commits the residency to comply with the CCE requirements for accreditation.
 
c. The residency’s mission/purpose and program , goals, and objectives, which are consistent with the CCE Residency Program Accreditation Standards.
 
d. A plan and process for the assessment of resident outcomes.
 
e. Disclosure of accreditation status for the residency with any agency other than CCE, to include the most recent action letter.

3. CCE Response
 
The Council establishes timelines regarding the residency’s self-study, site visit and Status Review Meeting in coordination with the CCE Administrative Office and the residency, according to CCE policies and procedures.
C. Process of Residency Accreditation (Initial/ContinuedReaffirmation)
 
1. Residency Self-Study
The residency must develop and implement a self-study process that involves all constituencies of the residency and demonstrates achievement of relates to effectiveness regarding its mission/purpose and , goals and objectives. The self-study report must:

a. Provide clear evidence that the residency complies with the CCE requirements for residency program accreditation.

b. Focus attention on the ongoing assessment of program outcomes, including those developed to demonstrate resident achievement of the core competencies, for the continuing improvement of academic quality.

c. Demonstrate that the residency has processes in place to ensure that it will continue to comply with the CCE requirements for accreditation.

d. Be submitted to the CCE Administrative Office no later than nine months prior to the CCE meeting wherein a decision regarding accreditation will be considered.
 
2. Site Team Visit and Report to CCE
Following receipt of the residency self-study report, the Council appoints a site team to review evidence contained within the eligibility documentation and self-study report relative to compliance with the CCE Residency Program Accreditation Standards. The site visit and report to the CCE are an integral part of the peer review process that uses the residency’s self-study as the basis for an analysis of the strengths, challenges, and distinctive features of the residency. This process is designed to ensure that, in the best judgment of a group of qualified professionals, the residency complies with the requirements for eligibility and accreditation and that the residency is fulfilling its mission/purpose and goals. An enduring purpose of CCE accreditation is to encourage ongoing improvement.
a. The residency must provide the site team with full opportunity to inspect its facilities and rotation sites, where feasible, and to interview all persons at the site/facilities related to the residency, and to examine all records maintained by or for the residency of which it is a part (including but not limited to budget and personnel records, and records relating to resident credentials, resident assessment of learning, resident advancement in the program, and program completion (degree, certificate, etc.).
 
b. A draft report is prepared by the site team and sent by the CCE Administrative Office to the residency Director and/or designated officer for correction of factual errors only.
 
c. Following the response of the residency to correction of factual errors, a final report is sent by the CCE Administrative Office to the residency Director and/or designated officer, governing official and site team members.
 
d. The residency may submit a written response to the site team report, and it must submit a written response if the report identifies areas of concern. The residency sends the response to the CCE Administrative Office which distributes it to the CCE President, Councilors and Site Team Chair. Any residency response to the site team report must be submitted to the CCE no less than 30 days prior to the Status Review Meeting.
3. CCE Status Review Meeting

a. The objective of the status review meeting is to provide an opportunity for the Council to meet with the residency representatives (if applicable) to discuss the findings of the site team in accordance with CCE policies and procedures. The Site Team Chair or other members of the site team may also be present at the request of the Council Chair.

b. Following the status review meeting, the Council reviews the self-study and supporting documentation furnished by the residency, the report of the on-site review, the residency's response to the report, and any other appropriate information, consistent with CCE policies and procedures, to determine whether the residency complies with the CCE Residency Program Accreditation Standards.

c. The Council’s action concludes with a written decision regarding accreditation status that is sent to the residency Director and/or designated officer, the governing official, and CCE Councilors.

d. The next comprehensive evaluation site visit normally is three years following the award of initial accreditation, or six years following the award of continuedreaffirmation of accreditation. If the residency’s sponsoring organization is an institution housing a CCE accredited DC program, every effort will be made to ensure the cycle of comprehensive visits coincides with the accreditation cycle of the DC program.
D. Additional Reports and Visits
 
In accordance with CCE policies and procedures the Council may require additional reports from, and/or visits to a residency, to confirm its continued compliance with the accreditation requirements. The residency must critically evaluate its efforts in the area(s) of concern, initiate measures that address those concerns, and provide evidence of the degree of its success in rectifying the area(s) of concern. Failure on the part of a residency to furnish a requested report or host a site visit on the date specified by the Council constitute cause for sanctions or revocation of accreditation. These actions are at the discretion of the Council, following appropriate notification.
 
1. Program Interim Report (PIR)
 
Periodic PIRs must be submitted to the Council in accordance with CCE policies and procedures at the mid-point of the accreditationreaffirmation cycle, with first report due three years after continuedreaffirmation of accreditation has been granted. PIRs are required as one of the reporting requirements the Council utilizes to continue its monitoring and reevaluation of its accredited residencies, at regularly established intervals, to ensure the residencies remain in compliance with the CCE Residency Program Accreditation Standards.

2. Progress Reports

Progress Reports must be submitted to the Council, on a date established by the Council. Progress reports address previously identified areas of non-compliance with accreditation requirements or concerns arising from review of the residency PIR.

3. Substantive Change Reports

Substantive Change applications must be submitted to the Council to provide evidence that any substantive change to the educational mission or residency does not adversely affect the capacity of the residency to continually comply with the CCE Residency Standards. The residency must obtain Council approval of the substantive change request prior to implementing the change in accordance with CCE Policy 1.

4. Focused Site Visits

At the discretion of the Council, Focused Site Visits are conducted based upon previous concerns not yet satisfactorily addressed for the residency to be in compliance with accreditation requirements, substantive change requirements, or extraordinary circumstances in which violation of accreditation requirements may prompt action to protect the interests of the public.
 
A progress review meeting by the Council regarding any additional reports submitted is conducted to discuss and make a decision regarding the adequacy of ongoing progress, the sufficiency of evidence provided regarding progress on issues of concern, whether any other significant concerns have emerged, and what, if any, subsequent interim reporting activities are required. If a site visit was conducted, the site team report is also discussed.
 
The Council determines if an appearance, or if participation via conference call, is necessary by the residency representatives at the next Council meeting. The Council then sends a follow-up letter to the residency identifying the status of previous concerns (if any), and/or a substantive change application, and the requirements for any additional interim activities. The residency must continue to submit PIRs in accordance with CCE policies and procedures.
E. Withdrawal from Accreditation


1. Voluntary Withdrawal of Initial Application

A residency may withdraw its application for accreditation at any time prior to the Council decision regarding initial accreditation by notifying the CCE Council of its desire to do so.

2. Voluntary Withdrawal from Accredited Status

An accredited residency desiring to withdraw from CCE accreditation forfeits its accredited status when the Council receives a certified copy of the residency’s governing official’s resolution clearly stating its desire to withdraw.

3. Default Withdrawal from Accredited Status

When a residency fails to submit a timely application for continuedreaffirmation of accredited status, the Council acts at its next meeting to remove the residency's accredited status. This meeting of the Council normally occurs within six months of the date when the residency application for continued accreditationreaffirmation was due.

4. Notification

In cases of voluntary withdrawal and default withdrawal CCE makes appropriate notification in accordance with CCE Policy 111.
F. Reapplication for Accreditation

A residency seeking CCE accreditation that has previously withdrawn its accreditation or application for accreditation, or had its accreditation revoked or terminated, or had its application for accreditation denied, follows the process for initial accreditation.
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Section 1 - III

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III. Accreditation Decisions and Actions

A. CCE Decisions

The Council makes a decision regarding the application for initial or continuedreaffirmation of accreditation following the status review meeting. When considering the accreditation status of a residency, the Council may take any of the following actions at any timeCouncil decisions may include:

1. To aAward or reaffirminitial accreditation
2. To dDefer the decision
2. 3. Continue accreditation
4. To iImpose Warninga sanction
3. 5. Impose Probation
6. To dDeny or revoke accreditation
4.7. Withdraw accreditation
B. CCE Notifications

The CCE makes notifications of Council accreditation decisions and actions in accordance with CCE Policy 111.
C. Enforcement of Standards

The U.S. Department of Education requires the enforcement of standards for all recognized accrediting agencies. If the Council’s review of a residency regarding any standard indicates that the residency is not in compliance with that standard (area of concern), the Council must:

1. Immediately initiate adverse action against the residency; or

2. Notify the residency of the finding(s) of noncompliance and Rrequire the residency to take appropriate action to bring itself into compliance with the standards within a time period that must not exceed 18 months. NOTE: If the residency is at least one year but less than two years in length.


If the residency does not bring itself into compliance within the 18-month time limit, the Council must take immediate adverse action unless the Council extends the period for achieving compliance for “good cause”. Such extensions are only granted in unusual circumstances and for limited periods of time not to exceed 18 months in length. The residency must address the three (3) conditions for “good cause” listed below.

Definition and Conditions for Good Cause

The Council will review the information/rationale provided and grant an extension for "good cause" if;

The residency has demonstrated significant recent accomplishments in addressing non-compliance, and

1. The residency provides evidence that makes it reasonable for the Council to assume it will remedy all non-compliance items within the extended time defined by the Council, and

2. The residency provides assurance to the Council that it is not aware of any other reasons, other than those identified by the Council, why the residency should not be continued for "good cause."

The Council may extend accreditation for "good cause" for a maximum of one year at a time (not to exceed 18 months in total). If accreditation is extended for "good cause," the residency must be placed or continued on sanction (Probation) and may be required to host an on-site evaluation visit. At the conclusion of the extension period, the residency must appear before the Council at a meeting to provide further evidence if its period for remedying non-compliance items should be extended again for good cause.

In all cases, the residency bears the burden of proof to provide evidence why the Council should not remove its accreditation. The Council reserves the right to either grant or deny an extension when addressing good cause.

Adverse accrediting action or adverse action means the denial, withdrawal, suspension,or revocation, or termination of accreditation, or any comparable accrediting action the Council may take against the residency.
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Section 1 - IV

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IV. Non-Compliance Decisions and Actions/Appeals

When the Council determines that a residency is not in compliance with CCE Residency Program Accreditation Standards, including eligibility and accreditation requirements, and policies and related procedures, the Council may apply any of the following actions.
A. Required Follow-up
In addition to regular reporting requirements and scheduled evaluations, the Council may require a residency to provide additional follow-up information, reports, host focused site visits, and/or make an appearance before the Council to provide evidence of compliance. Required follow-up is a procedural action which is not subject to appeal.


B. Deferral
In cases where additional information is needed in order to make a final decision regarding the accreditation of a residency seeking initial or continued accreditation, the Council may choose to defer a final decision regarding accreditation status. The additional information requested through the deferral process may relate to information submitted by the residency following an on-site evaluation which raises additional questions, requires clarification or additional evidence from the residency.

The Council may require the residency to submit a report, host a site visit and/or make an appearance before the Council to provide such information. When a decision is deferred, the residency retains its current accreditation status until a final decision is madeA notice of deferral is confidential. Deferral may be continued up toshall not exceed twelve (12) months. Deferral is not a final actiondecision and is not subject to appeal.
C. Warning
The intent of issuing a confidential Warning is to alert the residency of the needrequirement to address specific Council concerns regarding its accreditation. The Council may decide to issue a confidential Warning if the Council concludes that a residency:

1. is in non-compliance with the accreditation standards and the Council determines that the deficiency(ies) do not compromise the overall integrity of the residency and can be corrected by the residency within the permissible timeframein a short period of time; or

2. has failed to comply with reporting or other requirements and/or provide requested information.
 
Following a notice of Warning, the Council may require additional reportingthe residency to submit a report, host a site visit and/or make an appearance before the Council to permit the residency to provide additional information and/or evidence of compliance. Warning is a sanction, that is not subject to appeal, and shall not exceed twelve (12) months. A notice of Warning is a confidential action. Warning may be continued for up to twelve (12) months. Warning is a procedural action which is not subject to appeal.

The Council will make notification of a final decision to impose Warning by notifying the residency Director and/or designated officer, and the governing official that the residency has been placed on Warning in accordance with CCE policy and procedures.
D. Probation
Probation is an action reflecting the conclusion of the Councilmay be imposed at any time when the Council concludes that the residency is in significant non-compliance with one or more eligibility requirements, accreditation standardsrequirements, or CCE policy requirements. Such a determination may be based on the Council’s conclusion that:

1. The noncompliance compromises the integrity of the residency; for example, the number of areas of noncompliance, or other circumstances cause reasonable doubt that compliance can be achieved in the permissible timeframe; or
2. The noncompliance reflects recurrent noncompliance with one or more particular standard(s); or
3. The noncompliance reflects an area for which notice to the public is required in order to serve the best interests of residents and prospective residents.

The Council may require the residency to submit a report, host a site visit and/or make an appearance before the Council to provide evidence of compliance. Probation is a sanction, subject to appeal (see CCE Policy 8), and may be continued for up toshall not exceed eighteen (18) months. The Council will make a public notice of a final decision to impose Probation by notifying the appropriate agencies that the residency has been placed on Probation in accordance with CCE policy and procedures.
E. Show Cause Order
A Show Cause Order constitutes a demand that the residency provide evidence to inform the Council and demonstrate why the program’s accreditation should not be revoked. The Council may require the residency to submit a report, host a site visit and/or make an appearance before the Council to provide such evidence. If the residency does not provide evidence sufficient to demonstrate resolution of the Council’s concerns within the time frame established by the Council, the residency’s accreditation is revoked. A Show Cause Order is a sanction, subject to appeal (see CCE Policy 8), and may be continued for up to twelve (12) months. The Council makes public notice of a final decision to impose a Show Cause Order in accordance with CCE policy and procedures.
F. Denial or Revocation
An application for initial accreditation or continuedreaffirmation of accreditation may be denied if the Council concludes that the residency has significantly failed to comply and is not expected to achieve compliance within a reasonable time period. Denial of an application for Iinitial Aaccreditation or a Reaffirmation ofcontinued Aaccreditation constitutes Iinitial Aaccreditation not being awarded or Rrevocation of Aaccreditation, respectively.

Denial or Rrevocation of accreditation is an Adverse Action and subject to appeal (see CCE Policy 8). A residency seeking CCE accreditation that has previously withdrawn its accreditation or its application for accreditation, or had its accreditation revoked or terminated, or had its application for accreditation denied, follows the process for initial accreditation. The Council makes public notice of a final decision to deny or revoke accreditation by notifying the appropriate agencies in accordance with CCE policy and procedures.
G. Accreditation is a privilege, not a right. Any of the above actions may be applied in any order, at any time, if the Council determines that residency conditions warrant them. 4I3Tf the Council imposes any of the following actions: Deferral; Warning; Probation; a Show Cause Order; or Revocation of Accreditation, the Council provides a letter to the residency stating the reason(s) for the action taken.

Any sanction or adverse action, as defined in this section, is subject to appeal in accordance with CCE Policy 8.
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Section 1 - V

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V. Status Description

A residency or an institution accredited by the Council must describe its accreditation status in accordance with CCE Policy 22.

The Council updates the accredited status of the programs/institutions it currently accredits on its official website following each Council Meeting, to include:

a. Month/Year of initial accreditation status awarded by CCE.
b. The year the Council is scheduled to conduct its next comprehensive site visit review for continuedreaffirmation of accreditation and the next scheduled Council Status Review Meeting regarding that comprehensive site visit review.
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Section 1 - VI

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VI. Complaint and Contact Information

Complaint procedures are established to protect the integrity of the CCE and to ensure the avoidance of improper behavior on the part of those individuals acting on behalf of the CCE, the Council and the CCE- accredited residencies. By establishing formal complaint procedures, the CCE provides responsible complainants the opportunity to submit specific grievances and deal with them through a clearly defined process. CCE Policy 64 outlines the complaint procedures and may be obtained from the CCE Administrative Office and/or is available on the CCE website.

Information describing the organization and operation of the CCE and its Council may be obtained from the CCE Administrative Office, 10105 E Via Linda, Ste 103 PMB 3642, Scottsdale, AZ 85258, Telephone: 480-443-8877, E-Mail:cce@cce-usa.org, Website: www.cce-usa.org.
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