Development of the TOC

Since the first test in 2002, there have only been some minor changes and developments to the Test of Competence (TOC). Since then the number of applicants to join the register has decreased quite markedly and Government policies have not encouraged immigration. The TOC did not therefore appear sustainable due to the numbers coming forward to sit it, with the university provider finding it difficult to recover the costs incurred in running the tests three times a year as contracted.

Whilst the GCC is comparable with other worldwide chiropractic regulatory authorities in asking applicants with overseas qualifications to sit a form of examination to show they are fit to enter the register, it was not comparable with other UK healthcare profession regulators who appear to take a more proportionate approach by either using a staged assessment approach or a more tailored approach, for example by interviewing individual applicants to identify any gaps in their knowledge.

The chiropractic profession is fortunate in that it has a worldwide chiropractic community in which the standards and accreditation criteria appear to be converging and where there are international moves to develop forms of mutual recognition.

Research and Review

During 2012 - 2013, the GCC’s Education Committee initiated a programme of work to review the TOC including:

a)  mapping it to the then COP&SOP and the Degree Recognition Criteria

b) identifying how other UK healthcare profession regulators assess overseas applicants

c)  identifying how other worldwide chiropractic regulatory authorities / licensing boards assess overseas applicants.

During this work programme the Committee noted:

a) there would always be the need for some form of ‘test of competence’ to allow internationally qualified graduates to enter the UK register

b) whether the current TOC was cost-effective and sustainable in its current form given that less than 20 individuals were sitting the TOC each year including those re-sitting the test

c) the need to target the assessment of overseas applications on those areas where there is weak evidence of comparability

d) the expiry of the contract with the University of South Wales in September 2014

In October 2013 the Council delegated to the Education Committee the responsibility for developing a replacement to the Test of Competence for the assessment of applicants to join the register who do not hold a qualification that is recognised by the GCC (and who do not qualify for consideration under Directive 2005/36/EC). The aim was to be proportionate to the apparent low level of risk, learn from the approaches used by other UK healthcare profession regulators and anticipate moves to mutual recognition across the worldwide chiropractic community.

The TOC – legislative framework

The Chiropractors Act 1994 refers to:

a) the need for the Council to consult the Education Committee on matters relating to ‘tests of competence’ (para 11(3))

 b)  the Committee may appoint visitors to visit any place or institution where a test of competence is conducted (para 12(c))

 c) the need for any institution which runs a test of competence related to the provisions of the Act to provide information to the Committee (para 18 (1c & 3)

d)  the fact that tests of competence can be used within conditions of practice orders (para 22(5))[1].)

Statutory Instrument 2002 No: 2704 relating to the GCC’s Registration of Chiropractors with Foreign Qualifications (Rules Order of Council) 2002 states that the Registrar can determine whether an applicant has reached the required standard of proficiency (para 5) by requiring the applicant to take a test of competence (para 6(1)) [2].)

The test of competence may be formed of a written or oral test (or both) (para 6(2)) and may include a test requiring a practical demonstration by the applicant (para 6(3)). The test of competence shall be conducted by examiners appointed by the Council, who shall be fully registered chiropractors of not less than 5 years' experience who have successfully completed a course of training approved by the GCC (para 6(4))[3].)

Development of the TOC

In 2014 further work was undertaken in consultation with the Education Committee on:

a.            The TOC assessment process

b.            The Evidence of Practice Questionnaire

c.             Guidance for assessors;

d.            TOC question bank for use in the TOC assessment panel

e.            Policies related to the TOC as follows:

-          Exceptional Mitigating Circumstances

-          Reasonable Adjustments

-          Quality Assurance

-          Appeals against decisions of the Registrar

All the above documents were discussed and approved by the Education Committee on 16th September 2014.

Assessors were recruited and trained in October 2014 and further work was also undertaken on mapping the programme outcomes from the programmes from which the majority of overseas applicants apply against the Degree Recognition Criteria (2010) in readiness for the first sitting of the TOC in January 2015.