international mobility

International MobilityInternational Mobility

Recent Events and ActionsRecent Events and Actions

FCLB LanguageFCLB Language The FCLB Official Directory includes The FCLB Official Directory includes

a section for each state entitled a section for each state entitled “Special Requirements for “Special Requirements for Graduates of Foreign Colleges:”.Graduates of Foreign Colleges:”.

Most include a statement similar to: Most include a statement similar to: “Schools with CCE Reciprocal “Schools with CCE Reciprocal Agreements accepted” Agreements accepted”

CCE Language CCE Language

CCE Policy: BOD – 52 Cooperative CCE Policy: BOD – 52 Cooperative Accreditation of Non U.S. Accreditation of Non U.S. Chiropractic Programs/Institutions Chiropractic Programs/Institutions

CCE Website Heading: “Doctor of CCE Website Heading: “Doctor of Chiropractic Programs … Holding Chiropractic Programs … Holding Accredited Status from Accredited Status from Accreditation Agencies Having Accreditation Agencies Having Reciprocal Agreements with CCE”Reciprocal Agreements with CCE”

NBCE LanguageNBCE Language

NBCE Policy includes: “… the NBCE Policy includes: “… the chiropractic college shall submit to chiropractic college shall submit to the NBCE documentary the NBCE documentary certification that the chiropractic certification that the chiropractic college is accredited by a college is accredited by a chiropractic accrediting agency chiropractic accrediting agency recognized by the United States recognized by the United States Office of Education.”Office of Education.”

Prior to June 2004Prior to June 2004

The CCE Reciprocal The CCE Reciprocal Agreements seemed to provide Agreements seemed to provide a mechanism for recognition of a mechanism for recognition of international study by international study by Regulatory BoardsRegulatory Boards

The FCLB did not know that The FCLB did not know that reciprocal agreements had reciprocal agreements had been rescinded in January 2002been rescinded in January 2002

May 31, 2004May 31, 2004

EVENTEVENT A US citizen A US citizen

attending a foreign attending a foreign DCP sends an email DCP sends an email that reports the that reports the reciprocal reciprocal agreements “were agreements “were dissolved in 2002”dissolved in 2002”

FCLB ACTIONFCLB ACTION Researched Researched

assertion and assertion and found it to be found it to be true.true.

Started thinking Started thinking about about ramifications ramifications

June 10, 2004June 10, 2004Excerpts from letters from FCLB:Excerpts from letters from FCLB:

““It is the understanding of FCLB that It is the understanding of FCLB that CCE-USA currently maintains reciprocal CCE-USA currently maintains reciprocal agreements…”agreements…”

““42 US Boards … have developed 42 US Boards … have developed regulatory language that relies on these regulatory language that relies on these agreements as one criterion for agreements as one criterion for licensure”licensure”

…”…”uniform standards appear to be an uniform standards appear to be an excellent step to ensure that new and excellent step to ensure that new and existing CCEs will have existing CCEs will have substantially substantially equivalentequivalent processes worldwide.” processes worldwide.”

What Now?

What Now?What Now?

June 22, 2004June 22, 2004

EVENTEVENT CCE Announcement: CCE Announcement:

“CCE-USA will, for “CCE-USA will, for the record, keep the the record, keep the agreements in force agreements in force … providing … providing stakeholders an stakeholders an opportunity to opportunity to determine their determine their course of action course of action regarding regarding reciprocity.”reciprocity.”

NBCE ACTIONNBCE ACTION Monitor Monitor

developments and developments and plan to present plan to present information at the information at the Fall Board MeetingFall Board Meeting

July 19, 2004July 19, 2004

EVENTEVENT CCE Announcement: CCE Announcement:

“This will serve as “This will serve as public notice that the public notice that the CCE-USA Board of CCE-USA Board of Directors plans to Directors plans to reaffirm the decision to reaffirm the decision to rescind BOD Policy – 52 rescind BOD Policy – 52 … at its January 2005 … at its January 2005 meeting.”meeting.”

NBCE ACTIONNBCE ACTION Duly notedDuly noted Recognized Recognized

that NBCE that NBCE policy will need policy will need to be modified.to be modified.

October 14, 2004October 14, 2004

EVENTEVENT WFC/ACC Conference: WFC/ACC Conference:

FCLB facilitates a FCLB facilitates a discussion on discussion on chiropractic regulatory chiropractic regulatory reliance on programmatic reliance on programmatic accreditationaccreditation

CCE-USA reveals that the CCE-USA reveals that the reciprocal agreements reciprocal agreements never didnever did confer USDE confer USDE recognitionrecognition

NBCE ACTIONNBCE ACTION Staff attends Staff attends

meeting but meeting but did not attempt did not attempt to direct or to direct or affect any affect any solutions. solutions.


EVENTEVENT FCLB FCLB UPDATEUPDATE states: states:

“Healthy information exchange “Healthy information exchange and lively brainstorming are and lively brainstorming are leading toward the general leading toward the general concept of agreements concept of agreements facilitated by CCEI, which can facilitated by CCEI, which can assure regulatory agencies of assure regulatory agencies of substantial equivalencesubstantial equivalence in in educational competence of educational competence of chiropractic programs and chiropractic programs and their graduates worldwide.” their graduates worldwide.”

NBCE ACTIONNBCE ACTION Duly notedDuly noted


EVENTEVENT FCLB FCLB UPDATEUPDATE states: “Our states: “Our

members may rest assured members may rest assured that their current board that their current board requirements can remain in requirements can remain in place in which regulatory place in which regulatory agencies generally accept agencies generally accept as candidates for licensure as candidates for licensure those graduates of DCPs those graduates of DCPs with accreditation by the with accreditation by the commissions of the CCEs commissions of the CCEs (in addition to other criteria (in addition to other criteria as may be required by law.) as may be required by law.)

NBCE ACTIONNBCE ACTION Duly noted, but still Duly noted, but still

believe NBCE policy believe NBCE policy will need to be will need to be modifiedmodified

This information is This information is reported to our full reported to our full Board at its meeting a Board at its meeting a few days hencefew days hence

November 2004 – March November 2004 – March 20052005

NBCE ACTIONNBCE ACTION Staff develops a draft Staff develops a draft

policy revision that policy revision that incorporates the incorporates the substantially substantially equivalentequivalent terminology and terminology and receives legal OKreceives legal OK

March 10 – 12, 2005March 10 – 12, 2005

EVENTEVENT NBCE EC Meeting: NBCE EC Meeting:

EC discusses EC discusses optionsoptions

NBCE ACTIONNBCE ACTION EC moves to EC moves to

recommend to the full recommend to the full board a policy revision board a policy revision that includes the that includes the substantially substantially equivalentequivalent terminology.terminology.

March 11, 2005March 11, 2005

EVENTEVENT CCE-USA Announcement: CCE-USA Announcement:

Equivalency Based on CCEI Equivalency Based on CCEI Model Standards Replaces Model Standards Replaces Reciprocal AgreementsReciprocal Agreements

It includes: “It should be It includes: “It should be noted that … compliance noted that … compliance and conformity with CCEI and conformity with CCEI Model Standards does Model Standards does notnot necessarily express necessarily express identical equivalenceidentical equivalence with CCE-US Standards.”with CCE-US Standards.”

NBCE ACTIONNBCE ACTION Duly noted; Duly noted;

substantial substantial equivalence not equivalence not identical identical equivalence is equivalence is the language the language everyone has everyone has been using.been using.

May 2 - 7, 2005May 2 - 7, 2005

EVENTEVENT NBCE Board NBCE Board

meeting: Full Board meeting: Full Board discusses eligibility discusses eligibility policy optionspolicy options

NBCE ACTIONNBCE ACTION Full Board revises Full Board revises

eligibility policy to eligibility policy to extend eligibility to extend eligibility to those already in the those already in the system through 2006 system through 2006 and includes the and includes the substantially substantially equivalent terminologyequivalent terminology

Staff directed to Staff directed to document the document the presumed substantial presumed substantial equivalency equivalency

June 14 – November 3, 2005June 14 – November 3, 2005

EVENTEVENT CCE-USA can not CCE-USA can not

assert that any of assert that any of the other CCEs the other CCEs Standards are Standards are substantially substantially equivalent to their equivalent to their own.own.

NBCE ACTIONNBCE ACTION Staff concludes that Staff concludes that

there is evidence to there is evidence to support an assertion support an assertion that the Standards of that the Standards of all the CCEs are all the CCEs are substantially equivalent substantially equivalent but that the CCEI but that the CCEI Model Standards are Model Standards are not precise enough to not precise enough to be considered be considered substantially equivalentsubstantially equivalent

November 3 - 5, 2005November 3 - 5, 2005

EVENTEVENT NBCE Board NBCE Board

Meeting: Full Board Meeting: Full Board discusses options discusses options that include polling that include polling the state boards, the state boards, specifically “asking specifically “asking if the CCEI if the CCEI endorsement and endorsement and recognition of recognition of equivalency is equivalency is acceptable to them”acceptable to them”

NBCE ACTIONNBCE ACTION Because of the Because of the

complexity of the complexity of the issue, it is assigned to issue, it is assigned to the Board’s Exam the Board’s Exam Development Development Committee for closer Committee for closer oversightoversight

Staff is directed to Staff is directed to follow-up on all the follow-up on all the options presentedoptions presented

November 5 – December 13, November 5 – December 13, 20052005

EVENTEVENT Committee chair and Committee chair and

staff recognize that this staff recognize that this situation places foreign situation places foreign educated graduates at educated graduates at risk of not being able risk of not being able to become licensed in to become licensed in their state of choice their state of choice

Committee chair and Committee chair and staff ponder potential staff ponder potential solutions.solutions.

New broadcast email New broadcast email software is installedsoftware is installed

NBCE ACTIONNBCE ACTION Staff develops survey to Staff develops survey to

provide data to help provide data to help evaluate several evaluate several potential solutionspotential solutions

Survey PurposesSurvey Purposes Confirm (or refute) states’ requirement for Confirm (or refute) states’ requirement for

USDE recognition of DCPs.USDE recognition of DCPs. Confirm (or refute) states’ reliance on Confirm (or refute) states’ reliance on

reciprocal agreements to accept foreign reciprocal agreements to accept foreign educated applicants.educated applicants.

Would states accept the mutual endorsement Would states accept the mutual endorsement and recognition provisions of CCEI to allow and recognition provisions of CCEI to allow foreign educated applicants for licensure?foreign educated applicants for licensure?

Would states accept evidence of substantial Would states accept evidence of substantial equivalency to CCE-US standards to allow equivalency to CCE-US standards to allow foreign educated applicants for licensure?foreign educated applicants for licensure?

Would states require that NBCE annotate score Would states require that NBCE annotate score transcripts of foreign educated examinees?transcripts of foreign educated examinees?

DecemberDecember 14, 2005 14, 2005 Survey is broadcast emailed or faxed Survey is broadcast emailed or faxed

to all state boardsto all state boards

Survey Questions and Survey Questions and ResponsesResponses

1.1. Does your Board require that Does your Board require that licensure applicants provide licensure applicants provide evidence that they attended a DCP evidence that they attended a DCP that is accredited by an accrediting that is accredited by an accrediting agency recognized by the USDE?agency recognized by the USDE?

39 YES or CCECOA accredited39 YES or CCECOA accredited 2 NO2 NO 3 No Answer3 No Answer


2.2. Did your board accept CCE-US Did your board accept CCE-US reciprocal agreements as evidence reciprocal agreements as evidence that foreign DCPs were accredited that foreign DCPs were accredited by an accrediting agency by an accrediting agency recognized by the USDE? recognized by the USDE?

16 YES16 YES 24 NO24 NO 4 No Answer4 No Answer


3.3. Can and will your board accept the Can and will your board accept the mutual endorsement and mutual endorsement and recognition provisions of CCEI recognition provisions of CCEI member accrediting agencies as an member accrediting agencies as an equivalent substitute for the equivalent substitute for the previous reciprocal agreements? previous reciprocal agreements?

7 YES7 YES 25 NO25 NO 12 Others12 Others


4.4. If no to number 3, would evidence that a If no to number 3, would evidence that a foreign CCE’s standards are foreign CCE’s standards are substantially equivalent to CCE-US substantially equivalent to CCE-US standards be satisfactory for your board standards be satisfactory for your board to accept applications from those who to accept applications from those who attended a foreign DCP and passed the attended a foreign DCP and passed the NBCE examinations? NBCE examinations?



5.5. If no to number 4, and if NBCE If no to number 4, and if NBCE continues to grant eligibility to continues to grant eligibility to applicants from non-CCE-US accredited applicants from non-CCE-US accredited programs, would your board require that programs, would your board require that NBCE annotate its score transcripts with NBCE annotate its score transcripts with the name of the accrediting agency that the name of the accrediting agency that accredited the examinee’s DCP? accredited the examinee’s DCP?


FindingsFindings1.1. CCE-USA can CCE-USA can notnot state that the state that the

other CCE’s requirements, other CCE’s requirements, standards and procedures are standards and procedures are substantially equivalentsubstantially equivalent to their to their Council on Accreditation standards.Council on Accreditation standards.

FindingsFindings2.2. The other CCE’s will The other CCE’s will notnot state that state that

their requirements, standards and their requirements, standards and procedures are procedures are substantially substantially equivalentequivalent to the CCE-US Council to the CCE-US Council on Accreditation standards.on Accreditation standards.

FindingsFindings3.3. NBCE should NBCE should notnot conduct, or hire conduct, or hire

another organization to conduct, an another organization to conduct, an independent comparison of the independent comparison of the various CCE accreditation various CCE accreditation standards.standards.

FindingsFindings4.4. A number of US state licensing A number of US state licensing

boards will not (or cannot without boards will not (or cannot without changing their legislation) accept changing their legislation) accept the mutual endorsement and the mutual endorsement and recognition provisions of CCEI recognition provisions of CCEI member accrediting agencies as a member accrediting agencies as a substitute for the rescinded substitute for the rescinded reciprocity agreements. reciprocity agreements.

FindingsFindings5.5. A CCE’s stated adherence to the A CCE’s stated adherence to the

CCEI Model Standards does CCEI Model Standards does notnot satisfy our current policy.satisfy our current policy.

ConclusionConclusion Without the ability to document Without the ability to document

“substantial equivalency” as “substantial equivalency” as required by NBCE’s current policy, required by NBCE’s current policy, foreign educated students and foreign educated students and graduates will soon be ineligible to graduates will soon be ineligible to sit our examinations. sit our examinations.

May 2, 2006May 2, 2006

The current policy has The current policy has been extended through been extended through 2007 and referred for 2007 and referred for further studyfurther study

international mobility

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