Tuesday, November 4, 2008

The SPICES Model: E. Electives vs. Standard Programs

In Harden’s SPICES model (1), the E defines distinctions between elective programs and a standard course of study. In a standard program, all the students pass through a prescribed set of course, and have few opportunities to study a subject of their own choosing that is outside those courses set in the program. This is very much what the case was when I was a student at National College of Chiropractic; there was a prescribed set of courses and only a single elective course, acupuncture (and that because many states did not allow the practice of acupuncture by chiropractic physicians).

Elective programs that students can choose from allow a student to follow his or her own muse. Such programs can occur in a number of ways: as a single stand-alone class in a given term, as an independent study course, or as a series over time. At Palmer College, students can take elective classes in a variety of chiropractic techniques, for example. In the clinical research master’s program, students can take electives in biomechanics, and they can also design their own independent study course. Such courses have, in the past, included low back outcome assessment instruments, neurophysiology, pediatric journal assessment, etc. The point is that in each case a student designed a course that allowed him or her to pursue a personal interest. And in US medical education, there are even a few programs, such as Stanford University, where the entire curriculum is elective-based, where students can choose their own basic and clinical science courses.

Electives have many benefits. Harden notes that they are a way of coping with an over-crowded curriculum. This arises because as knowledge expands, it is not possible to cover everything, and in curriculum planning using electives may be a way to help students tackle areas where they feel they have interest, or deficiency. Electives provide a means for students to take more responsibility for their own learning. Further, electives can help facilitate career choice by students, and they can help students meet their own personal aspirations. Elective courses can lead to attitude changes as well.

But there are benefits to the standard program as well. Electives require more teachers and more teaching time, and we are all already quite busy. Not all faculty may be interested in teaching such courses. But the presence of electives can have beneficial effects on the standard courses. Program assessment in a standard program is pretty well understood, but it is harder to assess electives.

A combination of electives and a standard program may help make the educational experience in chiropractic more personalized and therefore more personally meaningful. All chiropractic programs have adopted some manner of offering elective courses.


1. Harden RM, Sowden S, Dunn WR. ASME Medical Education Booklet No. 18. The SPICES Model. Med Educ 1984;18:284-297

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