title: The simulated early learning of cervical spine manipulation technique utilising mannequins.
abstract: BACKGROUND
  Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy.
  
  
  METHODS
  We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks.
  
  
  RESULTS
  This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either "usual learning" (n = 19) or "mannequin learning" (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ(2) = 0.10, p = 0.75), four weeks (χ(2) = 0.40, p = 0.53), and eight weeks (χ(2) = 0.07, p = 0.79).
  
  
  CONCLUSIONS
  This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.
authors.affiliation: 6 Claredon Court, Alexander Heights, 6064 WA Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Chapman
authors.affiliation: School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia.
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Stomski
authors.affiliation: Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia.
authors.forename: Barrett
authors.initials: B
authors.lastname: Losco
authors.affiliation: Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia.
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Walker
keywords: Chiropractic; Education; Mannequin; Neck manipulation; Randomised trial; Simulated learning