Leadership and capacity building in international chiropractic research: Introducing the chiropractic academy for research leadership (CARL)

Abstract

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.

Full text

COMMENTARY Open Access
Leadership and capacity building in
international chiropractic research:
introducing the chiropractic academy for
research leadership (CARL)
Jon Adams
1
, Greg Kawchuk
2
, Alexander Breen
3
, Diana De Carvalho
4
, Andreas Eklund
5
, Matthew Fernandez
6
,
Martha Funabashi
2
, Michelle M. Holmes
3,7
, Melker S. Johansson
8,9
, Katie de Luca
10
, Craig Moore
1
, Isabelle Pagé
11
,
Katherine A. Pohlman
12
, Michael S. Swain
13
, Arnold Y. L. Wong
14
and Jan Hartvigsen
8,15*
Abstract
In an evidence-based health care environment, healthcare professions require a sustainable research culture to
remain relevant. At present however, there is not a mature research culture across the chiropractic profession
largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic
teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research
Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic
researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The
program centres upon an annual week-long program residential that rotates continental locations over the first
three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives.
Through a competivite application process, the first cohort was selected and consists of 13 early career researchers
from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic.
The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton,
Canada, and the final residential to be held in Sydney, Australia in 2019.
Keywords: Chiropractic, Leadership, Research, Evidence
Background
Health care professions require a sustainable research cul-
ture to underpin practice and justify effective, safe coord-
ination and integration of care within the wider health
care system [1]. Despite numerous calls for more research
[2–7], at present, a mature research culture across the
chiropractic profession remains elusive, largely due to
deficiencies in research capacity and leadership [8]. The
interrelated tasks of building research capacity and facili-
tating research leadership in chiropractic are especially
pertinent given some parts of chiropractic’scontemporary
focus on evidence-based health care [9]. Futhermore, it is
pertinent as a core foundation to produce a sound evi-
dence base relevant to appropriate practice and policy
decision-making [10]. Building research capacity and
facilitating research leadership can also have significant
positive effects to advance a broader leadership capability
and a wider professional development of chiropractic
beyond the research realm [8].
Given the need to develop research capacity and
leadership within chiropractic, a group of senior health
researchers (Adams, Hartvigsen and Kawchuk) having
research interests of relevance to chiropractic, have
planned and founded the world-first international chiro-
practic research leadership initiative –the Chiropractic
Academy of Research Leadership (CARL).
* Correspondence: jhartvigsen@health.sdu.dk
8
Department of Sports Science and Clinical Biomechanics, University of
Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
15
Nordic Institute of Chiropractic and Clinical Biomechanics, University of
Southern Denmark, Odense, Denmark
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Adams et al. Chiropractic & Manual Therapies (2018) 26:5
DOI 10.1186/s12998-018-0173-3

The aims of the CARL program
The CARL program is driven by a number of distinct
but interrelated aims. While there are undoubtedly sig-
nificant pockets of chiropractic research activity dotted
around the world, a challenge for many in this field has
been a lack of global networks and infrastructure. The
primary aim of the CARL program is therefore to
address this gap through mentoring of early career re-
searchers into a cohesive cohort. As such, this program
provides an opportunity for geographically disparate re-
searchers to share interests and insights and ultimately
develop longstanding, hopefully lifelong, friendships and
collaborations helping to develop a critical mass of
successful early-career chiropractic researchers on the
international stage.
Another aim of the CARL program is to encourage
multi-disciplinary perspectives and cooperation in chiro-
practic research –not only across different disciplinary
trainings and expertise but also across the researcher/
practitioner fields and chiropractic/non-chiropractic div-
ide where those exist. As with many budding research
fields, chiropractic academia can in some cases be a
highly competitive environment and CARL encourages
appointed Fellows to co-ordinate and collaborate their
efforts wherever possible.
The program also aims to provide much-needed ‘time-
out’from the day-to-day pressure of work environments
allowing space and time to reflect and consider longer-
term, deeper issues around both individual career devel-
opment and strategic blue-sky planning for the profes-
sion more broadly.
CARL further aims to develop confidence amongst
these future leaders in the profession. It is important for
a research culture that researchers are confident both in
their own location in the research and academic world
as well as in their discipline and focus or topic. This can
be as simple as reaffirming that chiropractic is indeed an
important field amongst many others in the health sys-
tem worthy of its own independent and integrative
examination and assessment.
The CARL program additionally aims to provide direct
mentorship, support and advice to a cohort of CARL Fel-
lows regarding their own research focus, strategic develop-
ment and career pathway. There are countless potential
opportunities and hazards in advancing any academic car-
eer and CARL encourages Fellows to identify and explore
these in a ‘safe’place away from what can sometimes be
the competitively-driven environment of a home institu-
tion. Peer-support is a core ingredient in advancing this
aim. Importantly, 50% of the program’s contact time fo-
cuses on providing leadership skills and identifying leader-
ship opportunities within the profession. This critical
feature recognizes that a relatively small percentage of
early career health researchers remain within academia in
the face of high rejection rates and an increasingly com-
petitive environment [11–13]. The CARL program not
only helps strengthen future researchers, but also aims to
build a cohort of high-functioning leaders who have been
exposed to other career opportunities within chiropractic.
Finally, CARL aims to promote and produce a prolific
range of tangible research outputs and products helping to
bolster and coordinate efforts to build an evidence base to
inform practitioners, patients, policymakers and other
relevant stakeholders. The focus is upon not only develop-
ment of new collaborative projects and project funding
but also dissemination via peer-review publications, pro-
fessional and research conferences and community-based
engagement.
Core principles of CARL
A number of core features are arguably important to de-
velop sustainable, effective health research capacity and
leadership. Foremost, the development should acknow-
ledge and reflect issues and topics of relevance to practi-
tioners and their patients. Unfortunately, health research
to date, beyond and within chiropractic, has illustrated a
disconnect between research and clinical practice [14–16],
and it is important that future chiropractic enquiry not be
defined by these same challenges [17].
Another core feature of CARL will be the camaraderie
of high achieving, like-minded individuals placed to-
gether within a supportive and productive environment.
It is known that feelings of isolation, the lack of profes-
sional support and/or recognition from within the chiro-
practic profession are substantial challenges faced by
higher-degree chiropractic research students and can be a
major barrier to research retention [18]. Moreover, the
challenges of career advancement within a competitive cli-
mate, overcoming disappointment and managing re-
searcher ‘burnout’are often either dealt with in isolation
or not discussed. While most chiropractors opt for clinical
practice, providing mentorship in a safe, prosperous envir-
onment for early career researchers will enhance their re-
search capability, leadership and career development.
Another closely related core feature of CARL is to en-
courage and reflect both a broad range of perspectives
beyond the chiropractic profession and the investigation
of topics that stretch beyond those exclusively of interest
to chiropractic. As such, CARL will include collabora-
tions and an interface with experts from across the wider
academy (e.g. clinical researchers, trial methodologists,
public health and health service researchers, social scien-
tists and health economists amongst many others) not
only enriching empirical investigation but also safeguard-
ing research from adopting predominantly or exclusively
‘chiropractic-centric’perspectives.
Multi-discplinary collaboration is also essential to
ensuring chiropractic is subjected to the same rigorous
Adams et al. Chiropractic & Manual Therapies (2018) 26:5 Page 2 of 6

critical methodological testing and evaluation as other
areas of health practice –a perspective that advances
the entire health care field within and beyond conven-
tional medical practice. Such a stance helps maintain in-
ternal and external validity and provides the potential
for a legitimate evidence base essential if chiropractic
care is to advance within the wider health system.
Finally, it is important to develop chiropractic research
focus beyond the short-term [19]. CARL will develop a
road-map and the infrastructure to facilitate strategic re-
search direction, growth and sustainability for future in-
vestigators and investigations will encourage a co-
ordinated, big-picture approach –issues of crucial sig-
nificance given the relative infancy of the chiropractic
research culture in many jurisdictions around the world.
The evolution and methodology of CARL
CARL was initially built upon the personal experience of
Distinguished Professor Jon Adams as an appointed Se-
nior Fellow (2009) on the Oxford International Primary
Care Research Leadership Program at the Nuffield De-
partment of Primary Care Health Sciences, University of
Oxford (www.phc.ox.ac.uk). In late 2015 Distinguished
Professor Adams, Professor Hartvigsen and Professor
Kawchuk collaborated on the idea of a similar inter-
national research leadership program around chiroprac-
tic and the concept of the CARL Program was founded.
The CARL Program identifies and mentors talented,
promising early career researchers over an initial three-
year period with future program years planned.
The design and content of the CARL Program was in
part informed by the list of aims outlined earlier as well as
the foundational features of the Oxford International Pri-
mary Care Research Leadership Program. As a result, the
program centres upon an annual week-long program resi-
dential that rotates continental locations over the first
three-year cycle. Each residential consists of an intense
week of activities whereby Fellows receive individual men-
torship, problem-solving, career development, insights into
academic and research management and presentations and
workshops from invited international senior academics.
Alongside these structured sessions and activities, Fellows
are also allocated time to explore areas of mutual interest
for collaboration and partnership. In addition, an essential
feature of the program and residential is to facilitate and
encourage ‘unstructured’,organicinteractionsandconversa-
tions between Fellows who, in many cases, may not have
necessarily had an opportunity to investigate and explore
collaborative opportunities with each other outside the
CARL Program. Between residentials, the Fellows work on
research and leadership projectsusingelectronicandinter-
net platforms for project management and communication.
Importantly, while the mentors inspire activities, the drive
of the program quickly becomes the charge of the Fellows
who shape and mold future directions and projects, with
mentor support, as their confidence and experience grows.
The first CARL cohort
The initial worldwide call for CARL Fellowship submis-
sions attracted over 30 full applications from inter-
national candidates. Following extensive peer-review by
the founders and a round of short-listed candidate inter-
views, the first cohort of the CARL program has now
been selected and consists of 13 early career leaders
from 5 professions in 7 countries who represent diverse
areas of interests of high relevance for chiropractic
(Table 1). Six are women, six are PhD students, four are
Postdoctoral Fellowss, three are Assistant Professors,
and four work as part time clinicians in addition to their
research activities. With regards to their motivations for
joining CARL, all Fellows have reported the need for
and benefit of being involved in an international net-
work helping to strengthen their research and leadership
careers, the importance of receiving explicit mentorship
and developing collaborations and friendships from their
program involvement.
Discussion: progress and successes of CARL
program to date
Health professions operating beyond the conventional
medical profession and curriculum are increasingly rea-
lising that they need to increasingly engage with the lar-
ger societal agenda of evidence-based practice [20].
Chiropractic is among the largest health care professions
in the world beyond conventional medicine. While there
are existing research groups in chiropractic who are pro-
ductive by any standard, global research activities in
chiropractic remain modest. In response to these cir-
cumstances, the Chiropractic Academy for Research
Leadership (CARL) Program was founded in 2016. This
model will provide the longevity and impact to deliver
one platform and growth strategy, which is required to
develop a mature, sustainable international chiropractic
research and leadership culture. With the first cohort of
Fellows appointed in late 2016, the inaugural CARL resi-
dential was held at the University of Southern Denmark
campus in Odense, Denmark in April 2017. The 5-day
program included guest lectures from successful young re-
searchers, experienced musculoskeletal research leaders,
experts on management and leadership as well as many
workshops and social activities. From these interactions
and scheduled work time, the primary outcome for the
first CARL residential was produced; a catalogue of collab-
orative research and leadership opportunities for the Fel-
lows to pursue over the coming year. Specifically, the
catalogue currently consists of numerous identified aca-
demic and leadership projects. In the six months since
the first residential in Denmark, CARL Fellows have
Adams et al. Chiropractic & Manual Therapies (2018) 26:5 Page 3 of 6

Table 1 Descriptive details about CARL fellows and own statements about reasons for joining CARL
Country, sex,
academic degrees
Current positions Why did you join CARL? What do you expect to get
out of CARL?
How might CARL benefit
chiropractic?
Australia, ♂,
chiropractor, MSc
PhD student
Part-time
clinician
Want to be part of global
collaboration among ECRs
to move chiropractic forward
Mentorship and help to
participate in research projects
Coordinated international
research planning and output
is critical to the progress and
standing of the chiropractic
profession within mainstream
health
Sweden, ♂,
chiropractor, MSc, PhD
Post Doc Part-
time clinician
Want to engage in global
collaboration and get
exposure to other research
groups and professional
networks with a common
focus on chiropractic/
manual medicine
Get exposure to new methods
and applications, expand
knowledge and skills.
Increased publication output
and research experience
Help build research capacity
in Chiropractic. Increase the
output and quality of research
relevant to the Chiropractic
profession
Canada, ♀,
chiropractor, MSc
PhD student Part
time clinician
Huge opportunity for PhD
student who wants to
continue in the field of
chiropractic research and
believes international
collaboration is of prime
importance
Become part of strong international
network. Develop research skills
and independence
CARL allows for the development
of a strong network of researchers
around the word that have the
capacity to collaborate and
support each other
Australia, ♀,
chiropractor, MSc, PhD
Post Doc Part-
time clinician
Want to become part
of international network
and learn from key
international academics
in supportive environment
Boost in research career and high-
quality research output. Broaden
opportunities for collaborating
with international researchers
The CARL leadership projects
will benefit all chiropractors,
with CARL fellows dedicated
to establishing and endorsing
initiatives that will foster
growth and increased visibility
for the chiropractic profession
UK, ♀, Natural
therapeutics, MSc
PhD student
Lecturer
Want to be able to co-
ordinate my research with
researchers internationally
in order to advance the field
Collaborate with other fellows
to identify areas of research
priority for the profession.
Having mentorship
Through the CARL program,
the CARL fellows can plan
research projects to have a
successful impact in practice
and contribute to the international
research agenda within chiropractic
and the future of the profession
Canada, ♀,
chiropractor, MSc, PhD
Assistant
Professor
I joined CARL to develop
and expand my international
network for collaborations,
for early career mentorship
and to ensure my research
continues to have an impact
in the field of chiropractic
Iexpect to learn from and work
with my colleagues in order to
become a better researcher
and leader in the chiropractic
profession
CARL can elevate the profession
in terms of research productivity
and impact and connect future
leaders that can motivate and
inspire chiropractic practitioners
worldwide to integrate evidence
to the benefit of their patients
Australia, ♂,
chiropractor, PhD
Clinician
Lecturer
To work with like-minded
early career researchers,
continuing my education
in research, and the
opportunity to be mentored
by leaders in the field
Leadership skills, publication
output, friendship and being
part of an up-and-coming
early research culture within
the profession
Change the landscape, where
private practice providers can
appreciate and further utilize
high-quality research, impacting
their practice in an evidence-
based manner –establishing
chiropractic cultural authority
Canada, ♀, physical
therapist, MSc, PhD
Post Doc
Research
Associate
To learn from successful
mentors as well as to build
strong collaborations to assist
with increasing the number
of publications and planning/
conducting future high-quality
studies. For my surprise, CARL
was much more than that
Learn from mentors’experience
get their guidance. To build strong
relationships with the other CARL
fellows, which will lead to strong
collaborations that will significantly
contribute to the advancement of
chiropractic and SMT research
Bringing the young career
researchers that have the
greatest potential of becoming
successful investigators in
chiropractic together, giving
them the opportunity to bond,
have ideas, work together and
support each other is a brilliant
idea that paves the way for
fruitful collaborations and high-
quality studies that will greatly
advance the evidence regarding
the chiropractic profession
Australia, ♂,
chiropractor
PhD student
Lecturer
I joined CARL to meet people
who share my passion for
An international network of
career long collaborators that
To exist, a profession must have
a knowledge base, quality
Adams et al. Chiropractic & Manual Therapies (2018) 26:5 Page 4 of 6

submitted a variety of papers to peer-reviewed journals
and have completed numerous leadership activities. A
fellow-driven newsletter will be released twice a year, with
the first and subsequent newsletter available at https://
chiroresearchfellows.wordpress.com/.
The next residential is now being planned for
Edmonton, Canada in April 2018 and will bring the Fel-
lows together to seed the Program catalogue with new
ideas and review progress as well as provide additional
advanced training in research productivity and leader-
ship skills. The following week, the CARL Fellows will
also take part and showcase their abilities at the Canad-
ian Chiropractic Association Convention in Calgary.
Conclusion
The long-term aim of CARL is to develop the essential
leadership skills and experiences to take on senior CARL
mentorship appointments and help secure the successful
Table 1 Descriptive details about CARL fellows and own statements about reasons for joining CARL (Continued)
Country, sex,
academic degrees
Current positions Why did you join CARL? What do you expect to get
out of CARL?
How might CARL benefit
chiropractic?
developing the scholarship
of chiropractic, and to work
collaboratively with them into
the future for the befit of
the community
will answer important research
questions and expand the
relevant knowledge base and
international leadership
education, and ongoing expansion
of that knowledge base through
postgraduate scholarly activity
and research. CARL serves a
necessary contribution from
aprofessiontothebetterment
of society
UK, ♂, MSc, PhD Post Doc I applied to join CARL to put
my work into the context of
other chiropractic researchers.
My long-term aim is to
understand dynamic
individualized biomechanical
factors in low back pain and
help to explain the effects
of spinal manipulation.
The CARL program has helped
help me to gain a deeper
appreciation of research areas
beyond my own focus in
biomechanics. In return, it is my
hope that my own expertise in
biomechanics might help the
other CARL fellows
A community of early career
researchers from across the
board of chiropractic research
based all over the world can
do more for the scientific
progress of the profession
than individual experts aligned
to their more disparate and
isolated topics.
I am confident that this program
can promote a synergy between
the biological, physiological and
social aspects of the
biopsychosocial model
Denmark, ♂,
chiropractor, MSc
PhD student CARL came across as a great
opportunity to meet like-minded
research colleagues and friends,
for sharing experiences and
improving research-related skills
CARL constitutes an excellent
Forum, just like a greenhouse,
where we can discuss issues
and barriers related to research
and career development, learn
and be inspired; collaborate,
and ultimately flourish as
health care researchers
CARL will strengthen the
profession by facilitating
international research
collaborations, fostering
future leaders and thereby
further position the
chiropractic profession as
an important contributor
to health care and health
care research globally
USA, ♀, chiropractor,
MSc
PhD student
Assistant
Professor
CARL opens up the opportunity
to create the most impactful
and innovative chiropractic
research, which is my desire
for the special pediatric,
pregnant, and post-partum
population
As the solo chiropractic clinical
scientist, CARL is for mentorship
in research capacity building.
With this network, chiropractic
research could become united,
cohesive, and impactful
CARL just fast-tracked chiropractic
research by networking early
career scientists and providing
the platform for collaboration.
This effort will undoubtingly impact
the current evidence-based
chiropractic literature gap and most
importantly the management and
care of chiropractic patients
Hong Kong, physical
therapist, MSc, PhD
Assistant
Professor
As an early career researcher
with a passion to conduct
high quality research, I want
to have some mentors and
peers to guide and support
my research journey
To broaden my research
skills and network through
collaboration. I am determined
to be a prominent research
leader and conduct impactful
chiropractic research and
nurture new research leaders
Given the complexity of spinal
problems, it is important to
coordinate personal resources
from different disciplines. This
program can empower the
next generation of chiropractic
research leaders through research
collaborations, grant writing
and knowledge translation
♀= Female
♂= Male
Adams et al. Chiropractic & Manual Therapies (2018) 26:5 Page 5 of 6

mentorship of a subsequent early-career researcher co-
hort of Fellows. The initial cohort of 13 appointed CARL
Fellows has shown excellent promise and produced nu-
merous outputs in the first six months since the pro-
gram launch and it is envisaged that this first cohort can
be supported on a more ongoing basis.
Abbreviations
CARL: Chiropractic Academy of Research Leadership
Acknowledgements
We thank the financial supporters of CARL for their generous contributions.
Funding
The Chiropractic Academy of Research Leadership (CARL) Program was
established and supported by researchers at University of Alberta, Canada,
the University of Southern Denmark and the Nordic Institute of Chiropractic
and Clinical Biomechanics (NIKKB), and the University of Technology Sydney,
Australia. The CARL Program was initiated in partnership with the World
Federation of Chiropractic (WFC), the European Centre for Chiropractic
Research Excellence (ECCRE), the Canadian Chiropractic Association (CCA),
and has received in-kind support from the Nordic Institute of Chiropractic
and Clinical Biomechanics (NIKKB) and the Australian Research Centre in
Complementary and Integrative Medicine (UTS:ARCCIM).
Availability of data and materials
Not applicable.
Authors’contributions
JA, GNK and JH drafted the first version of the manuscript. All authors
contributed to subsequent revisions and approved the final version of the
manuscript.
Authors’information
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
All authors approved the final version of the manuscript.
Competing interests
Through generous funding from sources listed above, participation in CARL
including travel and other expenses associated with the residentials is free
for the fellows. JA, GNK and JH receive no fee or other financial
compensation in connection with CARL. Not applicable.
Publisher’sNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Faculty of Health, University of Technology Sydney, Sydney, Australia.
2
Faculty of Rehabilitation Medicine, University of Alberts, Edmonton, Canada.
3
AECC University College, Bournemouth, UK.
4
Faculty of Medicine, Memorial
University of Newfoundland, NL, St. John ’s, Canada.
5
Institute of
Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
6
Private
practice of chiropractic, Drummoyne, NSW, Australia.
7
Department of
Psychology, University of Southampton, Southhampton, UK.
8
Department of
Sports Science and Clinical Biomechanics, University of Southern Denmark,
Campusvej 55, 5230 Odense M, Denmark.
9
National Research Centre for the
Working Environment, Copenhagen, Denmark.
10
Private practice of
chiropractic, South West Rocks, South West Rocks, NSW, Australia.
11
Department of Anatomy, Université du Québec à Trois-Rivières,
Trois-Rivières, Québec, Canada.
12
Research Institute, Parker University, Dallas,
TX, USA.
13
Department of Chiropractic, Faculty of Science and Engineering,
Macquaire University, Sydney, Australia.
14
Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
15
Nordic Institute of Chiropractic and Clinical Biomechanics, University of
Southern Denmark, Odense, Denmark.
Received: 6 November 2017 Accepted: 5 January 2018
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