LADDERS AND BRIDGES: STRENGTHENING UNDERGRADUATE PIPELINES FOR CHIROPRACTIC GRADUATE SUCCESS

Introduction

Chiropractic education has evolved significantly since its inception, moving from apprenticeship models to structured, accredited graduate programs emphasizing rigorous science, evidence-informed practice, and interprofessional collaboration. Accrediting bodies such as the Council on Chiropractic Education (CCE) have raised expectations for student competencies, requiring strong foundations in anatomy, physiology, biomechanics, clinical reasoning, and professional ethics. Recognized by the U.S. Department of Education as the nationally authorized accrediting agency for 18 chiropractic programs across 21 locations in the U.S., Puerto Rico, and Canada, the CCE must comply with federal criteria that ensure it serves as a reliable authority on educational quality, including rigorous standards for curriculum, institutional effectiveness, and student learning outcomes.

While the CCE sets broad but rigorous admission-related expectations, they do not prescribe specific admission criteria for all institutions. However, the CCE requires that each program¹: maintain clearly documented admissions policies and procedures that are transparent, consistently applied, and designed to foster student success²; admit students who are academically prepared for the rigor of chiropractic education³; report admissions data; and⁴ implement support systems that promote student achievement. Despite these requirements, undergraduate preparation for chiropractic varies widely. Many students enter graduate programs with uneven backgrounds in the sciences, limited research experience, or minimal exposure to professional practice. These disparities may contribute to higher rates of attrition, increased academic challenges, or delays in students’ progression through chiropractic training.

Scholars in the field of health professions education suggest that structured undergraduate preparation improves graduate success. Pre-medical, nursing, and physical therapy pathways, for example, often emphasize scaffolded science curricula, advising, experiential learning, and professional identity development. Such approaches help ensure that students enter graduate programs with both the technical knowledge and the dispositions required for success. In contrast, researchers in chiropractic education have only recently begun to examine these transitional factors.

While existing chiropractic education research explores various factors that influence student transition and persistence, it does not appear that the ConnectED¹ framework has been applied within this context. This interdisciplinary model, which was introduced to support college and career readiness, provides an innovative lens for examining and strengthening the undergraduate-to-graduate pipeline in chiropractic education. The emphasis on curricular alignment, mentorship, experiential learning, interprofessional collaboration, and research literacy provides a structured approach to enhancing student preparedness and success in chiropractic programs.

This paper aims to address this gap by exploring how chiropractic programs, in collaboration with undergraduate institutions, can enhance their educational pathways to better prepare students for the demands of graduate chiropractic training. Colleges and universities can help future chiropractors thrive academically and professionally by developing intentional pathways through curricular alignment, advising, experiential opportunities, interprofessional learning, and research engagement.

DISCUSSION

Literature Review

The literature on chiropractic education increasingly emphasizes the academic rigor of graduate-level training and the importance of robust undergraduate preparation. Current accreditation standards require that students entering a Doctor of Chiropractic Program have completed at least 90 semester hours of non-duplicative coursework, with emphasis on foundational subjects such as anatomy, physiology, chemistry, and other sciences that support success in the chiropractic curriculum.² However, the distribution and quality of this preparatory coursework vary considerably among institutions and students. Several studies have found that gaps in foundational sciences, particularly anatomy, physiology, and chemistry, introduce recurring challenges for first-year chiropractic students, often leading to attrition or remediation.^3–5

To address such challenges, pipeline and pathway programs from medicine, nursing, and allied health offer instructive models. These initiatives integrate academic enrichment, structured mentoring, clinical shadowing, and early research opportunities. Evaluations consistently demonstrate that such interventions improve retention, reduce the time to degree, and enhance professional identity formation among students. Importantly, pathway programs have also been successful in supporting students from underrepresented and disadvantaged backgrounds, helping them navigate structural barriers to health professions education.^6–8

For chiropractic education, where diversity remains limited, such models may provide crucial guidance. According to the National Board of Chiropractic Examiners,⁹ the chiropractic profession remains predominantly White, with 69% of practitioners identifying as such. Representation among other racial and ethnic groups is gradually increasing, including African American (3%), Asian/Pacific Islander (5%), Hispanic/Latinx (6%), Middle Eastern or North African (2%), Native American or Alaska Native (1%), and individuals identifying as multiethnic (2%). An additional 12% of chiropractors reported other racial/ethnic identities or preferred not to disclose this information. Additionally, about 30% of U.S. chiropractors are female, and 63% are male. While older cohorts remain predominantly male, younger practitioners show a trend toward greater gender balance, highlighting gradual progress in gender equity within the profession.

While chiropractic programs often demonstrate commitment to recruiting diverse student populations, their efforts have yet to yield a significant impact on the diversity among practitioners. This lack of representation underscores the importance of adopting frameworks and interventions that promote equity, support minority students, and foster a more inclusive learning environment, ultimately strengthening both educational outcomes and the accessibility of chiropractic care for diverse communities.

The underrepresentation of minority populations in chiropractic education and the profession limits the development of culturally competent care and hinders efforts to address health disparities in the communities most affected. According to Valantine,¹⁰ the lack of representation of minoritized populations in public health, healthcare, and research fields impedes scientific progress and negatively impacts communities most affected by health disparities. Brown et al.¹¹ highlight the implementation of pipeline programs, such as the Centers for Disease Control and Prevention (CDC) Undergraduate Public Health Scholars (CUPS) Program, to increase workforce diversity in public health and healthcare fields. The integration of pipeline programs to address diversity in the profession can help increase the number of minority chiropractors who, in turn, serve as mentors for students considering the field.

Mentorship, a key component of professional identity development, often emerges as a central theme in health professions literature. Research demonstrates that students who engage with their chosen field early through mentorship, clinical observation, and involvement in professional organizations are more likely to persist and perform well in graduate programs.¹² Within chiropractic, early exposure to philosophy, scope, and patient-centered ethos of practice may not only increase commitment to the profession but also reduce attrition during the demanding first years of graduate study.¹³

STEM education research further underscores the importance of foundational “gateway” courses. Success in introductory biology, chemistry, and physics has been shown to strongly predict persistence in STEM fields.

Interventions such as supplemental instruction, peer tutoring, and bridge programs can significantly reduce achievement gaps in these courses and improve student outcomes.¹⁴ Given the overlap between chiropractic prerequisites and STEM coursework; these findings point directly to the value of robust academic support structures in undergraduate chiropractic preparation.

Collectively, this body of literature provides strong evidence that intentional undergraduate preparation, through curriculum alignment, academic advising, experiential learning, and research engagement, can significantly enhance chiropractic student success. For undergraduate institutions aiming to strengthen their contribution to professional education pipelines, these findings underscore the value of developing structured, evidence-informed pathways that lead to chiropractic graduate education.

Conceptual Framework

The ConnectED Framework

The ConnectED framework, developed by ConnectED: The National Center for College and Career, offers a proven, systems-level model for building structured educational pathways through the Linked Learning approach. It integrates four core components: rigorous college-preparatory academics, career-technical education in industry-themed sequences, a progression of authentic work-based learning (e.g., job shadowing, internships, mentoring, employer projects), and comprehensive student supports addressing academic, social-emotional, equity, and personalized needs. This model replaces fragmented high school experiences with cohesive, engaging pathways that equitably prepare all students, especially underserved populations, for college, careers, and civic success. Grounded in research from STEM persistence, health professions pipelines, and Linked Learning studies, ConnectED shows that well-aligned, scaffolded pathways can reduce disengagement, close equity gaps, boost retention and performance, and strengthen professional identity. All of which are outcomes directly relevant to improving undergraduate-to-graduate transitions.

ConnectED operationalizes its vision through a set of interconnected developmental rubrics that frame self-assessment, planning, and continuous improvement at each phase of the educational pathway. These may include classroom tools such as the College and Career Readiness Classroom Framework; pathway-level models that address equity, programs of study, and work-based learning; district structures focused on alignment, leadership, and resource allocation; and community-level frameworks that support cross-sector partnerships and employer engagement. Other tools, such as Exploring College, Career, and Community Options (ECCCO) curriculum and ConnectED Studios, provide instructional support and professional development to strengthen the implementation process.

When applied to undergraduate preparation for transitioning to a chiropractic graduate program, this framework offers a strong, adaptable foundation for the proposed 5-domain model:

• Curricular alignment and rigor align with ConnectED’s emphasis on integrated, rigorous programs of study to support dedicated pre-chiropractic tracks with lab-intensive sciences such as anatomy, physiology, chemistry, and biomechanics, with the appropriate competency benchmarks to align with chiropractic accreditation standards and reduce preparation variability.

• Advising, mentorship, and pathway support mirror ConnectED’s personalized support systems and leadership structures that provide students with specialized advising, mentoring from practicing chiropractors, and articulation agreements (e.g., 3+1) to build confidence, clarity, and persistence.

• Experiential and clinical exposure resonate with ConnectED’s work-based learning continuum, facilitating early shadowing, volunteering, and capstone projects to contextualize sciences, reinforce professional identity, and affirm commitment through real chiropractic practice observation.

• Interprofessional and interdisciplinary learning supports ConnectED’s collaborative, real-world focus by incorporating joint modules, simulations, or team projects with nursing, physical therapy, or related fields to develop teamwork and systems thinking for team-based healthcare.

• Research and evidence-based practice literacy connect to ConnectED’s integration of inquiry, critical thinking, and performance assessment, promoting undergraduate research, methods courses, and journal clubs to foster evidence appraisal and scholarly habits aligned with chiropractic’s evolving scientific emphasis.

By adapting ConnectED’s equity-centered, multi-level design, undergraduate institutions and chiropractic programs can forge intentional pre-chiropractic pathways through cross-sector partnerships, aligned curricula, advisory boards, shared resources, and data-driven improvement. This strengthens the pipeline, enhances retention and readiness, supports professional cohesion amid chiropractic identity discussions, and advances the profession’s integration into collaborative, evidence-based healthcare.¹

Adopting the ConnectED Framework for Undergraduate-to-Graduate Chiropractic Pathways

We propose the ConnectED framework to strengthen undergraduate preparation for chiropractic education. The five domains (curricular alignment and rigor; advising, mentorship, and professional pathway support; experiential and clinical exposure; interprofessional and interdisciplinary education; and research and evidence-based practice literacy) work synergistically to scaffold undergraduate students toward graduate readiness. By applying this framework to chiropractic education, we explore how targeted interventions such as early exposure to the profession, competency-based learning pathways, and inclusive recruitment strategies can enhance continuity from undergraduate interest to graduate enrollment. The ConnectED framework provides a lens through which to examine and improve the structural, relational, and curricular components critical to sustaining a vibrant and diverse chiropractic workforce.

1. Curricular Alignment & Rigor

Undergraduate curricula that align closely with the scientific and clinical demands of chiropractic programs are critical for student success. Chiropractic education requires mastery of anatomy, physiology, biomechanics, and pathology, yet undergraduate experiences in these areas vary widely. Establishing pre-chiropractic tracks, similar to pre-medical programs, ensures students complete the foundational coursework needed for graduate entry. Moreover, integrating laboratory-intensive experiences develops competencies in applied sciences, while competency-based assessments can help identify gaps before students transition into graduate study.¹⁵

Supporting Evidence: Research in health professions education shows that well-structured prerequisite curricula improve student performance in professional schools.¹⁶ In STEM education, success in gateway courses such as chemistry and biology strongly predicts persistence in advanced study.¹⁴ These findings underscore the importance of aligning undergraduate curricula with chiropractic program expectations, particularly in foundational sciences. A recent scoping review of chiropractic education research confirms that foundational science competencies and curriculum design are central to student success and readiness for graduate chiropractic training.¹⁶ This alignment can support more equitable access, reduce attrition, and ensure students enter graduate study with the competencies needed for success. Strategic collaboration between undergraduate institutions and chiropractic programs may be essential to designing pathways that reflect these evidence-based principles.

2. Advising, Mentorship & Professional Pathway Support

Advising and mentorship are crucial for helping undergraduates navigate the complex prerequisites and admissions processes of chiropractic programs. In general, higher education research shows that when faculty advisors lack clarity about their advising expectations, students experience reduced satisfaction and are less effectively guided through their programs.¹⁷ Structured pre-chiropractic advising, combined with mentorship from graduate students or practicing chiropractors, can improve student confidence and clarity of career goals. Additionally, chiropractic programs should consider pathway agreements such as “3+1” articulation programs to provide clearer transitions and reduce uncertainty. Chiropractic programs find that such pathway programs are beneficial for¹ reducing time to degree²; in many cases, lowering educational costs for students, and³ increasing access to chiropractic education through the collaborative exchange between a local college/university and the chiropractic program.

Articulation agreements, in various forms depending on the program, also support students in aligning their educational pathways with their home state licensure requirements, particularly for those states that require completion of a bachelor’s degree for chiropractic practice. Given that the Council on Chiropractic Education (CCE) requires only 90 undergraduate semester hours for admission to a Doctor of Chiropractic program, articulation agreements can enable students to transfer credits between institutions to satisfy degree requirements for both programs. Beyond academic efficiency and regulatory compliance, articulation agreements also broaden the scope of advising and mentoring students receive by creating a support system of faculty and staff at both institutions.

Supporting Evidence: While there appears to be a gap in chiropractic-specific peer-reviewed studies to evaluate the impact of articulation agreements on student outcomes, recruitment, or institutional strategies, there are several chiropractic programs with such agreements outlined on their campus websites. In medicine and nursing, pre-professional advising and mentoring have been linked to improved academic outcomes and persistence, particularly for underrepresented students.¹⁸ These findings are transferable to chiropractic, where pathway clarity and supportive advising may similarly reduce attrition.

3. Experiential and Clinical Exposure

Early access to a clinical environment can provide vital experience for bridging the gap between theoretical course content and the practical application in chiropractic and other health professions education programs. Clinical shadowing provides meaningful context for enhancing student learning in the basic sciences – such as anatomy, physiology, and pathology. Participation in structured clinical experiences such as shadowing, volunteering in health clinics, and engaging in community wellness initiatives has been shown to enhance undergraduate students’ confidence, deepen their understanding of healthcare careers, and increase motivation to pursue professional training. These early exposures help students connect academic content to real-world practice, clarify vocational goals, and strengthen their sense of purpose within the health professions.¹⁹

Undergraduate students who shadow chiropractors, volunteer in health clinics, or participate in wellness projects are better able to connect foundational sciences to patient care. Such opportunities may also help confirm vocational commitment and reduce attrition in graduate school. Additionally, these experiential experiences serve as the beginning stages for students to develop their professional identity. Carefully coordinated shadowing experiences foster the development of core values, behaviors, and responsibilities of professional clinical practice as expected in health professions like chiropractic. Moreover, early exposure to these clinical settings allows students to affirm their commitment to these fields of study rather than arriving at that realization much further down the educational pathway. The shadowing experience introduces students to patient-provider dynamics to reinforce the career path decision and foster the persistence necessary to navigate the rigor of professional training.^20–22

Reflective journaling is a valuable addition to the early exposure in clinical settings. These exercises have been shown to enhance emotional resilience and self-awareness, further supporting students’ transition into clinical roles.²⁴ The format of reflective exercises in health professions education can take various formats, including but not limited to open-ended prompts, guided journaling, free writing, and even group debriefs. Regardless of the format, students are encouraged to critically evaluate their clinical experiences to make theory-to-practice connections while they grow in their professional identity. Whether early on or throughout the clinical experience, reflective writing exercises provide the opportunity for students to learn from their mistakes, achievements, and to have a healthy outlet for processing the emotional elements of their journey.^23,24

Supporting Evidence: Experiential learning is widely recognized as a high-impact educational practice. In medicine, early clinical exposure is associated with improved observation of musculoskeletal assessment, enhanced patient communication, and more effective evidence-based management benefits that could similarly apply to chiropractic education. One study found that chiropractic students who participated in early clinical placements reported higher levels of confidence and preparedness as they entered the formal clinical phase of their degree program.²⁵ This early exposure not only supports the development of student confidence but also plays a critical role in shaping patient perceptions. As Ivanova et al.²⁶ observed, patients are more likely to trust the competence of student interns and feel secure in their care when those interns demonstrate confidence in clinical interactions.

4. Interprofessional and Interdisciplinary Education

Contemporary healthcare emphasizes collaboration across disciplines. Chiropractic students who develop interprofessional competencies early may be better prepared for the collaborative care environments they will encounter in practice.²⁷ Early exposure to interprofessional education (IPE) fosters a deeper understanding of the roles and responsibilities of other healthcare providers, which is essential for effective team-based care. Competency in this area is especially critical for chiropractic students, as patient care often involves conditions that extend beyond the scope of chiropractic, necessitating timely and appropriate referrals to other healthcare professionals. Undergraduate programs can cultivate these skills by embedding joint courses, simulations, or case studies with students across health professions programs. Such experiences enhance communication, role awareness, and teamwork skills, ultimately contributing to improved patient outcomes and more efficient care delivery. These competencies align with evolving healthcare profession accreditation standards and the expectations of integrated healthcare systems. This interprofessional competency is consistent with the Council on Chiropractic Education’s (CCE) Meta-Competency 8, which requires chiropractic students to demonstrate the ability to collaborate across disciplines and refer patients appropriately when care needs exceed the scope of chiropractic practice.¹⁵

Supporting Evidence: Interprofessional education (IPE) is recognized by the World Health Organization²⁸ as essential for preparing health professionals to work in team-based care. Studies across allied health programs indicate that interprofessional learning improves attitudes toward collaboration and increases readiness for practice. Embedding IPE at the undergraduate level may therefore strengthen chiropractic students’ adaptability and professional integration. Chiropractic education programs that integrate IPE exposure to students in the clinical setting support the competency of those who elect to explore careers in public and private hospital settings as well as other integrated healthcare environments.^29,30

Green and Johnson³¹ argue for interprofessional collaboration as a foundational element in improving healthcare outcomes, emphasizing the integration of IPE across research, education, and clinical practice. They posit that fostering teamwork among diverse health professionals begins with intentional curricular design and collaborative learning experiences. Building on this framework, Knieper, Bhatti, and Tunning³² examine how chiropractic students perceive interprofessional healthcare teams, revealing a disconnect between the theoretical value of collaboration and students’ actual exposure to interprofessional environments. While students express positive attitudes toward IPE, their limited firsthand experience with collaborative teams suggests a need for more immersive, practice-based opportunities. Together, these studies highlight the importance of not only promoting IPE in theory but also ensuring that chiropractic students are meaningfully engaged in interprofessional contexts throughout their educational experience.

5. Research and Evidence-Based Practice Literacy

The chiropractic profession continues to evolve toward greater emphasis on evidence-based practice. Graduate chiropractic programs expect students to critically appraise research and integrate scientific evidence into patient care. Undergraduate experiences in research through coursework, mentored projects, or journal clubs prepare students for this expectation. Building statistical literacy and research methodology skills during undergraduate study also reduces the learning curve at the graduate level.³³

These foundational experiences at the undergraduate level not only ease the transition into graduate study but also foster a mindset of inquiry and accountability that is essential for strengthening the chiropractic profession. As students progress through their educational pathway and into practice, their ability to interpret data, evaluate clinical guidelines, and apply research findings becomes increasingly critical. Evidence-based practice encourages chiropractors and other healthcare practitioners to move beyond tradition or personal preference to a focus on validated approaches that prioritize patient outcomes. By cultivating these skills early, students are better prepared to engage in scholarly dialogue, contribute to clinical research, and make informed decisions in diverse healthcare settings. This proactive integration of EBP principles reflects a broader commitment within chiropractic education to produce chiropractors who are not only clinically competent but scientifically informed.

Supporting Evidence: Undergraduate research participation has been shown to foster a stronger sense of scientific self-efficacy, increase students’ sense of belonging in STEM fields, and improve post-graduate outcomes, particularly among students from underrepresented backgrounds. The development of these skills is especially valuable for students transitioning into doctoral-level programs like chiropractic. As the field of chiropractic increasingly emphasizes evidence-informed practice to improve patient care outcomes, students with a strong foundation in research are better equipped to critically appraise scientific literature, apply clinical guidelines, and contribute meaningfully to the body of knowledge in chiropractic. Early exposure to research principles not only enhances academic readiness but also supports the development of professional accountability and evidence-informed thinking, which are key competencies for aligning chiropractic education with broader healthcare standards.³⁴

Summary

These 5 domains collectively form a scaffold that supports students as they transition from general education into chiropractic-specific competencies. Curricular alignment ensures academic readiness; advising and mentorship offer personalized guidance; experiential learning fosters professional identity; interprofessional education cultivates collaborative practice; and research literacy anchors students in evidence-informed care. Together, they create a holistic framework designed to strengthen the undergraduate-to-graduate chiropractic pipeline and prepare students for success in a modern, integrated healthcare environment.

Strategies for Strengthening Undergraduate Programs

Curricular Alignment & Rigor

Undergraduate curricular alignment is a critical foundation for graduate chiropractic success. Dedicated pre-chiropractic tracks, similar to pre-medical or pre-dental programs, help ensure that students complete the appropriate breadth and depth of prerequisite coursework. These structured tracks not only reduce uncertainty in course selection but also promote early engagement with the sciences most predictive of success in chiropractic programs, including anatomy, physiology, chemistry, and biomechanics.¹⁶

Competency-based benchmarks offer another layer of accountability, allowing undergraduate programs to assess whether students have mastered essential concepts before they matriculate into graduate training. Evidence from allied health programs suggests that competency testing can identify at-risk students early and provide remediation that improves persistence.^35,36

Moreover, lab-intensive sciences are indispensable. Laboratory components in anatomy and physiology courses provide hands-on experiences in dissection, microscopy, and experimental methods that mirror the applied nature of chiropractic training. Students exposed to frequent lab experiences demonstrate greater confidence and conceptual retention, making them better prepared for graduate-level gross anatomy and clinical sciences.^37,38

Advising and Mentorship

Specialized advising is crucial in helping students navigate the chiropractic admissions process and manage the rigorous academic expectations. General advising often lacks the specificity required for health professions pathways; targeted pre-chiropractic advisors can provide tailored guidance on prerequisites, career options, and application strategies.³⁹

Articulation agreements, such as 3+1 or guaranteed-admission partnerships between undergraduate and chiropractic institutions, have proven effective in clarifying academic expectations and providing secure educational pathways. These agreements not only benefit students by streamlining progression but also strengthen institutional partnerships.

Mentorship programs link undergraduates with practicing chiropractors or advanced students, fostering professional identity formation and vocational commitment. Research in medical and nursing education shows that mentorship enhances self-efficacy, reduces attrition, and improves perceptions of belonging in the field.^7,12

Finally, targeted workshops, covering topics such as admissions readiness, NBCE exam preparation, and study skills, equip students with concrete strategies for success, addressing both cognitive and non-cognitive dimensions of readiness.

Experiential and Clinical Exposure

Experiential learning provides students with meaningful opportunities to connect theoretical knowledge to real-world practice. Shadowing chiropractors allows undergraduates to observe patient encounters, understand professional workflows, and contextualize anatomy and physiology within applied musculoskeletal care.⁴⁰

Internships and volunteer placements, whether in integrative health centers, rehabilitation clinics, or community health organizations, further expose students to the patient-centered ethos of chiropractic. Such experiences reinforce career commitment and provide material for reflection essays or capstone projects.

Capstone clinical projects that require students to integrate coursework, experiential learning, and reflective writing have been shown to improve professional identity and deepen engagement with health professions. In chiropractic, capstone experiences could include case studies, posture screenings, or community wellness initiatives supervised by faculty and clinicians.

Healthcare increasingly operates in team-based models. Chiropractic students who begin developing interprofessional competencies at the undergraduate level are better prepared for collaborative practice in graduate training and beyond. Joint modules co-taught with nursing, physical therapy, or exercise science faculty expose students to overlapping knowledge domains and highlight professional distinctions.³¹

Team-based projects, such as case studies addressing musculoskeletal disorders, encourage students from multiple disciplines to problem-solve collaboratively, improving communication skills and mutual respect.

Shared ethics courses focused on cultural competence, professional boundaries, and social determinants of health help students appreciate the ethical and social dimensions of practice. These experiences cultivate holistic awareness and adaptability, which are key attributes for chiropractic graduates in navigating interprofessional healthcare settings.³⁰

Research and Evidence-Based Practice Literacy

Chiropractic education increasingly emphasizes evidence-based practice. To succeed, students must not only interpret scientific research but also integrate findings into clinical reasoning. Undergraduate research apprenticeships, whether in biomechanics labs, kinesiology projects, or integrative health studies, give students early exposure to research design, data analysis, and dissemination.

Required research methods courses further build statistical literacy and familiarity with research ethics, preparing students to critically appraise the literature. These courses are vital for developing the competencies outlined by chiropractic accreditation bodies. Capstone projects, where students conduct independent or mentored research, promote ownership of scholarly inquiry and strengthen critical thinking skills.⁴¹

Finally, journal clubs that integrate chiropractic and related health sciences literature encourage undergraduates to engage with current research, practice critical appraisal, and develop a culture of lifelong learning that will carry into graduate education and clinical practice.⁴²

Additional Considerations

Colleges and universities occupy a pivotal position in bridging the gap between undergraduate education and graduate chiropractic training. By strategically designing curricula, advising structures, and co-curricular opportunities, institutions can strengthen student readiness for the demands of professional education. The proposed 5-domain framework (curricular alignment and rigor; advising, mentorship, and pathway support; experiential and clinical exposure; interprofessional and interdisciplinary learning; and research and evidence-based practice literacy) offers a comprehensive strategy to scaffold undergraduate preparation and improve student outcomes.

Enhancing Academic and Clinical Readiness

Intentional curricular design ensures that undergraduate students master foundational knowledge in anatomy, physiology, chemistry, biomechanics, and other sciences critical for chiropractic education. Evidence from allied health and STEM fields confirms that performance in gateway courses is a strong predictor of persistence and success in professional programs.¹⁴ By embedding competency-based benchmarks and lab-intensive coursework, undergraduate institutions can reduce the remediation burden that chiropractic colleges often face, allowing graduate programs to focus on advanced professional competencies.⁴³

Supporting Student Retention and Professional Identity

Structured advising and mentorship can directly influence retention by providing students with clear pathways, role models, and timely support. Studies in medical and nursing education demonstrate that mentorship enhances professional self-efficacy and reduces attrition.^7,12 In chiropractic education, early exposure to professional practice through shadowing or mentorship may foster stronger professional identity and commitment to the field.⁴⁴ This is particularly relevant given ongoing debates within chiropractic about scope and identity; undergraduate experiences that clarify professional roles may reduce confusion and strengthen cohesion.

Building Interprofessional Competence

The modern healthcare landscape increasingly emphasizes team-based, collaborative models of care. Chiropractors frequently interact with physicians, physical therapists, and other allied health professionals. Interprofessional education (IPE), when integrated at the undergraduate level, prepares students to engage in these collaborative environments.³⁰ By embedding shared modules, case studies, and simulations, universities can cultivate communication, collaboration, and systems-thinking skills. These competencies not only benefit chiropractic students but also contribute to broader healthcare workforce readiness.³¹

Fostering a Research-Oriented, Evidence-Based Culture

The chiropractic profession continues to evolve toward greater integration into mainstream healthcare, a process dependent on the adoption of evidence-based practice. Undergraduate exposure to research methods, critical appraisal, and scholarly dissemination fosters habits of inquiry that extend into graduate training and clinical practice. Embedding undergraduate students in faculty research projects or journal clubs not only prepares them academically but also strengthens the profession’s collective capacity for scholarship and innovation. In this way, undergraduate institutions can play a direct role in shaping the chiropractic profession’s scientific trajectory.^45,46

Addressing Challenges and Barriers

Implementing this framework is not without challenges. Resource constraints, including laboratory infrastructure, faculty load, and financial support, are common barriers to curricular expansion. Similarly, institutional silos between departments (e.g., biology, kinesiology, and pre-health advising) can hinder collaboration. These obstacles mirror those encountered in other health professions pathway initiatives. To overcome them, universities may consider phased implementation, shared resources across programs, external funding opportunities, and strategic partnerships with chiropractic colleges.

Another challenge lies in ensuring equity and access. Without intentional design, pathway programs may inadvertently privilege students with greater social and financial capital. As medical education research demonstrates, targeted pathway initiatives are particularly effective in supporting underrepresented students when they include tutoring, bridge programs, financial support, and mentoring Chiropractic education has an opportunity to apply these lessons, broadening access and diversifying the profession.

Implications for Policy and Accreditation

At a policy level, accrediting bodies could play a stronger role in articulating expectations for undergraduate preparation. While current standards focus on graduate-level outcomes, explicit guidance for undergraduate institutions could promote greater alignment across the educational continuum. Furthermore, professional organizations might advocate for the expansion of undergraduate pathway programs, positioning chiropractic alongside medicine, nursing, and physical therapy in the broader health professions pipeline conversation.

Future Research Directions

This conceptual framework invites further empirical investigation. Longitudinal studies comparing students from pathway programs with those entering graduate chiropractic education via traditional routes could clarify the framework’s impact on outcomes such as NBCE pass rates, time-to-degree, and retention. Qualitative research examining student, faculty, and advisor experiences would enrich understanding of how pathways influence professional identity and career commitment. Comparative studies across institutions could highlight best practices and provide models for scaling pathway initiatives nationally and internationally.

Ultimately, the integration of structured undergraduate pathways has the potential to transform the chiropractic education continuum. While challenges exist, the anticipated benefits of improved academic readiness, greater retention, enhanced professional identity, interprofessional competence, and stronger research capacity will provide compelling justification for investment. By embracing a comprehensive framework, colleges and universities can not only strengthen student success but also contribute to the advancement and credibility of the chiropractic profession in the evolving healthcare landscape.

Conclusion

Undergraduate preparation exerts a profound influence on student success in graduate chiropractic education. The evidence from chiropractic and allied health literature underscores that foundational science knowledge, early clinical exposure, structured advising, and opportunities for interprofessional and research engagement shape not only academic performance but also professional identity and resilience. When undergraduates enter graduate programs with uneven preparation, institutions must expend resources on remediation, and students risk academic struggle or attrition. Conversely, when students arrive well-prepared, they are more likely to thrive in the demanding environment of graduate chiropractic training, succeed on licensing examinations, and develop into confident, evidence-based practitioners.

The proposed five-domain pathway framework encompassing curricular alignment and rigor, advising and mentorship, experiential and clinical exposure, interprofessional and interdisciplinary education, and research and evidence-based practice literacy offers a roadmap for undergraduate institutions to intentionally design programs that better prepare chiropractic aspirants. This model situates chiropractic education within broader health professions pipeline initiatives, reinforcing the need for continuity and collaboration across the undergraduate-to-graduate continuum.

For colleges and universities, adopting such frameworks is not simply a matter of aligning prerequisites; it represents an investment in student retention, institutional reputation, and the long-term credibility of the chiropractic profession. By reducing variability in preparation and building holistic readiness, institutions can help ensure that chiropractic graduates are academically competent, clinically effective, and professionally integrated into collaborative healthcare systems.

At the same time, challenges must be acknowledged. Resource constraints, faculty workload, and institutional silos can complicate implementation, while equity concerns demand that pathway programs actively support students from underrepresented and disadvantaged backgrounds. Addressing these challenges will require innovation, inter-institutional partnerships, and a sustained commitment to inclusivity.

Future research should evaluate these pathway models empirically. Longitudinal studies that track student outcomes such as NBCE pass rates, retention, professional identity development, and post-graduate success will provide essential evidence to refine best practices. Qualitative investigations can further illuminate the lived experiences of students and faculty within pathway programs, offering insights into the mechanisms by which preparation influences professional success.

Ultimately, strengthening undergraduate preparation for chiropractic education is both an academic imperative and a professional responsibility. By embracing pathway frameworks, institutions can play a transformative role in preparing the next generation of chiropractors who will not only advance the field but also contribute meaningfully to the evolving landscape of healthcare.