Test of Competence - Evidence of Practice Questionnaire
Your details
Name: Click here to enter text.
Contact Number: Click here to enter text.
UK Contact Number: Click here to enter text.
(If different from above)
Email Address: Click here to enter text.
Introduction
All chiropractors who wish to practise in the United Kingdom must first of all
register with the General Chiropractic Council (GCC). However, before we can
register you, you will need to show us that you meet the standards set out in The
Code, Standards of Conduct, Performance and Ethics for Chiropractors
(http://www.gccuk.org/UserFiles/Docs/G20.006%20CofP_stage%203%20hyperlinks%202708.pdf)
Why are you asking me to fill in this questionnaire?
We will check the information you provide on this Evidence of Practice
Questionnaire, along with the contents of your qualification to inform the test
interview. This is so that you can show us how you meet the same standards as
those chiropractors who have a qualification that we recognise.
As the applicant it is your responsibility to send us the information that we ask you
for, we will not be seeking it on your behalf.
This questionnaire forms a key part of your application and will be considered by the
TOC assessment panel along with the content of your chiropractic education before
the test. You will also be asked questions about it during the TOC interview.
Before filling in the questionnaire, you should make yourself very familiar with The
Code, Standards of Conduct, Performance and Ethics for Chiropractors.
(June 2016) This is because we will need to make sure you meet the standards in
the Code before the Registrar grants you registration. Also, these are the standards
you must maintain all the time you are on the Register.
How do I fill in this questionnaire?
The questionnaire is split into 8 sections, in sections 1 – 7 you are asked to give
details on your practise as a chiropractor. There are text boxes for each response
which you can click on and then type in.
In sections with check boxes, you can simply click on the check box to select it.
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In this questionnaire we ask you to demonstrate your understanding of our Code by
linking aspects of your practice to the principles and standards in it. You are also
likely to be asked about the Code during the Test of Competence interview.
The questionnaire focuses on your practice. You are asked to provide specific
examples of what you have done – this should be where you have taken clinical
responsibility for a case. You must complete the questionnaire yourself and without
help.
What evidence must I send to back up the answers I give on the
questionnaire?
Anonymised Patient Records
This questionnaire requires you to attach anonymised patient records to support
your answers to Sections 2, 3 and 4 and Section 5 if applicable. You must
also clearly label which of your records relate to which section of the questionnaire.
You do not need to provide patient records for all the patients mentioned in
Section 1.
Where real clinical cases or examples are asked for, we expect you to normally use
cases or examples within the last 24 months.
You must protect patient confidentiality by anonymising any patient
information. If you do not do this, we will have concerns that you are not
able to meet the duty of confidentiality set out in our Code.
Please note that anonymised patient records will be used for the sole
purpose of the Test of Competence. The GCC will not use them for any
other purpose nor share the records with any third parties.
Please note that the patient records are compulsory supporting evidence in your
application to take the TOC. You must provide complete patient records including
case histories.
What if I’m not unable to obtain and anonymise real patient records for
some reason?
If you are an educationist who does not treat patients you may use the clinical cases
of chiropractic students that you have supervised rather than ones you have assessed
or cared for directly. But make sure your role and the actions you took in relation
to the patient are made clear. If you are a recent graduate you may use patient notes
taken as part of your supervised practical sessions within your course.
We recommend that you obtain real anonymised patient records where possible.
We will accept patient records taken while observing or shadowing chiropractic
care. In instances where you have exhausted all other options of obtaining real
records, you may create patient records based on real patients you have treated or
cases you have observed. In this case, you must ensure that you make explicit on
your application that you have not provided real patient records and provide us with
an explanation for why you have been unable to obtain these. Please be aware that if
you are unable to submit real records, you will be subject to a longer, more
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intensive, interview process to ensure that you meet the standards. If you have
queries in regards to patient records, please contact the GCC for guidance either on
020 7713 5115, or email us at [email protected]
The maximum word counts given in each section of the questionnaire are
mandatory. We are interested in the quality of your response not its quantity. We
will not consider any words beyond the maximum word count.
What happens when you receive my application and questionnaire?
When we receive your completed questionnaire, a member of the GCC staff will
check that you have completed all of the section and provided all required
information and kept within the word count. If you have, then your application will
be passed to the assessment panel.
It is in your own interest to check the questionnaire before you send it to us, this is
because your application will be delayed if we need to contact you for further
information or ask you to resubmit the questionnaire.
The TOC assessment panel will then consider your responses in this questionnaire
before you take the assessment interview. They will look at the questionnaire to see
how you have demonstrated to us your understanding of the Code and practising in
the UK.
What about the interview itself?
The TOC assessment interview will focus on:
 your responses to this questionnaire
 requirements set out in the Code, specifically where we have
identified differences in content between our standards and those of
other chiropractic regulatory authorities across the world.
Also remember…
 the questionnaire must be completed in English and typed. Hand written
questionnaires will be returned.
 to tell us the meaning of any abbreviations you use
 to clearly label any diagrams or charts you include in your response .
Standards of behaviour we expect from applicants
Our Student Fitness to Practise guidance (http://www.gccuk.org/UserFiles/Docs/FtPGuidanceforStudents.pdf) sets out the standards of
behaviour that we require of chiropractic students and prospective registrants. It
outlines the seriousness of behaviours such as plagiarism. If we find an applicant has
submitted evidence that it is not their own work, this will raise serious questions
about their fitness to register with us.
When you have filled in this questionnaire, please send it, together with
your evidence, to:
[email protected]
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Section 1: profile of your caseload
This section is designed to give us an insight into:

the scope and breadth of your clinical practice

a profile of the patients you have provided chiropractic assessment and care to; and

how you collect and analyse data about your professional practice.
We would like you to identify 10 patients in your caseload and then fill in the information in the table below about each of those patients.
When identifying the patients’ health needs, remember we are interested in the individual’s main health needs which helped you to
maintain your knowledge, skills and competence, information you will be asked to give at the end of this section.
Health needs
Patient
(might include health problems/ conditions/ injuries you were presented with,
what the patient reported to you, information on the symptoms presented, and
any medication they were on. Information may also include any past
treatments or tests.)
Gender
Age
Occupation
1.
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Health needs
Patient
Gender
Age
Occupation
(might include health problems/ conditions/ injuries you were presented with,
what the patient reported to you, information on the symptoms presented, and
any medication they were on. Information may also include any past
treatments or tests.)
text.
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Health needs
Patient
Gender
Age
Occupation
(might include health problems/ conditions/ injuries you were presented with,
what the patient reported to you, information on the symptoms presented, and
any medication they were on. Information may also include any past
treatments or tests.)
text.
9.
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10.
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Describe here how the above group of 10 patients you have selected and their health needs have helped you to maintain your clinical and
professional knowledge, skills and competence. Link this to our Code. (Maximum total number of words - 600)
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Word count (max 600) = Click here to enter text.
Explain here how you identify your patients’ health needs (Maximum total number of words - 200)
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Section 2: a neuromusculoskeletal case presentation
Describe a case in which a patient presented with neurological symptoms and where you suspected or found
neurological involvement as a result of musculoskeletal dysfunction. This can be one of the patients you included in
section 1 or another patient.
You must respond to all aspects of this section from a – k, using a maximum number of 2,000 words for this whole section.
You must send us an anonymised copy of the complete patient record.
a) the case history including the patient profile, presenting complaint, and relevant medical, family and social history
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b) the methods you used to physically examine the patient and why you chose these methods
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c) if you obtained further information or carried out further investigations (eg clinical imaging, laboratory tests) on the patient and why you
did this
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d) your evaluation of the patient’s health and health needs, including any relevant physiological, psychological, and social factors
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e) your differential diagnosis / rationale for care
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f) whether the case was:
i. suitable for chiropractic treatment, and if so your treatment and management plan based upon your working diagnosis / rationale for
care, the patient, and the likely effects and/or risks of treatment
ii. not suitable for chiropractic treatment and the steps you took to ensure ongoing care for the patient
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g) what you told the patient about the risks of the treatment and the management plan
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h) how you involved the patient in making informed decisions about their care
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i)
your ongoing management of the patient, including the frequency and duration of care, the frequency of patient review / re-evaluation, the
evidence for the care used, any outcome measures you used, whether you changed your treatment approach through the course of the
treatment and the reasons for this
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j)
how you applied chiropractic principles and concepts in the assessment and care of the patient
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k) Which specific, relevant sections of the Code does this refer to?
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Total word count (max 2,000) = Click here to enter text.
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Section 3: a case presentation in which the patient was considered unsuitable for chiropractic
treatment and/ or was referred to another healthcare practitioner
Describe a recent case in which, after clinical evaluation, you concluded that the patient was either unsuitable for
chiropractic care or you referred them to another healthcare professional for co-management. This can be one of the
patients you included in section 1 or another patient. It should be a different case to the ones you used in sections 2 and
4 of this questionnaire. (If you are unable to identify a patient where you have taken this action, then please develop an
example of such a case making clear in your response that this is a scenario not a real example.)
You must respond to all aspects of this section from a – l, using a maximum number of 2,000 words for this whole section.
You must send us an anonymised copy of the complete patient record.
a) the case history including the patient profile, presenting complaint, and relevant medical, family and social history
Click here to enter text.
b) the methods you used to physically examine the patient and why you chose these methods
Click here to enter text.
c) if you obtained further information or carried out further investigations (eg clinical imaging, laboratory tests) on the patient and why
you did this
Click here to enter text.
d) your evaluation of the patient’s health and health needs, including any relevant physiological, psychological, and social factors
Click here to enter text.
e) your differential diagnosis / rationale for care
Click here to enter text.
f) why you concluded that the case:
a. was not suitable for chiropractic treatment
b. required referral to another healthcare professional and how this would benefit the patient
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Click here to enter text.
g) the actions that you took and your role in the patient’s ongoing care
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h) how you involved the patient in making this decision and gained their consent
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i) the mechanism you used for referring the patient – supply a copy with your questionnaire
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j) the outcome of the referral and any ensuing modification of your treatment and management plan
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k) the evidence that informed your practice
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L)Which specific, relevant sections of the Code does this refer to?.
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Total word count (max 2,000) = Click here to enter text.
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Section 4: a case presentation in which you concluded that certain techniques were unsuitable
(contra-indicated)
Describe a recent case in which, after clinical evaluation, you concluded that some chiropractic techniques should not
be used with the patient because they were unsuitable (contra-indicated). This can be one of the patients you included
in section 1 or another patient. It should be a different case from the ones you use in sections 2 and 3 of this
questionnaire.
You must respond to all aspects of this section from a – k, using a maximum number of 2,000 words for this whole section.
You must send us an anonymised copy of the complete patient record.
a) the case history including the patient profile, presenting complaint, and relevant medical, family and social history
Click here to enter text.
b) the methods you used to physically examine the patient and why you chose these methods
Click here to enter text.
c) if you obtained further information or carried out further investigations (e.g. clinical imaging, laboratory tests) on the patient and why
you did this
Click here to enter text.
d) your evaluation of the patient’s health and health needs, including any relevant physiological, psychological, and social factors
Click here to enter text.
e) your differential diagnosis / rationale for care
Click here to enter text.
f) whether the case was suitable for chiropractic treatment and if so your management plan based upon your working diagnosis /
rationale for care, the patient, and the likely effects and/or risks of treatment
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Click here to enter text.
g) why you concluded that the case:
i.
some chiropractic techniques were contraindicated for this patient
ii.
how you selected the techniques that you decided to use and how you explained this to the patient
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h) how you involved the patient in making this decision and gained their consent to the treatment used
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i) your ongoing management of the patient, including the frequency and duration of care, the frequency of patient review / reevaluation, the evidence for the care used, any outcome measures you used, whether you changed your treatment approach through
the course of the treatment and the reasons for this
Click here to enter text.
j) how you applied chiropractic principles and concepts in the assessment and care of the patient
Click here to enter text.
k) Which specific, relevant sections of the Code does this refer to?
Click here to enter text.
Total word count (max 2,000) = Click here to enter text.
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Section 5: a case study of an ethical issue / dilemma
Describe a situation in which you were presented with, or found yourself having to address, an ethical issue / dilemma and the actions
you took in relation to this. This might be in relation to one of the patients you included in section 1 or another patient / situation. (If
you are unable to identify a situation where you have taken this action, then please develop an example of such a case making clear in
your response that this is a scenario not a real example.)
You must respond to all aspects of this section from a – h, using a maximum number of 2,000 words for this whole section.
Please attach an anonymised copy of any related documents (such as a patient record) if these are relevant to the case.
a) the nature of the situation
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b) who it involved
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c) why there was an ethical issue / dilemma
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d) the nature of the ethical issue / dilemma
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e) the different steps you took in thinking through the issue, reflecting on it and deciding the course of action you should take
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f) whether you sought any advice or help, and if so, from whom or where
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g) how you acted, including how you explained your actions to the people involved
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h) Which specific, relevant sections of the Code does this refer to?
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Total word count (max 2,000) = Click here to enter text.
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Section 6: application of patient management
We wish to gain an understanding of the methods of chiropractic patient management that you use and how these relate to those
specified in our education standards that set out what chiropractic degrees have to cover to be recognised by the GCC. We will not be
making an assessment of this information directly but will use it to inform the interview process.
Check one box for column a – c for each row of the table below and give brief details of the contraindications and cross referencing in
columns c) and d) to show the following:
a) your familiarity with the techniques
b) how frequently you use them in practice
c) contra-indications to the use of the techniques
d) cross – referencing with your cases (i.e. When was this element of patient management used within the cases you have presented
in sections 2 - 4)
e) the outcomes measures you use (see final row of the table).
Patient management
(a) Familiarity
(b) Frequency of use
(c) Contra-indications
(d) Cross-referencing
Very
familiar
Partly
familiar
Unfamiliar
Frequently
Occasionally
Never
Give brief details
Give brief details
Case history
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Physical examination
methods
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text.
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Laboratory tests
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Assessment
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Patient management
(a) Familiarity
(b) Frequency of use
(c) Contra-indications
(d) Cross-referencing
Plain film radiographs
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Other forms of imaging
(eg CT scans, MRI
scans)
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Chiropractic care - manipulation
Soft tissue techniques
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Articulatory techniques
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Thrust techniques
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Other chiropractic interventions
Advice, explanation and
reassurance
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Exercise and
rehabilitation
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Multi-disciplinary
approaches
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Preventive measures
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Supporting the patient’s ☐
health and wellbeing
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Patient management
(a) Familiarity
(b) Frequency of use
(c) Contra-indications
(d) Cross-referencing
with others
Promoting health and
wellbeing
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Advising on
medications
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e)
Do you use outcome measures for your chiropractic care? And if so, which outcome measures do you use?
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If you refer out for some methods of assessment (e.g. laboratory tests), please indicate this in your response in the table below.
For each of the three cases you discussed in sections 2 – 4, explain your rationale for choosing the forms of patient
management that you used (for assessment and care) and demonstrate their relationship to the Code
Maximum 400 words for each part of this section
Case study referred to in section 2: A neuromusculoskeletal case presentation
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Word count (max 400) = Click here to enter text.
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Case study referred to in section 3: A case presentation in which the patient was considered unsuitable for chiropractic treatment / was referred to
another healthcare practitioner
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Word count (max 400) = Click here to enter text.
Case study referred to in section 4: A case presentation in which you concluded that certain techniques were unsuitable (contra-indicated)
Click here to enter text.
Word count (max 400) = Click here to enter text.
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Section 7: learning undertaken in the last three years
We are interested in understanding how you function as a self-directed learner. We are interested in any assessment
and learning activities that you have undertaken in relation to chiropractic, including: peer review, patient feedback,
self-reflection, professional networking, audit, lectures, seminars, conferences, case studies, online learning etc.
Include any specific learning activities that you have undertaken in readiness for your potential move to the UK.
If you are a student / new graduate, then please relate the headings below to your development as a student. If you are an
experienced practitioner, then relate your answers to your Continuing Professional Development (CPD).
You must respond to all aspects of this section from a – g, using a maximum number of 1,500 words for this section.
a) how you have assessed your learning needs and interests
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b) how you have planned your learning
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c) the learning and development you have undertaken to:
i. keep your professional knowledge and skills up-to-date
ii. monitor and enhance the quality of chiropractic assessment and care you provide
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d) your evaluation of the learning and development you have undertaken
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e) how you have used your learning and development in your practice, and if not, why not
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f) what are your current learning needs?
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g) Which specific, relevant sections of the Code does this refer to?
Click here to enter text.
Total word count (max 1,500) = Click here to enter text.
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Section 8: Test of Competence (TOC) – Application Checklist
Use this checklist to make sure you have included all of the documents we
need to confirm if you are eligible for the TOC interview.
1. Confirmation of your chiropractic qualification
☐ A letter from the education institution which awarded your chiropractic
qualification, giving details of how it meets the registration requirements.
Details can be found on our website. (http://www.gccuk.org/UserFiles/Docs/Registrations/Qualification%20requirements%20for%2
0overseas%20applicants%200216.pdf)
2. List of modules taken as part of your chiropractic qualification
and learning outcomes of these modules
☐A list of the modules you undertook as part of your primary chiropractic
qualification, along with the criteria you were assessed against (learning
outcomes.) The form is available to download from the website
3. Completed Evidence of Practice Questionnaire
☐A completed copy of this questionnaire
4. Copies of anonymised patient records
☐Anonymised patient records that support the information you have provided
in the evidence of practice questionnaire. (Please refer to page 2)
5. Your current curriculum vitae (CV) / résumé
☐ An up-to-date CV/ résumé including details of all chiropractic work
undertaken outside the UK since you gained your primary chiropractic
qualification
6. Copy of passport
☐A copy of the relevant pages of your passport containing your photo and
personal details. The copy must be signed by someone of professional
standing
*Please note all documents must be completed and submitted in English. All documents
listed must be submitted to the GCC at the same time. This checklist must be completed
as part of your application. Further information on the above documents can be found on
our website at: http://www.gcc-uk.org/registration/test-of-competence/before-the-toc.aspx
If you have any queries about your application or the TOC process please
email us at [email protected]
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Section 9: declaration
Sign and date the declaration below to confirm you have read and understood it.

Caution: Should any entry on the Register be fraudulently procured
or incorrectly made, action will be taken under the provisions of
Section 10 of the Chiropractors Act 1994

I declare that all information supplied by me in support of my application for
registration with the General Chiropractic Council is, to the best of my
knowledge and belief, true and accurate

I understand that the Registrar may take steps to verify any such information
supplied by me, and that in the event of any such steps being taken, I agree to
cooperate fully

I declare that I have read the current General Chiropractic Council’s Code of
Practice and Standard of Proficiency and understand that my actions may be
judged against the standards and principles it contains.
Signed:
Date: Click here to enter a date.
Please provide your credit/ debit card details on page 25 for payment of the £1,500
test of competence fee.
What the fee covers
The fee covers costs for administering the test as well as the costs associated with
the interview process.
Your Evidence of Practice Questionnaire, along with your application, should be
completed and returned to [email protected]
Tel: (0)20 7713 5155
Email: [email protected]
Website: www.gcc-uk.org
Page 24 of 28
Payment of the Registration fee
by credit/ debit card
You can pay your fee by filling in this form, we do not take card payments over the
phone.
Candidates name: Click here to enter text.
I wish to pay £1,500 in respect of the fee for the test of
competence by:
American Express ☐ Delta ☐ Mastercard ☐ Visa Credit ☐ Visa Debit ☐
Card number:
Expiry date:
/
Issue date:
/
Security code (last 3 digits on the back of the card):
Card holder’s name: Click here to enter text.
Card holder’s signature:
Date (dd/mm/yy): Click here to enter text.
Refund policy
Payment will be collected from the above account when your TOC interview has
been confirmed.
If you decide to withdraw your application for the TOC after your place has been
confirmed we will refund 50% of your fee (£750) if you withdraw up to 1 day
before the closing date.
If you decide to withdraw your application on or after the closing date, your fee will
be non-refundable unless there is an Exceptional Mitigating Circumstance.
Page 25 of 28
Evidence of Practice Questionnaire
Diversity Monitoring Form
The General Chiropractic Council is committed to promoting and developing
equality and diversity in all our work. We want to be as sure as we can that
our policies and ways of working are fair and do not discriminate against
individuals or groups. To help us monitor the effectiveness of our policies and
practices we ask you to complete this diversity questionnaire. This information
will be treated in the strictest confidence under the Data Protection Act 1998.
Through this we can check a variety of processes to ensure equality and
address issues as they arise. This form will be detached and securely held
away from the rest of your application.
What is your gender?
Male
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Female
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Which of the following age brackets do you fall into?
Under 24
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25-34
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35-44
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45-54
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55-64
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65+
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Prefer not to say
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What is your ethnicity?
White – English/Welsh/Scottish/Northern Irish/British
☐
White – Irish
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White – Gypsy or Irish Traveller
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White – other (please specify)
☐
Mixed/Multiple ethnic groups – White and Black
Caribbean
☐
Mixed/Multiple ethnic groups- White and Black
African
☐
Mixed/Multiple ethnic groups – White and Asian
☐
Mixed/Multiple ethnic groups – other (please specify)
☐
Asian / Asian British – Indian
☐
Asian / Asian British – Pakistani
☐
Asian / Asian British - Bangladeshi
☐
Asian / Asian British - Chinese
☐
Asian / Asian British – other (please specify)
☐
Black/African/Caribbean/Black British - African
☐
Black/African/Caribbean/Black British - Caribbean
☐
Black/African/Caribbean/Black British – other (please
specify)
☐
Other – Arab
☐
Any other ethnic group (Please specify
☐
Prefer not to say
☐
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Click here to enter text.
Click here to enter text.
Click here to enter text.
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What is your religion or belief?
Buddhist
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Christian
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Hindu
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Jewish
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Muslim
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Sikh
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No religion
☐
Prefer not to say
☐
Other (Please specify)
☐
Click here to enter text.
The Equality Act 2010 defines a person as disabled if they have a physical or
mental impairment, which has a substantial and long-term (i.e. has lasted or is
expected to last at least 12 months) and adverse effect on the person’s ability
to carry out normal day-to-day activities.
Do you consider yourself to have a disability according to the definition
in the Equality Act?
Yes
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No
☐
Prefer not to say
☐
Which of the following best describes your sexual orientation?
Bisexual
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Gay man
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Gay woman or lesbian
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Heterosexual or straight
☐
Prefer not to say
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Other
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