Beyond Required CME: How We Identify Real Knowledge Gaps

Doctors Magazine recently asked clinicians how they identify continuing education that actually addresses knowledge gaps — not just hours that satisfy a license requirement. Our contribution came down to a single self-assessment standard we apply across our scoliosis and motor vehicle collision rehabilitation work. The longer version is below, because the question matters more than most clinicians admit and the honest answer is uncomfortable.

The question we ask

The test is direct: could I teach this at the level of a peer-reviewed paper? If the answer is no, that is a knowledge gap.

The standard does several things at once. It forces a defense — not a familiarity check, but a defense — of every clinical assumption against current evidence. It exposes the seams where reasoning has been quietly leaning on tradition, mentorship, or a single weekend course. And it sets a ceiling that no CME hour, attended passively, can clear on its own.

Why peer review forces an audit that CME does not replicate

Our self-assessment process starts with our own published research. Each peer-reviewed manuscript we complete is, in practice, a forced audit of what we actually know versus what we assumed. The literature review alone — the hours spent reconciling clinical observations against existing data, the methodological critiques from reviewers, the discipline of citing every load-bearing claim — does work that no continuing education course is structured to replicate. CME is built around content delivery. Peer review is built around accountability.

When we cannot confidently defend a clinical assumption in a manuscript, that gap becomes our next educational priority. The published record is the audit trail.

Crossing into adjacent medical societies

A second deliberate choice: we cross into adjacent medical societies rather than staying within chiropractic.

There is no shortage of high-quality scoliosis and spine research happening outside the chiropractic continuing education ecosystem — in orthopedic surgery, physical medicine and rehabilitation, biomechanics, and the international scoliosis research community. Engaging with researchers outside chiropractic has exposed clinical frameworks we would never have encountered staying inside our own specialty's required course menu. The same is true for cervical spine rehabilitation and motor vehicle collision injury, where the most rigorous work often sits in journals and conferences that the chiropractic CE catalog rarely surfaces.

What this looks like across our three clinical pillars

We apply the publishable standard across the three areas that define our clinical work:

• Scoliosis biomechanics. Could we defend our reduction protocols, our radiographic measurement choices, and our rehabilitation parameters to a reviewer reading a sagittal alignment paper? Where the answer is not yet, we go to the literature — not to the CE calendar.
• Cervical spine rehabilitation. Could we defend our soft tissue and ligamentous injury reasoning to a reviewer at a journal that reads orthopedic and PM&R submissions? That standard determines what we read, who we collaborate with, and which conferences are worth the travel budget.
• Motor vehicle collision injury. Could we present our injury documentation and rehabilitation reasoning at the level the medical-legal literature expects? If not, the gap is the assignment.

Why patients should care

Patients don't see continuing education choices, and most of the time they shouldn't have to. But the choices a clinician makes about how they identify their own knowledge gaps determine the quality of the care that reaches the treatment room.

Required CME hours, taken passively, are a floor. Holding our learning to a publishable standard — and crossing into the medical and research communities where the most rigorous work in our clinical areas is happening — is how we make sure the floor isn't also the ceiling.

This post expands on Dr. Dick's contribution to a Q&A feature in Doctors Magazine: "5 Ways to Identify Continuing Education Opportunities That Address Your Knowledge Gaps."

Justin M. Dick, DC, is the founder of Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He is a CLEAR Scoliosis Institute Fellow and Board member, holds the ISICO World Master Certification, and serves as adjunct faculty at Life University, Sherman College of Chiropractic, and Palmer College of Chiropractic. His peer-reviewed work is indexed on PubMed and Cureus and is collected on the research hub.