Research in Medical Education Annual Meeting (RIME @ AAMC)

  Every year an important meeting for medical educators and researchers to attend is the RIME meeting, which forms part of the American Association of Medical Colleges Annual Meeting.  [Here is the AAMC program by sponsor.]

The 2007 RIME meeting will be held from Sunday November 4 to Wednesday November 7. 

Every year the RIME abstracts are published in a special issue of Academic Medicine and indexed in PubMed.  Here are the 2007 RIME abstracts. PubMed records [coming soon]

Most earlier PubMed records for RIME do not include the abstracts. If you are interested in reading the RIME abstracts back to 1990, you can view the relevant issues of Academic Medicine, or link to the PubMed citations here:
2006;  2005;  2004;  2003;  2002;  2001;  2000;  1999;  1998;  1997;  1996;  1995;  1994;  1993;  1992;  1991; 1990 
Retrieve RIME PubMed Records 2000-2006

Use the AbstractPlus Display to view Related Articles; use the Citation Display to view full records that include MesH terms. Click Links/Linkout to link to full text [subscription required].

American Medical Education 100 Years after the Flexner Report

  From the September 28 issue of the New England Journal of Medicine: [free full text available]

Cooke M, Irby DM, Sullivan W, Ludmerer KM. American medical education 100 years after the Flexner Report. New Engl J Med 2006; 355(13):1339-1344.
Read letters in response to this article, from the January 4 2007 issue of NEJM

Excerpt: Medical education seems to be in a perpetual state of unrest. From the early 1900s to the present, more than a score of reports from foundations, educational bodies, and professional task forces have criticized medical education for emphasizing scientific knowledge over biologic understanding, clinical reasoning, practical skill, and the development of character, compassion, and integrity. How did this situation arise, and what can be done about it? In this article, which introduces a new series on medical education in the Journal, we summarize the changes in medical education over the past century and describe the current challenges, using as a framework the key goals of professional education: to transmit knowledge, to impart skills, and to inculcate the values of the profession.  Free full text 
See also A new series on medical education

Diagnostic Imaging Guidelines for the Chiropractic Profession: A Worldwide Consultation on the Web

  I just received a notice from The Week in Chiropractic (a weekly e-mailed newsletter from the FCER, Foundation for Chiropractic Education and Research) about imaging guidelines for chiropractic. Read all about this Web-based consultation, below.  See also Practice Guidelines

Between August 1st and October 31st, 2006, a Web site will be made available for chiropractors to evaluate new imaging guidelines on neuromusculoskeletal disorders in adults. Participants will be asked to provide comments and suggestions regarding various characteristics of the proposed imaging guidelines. Specific characteristics include ease of use; feasibility and desire of implementing these guidelines in practice; how comprehensive are each of the recommendations; corresponding comments . . .

There is an urgent need throughout the health care professions to develop practice guidelines. The purpose of this project is to develop evidence-based diagnostic imaging practice guidelines for neuromusculoskeletal disorders for use by chiropractors. The project consists of eight phases, four of which have already been completed. Based on an exhaustive literature review, and in collaboration with a staff chiropractic radiologist, a first draft of diagnostic imaging practice guidelines for chiropractic was produced and then sent for a first external review (phase 3). A group of over 70 international experts on the topic of neuromusculoskeletal disorders have evaluated the proposed guidelines to provide recommendations by consensus opinion (phase 4). The expert consensus guidelines will then be forwarded to various chiropractic specialties for further external review and consideration (phase 5). Simultaneously, a ‘’public’’ website will be made available for worldwide chiropractors to consider the Delphi expert consensus guidelines (phase 6). Upon completion of the second external review and after receiving comments by field practitioners about the ‘’public’’ website, the suggestions and comments will be considered by the executive committee and incorporated into the document for the Delphi expert panel to review (phase 7). The executive committee will then draft the final version of the guidelines based on consensus opinion. Phase 8 of this project will involve the dissemination and implementation of the international consensus opinion guidelines.

Diagnostic imaging practice guidelines are intended to reduce unnecessary radiation exposure, increase examination precision and decrease health care costs–all without compromising the quality of care.

Researchers:
André E. Bussières, DC, FCCS (C), BSc (Professor, Chiropractic Department, Université du Québec à Trois-Rivières)
Cynthia Peterson DC, RN, M.Med.Ed, DACBR, (Professor, Canadian Memorial Chiropractic College)
John A. M. Taylor DC, DACBR (Professor of Radiology, New York Chiropractic College)

Correspondence: Bussières, André, Département Chiropratique, Université du Québec à Trois-Rivières (UQTR), C.P. 500, Trois-Rivières, Québec, Canada G9A 5H7. andre.bussieres@uqtr.ca

Red Flags, Yellow Flags, Blue Flags, Black Flags

    

This page updated February 22, 2013.  

The other day a student asked me where the phrase “red flag” originated. He had also heard of yellow flags, and suspected that there were other colours of flags to indicate barriers to recovery. Well, we looked in various glossaries of medical and medical education terms, without success. So I e-mailed Dr. Shawn Thistle, and, sure enough, he helped. It is difficult to find where these terms originated (try Googling blue flags!) and Shawn thinks they may just be part of every doctor’s vocabulary. (Ever since I wrote the title above, I can’t get Dr. Seuss’s One fish two fish red fish blue fish out of my head.)

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Red flags/clinical red flags (biomedical factors) ~
These help identify potentially serious conditions, and are often listed in practice guidelines. Here is a description from Chapter 13 of the Clinical guidelines for chiropractic practice in Canada [Glenerin Guidelines]:
The main focus for the prevention of complications is the recognition of well-known and established indicators or “red flag” signs and symptoms which may require careful assessment and reassessment, changes in treatment plan, or other appropriate action, such as emergency care or referral to another health care specialist. Ignoring these “red flag” indicators increases the likelihood of patient harm. 

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Yellow  flags/clinical yellow flags (psychological or behavioural factors/predictors) ~
These indicate psychosocial barriers to recovery. Here is a definition from
New Zealand acute low back pain guide: incorporating the Guide to assessing psychosocial yellow flags in acute low back pain:
Yellow Flags are factors that increase the risk of developing or perpetuating long-term disability and work loss associated with low back pain … Before proceeding to assess Psychosocial Yellow Flags it is important to differentiate between acute, recurrent and chronic presentations. Evidence suggests that treating chronic back pain as if it were a new episode of acute back pain can result in perpetuation of disability. 

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Blue flags/occupational blue flags (social and economic factors) ~
These refer to conditions in the workplace that may inhibit recovery. Examples are monotony, low degree of control, poor relationships or high work demands. 

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Black flags/socio-occupational black flags (occupational factors) ~
These are also used for workplace issues, but refer to organizational issues such as financial reliance on disability benefits, workers’ compensation issues, or employer attitudes to the sick worker.

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References:
Helliwell PS, Taylor WJ. Repetitive strain injury. Postgrad Med J 2004;80(946):438-43.See An Approach to Diagnosis
Main CJ, Williams AC.  ABC of Psychological Medicine. Musculoskeletal pain. BMJ 2002;325(7363):534-7. 

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Click on the image below for The clinical flags approach to obstacles to recovery from back pain and aspects of assessment.

From:  Main CJ, Williams AC.  ABC of Psychological Medicine. Musculoskeletal pain. BMJ 2002 Sep 7;325(7363):534-7. PMC version

 

Friday Fun: Is Flying Funny?

   Can flying be funny? In the past five years our collective view of flying has certainly changed. I remember the days when for many people, the phrase Fear of Flying was simply the title of a book by Erica Jong. But how times have changed. Now we need humour to help us deal with the new fears …

Have a look at Airport Security Follies, a delightful collection of editorial cartoons. Scroll down the page to read them all.

Or listen to the Bar and Grill Singers’ rendition of John Denver’s  Leaving on a Jet Plane. It’s hilarious. Turn up your sound and click on the first link.You will need Windows Media Player. (Thanks to Sue Pelletier for this one.)

Here is a site I have sent you before, but it’s worth another look: SkyHigh Airlines. Check out the new Free Range Fares, guaranteed to be more random than ever and free of troublesome logic!

What is intervertebral disc degeneration, and what causes it? [literature review]

  The following literature review was published in the August 15, 2006 issue of Spine: [available by subscription only]

Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? [literature review]. Spine 2006; 31(18):2151-2161.

STUDY DESIGN: Review and reinterpretation of existing literature.
OBJECTIVE: To suggest how intervertebral disc degeneration might be distinguished from the physiologic processes of growth, aging, healing, and adaptive remodeling.
SUMMARY OF BACKGROUND DATA: The research literature concerning disc degeneration is particularly diverse, and there are no accepted definitions to guide biomedical research, or medicolegal practice.
DEFINITIONS: The process of disc degeneration is an aberrant, cell-mediated response to progressive structural failure. A degenerate disc is one with structural failure combined with accelerated or advanced signs of aging. Early degenerative changes should refer to accelerated age-related changes in a structurally intact disc. Degenerative disc disease should be applied to a degenerate disc that is also painful.
JUSTIFICATION: Structural defects such as endplate fracture, radial fissures, and herniation are easily detected, unambiguous markers of impaired disc function. They are not inevitable with age and are more closely related to pain than any other feature of aging discs. Structural failure is irreversible because adult discs have limited healing potential. It also progresses by physical and biologic mechanisms, and, therefore, is a suitable marker for a degenerative process. Biologic progression occurs because structural failure uncouples the local mechanical environment of disc cells from the overall loading of the disc, so that disc cell responses can be inappropriate or “aberrant.” Animal models confirm that cell-mediated changes always follow structural failure caused by trauma. This definition of disc degeneration simplifies the issue of causality: excessive mechanical loading disrupts a disc’s structure and precipitates a cascade of cell-mediated responses, leading to further disruption. Underlying causes of disc degeneration include genetic inheritance, age, inadequate metabolite transport, and loading history, all of which can weaken discs to such an extent that structural failure occurs during the activities of daily living. The other closely related definitions help to distinguish between degenerate and injured discs, and between discs that are and are not painful.
PubMed Record     DOI Link

MeSH terms:

Disease Models, Animal

Intervertebral Disk/pathology*

Intervertebral Disk/physiology

Intervertebral Disk Displacement/diagnosis*

Intervertebral Disk Displacement/etiology*

The drive for legitimation in Australian naturopathy: successes and dilemmas

  Dr. Hans Baer of the University of Melbourne has published another article on legitimation, this time in Social Science & Medicine. See also The drive for legitimation by osteopathy and chiropractic in Australia: Between heterodoxy and orthodoxy

Legitimation (from Wikipedia):
Legitimation is the act of providing legitimacy. Legitimation in the social sciences refers to the process whereby an act, process, or ideology becomes legitimate by its attachment to norms and values within a given society. It is the process of making something acceptable and normative to a group or audience.

Baer HA. The drive for legitimation in Australian naturopathy: successes and dilemmas. Soc Sci Med 2006; 63(7):1771-1783.

Abstract: Whereas naturopathic physicians have either “licensure” or state-mandated “registration” in 13 US states and four Canadian provinces, naturopaths in Australia have thus far failed to obtain “statutory registration” in any political jurisdiction, despite the fact that chiropractors and osteopaths have done so in all Australian states and territories, and acupuncturists and Traditional Chinese Medicine practitioners have done so in the state of Victoria. Ironically, naturopathy and various other complementary medical systems are taught in many public tertiary institutions. This essay presents an overview of the development and the current socio-political status of naturopathy in Australia and its redefinition in some contexts as “natural therapies” and “natural medicine” or even as the major component of complementary medicine. It also examines reasons why the Australian state has come to express an interest in naturopathy along with other complementary medical systems.
PubMed Link   DOI Link   [Available by subscription only; e-mail me.]

Impact of continuing education interventions on clinical outcomes of patients with neck pain who received physical therapy

   Just published in the September 2006 issue of Physical Therapy:

Brennan GP, Fritz JM, Hunter SJ. Impact of continuing education interventions on clinical outcomes of patients with neck pain who received physical therapy. Physical Therapy 2006; 86(9):1251-1262.

BACKGROUND AND PURPOSE: Physical therapists frequently attend continuing education courses with the goal of providing better care, yet the effectiveness of continuing education for improving outcomes has not been examined.
SUBJECTS: Data were obtained for all eligible patients (n=1,365; mean age=42.1 years, SD=14.0 years; 69.9% female) with a chief complaint of neck pain who were treated in 13 physical therapy clinics over a 24-month period. Disability data (Neck Disability Index scores) from the initial and final therapy sessions were recorded from clinical databases.
METHODS: Thirty-four of 57 physical therapists employed within the 13 clinics attended a 2-day continuing education course. Eleven of the 34 attendees also participated in an ongoing clinical improvement project for patients with neck pain. Clinical outcomes were compared in the pre- and post-course periods for therapists attending or not attending the course, and for therapists participating or not participating in the ongoing project.
RESULTS: There were no differences in clinical outcomes based on attendance at the continuing education course. There was an interaction between time and participation in the ongoing project, such that participants achieved greater change in disability after the course. The percentage of patients achieving at least the minimum detectable amount of change in disability with treatment increased significantly for participants after the course.
DISCUSSION AND CONCLUSION: Attendance at a 2-day continuing education course was not associated with improvement in clinical outcomes, but participation in an ongoing improvement project did result in greater clinical improvement for patients with neck pain. Further investigation of educational methods to improve clinical outcomes is needed. These results suggest that traditional continuing education formats may not be effective for improving patient care.
Full Text         PubMed Record 

The drive for legitimation by osteopathy and chiropractic in Australia: Between heterodoxy and orthodoxy

  This article was just published in Complementary Health Practice Review:

Baer HA. The drive for legitimation by osteopathy and chiropractic in Australia: Between heterodoxy and orthodoxy. Complementary Health Practice Review 2006; 11(2):77-94.

Abstract: This article examines the drive for legitimation on the part of osteopathy and chiropractic in Australia. A brief history is presented of the development of these two manual medical systems down under, their respective drives for statutory registration and public funding of their training institutions (all of which are embedded in public universities), and their respective niches within the context of the Australian dominative medical system. Ironically, although osteopathy is politically strong in both the United States, where it has evolved in osteopathic medicine and a parallel medical system to biomedicine, and in Britain, where it remains primarily a manual medical system, chiropractic over time became politically stronger than osteopathy in Australia. The author argues that although chiropractic and osteopathy remain distinct and related systems in Australia, from the perspective of the Australian state, they essentially are one and the same.
DOI Link    [Available by subscription only; e-mail me.]

Change the Display Format of Single Citations with My NCBI PubMed® User Preferences

   If you use PubMed a lot, this new feature may be of great interest to you. You can now customize the display of citations retrieved by using a new feature in My NCBI [National Technology Information System].

On June 21st I wrote, I wish PubMed would automatically display the full record. ‘ll keep you posted on exciting new developments on PubMed. This was at the end of an entry about that new AbstractPlus Display. Well, my wish has come true!

Currently, AbstractPlus is the default display in PubMed and if you use the Related Articles feature a lot, it’s great because the first few citations are automatically displayed. But I always like to see the full record, and if you do, too, I have good news. 

I was just reading the July-August NLM Technical Bulletin and I came across an article about how you can customize your PubMed Display:
Change the Display Format of Single Citations with My NCBI PubMed® User Preferences

All you have to do is sign in to My NCBI and click on User Preferences at the left of the screen. You can even choose a pretty colour to highlight your search terms. (The fact that I am excited about having the ability to choose a colour to highlight my search terms is a clear indication that is has been a very long day. But hey – yellow, green, plum, aqua … Who can resist?)

Give My NCBI a try, if you haven’t already. Besides customizing displays and filters, you can save searches and have them run for you at the time(s) you choose.