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The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
June, 2007, Vol. 07, Issue 06
Show Me Your Outcome Competencies
By Keith Eric Grant, PhD, NCTMB
In early 1984, I spent a month at the Esalen Institute practicing core shamanic methods in a small group led by Michael Harner, author of The Way of the Shaman2 and founder of The Foundation for Shamanic Studies. During sessions, Michael always was the model of focus and professionalism. Outside of the sessions, however, he was animated and social. And at dinner, we never had a problem figuring out where our group's table was, with Michael's laughter that could be heard across any crowded dinner hall. Often, the laughter came in recounting some scene from his favorite movie, "The Treasure of the Sierra Madre." Thus, we came to know the opening quote quite well. I also was given a model of being flexible and learned to shift my personal presentation to fit the needs of the context. That flexibility has been a "competency" of some of the best teachers I've had the privilege to learn from, which leads me to the real theme of this column. With apologies to Dobbs and Gold Hat, if you are the bearers of "high standards," where are your outcome competencies?
My fellow columnist, Ralph Stephens, and I both like to shine light on where we feel massage training and entry requirements fall short. In the inimitable words of baseball player and manager Yogi Berra, however, "Our similarities are different."3 For me, another Berra quote succinctly captures the root of the problem: "You've got to be very careful if you don't know where you're going, because you might not get there." The licensing and certification of massage practitioners likely has been lowering their competence.
It's not so much the licensing itself as it is how licensing has interacted with mainstreaming and training. At one time, teaching massage resembled teaching martial arts, a system of tacit knowledge conveyed from expert to student. The expert may not have said a lot, but they knew how to look at you while you practiced and would keep you at it as long as they felt there was "something missing." Consider that system to be history, now that we have explicitly defined entry requirements. Explicit requirements don't add to a tacit system; they replace it. You get what you explicitly value. The catch is that we haven't defined the outcomes we value; only the total hours and some blocks of hours in vaguely defined subject areas. Career colleges and community colleges teach to what we defined. Students self-select for their ability to match our explicit requirements. We are getting what we asked for, as long as graduates meet the entry requirements. You expected something else, perhaps?
Don't complain about getting what you asked for; do the work of defining the outcomes comprising what you want. Here's the recipe: Insist on differentiating between "high requirements" and "high standards." Standards lead to observable outcomes while requirements don't have to. Define a job specification for an "entry-level practitioner." Define all of the contexts in which you believe the job is done. For each context, break the performance into tasks. Get feedback from the stakeholders in each context. For each task, create a list of required observable competencies or, if covert, competency indicators. Define the needed proficiency levels. Get more feedback. Merge the individual lists of competencies into a master list of competencies, taking the highest proficiency level at which each occurs. Implement a plan to identify applicant learning gaps and teach them what they aren't doing. Assess the results, and modify definitions and teaching methods to obtain the outcomes you want. Reward yourself for creating something that meets specific goals for stakeholders and is a clear guide to schools and students in reaching them. Then go back and assess the results again. The beauty of this method is that all levels are explicit. If you compare your competency standards with someone else's, you can track down the exact source of differences.
The best resource I've come across for going through all of this is a set of books authored by Robert F. Mager called The New Mager Six-Pack.4 I'm of the opinion that no one should be allowed to talk about standards without first being required to demonstrate an understanding of what's in those books. Consider it an entry-level requirement for a "standard discusser" position. The books are clear, readable and filled with examples.
Your efforts, should you accept this mission, won't be alone. New resources to do information handling are coming from the venues of technology and distance learning. (I recently blogged about this: "Guidelines, Learning Objects, & Competency Definitions."5) The Massage Therapy Foundation's Best Practices Committee is actively working on an open and transparent creation process for evidence-based guidelines. At a March meeting of the committee, I co-located with Whitney Lowe in the physical world. Whitney has embodied a lot of the outcome-based concepts in an online clinical reasoning course.6 The course uses an open-source educational framework that supports working through case studies, first as small groups and then as individuals. I particularly like that the environment provides built-in discussion forums to teach students the ability to solve problems by interacting with mentors and peers; a refreshing walk away from the idea of pre-canned answers for everything. Finally, I've been following my own project to create a library of massage competency definitions.7 I'm grateful to a number of people on different massage e-mail lists for their contributions. You'll find their names next to the competencies they suggested.
While I've been discussing massage training, the same process works for personal and business goals as well. Define where you want to be. Define what being there looks like and what skills you are using. Set up a plan to close the learning and experience gaps. Implement that plan and you'll be heading where you want to go. Remember to enjoy the journey and the people you meet along the path.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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