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Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Putting POLITE Into Practice
First came the acronym RICE (Rest, Ice, Compression, Elevation), which eventually became PRICE (Protect, Rest, Ice, Compression, Elevation). Then in 2015, we started hearing POLICE (Protect, Optimal Loading, Ice, Compression, Elevation).
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
We Get Letters & Email
Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
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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