Scott:
This whole idea of defining ourselves professionally is more complex then it should be. But the Bible teaches us that when deception is universal, the telling of Truth will be forcefully opposed by the authorities.
How do we mature disciples through mentorship? The "Defining Dozen"is a manuscript that remains under construction, and I continue to struggle with it.
Below you will find a page and two photos. This is where I was at in 2008. It includes a photo of what I called "The Mayo Clinic of San Pedro" en la Republica Dominicana. I asked myself, what are the services provided here,how did he start, and how is it sustained?
We really should get together and present this. The American Journal of Clinical Medicine has started publishing a series of basics for the mission medicine curriculum. See fracture example attached. As part of their rotation each student is expected to take images, construct CME questions, and research the correct answers.
More to follow--Blessings.
WMR
NEW MATERIAL HERE
Splitters versus Lumpers—Wm. MacMIllan Rodney MD; Phoenix STFM work group 2008
Edited 09-11-7 for JPS presentation Fort Worth, Tx.
Which procedures add value and should be included within the legitimate boundaries of the specialty of family medicine? Curriculum can be
1) required,
2) optional but must be available, or
3)can be sought through special experiences.
Splitters have generated long lists which are operationally difficult. Lumpers consolidate using prepackaged curricula models such as ACLS and ALSO where available. The” lumper” position describes some of the general areas which define the specialty and set it apart from the limited generalist; i.e., generic primary care. The 'defining dozen' areas can be described briefly in the paper without diminishing the impact of the ‘splitter’s” lists.
The paper will be a standard manuscript with up to 10 double spaced pages, some tables, and a bibliography. The goal is to present and discuss at a national meeting. The onward to publish in a peer reviewed journal.
The following is 356 words.
There was concensus about the value of distinguishing family medicine from the generic primary care. For example the New England Journal of Medicine classified ads read "Family Practice--see Primary Care". A second priority was to establish guidelines clearly defending the minority rights of specific family physicians who were in niche groups such as Cesarean section and uterine aspiration. Lumpers did not worry about hospital privileges for skin biopsies, but saw much to be gained by specifying highly contested areas such as GI endsocopy, IV sedation/analgesia, ultrasound, and operative delivery privileges. The splitters list amplified most of the following areas, while declining to define some skills such as Office laboratory as a "procedure.
1.Skin surgeries included lacerations, biopsies, abcesses, and aesthetics.
2. Hospitalist/ER resuscitation skills were easily acquired through nationally available sources(ACLS, ATLS, and PALS)
3. Prenatal and Delivery care specified the procedural skills within ALSO and NRP.
4. Imaging procedures--Ultrasound, xray interpretation, echocardiography, and others
5. Office and hospital gynecology included Paps smears, colposcopy, surgical assisting, EMB, uterine aspiration etc
6. Anesthesia procedures including IV sedation/analgesia, local anesthesia of all kinds, and spinals
7. Issues unique to children with the disclaimer that there is overlap into adults--Circumcision, vascular access, etc.
8. The musculoskeletal skills up to and including management of nondisplaced, nonangulated fractures.
9. Office laboratory procedures including how to run the hemogram, urinalysis, Accuchek, pregnancy test, strep screen, HgbA1c machines, a microscope for wet mount, fluids, and urine.
10. Basic Urgent Care and Hospitalist procedures-This is where the group could specify the Andazolo concerns
11. GI endoscopy and anorectal[minimally invasive surgery with anesthesia issues][Include all endoscopies,laparoscopy, hysterosocopy
12. Miscellaneous
ENT endoscopy
Stress ECG
Transcendental Rectal Meditation
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