Clinical experience changes the combination and the weighting of audio-visual sources of information.

OBJECTIVE: Although audio and visual information constitute relevant channels to communicate pain, it remains unclear to what extent observers combine and weight these sources of information when estimating others' pain. The present study aimed to examine this issue through the theoretical framework of the Information Integration Theory. The combination and weighting processes were addressed in view of familiarity with others' pain. METHOD: Twenty-six participants familiar with pain (novice podiatry clinicians) and thirty non-specialists were asked to estimate the level of pain associated with different displayed locomotor behaviors. Audio and visual information (i.e., sound and gait kinematics) were combined across different intensities and implemented in animated human stick figures performing a walking task (from normal to pathological gaits). RESULTS: The novice clinicians and non-specialists relied significantly on gaits and sounds to estimate others' pain intensity. The combination of the two types of information obeyed an averaging rule for the majority of the novice clinicians and an additive rule for the non-specialists. The novice clinicians leaned more on gaits in the absence of limping, whereas they depended more on sounds in the presence of limping. The non-specialists relied more on gaits than on sounds. Overall, the novice clinicians attributed greater pain levels than the non-specialists did. CONCLUSION: Depending on a person's clinical experience, the combination of audio and visual pain-related behavior can qualitatively change the processes related to the assessment of others' pain. Non-verbal pain-related behaviors as well as the clinical implications are discussed in view of the assessment of others' pain.

Podiatric medicine: a current assessment.

Podiatric medicine had its own evolution in the medical field apart from allopathic and osteopathic medicine. Podiatrists are well-respected members of the health-care team and have earned recognition as physicians within their education, training, and credentialing processes. Unlike allopathic medical doctors and doctors of osteopathic medicine, whose scope of practice is based upon their education, training, and credentialing processes, podiatrists' scopes of practice are determined by state laws (and are often influenced by politics) with variances across the United States. In contrast to a lack of uniformity in the training and credentialing processes of an allopathic medical doctor, podiatrists complete a streamlined educational process that is competency-based and well-aligned from the undergraduate phase (podiatric medical school) to the postgraduate phase (residency) through the credentialing processes (licensure and certification). Podiatric medical students begin to directly engage in the specialty related to the diagnosis and treatment of the lower extremity much earlier in the educational process than an orthopedist, whose foot and ankle exposure is less extensive by comparison.

The continuing evolution of the medical staff organization: from MSO to PSO.

Regardless of the speed of the evolution from a MSO to a PSO, it is inevitable. During the course of this evolution, hospital management must be certain that individual clinicians and the PSO as a whole perform technical services that are integrated into the hospital's overall effort to achieve its goals. Although nonclinician managers cannot deliver clinical services or independently judge quality, they can obtain the expert advice and technical assistance needed to understand individual and aggregate PSO practice. Doing so allows managers to not only meet their ethical and legal responsibilities but also implement continuous quality improvement in the hospital, an activity of critical importance in the 1990s.