STANDARDS

“Set the standard for current reliable synthesized clinical knowledge” came close to a CALLING, but the simpler the focus the more powerful it can be.

Current and synthesized are components that make knowledge more reliable so this is more simply stated as “Set the standard for reliable clinical knowledge”. 

And if something wasn’t reliable it couldn’t be a STANDARD anyway so why not simply “Set the standard for clinical knowledge”?

The more I learn the more I realize there is no single STANDARD but there are many STANDARDS – some explicitly codified and some accepted uncritically by convention. And STANDARDS come from many different groups and systems.

"Set the standard for clinical knowledge” could be interpreted as providing an exemplar, and the DYNAMED MISSION works very well for continuing to develop this exemplar.

Setting the STANDARDS however sounds more like policy development. For global purposes that is beyond one product, beyond one company, and beyond one professional association.

Setting the STANDARDS also does not sound right or feel right as a personal CALLING. That would be hubris, not humility.  And it would be impractical—STANDARDS for clinical knowledge can only be established by large groups and ecosystems determining what is acceptable.

A more practical mission (a CALLING where I find the “most impactful way to serve”) is raising the standards. “Raise the standards for clinical knowledge”

There are many ways to achieve this mission including:

• Assessing the state of clinical knowledge to identify areas of improvement, for example:evaluating the quality of Cochrane reviews in Limitations in conduct and reporting of cochrane reviews rarely inhibit the determination of the validity of evidence for clinical decision-making. http://www.ncbi.nlm.nih.gov/pubmed/26107648
• evaluating the use of terms like “intention-to-treat analysis” in the medical literature in Intention-to-treat analysis: who is in? Who is out? http://ncbi.nlm.nih.gov/pubmed/12485553
• Collaboration across groups that develop standards for clinical knowledge (eg DynaMed Editorial Leadership, GRADE, HL7, G-I-N)
• Collaboration across groups that develop solutions for providing high-quality clinical knowledge (eg. DynaMed Editorial Leadership, ACP, Duodecim, McMaster University [Health Information Research Unit])
• Integrating high-quality clinical knowledge into clinical workflows (eg. reaching clinical knowledge through clinical decision support [CDS], using current reliable synthesized clinical knowledge to create and update CDS)
• Sharing examples of problems in clinical knowledge that can trigger reconsiderations of standards, for example:
• exposing the evidence for benefits and harms for thrombolytics 3-4.5 hours after stroke in Thrombolysis in acute ischaemic stroke: time for a rethink? http://www.bmj.com/content/350/bmj.h1075.long or presented as a keynote at http://www.ebhcconference.org/previous_editions/2015/presentations/P2.02_Alper_B.pptx
• publishing a paper describing five situations where critical thinking beyond “common EBM rules” was needed to better understand clinical knowledge in Evolution of evidence-based medicine to detect evidence mutations. http://www.ncbi.nlm.nih.gov/pubmed/25572989

Sharing my CALLING in words (Raise the standards for clinical knowledge) is the first step in making it real as it evolves. This CALLING works well with the DYNAMED MISSION and provides a HOW to further set the STANDARD and raise the STANDARDS.