Knowledge silos: assessing knowledge sharing between specialties through the vestibular schwannoma literature

OBJECTIVEIt is common for a medical disorder to be managed or researched by individuals who work within different specialties. It is known that both neurosurgeons and neurotologists manage vestibular schwannoma (VS) patients. While overlap in specialty focus has the potential to stimulate multidisciplinary collaboration and innovative thinking, there is a risk of specialties forming closed-communication loops, called knowledge silos, which may inhibit knowledge diffusion. This study quantitatively assessed knowledge sharing between neurosurgery and otolaryngology on the subject of VS.METHODSA broad Web of Science search was used to download details for 4439 articles related to VS through 2016. The publishing journal’s specialty and the authors’ specialties (based on author department) were determined for available articles. All 114,647 of the article references were categorized by journal specialty. The prevalence of several VS topics was assessed using keyword searches of titles.RESULTSFor articles written by neurosurgeons, 44.0% of citations were from neurosurgery journal articles and 23.4% were from otolaryngology journals. The citations of otolaryngology authors included 11.6% neurosurgery journals and 56.5% otolaryngology journals. Both author specialty and journal specialty led to more citations of the same specialty, though author specialty had the largest effect. Comparing the specialties’ literature, several VS topics had significantly different levels of coverage, including radiosurgery and hearing topics. Despite the availability of the Internet, there has been no change in the proportions of references for either specialty since 1997 (the year PubMed became publicly available).CONCLUSIONSPartial knowledge silos are observed between neurosurgery and otolaryngology on the topic of VS, based on the peer-reviewed literature. The increase in access provided by the Internet and searchable online databases has not decreased specialty reference bias. These findings offer lessons to improve cross-specialty collaboration, physician learning, and consensus building.

Failure of Administrative Data to Guide Asthma Care

Rationale: Asthma is a chronic inflammatory disease of the airways that is very common (7.9% ofCanadians over the age of 12). Despite numerous clinical guidelines, education events and administrativedata reviews, there has been little change to the way asthma is managed in the Canadian health caresystem for nearly 30 years. We evaluated, through the Physician Learning Program (PLP) in Alberta,possible reasons why administrative datasets have not been able to provide meaningful information toadjust health policy. Methods: Provincial data was attained through Alberta Health Service and Alberta Health on pulmonaryfunction testing from 2005-2011 (through the PLP). The number of asthma diagnosis made during the sametime frame were then compared. Results: The preliminary results of the PLP found that spirometry was billed for roughly half as often asthe asthma diagnostic codes were utilized during the same time frame. However, the review also revealedinconsistencies in how administrative data are captured, making it difficult to determine whetherspirometry is being underutilized by physicians in making asthma diagnoses. Conclusions: Inconsistencies in how administrative data are captured in Alberta may be contributingto an incomplete picture of the rates of asthma diagnosis and physiological testing, and may explain, inpart, the limited influence of administrative datasets on guiding meaningful change within the healthcaresystem.

A Glossary in Support of Physicians' Continuing Professional Development Across the World

ABSTRACT As the physician learning environment becomes more global, the importance of a common language for CME/CPD is becoming increasingly important in order that physicians, the regulatory community, and the public may grasp the meaning of particular terms and understand the context in which they are being used. Establishment of a common language for continuing professional development is essential for developing substantive equivalency agreements among regulatory jurisdictions and improving the quality of CME/CPD systems worldwide. The International Academy for CPD Accreditation (IACPDA) developed a glossary of commonly used terms and consensus-based definitions of those terms. There is not an expectation that accrediting bodies must change their terminology to conform to the glossary. Rather, the intent is for the glossary to facilitate greater understanding and potential for harmonization of standards among CME/CPD accreditors, certifying boards, medical regulatory authorities and other stakeholders, thus enabling improvement worldwide in the quality of CME/CPD activities in which health professionals participate, and therefore improvement in their competence and practice performance. This article highlights synergies created by a standardization in CME/CPD terminology and summarizes the methodology used, and design of, the new glossary of terminology by the IACPDA. While the IACPDA has identified modifications and enhancements to be incorporated into future updates, the current glossary is already publicly accessible. The IACPDA welcomes comments from all stakeholders, including the medical regulatory community.