"You can't provide quality care for women unless you're operating from a specialist framework.
As a consequence, ANA testing on HEp-2 substrates outside a proper clinical specialist framework may lead to inappropriate referrals to tertiary care specialists and, worst case inappropriate and potentially toxic therapy for the patient.
It is quite obvious that ANA testing on HEp-2 cells outside a proper clinical specialist framework may yield a sizable portion of ANA-positive individuals without consistent evidence of AARD, purportedly leading to inappropriate referrals to tertiary care specialists, as well as anxiety in patients and physicians alike [3] and, perhaps, inappropriate and potentially toxic therapy [6].
At the time of our study it was not clear if GPs who predominantly practised as forensic physicians would be revalidated against the GP specialist framework as GP appraisers can only sign-off competence in general medicine.
These roles and competences are classified in frameworks such as the CanMEDS (Canadian Medical Education Directives for Specialists) Roles Framework [ 1], the six core competences identified and described by the Accreditation Council for Graduate Medical Education (ACGME competencies) [ 2] and Tomorrow Doctor's at the UK [ 3].
Recently, there has been a shift towards outcome-driven, competency-based training, largely inspired by the Canadian Medical Education Directions for Specialists (CanMEDS) framework [ 2, 3].
Constructs assessed have also varied depending upon the availability of a job analysis with or without a set of nationally declared competencies, such as Canadian Medical Education Direction for Specialists (CanMEDS) Framework [ 6, 26].
Andrew Redfern, chief executive of Nottinghamshire-based specialist housing association Framework, told Inside Housing magazine: "It would mean the end of supported housing.
These changes make the results fit even better in our generalist-specialist trade-off framework (see Figure 1).
As Earth's climate changes and New York coastal communities face risks from unpredictable waters, Cornell researchers and other specialists are developing a framework to protect shorelines and the people who live near them.
