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Physicians, attorneys, and others who work in the impairment and evaluation field will benefit from membership in The American College of Occupational and Environmental Medicine (ACOEM). The courses, conferences, publications and networking through the special interest sections and local component societies of ACOEM helps to deepen the knowledge base and further the careers of its members. For a description of the benefits of membership click here.

You can apply for membership with the on-line application. ACOEM welcomes members from medical students, residents, non-physicians working in the field, and physicians. Benefits include discounted registration fees to our online training on the Sixth Edition.

By Craig Uejo, MD, MPH, QME, CIME, CIR and Christopher R. Brigham, MD, MMS

The Sixth Edition, published in December 2007, introduces new approaches to rating impairment, using a new approach based on a modification of the conceptual framework of the International Classification of Functioning, Disability, and Health (ICF). Although the fundamental principles underlying the Guides remain unchanged, other changes were also made to improve internal consistency, promote greater precision and simplify the rating process.

The approach to impairment evaluation has evolved over the past fifty years since the Guides started in 1958 with publication by the American Medical Association (AMA) of the article, "A Guide to the Evaluation of Permanent Impairment of the Extremities and Back". The prior Fifth Edition was published in 2000 and prior to the availability of the Sixth Edition were utilized in twenty six states including Alaska, Arizona, California, Delaware, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Montana, Nevada, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington and Wyoming.

Many states require the use of the "most recent Edition" of the Guides either by statute or code; therefore, states that are expected to implement the Sixth Edition immediately include Alaska, Hawaii, Kentucky, Louisiana, Mississippi, Montana, New Hampshire, New Mexico, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Vermont and Wyoming. The Sixth Edition will be the immediate new standard for Federal, Longshore and Harbor Workers Act, automobile casualty and personal injury cases. The most recent edition is also expected to remain the standard for automobile casualty and personal injury cases, both domestically and internationally. Some of the countries that use the Guides include Australia, Canada, Hong Kong, Korea, New Zealand, and South Africa.

Some of the recent changes included in the Sixth Edition include:

• Standardized assessment of Activities of Daily Living (ADL) limitations associated with physical impairments.
• Functional assessment tools to validate impairment rating scales.
• Measures of functional loss in the impairment rating.
• Improvement in overall intra-rater and inter-rater reliability and internal consistency.
• ICF classification uses five impairment classes with Class 0, normal, to Class 5, very severe.
• Within the ICF model, "diagnosis-based grids" (DBI) were developed for each organ system with Class 0-5 based primarily on the diagnosis.
• Final impairment value determined by adjusting the initial impairment rating given by factors that may include physical findings, the results of clinical tests, and functional reports by the patient.

We have received rave reviews and it's due to all of you who have participated and made this an exceptional learning event.

We just wanted to take a moment to say thank you to all our clients who made the San Diego, CA, Burlington, VT, Manchester, NH, Casper, WY and Anchorage, AK Seminars such successes.

We look forward to working with you in the future and seeing you all again soon.

With the emphasis in the Sixth Edition on Diagnosis- Based Impairments we are recruiting experienced nurses to join our team in our San Diego office, (please e mail Mindy here if you're a nurse that would like to submit your resume for review).