I have been very busy this past year, aside from becoming a father of a lovely daughter, with teaching, service, and research, all in the pain area. From each of these professional perspectives, I have repeatedly observed instances where the stated goals of this organization represent great need within the profession of dentistry. From informal discussions with members over the past 9 months, I hear that other members have similar experiences within their settings. I also hear from other members that they are excited by proposals we have been discussing, and that they want to see AUTOPP do more. Educating at the pre-doc, post-grad, and speciality training levels, educating practitioners, educating the public, and educating payers and state authorities: these continue to be essential activities if we are to make progress toward our goal of relieving pain. I believe that the membership of this organization views these needs as important for our profession and for our field. The present Executive Board hopes that, with the present newsletter, we can help this organization and its very talented membership achieve greater progress with at least some part of these activities. We look forward to your comments, critiques, and participation.

The following statement describes a number of issues that we, the Executive Board, wish to raise at the next annual AUTOPP meeting, to be held in conjunction with the AADR in Chicago, March 7-10.

It is clear that AUTOPP can have productive annual meetings with an enjoyable social hour and an informative educational program. However, we believe that AUTOPP needs to do more, simply because (1) there are multiple levels of incredible educational need concerned with pain management, and (2) we would appear, by our common interests and zeal for our work in the pain area, to represent those individuals who are capable of enacting any form of progressive change.

The Third Educational Conference was co-sponsored by AAOP. Members of that organization largely determined the content of the Conference. Aside from the meeting goals as initially outlined, there was immense interest in obtaining specialty recognition for TMD/OFP. While speciality recognition is an important milestone for this field, the apparent lack of congruence between AAOP and AUTOPP members was obvious to many at the Conference. With AAOP taking a major role at that conference and AUTOPP taking a rather minor role, there was some discussion at the AUTOPP business meeting regarding the actual direction and goals of AUTOPP. It appears that no one at the business meeting voiced a desire to quit AUTOPP or to abandon its major goals. Moreover, seven new members were admitted.

We believe that it is time to shift the emphasis in education from "TMD" to orofacial pain as the major focus, with TMD to be considered as just one type of orofacial pain. From that perspective, we believe that the primary focus of AUTOPP should be on further refinement of educational guidelines for dissemination and adoption by every dental school for the teaching of pain and its associated issues. We also believe in the sharing of teaching resources among members so that any educational guidelines can be translated to the forum where they have the potential to actually have an impact: in the classroom.

While the conceptual and research evidence for a dual-axis approach is very strong and continues to become even stronger, it is striking that, in general, a dual-axis approach remains largely a peripheral issue at most schools and at all levels of training. At the pre-doc level, the teaching is dominated by making a physical diagnosis or how to fabricating a splint. At the post-grad level, a surprisingly small amount of time is available for teaching concepts of modern pain management. And at the specialty level, medication management seems to increasingly dominate the teaching and all aspects of the problems that patients might present with.

In the absence of students learning a conceptual model that links nociception to pain experience and its associated behaviors as viewed by a dual-axis approach, we suggest that the teaching of "procedures" should represent a small part of student training. Procedural training, alone, may not be in the best long-term interest of either the training of the student or for the patient receiving the treatment. Based on the present authors' experiences at our respective institutions, we not only recognize the limitations in faculty resources and acknowledge the difficulty in faculty development, but also note that the knowledge base of the typical dentist or post-grad specialist for managing orofacial pain continues to be inadequate. Can we do anything about this?

While the primary goal for AUTOPP is clearly education, a secondary goal for AUTOPP was originally proposed in our bylaws as research activity. Although AUTOPP could act as a facilitating organization for collaborative clinical research, such research requires significant resources for training of reliable examiners, standardizing implementation of treatment protocols, and for data management. Some years ago, there was a committee appointed to address the development of a consistent clinical database across member clinics, but no outcome was ever reported from that committee. Certainly if there is at present a strong interest by any AUTOPP members to push forward with this issue, the field would likely benefit greatly, and it would certainly serve as a research base for funded collaborative research. However, if AUTOPP were to be productive only in promoting educational concerns, that would constitute in our mind a sufficient outcome for this organization, at this time.

A topic with much aplomb and currency these days is Evidence-Based Medicine (e.g., the Cochrane collaboration). We suggest that EBM represents a language within which we could describe the collective research and scholarly activities of this membership for a long time. Also, that language may be, because of its contemporary high visibility and valuation by parties at many levels, a mechanism for uniting (1) the teaching of pain (and its treatment), (2) the use of clinical research information according to EBM criteria, and (3) the incorporation of educational standards relevant to pain at the curricular level. Briefly, EBM is a natural matrix within which to organize our views toward educational and training standards, and to facilitate their adoption by the dental schools.

In summary, the development and implementation of a pain management program as a major focus is critically needed in dental schools. Several issues must be addressed. Do the dental schools have instructors competent in teaching this pain information? Do the schools have competent researchers interested in pain research? The introduction and implementation of EBM would require significant curricular change because dental schools are typically "procedure-oriented". Moreover, this orientation is restricted by the ADA Guidelines on Accreditation and Professionalism. Clearly, we in the pain community within the dental profession need each other, and we need what collaborative efforts can provide. Collectively, the sum is greater than the parts; we all know that based on what we can see of the accomplishments from other organizations. The present Executive Board invites the membership to consider what area or areas of participation each member could make a contribution to these goals. We look forward to your input between now and the March 7th meeting.

We ask the membership to consider these issues at this time, and to correspond with us regarding your views. Your responses can be sent to the current president, Richard Ohrbach, who will forward them to the other Executive Board members.

There are probably many other potential members around the world. Certainly, to propose such a membership goal is not to suggest that this endorsement implies the goal of developing international standards for education. This matter is clearly determined by many factors beyond just education. And yet, we in educational settings struggle with the same problems, regardless of setting. The second proposal is admitting members who are part-time salaried faculty who teach TMD/OFP, but who are not adjunct or visiting faculty. There are many in our field who are actively involved with the education of pre-doctoral, post-grad, and specialty students, but who are not full-time faculty; we propose inclusiveness.

Should we (1) actively solicit membership from our international colleagues, and if so, does the annual AUTOPP meeting shift in venue from the AADR meetings to the IADR meetings? And (2), should we open the membership to appropriate part-time clinical faculty?

The current Executive Board approves this proposal to be the new standard (and the bylaws will need to be modified). The rationale is as follows: The immediate post-meeting newsletter would provide a summary of the education/scientific session and list the plans for the coming year as discussed at the business meeting. The fall newsletter (October timeframe) would provide brief progress reports, and describe the plans for the next education/scientific session. The winter newsletter (February timeframe) would present the final program and the agenda for the next business meeting. To summarize, under this proposal, newsletters would be sent out by June 1, by October 15, and by 4-6 weeks prior to the actual date of the AADR meeting (which is in either March or April).

Would the membership find three newsletters, at specified time-frames and with stated goals for content, useful?

(1) Two prior AUTOPP-sponsored workshops generated educational materials for the field. The First Conference focused on Educational Standards, while the Second focused on educational methodologies. The Standards (as published in the Journal of Dental Education) were about to be adopted by the accreditation body for US/Canada dental schools (American Association of Dental Schools). The AADS instead just at that time abandoned its role in accreditation, shifting the responsibility to each school for determining its own standards. As we all know, such an approach typically leads to a vicious cycle of, at best, maintaining a status quo.

We propose that AUTOPP resurrect the prior conference reports, revise them as needed to reflect current evidence or the teaching situation, and begin to implement them via the current membership. As part of that process, we advocate that the Deans of all US and Canadian dental schools receive a copy of our recommended guidelines for consideration in the allocation of teaching resources and in the implementation of standards for competency prior to graduation. That is, each school must individually adopt them. We wonder if Part II of the US National Dental Boards would also need updating?

We feel that this approach is possible because it is the right thing to do. No other approach seems justifiable in light of the numbers of senseless and often harmful treatments that continue to be provided, by not only remotely-graduated but also recently-graduated practitioners, to people with facial pain disorders.

Is the membership interested in resurrecting those goals and following a pathway towards their general implentation?

(2) The Institute of Medicine recently published some guidelines for dental education, and it has been suggested that we consider a review of that document for possible adoption of some of the guidelines as perhaps one way to improve the professional education of the general and specialist dentist. We note that this suggestion was not uniformly embraced by the Executive Board for a variety of reasons. On the surface, using the report would seem to be a useful way to embed our activities within a larger view of dental education.

Is anyone sufficiently knowledgeable about this report and its relevance to actual dental education to make concrete recommendations regarding its utility for our organization?

(3) A group within the AAOP has been very active in developing the TMD/OFP specialty education guidelines, as part of the AAOP's important application for specialty recognition by the ADA. The prior educational conferences sponsored by AUTOPP clearly included the specialty training level as part of AUTOPP's mission. However, for reasons related to specialty application the AAOP has moved strongly forward with the development of specialty training standards.

The Executive Board's view about this is the following: (a) There is plenty within AUTOPP to engage in already in terms of the other educational needs, so the AAOP's activity in further development of specialty training program guidelines can represent good collaborative effort of the two organizations, and (b) in the meantime, the specialty TMD/OFP training programs who belong to AUTOPP should continue to develop according to their best understanding of what constitutes reasonable training standards, using a self-evaluation process.

What is the membership's view about the potential separation of the educational standards by the two organizations? And how should the AUTOPP member training programs deal with differences in program implementation given that the process is inherently at present a bootstrap one?

The first website for AUTOPP was created last year by Octavia Plesh, following some ideas that Jean-Paul Goulet had previously proposed. That initial website brought us to the question of what we actually wanted to do once we had a site, and, of course, many possibilities emerged but all necessitated revising the site. Expanding and improving the site entailed some other challenges, not the least of which was the skill in actually developing and maintaining a more complex site. The decision to obtain our own URL was made for two reasons: with our own URL, your link remains intact even though the server can be located anywhere in the world, and having a URL of one's own has become a clear rite of passage for organizations! Scott McCall, at the University at Buffalo, graciously accepted a request by the current president to be the first official Web-master, and the School of Dental Medicine at the University at Buffalo has offered us essentially unlimited server space. Scott will remain the webmaster until either he decides to resign or there is a move by the membership for such change; it would also appear that the organizational bylaws may need to be revised in order to formally include this role. The annual cost of the registration for the URL is about the same as postage for one edition of the newsletter if the newsletter were sent via surface mail to all members. With most members now receiving an electronic version, the organization saves considerable money by using an electronic forum, which is very important given our low dues and, hence, small budget. We can save even more money if any member without an e-mail address on record can provide one; we will, of course, continue to accommodate those members without email addresses in terms of mailing the newsletter. We anticipate that more of our communication will increasingly occur via the website.

In the Proposed Goals, we list the initial aims for the website. Obviously, these are ambitious goals, but with participation by other members within subcommittees or on an ad hoc basis, we believe that each of these goals can be readily accomplished. At this stage, we seek member input regarding the final content of the site: Are these suggested inclusions useful and important to you in your academic work? The intent of the website is to be not only a vehicle for newsletter type information but, moreover, a resource for our educational and training activities. We also want to know about member availability and interest in contributing to any part of it.

1. The current newsletter
2. Program for the next education/scientific session
3. Standards for education and training at the pre-doc and post-grad levels; this area of the site could include standards developed by other bodies such as those from Ontario (deemed excellent) and those from the ADA (deemed not so useful, but important by way of contrast). The standards for specialty training, developed by AAOP, could also be available here (with AAOP's approval), or a link could be provided.
4. Case library (see below)
5. Education page about TMD/OFP and important pain-links for the public
6. Listing and description of member undergraduate TMD/OFP education programs
7. Listing and description of member specialty TMD/OFP training programs
8. Listing of member university-based treatment clinics
9. Listing and description of member research programs and opportunities for research training
10. Membership guidelines, application form, and bylaws
11. Archival copies of past newsletters in order to develop an organizational memory
12. Archival listing of past education/scientific sessions

Overall, what content does the membership endorse for the website?

Does the membership agree that our web site should be educational for the general public? And, is anyone interested in developing such an area on the web site?

Does the membership endorse a referral pathway for research studies? Does the membership endorse a secondary goal for AUTOPP to facilitate clinical research across member sites?

We propose the following procedures for developing a case library: Determine formatting and style that would provide useful information, and provide a blank template for case submission through the web site. A decision is necessary regarding whether the content must include diagnoses, imaging, and outcomes; obviously, these create more work at the submission stage, but make the cases infinitely more useful. In order to ensure that the coverage is sufficiently broad, a taxonomy for case organization is needed; we suggest that the RDC dual axis approach in conjunction with the AAOP biomedical diagnoses be used. For example, cases are needed for the more uncommon muscle disorders and for the complicated arthritic problems, as well as for those cases with pain complaints dominated by biobehavioral findings. At the outset, we would determine some numbers for how many cases of each type would seem useful. Finally, a Case Librarian would need to be appointed each year to monitor and edit the submissions. In order to enhance participation, access to the cases would be restricted to those who had completed a submission. Even though this did not work for Glenn Clark's attempt, we hope that the immediacy of the web will enhance motivation. Our goal would be one case from each member. Clearly, this project needs a subcommittee to achieve the present goals.

Is the membership interested in developing a case library? And, should access be limited to those who make a contribution?