Monday, December 15, 2014

The Teacher’s Toolkit

In his book “Essential Skills for a Medical Teacher,” (1) Professor Ron Harden discusses what he terms the “teacher’s toolkit.” He likens it to the tools a carpenter has- a set of tools which together help to construct a structure, all of which are necessary but are used for different purposes. Hew views a teacher in similar fashion. The teacher also needs many tools. Among those tools, Harden lists:

Presentation tool:  This would be something like PowerPoint, used to help present content to students.
An audience response system: At Palmer, we have clickers, which are linked to the computer system, but you could equally use nothing more than a set of colored cards, as they do at the McMaster University evidence-based training program.

Simulated patients or simulators: to stand in for real patients during learning exercises.
Video clips: to use to demonstrate concepts and content.

Podcasts: for students to engage with learning at a later time.
Online information sources: we should all be providing this to our students.

Networking tools: can we figure out how to adapt social media platforms to educational purposes.
Peer-to-peer teaching opportunities: so students can support each other.

The point here is simply to note that we have many tools available to use, and we should both use them and use them in ways that optimize learning.
Let me take this opportunity to wish you a very happy holiday season and a great new year. I’ll be back in January, but hope that you are able to enjoy your time away and come back refreshed.

1.       Harden RM, Laidlaw JM. Essential skills for a medical teacher. New York, NY; Churchill Livingstone, 2014

Monday, December 8, 2014

Therapeutic Misconception

Much of the research that is conducted by teaching and clinical faculty at palmer as opposed to that done by our research faculty, is conducted in classroom settings and most often involves either survey research or the use of interview or focus groups. In the former case, where a survey is administered to a class (either on paper or using a tool such as SurveyMonkey), that research is typically exempt from consideration by the IRB because it is is low risk and has little danger for the participant. And when that happens, we often do not collect an explicit consent form from the student participant. His or her consent is implied by simply completing the survey; obviously, they consented if they did go and fill out the survey form.

But in clinical settings, such as the PCCR, consent is critically important. Informed consent documents (ICDs) need to be prepare for each study, and they are complex and complicated instruments. For example, there are 13 elements that must be included in an ICD. It has to be written at an appropriate level (which is usually 8th-grade reading level), and the patient must not be coerced into signing. It can take a great deal of time and energy to prepare ICDs and there is now a growing body of evidence about how well they relay important information to research participants.
But there is a real challenge here as well. So much research occurs in clinical settings. And this blurs the line between what a physician would if allowed to simply treat a patient and what a physician or research is allowed to do if that same patient is a participant in a research project. In the former case, a doctor would do whatever he or she felt was in the patient’s best interests- vary treatment, frequency of visits, etc. But when there is a research protocol, that same doctor cannot vary from it. However, patients, despite being given an ICD which explains this to them, often misunderstand this.  They believe that everything being done to them and for them when they are in research is done because ti si the best thing for them. This is not the case in research.  Studies have shown that when asked, they will tell you that they are getting the best treatment, even when assigned to a placebo group or to a no-treatment group.  This is how Lidz and Appelbaum describe it: “The therapeutic misconception occurs when a research subject fails to appreciate the distinction between the imperatives of clinical research and of ordinary treatment, and therefore inaccurately attributes therapeutic intent to research procedures. The therapeutic misconception is a serious problem for informed consent in clinical research.” (1)

I am always on the look-out for this when new research is planned. Please read more on this to avoid such problems if ever you do research involving patients.

1.       Lidz CW, Appelbaum PS. The therapeutic misconception: problems and solutions. Med Care 2002;40(9Suppl):V55-63

Monday, December 1, 2014

National Collaborating Centre for Methods and Tools

I would like to draw your attention to the National Collaborating Centre for Methods and Tools website ( it is one of several Canadian centers involved in sharing what works in public health. It is based on using evidence to inform the practice of public health and the website provides many tools to assist a healthcare practitioner in doing so. According to their website, their goals are:

·         To develop the organizational capacity and individual skills of those involved in public health to share what works in public health.

·         To identify, develop and evaluate relevant methods and tools for knowledge translation; and to make those methods and tools accessible to people involved in practice, program decision-making, policy-making and research.

·         To identify gaps in methods and tools for sharing what works in public health and to encourage researchers and others to fill these gaps.

·         To build active and sustainable networks that enable practitioners, program decision-makers, knowledge experts, policy-makers and researchers to share what works in public health; and to strengthen partnerships and links with other NCCs and their target audiences.

As you visit each web page on the site, you will find links to a registry of methods and tools used for knowledge translation (that is, from finding evidence, to using it on behalf of a patient). At present there are 188 links on the registry, and it provides a wealth of resources for your use. 
Even better is the page on the Learning Centre ( On this page you will find links to many free online educational modules. For example, one module is “Introduction to Evidence-Informed Decision Making,” another is “Quantitative Research designs,” and so on. These are not little module; most will take at least 3 hours to complete, and some will take longer, but they are great training programs.

As we return from Thanksgiving break, this would be a good way to have a refresher about evidence-based practice. I strongly recommend you bookmark this site.

Monday, November 24, 2014

Thanksgiving. Thank You.!

On this occasion of a short week and a time to celebrate thanks, I send mine to you. I am grateful to all who work here, who give so much of their time and their energy. I hope that you enjoy the time off later this week, I hope you are with family (as I will be- 3 children coming, with 3 spouses, 1 grandchild and 1 twin sister to a spouse), and I hope that you are able to eat, relax and catch your breath.

Happy Thanksgiving!

Monday, November 17, 2014

Three New Papers

Rowher A, Schoonees A, Young T. Methods used and lessons learnt in conducting document reviews of medical and allied health curricula - a key step in curriculum evaluation. BMC Medical Education 2014, 14:236  doi:10.1186/1472-6920-14-236

Background: This paper describes the process, our experience and the lessons learnt in doing document reviews of health science curricula. Since we could not find relevant literature to guide us on how to approach these reviews, we feel that sharing our experience would benefit researchers embarking on similar projects.
Methods: We followed a rigorous, transparent, pre-specified approach that included the preparation of a protocol, a pre-piloted data extraction form and coding schedule. Data were extracted, analysed and synthesised. Quality checks were included at all stages of the process.
Results: The main lessons we learnt related to time and project management, continuous quality assurance, selecting the software that meets the needs of the project, involving experts as needed and disseminating the findings to relevant stakeholders.

Conclusion: A complete curriculum evaluation comprises, apart from a document review, interviews with students and lecturers to assess the learnt and taught curricula respectively. Rigorous methods must be used to ensure an objective assessment.

Jones MR, West DJ, Harrington BJ, Cook CJ, Bracken RM, Shearer DA, Kilduff L. Match play performance characteristics that predict post-match creatine kinase responses in professional rugby union players. BMC Sports Science, Medicine and Rehabilitation 2014, 6:38  doi:10.1186/2052-1847-6-38
Background: Rugby union players can take several days to fully recover from competition. Muscle damage induced during the match has a major role in player recovery; however the specific characteristics of match play that predict post-match muscle damage remains unclear. We examined the relationships between a marker of muscle damage and performance characteristics associated with physical contacts and high-speed movement in professional rugby union players.

Methods: Twenty-eight professional rugby union players (15 forwards, 13 backs) participated in this study. Data were obtained from 4 European Cup games, with blood samples collected 2?h pre, and 16 and 40?h post-match, and were subsequently analysed for creatine kinase (CK). Relationships between changes in CK concentrations and number of physical contacts and high-speed running markers, derived from performance analysis and global positioning system (GPS) data, were assessed.
Results: Moderate and moderate-large effect-size correlations were identified between contact statistics from performance analysis and changes in CK at 16 and 40?h post-match in forwards and backs, respectively (e.g. backs; total impacts vs. ?CK (r?=?0.638, p?

Conclusions: Our data demonstrate that muscle damage induced by professional rugby union match play is to some extent predicted by the number of physical contacts induced during performance. Furthermore, we show for the first time that muscle damage in backs players is predicted by high-speed running measures derived from GPS. These data increase the understanding of the causes of muscle damage in rugby union; performance markers could potentially be used to tailor individual recovery strategies and subsequent training following rugby union competition.

Young KJ. Gimme that old time religion: the influence of the healthcare belief system of chiropractic’s early leaders on the development of x-ray imaging in the profession.School of Arts; Senior Lecturer, School of Health Professions, Murdoch University, South Street, Murdoch 6150, Australia  Chiropr ManTher 2014, 22:36  doi:10.1186/s12998-014-0036-5

Background: Chiropractic technique systems have been historically documented to advocate overutilization of radiography. Various rationales for this have been explored in the literature. However, little consideration has been given to the possibility that the healthcare belief system of prominent early chiropractors may have influenced the use of the diagnostic modality through the years. The original rationale was the visualisation of chiropractic subluxations, defined as bones slightly out of place, pressing on nerves, and ultimately causing disease. This paradigm of radiography has survived in parts of the chiropractic profession, despite lacking evidence of clinical validity. The purpose of this paper is to compare the characteristics of the chiropractic technique systems that have utilised radiography for subluxation detection with the characteristics of religion, and to discover potential historical links that may have facilitated the development of those characteristics.

Discussion: Twenty-three currently or previously existing technique systems requiring radiography for subluxation analysis were found using a search of the internet, books and consultation with experts. Evidence of religiosity from the early founders’ writings was compared with textbooks, published papers, and websites of subsequently developed systems. Six criteria denoting religious thinking were developed using definitions from various sources. They are: supernatural concepts, claims of supremacy, rules and rituals, sacred artefacts, sacred stories, and special language. All of these were found to a greater or lesser degree in the publicly available documents of all the subluxation-based chiropractic x-ray systems.
Summary: The founders and early pioneers of chiropractic did not benefit from the current understanding of science and research, and therefore substituted deductive and inductive reasoning to arrive at conclusions about health and disease in the human body. Some of this thinking and rationalisation demonstrably followed a religion-like pattern, including BJ Palmer’s use of radiography. Although access to scientific methods and research education became much advanced and more accessible during the past few decades, the publicly available documents of technique systems that used radiography for chiropractic subluxation detection examined in this paper employed a historically derived paradigm for radiography that displayed characteristics in common with religion.


Monday, November 10, 2014


This will be a brief but an important post. You may have heard of Coursera. It is an education platform that “partners with top universities and organizations worldwide to offer courses online for anyone to take, for free.” And this is no small thing. Just to give you an idea of their power, I want to draw your attention to a program that was brought to my attention by my friend and colleague, Dr. Stephen Perle, of the University of Bridgeport College of Chiropractic. The specific course he told me about is entitled “Instructional Methods in Health Professions Education.”  It will be offered 4 times in the next year, with the next session beginning in February of 2015.

A link to information about this course can be found at On this page, you can view an introductory video, look at the course objectives, and view the week-by-week format. It is free.
Please look this over and consider taking a course!

Monday, November 3, 2014

World Federation Educational Conference, Miami, October 30-November 1, 2014

I am just back from a program where I was fortunate enough to be a member of the planning committee. This was a program put on by the World Federation of Chiropractic, dedicated to looking at the educational advances and opportunities within the chiropractic profession. What follows below is the full list of presentations.

  • A Case Example of Change: Chiropractic Education and Practice in Denmark.
  • Ten-Year Experience of Chiropractic Services and Education in the US Veterans’ Administration Healthcare System.
  • Integration of Chiropractic Services in Primary Care Teams and Hospitals in the Province of Ontario, Canada.
  • Teaching an Inter-professional Approach to Managing Low Back Pain in the Primary Care Setting.
  • Chiropractors in Academic Hospitals: Opportunities for Integrated Education.
  • Interdisciplinary Clinical Training in a Chiropractic College Setting: Dental and Chiropractic Co-management of Temporomandibular Joint Disorders (TMD).
  • Inter-professional Education Initiatives to Improve Pain Care: the VA Connecticut Healthcare System Experience.
  • Interdisciplinary Clinical Education: Midwifery and Chiropractic Students’ Perceptions of Combined Service in a Chiropractic Teaching clinic in the UK.
  • Healthcare Professional Education and Chiropractic.
  • Establishing Interdisciplinary Practice in Two Challenging Environments: A View from the Field.
  • Incorporating Inter-professional Education (IPE) in a Curriculum – Benefits, Methods, Challenges.
  • Preparing Faculty and Students for Integrated Care – Values and Skills.
  • Creating a Climate for Innovation.
  • Scope of Diagnostic Imaging/Laboratory/Other Exams.
  • SMT Remains the Core – But What Other Manual Treatments?
  • McKenzie Method: Given its Evidence Base it Should be Core Curriculum.
  • The Role of Chiroprctic in Wellness and Lifestyle Assessment and Advice.
  • The Significance of Evidence-Based Care for Education and Practice Today.
  • The Rise and Role of Spinal Care Pathways.
  • The Jordan Hospital Spine Care Program.
  • Outcomes Chosen for CareResponse and Reasons Why.
  • EHR as the New Standard of Care: Empowering Outcomes, Evidence and Research.
  • The Masters and Doctors Degree Programmes in Chiropractic Medicine at the University of Zurich Faculty of Medicine: An Example of Interdisciplinary Education.
  • The Place of Anatomy Education in Inter-professional Health Curricula: An Example from Australia and New Zealand.
  • A Descriptive Study Relating the Experience of Radiographic Film Interpretation by Graduating Interns: Preliminary Results.
  • Faculty Development Increases Attitudes and Use of Evidence-Based Clinical Practice.
  • A Study to Describe Process of Introducing Validated Outcome Measures (CareResponse) as Part of Final Year Clinic Training and Management of Patients at the Welsh Institute of Chiropractic.
  • An Innovative Teaching Strategy Used to Address the Role of Chiropractors As Community Health Care Advocates: A Case Report .
  • Creating an Evidence-Based Teaching Program.
  • Establishing Inter-Professional Clinical Training Opportunities.
  • Alternate Career Paths – Research and Education.
  • Effective Use of the OSCE in Current Health Sciences Education.
  • Clinical Skills Testing for Chiropractic Licensure in a Changing Healthcare Environment: Signposts of Change and Navigating the Transition.
  • Accreditation Standards: Do they Require Amendment in the Changing Healthcare Environment: A North American View.
  • Accreditation Standards: Do they Require Amendment in the Changing Healthcare Environment: A European View.
  • Teaching Anatomy at Two New York City Medical Schools.
  • Serving as a Medical Director for Chiropractic for the Washington State Department of Labor and Industries.
  • For the NIH to PCORI and Lessons Learned.
  • The Canadian Experience.
  • The Role of a Chiropractic Researcher at Palladian Health.
  • Environment for Innovation: Exploring Associations with Individual Disposition Toward Change, Organizational Conflict, Justice and Trust.
  • Preparing the Leaders of Tomorrow – The Evolution of the Residency Program at the Canadian Memorial Chiropractic College.
  • Alternative Careers for Doctors of Chiropractic through a Master of Science Program in Clinical Research.
  • A Chiroprctic Academy of Educators.
  • Insertion of Chiropractic in Public Health System.
  • The “Flipped Classroom”.
  • What the Best College Teachers and Students Do.
  • Perspectives from Chiropractic Education.