Monday, July 28, 2008

New Technologies in Chiropractic Education

Let me give a confession. I do not always understand some of this newfangled technology. I watch my children using myspace and facebook and fail to see the appeal of these social networking sites. And indeed, it took me some time to build up the courage to develop this blog page, which is hosted by blogger, and which requires at least a modicum of technological expertise to use. But not all that long ago I had a bit of an epiphany, this time directed by, again, one of my children. My son Noah is a high-school teacher at Hinsdale Central High School, in Hinsdale, IL. We were talking about new technology when I made my standard rant about myspace- what good was it outside of marketing your band or looking like you had lots of friends? Noah first described how the political candidates were using myspace to maintain friend lists, in order to get the word out. And then he described how he used it to provide a means of communication to his students, and to their parents. And it all sort of clicked. That’s when I began to consider far more seriously how one might use web technology for educational purposes.

From that, I looked at various blog hosts, such as blogger (, livejournal (, wordpress (, TypePad (, and others. I played with each one and decided I would develop my page on blogger, mainly due to ease of use and what I felt were interesting design elements. This site is the result of my investigation, and I hope that people find it easy to use, informative and friendly. It is one way to provide faculty with information about educationally-related topics, and to allow for communication at the same time. But you might also consider developing blogs for the courses you teach, using the blog to post additional information for your students, and to foster their involvement in your discipline.

Beyond a blog site, you can consider developing podcasts. These do take more time, since you need to record your podcast, and this means developing scripts and planning words out. But this could be one way to provide students with additional information beyond that which you present in lecture format. This link will take you to apple’s site for podcasting: (Disclosure: I am a Mac fanatic... but this is being written on a Windows computer, and what you do is pretty much the same).

Then there is a site like ( This is a social bookmarking site, where you can gather a set of bookmarks which you share with other people. You can allow only students from a particular class to the url for that class; you can set different sites for different classes. Thus, you can provide a set of links for your students to use without the need to clutter up your personal website. Other social bookmarking sites include digg (, reddit ( and newsvine ( The latter also allows you to collect news article links to share.

This is but the tip of a growing iceberg, and one that most of us are only marginally familiar with. But sites such as these have the potential to transform education. We would do well to pay attention and figure out effective uses of these new technological developments.

Thursday, July 17, 2008


This is not an education-related post, but more for fun. RAGBRAI, the Register's Annual Great Bicycle Ride Across Iowa, is the nation's oldest and largest cross-state ride. I, along with a few other faculty, students and administrators from Palmer, will be joining 12,000 of our closest friends and riding bicycles from the western side of Iowa to the eastern shore. In fact, this year the ride ends in LeClaire, bring us back home after nearly 500 miles of bike riding.

RAGBRAI actually can be used to illustrate how a great idea can spread. This year will be, I believe, the 36th annual ride. There will be 10,000 riders registered for the complete 7-day ride, and an additional 2,000 riders per day who purchase day ride permits. And there are another 15,000 support personnel (truck drivers to transport gear, friends and family and others) who will move from overnight stop to overnight stop each day. As this mass of humanity rides acorss Iowa, they stop in small communities who over the course of an entire year will not see 25,000 people; thus, RAGBRAI is also an economic engine for these small towns. When it started, RAGBRAI had 36 riders in its first year; this grew over the years until the organizers capped the rider level at 10,000 full-time riders, plus day riders. So, in 36 years, it went from less than 50 participants, to 25,000.

And it is not a ride for the buff and fit; RAGBRAI attracts people of all ages and all sizes. I have been passed by a 76-year-old man riding a old fixed single-gear bicycle (with a sign on the back that read "Gears are for wimps"), by 8-year-olds and by grandmothers. I have seen 300-pound women riding mountain bikes with knobby tires for the entire trip, as well as seeing Lance Armstrong (who went by me so fast I thought my bike had stopped). I've ridden alongside the Reverand Robert Molsberry as he rode his hand-cranked bicycle on yet another RAGBRAI; Reverand Molsberry was paralyzed some years ago but refused to let that stop him riding. He even wrote a book about it, "Tour de Faith," which I highly recommend as a great description of the ride. In one of those bits of serendipity, I found out my son had coached his daughter during my son's stint as a student teacher at Grinnell High School. Small world!

It is in general a bit of an older crowd, but it is one that develops great friendships along the way. We will see the riders wearing cow costumes, the ones pulling huge speaker systems powererd by the sun behind them, the fellow who puts a large brick on his bike, and lots of people who otherwise would not be caught dead in skin-tight clothing wearing spandex. I am one of them. And we will eat lots of pie. In fact, the best proof of that was a cartoon in the Des Moines Register, which showed one bike rider talking to another: "How's the training going for RAGBRAI?" and the other answering "Great. I'm up to 4 pieces of pie per day." It's truth!

So I won't be posting until I return, which by that time I might even be able to sit down again. For some reason, we get asked a lot about how our butts are doing when we ride RAGBRAI... :-)

Tuesday, July 15, 2008

Ken Bain- Another Best Teacher

Yesterday at the faculty in-service we were fortunate to have nearly 3 hours with Dr. Ken Bain, who has passionately attempted to understand the qualities of those deemed best teachers. I found the presentation thought-provoking and informative, and I kept coming up with new ideas for my own classes as I participated in this one. And I note that Dr. Bain did so without relying on the use of slides or fancy technology (outside of the fact that this was a video-conference, of course); instead, he taught by asking question, rephrasing answers, and prodding the audience. Well done! So this morning I decided to look at some of his web resources. I am glad I did. I found a link to Montclaire College’s “Course Analysis Project,” which provides a list of questions an instructor can use to examine a course he or she teaches. These questions can help define your course intellectually. The full Analysis Project can be found at, and these questions come directly from that web site, for proper attribution. There are also questions about assessment and evaluation, and each question has a set of explanations to help you understand the goal of that question. We can all use these questions to help develop, revise and improve our courses.

1. What big questions will your course help students answer? Or what abilities (or qualities) will it help students develop?
2. What reasoning abilities must students have or develop to answer these questions?
3. What information will your students need to answer these questions? How will they obtain that information?
4. What paradigms of reality are students likely to bring with them that I will want them to challenge?
5. How will you help students who have difficulty understanding the questions and using evidence and reason to answer them? What questions will you ask them to focus their attention on significant issues, or to clarify concepts, or to highlight assumptions that they are likely to ignore? What writing will you ask them to do that will help them grapple with these matters?
6. How will you confront them with conflicting claims and encourage them to grapple (e. g., collaboratively) with the issues?
7. How will you find out what they expect from the course? How will you reconcile any differences between your plans and their interests?
8. How will you help students learn to learn, to examine and assess their own learning and thinking, and to read more effectively, analytically, and actively?
9. How will you find out how students are learning before you test them for a grade? How will you provide feedback before and separate from any grading of the student?
10. How will you communicate with students in a way that will keep them thinking?

Thursday, July 10, 2008

Number Needed to Treat

The Number Needed to Treat (NNT) is defined as “the number of patients who need to be treated during a specific period to achieve 1 additional good outcome.” (1) Conversely, it can also be considered to be the number of patients who need to be treated to prevent 1 additional bad outcome. The NNT is actually a measure that can help a reader of a scientific article understand whether a piece of research has practical value. And it arises in part because, while the practical interpretation of scientific research is complex, the move toward evidence-based medicine requires physicians and others to be able to interpret what they read, and journal editors and researchers understand this.

One change we are seeing is that one cannot ignore the size of an effect and focus only on statistical significance. (2) This is why we are seeing greater and greater use of confidence intervals (CI) rather than p values, because the CI provides information about both size and significance. The other change we are seeing is a move toward understanding that absolute changes in risk are more important than relative changes in risk. Bear with me here.

In the reference I cite for this entry (reference #2), Simon notes that he was told that snoring increases the risk of a stroke by 3-fold if left untreated. But, he asks not unreasonably, what was the risk before he knew that, given he is 42, in good health and has no other risk factors? Three times nothing is still nothing; 3 times some very small risk is still very small. Does he need to therefore have treatment?

Better would be some measure of absolute risk (noting that above, that 3-fold increase was a relative risk increase). And this is where number needed to treat comes in. The NNT is the average number of patients a doctor would have to treat to have 1 additional event occur. Here are a couple of examples: for prevention of stroke by taking low-dose aspirin daily, the NNT is 102; for preventing infection following a dog bite by administering antibiotics, the NNT is 16 (or, for every 16 dog bites treated with antibiotics, you would see one fewer infection on average). A perfect NNT would be 1, which is often seen in areas such as orthopedic surgery (ie, for every broken radius treated by surgery, you see 1 less broken radius- which makes perfect sense).

The NNT is calculated from a 2x2 contingency table, and is 1/(absolute risk reduction). As an example, say that among patients treated with detuned ultrasound (a placebo intervention), 17.9% of them later suffered chronic back pain, while in the group that received spinal manipulation only 1.3% later suffered chronic back pain. This is an absolute risk difference of 16.6% (17.9%-1.3%). Doing the math here shows that we have an NNT of 6, so for every 6 people who get the SMT, you will see 1 less case of chronic pain.

This is just a brief introduction to a complex and interesting measure, one that has a great deal of significance when you begin to calculate in costs of treatment, rarity of disease, and a host of other factors.

1. Guyatt G, Rennie D, Meade MO, Cook DJ. Users’ guides to the medical literature: a manual for evidence-based practice. New York, NY; McGraw Hill, 2008; p.793

2. Simon S. Number needed to treat., accessed July 10, 2008