Monday, April 27, 2009

Teaching Scholar Programs

Over the course of the past 20 years, there has been growing acknowledgement that there is a significant need to provide faculty development which enhances the teaching skills and scholarship of the medical education community. This is certainly equally true within the chiropractic profession but far less research exists which specifically is addressed to the needs of the chiropractic academic community. As noted by Rosenbaum et al (1), a number of challenges exist in providing opportunities for faculty to obtain training in teaching skills. These include the need for there to be someone with faculty development expertise to lead such a program, lack of locally-based advanced educational training programs, interest solely coming from highly motivated educators and lack of departmental members who can assist or take on such training opportunities. They conclude that institutions need to seek ways to expand resources available for training. They recommend increasing the number of faculty with advanced expertise in education, and to use peers to offer training once they have gained that expertise.

Few programs have been reported in the medical literature with the specific purpose of helping faculty develop expertise in providing teaching skills to their peers. Most follow train-the-trainer models (2). As part of Palmer’s R25 grant award, we are using a train-the-trainer model for implementing enhanced use of evidence-based methods in the classroom setting. We are working with a small number of faculty interested in the use of EBP; those individuals will then be give opportunity to provide training to their peers.

But it is important to note that most faculty development program still focus on developing participant skills for their own teaching. The goal of the program in development is to combine teaching effectiveness training with leadership skills so that we develop a cohort of teachers with enhanced personal skills who can then transmit them to their peers. This is already being done with the Excellence in Teaching program coordinated in part by Rita Nafziger of the Davenport campus through the Quad City Professional Development Network. Priority in this program is being given to faculty in their probationary period (new and recent hires), for those whom specific improvement plans may be in place and others as space and interest allows. This set of courses will provide foundational information on teaching and learning. The Teaching Scholar Program is designed to provide skills more directed at the higher level components of health care education as opposed to general education theory and methodologies, and thus will serve as a means of providing advanced teacher training beyond the probationary period.

Future blog posts will provide information on similar programs at other health care institutions.


1. Rosenbaum ME, Lenoch S, Ferguson KJ. Outcomes of a Teaching Scholars Program to promote leadership in faculty development. Teach Learn Med 2005;17:247-253
2. Steinert Y. Faculty development in the new millennium: key challenges and future directions. Med Teacher 2000;22:44-50

Monday, April 20, 2009

A Few New Articles of Note

These are three new articles I came across while reading journals on the Biomed Central websaite.

1. Connick RM, Connick P, Klotsas AE, Tsagkaraki PA, Gkrania-Klotsas E. Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades. BMC Med Educ 2009, 9:2doi:10.1186/1472-6920-9-2. (

Background: Medical doctors routinely undertake a number of practical procedures and these should be performed competently. The UK Postgraduate Medical Education and Training Board (PMETB) curriculum lists the procedures trainees should be competent in. We aimed to describe medical practitioner's confidence in their procedural skills, and to define which practical procedures are important in current medical practice.
Methods: A cross sectional observational study was performed measuring procedural confidence in 181 hospital practitioners at all grades from 2 centres in East Anglia, England.
Results: Both trainees and consultants provide significant service provision. SpR level doctors perform the widest range and the highest median number of procedures per year. Most consultants perform few if any procedures, however some perform a narrow range at high volume. Cumulative confidence for the procedures tested peaks in the SpR grade. Five key procedures (central line insertion, lumbar puncture, pleural aspiration, ascitic aspiration, and intercostal drain insertion) are the most commonly performed, are seen as important generic skills, and correspond to the total number of procedures for which confidence can be maintained. Key determinants of confidence are gender, number of procedures performed in the previous year and total number of procedures performed.
Conclusion: The highest volume of service requirement is for six procedures. The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed. This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.

2. Gotlib A, Rupert R. Chiropractic manipulation in pediatric health conditions- an updated review. Chiropr Osteop 2008, 16:11doi:10.1186/1746-1340-16-11. (

Objective: Our purpose was to review the biomedical literature from January 2004 to June 2007 inclusive to determine the extent of new evidence related to the therapeutic application of manipulation for pediatric health conditions. This updates a previous systematic review published in 2005. No critical appraisal of the evidence is undertaken.
Data Sources: We searched both the indexed and non-indexed biomedical manual therapy literature. This included PubMed, MANTIS, CINAHL, ICL, as well as reference tracking. Other resources included the Cochrane Library, CCOHTA, PEDro, WHO ICTRP, AMED, EMBASE and AHRQ databases, as well as research conferences and symposium proceedings.
Results: The search identified 1275 citations of which 57 discrete citations met the eligibility criteria determined by three reviewers who then determined by consensus, each citation's appropriate level on the strength of evidence scale. The new evidence from the relevant time period was 1 systematic review, 1 RCT, 2 observational studies, 36 descriptive case studies and 17 conference abstracts. When this additional evidence is combined with the previous systematic review undertaken up to 2003, there are now in total, 2 systematic reviews, 10 RCT's, 3 observational studies, 177 descriptive studies, and 31 conference abstracts defining this body of knowledge.
Summary: There has been no substantive shift in this body of knowledge during the past 3 1/2 years. The health claims made by chiropractors with respect to the application of manipulation as a health care intervention for pediatric health conditions continue to be supported by only low levels of scientific evidence. Chiropractors continue to treat a wide variety of pediatric health conditions. The evidence rests primarily with clinical experience, descriptive case studies and very few observational and experimental studies. The health interests of pediatric patients would be advanced if more rigorous scientific inquiry was undertaken to examine the value of manipulative therapy in the treatment of pediatric conditions.

3. Johnson MF, Hays RD, Hui KK. Evidence-based effect size estimation:An illustration using the case of acupuncture for cancer-related fatigue. BMC Compl Alternative Med 2009, 9:1doi:10.1186/1472-6882-9-1. (

Background: Estimating a realistic effect size is an important issue in the planning of clinical studies of complementary and alternative medicine therapies. When a minimally important difference is not available, researchers may estimate effect size using the published literature. This evidence-based effect size estimation may be used to produce a range of empirically-informed effect size and consequent sample size estimates. We provide an illustration of deriving plausible effect size ranges for a study of acupuncture in the relief of post-chemotherapy fatigue in breast cancer patients.
Methods: A PubMed search identified three uncontrolled studies reporting the effect of acupuncture in relieving fatigue. A separate search identified five randomized controlled trials (RCTs) with a wait-list control of breast cancer patients receiving standard care that reported data on fatigue. We use these published data to produce best, average, and worst-case effect size estimates and related sample size estimates for a trial of acupuncture in the relief of cancer-related fatigue relative to a wait-list control receiving standard care.
Results: Use of evidence-based effect size estimation to calculate sample size requirements for a study of acupuncture in relieving fatigue in breast cancer survivors relative to a wait-list control receiving standard care suggests that an adequately-powered phase III randomized controlled trial comprised of two arms would require at least 101 subjects (52 per arm) if a strong effect is assumed for acupuncture and 235 (118 per arm) if a moderate effect is assumed.
Conclusion: Evidence-based effect size estimation helps justify assumptions in light of empirical evidence and can lead to more realistic sample size calculations, an outcome that would be of great benefit for the field of complementary and alternative medicine.

Tuesday, April 14, 2009

Facebook in the Context of Higher Education

Facebook is one of the prevalent social networking sites, where users can interact with each other through an evolving set of networks based upon common interests among members. Initially, Facebook was confined to use in a higher educational setting, but now it is open to anyone who wishes to join. Typically, a member will join networks, which might be something such as former high school friends, current college friends, political interests, and so on. Facebook is customizable, so each member can develop their home site as they wish, add functionality (such as photographs or video clips), and in this manner interact with other “friends.” “Friend” is the term Facebook users for each member of a network.

I am new to Facebook, having resisted it for some time. My main reason for finally joining and creating a Facebook home page was after discussions I held with one of my sons, who is a high school teacher in Hinsdale, Illinois. He maintains a Facebook page for his classes, so that he can have a single site for remaining in contact with this students, and also allow for his students’ parents to see what is occurring in his classroom. At the same time I had this conversation, a close friend of mine was imploring me to get a home page because she was in regular contact with former friends from high school and she felt that I should join in the fun. My worry was that it would become a time waster; like most of you, I spend entirely too much time on the computer, either reading or responding to email, surfing the web, or continuing my education. But I note that given its control system, you can easily ensure that you limit what you do, control who you “friend,” and regulate your site’s activities.

The following information can be found in much more detail at

Facebook is used by somewhere in the vicinity of 80-90% of college students, meaning that nearly all of our students are conversant with it and likely maintain a home site. This means that we can harness it for use in educational settings and activities. In fact, it is likely that the older among us (and I must respectfully now count myself one), are far less savvy about this than any of our students.

A user has access to a number of tools. You can upload pictures and create an album, or send friends an image via the systems own email network. You can control who has access to your site and to the information it contains. For example, you can post your phone number, and then only allow certain friends to be able to see it. You can set the system up so that when you post new information it automatically informs the friends in your network. One point made in the link above is that “the means of communication- email, cell phones, instant messenging- have proliferated to the point of saturation. Facebook lets people assert control over this flood of communication.”

There are downsides to this technology as well. Notable among them is the fact that younger users often do not consider who may view the information they post, which is in fact, in this tech savvy world, not always as private as we may think. We have all read of people who were passed over for a job after a company perused that person’s Facebook page. Faculty would do well to remember this as well.

But there is opportunity here, to develop learning networks online, to enhance collaborative activity, and to continue changing the face of education. I encourage you to consider how you might use Facebook as a teaching tool. As I become more experienced, I will certainly look into this.

Monday, April 6, 2009

Finding Evidence, Part 2

In this entry, I would like to simply provide information about search engines beyond those with which most of us are familiar. We all are aware of PubMed, MANTIS, CINAHL, and perhaps AMED and Cochrane/DARE, but there is a wealth of rigorous search engines we can use to locate information. Here are but some:

Natural Standard Database: (Disclaimer: I am a member of their senior editorial board). From their website, they state “Natural Standard was founded by clinicians and researchers to provide high quality, evidence-based information about complementary and alternative therapies. This international multidisciplinary collaboration now includes contributors from more than 100 eminent academic institutions.” There are actually 8 separate databases on this site, some of which are more consumer oriented while some are clinician and researcher oriented. The “Comparative Effectiveness” and “Medical Conditions” databases are particularly useful.

National Guideline Clearinghouse: This is a database of evidence-based practice guidelines offered by the Agency for Healthcare Research and Quality (AHRQ). This database hews to evidence-based practice as all guidelines must be based off of systematic reviews to be included. You can search by disease/condition, treatment/intervention/ measures, or organization. You can also link to healthcare syntheses and expert commentary on this site.

TRIP Database: TRIP stands for Turning Research into Practice, and this database locates the most rigorous possible evidence with which to inform clinical practice decisions, and they do so based on the methods of evidence-based practice. It can link you to evidence-based synopses, systematic reviews and guidelines. It also provides links to evidence-based resources.

ACP Journal Club: This is a program from the American College of Physicians, and it states its goal as “ACP Journal Club's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts.” Its search function will allow you to look for condition-specific information or intervention-based information. The material is based on the latest information from top medical journals.

PEDRo: This is the Physiotherapy Evidence Database, an initiative of the Centre for Evidence-Based Physiotherapy. It contains an excellent tutorial on its use, as well as links to related topic areas. It will allow for basic and advanced searching of the physiotherapy literature.

PsycINFO: This is from the American Psychological Association and is their database for the psychological literature. It includes journal articles, books, dissertations and other “grey” literature and to date now includes close to 3 million citations.

There are certainly many other databases available for your use, many covering natural therapies. When one has a PICO question (Patient- Intervention- Comparison- Outcome), the use of the most appropriate database can help you resolve a clinical challenge more effectively and efficiently. These are only some of those you can use, but I hope you will consider bookmarking them and using them on a regular basis.