Dear Folks:
Merry Christmas: http://www.youtube.com/watch?v=wJYZtssgSiw&feature=related
Happy Chanukah: http://www.youtube.com/watch?v=jLqG3BqMC8E&feature=related
Happy Kwanza: http://www.youtube.com/watch?v=LvnQQcyPojs&feature=related
Happy New Year! http://www.youtube.com/watch?v=Z3sXVxqDbFk&feature=related
See you in 2012.
Monday, December 19, 2011
Monday, December 12, 2011
The Five Traditions of Critical Thinking
Continuing with the work of Stephen Brookfield (1), he notes that there are five main traditions regarding critical thinking. These are:
1. Analytic philosophy and logic. He notes that this is the most influential tradition informing how we teach and understand critical thinking. It is a process of constructing and deconstructing arguments, and is a daily part of instruction in US schools. It translates as being able to provide reasons for the opinions, conclusions or statements that a student makes. A classic example would be to show the calculations that led to the correct answer of a math problem, not just the answer itself. Brookfield notes that it is necessary for individuals involved in this form of analysis to be conversant in language, because language can be used to mislead and deceive student. To Brookfield, this smacks of propaganda, and it is necessary for students to be able to perceive language tricks- and we see tricks all the time in our literature, particularly our political literature related to chiropractic. We need to teach our students to see such tricks when they occur, so that they will not be so easily misled.
2. Natural science. This is essentially the hypothetic-deductive model and it is this model which informs the scientific method. Here, we posit a hypothesis, and we then create an experiment to test whether or not we get the expected results our hypothesis generates. We end up either corroborating or falsifying the hypothesis; if the latter, we then generate new hypotheses. Initially, this was espoused by Francis Bacon back in the 1600’s, but in science was expanded upon by Karl Popper, who developed the principle of falsifiability. To be scientific is to be falsifiable. And as a result, in this model the critical thinker is one who is open to having his or her opinions revised as new evidence is available. This is, sadly, not always the case with students, whether in chiropractic or not. Knowledge is provisional and always subject to revision.
3. Pragmatism. Brookfield says this about pragmatism: “Pragmatism emphasizes the importance of continual experimentation to bring about better (in pragmatist terms, more beautiful) social forms.” To build a democratic society, we need to experiment and change constantly in order to make democracy work better. The model here is to experiment, learn from mistakes, and deliberately seek out new information and possibilities. The concept of pragmatism arose from early political philosophers such as Ralph Waldo Emerson and John Dewey, though today it means something radically different from how it applies to critical thinking; to be pragmatic is to take advantage of situations which occur so as to benefit yourself. In education, pragmatism involves a willingness to question dogma and to always be open to revision. This is again not always the case in chiropractic education. Many voices need to be heard so that the learner can question their own assumptions in light of others’ point of view. We might apply a pragmatic approach by offering an activity based on a current situation and allowing student to offer their own approach to resolving the situation.
4. Psychoanalysis. This is the least well understood of the five approaches because it delves into psychoanalysis and psychotherapy. And it is seen in courses that put student experience as the central focus of the curriculum, so it is seen more in social work, nursing and general education (obviously, it is central to clinical psychology). It is based on the concept that each us has a core identity that wants to be realized. In higher education, this forms the basis for what is known as transformative learning, associated with Jack Mezirow. And the approach looks to see how childhood inhibitions interfere with our full development as an adult person.
5. Critical theory. This is an overtly political theory, which grew out of a Marxist approach to education, and which is tied to social justice and uncovering power inequities. It has a core set of assumptions: that western societies are unequal and have inherent discrimination (racial, economic, social), that this is seen as normal and inevitable by dissemination of the dominant ideology, and that critical theory helps to understand this so that change can occur. This may sound esoteric, but consider how chiropractic is positioned in American society compared to the dominant ideology of allopathic medicine. It looks for hegemony (such as is the case for medicine) in order to change it and to effect social action. Our students do recognize this. For example, they are cognizant that the progression of disease and how it is treated may be explained by how pharmaceutical companies and insurance companies structure health care. But they may not recognize it in other areas.
I highly recommend a read through Brookfield’s book, which is fascinating to me and I hope will be to you.
References
1. Brookfield S. Teaching for critical thinking. San Francisco, CA: John Wiley and Sons, 2012:1
1. Analytic philosophy and logic. He notes that this is the most influential tradition informing how we teach and understand critical thinking. It is a process of constructing and deconstructing arguments, and is a daily part of instruction in US schools. It translates as being able to provide reasons for the opinions, conclusions or statements that a student makes. A classic example would be to show the calculations that led to the correct answer of a math problem, not just the answer itself. Brookfield notes that it is necessary for individuals involved in this form of analysis to be conversant in language, because language can be used to mislead and deceive student. To Brookfield, this smacks of propaganda, and it is necessary for students to be able to perceive language tricks- and we see tricks all the time in our literature, particularly our political literature related to chiropractic. We need to teach our students to see such tricks when they occur, so that they will not be so easily misled.
2. Natural science. This is essentially the hypothetic-deductive model and it is this model which informs the scientific method. Here, we posit a hypothesis, and we then create an experiment to test whether or not we get the expected results our hypothesis generates. We end up either corroborating or falsifying the hypothesis; if the latter, we then generate new hypotheses. Initially, this was espoused by Francis Bacon back in the 1600’s, but in science was expanded upon by Karl Popper, who developed the principle of falsifiability. To be scientific is to be falsifiable. And as a result, in this model the critical thinker is one who is open to having his or her opinions revised as new evidence is available. This is, sadly, not always the case with students, whether in chiropractic or not. Knowledge is provisional and always subject to revision.
3. Pragmatism. Brookfield says this about pragmatism: “Pragmatism emphasizes the importance of continual experimentation to bring about better (in pragmatist terms, more beautiful) social forms.” To build a democratic society, we need to experiment and change constantly in order to make democracy work better. The model here is to experiment, learn from mistakes, and deliberately seek out new information and possibilities. The concept of pragmatism arose from early political philosophers such as Ralph Waldo Emerson and John Dewey, though today it means something radically different from how it applies to critical thinking; to be pragmatic is to take advantage of situations which occur so as to benefit yourself. In education, pragmatism involves a willingness to question dogma and to always be open to revision. This is again not always the case in chiropractic education. Many voices need to be heard so that the learner can question their own assumptions in light of others’ point of view. We might apply a pragmatic approach by offering an activity based on a current situation and allowing student to offer their own approach to resolving the situation.
4. Psychoanalysis. This is the least well understood of the five approaches because it delves into psychoanalysis and psychotherapy. And it is seen in courses that put student experience as the central focus of the curriculum, so it is seen more in social work, nursing and general education (obviously, it is central to clinical psychology). It is based on the concept that each us has a core identity that wants to be realized. In higher education, this forms the basis for what is known as transformative learning, associated with Jack Mezirow. And the approach looks to see how childhood inhibitions interfere with our full development as an adult person.
5. Critical theory. This is an overtly political theory, which grew out of a Marxist approach to education, and which is tied to social justice and uncovering power inequities. It has a core set of assumptions: that western societies are unequal and have inherent discrimination (racial, economic, social), that this is seen as normal and inevitable by dissemination of the dominant ideology, and that critical theory helps to understand this so that change can occur. This may sound esoteric, but consider how chiropractic is positioned in American society compared to the dominant ideology of allopathic medicine. It looks for hegemony (such as is the case for medicine) in order to change it and to effect social action. Our students do recognize this. For example, they are cognizant that the progression of disease and how it is treated may be explained by how pharmaceutical companies and insurance companies structure health care. But they may not recognize it in other areas.
I highly recommend a read through Brookfield’s book, which is fascinating to me and I hope will be to you.
References
1. Brookfield S. Teaching for critical thinking. San Francisco, CA: John Wiley and Sons, 2012:1
Monday, December 5, 2011
Teaching for Critical Thinking
In his excellent book “Teaching for Critical Thinking,” Stephen Brookfield introduces the basic process of critical think as involving 4 components: (1) identifying the assumptions underlying our thinking as it relates to our actions, (2) checking out how much these assumptions are accurate, (3) looking at our ideas and decisions from more than a single perspective, and (4) after doing all of this, taking informed action (1). Brookfield states that “if you can’t think critically your survival is in peril because you risk living a life that- without your being aware of it- hurts you and serves the interests of those who wish you harm.” His approach to critical thinking is certainly more than we might consider to be critical thinking; in our case, we often use the term to denote an ability to critically appraise or assess a journal article in order to glean information from it to use for patient management. Or, conversely, we often think of it as the art of tearing a paper apart. We are not always cognizant of the political margins around our thinking and learning.
To Brookfield, the core process of critical thinking is in hunting assumptions. He defines an assumption as a guide to truth embedded in your mental outlook, and he offers as examples how assumptions occur in daily life: the words people use are assumed to have specific meanings, as do the gestures they use. We make assumptions about political candidates and whether or not they are telling us the truth. All day long assumptions are being made by use, and most are held because our experience tells us to hold them- we might wear a sweater based on an assumption made by reading about the weather in the morning newspaper. Assumptions can occur at far deeper levels. Many are linked to dominant ideologies. We might assume a person wearing worn clothing is poor, that the guy in a suit over there is a college administrator, that everyone we meet is heterosexual because that is assumed to be the norm, etc.
When you think critically, you begin to question the assumptions about how problems are defined. Since we are in a chiropractic college, we make assumptions about the value of chiropractic- and we make assumptions about the value of allopathic medicine. And we act as a result. Here is but one example: when we read a newspaper article lauding a recent chiropractic research finding (or if we read the actual paper on which that news release might be based), we often applaud this finding and take it without delving into its rigor. When we read a paper that casts a more negative light on chiropractic, we often look to see if we can point out all its flaws. We assume the good paper is good and the negative one is bad.
When we think critically, we hunt out our assumptions, check them out to see if they are accurate, try to view these from multiple perspectives and only then are we able to take informed action. And this may play out in education every bit as much as others areas of life.
References
1. Brookfield S. Teaching for critical thinking. San Francisco, CA: John Wiley and Sons, 2012:1
To Brookfield, the core process of critical thinking is in hunting assumptions. He defines an assumption as a guide to truth embedded in your mental outlook, and he offers as examples how assumptions occur in daily life: the words people use are assumed to have specific meanings, as do the gestures they use. We make assumptions about political candidates and whether or not they are telling us the truth. All day long assumptions are being made by use, and most are held because our experience tells us to hold them- we might wear a sweater based on an assumption made by reading about the weather in the morning newspaper. Assumptions can occur at far deeper levels. Many are linked to dominant ideologies. We might assume a person wearing worn clothing is poor, that the guy in a suit over there is a college administrator, that everyone we meet is heterosexual because that is assumed to be the norm, etc.
When you think critically, you begin to question the assumptions about how problems are defined. Since we are in a chiropractic college, we make assumptions about the value of chiropractic- and we make assumptions about the value of allopathic medicine. And we act as a result. Here is but one example: when we read a newspaper article lauding a recent chiropractic research finding (or if we read the actual paper on which that news release might be based), we often applaud this finding and take it without delving into its rigor. When we read a paper that casts a more negative light on chiropractic, we often look to see if we can point out all its flaws. We assume the good paper is good and the negative one is bad.
When we think critically, we hunt out our assumptions, check them out to see if they are accurate, try to view these from multiple perspectives and only then are we able to take informed action. And this may play out in education every bit as much as others areas of life.
References
1. Brookfield S. Teaching for critical thinking. San Francisco, CA: John Wiley and Sons, 2012:1
Monday, November 28, 2011
New Articles from BioMed Central
Williams AM, Kitchen P, Eby J. Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis. BMC Compl Altern Med 2011;11:47
ABSTRACT
Background: An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province.
Methods: Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use.
Results: In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met.
Conclusions: The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments.
Zhang J, Peterson RF, Ozolins IZ. Student approaches for learning in medicine: what does it tell us about the informal curriculum? BMC Med Educ 2011;11:87
ABSTRACT
Background: It has long been acknowledged that medical students frequently focus their learning on that which will enable them to pass examinations, and that they use a range of study approaches and resources in preparing for their examinations. A recent qualitative study identified that in addition to the formal curriculum, students are using a range of resources and study strategies which could be attributed to the informal curriculum. What is not clearly established is the extent to which these informal learning resources and strategies are utilized by medical students. The aim of this study was to establish the extent to which students in a graduate-entry medical program use various learning approaches to assist their learning and preparation for examinations, apart from those resources offered as part of the formal curriculum.
Methods: A validated survey instrument was administered to 522 medical students. Factor analysis and internal consistence, descriptive analysis and comparisons with demographic variables were completed. The factor analysis identified eight scales with acceptable levels of internal consistency with an alpha coefficient between 0.72 and 0.96.
Results: Nearly 80% of the students reported that they were overwhelmed by the amount of work that was perceived necessary to complete the formal curriculum, with 74.3% believing that the informal learning approaches helped them pass the examinations. 61.3% believed that they prepared them to be good doctors. A variety of informal learning activities utilized by students included using past student notes (85.8%) and PBL tutor guides (62.7%), and being part of self-organised study groups (62.6%), and peer-led tutorials (60.2%). Almost all students accessed the formal school resources for at least 10% of their study time. Students in the first year of the program were more likely to rely on the formal curriculum resources compared to those of Year 2 (p = 0.008).
Conclusions: Curriculum planners should examine the level of use of informal learning activities in their schools, and investigate whether this is to enhance student progress, a result of perceived weakness in the delivery and effectiveness of formal resources, or to overcome anxiety about the volume of work expected by medical programs.
Erick PN, Smith DR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskeletal Dis 2011;12:60
ABSTRACT
Background: Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers comprise an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.
Methods: The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.
Results: This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers may be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.
Conclusion: Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.
ABSTRACT
Background: An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province.
Methods: Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use.
Results: In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met.
Conclusions: The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments.
Zhang J, Peterson RF, Ozolins IZ. Student approaches for learning in medicine: what does it tell us about the informal curriculum? BMC Med Educ 2011;11:87
ABSTRACT
Background: It has long been acknowledged that medical students frequently focus their learning on that which will enable them to pass examinations, and that they use a range of study approaches and resources in preparing for their examinations. A recent qualitative study identified that in addition to the formal curriculum, students are using a range of resources and study strategies which could be attributed to the informal curriculum. What is not clearly established is the extent to which these informal learning resources and strategies are utilized by medical students. The aim of this study was to establish the extent to which students in a graduate-entry medical program use various learning approaches to assist their learning and preparation for examinations, apart from those resources offered as part of the formal curriculum.
Methods: A validated survey instrument was administered to 522 medical students. Factor analysis and internal consistence, descriptive analysis and comparisons with demographic variables were completed. The factor analysis identified eight scales with acceptable levels of internal consistency with an alpha coefficient between 0.72 and 0.96.
Results: Nearly 80% of the students reported that they were overwhelmed by the amount of work that was perceived necessary to complete the formal curriculum, with 74.3% believing that the informal learning approaches helped them pass the examinations. 61.3% believed that they prepared them to be good doctors. A variety of informal learning activities utilized by students included using past student notes (85.8%) and PBL tutor guides (62.7%), and being part of self-organised study groups (62.6%), and peer-led tutorials (60.2%). Almost all students accessed the formal school resources for at least 10% of their study time. Students in the first year of the program were more likely to rely on the formal curriculum resources compared to those of Year 2 (p = 0.008).
Conclusions: Curriculum planners should examine the level of use of informal learning activities in their schools, and investigate whether this is to enhance student progress, a result of perceived weakness in the delivery and effectiveness of formal resources, or to overcome anxiety about the volume of work expected by medical programs.
Erick PN, Smith DR. A systematic review of musculoskeletal disorders among school teachers. BMC Musculoskeletal Dis 2011;12:60
ABSTRACT
Background: Musculoskeletal disorders (MSD) represent one of the most common and most expensive occupational health problems in both developed and developing countries. School teachers comprise an occupational group among which there appears to be a high prevalence of MSD. Given that causes of MSD have been described as multi-factorial and prevalence rates vary between body sites and location of study, the objective of this systematic review was to investigate the prevalence and risk factors for MSD among teaching staff.
Methods: The study involved an extensive search of MEDLINE and EMBASE databases in 2011. All studies which reported on the prevalence and/or risk factors for MSD in the teaching profession were initially selected for inclusion. Reference lists of articles identified in the original search were then examined for additional publications. Of the 80 articles initially located, a final group of 33 met the inclusion criteria and were examined in detail.
Results: This review suggests that the prevalence of self-reported MSD among school teachers ranges between 39% and 95%. The most prevalent body sites appear to be the back, neck and upper limbs. Nursery school teachers may be more likely to report suffering from low back pain. Factors such as gender, age, length of employment and awkward posture have been associated with higher MSD prevalence rates.
Conclusion: Overall, this study suggests that school teachers are at a high risk of MSD. Further research, preferably longitudinal, is required to more thoroughly investigate the issue of MSD among teachers, with a greater emphasis on the possible wider use of ergonomic principles. This would represent a major step forward in the prevention of MSD among teachers, especially if easy to implement control measures could be recommended.
Monday, November 21, 2011
Thanksgiving
On Thursday and Friday of last week, I spent time with faculty from all three of our campuses at a retreat held at the medical school at the University of Iowa. This was devoted to teaching faculty clinicians and clinical teaching faculty some of the skills involved in using evidence-based clinical practice. Topics looked at concepts such as risk and odds ratios, sensitivity and specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests. Our group was led by Dr. Marc Wilson, an internist at U Iowa who has also been long involved in the EBCP movement, and who has particular skills in facilitating physician groups. As a person who has worked with our Davenport faculty for some time now, and who is beginning to build contacts in our branch campuses, I realized that I was extremely grateful for all the work and the engagement I saw with our faculty. I realized that beyond that, I am grateful for a great many things, and so I wish to say thanks.
Thanks to our faculty for all the hard work you do. It may seem at times that it goes unnoticed, but I assure you this is not the case. We all share in your success when you publish a paper, or present new information at a conference, or reach a single student in a classroom setting. You make all of us proud.
I am grateful for the opportunity to work here at Palmer. It is a welcoming place to work, and it has provided a supportive environment in which to accomplish that work. I am lucky to work with the strongest set of faculty at any chiropractic college- at all of our campuses- and with the strongest set of administrators and staff as well.
I sent thanks to those whose work is often unheralded. Thanks to maintenance people, for support personal, janitorial staff, security and others. You all make this a better place, and you do so with good humor. And kudos to security, who often have to let me to the building when I show up at 3am because I am not able to sleep!
Again, I offer this short note of thanks to the college, to the people working in it, and to the jos it has given me. To all of you, please enjoy a restful holiday vacation. I hope you are able to spend it with family and friends, enjoying safe travels and good food. Happy holiday!
Thanks to our faculty for all the hard work you do. It may seem at times that it goes unnoticed, but I assure you this is not the case. We all share in your success when you publish a paper, or present new information at a conference, or reach a single student in a classroom setting. You make all of us proud.
I am grateful for the opportunity to work here at Palmer. It is a welcoming place to work, and it has provided a supportive environment in which to accomplish that work. I am lucky to work with the strongest set of faculty at any chiropractic college- at all of our campuses- and with the strongest set of administrators and staff as well.
I sent thanks to those whose work is often unheralded. Thanks to maintenance people, for support personal, janitorial staff, security and others. You all make this a better place, and you do so with good humor. And kudos to security, who often have to let me to the building when I show up at 3am because I am not able to sleep!
Again, I offer this short note of thanks to the college, to the people working in it, and to the jos it has given me. To all of you, please enjoy a restful holiday vacation. I hope you are able to spend it with family and friends, enjoying safe travels and good food. Happy holiday!
Monday, November 14, 2011
Making Microsoft Outlook More Productive For You
Most of us Outlook on a daily basis if for no other reason than to access our email. But it is a productive program that can help you control much of your day, and most of us do not take the time to use it to its full ability. I would like to offer a few ideas here that may help make your day more productive.
1. Turn off the new-message alert. Yes, I know that most of us have this on by default, so every time we get a new message sent to us, the program flags us that it has arrived. And I would bet that much of the time you then immediately go to the message to respond to it, or to at least read it. But think about it: how is this any different than someone sticking their head in your door every 5 minutes to ask you something? You can turn the alert off. Here is how:
Choose Tools, Options, and click E-mail Options.
a) Click Advanced E-Mail Options.
b) Uncheck the box next to "Play a sound."
c) Uncheck the box next to "Briefly change the mouse cursor."
d) Uncheck the box next to "Show an envelope icon in the notification area."
e) Uncheck the box next to "Display a New Mail Desktop Alert."
f) Click OK.
a) Click Advanced E-Mail Options.
b) Uncheck the box next to "Play a sound."
c) Uncheck the box next to "Briefly change the mouse cursor."
d) Uncheck the box next to "Show an envelope icon in the notification area."
e) Uncheck the box next to "Display a New Mail Desktop Alert."
f) Click OK.
2. Modify the subject line of archived Outlook email. Often what starts as an email chain about one subject may morph into a chain about something completely different? So, for example, you and a colleague begin a short series of back and forth emails about the dinner you just had together, and in that series you note a question about a work-related topic of some import, say, about a change in educational funding for research. This is now an email you wish to save, but the original topic line is about the dinner you had, so you cannot easily find that email now that you need it. You can actually edit the subject line to make it easier for you to find or to catalogue it. Here is how:
In Outlook, open the e-mail in question (You can't do this with message previews; you have to double-click the message to open it in a new window.)
a) Click anywhere in the Subject line to place your cursor.
b) Edit the subject as you see fit.
c) Hit Enter, then accept the warning Outlook gives you.
a) Click anywhere in the Subject line to place your cursor.
b) Edit the subject as you see fit.
c) Hit Enter, then accept the warning Outlook gives you.
3. Use Outlook to access your twitter account. For those of you who use twitter, you can use Outlook to read and manage your tweets. To do so, you need to add a plug-in to the system, known as Twlnbox. When you install this, it will add a new folder to your inbox (and you can then make individual folders for each sender, which may be of help in a large organization such as ours). From there, you can just provide your twitter user name and password and it will locate all the tweets to your account and put them in the folder. You can then read them like email. You can click the toolbar that the program will put on Outlook and use it to send our your own tweets, and it will also let you know when new tweets arrive.
These are just a few ideas about making Outlook do more of what you need it to do. This is based on a short article by Rick Broida from PCWorld, (http://www.pcworld.com/article/169013/be_more_productive_in_microsoft_outlook.html)
Monday, November 7, 2011
American Society for Bioethics and Humanities 2011 Conference
I just returned from attending the annual conference of the American Society for Bioethics and Humanities, which this year was held in Minneapolis(allowing me to visit both Surdyk’s for cheese and Kaczmarcuk’s for sausage, just saying). The theme for this year was “Generation(s) and Transformation(s)” reflecting an emerging theme in bioethics, that of “enhancement.” Enhancement is anything which enhances the development or ability of a person, most often applied to the developing fetus but also seen in developments in neurology, orthopedics (i.e., prosthetics) or even use of glasses or hearing aids. I come away from the meeting with a great deal of new knowledge as well as an understanding that bioethicists wear more bowties than any other group I have ever seen.
Over the course of three days, I attended the following sessions:
• Gender, Reproduction and Bioethics: this included papers on approaching the ethics of treating LGBT populations as well as the ethics of disaster preparedness.
• Queer Generations: A second session devoted to the specific ethical issues occurring over the lifespan of LGBT person.
• Politics and Bioethics: featuring two prominent politically-oriented ethicists, John Arras and Jonathan Moreno, who looked at how ethics and politics conflict and come together in a pluralistic society.
• Research Environment and Decision Making: this was mainly about ethical decision making in a research environment.
• Bioethics in News and Theater: this looked at the confluence of bioethics and humanities as used in situations outside formal ethics courses.
• Physicians’ Obligations: This program examined the obligations physicians have to patients, and also explored physician conscientious objections to treatment as well as the concept of “firing” patients.
• Medical Ethics and Humanities Education in US Medical Schools: this was an overview of the development of a project designed to assess the state of training of ethics in the United States.
• Ethics as Transformative: an interesting session which looked at teaching macroethics, as well as how to ethically break the law and how to settle arguments about enhancement.
• Transformations over Two Generations: noted ethicist Dr. Ruth Macklin traced her career over a 40+ year period showing how the bioethics world began and became the force it is today.
• Teaching Ethics: Of interest to me since I do, it looked at the use of debate and role play in teaching ethics to medical students.
• Research Ethics: This session looked at how a controversy in bioethics occurred at one hospital, how consent forms may actually create therapeutic misconception rather than reduce it, and how people understand wrongdoing in ethics environments.
• The Birth of a Bioethics Program: Steps, Strategies and Successes: this looks at the creation of a large ethics program in the Kaiser Permanente Health System, showing how much work had to be done to launch their ethics program.
• Physician’s Role: about what doctors need to do when caring for patients.
• Patient’s Role: a switch on the above, but with a focus on what it means to be seen as a patient.
This was all fertile ground, and I very much enjoyed a program that gave me additional knowledge in an area not too well understood to begin with.
Over the course of three days, I attended the following sessions:
• Gender, Reproduction and Bioethics: this included papers on approaching the ethics of treating LGBT populations as well as the ethics of disaster preparedness.
• Queer Generations: A second session devoted to the specific ethical issues occurring over the lifespan of LGBT person.
• Politics and Bioethics: featuring two prominent politically-oriented ethicists, John Arras and Jonathan Moreno, who looked at how ethics and politics conflict and come together in a pluralistic society.
• Research Environment and Decision Making: this was mainly about ethical decision making in a research environment.
• Bioethics in News and Theater: this looked at the confluence of bioethics and humanities as used in situations outside formal ethics courses.
• Physicians’ Obligations: This program examined the obligations physicians have to patients, and also explored physician conscientious objections to treatment as well as the concept of “firing” patients.
• Medical Ethics and Humanities Education in US Medical Schools: this was an overview of the development of a project designed to assess the state of training of ethics in the United States.
• Ethics as Transformative: an interesting session which looked at teaching macroethics, as well as how to ethically break the law and how to settle arguments about enhancement.
• Transformations over Two Generations: noted ethicist Dr. Ruth Macklin traced her career over a 40+ year period showing how the bioethics world began and became the force it is today.
• Teaching Ethics: Of interest to me since I do, it looked at the use of debate and role play in teaching ethics to medical students.
• Research Ethics: This session looked at how a controversy in bioethics occurred at one hospital, how consent forms may actually create therapeutic misconception rather than reduce it, and how people understand wrongdoing in ethics environments.
• The Birth of a Bioethics Program: Steps, Strategies and Successes: this looks at the creation of a large ethics program in the Kaiser Permanente Health System, showing how much work had to be done to launch their ethics program.
• Physician’s Role: about what doctors need to do when caring for patients.
• Patient’s Role: a switch on the above, but with a focus on what it means to be seen as a patient.
This was all fertile ground, and I very much enjoyed a program that gave me additional knowledge in an area not too well understood to begin with.
Monday, October 31, 2011
Steve Jobs, RIP
It is hard for me to think of someone, outside of my parents and family, who has had as profound an effect on my life as Steve Jobs did. As I sit here writing, I have an iPhone in my pocket, an iPad in my briefcase, a Macintosh computer on my desk at home (on which I have iTunes installed to download records), and an iPod in my desk drawer which I use when traveling or reading to listen to music. I bought my first Macintosh computer in 1984, an age when some of my current students were not even alive. It was a Mac IIe, with 1 meg RAM and a 5 ¼” floppy drive, and it so transformed my life as an editor and as a teacher that I cannot conceive of what life would be without it.
In 1984 I was early in my career with the JMPT, not yet its editor. Working with Dr. Roy Hildebrandt, every time we revised a manuscript which had been submitted to JMPT we had to have it retyped. Initially, we had to do this by hand; we then obtained an early IBM typewriter which could store up to a single page of text, which simplified the task a little bit but remained imperfect. With many submissions each month, our time was spent in reworking papers and typing them up again. That first Mac seemed magical- a full paper would be stored on this little piece of floppy material, and we could easily make changes and see them immediately reformat a page. OMG! Such power in that little piece of technology!
I also remember my first cell phone. Actually, it was called a bag phone, since it was the size of a regular land-line phone but was carried in a bag with a 9-volt battery. I imagine some of our students would not understand; they have grown up with cell technology. And that bag phone was only good for making phone calls. I look at the little device in my pocket, and I can make phone calls, but I can also access many programs that enhance productivity- or waste time- and I can read my email (and send email), access the web and watch movies.
In the classroom we use various technologies, most of which were either developed by Steve Jobs and Apple or Bill Gates via Windows. These have transformed education. We talk about Millennials, and how they learn differently than earlier generations (I am a baby boomer). I went to chiropractic college, and I sat in hours of lecture. Sometimes, the instructor had mimeographs of material, or an overhead on a acetate, and then maybe some slides (which required a slide projector). I learned well this way- and it took me a long time to understand that learning that way is no longer really operational- we have new technologies in play. There is even concern that the use of google may impact our memory and our learning, since so much information is now available for searching we need not remember it since it is always there. Google is now our brain. None of this is possible without Steve Jobs.
I will miss how visionary he was, how he transformed the world. I don’t know what Apple will do without him, but certainly the world is now a poorer place with him gone.
In 1984 I was early in my career with the JMPT, not yet its editor. Working with Dr. Roy Hildebrandt, every time we revised a manuscript which had been submitted to JMPT we had to have it retyped. Initially, we had to do this by hand; we then obtained an early IBM typewriter which could store up to a single page of text, which simplified the task a little bit but remained imperfect. With many submissions each month, our time was spent in reworking papers and typing them up again. That first Mac seemed magical- a full paper would be stored on this little piece of floppy material, and we could easily make changes and see them immediately reformat a page. OMG! Such power in that little piece of technology!
I also remember my first cell phone. Actually, it was called a bag phone, since it was the size of a regular land-line phone but was carried in a bag with a 9-volt battery. I imagine some of our students would not understand; they have grown up with cell technology. And that bag phone was only good for making phone calls. I look at the little device in my pocket, and I can make phone calls, but I can also access many programs that enhance productivity- or waste time- and I can read my email (and send email), access the web and watch movies.
In the classroom we use various technologies, most of which were either developed by Steve Jobs and Apple or Bill Gates via Windows. These have transformed education. We talk about Millennials, and how they learn differently than earlier generations (I am a baby boomer). I went to chiropractic college, and I sat in hours of lecture. Sometimes, the instructor had mimeographs of material, or an overhead on a acetate, and then maybe some slides (which required a slide projector). I learned well this way- and it took me a long time to understand that learning that way is no longer really operational- we have new technologies in play. There is even concern that the use of google may impact our memory and our learning, since so much information is now available for searching we need not remember it since it is always there. Google is now our brain. None of this is possible without Steve Jobs.
I will miss how visionary he was, how he transformed the world. I don’t know what Apple will do without him, but certainly the world is now a poorer place with him gone.
Monday, October 10, 2011
End of Term Youtube Bonanza
Here we are at the end of the Fall 2011 term and likely we are all feeling a bit tired and ready for a short break. I do, too, so herewith are some fun, heartwarming and interesting youtube clips to help you lead into or back from your vacation.
1. Woman hears her own voice for the first time: This video, taken by Sarah Churman’s husband Sloan, shows her dawning comprehension that she is hearing her own voice for the first time in her life; she is 29. It takes her a couple of seconds to process what is happening, but when she does, the smile and the tears that light her face are memorable. And her later comment is worth reporting: “I didn’t know I had an accent.” http://www.youtube.com/watch?v=ZNdV76hIiuM
2. And in a baby: Of course, if it is good in a 29-year-old woman, it has to be better in an infant. So here is an infant responding to his mom after he has had a cochlear implant. The smiel is worth the price of admission. http://www.youtube.com/watch?v=4AOuSvAQ5LU&feature=related
3. Bus driver surprised on his birthday: Well, you won’t see this happen any time in the United States, but here we see passengers help celebrate the birthday of their daily busdriver, even to fooling him with what looks like a protest, but is really just the opposite, a celebration: http://www.youtube.com/watch?v=HW1_DvztM1U
4. Christian the lion- a legendary story and video, about 2 men who rescued a lion from a store in Great Britain, raised him so that he could be released into the wild, and then went looking to see how he was doing several years later. This is a memorable reunion: http://www.youtube.com/watch?v=0ZIQUb-d4GQ&feature=related
5. And when I got back from Kandahar: Along similar lines, here we see a soldier returning home after a posting in Kandahar, and the reaction of his pet dog when he does. The dog is, shall we say, ecstatic: http://www.youtube.com/watch?v=ysKAVyXi0J4&feature=fvwrel
6. A young singer with a mighty voice: I confess I d not watch these reality singing programs, but this one is pretty fine. The young lady can sing: http://www.youtube.com/watch?v=pL2s2SWL8QE&feature=related
7. Ping pong outside the box: This is not your usual ping pong game here! http://www.youtube.com/watch?v=ga6zAEB9fOM
8. Hey, I play 3 instruments at once: And they are not even usual instruments, except the guitar. This fellow lays didgeridoos and stomp boxes along with his guitar- and he sings on top of it. http://www.youtube.com/watch?v=tiR1qT8ouGI
9. Grissom and Sarah: CSI, one of my favorite programs ever, developed the relationship of Gill Grissom and Sarah Sidle over a period of many years, using the so-called long arc of storytelling to do so. In the end, when William Petersen stepped out of the role he had owned for so long, the writers did him a good one by reuniting him with his lady love, in Costa Rica. Brings a smile to my face; this pay-off took 8 years to get to: http://www.youtube.com/watch?v=bkHNlwA_ESk&feature=related
Enjoy the upcoming break and for those just back, enjoy the new term. I’ll be back in a few weeks with new posts.
1. Woman hears her own voice for the first time: This video, taken by Sarah Churman’s husband Sloan, shows her dawning comprehension that she is hearing her own voice for the first time in her life; she is 29. It takes her a couple of seconds to process what is happening, but when she does, the smile and the tears that light her face are memorable. And her later comment is worth reporting: “I didn’t know I had an accent.” http://www.youtube.com/watch?v=ZNdV76hIiuM
2. And in a baby: Of course, if it is good in a 29-year-old woman, it has to be better in an infant. So here is an infant responding to his mom after he has had a cochlear implant. The smiel is worth the price of admission. http://www.youtube.com/watch?v=4AOuSvAQ5LU&feature=related
3. Bus driver surprised on his birthday: Well, you won’t see this happen any time in the United States, but here we see passengers help celebrate the birthday of their daily busdriver, even to fooling him with what looks like a protest, but is really just the opposite, a celebration: http://www.youtube.com/watch?v=HW1_DvztM1U
4. Christian the lion- a legendary story and video, about 2 men who rescued a lion from a store in Great Britain, raised him so that he could be released into the wild, and then went looking to see how he was doing several years later. This is a memorable reunion: http://www.youtube.com/watch?v=0ZIQUb-d4GQ&feature=related
5. And when I got back from Kandahar: Along similar lines, here we see a soldier returning home after a posting in Kandahar, and the reaction of his pet dog when he does. The dog is, shall we say, ecstatic: http://www.youtube.com/watch?v=ysKAVyXi0J4&feature=fvwrel
6. A young singer with a mighty voice: I confess I d not watch these reality singing programs, but this one is pretty fine. The young lady can sing: http://www.youtube.com/watch?v=pL2s2SWL8QE&feature=related
7. Ping pong outside the box: This is not your usual ping pong game here! http://www.youtube.com/watch?v=ga6zAEB9fOM
8. Hey, I play 3 instruments at once: And they are not even usual instruments, except the guitar. This fellow lays didgeridoos and stomp boxes along with his guitar- and he sings on top of it. http://www.youtube.com/watch?v=tiR1qT8ouGI
9. Grissom and Sarah: CSI, one of my favorite programs ever, developed the relationship of Gill Grissom and Sarah Sidle over a period of many years, using the so-called long arc of storytelling to do so. In the end, when William Petersen stepped out of the role he had owned for so long, the writers did him a good one by reuniting him with his lady love, in Costa Rica. Brings a smile to my face; this pay-off took 8 years to get to: http://www.youtube.com/watch?v=bkHNlwA_ESk&feature=related
Enjoy the upcoming break and for those just back, enjoy the new term. I’ll be back in a few weeks with new posts.
Monday, October 3, 2011
Apps for Healthcare Educators
I have an iPhone. Some of you have Androids, BlackBerrys or other cell phone. And all of us have a various set of apps on them. Some are for fun; in my case, I play solitaire when I, oh, wait while my wife tries on clothes at the local Von Maur. I have various newspapers on my phone, and I also have a wonderful little app called MedCalc 3000. This is an app that provides you immediate calculations of various measures used in evidence-based practice, such as sensitivity, specificity, likelihood ratios, confidence intervals, and so on. When I bought this app, at the high cost of just $4.99, I thought that there might be other good apps available. There are. I am not sure that they can be found for all phoe platforms, but I would be surprised if not. Here are a few good ones.
MedCalc 3000- you can read about this program at http://medcalc3000.com/pubapps/statist.htm. There are a number of different versions of the MedCalc program, some more for specialty physicians, but the one I note here has utility for those of us- which is all of us- involved in teaching with the tools of evidence-based practice. This little app lets you insert numbers from papers you read and then will calculate all sorts of statistics for you. Easy to use, intuitive and a good find. It costs $4.99, as noted above.
Med Calc- this is not related to the above app. This one is a more in-depth program that gives you access to many complicated formulas used in healthcare. For example, there is a body mass calculator in this program and there are many others. Take a look at http://itunes.apple.com/app/medcalc-medical-calculator/id299470331?mt=8. And it’s free.
Epocrates- we chiropractors cannot and do not prescribe drugs. But our patients still take them. And they take a lot of tem and of many different kinds. This program is the best available online phone-based app to easily locate information about the drugs our patients are taking. It has the additional strength of letting you investigate drug-drug interactions and drug-supplement interactions. It is free, but may cost money to upgrade annually as new information becomes available. Glance at it here: http://itunes.apple.com/us/app/epocrates/id281935788?mt=8
NEJM This Week- this is a free app that allows you to scan new information coming from the New England Journal of Medicine, which is one of the world’s most influential medical journals. Here is an overview for the program: http://itunes.apple.com/us/app/nejm-this-week/id373156254?mt=8
iRadiology- I will defer to our radiologists for other recommendations for good apps, and I know we have our strengths here, but this is one of the top programs for interns and residents to use. Take a look here: http://itunes.apple.com/us/app/iradiology/id346440355?mt=8
There is a good overview of apps for doctors at http://blog.softwareadvice.com/articles/medical/the-best-medical-iphone-apps-for-doctors-and-med-students-1100709/. The author links you to a couple dozen excellent programs. This is an amazing technological innovation, and I would love to hear what apps you find most useful.
MedCalc 3000- you can read about this program at http://medcalc3000.com/pubapps/statist.htm. There are a number of different versions of the MedCalc program, some more for specialty physicians, but the one I note here has utility for those of us- which is all of us- involved in teaching with the tools of evidence-based practice. This little app lets you insert numbers from papers you read and then will calculate all sorts of statistics for you. Easy to use, intuitive and a good find. It costs $4.99, as noted above.
Med Calc- this is not related to the above app. This one is a more in-depth program that gives you access to many complicated formulas used in healthcare. For example, there is a body mass calculator in this program and there are many others. Take a look at http://itunes.apple.com/app/medcalc-medical-calculator/id299470331?mt=8. And it’s free.
Epocrates- we chiropractors cannot and do not prescribe drugs. But our patients still take them. And they take a lot of tem and of many different kinds. This program is the best available online phone-based app to easily locate information about the drugs our patients are taking. It has the additional strength of letting you investigate drug-drug interactions and drug-supplement interactions. It is free, but may cost money to upgrade annually as new information becomes available. Glance at it here: http://itunes.apple.com/us/app/epocrates/id281935788?mt=8
NEJM This Week- this is a free app that allows you to scan new information coming from the New England Journal of Medicine, which is one of the world’s most influential medical journals. Here is an overview for the program: http://itunes.apple.com/us/app/nejm-this-week/id373156254?mt=8
iRadiology- I will defer to our radiologists for other recommendations for good apps, and I know we have our strengths here, but this is one of the top programs for interns and residents to use. Take a look here: http://itunes.apple.com/us/app/iradiology/id346440355?mt=8
There is a good overview of apps for doctors at http://blog.softwareadvice.com/articles/medical/the-best-medical-iphone-apps-for-doctors-and-med-students-1100709/. The author links you to a couple dozen excellent programs. This is an amazing technological innovation, and I would love to hear what apps you find most useful.
Wednesday, September 28, 2011
Two More Interesting Articles
1. Janamian T, Myers SP, O’Rourke P, Eastwood H. Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice. BMC Compl Alternative Med 2011;11:77 doi:10.1186/1472-6882-11-77
ABSTRACT
Background: Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice.
Methods: The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs.
Results: Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs.
Conclusion: Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use.
2. Kitzman R. How local IRBs view central IRBs in the US. BMC Med Ethics 2011; 12:13doi:10.1186/1472-6939-12-13
ABSTRACT
Background: Centralization of IRB reviews have been increasing in the US and elsewhere, but many questions about it remain. In the US, a few centralized IRBs (CIRBs) have been established, but how they do and could operate remain unclear.
Methods: I contacted 60 IRBs (every fourth one in the list of the top 240 institutions by NIH funding), and interviewed leaders from 34 (response rate = 55%) and an additional 12 members and administrators.
Results: These interviewees had often interacted with CIRBs, but supported local reviews, and offered advantages and disadvantages of each. Interviewees argued that local IRBs can provide "local knowledge" of subjects and PIs, and "curbside consults" with PIs, facilitating mutual trust. PIs may interact more fully and informally, and hence effectively with local IRBs. IRBs also felt additional responsibility to protect "their own" subjects. Respondents mentioned a few advantages of CIRBs (e.g., CIRBs may streamline reviews), though far more rarely and cursorily. Overall, interviewees were wary of CIRBs, which they saw as varying widely in quality, depending on who happened to be members. Both local and centralized IRBs appear to have unintended consequences. For instance, discrepancies arose between IRBs that appeared to reflect differences in institutional culture and history, and personalities of chairs and/or vocal members, more than in local community values per se, and thus do not seem to be the intent of the regulations. While some critics see CIRBs as solutions to many IRB problems, critical tradeoffs and uncertainties emerge.
Conclusions: These data have critical implications for future policy and research. Debates need to evolve beyond simply a binary discussion of whether CIRBs should replace local IRBs, to examine how and to what degree different models might operate, and what the relative advantages and disadvantages of each are. While some critics see CIRBs as panaceas, certain problems appear likely to continue. Careful consideration needs to be given to whether the advantages of local IRBs outweigh the problems that result, and whether a system can be developed that provides these benefits, while avoiding the disadvantages of local IRBs.
ABSTRACT
Background: Australian General Practitioners (GPs) are in the forefront of primary health care and in an excellent position to communicate with their patients and educate them about Complementary Medicines (CMs) use. However previous studies have demonstrated that GPs lack the knowledge required about CMs to effectively communicate with patients about their CMs use and they perceive a need for information resources on CMs to use in their clinical practice. This study aimed to develop, implement, and evaluate a CMs information resource in Queensland (Qld) general practice.
Methods: The results of the needs assessment survey of Qld general practitioners (GPs) informed the development of a CMs information resource which was then put through an implementation and evaluation cycle in Qld general practice. The CMs information resource was a set of evidence-based herbal medicine fact sheets. This resource was utilised by 100 Qld GPs in their clinical practice for four weeks and was then evaluated. The evaluation assessed GPs' (1) utilisation of the resource (2) perceived quality, usefulness and satisfaction with the resource and (3) perceived impact of the resource on their knowledge, attitudes, and practice of CMs.
Results: Ninety two out of the 100 GPs completed the four week evaluation of the fact sheets and returned the post-intervention survey. The herbal medicine fact sheets produced by this study were well accepted and utilised by Qld GPs. The majority of GPs perceived that the fact sheets were a useful resource for their clinical practice. The fact sheets improved GPs' attitudes towards CMs, increased their knowledge of those herbal medicines and improved their communication with their patients about those specific herbs. Eighty-six percent of GPs agreed that if they had adequate resources on CMs, like the herbal medicine fact sheets, then they would communicate more to their patients about their use of CMs.
Conclusion: Further educational interventions on CMs need to be provided to GPs to increase their knowledge of CMs and to improve their communication with patients about their CMs use.
2. Kitzman R. How local IRBs view central IRBs in the US. BMC Med Ethics 2011; 12:13doi:10.1186/1472-6939-12-13
ABSTRACT
Background: Centralization of IRB reviews have been increasing in the US and elsewhere, but many questions about it remain. In the US, a few centralized IRBs (CIRBs) have been established, but how they do and could operate remain unclear.
Methods: I contacted 60 IRBs (every fourth one in the list of the top 240 institutions by NIH funding), and interviewed leaders from 34 (response rate = 55%) and an additional 12 members and administrators.
Results: These interviewees had often interacted with CIRBs, but supported local reviews, and offered advantages and disadvantages of each. Interviewees argued that local IRBs can provide "local knowledge" of subjects and PIs, and "curbside consults" with PIs, facilitating mutual trust. PIs may interact more fully and informally, and hence effectively with local IRBs. IRBs also felt additional responsibility to protect "their own" subjects. Respondents mentioned a few advantages of CIRBs (e.g., CIRBs may streamline reviews), though far more rarely and cursorily. Overall, interviewees were wary of CIRBs, which they saw as varying widely in quality, depending on who happened to be members. Both local and centralized IRBs appear to have unintended consequences. For instance, discrepancies arose between IRBs that appeared to reflect differences in institutional culture and history, and personalities of chairs and/or vocal members, more than in local community values per se, and thus do not seem to be the intent of the regulations. While some critics see CIRBs as solutions to many IRB problems, critical tradeoffs and uncertainties emerge.
Conclusions: These data have critical implications for future policy and research. Debates need to evolve beyond simply a binary discussion of whether CIRBs should replace local IRBs, to examine how and to what degree different models might operate, and what the relative advantages and disadvantages of each are. While some critics see CIRBs as panaceas, certain problems appear likely to continue. Careful consideration needs to be given to whether the advantages of local IRBs outweigh the problems that result, and whether a system can be developed that provides these benefits, while avoiding the disadvantages of local IRBs.
Monday, September 19, 2011
Themes for PowerPoint
In an excellent article entitled “12 tips for creating better PowerPoint presentations,” Stephanie Krieger offers these thoughts on making your slide presentation work better (1). She focuses here on the idea that your slides should grab viewers' attention. Her thought is that to create slides that grab attention you should learn how to use slides effectively and try not to pack your slides with dense text-based information. You should get in the habit of including only elements that contribute to the point you are trying to make. Consider the difference between a text-based slide presenting, say, information documenting the growth of an investment, compared to a slide demonstrating the same information in graphic format. The graphic format makes a much stronger point. This information is from Krieger's post on the MicroSoft website.
One way to help grab and keep your students’ attention is to select or create your own theme. Quoting directly from Krieger’s article on the MicroSoft website: “Themes are the evolution of design templates in PowerPoint, but they're also much more than that. Themes were introduced in Microsoft Office 2007 to help you easily create the right look for your presentations and to coordinate all of your Microsoft Office documents almost instantly.
A theme is a coordinated set of fonts, colors, and graphic effects that you can apply to your entire document with just a click. The same themes are available for your Microsoft PowerPoint presentations, Microsoft Word documents, Microsoft Excel workbooks, and even your Microsoft Outlook email messages (and, in Office 2010, your Microsoft Access database forms and reports), so it's easy to create your own personal or business branding throughout all of your documents.
In PowerPoint, the theme also includes the slide master, slide layouts (and slide background options). When you apply a theme in your presentation, you automatically get slide layouts, colors, fonts, and graphic effects that go together, and you can format content with just a few clicks. In the PowerPoint Ribbon (at the top of your screen), find many built-in themes on the Design tab. To preview a theme, in the Themes gallery, simply hover your pointer over it. In Office 2010, you also see a selection of themes in this gallery that are automatically updated periodically from Office.com.
Using the galleries on the Design tab, you can also mix and match a slide design with different theme colors, fonts, and effects to quickly create your own look. You can even easily create a completely custom theme. Note: If you change the theme in your presentation but the formatting doesn't change, you may not have used theme-ready formatting when you created your presentation. When you start with a new PowerPoint 2010 or PowerPoint 2007 presentation, theme-ready formatting is automatic for fonts and colors on slide layouts and for Microsoft Office graphics, such as SmartArt graphics, charts, and shapes.”
References
1. Krieger S. 12 tips for creating better PowerPoint presentations. http://www.microsoft.com/atwork/skills/presentations.aspx, accessed September 12, 2011
One way to help grab and keep your students’ attention is to select or create your own theme. Quoting directly from Krieger’s article on the MicroSoft website: “Themes are the evolution of design templates in PowerPoint, but they're also much more than that. Themes were introduced in Microsoft Office 2007 to help you easily create the right look for your presentations and to coordinate all of your Microsoft Office documents almost instantly.
A theme is a coordinated set of fonts, colors, and graphic effects that you can apply to your entire document with just a click. The same themes are available for your Microsoft PowerPoint presentations, Microsoft Word documents, Microsoft Excel workbooks, and even your Microsoft Outlook email messages (and, in Office 2010, your Microsoft Access database forms and reports), so it's easy to create your own personal or business branding throughout all of your documents.
In PowerPoint, the theme also includes the slide master, slide layouts (and slide background options). When you apply a theme in your presentation, you automatically get slide layouts, colors, fonts, and graphic effects that go together, and you can format content with just a few clicks. In the PowerPoint Ribbon (at the top of your screen), find many built-in themes on the Design tab. To preview a theme, in the Themes gallery, simply hover your pointer over it. In Office 2010, you also see a selection of themes in this gallery that are automatically updated periodically from Office.com.
Using the galleries on the Design tab, you can also mix and match a slide design with different theme colors, fonts, and effects to quickly create your own look. You can even easily create a completely custom theme. Note: If you change the theme in your presentation but the formatting doesn't change, you may not have used theme-ready formatting when you created your presentation. When you start with a new PowerPoint 2010 or PowerPoint 2007 presentation, theme-ready formatting is automatic for fonts and colors on slide layouts and for Microsoft Office graphics, such as SmartArt graphics, charts, and shapes.”
References
1. Krieger S. 12 tips for creating better PowerPoint presentations. http://www.microsoft.com/atwork/skills/presentations.aspx, accessed September 12, 2011
Monday, September 12, 2011
Three New Article of Interest
1. Tiffin PA, Finn GM, Mclachlan JC. Evaluating professionalism in medical undergraduates using selected response questions: findings from an item response modelling study. BMC Medical Education 2011, 11:43doi:10.1186/1472-6920-11-43
ABSTRACT
Background: Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods: Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results: Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions: SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
2. Klemenc-Ketis Z, Kersnick J. Using movies to teach professionalism to medical students. BMC Medical Education 2011, 11:60doi:10.1186/1472-6920-11-60
ABSTRACT (provisional)
Background: Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.
Method: This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 +/- 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.
Results: Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards their own life, death and dying.
Conclusions: The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.
3. White MR, Jacobson IG, Smith B, Wells TS, Gackstetter GD, Boyko EJ, Smith TC for the Millenium Cohort Study Team. Health care utilization among complementary and alternative medicine users in a large military cohort. BMC Complementary and Alternative Medicine 2011, 11:27doi:10.1186/1472-6882-11-27
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
ABSTRACT
Background: Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods: Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results: Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions: SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
2. Klemenc-Ketis Z, Kersnick J. Using movies to teach professionalism to medical students. BMC Medical Education 2011, 11:60doi:10.1186/1472-6920-11-60
ABSTRACT (provisional)
Background: Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.
Method: This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 +/- 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.
Results: Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards their own life, death and dying.
Conclusions: The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.
3. White MR, Jacobson IG, Smith B, Wells TS, Gackstetter GD, Boyko EJ, Smith TC for the Millenium Cohort Study Team. Health care utilization among complementary and alternative medicine users in a large military cohort. BMC Complementary and Alternative Medicine 2011, 11:27doi:10.1186/1472-6882-11-27
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
Tuesday, September 6, 2011
Starting Prezi
In order to use Prezi, you must first sign up and select a plan. Do not worry; one of the plans is completely free and will be more than sufficient for you to begin working in this platform. From the prezi welcome screen (http://www.prezi.com), simply click on “Sign up” and provide the necessary information to the system. You will be urged to select a screen name and a password when you do so. You have options regarding pricing, so simply check the one that is free; this will allow you to store your work on the Prezi server but not work offline.
Once you begin working in Prezi, you will see what is known as the “Prezi Bubble Menu.” This does not look like your typical Windows menu system, because each menu choice appears as a circle, or, like a bubble, if you will. There is one main center bubble and 5 smaller bubbles around it. This is where all the action takes place. You will have these bubbles to choose from:
Write Bubble: this is how you can add text to the presentation and then format the text.
Transformation Bubble: This bubble is actually located inside the Write Bubble, and it allows you to move, resize or rotate any object you upload into the canvas (the canvas being the “whiteboard “ space you place all items into).
Insert Bubble: This is a submenu that includes commands Load Files as well as the command Shapes.
Frame Bubble: this has submenus offering you Bracket, Circle, Rectangle, and Hidden Frame bubbles.
Path Bubble: here you find 1-2-3 ADD, Capture View and Delete All bubbles.
Colors and Fonts Bubble: here you get to select the style for your presentation.
There is also the Show Bubble, which is the one from which you will present. In Show mode, the Bubble menu disappears and planning lines on screen are removed. You can set Autoplay options here and set timing if you wish, and you can also manually zoom in and out.
To use Prezi, you need to have Adobe Flash 9.0 or higher, 1gb memory, and a mouse, with an operating system of Windows XP, Vista or 7 and Mac OS X. When you log onto Prezi, there are 3 tabs on the screen. One is “Your Prezis.” This is where you can access all the Prezis you create, and as you create a number fo these, you can also organize them so that you an easily locate the one you need. There is the “Learn” tab. Clicking on this will allow you locate training sessions in Prezi, at the beginner, intermediate and expert level- there are text documents as well as video clips. There are links to tips and ideas from other creators, and there is also a link to the Prezi manual. Finally, the last tab is “Explore.” This is a page that can link you to other people’s Prezis as well as to message board and community resources.
Please note that one of the links- at least as I write- is to a Prezi presentation about how to convert your PowerPoint presentations into a Prezi. I recommend looking at this and playing around with the system.
To see a Prezi in action, click on http://prezi.com/recyyolzxm3e/how-to-create-a-great-prezi/, and use the arrow button at the bottom of the screen to take you through a Prezi about creating great Prezis. Enjoy and play around with this.
Once you begin working in Prezi, you will see what is known as the “Prezi Bubble Menu.” This does not look like your typical Windows menu system, because each menu choice appears as a circle, or, like a bubble, if you will. There is one main center bubble and 5 smaller bubbles around it. This is where all the action takes place. You will have these bubbles to choose from:
Write Bubble: this is how you can add text to the presentation and then format the text.
Transformation Bubble: This bubble is actually located inside the Write Bubble, and it allows you to move, resize or rotate any object you upload into the canvas (the canvas being the “whiteboard “ space you place all items into).
Insert Bubble: This is a submenu that includes commands Load Files as well as the command Shapes.
Frame Bubble: this has submenus offering you Bracket, Circle, Rectangle, and Hidden Frame bubbles.
Path Bubble: here you find 1-2-3 ADD, Capture View and Delete All bubbles.
Colors and Fonts Bubble: here you get to select the style for your presentation.
There is also the Show Bubble, which is the one from which you will present. In Show mode, the Bubble menu disappears and planning lines on screen are removed. You can set Autoplay options here and set timing if you wish, and you can also manually zoom in and out.
To use Prezi, you need to have Adobe Flash 9.0 or higher, 1gb memory, and a mouse, with an operating system of Windows XP, Vista or 7 and Mac OS X. When you log onto Prezi, there are 3 tabs on the screen. One is “Your Prezis.” This is where you can access all the Prezis you create, and as you create a number fo these, you can also organize them so that you an easily locate the one you need. There is the “Learn” tab. Clicking on this will allow you locate training sessions in Prezi, at the beginner, intermediate and expert level- there are text documents as well as video clips. There are links to tips and ideas from other creators, and there is also a link to the Prezi manual. Finally, the last tab is “Explore.” This is a page that can link you to other people’s Prezis as well as to message board and community resources.
Please note that one of the links- at least as I write- is to a Prezi presentation about how to convert your PowerPoint presentations into a Prezi. I recommend looking at this and playing around with the system.
To see a Prezi in action, click on http://prezi.com/recyyolzxm3e/how-to-create-a-great-prezi/, and use the arrow button at the bottom of the screen to take you through a Prezi about creating great Prezis. Enjoy and play around with this.
Monday, August 29, 2011
Prezi
Prezi is on online software program that provides you with a new method of presenting information. It’s strength, as you will see, is that it works in non-linear fashion, as opposed to a standard PowerPoint presentation. As a result, it can better engage your students as they grapple with the information you wish to teach them.
Presentation technology has certainly evolved in the 31 years I have been involved in chiropractic academia. There was a time when I used a mimeograph machine to make copies of information for students. This was supplanted in the early 1980s by the use of slide technology. We had slides in carousels that we took to class. We turned off the lights and clicked through our slides. It was costly to make them (and often they were converted from overhead projections we had made earlier) , and it took special expertise to photograph pictures from texts, but make them we did. Then I got my first computer, back in 1984, a Macintosh 2e. The world changed! I could begin to make my own graphics, from drawing and paint programs, and later from clip art and online sources. PowerPoint became ascendant (as did its detractors- see my old columns on Death by PowerPoint). Today, virtually all faculty at Palmer who teach in a lecture hall use PowerPoint in one way or another and for better or for worse. And PowerPoint is strictly linear; you move from slide to slide and from bullet point to bullet point. Where Prezi differs is that it allows for movement. The screen has layers and you can zoom in and out and around those layers.
Prezi describes itself as a digital storytelling tool. In the instruction book that I have (1), the author makes the following comment: “Most slide programs dictate a process. They’re set up to organize material for a presenter to talk about in a linear fashion, which is great for the presenter but not always great for the audience. Prezi, on the other hand, uses content to create a story line. With Prezi, the organization of the material doesn’t dictate a particular process- the story does.”
Prezi requires you to think differently about how you wish to present material. Next week I will provide a bit of information on how to get going with it, but for this week, let me leave you with a link to a Prezi presentation on its many uses. Simply go to http://prezi.com/jipjiqvj6dsc/about-perspective/ and click on play to begin seeing how you might incorporate this technology into your classroom settings. Enjoy!
References
1. Diamond S. Prezi for dummies. Hoboken, NJ; Wiley and Sons, 2010.
Presentation technology has certainly evolved in the 31 years I have been involved in chiropractic academia. There was a time when I used a mimeograph machine to make copies of information for students. This was supplanted in the early 1980s by the use of slide technology. We had slides in carousels that we took to class. We turned off the lights and clicked through our slides. It was costly to make them (and often they were converted from overhead projections we had made earlier) , and it took special expertise to photograph pictures from texts, but make them we did. Then I got my first computer, back in 1984, a Macintosh 2e. The world changed! I could begin to make my own graphics, from drawing and paint programs, and later from clip art and online sources. PowerPoint became ascendant (as did its detractors- see my old columns on Death by PowerPoint). Today, virtually all faculty at Palmer who teach in a lecture hall use PowerPoint in one way or another and for better or for worse. And PowerPoint is strictly linear; you move from slide to slide and from bullet point to bullet point. Where Prezi differs is that it allows for movement. The screen has layers and you can zoom in and out and around those layers.
Prezi describes itself as a digital storytelling tool. In the instruction book that I have (1), the author makes the following comment: “Most slide programs dictate a process. They’re set up to organize material for a presenter to talk about in a linear fashion, which is great for the presenter but not always great for the audience. Prezi, on the other hand, uses content to create a story line. With Prezi, the organization of the material doesn’t dictate a particular process- the story does.”
Prezi requires you to think differently about how you wish to present material. Next week I will provide a bit of information on how to get going with it, but for this week, let me leave you with a link to a Prezi presentation on its many uses. Simply go to http://prezi.com/jipjiqvj6dsc/about-perspective/ and click on play to begin seeing how you might incorporate this technology into your classroom settings. Enjoy!
References
1. Diamond S. Prezi for dummies. Hoboken, NJ; Wiley and Sons, 2010.
Monday, August 22, 2011
Preparing for ACC-RAC 2012
We are coming close to the deadline for submissions of abstracts to the upcoming Association of Chiropractic Colleges Research Agenda Conference, which will be held at the Treasure Island Hotel in Las Vegas in March of 2012. Last year, Palmer College had a tremendous showing, comprising nearly a third of all papers and workshops presented at the 2011 program. I am hoping we will continue to have such a huge presence at this program, and encourage you to consider submitting your work.
I do wish to remind you that if you are conducting human subject research you must have approval from the PCC Institutional Review Board or from the Human Protections Administrator in the case of exempt studies. College policy prevents us from granting approval retroactively, and this makes sense. The purpose for IRB review is to assess human risk and benefit, and obviously this can't be done after the fact. Risk has to be assessed prior to the entry of a person into a study.
Instructions for the conference submission can be found at http://www.chirocolleges.org/accrac/. The organizers note that the theme for this next program is “Diversity,” but that you may feel free to submit papers from a variety of disciplines: basic science, clinical science/health care systems, and educational research. You will need to prepare both a short abstract (limited to 195 words) and a longer and more detailed abstract (of up to 2100 words). In addition, you must submit an authorship form and provide information about IRB approval where it is appropriate to do so. Also, if you are presenting a case report, you will need to provide a signed patient release form with your submission. These are required, and copies of each form are included with the submission requirements on the website. The instructions have one statement worth noting: “If the submission does not meet the submission requirements (e.g., not a completed research study, missing items), it will be rejected without review. The ACC RAC Peer Review Chair will not contact authors if any submission does not meet the requirements. Notification will be sent out as a rejection notice.”
The Center for Teaching and Learning can help you with preparation of your material. I can help review your abstracts to ensure they comply with submission requirements, and if you are later accepted, we can help you develop your slides (using college templates) and your posters. Please also note that in addition to submitting your own research or other scholarship, you can also propose workshops. As example, I have submitted one with Stu Kinsinger of CMCC about the bioethical principle of autonomy in research and clinical practice.
We have done so well with past conferences. Let’s all work together to continue the streak. I know I have reviewed a growing number of submissions, and let’s send in more. Looking forward to it!
I do wish to remind you that if you are conducting human subject research you must have approval from the PCC Institutional Review Board or from the Human Protections Administrator in the case of exempt studies. College policy prevents us from granting approval retroactively, and this makes sense. The purpose for IRB review is to assess human risk and benefit, and obviously this can't be done after the fact. Risk has to be assessed prior to the entry of a person into a study.
Instructions for the conference submission can be found at http://www.chirocolleges.org/accrac/. The organizers note that the theme for this next program is “Diversity,” but that you may feel free to submit papers from a variety of disciplines: basic science, clinical science/health care systems, and educational research. You will need to prepare both a short abstract (limited to 195 words) and a longer and more detailed abstract (of up to 2100 words). In addition, you must submit an authorship form and provide information about IRB approval where it is appropriate to do so. Also, if you are presenting a case report, you will need to provide a signed patient release form with your submission. These are required, and copies of each form are included with the submission requirements on the website. The instructions have one statement worth noting: “If the submission does not meet the submission requirements (e.g., not a completed research study, missing items), it will be rejected without review. The ACC RAC Peer Review Chair will not contact authors if any submission does not meet the requirements. Notification will be sent out as a rejection notice.”
The Center for Teaching and Learning can help you with preparation of your material. I can help review your abstracts to ensure they comply with submission requirements, and if you are later accepted, we can help you develop your slides (using college templates) and your posters. Please also note that in addition to submitting your own research or other scholarship, you can also propose workshops. As example, I have submitted one with Stu Kinsinger of CMCC about the bioethical principle of autonomy in research and clinical practice.
We have done so well with past conferences. Let’s all work together to continue the streak. I know I have reviewed a growing number of submissions, and let’s send in more. Looking forward to it!
Monday, August 15, 2011
Setting Limits
I am quite enjoying the slight text “The Power of Less: The Fine Art of Limiting Yourself to the Essential… in Business and in Life” by Leo Babauta (1). It is a text that is designed to help you become more productive and effective in your work, largely by streamlining your life and focusing on what is essential. He notes that our lives have become cluttered; there is too much information, too much to do, too much clutter (yes, have you seen some faculty offices?). So we have what seems like unlimited work but limited time, and we have trouble trying to get all of everything done. We live without limits, so to say.
Being limitless is weak, according to Babauta. Learning to focus yourself with limits helps increase strength. Having limits simplifies things, so that life become manageable. It helps focus you, so that you put your energy toward a smaller number of things. It helps you focus on what is important, so that you stop trying to do everything but get done what is important to you. As a result, it helps you achieve. By focusing on a smaller number of things, we can actually get them done. It helps you show others that your time is important; we no longer say yes to everything, but only to those things that we know are important. And we become more effective.
We should set limits on all that we do. Think of how you would address this with regard to trying to do the following: answer emails, address daily tasks, talk on the phone, work on projects and reports, read information on the net and in print, address everything on your desk. When you first set limits, doing so might be arbitrary. How often should you check email? I know that I fail here; I tend to respond to emails as they arrive on my desktop. I need to stop doing so, since that interrupts what I am already doing, breaking my concentration. So perhaps I will check email every 3 hours- but that may or may not be best if so many come in over that period.
Babauta suggests that you analyze your current usage levels for a given activity, and then pick a lower limit. Test it out for about a week and see if it is working for you. If it does not, adjust it to a different level and test again. Do so until you find the level that works. I suggest you start with your email. Try to change your pattern and see if that works for you.
References
1. Babauta L. The power of less: the fine art of limiting yourself to the essential… in business and in life. New York City, NY; Hyperion 2009
Being limitless is weak, according to Babauta. Learning to focus yourself with limits helps increase strength. Having limits simplifies things, so that life become manageable. It helps focus you, so that you put your energy toward a smaller number of things. It helps you focus on what is important, so that you stop trying to do everything but get done what is important to you. As a result, it helps you achieve. By focusing on a smaller number of things, we can actually get them done. It helps you show others that your time is important; we no longer say yes to everything, but only to those things that we know are important. And we become more effective.
We should set limits on all that we do. Think of how you would address this with regard to trying to do the following: answer emails, address daily tasks, talk on the phone, work on projects and reports, read information on the net and in print, address everything on your desk. When you first set limits, doing so might be arbitrary. How often should you check email? I know that I fail here; I tend to respond to emails as they arrive on my desktop. I need to stop doing so, since that interrupts what I am already doing, breaking my concentration. So perhaps I will check email every 3 hours- but that may or may not be best if so many come in over that period.
Babauta suggests that you analyze your current usage levels for a given activity, and then pick a lower limit. Test it out for about a week and see if it is working for you. If it does not, adjust it to a different level and test again. Do so until you find the level that works. I suggest you start with your email. Try to change your pattern and see if that works for you.
References
1. Babauta L. The power of less: the fine art of limiting yourself to the essential… in business and in life. New York City, NY; Hyperion 2009
Monday, August 8, 2011
New Papers of Interest
Mirtz T, Perle S. The prevalence of the term subluxation in North American English-Language Doctor of chiropractic programs. Chiro Man Ther 2011; 2011,19:14
ABSTRACT
Background: The subluxation construct has been a divisive term in the chiropractic profession. There is a paucity of evidence to document the subluxation. Some authors have questioned the propriety of continuing to use the term.
Aim: The purpose of this study is to examine current North American English language chiropractic college academic catalogs and determine the prevalence of the term subluxation in the respective chiropractic program curricula.
Methods: Sixteen current English-language North American chiropractic college academic catalogs were studied. The term subluxation was searched for in each of the catalogs. Categories were developed for the usage of the term. These included "total times mentioned", "subluxation mentioned in a course description", "subluxation mentioned in a course title", "subluxation mentioned in a technique course description", and "subluxation mentioned in a philosophy course description." The prevalence of the "subluxation mentioned in a course description" was compared to the total programmatic curriculum.
Results: Palmer College in Florida devoted 22.72% of its curriculum to courses mentioning the subluxation followed by Life University (Marietta, GA) and Sherman College with 16.44% and 12.80% respectively. As per specific coursework or subjects, an average of 5.22 courses or subjects have descriptions mentioning the term subluxation. Three schools made no mention of the term subluxation in their academic catalogs; they were National University of Health Sciences, Canadian Memorial Chiropractic College, and Southern California University of Health Sciences.
Conclusion: Despite the controversies and paucity of evidence the term subluxation is still found often within the chiropractic curricula of most North American chiropractic programs. Future research should determine if changes in accreditation standards and research on evidence based practice will affect this prevalence.
White MR, Jacobson IG, Smith B, Wells TS, Gackstetter GD, Boyko EJ, Smith TC and the Millennial Cohort Study team. Health care utilization among complementary and alternative medicine users in a large military cohort. BMC Compl Alternative Med 2011,11:27
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
Tiffin PA, Finn GM, McLachlan JC. Evaluating professionalism in medical undergraduates using selected response questions: findings from an item response modelling study. BMC Med Educ 2011,11:43
ABSTRACT
Background: Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods: Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results: Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions: SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
ABSTRACT
Background: The subluxation construct has been a divisive term in the chiropractic profession. There is a paucity of evidence to document the subluxation. Some authors have questioned the propriety of continuing to use the term.
Aim: The purpose of this study is to examine current North American English language chiropractic college academic catalogs and determine the prevalence of the term subluxation in the respective chiropractic program curricula.
Methods: Sixteen current English-language North American chiropractic college academic catalogs were studied. The term subluxation was searched for in each of the catalogs. Categories were developed for the usage of the term. These included "total times mentioned", "subluxation mentioned in a course description", "subluxation mentioned in a course title", "subluxation mentioned in a technique course description", and "subluxation mentioned in a philosophy course description." The prevalence of the "subluxation mentioned in a course description" was compared to the total programmatic curriculum.
Results: Palmer College in Florida devoted 22.72% of its curriculum to courses mentioning the subluxation followed by Life University (Marietta, GA) and Sherman College with 16.44% and 12.80% respectively. As per specific coursework or subjects, an average of 5.22 courses or subjects have descriptions mentioning the term subluxation. Three schools made no mention of the term subluxation in their academic catalogs; they were National University of Health Sciences, Canadian Memorial Chiropractic College, and Southern California University of Health Sciences.
Conclusion: Despite the controversies and paucity of evidence the term subluxation is still found often within the chiropractic curricula of most North American chiropractic programs. Future research should determine if changes in accreditation standards and research on evidence based practice will affect this prevalence.
White MR, Jacobson IG, Smith B, Wells TS, Gackstetter GD, Boyko EJ, Smith TC and the Millennial Cohort Study team. Health care utilization among complementary and alternative medicine users in a large military cohort. BMC Compl Alternative Med 2011,11:27
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
Tiffin PA, Finn GM, McLachlan JC. Evaluating professionalism in medical undergraduates using selected response questions: findings from an item response modelling study. BMC Med Educ 2011,11:43
ABSTRACT
Background: Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods: Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results: Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions: SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
Monday, August 1, 2011
Transforming a Presentation into a Publication
I am just back from riding RAGBRAI, which this year involved 500 miles of biking over a 7-day period. I have to say it was hot, and one day it hit 101 degrees. But overall it was great fun and a superb ride. And coming into davenport at the very end was a nice touch; I was able to ride my bike home, a real treat in that I did not have to disassemble it to ship it home from a distant location. And Davenport looked great itself with all the Bix runners and RAGBRAI riders.
I had planned to continue presenting a continuation of my last two entries, but I came across a useful little paper that provides information on how to transform a presentation into a publication (1). It is well known that the yield of papers from conference presentations is rather low, usually around 10%. I am mindful that we had well over 30 papers presented at ACC-RAC last year, and if this rule were to hold true, at best we would see only 3 papers published. I would like to think we could do better than that, so this paper is timely. Let’s look at its suggestions.
The author recommends that you use PowerPoint for facilitating the transformation of a conference presentation into a potentially publishable article. This provides you the means to develop an outline of key ideas and topics, and the notes page allows you to add your own thoughts as you work out the details. In essence, this is similar to how some of us develop lectures. Schrager suggests you follow these steps:
1. Determine if the topic is appropriate for publication. Is your topic important and one that has not been adequately covered in the literature. Are you offering a new educational approach or a new look at an old topic? If the answer to such question is “no,” then perhaps this might not make a good paper for publication. But you might even then be able to prepare a review of that topic.
2. Identify a journal for the article. This will depend on the topic, the type or article and the audience you wish to reach. We have relatively few journals in our profession to choose from, but for educational papers the Journal of Chiropractic Education makes sense; other journals may also accept such papers. Make sure your content matches the goals of the journal you are submitting to.
3. Develop the article content. Set aside some time to ponder the ideas you wish to incorporate into your paper. Do a literature search on that topic as well so that you are grounded in the area to be discussed. Look for the best evidence-based information that is out there.
4. Write the manuscript. Now, you have to write. Keep mindful that you need to be more formal in your manuscript than you might have been in making a verbal presentation. Here at Palmer you have a CTL that will help you with writing and manuscript presentation. We have a dedicated wiki for developing papers, where I can immediately go in and help edit or work with you on your paper. If you are interested but do not have access, let me know and I can direct you to the site. Do not try to be perfect; it will frustrate you and that is why we have editors.
With just a little effort we can turn our ACC-RAC presentations into manuscripts and increase our yield of published papers. I am happy to help you do so.
References
1. Schrager S. Transforming your presentation into a publication. Fam Med 2010;42:268-272
I had planned to continue presenting a continuation of my last two entries, but I came across a useful little paper that provides information on how to transform a presentation into a publication (1). It is well known that the yield of papers from conference presentations is rather low, usually around 10%. I am mindful that we had well over 30 papers presented at ACC-RAC last year, and if this rule were to hold true, at best we would see only 3 papers published. I would like to think we could do better than that, so this paper is timely. Let’s look at its suggestions.
The author recommends that you use PowerPoint for facilitating the transformation of a conference presentation into a potentially publishable article. This provides you the means to develop an outline of key ideas and topics, and the notes page allows you to add your own thoughts as you work out the details. In essence, this is similar to how some of us develop lectures. Schrager suggests you follow these steps:
1. Determine if the topic is appropriate for publication. Is your topic important and one that has not been adequately covered in the literature. Are you offering a new educational approach or a new look at an old topic? If the answer to such question is “no,” then perhaps this might not make a good paper for publication. But you might even then be able to prepare a review of that topic.
2. Identify a journal for the article. This will depend on the topic, the type or article and the audience you wish to reach. We have relatively few journals in our profession to choose from, but for educational papers the Journal of Chiropractic Education makes sense; other journals may also accept such papers. Make sure your content matches the goals of the journal you are submitting to.
3. Develop the article content. Set aside some time to ponder the ideas you wish to incorporate into your paper. Do a literature search on that topic as well so that you are grounded in the area to be discussed. Look for the best evidence-based information that is out there.
4. Write the manuscript. Now, you have to write. Keep mindful that you need to be more formal in your manuscript than you might have been in making a verbal presentation. Here at Palmer you have a CTL that will help you with writing and manuscript presentation. We have a dedicated wiki for developing papers, where I can immediately go in and help edit or work with you on your paper. If you are interested but do not have access, let me know and I can direct you to the site. Do not try to be perfect; it will frustrate you and that is why we have editors.
With just a little effort we can turn our ACC-RAC presentations into manuscripts and increase our yield of published papers. I am happy to help you do so.
References
1. Schrager S. Transforming your presentation into a publication. Fam Med 2010;42:268-272
Monday, July 18, 2011
Single Tasking
This follows-up from the post from last week which examines the work of Leo Babauta (1). He had recommended that we use simple focus to help us be more efficient at work and get more done. He noted that we typically find ourselves multi-tasking and he suggests that there are 3 reason to not do so: (1) It is less efficient, because you need to continually switch gears to do so; (2) it is more complicated to potentially can lead to greater error and fatigue; and (3) it can be “crazy-making,” where we need to find calm. So he offers suggestions on how to single-task.
1. He recommends that when you get arrive in the morning, work on the most important task of the day, and don’t do anything else until this is completed. Take a break and then begin work on the second-most important task. Get that much done and your day is already golden.
2. When you are working on a task, turn off all other distractions, including email and cell phone and try not to answer your land-line phone. Focus on the task at hand.
3. When the urge to check email occurs, take a breath and refocus on what you are doing.
4. If other work arrives while you are at your original work, put it aside and return to the task.
5. Every now and again, look at the newly arrived work and reconfigure what is most important. Process emails and phone calls at a predetermined interval.
6. If an urgent interruption occurs, and they will, make notes of what you are doing, what your thoughts are on the task you were working on so that when you return to it you can pick up where you left off.
7. Take breaks every now and again- get up, stretch, go outside, stay sane.
I find I can do much of this, but that I tend to answer emails very quickly. I am trying to be less aware of the urgent need to do so, since that need is always present. But it requires attention.
When I return from RAGBRAI the week after next, I will discuss what Babauta suggests about focusing on the present.
References
1. Babuta L. The power of less. New York City, NY; Hyperion Press, 2009
1. He recommends that when you get arrive in the morning, work on the most important task of the day, and don’t do anything else until this is completed. Take a break and then begin work on the second-most important task. Get that much done and your day is already golden.
2. When you are working on a task, turn off all other distractions, including email and cell phone and try not to answer your land-line phone. Focus on the task at hand.
3. When the urge to check email occurs, take a breath and refocus on what you are doing.
4. If other work arrives while you are at your original work, put it aside and return to the task.
5. Every now and again, look at the newly arrived work and reconfigure what is most important. Process emails and phone calls at a predetermined interval.
6. If an urgent interruption occurs, and they will, make notes of what you are doing, what your thoughts are on the task you were working on so that when you return to it you can pick up where you left off.
7. Take breaks every now and again- get up, stretch, go outside, stay sane.
I find I can do much of this, but that I tend to answer emails very quickly. I am trying to be less aware of the urgent need to do so, since that need is always present. But it requires attention.
When I return from RAGBRAI the week after next, I will discuss what Babauta suggests about focusing on the present.
References
1. Babuta L. The power of less. New York City, NY; Hyperion Press, 2009
Tuesday, July 12, 2011
Simple Focus
Let me welcome you all back from what I hope has been a restful summer break. Over the past couple of weeks I have been able to catch my breath and think about the nature of the work I do. I have come to realize that in general terms I am all about efficiencies; put another way, I seem to be unable to look at a task and not find some way to do it better and more promptly. I suppose it is a good thing I was never a member of the Armed Services; I can see a superior officer giving me something to do and me telling the officer that there is a better way to do it…
But here is the point. We live in world that requires us to multitask all the time. We never seem to have time to focus only on a single task; that is, we no longer single task. All day long we are interrupted by email messages which ping as soon as they arrive, signaling that an answer is needed now; we have meetings where much is discussed but little is done; we have students walking in unannounced, and we have a need to make sure we get done all we need to get done. And this never seems to happen, so there is never any closure. I have, in the past, discussed the tyranny of email. But I recently found a little book entitled “The Power of Less” by Leo Babuta (1). It is subtitled “the fine art of limiting yourself to the essential… in business and in life.” And within the pages of this slim text is some very good advice.
The book provides a set of principles designed to help reduce the complexity of your life. One such is Principle 4: Focus is your most important tool in becoming more effective. And Babuta recommends that you should focus on a single goal rather than many; that is, he suggests we return to single tasking. Focus on what needs to be done now. Earlier in my career , I was incredibly single-minded when it came to getting jobs done. I could not rest until I had it completed, but I was able to focus on just that task and that task alone. It is rarer for me today to be able to do that; I have classes and preparation time, meetings, a need to contact faculty to help them with publication and teaching, IRB matters to attend to, research, my own scholarly work, and so on. All of this overlaps, and none have specific deadlines.
Babuta recommends that you focus on a goal, and maintain that focus; this will, more than anything, ensure you complete the task. He says to focus on now, keeping your mind on the present and not the future. This, he says, takes practice. He strongly says to focus on the task at hand, hoping that you can become so lost in the work that you may even lost track of time. To do so, you need to have no distractions, and that can be hard. And he says to focus on the positive. Replace negative thoughts with positive- yes, there is work to do, but that is why we are here, and that should be a joy. I remember my dad telling me that one of the greatest things is to wake up in the morning and look forward to going to work. I do, and consider myself fortunate in that regard, but can all of us say that?
I will have more to say about this next week.
References
1. Babuta L. The power of less. New York City, NY; Hyperion Press, 2009
But here is the point. We live in world that requires us to multitask all the time. We never seem to have time to focus only on a single task; that is, we no longer single task. All day long we are interrupted by email messages which ping as soon as they arrive, signaling that an answer is needed now; we have meetings where much is discussed but little is done; we have students walking in unannounced, and we have a need to make sure we get done all we need to get done. And this never seems to happen, so there is never any closure. I have, in the past, discussed the tyranny of email. But I recently found a little book entitled “The Power of Less” by Leo Babuta (1). It is subtitled “the fine art of limiting yourself to the essential… in business and in life.” And within the pages of this slim text is some very good advice.
The book provides a set of principles designed to help reduce the complexity of your life. One such is Principle 4: Focus is your most important tool in becoming more effective. And Babuta recommends that you should focus on a single goal rather than many; that is, he suggests we return to single tasking. Focus on what needs to be done now. Earlier in my career , I was incredibly single-minded when it came to getting jobs done. I could not rest until I had it completed, but I was able to focus on just that task and that task alone. It is rarer for me today to be able to do that; I have classes and preparation time, meetings, a need to contact faculty to help them with publication and teaching, IRB matters to attend to, research, my own scholarly work, and so on. All of this overlaps, and none have specific deadlines.
Babuta recommends that you focus on a goal, and maintain that focus; this will, more than anything, ensure you complete the task. He says to focus on now, keeping your mind on the present and not the future. This, he says, takes practice. He strongly says to focus on the task at hand, hoping that you can become so lost in the work that you may even lost track of time. To do so, you need to have no distractions, and that can be hard. And he says to focus on the positive. Replace negative thoughts with positive- yes, there is work to do, but that is why we are here, and that should be a joy. I remember my dad telling me that one of the greatest things is to wake up in the morning and look forward to going to work. I do, and consider myself fortunate in that regard, but can all of us say that?
I will have more to say about this next week.
References
1. Babuta L. The power of less. New York City, NY; Hyperion Press, 2009
Monday, June 13, 2011
End of the Term
Once again we find ourselves at the end of another term. I hope that everything went well for you, and in celebration of our coming vacation time, it is once again time for a set of interesting youtube clips:
1. Dan Osman speed climbing hard rock, without a rope. Insane! http://www.youtube.com/watch?v=8e0yXMa708Y&feature=related
2. Hiroyuki Suzuki and his yoyo- you have never seen yoyos do what Suzuki makes them do: http://www.youtube.com/watch?v=XvG3IK-hzRs
3. Anthony Bourdain gets schooled by a 10-year-old. This is the most amazing kid in the world and does she do a number on old Tony! http://www.youtube.com/watch?v=uVQk5NlGEBs
4. River and Book on the Bible: From Joss Whedon’s show “Firefly.” River, a savant, cannot understand either the Bible or Shepherd Book’s hair. http://www.youtube.com/watch?v=BNkcK2toExY
5. Ellen Page’s hidden talent. She is not only a gifted actress! http://www.youtube.com/watch?v=jhTaQizF4z4
6. Jonathon conducts Beethoven’s 5th symphony. Of course, Jonathan in only 3 years old. http://www.youtube.com/watch?v=0REJ-lCGiKU
7. The Cleverlys do Hocus Pocus. You’ll remember the song, but you ain’t never heard it this way! http://www.youtube.com/watch?v=WLgMfbGsxZ0
8. Julie Driscoll. These days she is best known for the title song to the British show Ab Fab (This Wheel’s on Fire) but she was one of the great voices of the late 1960’s Here’s why: http://www.youtube.com/watch?v=9aw-i7BzqH4&feature=player_embedded#at=14
9. Brazilian downhill mountain bike race: This’ll scare the death out of you: http://www.youtube.com/watch?v=56kJ99AvfoI
10. RAGBRAI- it’s coming up. (Please be warned of one profanity in this clip toward the end). http://www.youtube.com/watch?v=Pwf-B0mi_4I
That’s it for the moment, everyone. I’ll be back in July when we come back to work. Peace out!
1. Dan Osman speed climbing hard rock, without a rope. Insane! http://www.youtube.com/watch?v=8e0yXMa708Y&feature=related
2. Hiroyuki Suzuki and his yoyo- you have never seen yoyos do what Suzuki makes them do: http://www.youtube.com/watch?v=XvG3IK-hzRs
3. Anthony Bourdain gets schooled by a 10-year-old. This is the most amazing kid in the world and does she do a number on old Tony! http://www.youtube.com/watch?v=uVQk5NlGEBs
4. River and Book on the Bible: From Joss Whedon’s show “Firefly.” River, a savant, cannot understand either the Bible or Shepherd Book’s hair. http://www.youtube.com/watch?v=BNkcK2toExY
5. Ellen Page’s hidden talent. She is not only a gifted actress! http://www.youtube.com/watch?v=jhTaQizF4z4
6. Jonathon conducts Beethoven’s 5th symphony. Of course, Jonathan in only 3 years old. http://www.youtube.com/watch?v=0REJ-lCGiKU
7. The Cleverlys do Hocus Pocus. You’ll remember the song, but you ain’t never heard it this way! http://www.youtube.com/watch?v=WLgMfbGsxZ0
8. Julie Driscoll. These days she is best known for the title song to the British show Ab Fab (This Wheel’s on Fire) but she was one of the great voices of the late 1960’s Here’s why: http://www.youtube.com/watch?v=9aw-i7BzqH4&feature=player_embedded#at=14
9. Brazilian downhill mountain bike race: This’ll scare the death out of you: http://www.youtube.com/watch?v=56kJ99AvfoI
10. RAGBRAI- it’s coming up. (Please be warned of one profanity in this clip toward the end). http://www.youtube.com/watch?v=Pwf-B0mi_4I
That’s it for the moment, everyone. I’ll be back in July when we come back to work. Peace out!
Monday, June 6, 2011
Scanning the Literature
It is certainly clear that we live in an information society, where access to information is pervasive, from books and journals to online websites, blogs, podcasts and more. But given this crush of information, how do we go about gleaning the critical information from a given piece of research? Rosser (1) provides a bit of guidance on how to assess an article for its applicability to the question that drive you to find the article in the first place. He suggests you consider the following:
1. The authors: knowledge of the authors and their work may influence you to select an article for assessment.
2. Abstracts: this allows you to get a sense of the value of the article without having to read the entire piece. This saves you time in a very busy schedule. Since most journals now use structured abstracts, look for the following information to be included.
a. Objectives: are these clearly stated? If not, the article may be of little value.
b. Methods: Methods need to be clearly and transparently described. I have referred to this as: could you repeat what they authors have done based on their description of their methods? In an abstract, look to see if the authors provide information about the study population (so you know if theirs is comparable to yours). Lack of strong methods may compromise the paper and suggest significant bias exists. You should also understand study design. Common designs you will confront include:
i. Descriptive reports: These have value because they allow a hypothesis to be generated in a more rigorous fashion.
ii. Case-control studies: These are typically used to understand disease causation. These are usually retrospective, and involve examination of medical records. The idea is to go back in time, look to see if there was an exposure to some risk factor in the two groups involved, the cases and the controls. From this information, one can calculate an odds ratio, or a ratio of the odds of the exposure in the disease group divided by the odds in the unexposed group.
iii. Cohort studies: Here, instead of going back in time, we go forward, with a group of individuals none of whom have the condition of interest. They are followed over time and then we look to see how an exposure correlates to the development of condition of interest. An example here would the famous Framingham study, looking at cardiovascular risk factors that developed in members of that community, many of whom were followed for more than 40 years. From this, we can calculate risk ratios, a ratio of the risk of developing the condition in the exposed group to the risk in the unexposed group.
iv. Randomized controlled trial: a study which, as we know, is designed to allow us to test an intervention in an experimental group and compare results to a control group of some sort.
v. Meta-analysis: a method where the data from several controlled trials are collapsed into a larger group for statistical analysis. This increases power and may reveal a more accurate effect size for an intervention.
c. Results: In the abstract, the results should report number of participants, and important group statistics. The important findings should be highlighted.
d. Conclusion: these should be specific and answer the question delineated in the objective section.
This is imply information from the abstract, but paying attention to this alone can help you scan articles quickly, locate those to read in more detail, and save you time and energy.
References
1. Rosser WW. Looking right down to the pores. Why it is important to learn how to read journals. In: Rosser WW, Slawson DC, Shaughnessy AF. Information mastery: evidence-based family practice. Hamilton, ON; BC Decker, Inc., 2004:76-82
1. The authors: knowledge of the authors and their work may influence you to select an article for assessment.
2. Abstracts: this allows you to get a sense of the value of the article without having to read the entire piece. This saves you time in a very busy schedule. Since most journals now use structured abstracts, look for the following information to be included.
a. Objectives: are these clearly stated? If not, the article may be of little value.
b. Methods: Methods need to be clearly and transparently described. I have referred to this as: could you repeat what they authors have done based on their description of their methods? In an abstract, look to see if the authors provide information about the study population (so you know if theirs is comparable to yours). Lack of strong methods may compromise the paper and suggest significant bias exists. You should also understand study design. Common designs you will confront include:
i. Descriptive reports: These have value because they allow a hypothesis to be generated in a more rigorous fashion.
ii. Case-control studies: These are typically used to understand disease causation. These are usually retrospective, and involve examination of medical records. The idea is to go back in time, look to see if there was an exposure to some risk factor in the two groups involved, the cases and the controls. From this information, one can calculate an odds ratio, or a ratio of the odds of the exposure in the disease group divided by the odds in the unexposed group.
iii. Cohort studies: Here, instead of going back in time, we go forward, with a group of individuals none of whom have the condition of interest. They are followed over time and then we look to see how an exposure correlates to the development of condition of interest. An example here would the famous Framingham study, looking at cardiovascular risk factors that developed in members of that community, many of whom were followed for more than 40 years. From this, we can calculate risk ratios, a ratio of the risk of developing the condition in the exposed group to the risk in the unexposed group.
iv. Randomized controlled trial: a study which, as we know, is designed to allow us to test an intervention in an experimental group and compare results to a control group of some sort.
v. Meta-analysis: a method where the data from several controlled trials are collapsed into a larger group for statistical analysis. This increases power and may reveal a more accurate effect size for an intervention.
c. Results: In the abstract, the results should report number of participants, and important group statistics. The important findings should be highlighted.
d. Conclusion: these should be specific and answer the question delineated in the objective section.
This is imply information from the abstract, but paying attention to this alone can help you scan articles quickly, locate those to read in more detail, and save you time and energy.
References
1. Rosser WW. Looking right down to the pores. Why it is important to learn how to read journals. In: Rosser WW, Slawson DC, Shaughnessy AF. Information mastery: evidence-based family practice. Hamilton, ON; BC Decker, Inc., 2004:76-82
Monday, May 23, 2011
Bias in Prognostic Studies
In the evidence-based world every now and again you may come across a paper looking at prognosis. Such papers provide us information on understanding the natural history of a disease or condition, which may then be of use in understanding the nature of your specific patient’s illness (or of those patients who may later relate to the coursework you are teaching now). Knowing something about prognosis allows us to provide information to the patient about predicted outcomes of treatment, and for some conditions (such as, say, the common cold), we know a great deal. Conditions such as back pain are less well understood and therefore rife for discussion in a prognostic paper. But there are several kinds of bias which affect prognostic studies. These include:
Lead Time Bias: this occurs when earlier results related to diagnosis of a condition suggest a treatment effect even though the patient has not, for example, lived any longer. In reviewing studies of prognosis, we need to ensure that our inception cohort had a clearly defined inception point so that they all have the same starting point. Look to see that this is presented in the methods section.
Centripetal Bias: This occurs when a referral center has such a good reputation that it attracts people from outside its geographic location. This then affects the characteristics of the patients that center sees, since, for example, only those who can afford to travel there will be included in an analysis of the patients being seen. Effects or poverty would then be taken out of understanding how this disease progresses.
Popularity Bias: This happens when people with certain specific diagnoses are treated differently than those with other diagnoses or conditions. This may affect the patient flow in a tertiary care center known for its management of that specific condition, affecting the nature of the patients they then see and making them not reflective of the condition at it typically presents in a population.
Referral Bias: This occurs when a select group of patients is referred for study. The problem here is that this leads to that sample not being random or even a reasonable sample of the condition of interest.
Diagnostic Access Bias: If your starting point for conducting a prognostic study requires access to, say, an MRI imaging center, does your community even have one? Does each potential participant in the study have equal access to such a center? Some require referral and some require lengthy waits. This may affect the types of patient seen, making them atypical of the condition of interest.
Diagnostic Suspicion Bias: If the physician can identify the group assignment of a patient, he or she may treat that patient differently.
Expectation Bias: This occurs when a physician second-guesses what is happening in a trial due to prior knowledge he or she may have. The more information about each patient we have, the more our expectations may influence what we do and how we treat the patient, affecting prognosis.
These are sources of error in prognostic studies you should be aware of. Prognostic studies are not common in chiropractic, but are likely to occur in the future.
Lead Time Bias: this occurs when earlier results related to diagnosis of a condition suggest a treatment effect even though the patient has not, for example, lived any longer. In reviewing studies of prognosis, we need to ensure that our inception cohort had a clearly defined inception point so that they all have the same starting point. Look to see that this is presented in the methods section.
Centripetal Bias: This occurs when a referral center has such a good reputation that it attracts people from outside its geographic location. This then affects the characteristics of the patients that center sees, since, for example, only those who can afford to travel there will be included in an analysis of the patients being seen. Effects or poverty would then be taken out of understanding how this disease progresses.
Popularity Bias: This happens when people with certain specific diagnoses are treated differently than those with other diagnoses or conditions. This may affect the patient flow in a tertiary care center known for its management of that specific condition, affecting the nature of the patients they then see and making them not reflective of the condition at it typically presents in a population.
Referral Bias: This occurs when a select group of patients is referred for study. The problem here is that this leads to that sample not being random or even a reasonable sample of the condition of interest.
Diagnostic Access Bias: If your starting point for conducting a prognostic study requires access to, say, an MRI imaging center, does your community even have one? Does each potential participant in the study have equal access to such a center? Some require referral and some require lengthy waits. This may affect the types of patient seen, making them atypical of the condition of interest.
Diagnostic Suspicion Bias: If the physician can identify the group assignment of a patient, he or she may treat that patient differently.
Expectation Bias: This occurs when a physician second-guesses what is happening in a trial due to prior knowledge he or she may have. The more information about each patient we have, the more our expectations may influence what we do and how we treat the patient, affecting prognosis.
These are sources of error in prognostic studies you should be aware of. Prognostic studies are not common in chiropractic, but are likely to occur in the future.
Monday, May 16, 2011
A few youtube clips that may help you understand EBCP concepts better
1. Risk:
http://www.youtube.com/watch?v=4LMTnLGwoF4
This is a nice little introduction to the concept of risk in medical literature. The author uses a simulated study to help illustrate concepts here.
2. Confidence Intervals:
http://www.youtube.com/watch?v=Hn6C21GC0vA&feature=related And here is a presentation which clarifies understanding of confidence intervals, another key concept in reading and interpreting medical literature.
3. Sample Size Calculation:
http://www.youtube.com/watch?v=HuGl50C8Q30&feature=related
Here the idea is to know how many subjects you need in a study to be able to achieve statistical significance.
4. Regression Analysis:
http://www.youtube.com/watch?v=JPjW2HPTaEw&feature=related
This is a common procedure used in statistics but not one everyone necessarily understands. This little clip does a nice job of explaining what this is.
5. Evidence-Based Medicine 1:
http://www.youtube.com/watch?v=QsIYwWwi_r4
An introduction to the topic, looking at critical appraisal.
6. Evidence-Based Practice: http://www.youtube.com/watchv=SWMjkxNpl6k&feature=related
This is about the real world applications of EBCP.
7. Research Methods:
http://www.youtube.com/watch?v=0FyCTupSdXM
A primer on beginning research.
Beyond this, so much more exists on youtube that can help explain concpets related to evidence-based practice, to teaching effectiveness and to scholarship. Poke around, and enter what I have called a "youtube fugue..."
http://www.youtube.com/watch?v=4LMTnLGwoF4
This is a nice little introduction to the concept of risk in medical literature. The author uses a simulated study to help illustrate concepts here.
2. Confidence Intervals:
http://www.youtube.com/watch?v=Hn6C21GC0vA&feature=related And here is a presentation which clarifies understanding of confidence intervals, another key concept in reading and interpreting medical literature.
3. Sample Size Calculation:
http://www.youtube.com/watch?v=HuGl50C8Q30&feature=related
Here the idea is to know how many subjects you need in a study to be able to achieve statistical significance.
4. Regression Analysis:
http://www.youtube.com/watch?v=JPjW2HPTaEw&feature=related
This is a common procedure used in statistics but not one everyone necessarily understands. This little clip does a nice job of explaining what this is.
5. Evidence-Based Medicine 1:
http://www.youtube.com/watch?v=QsIYwWwi_r4
An introduction to the topic, looking at critical appraisal.
6. Evidence-Based Practice: http://www.youtube.com/watchv=SWMjkxNpl6k&feature=related
This is about the real world applications of EBCP.
7. Research Methods:
http://www.youtube.com/watch?v=0FyCTupSdXM
A primer on beginning research.
Beyond this, so much more exists on youtube that can help explain concpets related to evidence-based practice, to teaching effectiveness and to scholarship. Poke around, and enter what I have called a "youtube fugue..."
Monday, May 2, 2011
Asking and Answering Questions Effectively in a Public Forum
The latest issue of the Journal of the American Medical Writers Association has a very interesting article about how to ask effective questions in public forms, and how to provide effective answers in return (1). It notes that often we are asked to sit though meetings and programs where we bemoan the fact that audience members ask long and seemingly pointless questions and in response receive even longer and less meaningful answers. We have all seen this happen, and we all sit and try not to squirm when it does. Beyond our discomfort, however, is a more important point: there is supposed to be a successful exchange of information and it has not occurred. Similar to writing, we need to communicate effectively. Krumm’s article provides an overview on making that happen. He provides an overview of 3 related topics in doing so.
First, he brings up the issue of understanding the different types of question. Krumm defines 3 types of questions one may see in a scientific setting. (1) The first is the Specific Question. These are questions which require a categorical answer, such as either yes or no, or a factual answer (and for whom the question usually starts with a wh, such as what, who, where, etc.). (2) Second is the Leading Question. This is an open-ended question requiring an element of analysis, synthesis or evaluation, and they require answers with more in-depth analysis and interpretation. (3) Finally, there is the Presupposition Question. These are questions with assumptions behind them, often critical in nature, and often begin with the word why. These often appear to be, and are, confrontational.
He then looks at asking effective questions. He suggests the following. (1) First, think about the question. Identify what it is you wish to know- broad information or specific. (2) Ask a precise question. This does not mean it must be short, but that it is formulated clearly so that the audience and the presenter easily understand it. (3) Stick to the topic at hand. Make sure your question is related to the discussion at hand. Do not introduce tangential topics. (4) Ask 1 question at a time. Too many questions can make it hard for the presenter to know how to answer and for the audience to follow. If you need to, ask if you can ask a follow-up question. (5) Be careful about “why” questions. These are seen as accusatory and put the presenter on the defensive. (6) Ask your question politely. You should never be rude or confrontational. This is also important when a presenter may have given incorrect information. Follow the Golden Rule. (7) Conversely, do not be overly complimentary; there is no need for a constant stream of praise to a presenter.
For those now in position to answer properly asked questions, Krumm suggests this: (1) Rehearse answers to obvious question. You know what you will be presenting, so anticipate the question you will get and be ready to answer them. (2) Clarify the rules (where appropriate). Let people know when and how you will answer questions. (3) Listen to the question and do not interrupt. Listening is a key skill, and don’t barge in out of impatience. (4) Repeat the question. Not everyone will have heard it. (5) Ask for clarification when necessary. You can politely ask when you are unclear as to what you are being asked. (6) Be honest. If you don’t know the answer, say so. (7) Give short and precise answers. Stick to the point, and remember others want to ask questions as well. (8) Don’t be defensive if the questions are hostile. This is hard to remember, but you can best defuse anger with calm. Remain courteous.
Note: I will be gone for much of next week, and will post again upon my return, May 16. Until then.
References
1. Krumm P. How to ask effective questions and provide effective answers in a public form. AMWA J 2011;26:21-22
First, he brings up the issue of understanding the different types of question. Krumm defines 3 types of questions one may see in a scientific setting. (1) The first is the Specific Question. These are questions which require a categorical answer, such as either yes or no, or a factual answer (and for whom the question usually starts with a wh, such as what, who, where, etc.). (2) Second is the Leading Question. This is an open-ended question requiring an element of analysis, synthesis or evaluation, and they require answers with more in-depth analysis and interpretation. (3) Finally, there is the Presupposition Question. These are questions with assumptions behind them, often critical in nature, and often begin with the word why. These often appear to be, and are, confrontational.
He then looks at asking effective questions. He suggests the following. (1) First, think about the question. Identify what it is you wish to know- broad information or specific. (2) Ask a precise question. This does not mean it must be short, but that it is formulated clearly so that the audience and the presenter easily understand it. (3) Stick to the topic at hand. Make sure your question is related to the discussion at hand. Do not introduce tangential topics. (4) Ask 1 question at a time. Too many questions can make it hard for the presenter to know how to answer and for the audience to follow. If you need to, ask if you can ask a follow-up question. (5) Be careful about “why” questions. These are seen as accusatory and put the presenter on the defensive. (6) Ask your question politely. You should never be rude or confrontational. This is also important when a presenter may have given incorrect information. Follow the Golden Rule. (7) Conversely, do not be overly complimentary; there is no need for a constant stream of praise to a presenter.
For those now in position to answer properly asked questions, Krumm suggests this: (1) Rehearse answers to obvious question. You know what you will be presenting, so anticipate the question you will get and be ready to answer them. (2) Clarify the rules (where appropriate). Let people know when and how you will answer questions. (3) Listen to the question and do not interrupt. Listening is a key skill, and don’t barge in out of impatience. (4) Repeat the question. Not everyone will have heard it. (5) Ask for clarification when necessary. You can politely ask when you are unclear as to what you are being asked. (6) Be honest. If you don’t know the answer, say so. (7) Give short and precise answers. Stick to the point, and remember others want to ask questions as well. (8) Don’t be defensive if the questions are hostile. This is hard to remember, but you can best defuse anger with calm. Remain courteous.
Note: I will be gone for much of next week, and will post again upon my return, May 16. Until then.
References
1. Krumm P. How to ask effective questions and provide effective answers in a public form. AMWA J 2011;26:21-22
Tuesday, April 26, 2011
A Few New Articles of Note
1. White MR, Jacobson IG, Smith B, Wells TS, Gacksetter G, Boyko EJ, Smith TC and the Millenium Cohort Study Team. Health care utilization among complementary and alternative medicine users in a large military cohort. BMC Compl Alternative Med 2011;11:27 doi:10.1186/1472-6882-11-27
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
2. Dizon JMR, Grimmer-Somers K, Kumar S. Study protocol. Effectiveness of the tailored EBP training program for Filipino physiotherapists: A randomised controlled trial. BMC Med Educ 2011;11:14 doi:10.1186/1472-6920-11-14
ABSTRACT
Background: Evidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients.
Methods: A double blind randomised controlled trial, assessing the effectiveness of the EBP training intervention, compared with a waitlist control, will be conducted. An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and randomly allocated to EBP intervention or waitlist control. Intervention: The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques, delivered using effective adult education strategies. It consists of lectures and practical workshops. A novel component in this program is the specially-developed recommendation form, which participants can use after completing their training, to assist them to negotiate with referring doctors regarding evidence-based treatment choices for their patients. Pre and post measures of EBP knowledge, skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes. Behaviour to EBP will be measured using activity diaries for a period of three months.
Discussion: Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists, it will form the basis of a much needed national intervention which is contextually appropriate to Filipino physiotherapists. It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries. Trial Registration: Current Controlled Trials: ISRCTN74485061
3. Souba WW. The Being of Leadership. Phil Ethics Humanities Med 2011;6:5 doi:10.1186/1747-5341-6-5
ABSTRACT
The ethical foundation of the medical profession, which values service above reward and holds the doctor-patient relationship as inviolable, continues to be challenged by the commercialization of health care. This article contends that a realigned leadership framework - one that distinguishes being a leader as the ontological basis for what leaders know, have, and do - is central to safeguarding medicine's ethical foundation. Four ontological pillars of leadership - awareness, commitment, integrity, and authenticity - are proposed as fundamental elements that anchor this foundation and the basic tenets of professionalism. Ontological leadership is shaped by and accessible through language; what health care leaders create in language "uses" them by providing a point of view (a context) within and from which they orient their conversations, decisions, and conduct such that they are ethically aligned and grounded. This contextual leadership framework exposes for us the limitations imposed by our mental maps, creating new opportunity sets for being and action (previously unavailable) that embody medicine's charter on professionalism. While this leadership methodology contrasts with the conventional results-oriented model where leading is generally equated with a successful clinical practice, a distinguished research program, or a promotion, it is not a replacement for it; indeed, results are essential for performance. Rather, being and action are interrelated and their correlated nature equips leaders with a framework for tackling health care's most complex problems in a manner that preserves medicine's venerable ethical heritage.
ABSTRACT
Background: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.
Methods: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis.
Results: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001).
Conclusions: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.
2. Dizon JMR, Grimmer-Somers K, Kumar S. Study protocol. Effectiveness of the tailored EBP training program for Filipino physiotherapists: A randomised controlled trial. BMC Med Educ 2011;11:14 doi:10.1186/1472-6920-11-14
ABSTRACT
Background: Evidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients.
Methods: A double blind randomised controlled trial, assessing the effectiveness of the EBP training intervention, compared with a waitlist control, will be conducted. An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and randomly allocated to EBP intervention or waitlist control. Intervention: The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques, delivered using effective adult education strategies. It consists of lectures and practical workshops. A novel component in this program is the specially-developed recommendation form, which participants can use after completing their training, to assist them to negotiate with referring doctors regarding evidence-based treatment choices for their patients. Pre and post measures of EBP knowledge, skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes. Behaviour to EBP will be measured using activity diaries for a period of three months.
Discussion: Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists, it will form the basis of a much needed national intervention which is contextually appropriate to Filipino physiotherapists. It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries. Trial Registration: Current Controlled Trials: ISRCTN74485061
3. Souba WW. The Being of Leadership. Phil Ethics Humanities Med 2011;6:5 doi:10.1186/1747-5341-6-5
ABSTRACT
The ethical foundation of the medical profession, which values service above reward and holds the doctor-patient relationship as inviolable, continues to be challenged by the commercialization of health care. This article contends that a realigned leadership framework - one that distinguishes being a leader as the ontological basis for what leaders know, have, and do - is central to safeguarding medicine's ethical foundation. Four ontological pillars of leadership - awareness, commitment, integrity, and authenticity - are proposed as fundamental elements that anchor this foundation and the basic tenets of professionalism. Ontological leadership is shaped by and accessible through language; what health care leaders create in language "uses" them by providing a point of view (a context) within and from which they orient their conversations, decisions, and conduct such that they are ethically aligned and grounded. This contextual leadership framework exposes for us the limitations imposed by our mental maps, creating new opportunity sets for being and action (previously unavailable) that embody medicine's charter on professionalism. While this leadership methodology contrasts with the conventional results-oriented model where leading is generally equated with a successful clinical practice, a distinguished research program, or a promotion, it is not a replacement for it; indeed, results are essential for performance. Rather, being and action are interrelated and their correlated nature equips leaders with a framework for tackling health care's most complex problems in a manner that preserves medicine's venerable ethical heritage.
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