Monday, December 15, 2014

The Teacher’s Toolkit

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

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

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

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

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

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

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

Monday, December 8, 2014

Therapeutic Misconception

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

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

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

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

Monday, December 1, 2014

National Collaborating Centre for Methods and Tools

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

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

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

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

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

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

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