Creating One-Piece Posters via PowerPoint in MS PowerPoint 2007

This was originally prepared by a former member of the Center for Teaching and Learning, but it holds great advice for all of us as we move toward planning for possible trips to ACC-RAC in March of 2011.

To Begin
The average size of a poster is 5’ wide x 3.5’ tall. We will be using these measurements for this tutorial. This document is also written with the intent that the user has a basic knowledge of Microsoft PowerPoint.

We view the creation of a poster in PowerPoint as one big slide; all the aspects are the same except the pasteboard is approximately 600% bigger. The posters are printed on a HP Designjet 5500 ps which has a print area of 3.5’ x 100’; the printer is physically located in The Center for Teaching and Learning.

Setting the Pasteboard
Open PowerPoint. It will open a blank slide for you. If it does not, go to the Microsoft icon in the top left corner, click there and choose Blank Presentation, and then click OK. You now have a basic pasteboard that is set up for slide or onscreen output. We will now change the dimensions of the pasteboard to reflect our poster. In the menu bar at the top of the screen choose the Design Tab, then find the Page Setup…. You will then be prompted with a dialog box that allows you to make changes to the size.

IMPORTANT NOTE: PowerPoint 2007 will not allow you to change the pasteboard size larger than 56 inches, and you will need 60 inches. Because of this, we will create the poster in half scale and print it at 200%. So instead of our pasteboard being 60” x 42” we are going to set it up at 30” x 21.” In the dialog box, here would be our settings:
Width = 30
Height = 21
Pages = 1
Slides = Landscape
Notes = (doesn’t matter)

Now is when you will cut and paste text, import graphics and drop in backgrounds in the pasteboard. Many people use textboxes for importing everything. You will find this tool as a little square with the letter “A” and some lines in it (you can also access this by going to Insert and then Text Box in the top menu bar). Click the button and move your cursor to the page, then click and drag to create a text box. The reasoning behind using a textbox it that you can move the boxes around, resize, and even overlap them.

To import graphics or pictures, go to Insert in the tool bar, then to Picture, then From File. You will be prompted to move through the hierarchy to find your graphic. When you have found it, highlight it and click insert. You can change the size of your graphic by clicking once on the graphic (this will select it, and show 8 hollow squares around the image). To scale the picture proportionally, click and drag on the corner squares; if you click and drag the top and side squares it will distort your image.

REMEMBER: you are working in half scale; if your image says it is 3x5 it will actually print at 6x10. Whatever font you are using, the point size will double in the end product. You will not be able to print the poster from your PC and should contact Nina Brooks in The Center for Teaching and Learning (x5617) to arrange for her to print your poster on the HP large-format printer mentioned previously. Please contact her well in advance of the date you will need your poster.

And last but not least, save your work often (Just in case of a crash).

ASBH 12th Annual Conference Report

Last week I attended the 12th Annual Conference of the American Society for Bioethics and Humanities. I found it a fascinating meeting, and was thrilled to see that some of the nation’s leading ethicists were in attendance; they are sort of like idols to me. But as I went to each session, I was struck by how difficult a field bioethics has become. And I was equally struck by how, within chiropractic, we often do not need to confront the issues that are daily challenges in medicine.

For example, one of my sessions addressed this problem: for children with medulloblastomas, there are three possible therapies which can be offered. Each carries a mix of difficult decisions. In one case, there survival rate for Therapy A is highest (90%), but it also carries the highest rate of leaving a child with reduced capacity for intelligence (after treatment, intelligence will be 40% what it was before treatment). In Therapy B, the survival rate falls a bit, but the rate of mental retardation decreases a bit as well. And in Therapy C, the survival rate is lowest, but intelligence is generally preserved. The question was not, which one should a parent choose? The question was, do we even tell the parent about option A, which has best survival rate but almost invariably will impair the future mental capacity of the child. And the program was devoted to discussing when and where medical paternalism might be justified.

A second session was less life-threatening in its question, but was equally interesting. How honest should a medical student be in revealing to a patient that he or she is indeed a student at all? In training, medical students (and chiropractic students, of course) gain skills by treating actual patient under the supervision of attending physicians. Do patients want to know that the person treating them is a student? Do we have an obligation to tell them? How do we respect autonomy?

Can we benefit from past wrongs? Should we use data from Nazi concentration camp experiments? Should Roman Catholics allow their children to be vaccinated using vaccines grown in the tissues of aborted fetuses or accept treatment that came from the use of human stem cell lines? Do we apply consequentialist theories here or deontological ones? Is it right to make a good from an evil? There are no easy answers here.

It turns out that bioethics is a vibrant field that can cast light onto difficult subjects and issues. And we are confronting them- genetic research, stem cell research, gene therapy, the Human Genome Project, organ transplantation, public health ethics (population as opposed to personal level bioethics) and so on. It is why I find this so fascinating.

Another Term’s End- the Fun Entry

Here we are again, at the end of another term, at least here in Davenport, and so it is time to take a short break and head out for a chance to catch our collective breaths. To that end, I offer up a few fun and interesting youtube clips for your entertainment.

1. Big Bang Big Boom:
http://www.youtube.com/watch?v=sMoKcsN8wM8&feature=player_embedded
This is evolution as seen on a wall painting. I can only imagine how hard it must have been to film this using stop and go techniques over long periods of time.

2. The Passenger:
http://www.youtube.com/watch?v=OGW0aQSgyxQ&feature=player_embedded
A film clip in animation about a bookwork stuck on a bus that he might not wish to be on.

3. The Cat Piano:
http://www.youtube.com/watch?v=Uj4RBmU-PIo&feature=player_embedded#!
You know what? There really were cat pianos!

4. Rango: http://www.youtube.com/watch?v=SKi2KzKbjVY&feature=player_embedded
Because you know you want to see a movie in which a chameleon plays a role in helping rid a town of bad guys.

5. The Fall: http://www.youtube.com/watch?v=QhARR-zmTCE&feature=player_embedded
Simply gorgeous, produced by Tarsem, a former video producer who also wrote and filmed the Jennifer Lopez movie “The Cell.”

6. Let Me In: http://www.youtube.com/watch?v=qjavOLdPk1c
I previously sang the praises of “Let the Right One In,” and this is the American remake. While not the same as the original, which I consider a perfect movie, this is also quite good in its own way.

7. Harry Potter and the Deathly Hallows:
http://www.youtube.com/watch?v=Qi7SVlKWFn0&feature=related
Because you know it’s coming soon to a theater near you, and you’ll go see it.

Have a great break, even if it is a short one!

An Introduction to Evidence-Based Clinical Practice

Evidence-based medicine developed out of a movement started by a group of medical educators at McMaster’s University during the 1980s (1). These physicians observed that a gap had developed between what occurred in clinical practice and what was obtainable in reports of clinical research. Essentially, clinicians could not stay abreast with new research because it was being produced so fast; consequently they were not putting into practice the most current information. Evidence-based methods were designed to bridge this gap. This concept has been embraced by the chiropractic profession as well, leading to what we now call evidence-based chiropractic (EBC), or evidence-based chiropractic practice (EBCP).

EBCP is unique in several ways:

• For example, chiropractic interventions are difficult to investigate by experimental methods, because it is hard, if not impossible, to design an effective placebo, and it is impossible to blind either the doctor or the patient to the interventions being studied. As a result, there are fewer chiropractic articles that use placebo group controls than in other scientific or medical disciplines.

• Chiropractors commonly use a number of treatment modalities in addition to adjustment, while clinical trials may focus on a single intervention in order to isolate its effects.

• Traditionally, it was hard for chiropractors to obtain funding for rigorous research, though this has certainly changed, all the more so here at PCC.

But these challenges have also meant that we have a uniqueness to our profession. While we might not always have the most rigorous of studies, and for understandable reasons, we have developed an impressive body of evidence to support what we do.

Sackett has stated that EBP is “ … the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” (1) This is an important statement, because in it we see that the practitioner’s clinical expertise is an important component; the goal is to integrate clinical expertise with best evidence on behalf of the patient. EBCP is therefore not in any way cookbook medicine or practice, it is the integration of best evidence with the past training and expertise of the clinician, resulting in better care for the patient. And new evidence is replacing old all the time.

Patient preferences also play an important role. This includes the personal values, concerns and expectations that patients have about their care. Considering these are critical steps in the EBCP process.

• Personal values: These are the beliefs patients have about the care being offered to them, which may be based on personal, religious or philosophical reasons.

• Patient concerns: Such as financial concerns, time constraints, office location, ease of parking, etc.

• Patient expectations: This relates to the degree that patients will accept a doctor’s recommendations. Compliance is an ongoing problem in patient care, as well as in clinical trials and other forms of research.

References
1. Evidence-Based Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-2425
2. Sackett DL. Evidence-based medicine. Lancet 1995;346:1171

Effective Workshops, Part 2

Picking up from last week’s entry, let me bring this to a close by adding in these additional tips, based on the work of Dr. Yvonne Steinert (1).

7. Encourage active participation and allow for problem solving and/or skill acquisition. Steinart notes that active participation is a key ingredient of a successful workshop; therefore, you should plan to have people and groups involved in all aspects of the workshop you are leading. Invite questions, lead debate and engage attendees. In order to allow this to happen, you should work to limit the size of the small groups, so that everyone can have an opportunity to be heard and to be involved. In fact, the actual lay-out of the room can help or hinder this process; lecture rooms are not conducive to small-group activity.

8. Provide relevant and practical information. We know this from the general problem facing continuing education that often people attend programs or conferences and when they return it has changed nothing on what they do. You need to ensure that your participants have learned something new which they can apply when they return to their work setting. Your workshop can contain mini-lectures around which the small-group activities revolve, but a long lecture is not a good way to provide skills and knowledge which will be applied upon return to work. People need to interact with both you and others to reinforce learning.

9. Remember principles of adult learning. This means that we each will bring to the sessions we attend our past experiences and training, and our own personal motivations and expectations about the workshop. We need to remind ourselves that as adults, we are often re-learning, rather than learning, so we need to be careful in how we present information so that we do not create resentment among those who are in attendance. The incentive for learning is self-motivated, not externally motivated, and feedback is therefore critically important.

10. Vary your activities and your style. Consider the pacing of your presentation, and ensure that it meets with participant needs and attention. I find that I am resistant to certain kinds of group work; I tend to work best alone, but I also know that I will learn better when I have people to play ideas and thoughts against. Consider this as well.

11. Summarize your session and request feedback from the group. Always restate your goals and objectives in running the workshop in order to summarize and synthesize the points you have made. You may wish to ask the group to also summarize what they have learned, and you can ask as well for them to give you thoughts on what you might do to improve this session in the future.

12. Enjoy yourself- and have fun. There was a time when I because quite fearful before I ran sessions for professionals. It took time for me to realize that the people attending would not know whether or not I presented all I meant to present, nor would they know if I had made a flub somewhere along the line. This was liberating; I could now go and just do the session and enjoy myself and I now look forward to running workshop sessions. If you have a good time, chances are so will the people taking the session with you.

References
1. Steinert Y. Twelve tips for conducting effective workshops. Med Teacher 1992;14:127-131

Effective Workshops

Last week, a few members of the Palmer faculty attended a workshop by Dr. Kristi Ferguson of the University of Iowa. Her presentation was dedicated to providing faculty with information about how to teach not students, but other faculty. In her presentation, she cited the work of Dr. Yvonne Steinert, who has provided a list of tips for conducting effective workshops (1). Among her tips are the following:

Planning Phase

1. Defining your objectives for the teaching session. What are you trying to achieve in your workshop? Is this related to skills acquisition or to changing attitudes? You should determine what your goals are, because this will impact on the methods you use to teach, your course strategies, your activities and your assessment methods.

2. Find out who your audience is. If we are limited to just members of the PCC faculty, this could be broken down into such groupings as full faculty, life sciences faculty, clinical sciences faculty, clinician faculty, etc. You would not want to include, for example, life sciences faculty if the main goal of your presentation is to discuss new diagnostic methods; perhaps you might not wish to include clinicians if your goal is to discuss large group teaching strategies. You need to understand whether or not the group you are presenting to will know core concepts in your area of discussion.

3. Determine your teaching method and design the appropriate workshop activities. There are so many options here. You can use video, audiotapes, live demonstrations, small group or large group activities, and so on. Your teaching method should fold back onto the goals of your program, and you should also be aware of the group’s past experiences with various teaching methodologies.

Workshop Phase

4. Introduce the members to you and to each other. You can use whatever strategy you want to , depending on the size of the group you are working with. But this knowledge is useful for you in moving forward with your presentation and beginning the process of developing a relation with your audience.

5. Outline your objectives for the teaching session. You should let the group know in advance what it is you hope to accomplish in the workshop. Let me people know what to expect, and let them have a schedule of events for the workshop.

6. Create a relaxed atmosphere for learning. Cooperation and collaboration is essential. Ensuring that people feel comfortable and free to ask questions is equally important. I find that when there is a need to use small group activities, it is best to make sure that introductions have already occurred, because some people are not comfortable in those settings, and feeling comfortable helps them engage more effectively.

I will continue next week with the remainder of Dr. Steinert’s recommendations.

References
1. Steinert Y. Twelve tips for conducting effective workshops. Med Teacher 1992;14:127-131

PICO

One of the core concepts of evidence-based clinical practice (EBCP) is the development of a PICO question. You may have heard this term bandied about in discussion but may not have been exactly what is meant by it. Let me discuss that here.

One of the initial steps in applying the concepts of EBCP to clinical practice is formulate a clinical question. This is important for several reasons, one of the most important being that it helps you design an appropriate search strategy for locating information; that is, you need it to get a useful answer to the clinical question you are attempting to answer. This would occur, for example, if you were confronted with a patient for whom you are not sure how to proceed, not for one where you know exactly what you wish to do. Developing a PICO question is quite helpful in this regard.

PICO standards for: Patient (or Population or Problem), Intervention, Comparison (or Comparator) and Outcome.

P: Patient. What kind of patient is the focus of your question? That is, what is his or her diagnosis, population of problem? Typically, we are looking at a diagnostic question; we have a pteitn with a particular diagnosis that lies outside our area of general knowledge and we are trying to figure out what to do. The more carefully we can define this patient, the better we can search for information. Therefore, we need to look at not just the diagnosis, but perhaps at age range, gender, stage of illness, severity of illness, etc.

I: Intervention. What intervention are we considering using for this patient? In the case of chiropractic, it might include chiropractic adjustment, or perhaps it might involve some other supportive therapy such as physiotherapy of some sort, massage, mobilization or exercise. We could do the same if we were examining a new diagnostic test, to compare it against an established test.

C: Comparison. What do you wish to compare the intervention with? That is, what is the control you are looking at for your intervention? Normally, the comparison should be some established standard treatment for the condition of interest. At times, it might no treatment at all. For manipulation/adjustment, perhaps it would be an intervention for pain relief, such as NSAIDs, or perhaps some other form of conservative care such as exercise. It could even be surgical.

O: Outcome. What, ultimately, is the outcome you are interest in? Often in chiropractic it will be pain relief or reduction of disability, but it is certainly not limited to this. You could do the same approach for reduction of subluxation, remembering that you would compare your method of reduction measurement to some other measurement of same. You could look at sot issues, if you wanted.

Once you have the PICO question developed, it will help inform the search strategy you develop to locate information you can then assess and apply to your patient. The next step in the process of finding and applying evidence would be to conduct a literature search.