For those of us who use small-group learning processes in the classroom, helping those small groups become effective may involve a number of important considerations. Literature on small-group effectiveness has identified several characteristics that differ between new groups and groups that have existed for some time (1). Among these are:
Group Trust and Attraction: People’s willingness to be attracted to a group (and thereby participate) relates to the level of trust members have in each other. This occurs when members see each other reliably complete tasks over time; thus, newer groups may lack trust that older groups have established. A tactic here would be to provide small tasks at the outset that can be completed, thus beginning to build that trust.
Motivation to Achieve Group Goals: Group goals are seen as a key in the development of group trust and cohesiveness. In groups with high levels of diversity, finding common goals is helpful in developing team identity. Goals also provide a basis for team interaction. Highly cohesive groups are generally more effective at achieving group goals.
Willingness to Help Each Other: Effective groups are generally comprised of people willing to help one another. They fell responsibility toward one another and are more willing to provide interpersonal support.
Awareness of Each Other’s Skills and Abilities: New groups do not yet understand what each member brings to the table, and their perceptions of each other may initially be based on stereotyping and observable physical characteristics. Over time, as they work together, each person’s skills are brought to the fore.
Effective Sharing of Task-Related Information: Information sharing in new groups is not likely to support high task performance on tasks; thus, exchange of task-related information is likely to be low and focused on lower-level learning. Interpersonal issues seem to take precedence. Over time, as groups develop, group members begin to get more comfortable with each other and shift to task-related issues. Long-lived groups have a lessened reliance on their best member.
Willingness to Disagree: Completion of tasks requires some constructive conflict, but new groups generally withhold information that would make such constructive conflict possible. That is, they suppress information that might create conflict in order to maintain harmony at all costs.
Methods of Resolving Conflict: Conflict resolution differs between new small groups and established ones (groups with more than, say, 20 hours of action). For example, voting is often used in new groups to resolve conflict, while consensus emerges as a main conflict resolution process in more established groups.
Overall Ability to Complete Difficult Intellectual Tasks: In new groups, members need to work on tasks while at the same time learn to work with each other. This can lead to some dysfunction, but this dysfunction is also actually useful for the group to later find ways to work out its issues and begin to trust one another. Give-and-take discussions need to occur at some point.
The point of all this is simply to note that you can anticipate certain problems when you first constitute small groups for classroom learning, but that you can also develop tactics and strategies to help smooth the process from new group to established group. This then enhances learning.
References
1. Michaelson LK, Bauman Knight A, Fink LD, eds. Team-based learning: a transformative use of small groups in college teaching. Sterling, VA; Stylus Publishing, 2004
Monday, February 15, 2010
Monday, February 8, 2010
A Short Description of Multiple Regression
The context for evidence-based practice revolves around the diagnosis and management of a patient. When a physician is confronted with a patient for whom he or she does not know the best method to proceed, that physician can search the literature to find guidance and direction. One of the challenges of living in a evidence-based world is to be able to then interpret the literature that is uncovered. And because most of us trained as clinical practitioners (for those that are involved in patient care), we do not generally have statistical expertise. We come across terms that confuse us: confidence intervals, p-values, t tests, Pearson’s r, Cronbach’s alpha, linear and multiple regression, analysis of variance (ANOVA), etc. And we simply glitch over those terms, looking to see if our answer is somehow embedded in that paper, but not understanding that answer when it appears. To help, I wish to discuss one form of analysis we often come across: multiple regression.
Multiple regression is nothing more than a statistical method for studying the relationship between several independent or predictor variables and a single dependent or criterion variable. This is a technique widely used in social sciences and increasingly common in biological clinical research. It uses linear equations with more than 2 variables, in the forms y= a + b1x1 + b2x2, where y is the dependent variable, a and b are constant numbers and x1 and x2 are independent variables.
There are two main uses for multiple regression. One is for prediction, and the other is for causal analysis. In prediction studies, what the research is attempting to do is to develop a formula for making predictions about the dependent variable, based on the observed values of the independent variables. (1) (Note: A dependent variable is what you measure in the experiment and what is affected during the experiment. The dependent variable responds to the independent variable. It is called dependent because it "depends" on the independent variable. In a scientific experiment, you cannot have a dependent variable without an independent variable. Further, dependent variables are also called response variables or outcome variables; independent variables may be called predictor variables or explanatory variables). We might, for example, want to predict future episodes of low back pain based on such variables as past episodes of pain, pain intensity, length of episode, and age. In a causal study, the independent variables are seen as the cause of the dependent variable and therefore the aim of the study becomes determining whether a given independent variable affects the dependent variable in a meaningful way, and to estimate how large that effect is. We might have data showing that people who participate in a back school have less severe episodes of later back pain. A multiple regression can determine if this relationship is real or if it could be explained away by the fact that the people who took the back school were younger, fitter and did more exercise than those who did not.
Multiple regression has some truly notable attributes. In prediction studies, it makes it possible to combine variables to optimize predictions about the dependent variable. But, in causal studies it actually separates the effects of independent variables on the dependent variable so you can look at the contribution of each variable on its own.
Some caveats: First, one of the main conceptual problems with regression techniques are that they can ascertain relationships, but cannot be sure about underlying causal mechanisms. Second, the more predictor variables you add to the model, the more likely some will appear to be significant due to chance alone.
References
1. Allison PD. Multiple regression: a primer. Thousand Oaks, CA: Pine Oaks Press, 1999
Multiple regression is nothing more than a statistical method for studying the relationship between several independent or predictor variables and a single dependent or criterion variable. This is a technique widely used in social sciences and increasingly common in biological clinical research. It uses linear equations with more than 2 variables, in the forms y= a + b1x1 + b2x2, where y is the dependent variable, a and b are constant numbers and x1 and x2 are independent variables.
There are two main uses for multiple regression. One is for prediction, and the other is for causal analysis. In prediction studies, what the research is attempting to do is to develop a formula for making predictions about the dependent variable, based on the observed values of the independent variables. (1) (Note: A dependent variable is what you measure in the experiment and what is affected during the experiment. The dependent variable responds to the independent variable. It is called dependent because it "depends" on the independent variable. In a scientific experiment, you cannot have a dependent variable without an independent variable. Further, dependent variables are also called response variables or outcome variables; independent variables may be called predictor variables or explanatory variables). We might, for example, want to predict future episodes of low back pain based on such variables as past episodes of pain, pain intensity, length of episode, and age. In a causal study, the independent variables are seen as the cause of the dependent variable and therefore the aim of the study becomes determining whether a given independent variable affects the dependent variable in a meaningful way, and to estimate how large that effect is. We might have data showing that people who participate in a back school have less severe episodes of later back pain. A multiple regression can determine if this relationship is real or if it could be explained away by the fact that the people who took the back school were younger, fitter and did more exercise than those who did not.
Multiple regression has some truly notable attributes. In prediction studies, it makes it possible to combine variables to optimize predictions about the dependent variable. But, in causal studies it actually separates the effects of independent variables on the dependent variable so you can look at the contribution of each variable on its own.
Some caveats: First, one of the main conceptual problems with regression techniques are that they can ascertain relationships, but cannot be sure about underlying causal mechanisms. Second, the more predictor variables you add to the model, the more likely some will appear to be significant due to chance alone.
References
1. Allison PD. Multiple regression: a primer. Thousand Oaks, CA: Pine Oaks Press, 1999
Monday, February 1, 2010
How to Find the Best Evidence
Keeping up with the current best evidence is a difficult process for all of us. New knowledge is expanding at a frightening rate, and it is easy for us to become overwhelmed by it. The authors of the small text Evidence-Based Medicine: How to Practice and Teach EBM (1) suggest that one method by which we can remain up-to-date is to use a form of “learning by inquiry.” This is based on the idea that when we are confronted with a clinical question where we are unsure of the answer, we develop methods for finding the current best answer as efficiently as possible. The authors remind us that there is a hierarchy of evidence that exists, which they base on the concept of the 4S (see below). We need to be able to develop a clinical question which will also allow us to do an efficient and effective search, no matter that the search is done on a web-based database or simply by hand searching a textbook or pocket manual. With regard to orienting ourselves to evidence-based information sources, the authors suggest the following:
1. Burn your traditional textbooks. This hurts, of course, because I have developed and published textbooks, but I also recognize the truth here. I know that the first textbook I wrote took 4 years to complete; by the time I was done, it was out of date. And this is endemic to most textbook publishing. But part of the problem is that not everything in the text is out of date; just some of it is. But we don’t know which parts, making it a less trustworthy source of clinical information. They note that textbooks are good at answering what are called “background” questions, questions such as, say, information about pathophysiology, but they are not good at “foreground” questions concerning causal factors, risks, and management.
2. Take a “4S” approach to evidence-based information. They note the rapid evolution of information services occurring at present. Thus, they suggest noting the presence of a 4S hierarchical structure, where studies lie at the base of a pyramid, with syntheses on top of that, synopses higher yet, and systems at the pinnacle. You should always try to locate information that will answer your question that is located at the highest level of this pyramid. A system would “integrate and concisely summarize all relevant and important research evidence about a clinical problem” and would help link you to the relevant information. Systems do not tell you what to do, but need to be integrated with the specifics of the patient’s situation. Some systems do exist; one noted in the text is Clinical Evidence (http://www.clinicalevidence.com, also available in Ovid). PIER (Physician’s Information and Evidence Resource)is another (http://pier.acponline.,org/index.html). These are, unlike textbooks, regularly updated. Synopses are reviews of individual studies and reviews. A perfect synopsis would provide just the information you need to support your clinical action. A synthesis is useful when no systems or synopses are available. The Cochrane database is one example of a repository of syntheses. These look for evidence and then summarize the findings.Finally, studies are, of course, individual pieces of research on a topic. If no systems, synopses or syntheses exist, one can rely on studies to help guide action.
3. Organize access to evidence-based information services. Most of the references we use can be found on the internet. And because we work at an academic institution, we are provided access to a rich database of resources, but we need to keep mindful that not all of these resources are useful or appropriate for our needs. We have to determine what we want. And for those not in academia, they may be limited to open access resources such as Biomed Central (http://www.biomedcentral.com/), which offers access to all its publications at no cost to the consumer.
4. Is it time to change how you seek best evidence? How many of us use the 4S approach? How often is that instead we use the basic idea that systematic reviews are the pinnacle of information we need? Can we change our behavior to use better resources?
This is simply a guide to doing just that, to looking at the use of systems as the pinnacle of information seeking for clinical guidance.
References
1. Struas S, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM, 3rd edition. New York, NY: Elsevier, 2005:31
1. Burn your traditional textbooks. This hurts, of course, because I have developed and published textbooks, but I also recognize the truth here. I know that the first textbook I wrote took 4 years to complete; by the time I was done, it was out of date. And this is endemic to most textbook publishing. But part of the problem is that not everything in the text is out of date; just some of it is. But we don’t know which parts, making it a less trustworthy source of clinical information. They note that textbooks are good at answering what are called “background” questions, questions such as, say, information about pathophysiology, but they are not good at “foreground” questions concerning causal factors, risks, and management.
2. Take a “4S” approach to evidence-based information. They note the rapid evolution of information services occurring at present. Thus, they suggest noting the presence of a 4S hierarchical structure, where studies lie at the base of a pyramid, with syntheses on top of that, synopses higher yet, and systems at the pinnacle. You should always try to locate information that will answer your question that is located at the highest level of this pyramid. A system would “integrate and concisely summarize all relevant and important research evidence about a clinical problem” and would help link you to the relevant information. Systems do not tell you what to do, but need to be integrated with the specifics of the patient’s situation. Some systems do exist; one noted in the text is Clinical Evidence (http://www.clinicalevidence.com, also available in Ovid). PIER (Physician’s Information and Evidence Resource)is another (http://pier.acponline.,org/index.html). These are, unlike textbooks, regularly updated. Synopses are reviews of individual studies and reviews. A perfect synopsis would provide just the information you need to support your clinical action. A synthesis is useful when no systems or synopses are available. The Cochrane database is one example of a repository of syntheses. These look for evidence and then summarize the findings.Finally, studies are, of course, individual pieces of research on a topic. If no systems, synopses or syntheses exist, one can rely on studies to help guide action.
3. Organize access to evidence-based information services. Most of the references we use can be found on the internet. And because we work at an academic institution, we are provided access to a rich database of resources, but we need to keep mindful that not all of these resources are useful or appropriate for our needs. We have to determine what we want. And for those not in academia, they may be limited to open access resources such as Biomed Central (http://www.biomedcentral.com/), which offers access to all its publications at no cost to the consumer.
4. Is it time to change how you seek best evidence? How many of us use the 4S approach? How often is that instead we use the basic idea that systematic reviews are the pinnacle of information we need? Can we change our behavior to use better resources?
This is simply a guide to doing just that, to looking at the use of systems as the pinnacle of information seeking for clinical guidance.
References
1. Struas S, Richardson WS, Glasziou P, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM, 3rd edition. New York, NY: Elsevier, 2005:31
Monday, January 25, 2010
Recent Literature of Note
Every now and again I think it is a good idea to provide some links to new information that you might find inriguing or even controversial. Here are abstracts and information for three new article of interest to our profession. I have provided links to each article.
1. Mirtz TA, Morgan L, Wyatt L, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropr Osteop 2009;17:13. http://www.chiroandosteo.com/content/17/1/13
ABSTRACT
Background: Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
Aim: The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
Methods: The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
Results: The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
Conclusion: There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.
2. Siemans RD, Punnen S, Wong J, Kanji N. A survey on the attitudes towards research in medical school. BM C Med Ed 2010;10:4. http://www.biomedcentral.com/1472-6920/10/4
ABSTRACT
Background: An observed decrease of physician scientists in medical practice has generated much recent interest in increasing the exposure of research programs in medical school. The aim of this study was to review the experience and attitudes regarding research by medical students in Canada.
Methods: An anonymous, cross-sectional, self-report questionnaire was administered to second and fourth year students in three medical schools in Ontario between February and May of 2005. Questions were primarily closed-ended and consisted of Likert scales. Descriptive and correlative statistics were used to analyze the responses between students of different years and previous research experience.
Results: There was a 47% (327/699) overall response rate to the questionnaire. Despite 87% of respondents reporting that they had been involved in some degree of research prior to medical school, 43% report that they have not been significantly involved in research activity during medical school and 24% had no interest in any participation. There were significant differences in the attitudes towards research endeavors during medical school between students in their fourth year compared to second year. The greatest barriers to involvement in research in medical school appear to be time, availability of research mentors, formal teaching of research methodology and the perception that the student would not receive appropriate acknowledgement for work put towards a research project.
Conclusion: The results of this self-report survey outline the significant differences in attitudes towards mandatory research as a component of critical inquiry and scholarship in the undergraduate curriculum in Ontario medical schools.
3. Rayner J, McLachlan H, Forster DA, Cramer R. Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners. BMC Compl Alt Med 2009;9;52. http://www.biomedcentral.com/1472-6882/9/52
ABSTRACT
Background: Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.
Methods: Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.
Results: Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.
Conclusions: The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.
1. Mirtz TA, Morgan L, Wyatt L, Greene L. An epidemiological examination of the subluxation construct using Hill's criteria of causation. Chiropr Osteop 2009;17:13. http://www.chiroandosteo.com/content/17/1/13
ABSTRACT
Background: Chiropractors claim to locate, analyze and diagnose a putative spinal lesion known as subluxation and apply the mode of spinal manipulation (adjustment) for the correction of this lesion.
Aim: The purpose of this examination is to review the current evidence on the epidemiology of the subluxation construct and to evaluate the subluxation by applying epidemiologic criteria for it's significance as a causal factor.
Methods: The databases of PubMed, Cinahl, and Mantis were searched for studies using the keywords subluxation, epidemiology, manipulation, dose-response, temporality, odds ratio, relative risk, biological plausibility, coherence, and analogy.
Results: The criteria for causation in epidemiology are strength (strength of association), consistency, specificity, temporality (temporal sequence), dose response, experimental evidence, biological plausibility, coherence, and analogy. Applied to the subluxation all of these criteria remain for the most part unfulfilled.
Conclusion: There is a significant lack of evidence to fulfill the basic criteria of causation. This lack of crucial supportive epidemiologic evidence prohibits the accurate promulgation of the chiropractic subluxation.
2. Siemans RD, Punnen S, Wong J, Kanji N. A survey on the attitudes towards research in medical school. BM C Med Ed 2010;10:4. http://www.biomedcentral.com/1472-6920/10/4
ABSTRACT
Background: An observed decrease of physician scientists in medical practice has generated much recent interest in increasing the exposure of research programs in medical school. The aim of this study was to review the experience and attitudes regarding research by medical students in Canada.
Methods: An anonymous, cross-sectional, self-report questionnaire was administered to second and fourth year students in three medical schools in Ontario between February and May of 2005. Questions were primarily closed-ended and consisted of Likert scales. Descriptive and correlative statistics were used to analyze the responses between students of different years and previous research experience.
Results: There was a 47% (327/699) overall response rate to the questionnaire. Despite 87% of respondents reporting that they had been involved in some degree of research prior to medical school, 43% report that they have not been significantly involved in research activity during medical school and 24% had no interest in any participation. There were significant differences in the attitudes towards research endeavors during medical school between students in their fourth year compared to second year. The greatest barriers to involvement in research in medical school appear to be time, availability of research mentors, formal teaching of research methodology and the perception that the student would not receive appropriate acknowledgement for work put towards a research project.
Conclusion: The results of this self-report survey outline the significant differences in attitudes towards mandatory research as a component of critical inquiry and scholarship in the undergraduate curriculum in Ontario medical schools.
3. Rayner J, McLachlan H, Forster DA, Cramer R. Australian women's use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners. BMC Compl Alt Med 2009;9;52. http://www.biomedcentral.com/1472-6882/9/52
ABSTRACT
Background: Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement.
Methods: Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically.
Results: Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering.
Conclusions: The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.
Wednesday, January 20, 2010
Taking Back Control of E-Mail: (Part 2)
Continuing our discussion of the recommendations made by John Freeman (1), these are a few more of the considerations he offers:
6. Read the entire incoming e-mail before replying. Because time has become of the essence, we have a tendency to want to handle each piece of e-mail as quickly as possible. Sometimes we respond to fast, and we do not provide the information that was needed. Be able to respond that e-mail with the information it requests, in the time frame it asks for. If you cannot, provide that information to the person you are writing; let them know when you will get that information to them. And don’t set up a large file system for all the e-mails you send and that you receive; most experts recommend against this.
7. Do not debate complex or sensitive matters by e-mail. This is how flame wars start. Often this happens because we cannot send intonation or affect with our message, and it is then misunderstood. Bad feelings build up over time. It is far better for most meetings to occur face-to-face, but we often use e-mail to avoid face-to-face meetings. If you cannot do face-to-face, then use the phone; if not the phone, try Skype. Complex question require thought and strategy, and e-mail does not lend itself to complicated discussion; we need time to explain out thoughts in such cases. Being present helps you more than you might think.
8. If you have to work as a group by e-mail, meet your correspondents face-to face. By doing so you put faces to names and you begin to build trust. It may not always be possible to do so, but many mechanisms exist to help create “face-to-face” scenarios, such as, again, Skype or other videoconferencing technology. This will help put out fires before they have a chance to begin.
9. Set up your desk to do something else besides e-mail. I’ve set my computer off to a side of my desk, and have kept my work area free from the computer, so I am not constantly looking at it. I am not reminded, this way, of the messages on it asking my attention. I spend too much time on the computer as it is, and a lot of my collaborative works takes place through the computer. All of us need to get out more and interact in person, me as much as anyone.
10. Schedule media-free time every day. Get away from the computer. I have had what I call “youtube fugues” occur wherein I want to find one single youtube clip, do so, and then begin linking to related clips. Before I know it, 2 hours has passed, and I have not been productive. So get away from the technology, from your computer and your handheld and your laptop and your cell phone and PDA, and so on. Get your attention back, because right now, as our work speeds up, we become fragmented and do not work in long bursts any more.
We can get some control back. We can re-engage with the outside world, but it will take some work. Otherwise, we will be subsumed into The Matrix.
References
1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009
6. Read the entire incoming e-mail before replying. Because time has become of the essence, we have a tendency to want to handle each piece of e-mail as quickly as possible. Sometimes we respond to fast, and we do not provide the information that was needed. Be able to respond that e-mail with the information it requests, in the time frame it asks for. If you cannot, provide that information to the person you are writing; let them know when you will get that information to them. And don’t set up a large file system for all the e-mails you send and that you receive; most experts recommend against this.
7. Do not debate complex or sensitive matters by e-mail. This is how flame wars start. Often this happens because we cannot send intonation or affect with our message, and it is then misunderstood. Bad feelings build up over time. It is far better for most meetings to occur face-to-face, but we often use e-mail to avoid face-to-face meetings. If you cannot do face-to-face, then use the phone; if not the phone, try Skype. Complex question require thought and strategy, and e-mail does not lend itself to complicated discussion; we need time to explain out thoughts in such cases. Being present helps you more than you might think.
8. If you have to work as a group by e-mail, meet your correspondents face-to face. By doing so you put faces to names and you begin to build trust. It may not always be possible to do so, but many mechanisms exist to help create “face-to-face” scenarios, such as, again, Skype or other videoconferencing technology. This will help put out fires before they have a chance to begin.
9. Set up your desk to do something else besides e-mail. I’ve set my computer off to a side of my desk, and have kept my work area free from the computer, so I am not constantly looking at it. I am not reminded, this way, of the messages on it asking my attention. I spend too much time on the computer as it is, and a lot of my collaborative works takes place through the computer. All of us need to get out more and interact in person, me as much as anyone.
10. Schedule media-free time every day. Get away from the computer. I have had what I call “youtube fugues” occur wherein I want to find one single youtube clip, do so, and then begin linking to related clips. Before I know it, 2 hours has passed, and I have not been productive. So get away from the technology, from your computer and your handheld and your laptop and your cell phone and PDA, and so on. Get your attention back, because right now, as our work speeds up, we become fragmented and do not work in long bursts any more.
We can get some control back. We can re-engage with the outside world, but it will take some work. Otherwise, we will be subsumed into The Matrix.
References
1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009
Monday, January 11, 2010
Taking Back Control (of E-Mail): Part 1
Following up last week’s discussion of how e-mail has come to tyrannize our lives, John Freeman (1) has provided a few modest suggestions to help us gain back a small measure of control, at a time when the use of e-mail is expanding exponentially. For example, soon US airlines will offer e-mail service during flights; this has added significance in that if you can get wireless access 5 miles above the earth when you are travelling at 600 miles per hour, you can get it anywhere (including the top of Mt. Everest). And we need to get past one of the signal points of the book: e-mail makes us feel needed, and we treat it like we do gambling at Las Vegas (we keep checking our e-mail in the hope that we get a message that really matters, similar to playing the slots, for example). So here are a few suggestions.
1. Don’t send. This is the first, most basic, and most important step. Sending e-mail only creates more e-mail. When you don’t send a message, other people don’t have to send messages and this stops the cycle of endless unnecessary notes that fly back and forth (“Thank you.” “No, thank you,” etc. ad infinitum). This will also help you begin to ask yourself an important question: is this e-mail necessary? Does it need to arrive immediately? This will be difficult at first, and I know that I fail at this regularly, always letting someone know I received their message, often as soon as I received it. This also helps stop the endless paper(less) trail.
2. Don’t check it first think in the morning or late at night. In fact, don’t check it when you head to the bathroom, take your kids out or are spending time with your spouse. One of the real problems with e-mail is that it breaks the boundary between work and private time; you are often expected to respond to an e-mail as soon as it arrives, no matter what time it arrives. I can attest to this; when I was at NUHS I would go on vacation, place an out-of-office message on my machine with instructions as to whom to contact for an emergency, and come back to angry people who were upset I had not responded to them on the day they wrote me. We need to break the workaholic cycle, and we should not be getting e-mails from our boss or co-worker that was sent at 3am. Unless, of course, the nature of our work absolutely requires it.
3. Check it twice a day. This is nearly impossible for many people to imagine. But you can check your e-mail less than you do. E-mail interrupts our work, leading us to work in smaller and smaller chunks of times on projects, and taking our attention away from what we were doing. Set an agenda for your day.
4. Keep a written to- do list and incorporate e-mail into it. I know people use all sorts of means to track their to- do items, including day planners, Outlook reminders and calendars, other computer calendars (such as Mac’s iCalendar), and so on. I go low tech; I use a piece of paper in which I list my reminders. Using this list pulls you out of the computer and allows you (and me) to think about what I need to do to get things done, and I can then send a couple of direct e-mails to those who need to know where I am.
5. Give good e-mail. Watch Dr. Marchiori here. He does this well. Short notes back to you, direct answers to questions, no fluff, no fooling around. I appreciate this, and I do not feel I have to then send him another e-mail to let him know I got his e-mail. Keep your messages short, folks. Sometimes you can just put your entire message in the "RE:" line.
Next week, I will finish up on the ideas that Johnson brings up. I am beginning to follow them, and they do make life easier once you get past your initial hesitancy to not go and read your e-mail and respond immediately. Takes time, but worth it!
References
1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009
1. Don’t send. This is the first, most basic, and most important step. Sending e-mail only creates more e-mail. When you don’t send a message, other people don’t have to send messages and this stops the cycle of endless unnecessary notes that fly back and forth (“Thank you.” “No, thank you,” etc. ad infinitum). This will also help you begin to ask yourself an important question: is this e-mail necessary? Does it need to arrive immediately? This will be difficult at first, and I know that I fail at this regularly, always letting someone know I received their message, often as soon as I received it. This also helps stop the endless paper(less) trail.
2. Don’t check it first think in the morning or late at night. In fact, don’t check it when you head to the bathroom, take your kids out or are spending time with your spouse. One of the real problems with e-mail is that it breaks the boundary between work and private time; you are often expected to respond to an e-mail as soon as it arrives, no matter what time it arrives. I can attest to this; when I was at NUHS I would go on vacation, place an out-of-office message on my machine with instructions as to whom to contact for an emergency, and come back to angry people who were upset I had not responded to them on the day they wrote me. We need to break the workaholic cycle, and we should not be getting e-mails from our boss or co-worker that was sent at 3am. Unless, of course, the nature of our work absolutely requires it.
3. Check it twice a day. This is nearly impossible for many people to imagine. But you can check your e-mail less than you do. E-mail interrupts our work, leading us to work in smaller and smaller chunks of times on projects, and taking our attention away from what we were doing. Set an agenda for your day.
4. Keep a written to- do list and incorporate e-mail into it. I know people use all sorts of means to track their to- do items, including day planners, Outlook reminders and calendars, other computer calendars (such as Mac’s iCalendar), and so on. I go low tech; I use a piece of paper in which I list my reminders. Using this list pulls you out of the computer and allows you (and me) to think about what I need to do to get things done, and I can then send a couple of direct e-mails to those who need to know where I am.
5. Give good e-mail. Watch Dr. Marchiori here. He does this well. Short notes back to you, direct answers to questions, no fluff, no fooling around. I appreciate this, and I do not feel I have to then send him another e-mail to let him know I got his e-mail. Keep your messages short, folks. Sometimes you can just put your entire message in the "RE:" line.
Next week, I will finish up on the ideas that Johnson brings up. I am beginning to follow them, and they do make life easier once you get past your initial hesitancy to not go and read your e-mail and respond immediately. Takes time, but worth it!
References
1. Freeman J. The tyranny of e-mail. New York, NY; Scribner, 2009
Monday, January 4, 2010
The Tyranny of E-Mail
Welcome back to work, and let me please wish you a very happy new year. I hope that you were able to enjoy your time off and am now well rested and ready to get back at it.
While I was away on break, I had occasion to replace my cell phone. This is of no apparent note, except for the fact that doing so allowed me to finally be able to text message and to access my email when away from my computer. This seems a good thing in today’s busy world. But while I was on vacation I also had occasion to read an interesting and intriguing new book, John Freeman’s The Tyranny of E-Mail (1). After doing so, I had serious room for thought.
I can remember a time before e-mail existed. I can also remember a time when, as the dean of postgraduate education at National University of Health Sciences, I was receiving more than 300 e-mails per day, all of which required action. I know that I tend to respond to e-mail promptly, often within seconds of when I receive a message. This is not unusual. As Freeman notes, studies have shown that in corporate environments, the average time from when an e-mail is sent to when a response is received is less than 3 minutes. I know that I have had meetings with administrators where they have interrupted their face-to-face meeting with me to respond to an e-mail that just came in on their Blackberry or iPhone; I am struck by the fact that they felt it necessary to do so when all they had to do was wait 10 minutes for me to finish up. I do not mean this as a rant, but e-mail is transfiguring the nature of how we work, and in some ways of how we learn.
The average worker now receives approximately 200 e-mail messages per day. In 2007, 35 trillion e-mail were sent globally, compared to 3 million text messages and just 165 billion phone calls. Part of the reason for this is the growth of hand-held devices, such as the Blackberry I just purchased. There is at least one study which has shown that 59% of people with hand-held devices that can receive e-mail respond to their email as soon as one arrives. This is flat-out scary.
And this is the environment in which we teach. No doubt we have all taught classes where at least one of our students has sent a text message during class. And the reason for the book calling e-mail "tyrannical" is this: when you receive an e-mail and you do not respond, you are actually preventing someone else from getting work done. But the faster you respond, the faster you get new e-mails back, and this cycle onto itself. And e-mails create e-mails, ad infinitum; you send a short note of thanks, only to get back an e-mail which also thanks you back, and you feel the need to respond to that, and this ends up creating yet more e-mails. And then there is the ubiquitous “cc” trail, which amps up the amount of e-mail as everyone on the “cc” list feels compelled to add something, and more messages fly back and forth. People stop using spelling and grammar correctly in order to save time in order to send out more and more e-mails. And through all of this you cannot read mood or personality, because all you have is text, not intonation or facial expression, so you resort to emoticons to help convey mood, use a smiley face to let the reader know you are not being sarcastic. And so it goes. We use out-of-office replies to let people know we will not respond to their e-mail- because they can’t get work done if we don’t. Some people use the out-of-office message just go to the doctor for an hour.
We need to take back control. Next week, I’ll talk about how we might do just that.
References
1. Freeman J. The tyranny of e-mail. New York; Scribner, 2009
While I was away on break, I had occasion to replace my cell phone. This is of no apparent note, except for the fact that doing so allowed me to finally be able to text message and to access my email when away from my computer. This seems a good thing in today’s busy world. But while I was on vacation I also had occasion to read an interesting and intriguing new book, John Freeman’s The Tyranny of E-Mail (1). After doing so, I had serious room for thought.
I can remember a time before e-mail existed. I can also remember a time when, as the dean of postgraduate education at National University of Health Sciences, I was receiving more than 300 e-mails per day, all of which required action. I know that I tend to respond to e-mail promptly, often within seconds of when I receive a message. This is not unusual. As Freeman notes, studies have shown that in corporate environments, the average time from when an e-mail is sent to when a response is received is less than 3 minutes. I know that I have had meetings with administrators where they have interrupted their face-to-face meeting with me to respond to an e-mail that just came in on their Blackberry or iPhone; I am struck by the fact that they felt it necessary to do so when all they had to do was wait 10 minutes for me to finish up. I do not mean this as a rant, but e-mail is transfiguring the nature of how we work, and in some ways of how we learn.
The average worker now receives approximately 200 e-mail messages per day. In 2007, 35 trillion e-mail were sent globally, compared to 3 million text messages and just 165 billion phone calls. Part of the reason for this is the growth of hand-held devices, such as the Blackberry I just purchased. There is at least one study which has shown that 59% of people with hand-held devices that can receive e-mail respond to their email as soon as one arrives. This is flat-out scary.
And this is the environment in which we teach. No doubt we have all taught classes where at least one of our students has sent a text message during class. And the reason for the book calling e-mail "tyrannical" is this: when you receive an e-mail and you do not respond, you are actually preventing someone else from getting work done. But the faster you respond, the faster you get new e-mails back, and this cycle onto itself. And e-mails create e-mails, ad infinitum; you send a short note of thanks, only to get back an e-mail which also thanks you back, and you feel the need to respond to that, and this ends up creating yet more e-mails. And then there is the ubiquitous “cc” trail, which amps up the amount of e-mail as everyone on the “cc” list feels compelled to add something, and more messages fly back and forth. People stop using spelling and grammar correctly in order to save time in order to send out more and more e-mails. And through all of this you cannot read mood or personality, because all you have is text, not intonation or facial expression, so you resort to emoticons to help convey mood, use a smiley face to let the reader know you are not being sarcastic. And so it goes. We use out-of-office replies to let people know we will not respond to their e-mail- because they can’t get work done if we don’t. Some people use the out-of-office message just go to the doctor for an hour.
We need to take back control. Next week, I’ll talk about how we might do just that.
References
1. Freeman J. The tyranny of e-mail. New York; Scribner, 2009
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