Category Archives: Learning

TEBM15 – more of what I learnt

I’ve been thinking about TEBM15 lately and how I can use what I’ve learnt in practice. The first thing I aim to do is to rewrite all my lesson plans for database refresher training sessions (due to the changes to Clinicians Health Channel, I have to do this anyway). One of the tips given by a TEBM educator was only teach the essentials. So – what are the essentials in teaching say, Medline via OVID? Is it absolutely necessary to include MeSH? A senior teaching clinician here mentions MeSH in his annual searching session to interns but it is only a small section (and we didn’t manage to go into great detail about it this year). He says it is essential. I’ve included it in the past but I wonder … To put the boot on the other foot – can you effectively teach searching in an EBM course if you don’t know what MeSH is (one of the clinical attendees at TEBM15 said he didn’t know what MeSH was)? Is MeSH too technical, too much jargon? That was another teaching tip – don’t get bogged down in technical details.

teachornot

What I would like to know is, if you include MeSH in your Medline searching sessions, what place does it have (do you put a lot of focus on it or briefly mention it)? Or if you don’t include it, why not? Is MeSH a technical aspect or an essential aspect? I’m in a inquiring and nosey mood at the moment so please spill the beans!!

 

TEBM15 – what I learnt

It has been awhile since I returned from the UK and I have been meaning to write about the experience and what I learnt for awhile now. But every time I started to settle down to writing, something cropped up that I had to deal with.

There was only one other librarian there. Most were university lecturers, clinical educators, and hospital consultants or researchers who had teaching as part of their work duties. They came from all over the world, and I wasn’t the only Australian there. There was someone from Monash Health and someone from the University of Melbourne. In the group I was in (small group teaching is a common method used in medical education), there was a university lecturer of undergraduates from South Korea, a university research fellow from Norway, a clinical educator from Plymouth Primary Care, 2 from the Nuffield Primary Health Care (which CEBM is a part of), and 2 from NIHR Applied Health Research and Care. The picture below is all of us after the course end. TEBM Group 3My last post expressed a bit of my nervousness about the timetable. It looked very intensive! And it was intensive, but very stimulating and inspiring. There was some prep to do before the course and one of them was to prepare a teaching session that you would deliver normally. On the first day during small group work in the afternoon, people delivered their presentations. I did mine without powerpoint (the only person to do so!) and it was mostly off the top of my head after reviewing my notes (I had run out of time to prepare and send one – bad me!). The comments from the facilitators were that it needed a bit more structure and could I do it again? Sure. I had just brought an iPad that didn’t have Microsoft Office applications. So  before going out to dinner at Jamie Olivers the following evening, I downloaded ppt and then after dinner, worked on my presentation and emailed it to the facilitator at 10.30pm and presented again the next day. The mini presentations were commented on by the facilitators and the group and it was a great learning experience. The final group work on the last day was to prepare and deliver a stats presentation, teaming up with another to do it. Now this was challenging! I teamed up with a clinician and said ‘let’s do likelihood ratios’. There was a statistician in the room who helped people with various problems. The clinician and I used the formula in the workbook provided but we couldn’t figure it out. And we asked for advice … and it turned out the formula in the workbook was incorrect! What happened next was a mini class for the group about how to calculate likelihood ratios.

The plenary sessions were delivered by a mix of professionals – clinical educators giving their tips and tricks for specific areas (eg RCTs), curriculum designers and assessors, a highschool science teacher about lesson planning, and a medical librarian. I thought I wouldn’t learn anything from the searching session but I was wrong! Her tips were: make sure access to electronic sources is available beforehand, what to do if there isn’t access available and make searching sessions relevant by using clinically relevant examples (if you have a defined group) and health news reported in the media (if you don’t). I liked the random allocation of the resource to use. Many tips were repeated: safe learning place (what does that actually mean?), use humour, use stories (many presenters used personal stories to illustrate a clinical example, use a mix of media – voice, ppt, videos, images. During each plenary, everyone – including the presenters and facilitators attended – and in some sessions, there was lively debate amongst them. Rod Jackson’s session about the GATE Frame was interesting but what he brought to the session was infectious enthusiasm which really made an impact. The highschool teacher talked about session planning which was really good and something I really wanted to know about. She gave out a handout called Bloom’s Taxonomy – Teacher Planning Kit which is a great tool for working out what sort of questions and words to use in education sessions. And I was really impressed when she told me at one lunch break that she runs a journal club for her final year students – cool!! Both the diagnostics and the RCT session underlined keeping things simple and not throwing too many concepts at people and the teaching stats plenary included a fun activity (head measurement) to demonstrate a inter-rater reliability concept. And I was chuffed when the SR presenter used a concept from my presentation in his!

On the final day we had presentations from all the groups, and a wrap-up from the Chair and Director of CEBM, Carl Heneghan (with some genial threats that he was going to follow up on what we have done in 3mths time … ).

All ppts are available on the TEBM15 website and accounts of this year’s course are mentioned on the CEBM blog.

EBM – is it applicable to every aspect in healthcare?

A friend of my husband’s, a physiotherapist and yoga instructor in Queensland, is staying with us this week. Last night, he said to me that EBM is a medical model and can’t be applied to everything (I had mentioned a literature search I had completed late last year for evidence about yoga for treatment of pain).  His comment about yoga and pain was that it would be very difficult to construct a trial of yoga for pain because: therapist expressions and attitudes during therapy (patients might guess something wasn’t right), the question of sham yoga, and whether it was ethical to give people in pain fake therapy. It is true that there has been some debate about the health of EBM in the literature lately (for example the opinion piece written by Des Spence titled Evidence Based Medicine is Broken) but is it the model itself broken or is it something else? It is true that RCTs are the gold standard in trial design, but it is also true that RCTs cannot be applied to all types of research questions. Carl Heneghan, Director of CEBM, wrote a BMJ blog post recently about the health of EBM. It is true that published evidence is suffering from many ills including poor trial design, peer review sheannigans, and research that doesn’t address patient needs, but this is the about quality of the evidence, not the quality of EBM as a model. EBM teaches you to critically appraise the literature and ask questions such as – does this apply to my patient? Evidence is only a third of the EBM equation – the others, which are equally important and are being ignored in this argument, is clinicial judgement and patient values. Evidence is important, but it only makes up part of the picture.