Effective Practice & Organisation of Care (EPOC): Cochrane Reviews

Following is a list of current systematic reviews from the EPOC Cochrane review group. Included are the ‘plain language summaries’ and links to the full abstracts. Full text of the Cochrane reviews is available by subscription only. (The Cochrane Database of Systematic Reviews 2006 Issue 1. Copyright © 2006 The Cochrane Collaboration. Published by Wiley InterScience [full text by subscription]

Not included in this list are organizational interventions, structural interventions, or reviews to improve specific types of practice.  All are available here.

View new Cochrane reviews here.
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Effects of interventions aimed at changing the length of primary care physicians' consultation (new)
[Plain language summary not yet available.]

Continuing education meetings and workshops: effects on professional practice and health care outcomes
Educational meetings are one of the most common types of continuing education for health professionals, and an important aim of continuing education is to influence professional practice. This review looked at whether educational meetings and workshops aimed at qualified health professionals were effective in improving professional practice or health care outcomes. The following types of planned educational activities were included: meetings, conferences, lectures, workshops, seminars, symposia and courses that occurred off-site from the practice setting. The review found that interactive workshops could result in moderately large changes in professional practice. Lectures or presentations alone were unlikely to change professional practice.

Educational outreach visits: effects on professional practice and health care outcomes
An outreach visit is a personal visit to a health care provider in his or her own setting. It is also called 'detailing', and is a strategy commonly used by pharmaceutical companies. The review found that educational outreach visits combined with social marketing strategies appears to change professional practice, especially prescribing. The effects are small to moderate, although potentially important.

Local opinion leaders: effects on professional practice and health care outcomes
Local opinion leaders can also theoretically influence the behaviour of their colleagues. However, exactly how they might influence them remains unclear. The review concluded that while most trials found some benefit from using local opinion leaders to improve practice, only a few found any important impact on patients' outcomes. If it is possible to identify local opinion leaders, they may be important agents for change for some problems, but not others.

Audit and feedback: effects on professional practice and health care outcomes
Providing healthcare professionals with data about their performance (audit and feedback) may help improve their practice. Audit and feedback can improve professional practice, but the effects are variable. When it is effective, the effects are generally small to moderate. The results of this review do not provide support for mandatory or unevaluated use of audit and feedback.

Mass media interventions: effects on health services utilisation
Mass media information on health-related issues may induce changes in health services utilisation, both through planned campaigns and unplanned coverage. Further research could target how best to compose media messages, and whether they have a different impact on members of the public and health professionals. More information is needed on whether mass media coverage brings about appropriate use of services in those patients who will benefit most.

Interprofessional education: effects on professional practice and health care outcomes
Interprofessional education (IPE) is defined as any type of educational, training or teaching initiative involving more than one profession in joint, interactive learning. This review looked at the effectiveness of IPE compared to educational interventions in which doctors, nurses etc were learning separately from one another. Although a large body of literature was identified on the evaluation of IPE, none of the studies met the inclusion criteria for the review. More rigorous studies, such as randomised trials, are needed in order to provide reliable evidence of the impact of IPE on professional practice and health care outcomes.

Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes
Some strategies to change the practice or behaviour of health care professionals are successful in improving health care while others are not. One explanation may be that there are different barriers to change in different settings and at different times. Change may be more likely if the strategies are specifically chosen to address the identified barriers. Barriers could be related to the individual (e.g. uncertainty about the risks of a procedure); related to social issues (e.g. peer pressure to perform a certain way); or related to the organisation (e.g. no access to equipment). And to successfully change behaviour, barriers should be identified and a strategy developed to overcome those barriers. In other words, it is thought that strategies tailored to overcome barriers should be more effective to change behaviour than non-tailored strategies or no strategy at all.

Fifteen studies evaluated tailored strategies for behaviour change in health care professionals. The results were mixed. It is therefore, unclear whether tailored strategies are more effective than non-tailored strategies or no strategy. Due to a small number of studies, it is also not possible to determine whether strategies tailored to overcome organisational barriers are more effective than those that were not. It is also not clear whether all barriers or important barriers were identified and addressed by the strategies. More research about how to identify and overcome barriers is needed.

Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians
This review examined the impact of different payment systems on primary care physician behaviour. Three payment systems were included: capitation (payment is made for every patient for whom care is provided), salary, and fee for service (payment is made for every item of care provided). There was some evidence that primary care physicians provide a greater quantity of primary care services under fee for service payment compared with capitation and salary, although long-term effects are unclear. There was no evidence, however, concerning other important outcomes such as patient health status, or comparing the relative impact of salary versus capitation payment.

Target payments in primary care: effects on professional practice and health care outcomes
This review looked at the effects of target payments on the behaviour of primary care physicians (e.g. general practitioners and family physicians). Under a target payments system a lump sum is paid to physicians who provide a certain quantity or level of care. Two studies assessed the impact of target payments on immunisation rates. There was some evidence that target payments resulted in an increase in immunisations by primary care physicians. However there was insufficient evidence to provide a clear answer as to whether target payments were an effective method of improving quality of care.

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes
Telemedicine is using telecommunications technology for medical diagnosis and health care. It includes transmitting test results down phone lines, using video technology for long distance consultations or education, and many other uses. The review found studies showing various forms of telemedicine are feasible, but there is not yet enough evidence to show the effects on health outcomes or costs of many expensive uses of technology. Overall, people self-monitoring at home or having video consultations were satisfied with their experience. More research is needed to assess the effects of the range of telemedicine techniques.

Guidelines in professions allied to medicine
The issuing of clinical guidelines to nurses, midwives, dieticians and other health-care professionals allied to medicine may reduce variations in practice and improve patient care. This review found that, despite limited research, there is some evidence that guidelines can improve care and that professional roles can be substituted effectively, for instance a nurse can perform the function of a physician in certain circumstances. Such interventions offer the possibility of reduced costs but further research is needed in all areas of this topic.

Organisational infrastructures to promote evidence based nursing practice
Organisational infrastructures may be important in the development of evidence based nursing practice. We did not find any evaluated infrastructure developments that were of sufficient quality to be included in the systematic review. There are no clear implications for organisational practice as there is no good evidence about the impact of organisational infrastructures on the development of evidence based nursing practice.

Teaching critical appraisal skills in health care settings
Critical appraisal involves interpreting information in a systematic and objective manner. This review looked at whether teaching critical appraisal skills to health professionals led to changes in the process of care, patient outcomes or health professionals' knowledge/awareness. The review found that teaching critical appraisal skills to health professionals improved their knowledge of these skills. However there was a lack of good quality evidence as to whether teaching critical appraisal skills led to changes in the process of care or to changes in patient outcomes.

Twelve Tips: Medical Teacher series

 medical_teacher.jpg  The Twelve Tips series is an excellent resource that began in 1987; full text by subscription.  This page last updated December 28, 2007.

  • Balandin S, Lincoln M, Sen R, Wilkins DP, Trembath D. Twelve tips for effective international clinical placements. Medical Teacher 2007; 29(9-10):872-877.
    Abstract: As universities adopt an increasingly international focus, student health professionals are keen to gain clinical experiences in other countries. Such clinical placements provide students with the opportunity to share their knowledge and at the same time acquire new clinical and cultural skills. The experience gained will not only enhance their clinical practice overseas, but will also enhance it in their home country where they are likely to work with people from culturally, linguistically and clinically diverse backgrounds. Careful preparation and adequate supports are critical if students and the host institutions are to gain maximum benefit from cross-cultural clinical placements. The tips below are based on an ongoing collaboration between the Indian Institute of Cerebral Palsy, Kolkata, India and The University of Sydney, as well as recommendations from the burgeoning literature on international clinical placements. The authors are from both the sending and the receiving institutions, and have found that close collaboration between the home and host institutions along with student reflection, evaluation and the opportunity to integrate new knowledge with other clinical experiences are keys to a satisfactory outcome for all concerned.  PubMed Record   Journal Record

  • Couser G. Twelve tips for developing training programs for international medical graduates. Med Teach 2007; 29(5):427-430.
    Background: International Medical Graduates (IMGs) are a diverse group of doctors who provide essential health services in many western countries, and hospitals are increasingly relying upon IMGs to fill vacancies in all staff grades. Clinical skills and experience vary greatly between doctors, and orientation and clinical skills training is a way of addressing any identified deficiencies.
    Work done: This paper relates the experiences of establishing a training program and support services for IMGs working in the public hospital system in Tasmania, Australia, and offers advice for other agencies contemplating establishing similar programs.
    Conclusions: A ‘hub and spoke’ model is a useful model to adopt: a central coordinating office designs and implements programs informed by best available evidence, and clinical educators on site at healthcare facilities implement programs and provide direct assistance and orientation. Broad-based programs attending to orientation, doctor’s families’ needs, communication skills and clinical skills training are required. Support from health administrators is essential. Practice points Understand the practices and certification requirements of your jurisdiction. Involve IMGs with the planning and implementation of programs. Consider the needs of spouses and families. Orientation to health systems is of paramount importance. PubMed Record   Journal Record

  • Mann KV, Sutton E, Frank B. Twelve tips for preparing residents as teachers. Med Teach 2007;29(4):301-6.
    BACKGROUND: Residents are frequently identified by medical students as their most frequent and memorable teachers; residents also teach their peers, junior and senior colleagues, other health professionals, and their patients. Many will teach in their future practice. Developing the skills to become a teacher is an important part of postgraduate education, and warrants a systematic, planned approach that may include many complementary learning opportunities.
    AIMS: Our purpose is to describe one such approach: a 4-week elective experience in medical education offered to postgraduate learners.
    METHOD: The paper describes the background and goals for the elective, and the various steps in planning, implementing, and evaluating such a course, drawing on the literature and mining our own experience for examples. Specifically, we address the following: needs assessment; the determination and selection of content, sequence, and teaching and learning methods; the experiential learning opportunities offered; and the emphasis on the participants’ developing self-awareness of themselves as teachers, and as part of a community of teachers.
    RESULTS: The program implementation, program evaluation, and response to feedback received are described.
    CONCLUSION: A 4-week elective experience in medical education was positively received by participants.  PubMed Record

  • Siddiqui ZS, Jonas-Dwyer D, Carr SE. Twelve tips for peer observation of teaching. Med Teach 2007;29(4):297-300.
    Abstract: This paper outlines twelve tips for undertaking peer observation of teaching in medical education, using the peer review model and the experiences of the authors. An accurate understanding of teaching effectiveness is required by individuals, medical schools, and universities to evaluate the learning environment and to substantiate academic and institutional performance. Peer Observation of Teaching is one tool that provides rich, qualitative evidence for teachers, quite different from closed-ended student evaluations. When Peer Observation of Teaching is incorporated into university practice and culture, and is conducted in a mutually respectful and supportive way, it has the potential to facilitate reflective change and growth for teachers. PubMed Record

  • Azer SA. Twelve tips for creating trigger images for problem-based learning cases. Med Teach 2007;29(2-3):93-7.
    Abstract: A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5-6 text lines that provide the key information about the main character (usually the patient), including 3-4 of patient’s presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patient’s investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows:
    (1) to introduce the patient to the students;
    (2) to enhance students’ observation skills;
    (3) to provide them with new information to add to the cues obtained from the trigger text; and
    (4) to stimulate students to ask questions as they develop their enquiry plan.
    When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images. PubMed Record

  • Orlander JD. Twelve tips for use of a white board in clinical teaching: reviving the chalk talk. Med Teach 2007;29(2-3):89-92.
    Abstract: Little has been written on the art of using a board in clinical teaching. The technological development of the white board appears to have coincided with that of the laptop computer and accompanying LCD projector, so that fewer and fewer teaching sessions appear to utilize the board as an efficient teaching tool. I have observed this most commonly among younger faculty who are most comfortable with technology and who may lack training and experience with a blank board. This paper offers suggestions on using the board in clinical teaching in order to enhance the educational process through better engagement of the learners. PubMed Record

  • Sandars J. Twelve tips for using blogs and wikis in medical educationMed Teach 2006;28(8):680-2.
    Abstract: Blogs and wikis are an emerging area in medical education but are widely used by the general public. These easily accessed websites can be used for a variety of purposes. They can provide a learning resource that can be read by learners, they can be written by learners as a portfolio, and they can be used as a collaborative learning space. The exact use will depend on the requirements of the learner and the educator. PubMed Record

  • McLean M, Van Wyk J. Twelve tips for recruiting and retaining facilitators in a problem-based learning programme. Med Teach 2006;28(8):675-9.
    Abstract: Successful curriculum reform requires considerable staff development. It is imperative for management to ensure that its academic staff members are committed to the change. This requires planning and negotiation. As facilitators form the ‘teaching’ backbone of a problem-based learning programme, faculty management must ensure mechanisms are in place to recruit facilitators, and that once recruited, the experience is sufficiently rewarding personally for their enthusiasm to be sustained. This article offers several solutions to difficulties which many medical schools encounter during the early years of an undergraduate PBL programme which replaces a traditional curriculum. The advice offered ranges from recruiting facilitators from the private sector to encouraging staff to become involved in other areas of curriculum development. Most importantly, however, is the reward and incentive system, which must be well advertised in advance of any programme implementation. The suggestions presented in this article will be useful to faculties planning to implement problem-based learning as well as those who already have a programme in place. PubMed Record

  • Sandars J. Twelve tips for effective online discussion in continuing medical education. Med Teach 2006; 28(7):591-593.
    Abstract: Online discussions for continuing medical education are increasing but many are ineffective. Close attention needs to be paid to the requirements of the learner and the wider healthcare organizational context within which continuing medical education takes place. There is a preference for structured and facilitated online discussions by this group of doctors. The essential skills for effective online facilitation are outlined. PubMed Record

  • Ramani S, Gruppen L, Kachur EK. Twelve tips for developing effective mentors. Med Teach 2006; 28(5):404-408.
    Abstract: Mentoring is often identified as a crucial step in achieving career success. However, not all medical trainees or educators recognize the value of a mentoring relationship. Since medical educators rarely receive training on the mentoring process, they are often ill equipped to face challenges when taking on major mentoring responsibilities. This article is based on half-day workshops presented at the 11th Ottawa International Conference on Medical Education in Barcelona on 5 July 2004 and the annual meeting of the Association of American Medical Colleges in Boston on 10 November 2004 as well as a review of literature. Thirteen medical faculty participated in the former and 30 in the latter. Most participants held leadership positions at their institutions and mentored trainees as well as supervised mentoring programs. The workshops reviewed skills of mentoring and strategies for designing effective mentoring programs. Participants engaged in brainstorming and interactive discussions to: (a) review different types of mentoring programs; (b) discuss measures of success and failure of mentoring relationships and programs; and (c) examine the influence of gender and cultural differences on mentoring. Participants were also asked to develop an implementation plan for a mentoring program for medical students and faculty. They had to identify student and faculty mentoring needs, and describe methods to recruit mentors as well as institutional reward systems to encourage and support mentoring.  PubMed Record    
    DOI Link 
  • Stinson L, Pearson D, Lucas B. Developing a learning culture: twelve tips for individuals, teams and organizations. Med Teach June 2006;28:309-312.
    Abstract: A culture of learning in providing health services and education for health professionals is a constant challenge for individuals, team and organizations. The importance of such a culture was highlighted by the findings of the Bristol Royal Infirmary Inquiry (2001). This was discussed in the context of the literature on the Learning Organization (Senge, 1990) at the 2004 Association of Medical Education in Europe (AMEE) conference, and reviewed a year later at the 2005 AMEE conference. This paper outlines twelve tips for educational and health service organizations in facilitating a culture of learning for their members and also offers specific advice to individual students and professionals.   AbstractPlus   Journal Link
  • Ramani S. Twelve tips to promote excellence in medical teaching. Med Teach 2006 Febv;28(1):19-23.
    Abstract: For medical teachers around the world, teaching duties have expanded beyond the classroom and include teaching small groups, assessment, providing instructional materials beyond the syllabus, problem-based learning, learner-centred teaching, clinical teaching on-the-fly—and the list goes on. Faculty development is essential to train medical faculty in essential educational theory and specific teaching skills as well as to encourage a flexible and learner-centred approach to teaching. Finally, self-reflection and critique of teaching techniques are vital to propel medical schools towards promoting and aiming for uncompromising excellence in medical education. The twelve tips described in this article relating to educating teachers, evaluating teaching and eradicating institutional apathy are simple measures that educational leaders can apply to promote excellence in teaching at their parent institutions. The tips introduce a multi-dimensional approach to improving the overall quality of medical education consisting of measures aimed at individual teachers and those aimed at overhauling the teaching climate at medical institutions.  Journal Record      PubMed
  • Gill D, Parker C, Richardson J. Twelve tips for teaching using videoconferencing. Med Teach 2005 Nov;27(7):573-7.
    Abstract: Videoconferencing is a highly flexible teaching tool. It can assist in delivery
    of a rapidly changing curriculum and can solve some of the problems caused by trying to deliver teaching to an audience dispersed across campuses. When well planned and delivered effectively, videoconferenced teaching sessions can be stimulating and enjoyable. An enthusiastic approach, a well-planned session, interactive teaching, use of site facilitators and a good working relationship with technical support are keys to success.  PubMed
  • Curry M, Smith L. Twelve tips for authoring on-line distance learning medical post-registration programmes. Med Teach 2005; 27(4):316-321.
    Abstract: With innovation and creativity, almost anything can be delivered and assessed on-line. Successful on-line distance learning puts the needs of the learner first, and is characterized by the quality and clarity of learning and support materials, together with good tutorial and support networks. This in turn depends upon trained authors and implementation of relevant quality assured systems and processes. These pragmatic tips outline the main points, which should help prospective on-line developers and authors.  PubMed
  • Ker JS, Dowie A, Dowell J, Dewar G, Dent JA, Ramsay J et al. Twelve tips for developing and maintaining a simulated patient bank. Med Teach 2005; 27(1):4-9.
    Abstract: Simulated patients have become almost indispensable in the education and training of health care professionals. Their contribution to the creation of a safe, yet realistic, learner centred environment is invaluable. Their support in enabling learners at all stages of their professional careers to develop both competence and confidence through repeated practice helps to ensure that learning from real patients can be maximized. A simulated patient bank can enable tracking and training of simulated patients to be coordinated in an effective and efficient way both for patients and learners. This paper shares experiences of developing a simulated patient bank against the background of changes in health care delivery and education and training. Twelve tips to developing and maintaining a simulated patient bank have been identified. The tips focus on the needs of the simulated patient bank and ensure that training is at an appropriate level for the learners, patient care is not compromised and simulated patients feel they are valued members of the educational team.  PubMed

  • Lockyer J, Ward R, Toews J. Twelve tips for effective short course design. Med Teach 2005; 27(5):392-395.
    Abstract: Short courses are commonly used by physicians to stay up-to-date and acquire new skills for practice. Unfortunately, many short courses are not designed to maximize their impact on practice as they fail to acknowledge how people learn and change. Designers of effective short course planning should pay attention to writing outcomes based objectives; conducting needs assessments; determining the optimal content, resources, speakers and format; preparing ancillary materials (handouts and pre- and post-course assessments); and preparing speakers and evaluation. This paper discusses how each of the components of the curriculum design can be used to enhance the learning experience and obtain the desired course outcomes.  PubMed

  • Smith L, Curry M. Twelve tips for supporting online distance learners on medical post-registration courses. Med Teach 2005; 27(5):396-400.
    Abstract: There is an increased interest in online distance learning programmes targeted at medical professionals as they are often marketed as providing an ideal way to study due to the flexibility to access high quality materials anywhere, any time and any place. Traditionally, however, online distance learning programmes have low retention rates. Online distance learners are distinctive students who have more constraints than traditional face-to-face students such as time issues as many are working full-time and have family commitments. Lack of student support has been identified as a major factor in students dropping out of online distance learning courses. This article examines the characteristics of a good support system for online distance learning courses and provides practical advice on implementation from development through to evaluation.  PubMed
  • Azer SA. Becoming a student in PBL course: twelve tips for successful group discussion. Med Teach 2004; 26(1):12-15.
    Abstract: Problem-based learning (PBL) serves as an educational method to foster self-directed learning, integration across disciplines, small-group learning and decision-making strategies. The approach is student centred. During the discussion of a PBL case there are a number of important issues to be considered by students, such as keeping ground rules, knowing their roles, keeping group dynamics, becoming a purposeful learner, planning how to use tutors’ feedback to enhance group discussion and boost student’s learning skills, as well as striving to become a winning team. This paper provides 12 practical tips to PBL students to enhance their skills in discussing a case in their group.  PubMed
  • Dent JA. Twelve tips for developing a clinical teaching programme in a day surgery unit. Med Teach 2003; 25(4):364-367.
    Abstract: Healthcare policy in the UK is moving towards an expansion in day care services. As it becomes increasingly difficult to deliver clinical teaching to undergraduates in traditional inpatient venues, opportunities must be sought in ambulatory care. The proposed increased activity of day surgery units provides one such resource for the development of a structured clinical teaching programme. This paper highlights 12 tips for the preparation, delivery and evaluation of a clinical teaching programme in the day surgery unit. It describes the implications for staff and resources and indicates the educational opportunities that can be provided.  PubMed

  • Howe A. Twelve tips for developing professional attitudes in training. Med Teach 2003; 25(5):485-487.
    Abstract: This article is based on a workshop run at AMEE Lisbon, building on work from previous conferences and reported in Medical Teacher (Howe, 2002a). The 30 workshop participants were particularly asked to address the question ‘What would you consider essential to include in a medical education curriculum that wishes to teach and assess professional development?’. This question was posed without further constraints, ie. regardless of whether undergraduate or postgraduate, the country or situation of the participant, and the type of setting in which they worked. Participants were invited to consider all aspects of the question, and no assumption was made about the need to reach a consensus. The workshop divided into two groups and shared ideas. This paper presents the main emergent points from discussion, for interest and further collaboration; the level of agreement was considerable, consistent with the peer reviewed literature (Howe, 2002b). The conclusions are therefore shared in the ‘Twelve Tips’ format as a pragmatic framework for those wishing to review their own curriculum with reference to professional development (PD) issues, or when setting up new opportunities.  PubMed

  • Ramani S. Twelve tips to improve bedside teaching. Med Teach 2003; 25(2):112-115.
    Abstract: Bedside teaching has long been considered the most effective method to teach clinical skills and communication skills. Despite this belief, the frequency of bedside rounds is decreasing and it is believed that this is a major factor causing a sharp decline in trainees’ clinical skills. Several barriers appear to contribute to this lack of teaching at the bedside and have been discussed extensively in the literature. Concern about trainees’ clinical skills has led organizations such as the American Council for Graduate Medical Education (ACGME) and the WHO Advisory Committee on Medical training to recommend that training programs should increase the frequency of bedside teaching in their clinical curricula. Although obstacles to bedside teaching are acknowledged, this article in the ’12 tips’ series is a detailed description of teaching strategies that could facilitate a return to the bedside for clinical teaching.  PubMed

  • Henderson E, Berlin A, Freeman G, Fuller J. Twelve tips for promoting significant event analysis to enhance reflection in undergraduate medical students. Med Teach 2002; 24(2):121-124.
    Abstract: The facilitation of reflection and development of reflective abilities are increasingly considered to be an important component of professional development (Eraut, 1994). It is known that students find the process of reflection difficult and that it does not come naturally to all, requiring a safe trusting environment in which students can develop with staff support (Woodward, 1998). The structured and deliberate review of significant events has been advocated as a useful way to encourage reflection (
    Brookfield, 1990). These tips are based on recent research, which revealed that students’ difficulties with significant event analysis arise from a range of unforeseen emotional reactions or conflicts. We pass on our tips for minimizing these conflicts and enhancing the reflective and creative aspects of significant event analysis.  PubMed

  • Howe A. Twelve tips for community-based medical education. Med Teach 2002; 24(1):9-12.
    Abstract: Teaching and learning in primary care and community settings is now a very common aspect of most medical trainings, and there is a growing expertise and evidence base related to the contribution of primary care practice to the reform of medical education. This article in the ’12 tips’ series touches on both practical and political aspects of community-based medical education, addressing the context in which this contribution has developed, its impacts to date, and some core essentials of effective educational practice.  PubMed

  • Montemayor LL. Twelve tips for the development of electronic study guides. Med Teach 2002; 24(5):473-478.
    Abstract: With recent advances in technology, electronic study guides are becoming extraordinary management, learning and assessment tools in the teaching-learning process, replacing printed study guides. The educational advantages they offer are listed here. During the elaboration of an electronic study guide, there are important issues to consider, such as the student’s capabilities in the use of electronic media, the type of software to be used, proper authorizations and accessibility, the inclusion of all information and links needed, as well as a clear explanation on the use of the software. This paper offers twelve useful tips for the development of electronic study guides.  PubMed

  • Reeves S, Koppel I, Barr H, Freeth D, Hammick M. Twelve tips for undertaking a systematic review. Med Teach 2002; 24(4):358-363.
    Abstract: The need to underpin health and education with a firm evidence base is of increasing significance. Systematic review offers an effective approach to critically assessing research in order to understand its overall impact on practice. Based on 5 years’ experience undertaking systematic reviews of interprofessional education, this paper offers guidance for researchers and practitioners about to embark upon systematic review work.  PubMed

  • Wadoodi A, Crosby JR. Twelve tips for peer-assisted learning: a classic concept revisited. Med Teach 2002; 24(3):241-244.
    Abstract: Peer-assisted learning (PAL) is a useful learning method. PAL is learning through active help of peer group members. PAL is increasingly being used in medical education although documented experience to date is limited. A PAL programme has been instigated and run by students at a Scottish medical school. The experience has resulted in the formulation of 12 tips to running PAL. These 12 tips cover organizational issues, tutor selection, training the tutor, and running and evaluating the sessions. It is hoped that these tips will be useful in the initiation and running of PAL programmes in other institutions.  PubMed

  • Dent JA, Ker JS, Angell-Preece HM,
    Preece PE. Twelve tips for setting up an ambulatory care (outpatient) teaching centre. Med Teach 2001; 23(4):345-350.
    Abstract: The ambulatory care setting is becoming an increasingly important environment for clinical teaching. This reflects the changing focus of healthcare delivery with more procedures and patient treatment being delivered in this setting. Maximizing learning opportunities for students without compromising patient care has never provided a greater challenge. This paper shares 12 educational tips for developing an ambulatory care teaching centre where both students and patients benefit from a protected yet realistic clinical setting.  PubMed

  • Hartley S, Gill D, Walters K, Bryant P, Carter F. Twelve tips for potential distance learners. Med Teach 2001; 23(1):12-15.
    Abstract: Distance learning courses are becoming popular among medical professionals due to their flexibility, allowing minimal disruption to personal and professional commitments. The ability to continue professional duties, allied to the reduced cost of distance learning courses, also makes them attractive to institutions looking to develop the skills of their staff. However the nature of distance learning courses means that they are often of long duration and many students fail to maintain motivation while working in isolation. This is reflected by high non-completion rates. This article outlines issues that all students planning a distance learning course should consider, relating to choice of course, time management, funding and adjusting to the different nature of distance learning. The authors advise developing a support network for distance learning students, either in person or electronically, to increase motivation and completion.  PubMed

  • Toohey S, Watson E. Twelve tips on choosing Web teaching software. Med Teach 2001; 23(6):552-555.
    Abstract: Experimentation with the new technology of web-based teaching has meant that many medical schools are using more than one software system for delivery. In the medical faculty at the University of New South Wales at the end of 1999, three different software packages (WebTeach, Top Class and Learning Space) were used for mediating teaching and learning on the web. The type of applications for which web-based teaching is used also varied widely. They ranged from a distance-education coursework masters programme delivered via the web, to the provision of additional resource materials and case discussions to supplement undergraduate classes on campus. Once web-based teaching moves out of the experimental phase and into the mainstream there is usually pressure to standardize on one software system. This has the advantage of limiting costs for training and support but it may require some compromise on functionality. Faced with the need to limit the number of software packages in use at UNSW the published comparisons of web software (Landon, 2001; University of California at Berkeley; 2001; Marshall University, 2001; Murdoch
    University, 2001) were first investigated. These show in broad terms what each package will do but often lack sufficient detail to determine whether the package will meet specific requirements. To get a better idea of how different software packages operate under the pressure of day-to-day teaching, 15 academic course coordinators, instructional designers and educational developers from six Australian universities who are involved in designing and delivering web courses were interviewed. The authors also joined online user groups and asked questions of international users. The aim was to find out what strengths and weaknesses they had found in the packages they used and whether they would make the same choice again. The authors were particularly interested to find out what questions they would ask when considering a new package. The twelve tips that follow summarize their advice to those considering the choice of a web teaching package.  PubMed

  • Steinert Y. Twelve tips for using role-plays in clinical teaching. Med Teach 1993; 15(4):283-291.  PubMed

  • Steinert Y. Twelve tips for using videotape reviews for feedback on clinical performance. Med Teach 1993; 15(2-3):131-139.  PubMed

  • Harden RM. Twelve tips to encourage better teaching. Med Teach 1992; 14(1):5-9.  PubMed
  • Steinert Y. Twelve tips for conducting effective workshops. Med Teach 1992; 14(2-3):127-131.  PubMed

  • Harden RM. Twelve tips on using double slide projection. Med Teach 1991; 13(4):267-271.
    Abstract: Double slide projection is not a technique that everyone will choose to use. It is a technique, however, which does offer the lecturer a number of advantages and it is not difficult to implement in the average lecture theatre. Careful consideration, however, must be given to the use to which the two projection system is to be put. In this paper 12 tips are given in the use of double slide projection and 10 possible uses for double slide projection are described. Three ways in which the lecturer can control the slide changes are presented.  PubMed
  • MacLean I. Twelve tips on providing handouts. Med Teach 1991; 13(1):7-12.  PubMed
  • Harden RM. Twelve tips for organizing an Objective Structured Clinical Examination (OSCE). Med Teach 1990; 12(3-4):259-264. PubMed
  • McAleer S. Twelve tips for using statistics. Med Teach 1990; 12(2):127-130.  PubMed

  • Biggs JS. Meetings: twelve tips for chairing a new committee. Med Teach 1989; 11(1):47-50.  PubMed

  • Laidlaw JM. Twelve tips for designing instructional text using desktop publishing. Med Teach 1989; 11(2):139-143.  PubMed

  • Laidlaw JM. Twelve tips for lecturers. Med Teach 1988; 10(1):13-17.  PubMed

  • Laidlaw JM. Exhibitions: twelve tips for exhibitors. Med Teach 1988; 10(2):133-137.  PubMed

  • Leiper JM. Twelve tips for using a public address system.  Med Teach 1988; 10(3-4):273-276.  PubMed

  • Laidlaw JM. Twelve tips on preparing 35 mm slides. Med Teach 1987; 9(4):389-393.  PubMed

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Characterizing the Course of Low Back Pain: A Latent Class Analysis

From the April 15 issue of the American Journal of Epidemiology:

Kate M. Dunn, Kelvin Jordan and Peter R. Croft. Characterizing the Course of Low Back Pain: A Latent Class Analysis. American Journal of Epidemiology 2006 163(8):754-761; http://dx.doi.org/10.1093/aje/kwj100

From the Primary Care Sciences Research Centre, Keele University, Keele, United Kingdom
Correspondence to Dr. Kate M. Dunn, Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
(e-mail: k.m.dunn@cphc.keele.ac.uk).

Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the
United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention. classification; cohort studies; longitudinal studies; low back pain; primary health care; prospective studies; statistics
Abbreviations: RMDQ, Roland-Morris Disability Questionnaire

PubMed Record     Related Articles

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The Index to Chiropractic Literature (ICL)

If you are interested in searching the chiropractic literature, and you haven't checked out ICL lately, have a look at this free database:  Index to Chiropractic Literature

I recently gave a presentation onICL at ACC/RAC, and you can both read the abstract published in the Journal of Chiropractic Education, and view my PowerPoint presentation, which illustrates some of the new search and delivery features.

Have a look at what full records look like now. We can makes links to full text and links to further resources and PubMed records (if available).

Speaking of Further Resources, from this page you can link to chiropractic organizations, current documents and Web sites, free literature databases, practice guidelines, and more.

The What's New page documents additions and changes, and you can provide feedback to the editors.

Give ICL a try and let me know what you think.  — ATV

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Retracted publications: locating them in PubMed

As most of you know, one of the strengths of Cochrane reviews is the authors’ commitment to keeping them updated. Reviews that are considered out of date are withdrawn, although you can still view the abstracts in MEDLINE.At a Cochrane workshop that I attended earlier this week, there was a question about retracted publications such as articles, and how to locate them. The librarian giving the presentation answered that these can be searched in OVID’s MEDLINE, but not in PubMed. Well, I didn’t believe her because I know that we can do a lot more in PubMed than appears on the home page. Turns out you can search both retracted publications, and the notices of them, as publication types. Here they are:

Retracted Publication [Publication Type]
Work consisting of the designation of an article or book as retracted in whole or in part by an author or authors or an authorized representative. It identifies a citation previously published and now retracted through a formal issuance from the author, publisher, or other authorized agent, and is distinguished from RETRACTION OF PUBLICATION [PUBLICATION TYPE], which identifies the citation retracting the original published item.

Retraction of Publication [Publication Type]
Work consisting of a statement issued by one or more authors of an article or a book, withdrawing or disavowing acknowledgment of their participation in performing research or writing the results of their study. In indexing, the retraction is sent to the editor of the publication in which the article appeared and is published under the rubric "retraction" or in the form of a letter. This publication type designates the author's statement of retraction: it should be differentiated from RETRACTED PUBLICATION [PUBLICATION TYPE] which labels the retracted publication.Then there is this:

Retraction of Publication [MeSH Heading]
– for publication retraction as a subject (e.g., an article on "Retraction of Fraudulent Data")Are you completely confused? If you copy retracted publication[pt] into the PubMed search screen, you will retrieve 674 retracted publications.

Here is an article retracted from the Clinical Journal of  Sports Medicine:

Women hydrate more than men during a marathon race: hyponatremia in the Houston marathon: a report on 60 cases [retracted publication]

If you click on this link you will see the link to the retraction [retraction of publication]

If anyone is still reading at this point, I will be amazed. And here is the full list of publication types searchable in PubMed:
http://www.nlm.nih.gov/mesh/pubtypes2006.html

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