Monthly Archives: April 2013

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April 19, 2013

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Education design

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Tools I Use to Make My Teaching Videos

I began developing an online course in EBM and use videos for instruction. I thought it would be useful to tell others what I use. Videos are a useful way to teach others and are more learner-centered in that learners can use them when they want and can skip around in them for the information they need.

First off your videos need to be relatively short: 3-5 minutes is optimal. Longer than 10 minutes and learners will abandon the video. You have to be thoughtful on how to break up a longer topic into shorter chunks. They need to be engaging either through your teaching style or material presentation. They need to be consistent– use the same backgrounds, intro and exits.

Here’s what you need to make teaching videos: (Note: I am a PC guy. Mac has good built-in software that I can’t really comment on as I dont use Macs)
1) Video Hosting Service: YouTube and Vimeo are 2 of the more popular hosting sites. Some of the tools below also have their own site to post videos on. I personlly like YouTube. Here is my YouTube channel.

2) Video Editing Software: I actually record myself giving intros and endings for each of my teaching videos. That way I have a “physical” presence. Because of this I need a video editor to splice these together with the main body of my video. There’s lots of video editing software out there. I use Corel Vidoe Studio Pro because it also contains a screen capture tool and seemed easy to use and wasnt too expensive ($60).

3) Screen Capture Software: I usually display a PowerPoint slide or a paper or a website when I teach. I use sceen capture software to record my computer screen and my voice. I like Screencast-o-matic because its easy and cheap (free). I bought the Pro version ($15/yr) so I have more tools available but the free version is good.

4) Video camera or webcam if you want to video something other than your computer screen.

5) Bamboo tablet: I use this to write on my screen when I explain/demonstrate how to make calculations. (http://www.wacom.com/en/products/pen-tablets/bamboo). This YouTube video shows me using the tablet and the digital drawing program I describe below.

6) Digital Drawing Program: this is the background I write (or draw) on with the Bamboo tablet. I like Autodesk Sketchbood Express because it was more intuitive to use and free. Khan Academy uses SmoothDraw but I didn’t find it as easy to use.

7) Microphone. Often they are built in to your computer or webcam. I bought a high def one off ebay for <$10 because I wanted improved sound.

8) Audacity (http://audacity.sourceforge.net/) is software for recording and editing sound. If you want to just do voice recordings this is a good program.

So that’s it. For a minimal outlay of money you can develop pretty good quality videos. There is a learning curve on editing. You will also have to decide your style. Look around at other videos and do what works for you. This guy has incredible videos but they take a little more time and skill to make.

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April 15, 2013

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Evidence Resources

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Why Aren’t All Journals Open Access?

Many will say this is a stupid question. Of course they can’t be open access because the journal needs to make money to exist. But think about this: what is the point of a published medical journal article?

Isn’t knowledge dissemination the main point of a journal article? So why do we not have access to all journal articles?

knowledge

How would journals continue to exist without subscriptions and advertising dollars? The model for most open access journals is that the authors pay for their article to be published. That is a viable option. Another option is that journals could develop special content that would still attract subscribers and not be open access. For example, JAMA has great content about the clinical examination and how to read research articles. Journals could develop apps for practice based application of material. Etc. Etc.

What about advertisers? Why would they continue to take out ads. Think about open access. Even more people would see the ads. As part of the “right” to download an article a little advertising banner is printed on the article somewhere. Thus, advertiser exposure is increased even more.

I don’t pretend to have all the answers but it seems that medical knowledge should be in the hands of those that need it, when they need it. The most important information gets published in the most restrictive journals. I think its time for the development of a creative way to fund open access to all journals.

What do you think? What are your solutions?

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April 4, 2013

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evidence based practice

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“Can EBM Be Patient-Centered?”

I am a member of an international listserv about evidence-based healthcare. One poster asked “Is EBM patient-centered and is patient-centered care evidence based?” It is almost as if he views the 2 as exclusionary. In my experience many people don’t understand the EBM paradigm. This figure shows what EBM is and that it,by definition, is patient-centered.

EBM paradigm

The most important component of the EBM paradigm (the circles are in the order of importance) is patient preferences and actions. An evidence-based decision should consider patient values. Period. Thus, EBM is patient-centered.

Question 2: Is patient-centered care evidence based? It can be but might not be. Patients often don’t want the evidence-based care I offer them like immunizations or colon cancer screening. So they aren’t receiving evidence-based care but they are receiving patient-centered care.

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April 1, 2013

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Bias, evidence based practice, Evidence Resources

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Why Can’t Guideline Developers Just Do Their Job Right????

I am reviewing a manuscript about the trustworthiness of guidelines for a prominent medical journal. I have written editorials on this topic in the past (http://jama.jamanetwork.com/article.aspx?articleid=183430 and http://archinte.jamanetwork.com/article.aspx?articleid=1384244). The authors of the paper I am reviewing reviewed the recommendations made by 3 separate medical societies on the use of a certain medication for patients with atrial fibrillation. The data on this drug can be summarized as follows: little benefit, much more harm. But as you would expect these specialists recommended its use in the same sentence as other safer and more proven therapies. They basically ignored the side effects and only focused on the minimal benefits.

Why do many guideline developers keep doing this? They just can’t seem to develop guidelines properly. Unfortunately their biased products have weight with insurers, the public, and the legal system. The reasons are complex but solvable. A main reason (in my opinion) is that they are stuck in their ways. Each society has its guideline machine and they churn them out the same way year after year. Why would they change? Who is holding them accountable? Certainly not journal editors. (As a side note: the journals that publish these guidelines are often owned by the same subspecialty societies that developed the guidelines. Hmmmm. No conflicts there.)

conflict of interest

The biggest problem though is conflicts of interest. There is intellectual COI. Monetary COI. Converting data to recommendations requires judgment and judgment involves values. Single specialty medical society guideline development panels involve the same types of doctors that have shared values. But I always wonder how much did the authors of these guidelines get from the drug companies? Are they so married to this drug that they don’t believe the data? Is it ignorance? Are they so intellectually dishonest that they only see benefits and can’t understand harm? I don’t think we will ever truly understand this process without having a proverbial fly on the wall present during guideline deliberations.

Until someone demands a better job of guideline development I still consider them opinion pieces or at best consensus statements. We need to quit placing so much weight on them in quality assessment especially when some guidelines, like these, recommend harmful treatment.