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Time to write
Fig.1 H809 EMA Mindmap (for fellow H809 / MA ODErs I’ve added a PDF version in the TMA Forum) Created using Simpleminds.
- H809 – Practice-based research in e-learning
- MA ODE – Masters in Open and Distance Education
- TMA – Tutor Marked Assignment
- PDF – PDF
Yonks ago I realised for me the best time to study was v.early in the morning. 4.00 am to breakfast isn’t unusual, 5.00 am is more typical. All it costs is an early night. This is easy too – no television. Its move from the shed to the dump is imminent.
A week ahead of schedule I find I have an EMA to complete – this’ll give me a three hour, exam like run of it. Even the dog knows not to bother me.
For those on the same path the mindmap of my H809 EMA is above.
Ask if you’re interested in a legible PDF version.
This gorse bush off density has patterns within it that I can decipher. The net result ought to come out somewhere around the 4,000 word mark too. This approach could not be more different to my earliest TMAs and EMAs three years ago – they were too often the product of what I call ‘jazz writing’ (this kind of thing), just tapping away to see where it takes you. This process used to start on scrolls of backing wallpaper taped to my bedroom wall. Now it goes onto a whiteboard first.
As always this blog is an e-portfolio: most notes, moments in student forums and references are in here.
I recommend using a blog platform in this way. You can default to ‘private’, or share with the OU community … or ‘anyone in the world’. One simple addition to this would be a ‘share with your module cohort’.
By now I have clicked through some 165 posts taggeed H809 and can refer to H809ema for those picked out for it.
One split occured – I very much wanted to explore the use of augmented reality in museum visits, but found instead a combination of necessity and logic taking me back to the H809 TMA 01 and a substantial reversioning of it. Quite coincidentally this proposed research on adherence to preventer drugs amongst moderate to severe asthmatics had me taking a very close interest on a rare visit to a hospital outpatient’s. Nasal endoscopy must look like a circus trick to the casual observer as the consultant carefully ‘lances’ my skull through the nose with a slender and flexible rod on which there is a tiny camera and light. ‘Yes, I can see the damage from surgery’ he declares (this was 33 years ago), ‘but no signs of cancer’.
There’s a relief.
An unexplained nose bleed lasting the best part of 10 weeks was put down to my good-boy adherence to a steroid nasal spray that had damaged the soft tissue. And the medical profession wonder why drug adherence can be so low? 20% to 60% 33 years on and courtesy of the OU Library I found a wholly convincing diagnosis – allergic rhinitis. The ‘paper’ runs to over 80 pages excluding references and has some 20 contributors (Bousquet, 2008). I’ll so miss access to the online library as most papers appear to cost around the £9 to download. This desire to remain attached by a digital umbilical chord to such a resource is one reason I wish to pursue yet more postgraduate studying and potentially even an academic career. I get extraordinary satisfaction browsing ‘stuff’ to feed my curiosity.
When I stop diddling around here I’ll pick off this mindmap in a strick clockwise direction from around 1 O’Clock.
Simpleminds is great as a free App. It’s taken me a couple of years to get round to paying £6 for a version that can be exported into a word file though I rather enjoy the slower, more considered ‘cut and paste’ which adds another opportunity to reflect, expand or ditch an idea.
Bousquet, J, Khaltaev, N, Cruz, A, Denburg, J, Fokkens, W, Togias, A, Zuberbier, T, Baena-Cagnani, C, Canonica, G, Van Weel, C, Agache, I, Aït-Khaled, N, Bachert, C, Blaiss, M, Bonini, S, Boulet, L, Bousquet, P, Camargos, P, Carlsen, K, & Chen, Y (2008) ‘Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Update (in collaboration with the World Health Organization, GA2LEN’, Allergy, 63, pp. 8-160, Academic Search Complete, EBSCOhost, viewed 19 June 2013.
We’re no longer trying to sell magic potions out the back of a tub-trap
Fig.1. We’re no longer trying to sell magic potions out the back of a tub-trap.
Still playing catch-up after the Tutor Marked Assignment (TMA)
Through week six writing and most activities (a few hours left to wrap)
I’m on my seventh Open University Postgraduate module – six on e-learning, one from the MBA programme.
I’m familiar with week 7 as we begin week 8.
I’ll catch up over the weekend.
If it rains a good deal and my son’s football is off (again). This will come back to haunt me – with all the bad weather they are moving to two matches a week. The Daddy Taxi might be busy.
For H809 conjured up the ‘Perfect Storm of Online Research’
- Young people, including minors
- Online – gamified if not virtual worlds, with social aspects (whether wanted or not)
- Medical – not a medical market research but ostensibly an ‘intervention’ of sorts that would require expertise, training and sign off for everyone involved.
- Global – what isn’t if it is accessible online?
The good news?
- They haven’t found life on Mars yet so I can keep it contained to Earth.
- Set further parameters.
I’m looking at use of e-learning to improve uptake of preventer medication by young people with severe moderate asthma (i.e. they are supposed to take a daily preventer inhaler, like me, I do – they don’t).
I may ‘contain’ the research to a group where in some cases a step has already been taken to ameliorate the situation – swimming. I’ll talk to the ASA (hypothetical) and have participants as UK swimmers with asthma
This on ethics and permissions relating to research will be of value.
University of Oxford Research Integrity
By entering medical research I have entered a minefield!
There are pages of protocols and procedures, training and checks with personnel and so on from the universities, the NHS and UK Government legislation.
Fig.2 A foothill just turned into climbing Olympus Mons, the 21000m largest mountain on Mars.
A picnic just turned into a medieval banquet for Henry VIII and all his six wives … (I’m off to walk the dog).
If I’m burying my head in sand then it is the red sand of Mars. In any case, why climb Olympus Mons when I can land on it in a Twitter / PayPal sponsored Mars Rocket.
In truth I am reassured by the scope and comprehensive nature of the guidelines, protocols and legislation.
- Artist Rendering of Olympus Mons on Mars (myscienceacademy.org)
- Olympus Mons: Giant Mountain of Mars (space.com)
Reflection on Block 1 – towards compliance for those with moderate severe asthma
The most straight forward of assignments has proved anything but … not for how to write this 2000 word piece, that is straight forward, but rather committing to a subject, then narrowing down the theme, possible research question and then dig up some papers … and not simply offer the lot, but give the five ‘that say it all’. To pick five how many must you read, at least as abstracts. I made three false starts, even read a PhD thesis on blogging before deciding it is a minefield. I may like to blog but I no more want to research it for an OU assignment than sort out pebbles on Brighton Beach. Lifelogging, memory and neuroscience all interest me … but are too big to get my head around in a few months – a few years perhaps. Looking at my notes I see I have papers also on augmented learning for field trips and museum visits. Then I returned to a platform that caught my eye three yesrs ago on H807 when I interviewed Dr. B. Price Kerfoot of Harvard Medical School on ‘Spaced Education’. So far this system has been usef with doctors, to support their learning and decission making … the next step will be patients. One of the humdingers here is ‘compliance’ – taking the medication you are prescribed if you have a chronic condition. What dawned on me this afternoon is that as a asthmatic I am the perfect patient – compliant to the nth degree. What surprised me is that such a large percentage of asthmatics are not. But with alleregies – a double-whammy of irritations, I ignore the nasal steroids and antehistemines almost completely. Compliant, and defiant in one go so just about canceeling the two out. But why? This is what fasciantes. You know you need to take something to avoid a return of the symptoms, but as there are no symptoms you stop taking the medication. Anyway, I am sifting through papers to set me straight and to offer some answers. If you have a moderately severe chronic condition and wish to share your medication regime or attitude please speak up – asthma, allergies, diabetes, epilepsy, other mental illnesses – chat on Skype? Meanwhile I checked my preventer inhaler – it was empty. I at least had a spare and will get a repeat prescription in tomorrow.
The wonders of the OU Library
I will never tire from serving my curiosity when I entre the OU Online Library. I am often lost for weeks at a time, dipping into everything that catches my eye, reading some of if all the way through, following up further leads, then further leads until I find I’ve either circumnavigated the globe, dropped back a century or more or am spinning circles in a slow, spiraling descent through a single authors previous thinking.
I don’t need a ball of thread to help me find my way out and there’s no Minotaur to slay at the centre.
All I hate is a underpowered laptop and a rubbish internet connection.
Currently my interest is reseach on compliance, noncompliance, adherence and coherence in use of asthma drugs. I should know, I am one. My compliance is excellent. One asthma attack in my teens and I do everything to the letter. I fail to understand how and why 30% of people with my condition end up hospitalised or dead. The reading is extraordinarily diverse, bringing it down to the person, their identity with the condition and unwillingness to take a couple of puffs on an inhaler morning and night – when surely they are in and out of the bathroom anyway?
If you know any asthmatics like this please put them in touch or send them to my blog where I will add notes.
How to improve asthma patient outcomes using spaced education
There had been no plans to make this content public, but I thought I’d share it because of my interesting realisation that the Zemanta search tool may be a reasonably valid way to winkle out papers relevant to a topic of interest. Out of habit it now I offer link to further content that on first appearances seems to offer similar or contrasting views. Before I look at the selection that was offered to me, and the 7 from the 16 or so I was offered I am going to go through conventional route using the Open University Online Library and see what I may find that to any large extent differs.
I am not a physician or Medical Docotor, though I am asthmatic and have been in, on and off a variety of inhalers and sometimes oral steroids for some thirty years.
Preventer – Inhaled Steroid – two puffs twice a day. Used with a spacer to reduce chances of thrush.
Reliever – as needed, which is generally never, with rare need if I develop a chest infection, in which case I may end up on antibiotics anyway.
Oral Steroids – Very rarely, usually related to a chest infection. Once every five years?
Nebulizer – Never. Unlike my late father and one (or two) relations who take the view that they only need the preventer when they are wheezy … and end up hospitalised when they have an asthma attack and in the case of my father on steroids for so long that he became diabetic.
Preventative measures – know your triggers, avoid them, keep fit and attend an annual Asthma Clinic. I have to be cautious with house dust allergy and its partner in crime – damp. The odd list of triggers includes, at times, bleach, cumin seeds, one of the Lucozade sports drinks (odd that, coming from GSK who also produce asthma drugs). Possibly white flour. Yeast causes other problems too. We have a dog, but I’m not comfortable for long in a house with soft furnishings where there are cats. Get the bedroom windows open as often as possible. Use a specialist vacuum cleaner on the mattress, pillows and duvet. No carpets. No curtain. Leather sofa preferred.
Fig. 1. Twenty years ago I found myself producing, directing and writing a two information videos for a major pharmaceutical company – ‘Living with Asthma’ and ‘the Cost of Asthma’.
These had a shelf life of some ten to fifteen years, eventually to be replaced by DVD and online interactive equivalents. We did a combination of narrative drama reconstruction – a thread from a TV soap in which a protagonist has an asthma attack, interviews with patients and experts (doctors and pharma) and narration with 3D animations and charts.
The purpose of this exercise is to:
- Justify and explain the question for a piece of empirical research.
- Offer FIVE pieces that support then set you research on its way.
|What is the proposed research about?||Asthma patient ignorance of best practice in relation to taking their prescribe drugs – why they are taking the drugs, how they work, when they should take them, how and how often …|
|What is it trying to find out or achieve?||Improve patient care i.e. compliance (UK) – so taking their medicine correctly. This is important where the condition is chronic and the symptoms aren’t continuous. People tend to lapse taking the preventative drugs … it takes several days on onset of symptoms for these to kick in.|
|How will it go about doing that?||A randomised controlled trial in which all asthmatics are invited to sign up to receive information over a period of x months, reminders about asthma and their drug taking regime.|
|What will we learn from it and why was it worth learning?||That a significant percentage of asthmatics who have been prescribed an inhaled steroid (preventer medicine) to take twice daily are failing to do so, simply because they don’t see the need to do so unless they are feeling wheezy (a misconception, it should be taken regardless) or they allow their inhalers to run on empty for some time before being aware of this.That a significant percentage of asthmatics, probably largely the same group as above, misuse their reliever inhaler a) taking it too often b) not correctly inhaling so that drug ends up lining their mouth rather than entering their lungs.Taking the right dosage of inhaled steroid, as prescribed, in the correct manner, is likely to reduce need for the reliever inhaler to nil and will result in less long term damage being done to the lining of the lungs.It will improve patient outcomes, reduce the use of inhibitors and reduce hospital visits or overnights where a person has suffered an avoidable asthma attack.|
- Study Shows Combining 2 Inhalers Could Be Better Treatment For Asthma Patients (pittsburgh.cbslocal.com)
- Asthma Threatens The Baby Boomers Generation (livingwithallergy.com)
- New Phase 2 Asthma Clinical Trial Now Enrolling at Achieve Clinical Research in Birmingham, Alabama; Accepting Male & Female Participants Age 16-75 (prweb.com)
- 3 Steps To Helping Your Asthmatic Child (dominicspoweryoga.com)
Learning & Memory – my 1,500th post to this blog
Fig. 1. Looks a like a good read
I’m starting to read papers on neuroscience that result on my starting to use my hands and fingers as I read, even reading and re-reading phrases and sentences out loud as I try to ‘get my head around it’. (A search in the Open Universal Online library for ‘hippocampus rats memory’ brought me to the above.
This is the kind of thing from the abstract:
The nucleus accumbens shell (NAC) receives axons containing dopamine-b-hydroxylase that originate from brainstem neurons in the nucleus of the solitary tract (NTS). Recent findings show that memory enhancement produced by stimulating NTS neurons after learning may involve interactions with the NAC. However, it is unclear whether these mnemonic effects are mediated by norepinephrine (NE) release from NTS terminals onto NAC neurons. (From Kerfoot & Williams (2011:405)
On the other hand, when I read this I think I’ve taken it too far. Like the skier who watches with admiration as someone comes down a gully but would never do it themselves.
The A2 neurons are activated during times of heightened arousal by the release of glutamate from vagal nerve fibers that ascend from the periphery to the brainstem (Allchin et al. 1994; King and Williams 2009). Highly arousing events increase epinephrine secretion from the adrenals and facilitate binding to b-adrenergic receptors along the vagus nerve (Lawrence et al. 1995) that in turn, increase impulse flow to brainstem neurons in the NTS (Lawrence et al. 1995; Miyashita and Williams 2006). Epinephrine administration, stimulation of the vagus nerve or direct infusion of glutamate onto A2 NTS neurons are all known to significantly potentiate norepinephrine release within the amygdala and hippocampus (Segal et al. 1991; Liang et al. 1995; Williams et al. 1998; Izumi and Zorumski 1999; Hassert et al. 2004; Miyashita and Williams 2004; Roosevelt et al. 2006). (From Kerfoot & Williams (2011:405).
Fig. 2. Neuroscience for Dummies (Frank Amthor 2012) L5704
This is the bold step I’ve taken, not having to reading papers on neuroscience but feeling the need to do so. I’ve had three years of considering the theory behind learning, now I want to see (where it can be seen) what is happening. Papers rarely illustrate. What I want are papers with photos, charts, and video clips, with animations and multi-choice questions, then a bunch of contactable folk at the bottom to have a conversation with.
Figure 2 will have to do for now, though having got through ‘Neuroscience for Dummies’ I’m ready for the sequel ‘Neuroscience for the Dolterati’.
To understand how the nervous systems works, according to Professor Frank Amthor I need to know how neurons work, how they talk to other neural circuits and how these circuits form a particular set of functional modules in the brain. Figure 2 starts to do this. (Amthor, 2012. Kindle Location 323)
What is going on here?
If I understand it correctly there is, because of the complexity of connections between neurons, a relationship with many parts of the brain simultaneously, some common to us all, some, among the millions of links, unique to us. Each neuron is connected to 10,000 others. To form a memory some 15 parts of the brain are involved.
Learning is situated, much of it we are not aware of.
There is a multi-sensory context. Come to think of it, while I was concentrating I got cramp in my bum and right thigh perched as I am on a hard kitchen chair, and the lingering after taste of the cup of coffee I drank 45 minutes ago. I can hear the kitchen clock ticking – though most of the time it is silent (to my mind), and the dog just sighed.
Does it matter that my fingers are tapping away at a keyboard?
Though second-nature touch-typing it occupies my arms and hands and fingers which could otherwise be animated as if I were I talking. Would this in some way help capture the thought? I am talking, in my head. The stream of consciousness is almost audible. It was a couple of sentences with a few new acronyms involving an image I have in my head on what neurons, synapses and axons looks like.
What would happen where I to use a voice recorder and speak my thoughts instead?
By engaging my limbs and voice would my thinking process improve and would the creation of something to remember be all the stronger.
I’m getting pins and needles/cramp in my right leg. Aaaaaaaaaaagh! Party over.
The question posed is often ‘what’s going on in there?’ referring to the brain. Should the question simply be ‘what’s going on?’
My eyesight is shifting. In the space of six months of moved to reading glasses. Now my normal glasses are no good either for reading or distance. Contacts are no use either. As a consequence I’m getting new glasses for middle distance and driving. The solution with the contact lenses is more intriguing.
To correct for astigmatism and near or short sightedness I am going to have a one lens in one eye to deal with the astigmatism and a different lens to deal with the short sightedness in the other. My mind will take the information from both and … eventually, create something that is sharp close up and at a distance. This has me thinking about what it is that we see, NOT a movie or video playing out on our retina, but rather an assemblage of meaning and associations formed in the brain.
I will try these lenses and hang around, wander the shops, then return. I am advised that I may feel and appear drunk. I can understand why. I could well describe being drunk as trying to navigate down a path with a microscope in one hand and a telescope in the other while looking through both. I feel nauseous just thinking about it.
So ‘stuff’ is going on in the brain.
These days the activity resulting in the brain figuring something out can, in some instance and to some degree, be seen. Might I have an fMRI scan before the appointment with the optician? Might I then have a series of further scans to follow this ‘re-wiring’ process.
I need to be careful here, the wrong metaphor, however much it helps with understanding may also lead to misunderstanding. Our brain is organic, there are electro-chemical processes going on, but if I am correct there is no ‘re-wiring’ as such, the connections have largely existed since birth and are simply activated and reinforced?
Fig.3 . Synaptic transmission
Any neuroscientists out there willing to engage with a lay person?
What would observing this process of unconscious learning tells us about the process of learning? And is it that unconscious if am I am aware of the sensations that have to be overcome to set me right?
Kerfoot, E, & Williams, C n.d.(2011), ‘Interactions between brainstem noradrenergic neurons and the nucleus accumbens shell in modulating memory for emotionally arousing events’, Learning & Memory, 18, 6, pp. 405-413, Science Citation Index, EBSCOhost, viewed 7 March 2013.
Amfor, F (2012) Neuroscience for Dummies. Cheat Sheet. (for the time challenged)
- Our brains, and how they’re not as simple as we think (3quarksdaily.com)
- Brain Activity Mapping: What is it and why is it important? (momentumblog.bcm.edu)
- The left brain is rational, and other lies you’ve been told about neuroscience (io9.com)
- fMRI Scan Detects Mental Pictures (fastcompany.com)
- Study: Mental picture of others can be seen using fMRI (rdmag.com)
- What is consciousness? A scientist’s perspective (thebrainbank.scienceblog.com)
- Gatekeeper nerve cells explains the effect of nicotine on learning and memory (sott.net)
- How Love Grows in Your Body (blogs.berkeley.edu)
- Essentials of the gut-brain connection: Vagus nerve anatomy (midwestprs.com)
- How electrodes in the brain block obsessive behaviour (newscientist.com)
Learning in extremis
Fig.1. Three years later
“Emergency Home Birth!” my wife exclaimed pointing at a book on pregnancy and childbirth.
My wife went into labour at 2.30am, we’d planned a home birth (this is her second) however our hospital was some 37 miles away and our allocated Midwife was another 20 miles beyond that.
I got her on the phone and she spoke to my wife between contractions – she wouldn’t make it.
‘Call an ambulance and I’ll be over in due course’, she said.
Chapter Six, ‘Emergency Home Birth’ looked like it needed half an hour to read and at least as long again to digest; there wasn’t time.
Thankfully om the facing page of Chapter Six the editor had laid out the essentials in clear bullet points – towels, scissors and string are the ones I remember, probably because I required all three, these and the warning that the umbilical cord can get caught around the baby’s throat. I needed that too.
Just in time learning, delivered just in time.
And so it was, at around 3.20am, my wife on floor holding onto the the end of the bed, towels in place that our son was born.
First his head, the umbilical cord wrapped tightly around his throat. I eased this over his chin and around his head, surprised at how thick and tough it was – then one,the both shoulders and he fell into my arms like a muddy rugby ball out of a scrum. My wife rolled around and sitting at the end of the bed she took him into her arms.
A few minutes later the midwife arrived, thought everything was going well and went to run a bath. In due course she showed me how to cut the umbilical cord then took my wife to the bathroom.
Learning in extremis?
In my day job I was supporting the teaching of such techniques at the logistics and distribution group UGC in Oxford.
I didn’t need a book, or a training video and given this was 1996 I wasn’t going to have Google, Quora or YouTube offer some advice.
I’ve had no further need for these particular parenting skills, though it’s been an adventure following two infants through childhood into their early teens.
Learning works best when it is pushed, when there is a challenge of time and circumstances, where it can be applied and seen to work.
How do we apply this to formal education, to studying for exams through secondary and tertiary education?
What is the difference with learning in the workforce, between physical actions on a factory floor, in a mine, power station or warehouse, out on a civil engineering building site or in an office or boardroom?
There need to be exams – from mocks to annual exams and finals.
Essays and regualr assignments are part of this best practice.
And how about tests, even the surprise test, not so much for the result, but for the pressure that ought to help fix some learning in our plastic, fickle minds?
In advertising we often spoke of ‘testing to destruction’ that nothing beats a clear demonstration of the products power, staying power or effectiveness in memorably extreme conditions.
I like the idea of working Against the clock, of competition too, even learning taken place, as I have heard, as someone cycles around Europe, or drives a Russian Jeep from Kazakstan back to Britain.
I believe in the view that ‘it’ll be alright on the night’ – that you can galvanise a group to rally round when needed and those new to this game will pick up a great deal in the process; personally I loved the ‘all-nighters’ we did in our teens breaking one set then building another in the Newcastle Playhouse, some sense of which I repeated professionally on late night and all night shoots, often in ‘extreme’ places.
- Umbilical Cord: To Clamp or Not to Clamp? (lovingcareblog.com)
- Where Does Intelligence Come From? (dranilj1.wordpress.com)
- Zoologists watch as monkey midwife delivers baby (io9.com)
The Educational Impact of Weekly E-Mailed Fast Facts and Concepts
In this study, the authors assessed the educational impact of weekly Fast Facts and Concepts (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education.
The more papers I read, like learning a foreign language, the thinner the blur between mystery and comprehension in terms of judging a paper and its contents. My goal is to be able to conduct such research and write such papers. I understandably feel that a first degree in medicine and a second masters degree in education is required at this level. At best I might be able to take on psychology or neuroscience. My preference and hope would be to become part of a team of experts.
Purpose: Educational interventions such as electives, didactics, and Web-based teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost.
What – A clear problem:
Integrating palliative care into residency training can be limited by the number of trained faculty, financial constraints, and the difficulty of adding educational content with limited resident duty hours. (Claxton et al. p. 475 2011)
Who – Participants
Beginning internal medicine interns
Why – Time- and cost-efficient strategies for creating knowledge transfer are increasingly important. Academic detailing, an educational practice based on behavioral theory, uses concise materials to highlight and repeat essential messages. Soumerai (1990)
How – We designed this study to assess the educational impact of weekly e-mailed FFAC on
internal medicine interns in three domains: knowledge of palliative care topics, satisfaction with palliative care education, and self-reported preparedness in palliative care skills.
This randomized, controlled study of an educational intervention included components of informed consent, pretest, intervention, and posttest.
Fast Facts and Concepts
FFAC are 1-page, practical, peer-reviewed, evidence-based summaries of key palliative care topics first developed by Eric Warm, M.D., at the University of Cincinnati Internal Medicine Residency Program in 2000.6
One e-mail containing two FFAC was delivered weekly for 32 weeks to interns in the intervention group.
All participants completed a pretest that assessed knowledge of palliative care topics, self-rated preparedness to perform palliative care skills, and satisfaction with palliative care education.
Method: Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups in July 2009. Pretests and post-tests assessed medical knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point Likert scale and satisfaction based on ranking of education quality.
The intervention group received 32 weekly e-mails.
No e-mails were sent to the control group.
Respondents completed a post-test 1 to 8 weeks after the
All study participants were informed of the content and the online availability of FFAC during recruitment. At the conclusion of the study, both control and intervention groups were given a booklet that contained all the e-mailed FFAC.
Descriptive statistics and t tests were used to compare the demographic data between the control and intervention groups. Medical knowledge, preparedness, and satisfaction were compared pretest and post-test within groups by Wilcoxon tests and between groups via Mann-Whitney U tests. The data did not meet assumptions for multivariate analysis due to the small sample size. Only univariate analysis was performed.
Although traditional academic detailing techniques include educational outreach visits and distribution of printed graphic materials, e-learning techniques such as e-mail delivery of educational content, listservs and Web-based tutorials can also be considered rooted in this behavioral theory given their focus on repeated, concise content.
Pain assessment and management, breaking bad news, communicating about care goals, and providing appropriate medical care for a dying patient are necessary skills for surgery, family medicine, pediatric, obstetrics and gynaecology, physical medicine and rehabilitation, emergency medicine, neurology, radiation oncology, anesthesiologist, and psychiatry residents.
Studies that focus on e-mail education interventions have shown that weekly e-mails change the behavior of e-mail recipients, improve learner retention of educational content and that retention improvements increase with the duration over which e-mails were received. (Kerfoot et al. 2007 ) (Matzie et al. 2009)
Results: The study group included 82 interns with a pretest response rate of 100% and post-test response rate of 70%. The intervention group showed greater improvement in knowledge than the control (18% increase compared to 8% in the control group, p = 0.005).
Preparedness in symptom management skills (converting between opioids, differentiating types of pain, treating nausea) improved in the intervention group more than the control group ( p = 0.04, 0.01, and 0.02, respectively).
There were no differences in preparedness in communication skills or satisfaction between the control and intervention groups.
Conclusions: E-mailed FFAC are an educational intervention that increases intern medical knowledge and self-reported preparedness in symptom management skills but not preparedness in communication skills or satisfaction with palliative care education.
Claxton, R, Marks, S, Buranosky, R, Rosielle, D, & Arnold, R 2011, ‘The Educational Impact of Weekly E-Mailed Fast Facts and Concepts’, Journal Of Palliative Medicine, 14, 4, pp. 475-481, Academic Search Complete, EBSCOhost, viewed 25 February 2013.
Matzie KA, Price Kerfoot B, Hafler JP, Breen EM: (2009) Spaced education improved the feedback that surgical residents given to medical students: A randomized trial. Am J Surg 2009;197:252–257.
Price Kerfoot B, DeWolf WC, Masser BA, Church PA, Federman DD: (2007) Spaced educational improves the retention of clinical knowledge by medical students: A randomized controlled trial. Med Educ 2007;41:23–31.
Soumerai SB, Avorn J: (1990) Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA 1990;263:549–556.
- Palliative care: knowing when not to act (oup.com)