Category: College

Does it work? When doctors need evidence

Healthcare professionals can generate important clinical questions for addiction research. Answering such questions by conducting a Cochrane review of evidence is a satisfying learning process and can contribute to drugs policy. This article summarises the experiences of an addiction medicine researcher conducting a Cochrane review, developing and evaluating a researcher-facilitated programme for medical student research activity in general practice.

photo credit: theconversation.net

One summer afternoon in 2010, an interview with a family physician in Dublin opened my eyes about talking therapies for drink problems among people who also used other drugs. “Does counselling work for these people?” the doctor asked.  “Yes”, I was absolutely convinced about it, but I had no evidence for my faith. Surprised by his interest, I sent him the only two studies on the topic that I knew of; never heard back from him.

I searched for more studies without success. Many studies on general population showed up in my internet search, but none for people who also used other drugs.
This made me doubt my beliefs. At that time, a national funding agency announced a call for Cochrane training fellowships. Cochrane collaboration hosts the largest database of systematic reviews to inform healthcare decisions. Cochrane reviews are the jaguars of medical evidence synthesis. The fellowship was a godsend. I could use the funding to learn from Cochrane gurus and answer the Dublin doctor’s question by making the most of all available literature. My supervisor introduced me to a Cochrane author, Dr Liam Glynn, who reviewed self-management strategies for high blood pressure. He agreed to mentor my fellowship. We booked the title for our review with the Cochrane Drug andAlcohol Review Group in Italy and started to work on it when we got the funding.
The review found very few studies, most of which didn’t have a control group or randomised patients without drink problems; we could not give any recommendations to doctors.
The next step in the quest for the answer, we approached patients with dual drug and alcohol problems and fed their ideas back to the experts. Expert consensus recommendations are standard in the absence of scientific studies. The group had to rely on semi-structured interviews with doctors and patients and “B class” evidence from my review. The result of their consensus was a manual for family doctors.
Having developed the manual, we tested its value to answer our original question: “Does it work?” The new pilot trial encourages doctors to ask people who use illicit drugs about alcohol and to help those with mild problems; severe problems are best treated by a specialist.  Sixteen general practices (GPs) in two deprived regions will be randomised to receive the manual-based training or to keep doing what they do. The latter group will be trained later.
When I finished my Cochrane training and review, it was time for me to give back and teach medical students because the fellowships worked on the pay-it-forward model. Equipping the new generation of doctors with critical literature review and appraisal skills was my contribution to the improvement of addiction healthcare delivery. The aim of our teaching project was to create and evaluate a training-through-research programme for medical students, facilitated by a seasoned researcher.
We offered online webinars, methodological advice, mentoring, and one-one interaction. Our medical school emailed all students and we randomly selected a handful needed for our research projects. Collaborators from biostatistics, psychiatry and public health aided the programme. The students presented their work at four conferences and wrote three academic papers for medical journals.
Teaching literature reviews to medical students was a rewarding learning experience. I learned that the quality and commitment of students varies; different expectations led to different work processes and outputs. Some students submitted their work in more finished stage than others; competing priorities precluded achievement of higher standards. The manuscript preparation, submission and publication processes were too long for short student projects, although some students persevered and remained involved until the end.
From a personal perspective, I still don’t know whether counselling works for drink problems in people who also use other drugs, but I’ve learned how to query the literature when doctors need evidence.

This post is based on our presentation at the INMED conference in Belfast, and o recent article in the Substance Abuse journal. References:
  • Klimas, J., & Cullen, W. (2014). Addressing a Training Gap through Addiction Research Education for Medical Students: Letter to editor. Substance Abuse. doi: 10.1080/08897077.2014.939802
  • Klimas, J., & Cullen, W. (2014). Teaching literature reviews: researcher-facilitated programme to support medical student research activity in general practice. Poster presented at the Annual scientific meeting of the Irish Network of Medical Educators, February 21, Belfast, NI.

 

Addressing a Training Gap through Addiction Research Education for Medical Students: New Paper out Now

Can medical doctors use scientifically proven treatments for addiction? Can they access and critically appraise the latest advances in the addiction science? 


In this letter to the editor, we respond to the editorial by Gordon and Alford (2013), in the recent special issue of the Substance Abuse (Vol. 33, No. 3), provides an insightful reflection on the early attempts at describing curriculum development and implementation of addiction content into various learning environments. We report on preliminary results of our course in addiction medicine research facilitated by a PhD researcher in the University of Limerick. We wanted to help medical students learn how to do and read addiction medicine research. The first cohort of 14 students received the training favourably.read the full text at: http://www.tandfonline.com/doi/full/10.1080/08897077.2014.939802#.U-JhKfldVAs

Cited Study:

J Klimas, W Cullen – Substance Abuse, 2014

DOI:
10.1080/08897077.2014.939802

Answer to Ethan #38: how to write a science blog

Ethan Siegel posed challenging questions in his post about science blogging. They prompted me to think about my own blog. If you’d ever been thinking about your own blog too, my thoughts might help.
Figure 1 Ethan’s blog. Photo credit scienceblogs.com

1) What is it that you’d like to write about?
I started my blog without careful planning. Shortly after the start, I’ve read someone else’s blog and I realized that I could write about the research I’m doing and about our research group. Blogging was my way of publicising and highlighting my research work. There wasn’t much research to write about at that time. Or, perhaps, as a starting writer, I didn’t see the writing opportunities as I see them now. I started to write about many other topics, including my personal life, hobbies and interests. Sometimes midway my evolution as a blogger, I took stock and divided my topics into three main categories: science, academic and creative. The science and academic categories differed mainly by the language and style of writing. Creative group was everything else. For instance, travel, concerts, poetry, etc.
2) Who is your audience?
Figure 2 William Zinsser, photo credit: npr.org

The first time I have been asked this question was when I talked to Rachel Dresbeck, PhD. I didn’t like that question because I was reading William Zinsser and he said to forget about writing for somebody. “Write for yourself”, I’ve read in his book (On writing well). I told Rachel that I’m writing for academics and psychiatrists who get bored on conferences and who check social media for amusement. She laughed. I laughed too. But there’s a grain of truth in that answer. I write for everybody who likes my posts and who shares my passions. As I grow, my passions develop too. With them, my target audience changes too – from enthusiast researchers and potential researchers to free spirits, artists and life lovers.

3) what are the goals of your writing?
To write a lot.
Some writing leads to more writing. It’s an amazing discovery; one topic leads to another.
To enjoy writing and like its results.
Some topics are easier to write about – on some days, my thoughts flow better. I find it really surprising to read posts that were difficult to write and see that I like them.
To share my ideas and see whether they spark some discussion.
In agreement with my point #1, I don’t write for a particular person or group. Nevertheless, I still want, need, and urge to share my writing with someone. Maybe it’s just the residual momentum from my blogging youth, or a continuing need for highlighting my work/life. Regardless of the motivation, I continue to write a public blog and assume that the silence of commentators = agreement and that “the vast majority of them simplywon’t comment or engage you.

Figure 3 Portland, Oregon guide by Rachel Dresbeck
photo credit abebooks.com

4) what else is Ethan advising to science bloggers?
This is merely a summary of  Ethan’s useful tips, some of which I mentioned above:
  • write often
  • be self-critical and honest about your own writing
  • find your own style
  • share your work with the online community
  • be a real person
  • be prepared for the kind of negativity that only the internet can heap upon you 

HORIZON 2020 Marie Skłodowska-Curie Actions Information Day: Mobility is part of their job description

Being able, ready and happy to move for work enhances academic career. On 4th June 2014, in the Gibson Hotel, Dublin, Ireland, the Irish Marie Skłodowska-Curie Office hosted an information day on the individual fellowships. Guest speaker on the day was Alessandra Luchetti, Head of the EU Marie Skłodowska-Curie Actions Unit (Figure 1). The event, co-organised with InterTradeIreland introduced the new opportunities for researchers in the Marie Skłodowska-Curie Actions under Horizon 2020.
In the past, the Marie Curie Actions programme was one of the big success stories of Irish participation in FP7 funding programme, representing almost €100 million of the €600 million drawn-down by Ireland from FP7. The Actions have funded researchers from industry, community and academia to build their research capacity, with a strong focus on international mobility and strengthening careers for researchers.
 

Figure 1 Guest Speaker: Alessandra Luchetti, Head of Unit, Marie Skłodowska-Curie Actions, European Commission: – you are lucky that I do not have to talk in Italian, I’m talkative, so I am genetically modified
More than 25 years ago, it was only the EU mobility scheme; it is the oldest and the most famous. Today, the cutoff for a successful application is 92%. The focus of the fellowship is on career development. UK and USA are the most preferred countries for the European and for the Global schemes, respectively. Ireland has funded identical twins in the FP7 programme (one of them through reserved list).
The fellowship has many benefits. Researchers have the opportunity to go to a centre that is top of their field. The social capital increases, you meet politicians, high-level academics. The fellowship gives leverage to link in with community. The label of MC fellow at the end of the email opens many doors. The postdoctoral researchers, who are normally stuck in Limbo – because they can’t apply for solo-funding – can use this first individual fellowship grant to demonstrate capability of attaining further funding. For the principal investigators, the fellowship offers to do more research with bigger teams. For example, an Irish-EU funding stream – Inspire – funded 21 experienced researchers in 2 calls at the UCD Energy Institute.

Irish Network of Medical Educators (#INMED2014): The 7th Annual Scientific Meeting

A network of volunteers for all interested in medical education on the island of Ireland met in Belfast yesterday. The network’s aim is to improve education. Network’s vision:

“The Network seeks to enhance medical education on the island of Ireland by bringing together individuals and organisations with an interest in and responsibilities in medical and healthcare education in a National Medical Education Network.”

The 2014 conference theme was creating supportive learning environments. See figure 1 below.

This year, the programme extended over two half-days and a full day between them.
The Wednesday half day offered five pre-conference workshops: Maximising clinical education opportunities, Researching clinical workplaces, Identifying trainees in difficulty, Overcoming obstacles to reflective practice, and Mixed methods research. As of Tuesday, February 18 (8am), there were 152 names on the delegate list. Of those, 7 were marked as judges, 4 as chairs, and 4 as chair/judge – a transparent practice rather unusual at conferences.

Thursday was the main day of the conference. It started with the usual welcomes and opening addresses in a packed room. In fact, delegates who came late stood in the back of the room, because there were no free seats left.

Two keynotes attracted most delegates, Prof Billet from Australia and Prof McAvoy from Britain. Prof Billet’s lecture was pre-recorded and projected on a large screen, because he was in Geneva at the time of conference. He explained meaning of important education terms, such as curriculum or apprenticeship. In simple words, he talked about learning by doing, but his theory-heavy talk with big words was difficult to follow in some places, as reported by delegates. The organizers helped the audience by pausing the video, interacting with the audience, and letting 20 seconds of silence for free-flow thinking

Doctors in difficulty and the re-mediators were discussed by Prof McAvoy (shown in Figure 2). Her talk reminded us that doctors are people too. Most are motivated, they’re not burned out. The reasons for their underperformance are subject of McAvoy’s research: professional, personal, physical health (e.g., high blood pressure), or mental health problems; the group identified 18% of cognitive problems among doctors, and in one case recommended psychiatric assessment which ended doctor’s career. Comprehensive assessment of underperforming doctors is critical – if you’re not getting the diagnosis right, the treatment won’t be effective. Following the assessment, absolute clarity of feedback is paramount for performance improvement.

Figure 2. Professor McAvoy

An hour and a half before the lunch, the delegates viewed 77 research and education posters. Judges assessed the posters allowing 3 minutes for presenters’ speech plus a couple of question.

Lunchtime provided opportunities for meeting the experts. After lunch, the delegates scattered into 5 workshops: i. student narratives (n= 6), ii. clinical ethics (n= 15), iii. emotional intelligence (n= 12), iv. organizational culture (n= 13), and v. emotions (n= 16). The numbers of delegates who attended workshops but did not put their names on the list are not included. Students led the mental health session from 4-5PM. The day finished with traditional AGM, drinks and dinner.

Friday half day concluded the conference with four sessions including research presentations, keynote speech by Prof Dornan from Netherlands, and hot topics in medical education. Read more about the conference here: www.inmed.ie