One of the main reasons I keep coming back as a tutor on the Oxford Teaching Evidence-Based Practice course (this is my sixth year) is because I never stop learning from the other participants and tutors. This year is no different.
In our small group work we discussed the challenges teachers face to engage your students right from the beginning of your teaching session. What we agreed on was that as a teacher you often begin with the best intentions in your teaching, but at some point, you run the risk of losing your audience. This led to us discussing the importance of having “hooks” within your teaching session, to systematically engage your audience with your teaching.
So what is a “teaching hook”? OK, let me give you an example, this week I have been teaching the participants on how to teach randomised controlled trials. Now you could go straight into identifying a RCT paper and systematically appraising it using a critical appraisal tool. That would be ok for say a journal club, but when I want to teach students on RCTs, I think I have to help them understand why RCTs are so special.
One of the examples I use is to ask the students if they know about the origins of the Cochrane Collaboration, one of the largest collections of systematically reviewed randomised controlled trials. This leads on to a story about Archie Cochrane, a clinical epidemiologist and one of the pioneers of evidence based medicine. However I hook the audience into my teaching session by telling a story about Archie’s experience as a prisoner of war in Salonica, Greece during World War 2. During this period, in 1941, Archie was posted in a camp and as a doctor was observing how some of the surrounding prisoners became very sick, very quickly. Perhaps not surprisingly given the POW conditions, but Archie had a hypothesis as to the cause of their deterioration and was convinced that there was something vital missing in their diet, a mineral or vitamin likely found in yeast. So he tested his theory. He latterly wrote in the BMJ in 1984 what he did.
“. . . I recruited 20 young prisoners . . . I gave them a short talk about my medical hero James Lind and they agreed to co-operate in an experiment. I cleared two wards. I numbered the 20 prisoners off: odd numbers to one ward and evens to the other.
Each man in one ward received two spoonfuls of yeast daily. The others got one tablet of vitamin C from my “iron” reserve. The orderlies co-operated magnificently . . . They controlled fluid intake and measured frequency of urination.
. . . There was no difference between the wards for the first two days, but the third day was hopeful, and on the fourth the difference was conclusive . . . there was less oedema in the “yeast” ward. I made careful notes of the trial and immediately asked to see the Germans.” A. L. Cochrane (Br Med J 1984; 289: 1726-7)
What amazes me, and I express this to my audience, is that even under the worst conditions imaginable in the camp, Archie had a theory and wanted to test it in a scientific way and the study design he tried to use was a randomised controlled trial. He even tried to control for fluid input and output to reduce the risk of confounding!
He reflected again latterly on his actions and said:
“It could be argued that the trial was randomised and controlled, although this last was somewhat inadequate. In those early days, when the randomised controlled trial was little known in medicine, this was something of an achievement.”
What? “Something of an achievement”? I’d say it was a massive achievement! A true scientist who even in a prisoner of war camp, in the most appalling conditions in 1941 decided to test a theory with the best randomised controlled trial he could set up.
Even more remarkable was the fact that the first widely recognized modern day RCT was published in 1948 .