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Shape of services?

27 Feb, 15 | by Bob Phillips

With the publication and debate around Shape of Trainingbomb (a UK-based review of how training the medical workforce will be revised for a new era of health care) there is a fair bit of … conversation … about a number of things. Some of these things include the question about how a ‘medical’ service is to be delivered with fewer doctors.

Hot of the press, and in keeping with our new blog theme on qualitative work, there is a systematic review and meta-ethnographic synthesis of studies looking at how units have found the introduction of nurse practitioners (NP) into their clinical work.

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More than numbers: Sampling

27 Feb, 15 | by Bob Phillips

So, medical school taught us all about the rules of sampling in  research – generally more is better, if you want to be more accurate then do a power calculation (although sometimes this may be akin to picking a number out of the air). And we all know that randomisation is good practice too – right?

Wrong. These principles hold true for lots of quantitative research, where you are going to use your results to calculate test statistics, and to answer questions about causation or relationships using numbers. However, remember back to the introduction to this series – in qualitative research, the questions, methods, reasoning and results are different to what we’ve been ‘brought up on’! This is also the case in sampling.

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More than numbers: Ethnography or phenomenology?

20 Feb, 15 | by Bob Phillips

What kind of qualitative researcher do you want to be? Going back to the previous blog, maybe you want to work on the research question ‘what is it like to be a teenager with Duchenne muscular dystrophy?’ Now, there are multiple ways to approach this question in qualitative research. Two of these approaches are ethnography and phenomenology.

Now phenomenology is a theoretical approach in which the researcher considers the individual’s experiences, perceptions and behaviours. The phenomenological researcher is most interested in the ‘lived experience’ of that individual – their experiences of their imagination, the outside world, and social interaction. They might chose to explore how an individual assigns meaning or interprets the things they experience. In our research question, they might think about the way a teenager with DMD thinks about the progression of their disease, or how their sense of personal identity changes over time.

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P3: Reflection and assessment

17 Feb, 15 | by Bob Phillips

Simply finishing a talk does not make you a good presenter. The routine line to someone who’s stopped speaking “Thank you for your presentation, I very much enjoyed it,” is as insightful and honest as “Thank you for holding the line, your call is important to us.” It is trite cliche designed to give the impression of gratefulness and interest. Feedback for presentations is generally useless.

Why?

You never gave honest feedback, why do you think anyone else does?

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More than numbers

13 Feb, 15 | by Bob Phillips

109px-Aristoteles_LouvreToday begins a series of posts about understanding qualitative research in medicine, written by Jess Morgan (but open to further contributions!). Feel free to comment, tweet or facebook your thoughts too…

 

Have you ever wondered what on earth qualitative researchers are on about? What is ethnography? Phenomenology? Purposive sampling? And then what about triangulation, reflexivity and deviant case analysis? How are you even supposed to tell if a qualitative paper is even any good when there are no power calculations, blinding or difficult stats? This series of blogs aims to tackle some of these issues – to make them more accessible and to allow you to begin to evaluate the qualitative work that you come across.

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How do I know what is the correct dose to give to a child?

10 Feb, 15 | by Bob Phillips

4edf2b66cd95a7f7233a359e1e2a0843There’s an explosion of stuff about paediatrics and here in the ADC we hope to show you the sparkliest bits. Drugs (good ones, not naughty ones) are very interesting and @Pharmaforkids is going to explore some of the mysteries of dosing and formulation in a series of articles.

This may sound simple, and there is one answer that will probably get you through your 1st jobs in paediatrics, RCPCH membership, and probably a significant way into your consultant/GP practice – look in the British National Formulary for Children (BNFc).

But where do formularies get their data from?  Does it matter?  Well yes, if you ask me, but I am paediatric pharmacologist! more…

P3: Illustration and presentation

6 Feb, 15 | by Bob Phillips

Medicine progresses as evidence is accrued to support improved practice – it is supposed. Yet psychological science has long shown that standard “powerpoint” presentations are a very poor means of data transfer: different visual and auditory inputs cannot be processed at the same time. Moreover it is impossible to internally question data or remember data due to this cognitive load.

The p cubed value of such presentations is limited and poor.

Where does the problem lie? How can it be corrected? more…

StatsMiniBlog: Complex vs. Complicated

3 Feb, 15 | by Bob Phillips

20140205-091454.jpg These two words, though often used synonymously are different – do you know how?

It’s actually not that difficult.

Complicated = made of lots of parts, but “logical and rational” — like a car engine, 10001 piece jigsaw of the Gobi desert, or (dare I say it) a heart

Complex = constructed with pieces with varying and incalculable influences, but often with a predictable ‘overall’ effect — like a flock of birds, a game of rugby league, or the initial diagnostic conversation with the parents of a child with leukaemia

The difference is important. In the former, we can try to understand and manage the pieces to affect the overall outcome. In the latter, we can fiddle with the bits but it’s effect will need to be seen rather than predicted.

– Archi

Can we incentivise improvements in child health? (Part 2)

30 Jan, 15 | by Bob Phillips

In an earlier post, I entered a world of capitation, fee-for-service, block contracting and incentivisation, all ways of levering people to ‘do the right thing’, and ending by asking how to know what the ‘right thing’ was.

We could do this a number of ways – we can ask people; we can measure universally agreed ‘good’ things (mortality is a pretty strong candidate), or we could measure processes or surrogates. In primary care in the UK the current financial incentivisation scheme devotes 3% (yes – three) to children and young people; but a rather nice piece of work from Peter Gill and friends has come up with a series of other ‘measures’ that might be effective and meaningful and get things done even better.

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P3: Deciding on content

27 Jan, 15 | by Bob Phillips

The most important concept in developing and delivering a presentation is the understanding that you cannot “cover everything.” Nor should you attempt to. Your role as a presenter is to convert the “what” of “everything” into a “so what” for your particular audience. For many, both on the podium and in the audience, this is a dramatic shift in perspective.

One person speaking and many listening is the least effective form of data transfer. If you want everyone in the audience to know “everything”, send a document; it is much more efficient. You will never achieve that as a speaker. Your role is to interpret that “everything”, to offer insight, or challenge it. There is never a situation where your role is simply to recite a list of facts.
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