Liz Wager: Training and the placebo effect

Liz WagerI’ve been at the Vienna School of Clinical Research running a publication workshop for an enthusiastic bunch of doctors, researchers and drug company folk. Back home, catching up on my reading, Diana Wood’s BMJ editorial on problem based learning struck a chord. She argues that we don’t really know whether problem based learning works better than other teaching methods. But that’s true of an awful lot of training.

A few years ago, the BMJ did a randomized trial of reviewer training. This showed that that neither attending a course nor doing a distance learning package had much effect on reviewer performance. But the BMJ carried on offering the face-to-face training sessions for a while because reviewers liked them.

At the time, I thought this was a bit spineless, but I realise I’m in no position to criticize, since I make at least some of my living by peddling unproven training courses. Maybe it’s enough if participants enjoy the course and think it helps them – but some firmer evidence would be nice.

Still pondering about the effects of training, I was delighted by the study from Kaptchuk and colleagues (May 3, 336:999), showing that warm and encouraging human interaction accounts for much of the placebo effect. It’s maybe not a surprising finding, and it probably goes a long way to explain the success of many complementary therapies and why it’s ridiculous to expect GPs to deal with patients in 7- (or even 10-) minute time slots but it is, nevertheless, useful.

It made me think about the difference between giving information and training. The students attending my workshop in Vienna were smart, keen and well-educated. Most had already published some research and must have read masses of journal articles. Virtually everything I taught them was quite easily available in books and websites. But I was struck that none of the students had heard of the CONSORT statement on trial reporting ( and only a handful were aware of the ICMJE authorship criteria ( As well as lectures, the course included practical exercises: these can be a salutory experience for a trainer when you see whether students have really got your message. Confucius certainly knew a thing or two when he wrote ‘What I hear, I forget; what I see, I remember; what I do, I understand’.

So what’s this got to do with placebos? Only that, for all the possibilities of on-line training and distance learning (which I don’t decry), it still seems that humans respond best to interaction with another human being.  Any comments? Have your say on the blog.

 About Liz Wager

Liz Wager is a freelance writer, trainer and publications consultant who works
for a number of pharmaceutical companies, communication agencies, publishers and
academic institutions. She is also the Secretary of COPE (the Committee On
Publication Ethics) and a member of the BMJ’s Ethics Committee.

  • Andrew Walker

    A few weeks ago I led my fisrt workshop at the European Medical Writers Association meeting in Barcelona. The feedback from the delegates was largely positive in that most of them found it instructive and stimulating. That in itself was gratifying. What was unexpeted was the effect that the experience had on me, the trainer. I returned to work rejuvenated, full of new ideas and strategies fro dealing with the challenges of working in multidisciplinary teams. Thus I support your observation that in teh context of training, humans respond best to human contact but would like to add that the benefits can work both ways!

  • Simona Brown

    At first I thought of an invaluable opportunities of training where I would be offered guidance, emotional and material support and feed-back about my performance. Even if no training experience is perfect, surely the live experience is to be preferred?

    But in the same time, I also thought of endless hours dedicated to compulsory training, when I felt that I would be better off on my own in the library.

    The reality is both reactions are specifically related to the quality of the process and its capacity to achieve the learning objectives. I think that the value of an educator lies both in offering selective and relevant information and in emitting inspiring energy.

    Faith in the process of training is a factor its effectiveness as it is connected to motivation and operant conditioning. It is also related to the learner’s confidence in delivering the newly acquired skills.

  • I was interested to read your post – particularly in light of the fact that we are just about to launch an MSc Advanced Occupational Therapy here at University of Salford to be delivered totally on-line. We have taken a good two years in the development of this and the points you raise are pertinent. We have acknowledged the need for interaction – both within a learning environment and in the more social aspects of being a student and to this end we are not just facilitating learning of an individual – but we will be facilitating and encouraging a virtual learning community where the cohort will be encouraged to engage in activities that require discussion, collaboration and networking. Their learning will then be transferred to their current work environment where they can also collaborate with colleagues etc. In terms of the social side – we are exploring many avenues for virtual social space and will be asking students to consider blogs, Facebook and Second Life as possible areas for a virtual coffee and to maintain an on-line presence.
    Of course, as you mention, no learning experience is infallible and I’m sure that we will have many issues to resolve, but it is quite exciting nonetheless to be one of the first within the health professions in the UK to offer an entire programme online.