Strategies for Serving World Wide Cancer Education Needs: Prescription, Open, and the "Golden Swamp"

[Gerry Hanley]

There are a variety strategies for OERC being a source of educational resources on cancer and managing the the quality assurance processes for the collection of resources.  This forum will be for sharing and exchanging ideas and opinions on what should be the OERC's practical implementation of its quality assurance process.

[Gerry Hanley]

From Ian Magrath

An article that just came out in Lancet. It mentions "telecommunications" but doesn't say much more. It crossed my mind that OERC might write a letter in follow up on this topic, but it would mean dropping everything to get it done and given that it is still early days, it may not be the right time - perhaps better to write a more detailed article later in partial follow up to this one. However, let me know what you think.

[Gerry Hanley]

From Anil Srivastava

Internet is a "a golden swamp". My friend, Judy Breck, has talked and written about it at some length. See her website http://www.goldenswamp.com/.

[Gerry Hanley]

From Ian Magrath

I agree about the "non-prescriptive" approach. In fact, experts disagree all the time. Many widely held tenets prove to be wrong, and such things as standard practice change over time. For example, there are many who think that today, mammography does more harm than good, and as treatments improve and, hopefully become less toxic, screening is bound to become less important in terms of the fractional reduction in mortality, although those who were involved in its development or make their livings from it, or would just simply like it not to be so, are bound, on average, to have different views. There are many other examples of this. I sent around the following URL recently, which may be of interest:
http://www.the-scientist.com/article/display/57601/

Many lay people, more junior health providers have much to contribute about cancer or drugs - those who experience them at first or close hand, for example, so I would favor a relatively light review process. It's easier for manuscripts where one can have a system in which, for example, only obviously methodologically flawed papers (or papers which do not provide sufficient information about methods) or which come to firm conclusions obviously not supported by the data, are excluded. This sounds simple, but is not as simple as it sounds, since there can be disagreement regarding methods too.

However, a system such as that currently used by journals may not be appropriate in our setting where most of the material is not primary data but presentations or documents which summarize but do not generally discuss methodology, although they may refer to the source of the data/conclusion.
Here, one would have to adopt a method in which only clearly wrong material is excluded - again, easy in some cases, not in others.

There is a peer review process in existence in Merlot and it may be interesting to see whether this could be made more quantitative- e.g., how many or what fraction of subject matter experts rated it highly - and perhaps how many non-experts rated it highly. Still one has the problem of getting enough people willing to spend time reviewing the material.

I agree with Anil that we should look at what others do, and guides to the review process, but even these are not necessarily right, although we may choose to adopt them.

We might also look at WHO's standards for "guidelines" which require good evidence for all included material and see whether this is of help.

Finally, it would be an excellent training exercise for young people to be involved in the review process as part of gaining an understanding of "evidence." We are discussing setting up some workshops with ESO on systematic review.

In the end, in my view, there is no absolute best way of doing things, though doubtless lots of opinions on this. It goes back to the philosophical premise discussed by the ancient Greeks - "what do we know?"
One thing I would say is that this topic (epistemology) ought to be openly discussed, and included in the curricula of not only medical students, but perhaps in all higher educational courses. At least Socrates admitted that he was ignorant, and "knew" nothing, although was perhaps wiser than others on the grounds that he recognized this! It might, too, constitute a long term discussion in a group, periodically summarized. I think I proposed this before.

Regards,

Ian

[Gerry Hanley]

From Stephan K. Thieringer

As many of the people involved building the collection at this time are not experts in the field and not qualified to asses content in it's validity and quality may I suggest a somewhat formalized process to get good and relevant resources selectively entered and pointed to in the process of this undertaking.

Many times when OER and free open accessible resources are referenced the critic is also often that is has become more of referatory and thus unusable by many as the user can not rely on the sources or the selective nature of the submission in the first place.

Would it make sense to setup a somewhat formal process amongst members of this group to validate for the intern the quality of the resources and contents prior to entry into the collection?

Ian, I believe that your reference to Alberto is exactly that and I would think that we have other resources in our network who may be willing to assist in this process. Again I can not emphasize enough the importance of that as we will otherwise be a lot less credible if we do not
dedicate some effort to that.

Thoughts?


Warm regards,


Stephan K. Thieringer

[Gerry Hanley]

Thanks for your message. Here’s my suggestion for getting our quality assurance process going
1. We trust the good judgment of experts making recommendations – if Ian, Larry, Dianne, Pierre, Elder, Anil post a website at http://voices.merlot.org/group/oercancer/forum/topics/websites-for-... , we have the intern do the cataloging of the site. Of course people are welcome to comment on the websites that are listed.

2. When we reach about 100 entries, I’ll be doing a batch upload into MERLOT. We then can leverage the multiple review and quality assurance processes available in MERLOT. The simplest is that people can add “member comments” and rate the materials. The editorial board will take time to develop.

3. If we want to have real discussions about any material/topic – we can start a discussion forum in the OERC Voices for Healthcare professionals http://voices.merlot.org/group/voicesforoerchealthcareprofessionals For example, the topic of breast cancer screen has come up as a key topic a few times.

I hope this supports your goals. We can discuss this at our next OERC conference call.

Cheers,
Gerry

[Larry Lessin]

I believe that Ian has summarized my position on this quite well. We are not in a position for "expert reivew", or journal-type editorial board, which, as Ian states, is flawed in any case. I would emphasize that we are providing materials primarily for educators to use in the preparation of cancer-related lectures or curricula. It is up to the user to assess and modify the material to needs of the learners. I like and have advocated the "Amazon.com" 5-star method of user reviews, which is currently used by Merlot in other communities. Text comments by users are quite useful as well.