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More confused—but better informed

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7513.0-f (Published 11 August 2005) Cite this as: BMJ 2005;331:0-f
  1. Jane Smith, deputy editor (jsmith{at}bmj.com)

    “I am now thoroughly confused but better informed.” This confession by Martin Dawes relates to combating head lice (p 362), but we might consider using it as a measure of success for a medical journal. Confusion may be but a step on the path to understanding.

    Dawes's confusion is over a study by Nigel Hill and colleagues that compared the effectiveness of pediculicides with the “Bug Buster” set of combs in removing head lice (p 384). This showed that the combs were more effective but it also showed much lower rates of cure with the pediculicides (13%) than have been found in other trials (70-80%). Dawes tries to unravel why that might be so (differences in study population, biases, a single dose), but he ends up concluding that bug busting is probably as good as two applications of pediculicides.

    Other results in this week's BMJ will probably sow confusion as well. On p 373, for example, David Tappin and colleagues show that motivational interviewing, which has been shown to be effective in persuading people to give up smoking, had little effect among pregnant smokers in Glasgow. The authors speculate that their study might have included heavier, more dependent smokers. And Dieter Melchart and colleagues (p 376) show that although acupuncture was better than no treatment in people with tension headaches, proper acupuncture was no more effective than a minimal procedure of superficial needling at non-acupuncture points.

    In contrast, the systematic review by Sonia Littlewood and colleagues on the effects of early practical experience in medical education (p 387) suggests some fairly firm conclusions, albeit from a variety of largely descriptive observational studies. They conclude that early exposure to real patients in real social or clinical settings helps medical students to learn and to develop appropriate attitudes—and their teachers and patients can benefit too. Jan Matthys adds a note of caution here, however: in his letter he reports that the presence of students can adversely affect the blood pressure of patients (p 406). Indeed, he suggests that blood pressure measurement may be useful in seeing whether a doctor in training is a neutral bystander or an obtrusive observer.

    Anyone reading Career Focus this week will definitely be better informed. In an issue devoted to the theme of interviews there's plenty of good advice on how to prepare to be interviewed (and to interview) in the traditional way. But there are also articles about other ways of selecting the right person for the job: the objective structured interview, with stations to test different skills; presentations; psychometric testing, etc. That's just as well—because, to add to our confusion, a study cited in “What the educators are saying” warns against relying too much on interviews as a way of selecting medical students (p 392). “A selection process in which only interviews are used or in which the results of interviews are weighted heavily… will lead to unfair decisions about applicants.”

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