Martin Morris | email@example.com
By the end of this session you will have a
better understanding of:
• key points in the history of medical
• the research cycle and how medical
knowledge is produced; and
• how that evidence is disseminated
First things first…
• What is research?
• Have you ever conducted any?
• Do you read any?
• Why should you do research?
Did you know?
The word “research” comes
from the French “recherche”
which means to travel
through, or survey.
Definitions of “research”
• To search or investigate exhaustively
• To investigate or examine a subject from
• Undertake to discover, establish or
confirm a fact or principle
• The systematic and rigorous study or
investigation into a field of knowledge
Medieval cures for toothache
Which of the following did
medieval dentists recommend
• Ground up ant eggs, blown
into the mouth with a quill?
• Baked newts and woodlice?
• Rosemary boiled in wine?
The Ancient World
• Evidence from the
ancient world of
• Ancient Greeks rejected spirits/demons
as cause of disease
• Science based on logic and reason
Hippocrates (460 – 377 BC)
“The Father of Medicine”
Galen (129 – 200 AD)
until the Renaissance
The Dark Ages
• In West: move
towards belief that
disease is “God sent”
• While in Arabic
thrive in medicine
Avicenna ( ا(بن سینا
• Avicenna (980 – 1037
AD) was a Persian
(and general polymath)
• Wrote the Canon of
Medicine, was still in
use 500 years later
The Renaissance and beyond!
• Andreas Vesalius (1514-1564)
• Giovanni Morgagni (1682-1771)
• William Harvey (1578-1657)
…and later on…
• Bacon, Copernicus,
• Lind conducts first clinical trial
(1747 – related to scurvy)
We doctors have always
been a simple, trusting folk!
Did we not believe Galen
implicitly for more than 1500
years and Hippocrates for
more than 2000 years?
20th Century Medicine
The biomedical model
• Health defined as “the absence of
disease”. Some now consider this to be
insufficient (e.g. First Nations Health)
• Disease caused by pathogens
• Behavioural sciences, interdisciplinarity
• The rise of information!
• Economics of providing health care
New viewpoints are
emerging about how
we define “health”
• Science and dentistry/medicine
depend intimately on one another
• Knowledge and discovery have
accelerated since the Renaissance
• Medical knowledge is built on
• We cannot practice Evidence-Based
Dentistry without reliable evidence
“…an approach to oral health
care that requires the judicious
integration of systematic
assessments of clinically relevant
scientific evidence, relating to
the patient's oral and medical
condition and history, with the
dentist's clinical expertise and
the patient's treatment needs
American Dental Association (2008). ADA Policy on
Evidence Based Dentistry.
Viewed: Oct. 1, 2012
Research happens because…
• A problem to be solved
• A desire to find a solution
• Agreement on validity/paradigm
• Methods and techniques
appropriate to finding out
• A wish to disseminate the findings
What makes a good question?
A good research question specifies:
• the boundaries of the research,
• the kinds of information that will
be sought, and
• the types of settings/people which
will be included
• Specific (or significant)
• Measurable (or manageable)
• Time-bound (or has a Timeframe)
What is PICO?
Patient or Population
A PICO example
Martin is a 43-y/o librarian who
drinks way too much coffee and is
concerned at the staining this is
causing to his teeth.
He has heard that whitening
strips are a good alternative to
home bleaching kits. What do
Constructing the PICO
Martin is a 43-y/o librarian who drinks way too much coffee and is concerned
at the staining this is causing to his teeth.
He has heard that whitening strips are a good alternative to home bleaching
kits. Which therapy will you recommend?
stroke patient with
In elderly stroke patients with arm weakness, does virtual reality as
compared to exercise therapy improve arm function?
A PICO example
In patients with tooth
compared to home
bleaching kits lead to
Good and Bad Questions
What causes tooth loss?
How can we make people in Montreal
clean their teeth more regularly?
Is there a connection between
repeated reuse of cooking oil and
increased incidence of oral cancers?
Create examples of good and bad
research questions linked to:
• Encouraging better oral hygiene
• Materials for dental implants
• Oral health of prisoners, OR
• Your own area of interest!
The Scientific Method
What do we want to learn more about?
Gathering of information
A suggested explanation based on limited
A carefully planned and followed experiment
to test the hypothesis
Information collected during the experiment
A record of what was noticed during the
Does the hypothesis still hold, or not?
Possible new question?
Inductive, deductive research
From: Allen, A.K., (2012) Research Skills for Medical Students, London: Learning Matters, SAGE. p.10
Basic types of research
Numbers not the
cause and effect
Basic types of research #2
• Examples of quantitative studies
– Clinical trials, meta-analyses of CT’s
• Examples of qualitative studies
–Psychological effects of oral cancer
– What does “good health” mean to First
The evidence pyramid
is used to illustrate
the evolution of the
► As you move up the
► …but the relevance
for its application in
settings increases. Bench-top research
Matching design with question
► (treatment, prevention)
► (etiology, cause)
Systematic review of RCT or RCT
Quantitative: Cohort, case control
Quantitative: Cohort, case control
Quantitative: Comparison to standard
Quantitative: Cost-effectiveness Study
Qualitative: Case studies etc.
Scope of information sources
Books (General Topic)
Books (Specific Topic)
Books (Collections of essays)
Newspapers Magazines Journals
Choosing an info source
• Stage of your research
– Your level of background knowledge
– How focused your research question is
• What type of information you
are looking for
– Scope of the information (ex. encyclopedia vs.
– Information time-line (current vs. retrospective)
Journal of Clinical
International seminars in
Conflict and Health
Journal of the
History of Biology
Journal of Translational
Journal of Pharmacy
“That which is produced on all levels of
government, academics, business and
industry in print and electronic formats,
but which is not controlled by commercial
(i.e. where publishing is not the primary
activity of the producing body.)
The Fourth International Conference on Grey Literature, (Luxembourg, 1997)
Type of Info Examples Helpful Links
Data and statistics • Statistics Canada
• Health Canada
• Canadian Laws
• United Nation policy
• Health tech assessment
• Clinical trial registries
• McGill theses
• Other theses
• Anderson, T. (2004) Dental Treatment in Medieval
England. British Dental Journal. 197, 419 – 425.
• History of Medicine slides adapted from Giustini’s here:
• “Mad Scientist” – www.camelcitydispatch.com/wp-content/
• Edwin Smith Papyrus:
• Various icons from the Noun Project (www.nounproject.com)