1. " Elizabeth C. Whipple, MLS Peggy Richwine, MS, MLS, AHIP Frances A. Brahmi, MLS, PhD, AHIP Indiana University School of Medicine, Ruth Lilly Medical Library, Indianapolis, Indiana Teaching First-year Medical Students Where to Go First: Connecting Information Needs to E-resources OBJECTIVE To introduce first-year medical students to e-resources that are best for different types of background questions. The goal is to go from a specific question, generalize it into a type of question, and then identify the best e-resources for that type of question. This is their first introduction to the lifelong learning competency in the school competency-based curriculum. IU MEDICAL CAMPUSES Indiana University School of Medicine is the only medical school in the state. In order to serve the entire state, the School has eight regional campuses across the state, in additional to the main campus in Indianapolis. From the north end of the state to the south: GaryIU Northwest South BendNotre Dame Fort WayneIPFW West LafayettePurdue MuncieBall State IndianapolisIUPUI Terre HauteIndiana State BloomingtonIU EvansvilleUniversity of Southern Indiana CASE STUDY QUESTIONS MS I INFORMATION RESOURCES TYPES OF BACKGROUND INFORMATION AND BEST RESOURCES ACKNOWLEDGEMENTS CONCLUSIONS Special thanks to Deborah Griffith, EdD, Kathleen Zoppi, MPH, PhD, Jennifer Custer, BA, and Javier Savilla Martir, MD, who created the case study used for the first year medical students at Indiana University School of Medicine. The different kinds of information needed and which e-resources to use are more important than the intricacies of the searching mechanism. As digital natives, finding information electronically is second nature to the students; our training session focused on identifying broad categories of information and the corresponding e-resource to enhance the efficiency and relevancy of their search. An online annotated list of the e- resources that were introduced at the campuses was made available on the librarys website (http://medicine.iu.edu/msiresources). Traffic to the library website continues months after visiting the campuses. Plans are being developed to collect information on the value of the training sessions. METHODS First- and second-year medical students at the Indiana University School of Medicine are located at nine campuses across the state with varying methods of instruction. First-year medical students need a baseline understanding of the resources available and which resources are best for certain types of questions. At our training session, they were presented with a case study with specific questions to answer, utilizing e-resources that we presented to them earlier in the session. The case study and questions had been used previously to demonstrate searching features of the various resources. Students divided into groups that each took a question and searched the various resources highlighted, then shared which resources worked best for their type of question. Our educational emphasis was on the process of identifying the types of background information, not the specific answer to a question. Drug information, lab test normal values, calculators, physical exams, and differential diagnoses comprise types of background information. CASE STUDY Initial Clinic Visit: Subjective: Mr. Roberto Martinez is a 55 year old male, currently employed by a landscaping firm in Indianapolis, who presents with back pain. He came to the US from Mexico approximately 10 years ago on a seasonal agricultural worker (H2A) visa. For the first 5 years of his stay in the United States, Mr. Martinez worked as a farm laborer in rural northern Indiana. Four years ago, he was in an automobile accident and injured his back. Mr. Martinez has been troubled by chronic back pain ever since. At that time he underwent a 3-level lumbar fusion for an L-2 burst fracture, but the pain never completely resolved and is worse on some days than others. For the past year he has been driving a truck for a landscaping and yard care service. Mr Martinez had been seeing his regular physician for this condition, but unfortunately the physician recently retired. He is coming to your clinic for an initial visit because he is out of the NSAID he takes for pain and because he has noted some new numbness on the outside of his left thigh for the past couple of weeks. He has three children whom he still supports, and his mother and sister live in Mexico (part of his income goes to their support as well). His wife passed away last year of complications of diabetes at age 52. In the past he had had health insurance benefits through his wives work. His present job does not offer health insurance. Objective: GEN: Middle-aged Hispanic man with salt-and-pepper hair and sun-beaten skin resting comfortably on the exam table; somewhat anxious but in no acute distress. HEIGHT: 74 inches; WEIGHT: 311 pounds; BMI: 39.9 VITALS: BP:132/72 (large cuff) HR: 76/min RR: 28/min. T: 98.6 F oral. MUSCULOSKELETAL: Lumbar spine has limited range of motion in all planes secondary to some muscle tightness and surgical fusion. Mild to moderate muscle spasm of the paraspinous muscles L>R but no trigger points. No bony tenderness. Moderate tenderness to palpation over the left sacroiliac joint with positive pelvic compression. Patrick and Gaenslen tests both positive. Straight leg raising reproduces pulling in the bock on the left side but no radiation into the leg. Strength, sensation, and reflexes are normal in both lower extremities except for decreased sensation to light touch over the distribution of the lateral femoral cutaneous nerve on the left. No thigh tenderness. Assessment and Plan: Meralgia paresthetica, probably aggravated by tight belt and obesity. Unlikely to be caused by lumbar disk disease or spinal nerve root impingement. Patient reassured that this will likely resolve with weight loss and the avoidance of constrictive garments and belts. May need dietary consultation if weight loss efforts fail. Left sacroiliitis with paraspinal muscle spasm. Refill Naprosyn 375 mg BID for use on a regular schedule and begin Vicodin for breakthrough pain, particularly at night. Use heat and ice as symptomatically helpful. Will avoid muscle relaxants for now because of potential sedating effects. Degenerative disease of the lumbar spine is most likely the cause of patients chronic pain. Will obtain plain xrays today and consider MRI if symptoms worsen or become more suggestive of disk disease or spinal stenosis. Begin an exercise program and possibly physical therapy after the S-I joint inflammation subsides. Will also review the evidence for the use of glucosamine and chondroitin for osteoarthritis prior to next visit. Schedule follow-up appointment in 4 to 6 weeks. Type of background informationBest resource Definition, basic factsOnline Books - Merriam-Webster's Medical Dictionary Practice of MedicineHarrisons's Disease – Description, diagnosis & treatment Ovid - Primary Care; StatRef - Current Medical Diagnosis and Treatment; Harrison's Drug – indications, interactions, etcMicroMedex Differential diagnosisHarrison's Diagnostic examinationStatRef - Degowin's Diagnostic Evaluation Laboratory test valuesOvid - Manual of Laboratory & Diagnostic Tests CalculatorseMedicine - eTools; StatRef - MedCalc GuidelinesHarrison's ImageseMedicine; ImagesMD Review articleOvid Medline; PubMed RESOURCES USED Books@Ovid Stat!Ref eMedicine Harrison's Micromedex Primal Pictures PubMed/MEDLINE MedlinePlus INHealthConnect Google CASE STUDY QUESTIONQUESTION TYPE 1.What is meralgia paresthetica and how is it treated? Disease description & treatment 2. What are the drug constituents of Vicodin? Drug information 3. What is the Patrick test and what does a positive result mean? Physical exam test 4. What does BMI stand for? How is it calculated? What would Mr. Martinez's BMI have been had he weighed 250 pounds? Calculation 5. What is the normal hemoglobin A1c range? What does a value of 8.2% tell you? Laboratory test 6. Find an image of Gaenslen's maneuver.Image 7. Find an image of the sensory distibution of the lateral femoral cutaneous nerve. Anatomical image 8. Find an easy-to-read trustworthy Spanish language article on losing weight to give Mr. Martinez. Patient education 9. Check for any local financial assistance programs that may be able to help Mr. Martinez. Local services 10. Find a review article that discusses the use of both glucosamine and chondroitin for osteoarthritis. Review article http://medicine.iu.edu/msiresources