Bridging Clinical Reasoning with Information Mastery: A Student’s perspective Lindsay Smith, MSIV Drs. Todd Felix, Dave Richard, Sam Faber PennState University College of Medicine

Disclosures No financial disclosures Senior faculty’s clinical expertise outweighs junior faculty’s evidence based approach, or so they say……

Clinical Reasoning Critical thinking skills in diagnostic and therapeutic decisions Case based conference led by students, facilitated by faculty and librarian Concepts of analytic and intuitive systems as well as cognitive errors highlighted as case unfolds and clinical questions arise.

Information Mastery It all starts with a patient encounter Buy in from students is high Each student required to answer a clinical question via 5 slide powerpoint, graded exercise Various EBM resources utilized

PICO Question Eval Topic RangeScore Background 1.Establishes a clear clinical question (+1 point) 2.Properly translates clinical question into PICO format (+1 point) 3.Provides useful background information (+1 point) 0-3 Search Process 1.Discusses search process using appropriate, evidence based resources (+2 points, using at least 2 EBM resources) 2.Reviews strength of recommendation for sources used (+1 point) 0-3 Summary and Recommendations 1.Summarizes findings from evidence reviewed (+1 point) 2.Discusses shortfalls of current available evidence (+1 point) 3.Gives recommendations for clinical practice (+1 point) 0-3 Organization/Deductions 1.Presents information clearly and concisely (+1 point) 2.Powerpoint slides not submitted on time (-1 point) -1-1 Total Score 10

Case 1 45 yo pre-menopausal female with a history of DM2 and HTN presents for a routine PE Medications: metformin, HCTZ, calcium supplements and a multivitamin PMH: negative for osteoporosis ***In adult females does calcium supplementation compared to dietary calcium consumption increase the risk of cardiovascular disease?

Calcium and Cardiovascular Risk P – Population-Adult females I – Intervention-Calcium supplementation C – Comparison-Dietary calcium consumption O – Outcome-Cardiovascular morbidity

Which source would you choose? A. TRIP B. Dynamed C. Uptodate D. Pubmed E. Other

Dynamed, Cochrane Essential Evidence Plus TRIP, Pub Med UpToDate Textbook Medline Usefulness Usefulness = Relevance x Validity / Work

UpToDate Controversial Several meta-analyses - differing conclusions regarding cardiovascular disease outcomes Debate about cardiovascular risk, particularly when the total calcium intake exceeds recommended amounts or supplements are given in large doses

In adult patients does calcium supplementation compared to dietary calcium consumption increase the risk of cardiovascular disease? Bottom Line –Inconsistent evidence regarding calcium supplementation and cardiovascular disease, with current evidence varying in regards to amount of calcium supplementation and concurrent use of vitamin D. (SOR B)

Evidence and its uses in health care and research: the role of critical thinking. Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings.” Jenicek MJenicek M, Croskerry P, Hitchcock DL Med Sci Monit Jan;17(1):RA12-7Croskerry PHitchcock DLMed Sci Monit.

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