Evidence-Based Searching In Undergraduate Internal Medicine Education Will Olmstadt Katherine Alexander Helen Mayo UT Southwestern Library Presented for SCC-MLA, October 25, 2004

2 Background ·Asked by medical school spring 2003 ·Responded with proposal ·Pilot-tested curriculum on 4 th year students ·Moved to 3 rd year based on feedback ·Internal medicine clerkship director

3 Development ·Decided key competencies ·PICO ·Medical Subject Headings ·Subheadings ·Boolean Logic ·Limits ·Finding older literature ·Appropriate scenarios

4 Development ·Pre and post-tests ·5-question form ·Sought IRB approval ·Grading and evaluation ·Individual feedback ·Based on a template ·Data tracking ·Access and Excel files ·Reports generated after each block

5 Scheduling ·Clerkship director assigned students ·One classroom, 18 workstations ·Five blocks of 4-8 students, twice a week ·Make-up sessions built in ·Taught from ·Two librarians shared teaching duties ·Three-hour time period ·No students post-call (ideally)

6 Class ·Pre-test ·Why are you here? ·Older literature ·Evidence-based medicine overview ·Forming an answerable clinical question (PICO) ·Using Ovid MEDLINE to answer a PICO ·Choice of one of 10 exercises in-class ·Submit exercise for librarian review ·Post-test ·Workbook for students to keep

7 Results ·Taught 209 students ·Pre and post-test data ·Invaluable contact with students ·Verbal feedback ·Leverage in other curricula ·Model for other courses taught

8 Results: Pre and Post-Tests ·195 Pre-Tests ·Some prior knowledge of all competencies except PICO ·202 Post-Tests ·All students reported new or enhanced learning ·Suggested some overconfidence

MS3 Pre-Test Summaries (N=195) 0.51% 63.59% 46.67% 78.46% 56.41% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% % PICO Headings Subheadings Connectors Limits Competencies % Students Indicating Prior Knowledge

MS3 Post-Test Summaries (N=202) 99.50% 85.15% 92.08% 51.49% 79.21% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% % PICO Headings Subheadings Connectors Limits Competencies % of Students Learning or Learned More

11 Results: Student Contact ·Informal contact with students ·Answer questions about library ·Answer questions about librarianship ·Mechanics of their curriculum ·Satisfaction with their education ·Generated reference questions

12 Results: Verbal Feedback ·Im already searching on something for my patients. ·I thought I knew how to do this, but man, I was wrong. ·I was really dreading this, and it was actually good. (Former CDC intern) ·Awesome! ·This needs to be in the second year.

13 Results: Other Curricula ·Based on feedback, moved to 2 nd year ·In process ·Larger groups ·Same curriculum, more scenarios ·Success leveraged for interactions with allied health curriculum and others ·Served as model for scheduled class

14 Some surprises ·Most popular exercise: risks of SSRI in pregnancy ·Least popular exercise: screening for eating disorders ·Wide array of routinely used sources ·MD Consult ·Harrisons Online ·Google ·Up To Date

15 Continuing Issues ·One shot nature ·Providing meaningful feedback ·Attention span ·Zipfs principle of least effort ·Some third years post-call anyway ·Instructor backup / availability ·Classroom use

16 Future Directions ·Teaching in 2 nd year 2004 and beyond ·Teaching 3 rd year ·Investigating 1 st year involvement ·Medical ethics course ·Investigating web component ·Basic searching tutorial ·Purchased software

17 Contact Information Will Olmstadt Katherine Alexander Helen Mayo