1. Using Web 2.0 Technology to Teach Evidence Based Medicine Kevin E. Johnson M.D. Assistant Residency Director New Hanover Regional Medical Center Wilmington, North Carolina Assistant Professor, Department of Family Medicine University of North Carolina at Chapel Hill STFM 43 rd Annual Spring Conference

2. Behavioral Objectives: At the end of this Session, the participants will: – Describe how free web based technology can be used to enable an interactive Evidence Based Medicine (EBM) education system. – Demonstrate in real time the use of a web based system to document completion of an EBM summary, and articulate how this can generate further discussion in a small group setting. – Summarize how a blog and Really Simple Syndication (RSS) can be used to disseminate evidence based answers to a broader audience. – Describe how the system can lead to better documentation of learner involvement in EBM activities.

3. The Plan Demonstrate the program Describe the technology Disseminate the information Challenge and Dream a little

4. Why? We have the technology – and it’s free! We have new learners – Millennials, how are the different? We need documentation – Because everyone loves citations. (NOT!)

5. Why #2? “Expediency Based Medicine” 1 – Librarians are not Family Doctors – Learners are great at shortcuts Evidence shows #1 searched site by learners: 2 – Google (followed by Wikipedia..) – least used was the NLM and Library sites… Skills at searching improve with training 5 – (Ah Ha Moment!)

6. What is an ACORN? Something our nutty ARD dreamt up… A Collection Of Residency kNowledge – “From seeds grow mighty oaks.” – A CORK didn’t sound weighty enough.

7. ACORN is… An internet based tool used to quickly record from anywhere with access, EBM questions which learners have researched and answered. The information recorded is used to create a blog post which serves as documentation of their efforts and a source for discussion for didactics.

8. The Free Sites Used

9. Competencies? Patient Care: Generating and answering questions provides the best up-to-date medical care that is available, i.e. evidence based medicine. You are no longer relying on your own possibly outdated or incorrect knowledge, but rather expanding your knowledge base to the entire web. This process differs from just letting the patients loose with an Rx pad and a computer, in that the physician serves in an apomediary role. Medical Knowledge: Every time you learn a new answer in context of a patient care encounter, your knowledge base grows, making the next question you ask more in depth and expert. Practice Based Learning: which includes Critical appraisal of the medical literature, research and practice improvement. Some of you have already unwittingly added to the core patient care knowledge... Specifically all of our 3rd years, who have already completed FPINs Interpersonal and Communication Skills: Communication is more than just giving a patient history in a concise and proficient manner, being able to synthesize correct conclusions from your reading and communicating them in writing is an important step in achieving competency in this area. Systems Based Practice: The primary care physician who can correctly answer questions rather than relying on referral will of course reduce health care costs and provide better, cohesive care. Professionalism: Accountability. To your profession, your colleagues, and your patients. Evidence Based care your patients deserve, respect your profession deserves, and completing assignments and teaching that your colleagues deserve. Patient Careapomediary Medical Knowledge Practice Based Learning Interpersonal and Communication Skills Systems Based Practice: Professionalism

10. The Step by Step Learner has a question Learner researches question, finds answer Learner enters information in a web form: – Question/PICO/Search/Source/Answer Information transferred to a blog post – Currently done by presenter- via mail merge Blog is reviewed in didactic session – Comments, corrections, other search options discussed

15. Behind the scenes Form feeds Google Spreadsheet

17. Behind the Scenes Downloaded to Excel Spreadsheet

19. Behind the Scenes Copied to Word Template edited to style

21. Behind the Scenes Copied to Blog post Add Title and “tags”

23. Behind the Scenes And….

26. Listening to learners Last Clerkship I was told I was “workin’ too hard” by a MS-3. Considering changing process – Document directly into blog post – Advantage-> Speed – Disadvantages ->Loss of control… Lesson learned- I am still a digital immigrant!

27. What else do we do? Documentation for Portfolio – Practice Based Learning Competency Documentation for clerkship rotations – Use with PGY-3s on family medicine Didactic review – real time digestion of EBM Discuss best strategies Correct / Dispute

28. Next Steps Continue to refine site Automate post from data collected Consider expansion of scope

29. Resources 1.Expediency Based Practice? http://www3.interscience.wiley.com/journal/123238083/abstract?CRETRY=1&SRETRY=0 http://www3.interscience.wiley.com/journal/123238083/abstract?CRETRY=1&SRETRY=0 2.A Study on the Use of Search Engines for Answering Clinical Questions http://web.science.mq.edu.au/~diego/publications/hikm10.pdf http://web.science.mq.edu.au/~diego/publications/hikm10.pdf 3. Sample Site- https://sites.google.com/site/stfmsamplesiteebm/ https://sites.google.com/site/stfmsamplesiteebm/ 4. ACORN BLOG http://oak-cfm.blogspot.com/ http://oak-cfm.blogspot.com/ 5. Review of Resident Barriers to EBM http://journals.lww.com/academicmedicine/Abstract/publishahead/What_Are_the_Barriers_to_Residents__Practicing.9999 5.aspx http://journals.lww.com/academicmedicine/Abstract/publishahead/What_Are_the_Barriers_to_Residents__Practicing.9999 5.aspx

30. Video Show’s basic steps above…