1. Improving Access to Information during Rounds through Librarian Support Lisa Olsen Kilburn Information Resources Specialist Southern Regional AHEC October 2010

2. Accreditation Council for Graduate Medical Education General Competencies Practice-based Learning and Improvement –locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems (aka evidence based medicine) –use information technology to manage information, access on-line medical information; and support their own education

3. The Problem Searching the literature takes time Residents are very busy

4. Duke/Southern Regional AHEC Family Medicine Residency Program MD and DO Family Medicine Residency Fayetteville, North Carolina 21 residents 8 four week rotations on Inpatient Medicine seeing patients at Cape Fear Medical Center Average 10 – 15 patients on service

5. Medical Rounds Schedule –Residents start rounding on patients at 7 am –Meeting at 10 am to discuss assessment and plan In attendance –Attending physician –2 to 5 residents –Attending pharmacist –Pharmacy resident –Medical and pharmacy students

6. Intervention by the Information Resources Specialist Attend rounds once a week Prompt the residents to develop questions Research the questions Post links to relevant articles to a blog on the AHEC Digital Library Post the search strategy used Email the articles to the faculty and residents Finish everything before the end of the day

7. Resident Requirements Complete a search request form with the question in PICO format Ask 2 questions per year Review the posted articles Post 2 comments Present articles to medicine team Deadline: Third quarter evaluation

8. Technical Challenges Residents access to the internet and thus the blog was somewhat variable Some links required tech support to create –Online textbooks were difficult to work with Due to licensing agreements with publishers, rotating medical and pharmacy students usually did not have access to the blog

9. Participant Satisfaction Surveys November 2009 (4 month) –66% response rate –68% of residents June 2010 (1 year) –59% response rate –50% of residents Handed out at noon conference Missing participants were sent the survey via email and inter-office mail Collected by the Residency Coordinator and the library

10. Survey Results in Aggregate 97% were “satisfied” or “very satisfied” with the librarian presence 94% rated the articles as “moderately” or “extremely” useful 25% admitted they would not have done the research on their own 85% voted to continue the program

11. Responses by Position Residents Resistance due to the perceived increased workload –2 votes to cancel the program (1 maybe) –90% spent less than 30 minutes reviewing the articles –100% spent less than 15 minutes commenting on the articles Faculty Strong support from the Residency Director Variable support from faculty –Presentation at rounds –Rotating faculty –Faculty turnover

12. Use of Posted Articles FrequentlySometimesRarelyNever Formal discussion during rounds 4930 Informal discussion with peers 1922 Informal discussion with attending physician 1860 Discussion with patients 2562 Not used/discussed2514

13. Began emailing articles

16. Most Frequently Cited Journals New England Journal of Medicine (9) Annals of Internal Medicine (6) Chest (5) Cochrane Database of Systematic Reviews (4) Journal of Thrombosis and Thrombolysis (4) Lancet (4) Annals of Emergency Medicine (3) CDC website (3) Critical Care Medicine (3) Expert Opinion on Pharmacotherapy (3) Neurology (3)

19. Outcomes Benefits Questions regarding clinic patients as well as hospitalized patients Questions outside of the weekly visit Increased visibility for the library Challenges Faculty and resident preference for review articles Medically difficult questions Articles not received in time to affect patient care Medicine team personality

20. Conclusion The program is ongoing Benefits to both the residency and the library Could easily to adapted to other institutions