Facing the Challenge of Teaching Evidence-Based Medicine to Medical Students
I would encourage you all to read this article!
George P., Reis S., Nothnagle M., (2012). Using a Learning Coach to Teach Residents Evidence-based Medicine.
Family Medicine, 44(5), 351-355. http://www.stfm.org/fmhub/fm2012/May/Paul351.pdf
This study demonstrates how important the acquisition of
‘information mastery skills’ are to physician success in practicing evidence-based medicine! It shows what one university medical school did to try to improve these skills in their students, targeting their second year family medicine residents. [Alpert Medical School, Brown University, Family Medicine Residency Program and the Department of Family Medicine, Memorial Hospital of Rhode Island]
The article quotes the current ACGME accreditation competency:
“The ACGME requires that residents demonstrate competency in information mastery or the ability to 'locate, appraise, and assimilate evidence from scientific studies'.“
Reiterated in the
ACGMEs Next Accreditation System (NAS) ‘General Milestones’
*:
(adopting July 2013)
Level 2: (residents) “Formulates a searchable question from a clinical question (e.g., using PICO format).”
Level 3: (residents) “Applies a set of critical appraisal criteria to different types of research, including synopses of original research findings, systemic reviews and meta-analyses, and clinical-practice guidelines.” “Critically evaluates information from others.”
Level 4: (graduating resident) “Demonstrates a clinical practice that incorporates principles and basic practices of evidence-based practice and information mastery.”
Overall, I agree with the approaches taken by the developers of the course, the
one-on-one coaching model coupled with being a
structured component of the curriculum, and would encourage the adoption of a similar type of program at UMHS. Post intervention assessment of the resident’s EBM knowledge showed a notable increase of
31.8% , along with improved attitudes toward EBM and its increased use in the clinical setting. However there is still room for improvement as the average score on the posttest was still only 58%!
A few areas I suggest warrant further consideration or emphasis when undertaking such a program :
- stressing the quality and value of subscription clinical point-of-care databases, full-text journal databases, and other library resources.
- the integral involvement of the medical librarians in the program (course development, delivery, and evaluation).
- incorporating the ‘6S’ model ** for accessing pre-appraised evidence and providing directional steps to the search process.
- augmenting the course with training in current methods for staying up-to-date while navigating the flood of medical information, such as RSS alerting.
- recognizing that information resources are dynamic and will continue to challenge the information searcher’s flexibility and adaptability. Thus, it is important that the program emphasize teaching the concepts of information searching rather than focusing on the idiosyncrasies of any individual resource, or promoting dependency on any one database.
- working toward seamless integration of relevant evidence-based clinical information into the individual patient’s electronic medical record (a CDSS or Computerized Decision Support System).
Evidence-based practice isn’t just about finding
an answer to your clinical question, it is finding the
current best answer based on the peer-reviewed medical evidence, for the care of your particular patient.
I invite your comments ….
Ann Celestine,
Library Director
http://lib.umhs-sk.net/
*Nasca, T. J., Brigham, T., Philibert, I., & Flynn, T. C. (2012).
The Next GME Accreditation System — Rationale and Benefits. New England Journal Of Medicine, 366(11), 1051-1056. doi:10.1056/NEJMsr1200117.
**DiCenso, A., Bayley, L., & Haynes, R. (2009).
Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12(4), 99-101. doi:10.1136/ebn.12.4.99-b
Labels: evidence-based medicine, evidence-based practice, information literacy, medical education, medical information search, medical student competencies, medical students
Take your searching skills to the next level with MeSH! What is MeSH? MeSH simply means
Medical
Subject
Headings and is a taxonomy of medical subject terms compiled and maintained by the National Library of Medicine. Searching the medical journal literature via our
EBSCOHost platform utilizing specific medical subject heading terms rather than keywords, can result in a more efficient, productive, and successful search. Please invest a few minutes of your time viewing this tutorial and then do a practice search or two in our full text EBSCO databases. UMHS / IUON subscribes to these online resources with full text for the benefit of our students and faculty.
Raising your level of expertise in essential information searching skills will serve you well throughout your medical career. Remember ~ dynamic evidence-based medical practice depends first on
finding the
current best evidence!Labels: database searching, information literacy, IUON, journal databases, keyword searching, medical information search, MeSH, searching skills, subject searching, UMHS-SK
The
European Center for Disease Prevention and Control has published a literature review providing an overview of online health information-seeking behaviour among European adults from the perspective of both the
health consumer and the
health professional.
Note some highlights from the report:
"..the wealth of information available [on the Internet] means that ‘healthcare professionals are increasingly finding that they have more information available than they can handle with confidence in their busy time schedules’ and ‘the hardest task now is to actually locate the information required from the flood of information received’. The literature also highlights the difficulty of identifying and filtering the most useful, accurate and credible sources while searching online for health information."
"In a study in the
British Medical Journal, researchers also found that,
out of 26 medical situations investigated 'Google searches found the correct diagnoses in 15 of the cases’", calling for caution if using Google (or any other general internet search engine) to search for a diagnosis.
Click on the post title for access to the 12 page PDF:
"Literature review on health information-seeking behaviour on the web: a health consumer and health professional perspective" ~ ECDC Technical reports(Oct 2011).
Labels: credibility of information, ECDC, information literacy, information seeking behaviour, internet users research, medical information search
This recently released article by Gloria Miccioli [LLRX], provides a good
annotated guide to key, reliable internet sources for researchers of the medical literature.
Labels: internet resources, internet search, LLRX, medical information search
PubMed Clinical Q&A is a collection of summaries of health information, systemic reviews and answers to clinical questions. A great searchable resource for those
PBL sessions!"Each summary contains several questions that compare treatments, for example:
"How do statins compare in reducing 'bad cholesterol' (LDL-c)?"A brief answer which highlights recent findings is available, along with a link back to the source of the evidence where more details can be found."
...just one of the many excellent full text
medical ebooks available on the
NCBI Bookshelf [find permanent link in the right sidebar].Labels: clinical queries, ebooks, evidence-based practice, medical information search, NCBI Bookshelf, problem-based learning, PubMed
A more user-friendly
Advanced Search interface is now available for
PubMed.
Click on the title for more information on features and capabilities
from the NLM Technical Bulletin No. 362, May/June 2008. Labels: information literacy, medical database, medical information search, PubMed, search limiters, search skills
Dear Medical Professional:
In a recent survey of 6,000 physicians, 77-percent said they turned to the Web frequently to find medical information. If you're like them, then it's time to stop relying on the leading big-name, mass-market search engines and use the one designed especially for medical professionals:
SearchMedica.
Trying a
SearchMedica query for yourself will show you the difference between a professional tool and one designed for consumers.
Try
“hypertension“ using Google.
Now try
“hypertension“ with SearchMedica.
We think you'll discover that SearchMedica delivers results that are credible, relevant, and easy to manage using our “results by category“ feature. If you agree, we invite you to begin using SearchMedica immediately. You don't need a password or login, and SearchMedica is absolutely
free of charge. There is never a fee.
Thank you for trying SearchMedica, and we hope you’ll tell your friends and colleagues about it.
Best Regards,
The SearchMedica Team
Stop Searching. Start Finding.Labels: internet search, medical information search, research study, search engines, SearchMedica, study report
