Wednesday, May 23, 2012

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.
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

*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

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Friday, May 18, 2012

Going Beyond Keyword Searching

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!

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Wednesday, May 09, 2012

Are You Up for a Diagnostic Challenge?

The New York Times Well Magazine  has a great monthly series with Yale School of  Medicine physician, Dr. Lisa Sanders [author of the book "Every Patient Tells a Story" ] where readers can join in and test out their medical diagnostic skills. The series is called "Think Like a Doctor" .

"Every month, the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle."
Are you up for the challenge?
The latest 'medical mystery' to solve with Dr. Sanders is called "More than Meets the Eye", and the solution is already posted, but test your skills before you read the follow up article ~ "Eye Exam Solved" . At the bottom of the article are links to previous cases, so have fun!

And for more fun, don't forget our great new online library resource called fmCASES from MedU, were all you UMHS-SK medical students are invited to work through over 30 typical family medicine case and keep honing those diagnostic skills!

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Tuesday, May 08, 2012

MEDLINE® Complete is Here!

MEDLINE® Complete , the latest product offering from EBSCO and described as "an unprecedented full-text collection of the most sought-after medical journals", is now available to our faculty and students! "This exceptional database provides full text for the most prominent journals used in the field of medical research. MEDLINE Complete is the largest full-text companion to the MEDLINE index, containing full text for more than 2,060 journals." This upgrade to our EBSCO subscription provides access to an additional 500 medical journals. Check it out on your computer or mobile devise utilizing your EBSCO login. Please pop in to see me in the library for further instruction on how to search this, or any of our other great library resource databases.

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