Thursday, April 17, 2014

The MedEd Revolution: AMA Steps Up Focus on Information Literacy

Medical education, in it's current modern form (since the Flexner Report of 1910) seems ripe for change if the response rate to a recent AMA program initiative is any indication.  The American Medical Association recently developed a proposal outlining a number of  key trans-formative changes they would like to see in the way physicians are educated. The response from US medical schools was in their words "overwhelming". 
"The reason the AMA emphasizes “accelerating” change is that incremental changes aren’t enough to ensure that future doctors get the training they need in a world in which rapid business, population and technological changes have made being a doctor a much more dynamic profession. These have to be systemic changes, as bold and far-reaching in our time as they were in the wake of the Flexner report."
Click to read the full report (posted March 18, 2013): Medical schools signal readiness for revolution 

In my role as Library Director at UMHS, a top tear Caribbean medical school, I habitually stress to our faculty and students the importance of that fundamental element for success as an 'evidence-based' medical practitioner, the ability to find the current best evidence. To determine the best diagnosis and course of treatment for the best clinical outcomes, medical students must learn how to locate the best, most up-to-date, credible medical evidence to support their case. This requires a fairly sophisticated level of skill in information searching, along with knowledge of the credible medical literature, the databases that contain it, as well as an understanding of the structure and functioning of the online environment.

I commend the AMA for recognizing the fact that mature information seeking behavior needs to be acquired by medical students, and for stepping up the focus on the importance of acquiring the concepts involved. Now the onus is on medical schools to include throughout their curriculum, embedded or otherwise, adequate instruction and ongoing reinforcement of information searching skills.  

" The proposals reflect a changing health care delivery system transformed by technology so that the skill of finding and applying information is as important — or more so — than memorizing it."  
You may be thinking, "Isn't Generation Y completely computer savvy already?" In fact the answer is no, for the most part they aren't. I can say this confidently because of another report finding, also recently released, called the JISC Digital Information Seeker Report. This report demonstrates what my gut has told me all along, that the crucial factor in student's information seeking behavior is convenience! What does this lead to? The report's initial results indicate that
" users progress through the educational stages, the digital literacies they employ do not necessarily become more sophisticated."  "...findings indicate the students use smart phones and laptop computers to access Wikipedia, Google, teachers or professors, friends and peers to get information for their academic studies."
Click to read the full report (posted March 20, 2013): JISC Digital Information Seeker Report 

Google is great for KISS ('keep it simple searching') and 'needle-in-a-haystack' type searches, however when it comes to a medical diagnosis the best, most accurate information is required! An interesting  BMJ research article by Hangwi Tang and Jennifer Hwee Kwoon Ng, called "Googling for a diagnosis - use of Google as a diagnostic aid: internet based study.",  found that Google yielded a correct diagnosis 58% of the time (based on one year's worth of diagnostic case records published in the New England Journal of Medicine). Not an accuracy rate that would inspire patient confidence!

If the anticipated MedEd revolution unfolds as the AMA is indicating, it is my hope that medical schools will recognize the expertise already in their midst and turn to their 'Information Professionals" ~ the medical librarians! I will rest my case with the age-old words of wisdom penned by Samuel Johnson...
“Knowledge is of two kinds. We know a subject ourselves, or we know where we can find the information.”

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Monday, February 04, 2013

Navigating the Medical Literature with Medline & DynaMed

Join us for this EBSCO training event on
Thursday February 7, at 12:00 -1:00 in the Western Classroom.

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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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Monday, November 28, 2011

Health Information-Seeking Behaviour on the Internet

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).

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Tuesday, October 04, 2011

Information Search Assist: Drop In Q&A Session

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Monday, May 02, 2011

Why Not Just Google for Evidence-Based Practice?

A recent study evaluated the information literacy skills of first-year dental students and looked to identify any significant associations between search engine use and database preferences.

Conclusion: The study confirmed that information literacy was lacking and that "preference for the use of Google was significantly associated with students who were unable to find evidence-based citations."
"Few issues in higher education are as fundamental as the ability to search for, evaluate, and synthesize information. The need to develop information literacy, the process of finding, retrieving, organizing, and evaluating the ever-expanding collection of online information, has precipitated the need for training in skill-based competencies in higher education, as well as medical and dental education."
Recommendation: Integrate evidence-based learning modules early in the curriculum to help students filter and establish the quality of online information.

Click post title for full text of the research article: "Why not just Google it? An assessment of information literacy skills in a biomedical science curriculum." (April 25, 2011), Kingsley K [et al], BMC Medical Education 2011, 11:17doi:10.1186/1472-6920-11-17.

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Wednesday, September 24, 2008

Mark your Calendars!

Tuesday, October 7th
You are all invited [students & faculty ; medicine & nursing] to attend a training seminar on searching our online journal & point-of-care databases.
Eric Block, our EBSCO Rep., will be conducting 2 sessions, demonstrating the various features of DynaMed, CINAHL, Medline, the Nursing Reference Center,etc.
You are welcome to attend one or both sessions.

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Wednesday, May 21, 2008

Advanced Searching for 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.

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