Evidence-Based Searching

In Undergraduate Internal Medicine Education

Will OlmstadtKatherine Alexander

Helen MayoUT Southwestern Library

Presented for SCC-MLA, October 25, 2004

2

Background

· Asked by medical school spring 2003

· Responded with proposal

· Pilot-tested curriculum on 4th year students

· Moved to 3rd year based on feedback

· Internal medicine clerkship director

3

Development

· Decided key competencies· PICO· Medical Subject Headings· Subheadings· Boolean Logic· Limits· Finding older literature

· Appropriate scenarios

4

Development

· Pre and post-tests· 5-question form· Sought IRB approval

· Grading and evaluation· Individual e-mail feedback· Based on a template

· Data tracking· Access and Excel files· Reports generated after each block

5

Scheduling

· Clerkship director assigned students· One classroom, 18 workstations· Five blocks of 4-8 students, twice a week· Make-up sessions built in· Taught from 2003-2004· Two librarians shared teaching duties· Three-hour time period· No students post-call (ideally)

6

Class

· Pre-test· Why are you here?· Older literature· Evidence-based medicine overview· Forming an answerable clinical question (PICO)· Using Ovid MEDLINE to answer a PICO· Choice of one of 10 exercises in-class· Submit exercise for librarian review· Post-test· Workbook for students to keep

7

Results

· Taught 209 students

· Pre and post-test data

· Invaluable contact with students

· Verbal feedback

· Leverage in other curricula

· Model for other courses taught

8

Results: Pre and Post-Tests

· 195 Pre-Tests· Some prior

knowledge of all competencies except PICO

· 202 Post-Tests· All students reported

new or enhanced learning

· Suggested some overconfidence

MS3 Pre-Test Summaries (N=195)

0.51%

63.59%

46.67%

78.46%

56.41%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

PICO Headings Subheadings Connectors Limits

Competencies

% S

tud

ents

Ind

icat

ing

Pri

or

Kn

ow

led

ge

MS3 Post-Test Summaries (N=202)

99.50%

85.15%92.08%

51.49%

79.21%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

PICO Headings Subheadings Connectors Limits

Competencies

% o

f S

tud

ents

Lea

rnin

g o

r L

earn

ed M

ore

11

Results: Student Contact

· Informal contact with students

· Answer questions about library

· Answer questions about librarianship

· Mechanics of their curriculum

· Satisfaction with their education

· Generated reference questions

12

Results: Verbal Feedback

· “I’m already searching on something for my patients.”

· “I thought I knew how to do this, but man, I was wrong.”

· “I was really dreading this, and it was actually good.” (Former CDC intern)

· “Awesome!”· “This needs to be in the second year.”

13

Results: Other Curricula

· Based on feedback, moved to 2nd year· In process· Larger groups· Same curriculum, more scenarios

· Success leveraged for interactions with allied health curriculum and others

· Served as model for scheduled class

14

Some surprises

· Most popular exercise: risks of SSRI in pregnancy

· Least popular exercise: screening for eating disorders

· Wide array of routinely used sources· MD Consult· Harrison’s Online· Google· Up To Date

15

Continuing Issues

· “One shot” nature· Providing meaningful feedback· Attention span· Zipf’s principle of least effort· Some third years post-call anyway· Instructor backup / availability· Classroom use

16

Future Directions

· Teaching in 2nd year 2004 and beyond

· Teaching 3rd year 2004-2005

· Investigating 1st year involvement· Medical ethics course

· Investigating web component· Basic searching tutorial· Purchased software

17

Contact Information

Will Olmstadtwill.olmstadt@utsouthwestern.edu

214-648-9244

Katherine Alexander katherine.alexander@utsouthwestern.edu

214-648-3905

Helen Mayohelen.mayo@utsouthwestern.edu

214-648-2528