EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

EBM, Scientific Literature, Teaching & Learning in Medicine: Kicking it up a notch

This is the time of year when things get pretty busy for the Information & Education Services librarians at UCHC.

After library orientation sessions for new residents and fellows in July and finishing up the MPH Health Informatics course, the reference librarians begin to gear up for instructional sessions for incoming medical and dental students and greet 400+ returning students. There are many questions from individuals about using or downloading PDA based information; our academic computing specialists field those questions. And when all the good parking spaces suddenly disappear, summer is over and a new Academic year has begun around here!

During Fall semester, I teach a searching/training session for groups of third year medical students who are rotating through their ‘home’ institution (i.e. UCHC). These week-long rotations are collectively called Home Week; there are seven sessions spaced throughout the academic year.

Home Week searching/training sessions are a logical time to describe and demonstrate evidence-based medicine sources such as the Cochrane Library or advanced techniques for searching Medline using Medical Subject Headings, clinical subheadings and Clinical Queries for this group. Examples of comparisons of treatments found in ACP Journal Club or BMJ Clinical Evidence are given. Another function for the class is to provide updates on new database subscriptions or those which they may have used previously but which have been revamped – such as Essential Evidence (previously known as InfoRetriever). The biostatistical analyses and critical appraisal of clinical trials (BMJ “how to read a paper” stuff) is covered by a PhD later the same morning.

Insight for instructing the Home Week evidence based literature session is grounded by my participation in problem-based learning (PBL) as a facilitator for first or second-year groups. PBL classes meet once per week for three hours; there are eight students and two facilitators in each group. The majority of facilitators are physicians. A PBL case-study runs for two weeks, and there are 8-10 hypothetical patient/case studies per semester.

This shared small group experience has been a real-life learning lab for me… hearing directly from students as to how they begin to use scientific literature sources to solve diagnosis, medical problem-solving and treatment options presented by each hypothetical patient. Besides their textbooks, the students’ all-purpose “Big Three” clinical sources – used heavily during the first two years – tend to be Access Medicine, including Harrisons’ Principals of Internal Medicine, Up to Date and frequent searches of Medline to locate original research studies or clinical reviews.

The students also hear about accessing the Big Five journals (JAMA, Annals of Internal Medicine, BMJ, Lancet and the New England Journal of Medicine) from everybody (lecturers, clinical preceptors, librarians). Yes, the running joke is that while we all use Wikipedia… please try searching Medline too, OK? 🙂

The information requirements of third year students’ are not static either.

These digital natives were required to purchase a new laptop prior to beginning their first semester at medical school. Their laptops are configured once they arrive onsite to serve as their wireless docking station, course notebook and the instrument by which they take all exams. A new requirement for the incoming Class of 2012 is to arrive with both a new laptop and PDA.

As their clinical knowledge base expands, third year students’ choice of information sources widens. Their search strategies are affected by the types of patients that they have seen at their community preceptors’ medical practice, or where they may have volunteered in area health clinics, such as one UCHC runs each summer for migrant workers. As one of our core library user groups, students have considerable latitude to experiment and “grow through” various literature sources available to them from UCHC Library.

While they may never call it “evidence-based clinical reasoning”, this is an aspect of their education in which librarians and highly-knowledgeable curriculum support staff play a proactive role as “information consultants” for this group.

Many of the subscription databases are selected specifically because they offer both a web-based database with an accompanying PDA component. Examples: Lexi-Comp and Micromedex are standard pharmaceutical reference sources; dosing, drug interactions, algorithms or potential adverse affects can all be loaded onto a PDA which travels with the student during their rotations or accessed through the wireless network.

Significant time and money has been expended in selecting comprehensive “clinical decision support tools” like DynaMed or FirstConsult. There are several free PDA tools of use for the students, such as Diagnosaurus, Archimedes and ePocrates. While UCHC has access to Ovid, few students use the database so I no longer teach it for Home Week. Students are encouraged to pick and choose which source(s) to “specialize” in to answer their patient care questions, as any of these resources provide a specific utility and represent an “information niche”.

The hour in the Home Week session passes quickly. I do save the final ten minutes to discuss, demonstrate and convince this group of the utility and power of using Scopus for answering clinical questions. Why? Because the Scopus database represents (to me) an example of the future of searching.

Scopus does – and will – cover much of the literature needs required by clinicians, students and researchers for the next several years. Following is an excerpt from the Scopus “About” page:

Updated daily, Scopus covers 29 million abstracts of over 15,000 peer-reviewed titles from more than 4,000 publishers, 265 million references and 265 million quality web pages through Scirus‘ web search to cover the scientific web.

Scopus sets a new standard in contemporary clinical databases. Most students are already aware of how essential Medline is for their searches… what I enjoy describing for them is what access to the vast content in Scopus can mean for their clinical knowledge base and effective patient care.

And I am grateful that the clinical faculty give me 60-70 minutes to demonstrate these sources for the third year students, year after year.

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Note: Most of the sources mentioned above are subscription databases, available only onsite at UCHC, via proxy access for affiliates or at any other institution which subscribes to them.

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