“Question everything… especially what you read. “
A 2009 quote from Dr. P, PBL facilitator
.One of the many tasks for first-year graduate students in clinical or research areas is building a healthy skepticism about what one reads in the medical literature.
Ideally, as they progress through four years of medical education, students find that they must change their approach to searching as well as exploring what new resources will answer their questions of increasing complexity. What answered their learning issues in their first year often doesn’t carry over to their third-year clerkship, when they are faced with finding solutions to the care of actual living patients.
This evolution (both practical and intellectual) asks that they grow a set of appraisal techniques for examining, embracing or rejecting what they find in the ever-increasing assortment of health science, pharmacology or social science databases available to them. (Note that I’m not referring to what can be found by simply plugging a few words into a search engine.)
And very likely, they jettison the use of a few previously well-used resources as their clinical questions and experience become more complex.
.“Separate what is of statistical importance from what is clinically significant. “
Another 2009 quote from Dr. P
As a facilitator for PBL, many first-year students have stated in class that they rely most on the library’s subscription to the Access Medicine* collection – including Harrisons’ Online – as a “first place” to go to do research.
It is what the librarians consider as a sort of a “package product”. This subscription resource has developed in major ways over the years which UCHC Library has been providing it for our users.
As examples: there are now 60 core medical textbooks on the site, lists of DDx criteria, audio cases, calculators and clinical videos, podcasts, study guides for USMLE. The library added subscriptions to Access Surgery and Access Emergency Medicine when they became available from the company.
Residents especially appreciate having 24×7 access to these resources.
And truly, we librarians were thrilled back in 1999 when the subscription to a digital version of Harrisons’ Principals of Internal Medicine was rolled out. LOL. (Link here to an academic paper from 1999 reviewing the resource.) Back then, the medical and dental students were excited about this 16th digital edition too, although most of them elected to purchase their own hardbound copy of the textbook. These memories seem a little quaint from eleven years on.
In 2010, here’s a screenshot of the newly-redesigned Access Medicine front page:
What are other examples of what librarians consider garden-variety “packaged databases” that are frequently mentioned by first year students as essential to their research?
MD-Consult*, Up to Date* and for locating primary studies (or for “just shopping around” as one student said), PubMed.
As librarians (and instructors) a major teaching role for us is to encourage their exploration… and also to model the effective use of these information resources. Feedback from students or faculty on the nature of their experiences as they “consume” these products is very important.
And (dare I mention!) the librarians are there in the classrooms to also reinforce that using sources such as Google or Google Scholar to do credible clinical research represent truly two of the least satisfactory choices but also the ones most easily or readily available. (Sigh.)
There are many free information sites in the world… the librarians don’t use or teach (or endorse) many of them. Why? Not because we are close-minded, too traditional, or old and cranky. This is a conversation thread that will be continued in Part 2 of this post.
Seeing a dozen patients with XYZ syndrome will significantly increase their practical assessment skills. So will participating in the care of a patient that even the seasoned clinicians and experts haven’t yet figured out a diagnosis for. A common short-hand for diagnostic skills is Horses versus Zebras.
Learning to comb the literature for clinically-sound research studies – and weighing what has been found for validity or predictive value – are skills not easily learned. Is four years sufficient time for practice in this pick-and-choose process?
Many students in their third and fourth year of study come back to meet with the reference librarians for a “refresher course” on how to search more efficiently, as they begin their required fourth year individual research project (called their “selective“).
I consider these reference training sessions with students as excellent indicators that they are growing quite sophisticated about what they consider to be “good” evidence. Getting choosy is a wonderful thing.
* Please note: Resources mentioned are subscriptions and limited to UCHC students, staff and faculty only. If off-site, use the Library’s proxy access to connect to them.