May is the time of year when I get to sit in the back of a classroom with my mouth shut, listening (as opposed to standing in the front of a classroom, yakking about searching).
This post, Part 2 of “Show Me the Evidence“, is not about how to search a database better or when to find a systematic literature review… or anything about a library or its collections.
The “evidence” in this case isn’t a tangible product, nor can it be measured in ounces or liters. This evidence is formed during years spent in a classroom and framed by clinical experience, listening to a patient describe their symptoms or the way a tumor feels under one’s hand or scalpel. This evidence dwells in a scientists’ mind, whether they practice medicine or perform experiments, collecting images and allowing a peripheral brain to develop. This knowledge has been informed by a hundred nights on call, scrutinizing CT scans, dissecting mice, examining EKG strips, observing the gait and balance of a child, listening to the characteristic sounds of COPD through a stethoscope. It could be the red flag raised by how a patient’s liver appears in a CT scan, or a questionable lab value.
This evidence-base has been formed by workdays lasting 18 hours, hunkered down in a pathology lab or an operating room. It allows a collection of “clinical suspicions” to coalesce. It improves diagnostic accuracy and surgical intuition. It dwells in the life of the mind, it could be called intellectual rigor.
A newer graduate program offered at UConn Health Center is the Masters in Clinical and Translational Research (MCTR) program. There are over 50 faculty who teach individual components for this course, and it is a varied group: senior researchers, epidemiologists, a couple of psychiatrists, a pharmacologist, two biostatisticians, a health law attorney, an IT specialist, hospital administrators.
As the only librarian in the group, my main contribution is to spend three hours teaching the students about the range of information available to them through the UConn libraries and how to best choose, search and evaluate the sources that complement their clinical areas. Following are key areas of course content:
- Clinical Research Fundamentals. Trial Design, Execution, Management. The role of the Principal Investigator.
- Selecting the Type of Study: Observational Prospective Studies. Experimental Intervention Studies. Non-Randomized Intervention Studies. Case-control and Non-Randomization Study Design.
- Measurement of Exposure; Principles for Inferring Causation. Group Interventions, Intention to Treat Analysis.
- Application of Pharmacokinetic Principles in Design or Execution of Phase I or Phase II Studies.
- Patient Recruitment, Retention and Management.
- Elements of Informed Consent; Drafting the Form. HIPAA Rules.
- Ethical Treatment of Human Subjects. The Common Rule. Federal Regulations. Scientific Misconduct.
- Survey Design: Questionnaires, Sampling, Response Rates, Recruitment. Cross-sectional versus longitudinal surveys.
- Working with the Institutional Review Board (IRB).
- Studies in Genetics.
- Computerized Data Management: Storage and Retrieval Needs, Data Elements, Data Entry; System Security, Backup and Storage. Data Archiving.
Each student in the program presents a capstone research project at year-end; the assignment is to design a clinical study of their choice from beginning to end with special care taken to select the “correct” potential patient subjects and to choose the “best” study design. The individual who writes the proposal serves as the PI (principal investigator). There were six students in the class this year. Four are physicians, the others are in physical therapy or dentistry.
Their presentations were awe-inspiring. They have such a sure technical grasp of methodologies (that remain dense to me) and confidence in planning the micro- and macro-aspects of their clinical research project. Certainly I hope they will succeed in securing funding for these proposals.
So I sit in the back of the room, and am reminded annually of just how much I’ll never understand about gene expression profiles, how vectors are designed or how chromosome 10 got lost. It is a humbling experience.
Didn’t Ben Franklin say: “It is better to keep one’s mouth closed and to be thought a fool, than to open it and remove all doubt“? That’s excellent advice.
But the students also showed that they have become better searchers and THAT evidence is awesome, too! 🙂