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

Tag Archives: Health Science Librarians

The Friday Post #52: Medical Students, Video: Tips on How to Survive Medical School

Welcome back, everyone!  This is the Friday Post #52 for Aug 27, 2010.

The area in the pink box (below) has been the focus of instructional activities this week:

Image source: http://library.uchc.edu – All rights reserved – copyright 2010

August is a challenging month for academic reference librarians.  This week at UCHC, an interactive instructional session for first year medical and dental students (140 of them) was our main event. In 2009, the reference librarians presented a mock PBL case, written with a fourth year student who narrated the case while the librarians linked to the databases on the overhead screen in one of the large teaching auditoriums.  As each clinical scenario was described in the case, librarians linked into an assortment of resources.

This year, the 90-minute instructional session was more interactive. Everyone was handed an electronic clicker (aka audience response system) to use to respond to our librarian-questions which were interspersed between live demonstrations of PubMed, Lexi-Comp, 3-D Tooth Atlas, ADAM (Interactive Anatomy) and others.

Their new laptops also came in handy as the students quickly tried a “test run” on each of the resources. The live interactive feedback from this group was something new to try in 2010, and it was both fun and instructive. Although perhaps next year we will skip the video procedure showing the skin punch biopsy… when it is projected onto a 24 ft. square overhead, it’s just way too graphic for the first week of medical school (LOL).

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The Girl with the Blue Stethoscope (a fourth-year medical student and blogger from Australia) began a series in July 2010 titled “How to Survive Medical School.  For the members of the Class of 2014 this should be pretty much essential reading.

Her first installment was “How To Survive Medical School Part 1: Friends“.  The second installment:  How To Survive Medical School Part 2: Ask For Help. Thank you, Girl with the Blue Stethoscope… I’m looking forward to the next installment!

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Then this: Tufts University medical students raise the bar with this video for – and about – first year medical students called 99 Problems til First Years Done!

Video source: http://youtube.com – All rights reserved – copyright 2010

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That’s the Friday Post #52 for Aug 27, 2010, folks.  Enjoy a summer weekend!

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Reference for Academic-Health Science Libraries, Collection Management, Open Access: Peripheral Finds

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Having been hunkered down in my cubicle for the past month updating the library’s Reference Collection, I am now ready to step back into the light and offer up Part #3 of Reference Ruminations (if you missed the first two postings, here’s part 1 and part 2).

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Digging around looking for new or updated titles is part of the fun of collection management.  Less fun is staying within one’s $$ budget while keeping a current health science reference collection to a constant size. Migration from print to online format continues at a fast pace in 2009.

Trolling” or “trawling” (if these are the correct terms) describes the specialized peripheral vision belonging to librarians (or scientists) that requires one to never pass up examining a new book, journal article or website (or whatever else looks interesting – the shoe section at Marshalls also qualifies) even though we weren’t specifically looking for that type of information.

An eclectic list follows… they represent sites that I wasn’t exactly looking for – but turned out to offer timely, focused reporting on a variety of health-related data, policy or statistical information that I couldn’t ignore. The publishers or data-gatherers linked below include nonprofit organizations, academies, public or social policy institutions, government agencies, charitable foundations and others.  Most (but not all) of this content is freely distributed.

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It is my hope that you will find information of value to your research from the links below.

  • Research efforts conducted or sponsored by NAP’s Institute of Medicine (IOM) is organized into “seventeen health topic areas: mental health, child health, food and nutrition, aging, women’s health, education, public policy, health care and quality, diseases, global health, workplace, military and veterans, health sciences, environment, treatment, public health and prevention, minority health.”  Link to IOM topic pages here.  Many of their publications are available online at no cost.
  • The LeapFrog Group has provided data on hospital safety ratings by state on their website, openly available at this link. MD-Consult had this to say about the data, published Apr 15 2008:  Hospitals are barely meeting quality and efficiency standards, according to a survey issued on April 15 by the Leapfrog Group, an organization made up of some of America’s largest employers.”
  • Epidemiologists and MPH students use the longitudinal reports, surveys and other data compiled by the staff at National Center for Health Statistics (NCHS).  Researchers can register with NCHS to download actual datasets for research purposes at no charge; see CDC Wonder for more information about these files.
  • A major charitable organization for promoting health and social justice worldwide, The MacArthur Foundation website could take hours to examine. One place to begin for those interested in demography or epidemiology is their domestic Research Networks page.

  • The Childrens’ Defense Fund has an extensive digital library of data, statistics and policy synthesis reports on American children, their health, families and communities.  In December 2008, CDF published a 80-page report on “The State of America’s Children“, available online (link to the 80-page PDF).
  • A particularly useful site for recent data and policy reports on American families at risk is the Knowledge Center from the Annie E. Casey Foundation, a nonprofit organization whose stated mission is “helping vulnerable kids and families succeed”.  As an example, the Kids Count page allows one to search for demographic or health information using standardized key indicators (such as access to housing, poverty, birth outcomes, access to early childhood education, uninsured families and other community and socioeconomic factors) across states.

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Since I was taking photos anyway, below are a few more views of the library.  The main floor of the library had a major renovation, completed in 2005.  In 2008, some areas of the 2nd floor were renovated.

These are the so-called Barney Chairs (as in, plush, overstuffed and really purple), positioned next to the Reference stacks for those who like to sit comfortably by the windows to read:

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The 2nd floor of the library is a popular quiet study space.

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A library plant, Crown of Thorns (euphorbia milii), flowered this week.

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All Photos: Courtesy of UCHC – All rights reserved – Copyright 2009


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.

Research, Decisionmaking, Libraries: Search or Find? Fishing or Virology?

Many folks who are dedicated fishermen/fisherwomen just like to be out on the water, in the day’s weather (on a lake, river, ocean, wherever) and don’t mind all that much whether they just Fish or whether they Catch. Many who do catch anything immediately release it back into the water, and no harm is done to the fish or the person’s ego. Then there are certain type-A people who don’t want to Fishthey only want to Catch… and catch the biggest, rarest or hardest critter to land, at that. (But this post isn’t about fishing. I failed fishing anyway… my brother said I talked too much and scared all the fish away).

On Nature Networks, a blog called Lab Life is written by a PhD student from Harvard, Anna Kushnir. Ms. Kushnir is working on completing her dissertation in cell biology and virology this spring. This is what she wrote in her “About” page:

My research interests are focused on virus-cell interactions, specifically cell signaling and gene transcription. However, I would much rather write about science than actually do it. Science writing/editing are my goals post graduation.

She has spent time using medical search engines, and wrote a post on her blog on Mar 22 2008, entitled “I hate PubMed“, voicing frustration with the complexities and frustrations of using that database versus other sources, including Google Scholar.

Ms. Kushnir is one of those who wants only to catch, not to learn how to fish… saying “Why should I have to?”

<sigh>. This whole discussion highlights just how many users dislike using PubMed. They find it difficult to use, difficult to retrieve relevant citations, and apparently just don’t want to keep struggling with it. I think this is why so many people like Google Scholar: easy to use, free, easy to locate some articles. However, an essential point which Ms. Kushnir and many others miss is this: if a publisher has signed an agreement with Google to provide access to their full-text articles from a highly-selective list of journals… then – and only then – will you or I find those articles in Google Scholar.

PubMed is a tried-and- true daily workhorse for the work that information professionals do – which essentially is to sift through hundreds of citations to come up with the five or ten near-perfect articles that the individual clinician or student needs to:

  • provide outstanding patient care that will save a life
  • gain an overview of the historical development of a disease management breakthrough
  • write a grant proposal that will be a winner and start a successful career
  • locate a 2008 review on state-of-the-art medical care for a specific patient with multi-organ medical problems
  • to sift and filter through a lifetime of work that an individual researcher has produced
  • or… learn to set up a “news alerts” on specific individual researchers or articles, eliminating the need to frequently scan newly-published literature
  • and for any other reasons you can name…

These are only a few reasons why health science librarians provide professional searches or train clinicians how to search for themselves.

If you are a virologist, and there are four or five key, critical journals which you must use for your work… but IF those journals are not indexed in Google Scholar then that source will be of little use to you.

You’d miss reading key research essential to the work that you are involved in. Unless, of course, you decide to branch out and learn to search other subscription databases such Scopus, Biosis, Web of Science, etc. You’d also miss key research published in open access journals such as PLoS (Public Library of Science) or BioMedCentral.

You’d be missing a lot.

There are currently more than 30 comments about this blog post: from fellow scientists, researchers, medical librarians offering assistance or advice.

Ms. Kushnir, please take some kind and gentle advice from the librarians who have posted on your blog. Meet with some of us, take 2 hours to learn what is available through the large university library which you are a part of – and become a better searcher.

Your career – and your scientific discoveries – might even depend on it.

EBM, Education, PDAs: Getting Up to Speed with PDAs

It’s been a busy week here and so I am getting back to blogging. The second-year medical students have purchased new PDAs this month in preparation for their clinical clerkship which begins in July. They are also starting a formal course on clinical reasoning. Reference librarians are assisting them in getting up to speed with various clinical software – chiefly Lexi-Comp, DynaMed, Diagnosaurus, Archimedes, Shots – and “best ways” to use these decision support tools. As anyone who has used PDAs knows, what looks to be an easy and straightforward install can turn out to be anything but that… I spent hours trying to get an updated DynaMed on my PDA on Monday – with no luck at all so far. 😦

The standard rule of “smaller, cheaper, faster” definitely applies to PDAs. The newest models are slimmer, sleeker and offer more features including higher screen resolution than the model I am using currently (which is barely 3 years old). With a PDA in your pocket you can search for potentially dangerous drug interactions, calculate normal values (for example, determine a patient’s creatinine clearance rate), check your email or read an pertinent review article from NEJM using the hospital wireless network – all at bedside and without getting anywhere near the library! What a benefit for busy students and clinicians!

If you are interested, here are a few links to PDA resources. The first page was written by library staff for use by students, faculty and clinicians:

P.S. And I really like Lexi-Comp! *

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Image/Photo Credit: Lexi-Comp Inc. – Copyright 2008 – All rights reserved.

* Just in case you are wondering: Lexi-Comp. Inc. did not pay me to say that. Our subscriptions to Lexi-Comp – accessible on the internet or the version for PDA use – are great products, updated daily and well-utilized in this clinical setting. Heck – only librarians would say they loved a database, anyway! 😉

News: UCHC Librarians are “Managing the Information Explosion”

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Photo credits: University of Connecticut Health Center – Copyright 2007

UConn Health Center Magazine is a news publication of the University of Connecticut Health Center which comes out three times per year. In the Fall 2007 issue (Vol. 3, number 3), Lyman Maynard Stowe library staff are featured in an article entitled “Managing the Information Explosion”. There’s a gorgeous pan-shot of the recently renovated library (which was completed in 2005) in this article.

The author, Karen Baar, interviewed a number of library staff this summer and was especially interested in how library collections, instruction and services have evolved in an academic-medical setting since the shift from in-print to electronic began in the early 1990s. She was also interested in learning more about librarians as formal instructors for UCHC physicians, residents, graduate students, nursing staff, pharmacists, researchers and as facilitators for problem-based learning groups with first and second year medical students (which librarians have done since since 1996).

The three librarians in the photo on page 20 are Evelyn Breck Morgen, Library Director, Alberta Richetelle, program director for HealthNet (Connecticut Consumer Health Information) and myself, reference librarian.

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This article is a nice validation of the central nature the library plays in the intellectual life of this institution!