Connie Schardt

Utilization of the PICO framework to improve searching PubMed for clinical questions

BackgroundSupporting 21st century health care and the practice of evidence-based medicine (EBM) requires ubiquitous access to clinical information and to knowledge-based resources to answer clinical questions. Many questions go unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies, and accessing databases to identify best levels of evidence.MethodsThis randomized trial was designed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system. Two of the search interfaces utilized a specific framework called PICO, which was designed to focus clinical questions and to prompt for publication type or type of question asked. The third interface was the standard PubMed interface readily available on the Web. Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US. Thirty-one subjects were randomized to one of the three interfaces, given 3 clinical questions, and asked to search PubMed for a set of relevant articles that would provide an answer for each question. The success of the search results was determined by a precision score, which compared the number of relevant or gold standard articles retrieved in a result set to the total number of articles retrieved in that set.ResultsParticipants using the PICO templates (Protocol A or Protocol B) had higher precision scores for each question than the participants who used Protocol C, the standard PubMed Web interface. (Question 1: A = 35%, B = 28%, C = 20%; Question 2: A = 5%, B = 6%, C = 4%; Question 3: A = 1%, B = 0%, C = 0%) 95% confidence intervals were calculated for the precision for each question using a lower boundary of zero. However, the 95% confidence limits were overlapping, suggesting no statistical difference between the groups.ConclusionDue to the small number of searches for each arm, this pilot study could not demonstrate a statistically significant difference between the search protocols. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results.

Resident utilization of information technology.

AbstractOBJECTIVE: To determine if a simple educational intervention can increase resident physician literature search activity. DESIGN: Randomized controlled trial. SETTING: University hospital-based internal medicine training program. PATIENTS/PARTICIPANTS: Forty-eight medical residents rotating on the general internal medicine service. INTERVENTIONS: One-hour didactic session, the use of well-built clinical question cards, and practical sessions in clinical question building. MEASUREMENTS AND MAIN RESULTS: Objective data from the library information system that included the number of log-ons to MEDLINE, searching volume, abstracts viewed, full-text articles viewed, and time spent searching. Median search activity as measured per person per week (control vs intervention): number of log-ons to MEDLINE (2.1 vs 4.4, P<.001); total number of search sets (24.0 vs 74.2, P<.001); abstracts viewed (5.8 vs 17.7, P=.001); articles viewed (1.0 vs 2.6, P=.005); and hours spent searching (0.8 vs 2.4, P<.001). CONCLUSIONS: A simple educational intervention can markedly increase resident searching activity.

PubMed Instruction for Medical Students: Searching for a Better Way

In 2007, Duke University Medical Center Library instituted an interactive, online PubMed tutorial and quiz for medical students to replace an in-person lecture. This article describes the events leading to this educational paradigm shift and how the tutorial was implemented. Important concerns in the switch to an online approach to PubMed training were student satisfaction and the extent to which searching skills would improve. To determine the effectiveness of the online model, two years of student quizzes and evaluations were examined. Results indicate that students benefit from and appreciate the interactive tutorial.

Innovation in evidence-based medicine education and assessment: an interactive class for third- and fourth-year medical students

INTRODUCTIONEvidence-based medicine (EBM) is an importantcomponent of an undergraduate medical educationcurriculum that promotes lifelong learning andcritical thinking [1]. Defined as ‘‘the conscientious,explicit, and judicious use of current best evidence inmaking decisions about the care of individualpatients’’ [2], EBM can be considered another impor-tant clinical tool, not unlike the stethoscope. Theauthors designed and assessed an innovative EBMcourse for third-year medical students to strengthenthe EBM curriculum for undergraduate medicaleducation.BACKGROUNDPrevious studies have advocated real-time teaching ofEBM during attending rounds, in a case-based formatwith role playing or with standardized patients [3–5].At the same time, brief training in literature searchingand critical appraisal skills has been shown to beeffective, and interactive workshops have beensuggested as an ideal format for medical students[6–8]. At many academic medical centers, includingthe authors’, constraints on resident and student dutyhours and increased demands for productivity fromclinical teaching faculty have made adding formalcurricula to the clinical services problematic. In aneffort to combine an interactive learning environmentwith core topics in EBM, we devised a multidisciplin-ary, case-based seminar series that is team-taughtby clinicians and a librarian and is designed to beinteractive, engaging, and clinically relevant.METHODSDesigned by a medical librarian and a physician(Schardt and Gagliardi), the EBM course is intendedto provide an interactive forum for students todevelop skills in practicing EBM in the care ofpatients. The first version of the EBM course wasoffered as a noncredit elective to 8 third-year medicalstudents in 2006 and consisted of 6 90-minute sessionsconducted over the course of the spring semester.After experimenting with a 10-session format, wesettled on 6 120-minute sessions conducted onconsecutive Thursday evenings, from 5:00 p.m. to7:00 p.m.After the third iteration of the course in 2008, itbecame a credit-bearing elective, which requiredopening it not only to third-year medical students,but also to fourth-year medical students. Since the2008/09 academic year, the EBM course has attractedapproximately forty students per year. The currentstudy with pre- and post-course assessments ofknowledge as well as attitudes was conducted duringthe 2008/09 academic year.The EBM course is designed to optimize studentreadiness and participation, faculty willingness toteach, and instructional strategies to maximize reten-tion and use of EBM skills, with key features outlinedbelow.1. Timing in the curriculumAt our institution, medical students complete theirrequired clinical clerkships during the second year.The EBM course is designed for students who arepursuing academic endeavors during the third year,which is dedicated to research. This is optimal timingbecause students have completed their requiredclinical clerkships and, therefore, have had somepatient care experience along with the opportunity toobserve and practice EBM in a variety of settings.Additionally, as they are about halfway through theirscholarly research activity year, they are cognizant ofsome of the logistical and practical issues involved indesigning and conducting scientific research.2. Course organization and facultyTable 1 shows the course outline. The introductorysession provides an overview of the EBM frameworkand the basics of study design. The subsequent foursessions are case based and teach relevant issuespertaining to the retrieval, appraisal, and applicationof studies of therapy, diagnosis, harm, and systematicreviews. The final session is designed to demonstratethe real-time application of EBM skills. Cliniciansfrom the emergency department and in-patient unitstake students through actual clinical cases they haveencountered and demonstrate how they used EBM tocontribute to their care of actual patients. Each caseusually takes five to fifteen minutes and effectivelydemonstrates that EBM can be incorporated intoclinical practice.We rely on a diverse faculty with a broad spectrumof clinical interest and experience. Facilitators areclinically based and recruited from departments anddisciplines in which they are likely to have encoun-tered many of the students in clinical settings. Inthis way, no one faculty member is responsible fordelivering of all content, students benefit fromwitnessing the use of EBM skills by a variety of

Collaborating to Create an Online Evidence-Based Medicine Tutorial

Medical librarians have had an interest in learning and teaching the process of evidence-based medicine for several years. Many have attended and taught evidence-based medicine classes for health care providers and for other librarians. Although numerous evidence-based medicine Web sites exist, such as Evidence-Based Health Care Resources from the University of Rochester Medical Center,1 few include a Web-based tutorial. Librarians at Duke University and UNC-CH work with medical school faculty to teach and support the evidence-based medicine process, and their respective libraries were interested in developing an online evidence-based medicine tutorial. The NC Area Health Education Centers Program was developing a digital library at the same time, and needs assessments indicated the desire for an online EBM tutorial. During 1999, two librarians and a curriculum support specialist worked together to create an interactive Webbased tutorial. The objective of the tutorial is to provide an introduction to evidencebased medicine (EBM) and the steps in the EBM process: define ‘‘evidencebased medicine,’’ construct a well-built clinical question based on a patient problem, identify searching strategies that could improve MEDLINE retrieval, and identify key issues that help determine the validity of evidence. The tutorial contains nine units. The first one welcomes users to the tutorial, states the objectives, and introduces the developers. The next five units are the core of the tutorial:

Journal club for faculty or residents: a model for lifelong learning and maintenance of certification.

Abstract The journal club offers a model for lifelong learning and maintenance of certification (MOC) for residents and faculty staff. First, it sharpens participants’ critical appraisal skills by providing a space to discuss relevant medical literature. Second, it motivates participants to seek new medical literature on their own using technology. Our model sets forth a four-year journal club curriculum that could be used as one continuous curriculum or in bits and pieces. In the first year, the focus is teaching residents how to read an article. The second year focuses on what is of interests to the reader. The third year applies the residents appraisal skills to assigned articles to test whether they can determine which have reliable and valid findings and which are flawed. In the fourth year residents are asked to distinguish whether articles are well researched and referenced. Our model also motivates participants to read articles in faculty journal clubs throughout their career. In most academic settings category 1 continuing medical education (CME) credits can be awarded so journal club can have the added benefit of satisfying maintenance of certification CME credits. From journal club both residents and faculty can learn what is new and learn to apply this new information in their practice. Finally, because technology creates an overabundance of relevant medical literature, participants using our model can develop strong critical appraisal skills and methods for organizing the information they find that make this information readily available for future use and retrieval.

Supporting PDAs: the experience of a health sciences library

This paper discusses the Duke University Medical Center Library’s experience in supporting the use of mobile technology. Over the past several years, the library contributed to the formation of a mobile technology infrastructure through surveys, organization of information sharing events, and the development and review of medical center wide proposals and reports.