Lauren A. Maggio

Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006-2011.

Purpose To characterize recent evidence-based medicine (EBM) educational interventions for medical students and suggest future directions for EBM education. Method The authors searched the MEDLINE, Scopus, Educational Resource Information Center, and Evidence-Based Medicine Reviews databases for English-language articles published between 2006 and 2011 that featured medical students and interventions addressing multiple EBM skills. They extracted data on learner and instructor characteristics, educational settings, teaching methods, and EBM skills covered. Results The 20 included articles described interventions delivered in 12 countries in classroom (75%), clinic (25%), and/or online (20%) environments. The majority (60%) focused on clinical students, whereas 30% targeted preclinical students and 10% included both. EBM skills addressed included recognizing a knowledge gap (20%), asking a clinical question (90%), searching for information (90%), appraising information (85%), applying information (65%), and evaluating practice change (5%). Physicians were most often identified as instructors (60%); co-teachers included librarians (20%), allied health professionals (10%), and faculty from other disciplines (10%). Many studies (60%) included interventions at multiple points during one year, but none were longitudinal across students’ tenures. Teaching methods varied. Intervention efficacy could not be determined. Conclusions Settings, learner levels and instructors, teaching methods, and covered skills differed across interventions. Authors writing about EBM interventions should include detailed descriptions and employ more rigorous research methods to allow others to draw conclusions about efficacy. When designing EBM interventions, educators should consider trends in medical education (e.g., online learning, interprofessional education) and in health care (e.g., patient-centered care, electronic health records).

Public Access and Use of Health Research: An Exploratory Study of the National Institutes of Health (NIH) Public Access Policy Using Interviews and Surveys of Health Personnel

Background In 2008, the National Institutes of Health (NIH) Public Access Policy mandated open access for publications resulting from NIH funding (following a 12-month embargo). The large increase in access to research that will take place in the years to come has potential implications for evidence-based practice (EBP) and lifelong learning for health personnel. Objective This study assesses health personnel’s current use of research to establish whether grounds exist for expecting, preparing for, and further measuring the impact of the NIH Public Access Policy on health care quality and outcomes in light of time constraints and existing information resources. Methods In all, 14 interviews and 90 surveys of health personnel were conducted at a community-based clinic and an independent teaching hospital in 2010. Health personnel were asked about the research sources they consulted and the frequency with which they consulted these sources, as well as motivation and search strategies used to locate articles, perceived level of access to research, and knowledge of the NIH Public Access Policy. Results In terms of current access to health information, 65% (57/88) of the health personnel reported being satisfied, while 32% (28/88) reported feeling underserved. Among the sources health personnel reported that they relied upon and consulted weekly, 83% (73/88) reported turning to colleagues, 77% (67/87) reported using synthesized information resources (eg, UpToDate and Cochrane Systematic Reviews), while 32% (28/88) reported that they consulted primary research literature. The dominant resources health personnel consulted when actively searching for health information were Google and Wikipedia, while 27% (24/89) reported using PubMed weekly. The most prevalent reason given for accessing research on a weekly basis, reported by 35% (31/88) of survey respondents, was to help a specific patient, while 31% (26/84) were motivated by general interest in research. Conclusions The results provide grounds for expecting the NIH Public Access Policy to have a positive impact on EBP and health care more generally given that between a quarter and a third of participants in this study (1) frequently accessed research literature, (2) expressed an interest in having greater access, and (3) were aware of the policy and expect it to have an impact on their accessing research literature in the future. Results also indicate the value of promoting a greater awareness of the NIH policy, providing training and education in the location and use of the literature, and continuing improvements in the organization of biomedical research for health personnel use.

Reproducibility of literature search reporting in medical education reviews.

Purpose Medical education literature has been found to lack key components of scientific reporting, including adequate descriptions of literature searches, thus preventing medical educators from replicating and building on previous scholarship. The purpose of this study was to examine the reproducibility of search strategies as reported in medical education literature reviews. Method The authors searched for and identified literature reviews published in 2009 in Academic Medicine, Teaching and Learning in Medicine, and Medical Education. They searched for citations whose titles included the words “meta-analysis,” “systematic literature review,” “systematic review,” or “literature review,” or whose publication type MEDLINE listed as “meta-analysis” or “review.” The authors created a checklist to identify key characteristics of literature searches and of literature search reporting within the full text of the reviews. The authors deemed searches reproducible only if the review reported both a search date and Boolean operators. Results Of the 34 reviews meeting the inclusion criteria, 19 (56%) explicitly described a literature search and mentioned MEDLINE; however, only 14 (41%) also mentioned searches of nonmedical databases. Eighteen reviews (53%) listed search terms, but only 6 (18%) listed Medical Subject Headings, and only 2 (6%) mentioned Boolean operators. Fifteen (44%) noted the use of limits. None of the reviews included reproducible searches. Conclusions According to this analysis, literature search strategies in medical education reviews are highly variable and generally not reproducible. The authors provide recommendations to facilitate future high-quality, transparent, and reproducible literature searches.

Critical appraisal of emergency medicine educational research: the best publications of 2009.

OBJECTIVES The objective was to critically appraise and highlight medical education research published in 2012 that was methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). METHODS A search of the English language literature in 2012 querying Education Resources Information Center (ERIC), PsychInfo, PubMed, and Scopus identified EM studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. This year, publications limited to a single-site survey design that measured satisfaction or self-assessment on unvalidated instruments were not formally reviewed. Six reviewers then independently ranked all remaining publications using one of two scoring systems depending on whether the study methodology was primarily qualitative or quantitative. Each scoring system had nine criteria, including four related to methodology, that were chosen a priori, to standardize evaluation by reviewers. The quantitative study scoring system was used previously to appraise medical education published annually in 2008 through 2011, while a separate, new qualitative study scoring system was derived and implemented consisting of parallel metrics. RESULTS Forty-eight medical education research papers met the a priori criteria for inclusion, and 33 (30 quantitative and three qualitative studies) were reviewed. Seven quantitative and two qualitative studies met the criteria for inclusion as exemplary and are summarized in this article. CONCLUSIONS This critical appraisal series aims to promote superior education research by reviewing and highlighting nine of the 48 major education research studies with relevance to EM published in 2012. Current trends and common methodologic pitfalls in the 2012 papers are noted.

Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

Evidence-based medicine (EBM) skills, although taught in medical schools around the world, are not optimally practiced in clinical environments because of multiple barriers, including learners’ difficulty transferring EBM skills learned in the classroom to clinical practice. This lack of skill transfer may be partially due to the design of EBM training. To facilitate the transfer of EBM skills from the classroom to clinical practice, the authors explore one instructional approach, called the Four Component Instructional Design (4C/ID) model, to guide the design of EBM training. On the basis of current cognitive psychology, including cognitive load theory, the premise of the 4C/ID model is that complex skills training, such as EBM training, should include four components: learning tasks, supportive information, procedural information, and part-task practice. The combination of these four components can inform the creation of complex skills training that is designed to avoid overloading learners’ cognitive abilities; to facilitate the integration of the knowledge, skills, and attitudes needed to execute a complex task; and to increase the transfer of knowledge to new situations. The authors begin by introducing the 4C/ID model and describing the benefits of its four components to guide the design of EBM training. They include illustrative examples of educational practices that are consistent with each component and that can be applied to teaching EBM. They conclude by suggesting that medical educators consider adopting the 4C/ID model to design, modify, and/or implement EBM training in classroom and clinical settings.

Expert searcher, teacher, content manager, and patient advocate: an exploratory study of clinical librarian roles

OBJECTIVE The research explored the roles of practicing clinical librarians embedded in a patient care team. METHODS Six clinical librarians from Canada and one from the United States were interviewed to elicit detailed descriptions of their clinical roles and responsibilities and the context in which these were performed. RESULTS Participants were embedded in a wide range of clinical service areas, working with a diverse complement of health professionals. As clinical librarians, participants wore many hats, including expert searcher, teacher, content manager, and patient advocate. Unique aspects of how these roles played out included a sense of urgency surrounding searching activities, the broad dissemination of responses to clinical questions, and leverage of the roles of expert searcher, teacher, and content manager to advocate for patients. CONCLUSIONS Detailed role descriptions of clinical librarians embedded in patient care teams suggest possible new practices for existing clinical librarians, provide direction for training new librarians working in patient care environments, and raise awareness of the clinical librarian specialty among current and budding health information professionals.

Why Medical Schools Should Embrace Wikipedia: Final-year Medical Student Contributions to Wikipedia Articles for Academic Credit at One School.

Supplemental Digital Content is available in the text.

Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools.

Purpose Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges. Method A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education–accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach. Results Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students’ lack of willingness to admit uncertainty, a lack of clinical context, and students’ difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM. Conclusions The identification of these four learner-centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula.

Access of primary and secondary literature by health personnel in an academic health center: implications for open access

PURPOSE The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. METHODS Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. RESULTS In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. CONCLUSION When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research.

How are medical students trained to locate biomedical information to practice evidence-based medicine? a review of the 2007–2012 literature

OBJECTIVES This study describes how information retrieval skills are taught in evidence-based medicine (EBM) at the undergraduate medical education (UGME) level. METHODS The authors systematically searched MEDLINE, Scopus, Educational Resource Information Center, Web of Science, and Evidence-Based Medicine Reviews for English-language articles published between 2007 and 2012 describing information retrieval training to support EBM. Data on learning environment, frequency of training, learner characteristics, resources and information skills taught, teaching modalities, and instructor roles were compiled and analyzed. RESULTS Twelve studies were identified for analysis. Studies were set in the United States (9), Australia (1), the Czech Republic (1), and Iran (1). Most trainings (7) featured multiple sessions with trainings offered to preclinical students (5) and clinical students (6). A single study described a longitudinal training experience. A variety of information resources were introduced, including PubMed, DynaMed, UpToDate, and AccessMedicine. The majority of the interventions (10) were classified as interactive teaching sessions in classroom settings. Librarians played major and collaborative roles with physicians in teaching and designing training. Unfortunately, few studies provided details of information skills activities or evaluations, making them difficult to evaluate and replicate. CONCLUSIONS This study reviewed the literature and characterized how EBM search skills are taught in UGME. Details are provided on learning environment, frequency of training, level of learners, resources and skills trained, and instructor roles. IMPLICATIONS The results suggest a number of steps that librarians can take to improve information skills training including using a longitudinal approach, integrating consumer health resources, and developing robust assessments.