Proactive Participation of Medical Librarians in EBM : Finding &Teaching How to Find Evidence

Jarmila PotomkováMedical Librarian

Dana ŠubováE-Librarian

Vladimír MihálProfessor of Pediatrics & Vice-Dean for Clinical Education

Vladimír JanoutProfessor of Epidemiology

Palacky University Faculty of MedicineOlomouc, Czech Republic

Contact: potomkov@.tunw.upol.cz

PALACKÝ UNIVERSITY IN OLOMOUC

founded 15731573 (Jesuit College)

restored 19461946 7 faculties Medicine, Science, LawPhilosophy, Theology,Physical Culture,

Education

FACULTY OF MEDICINE

1,9001,900 students students 280 graduates/year 250 teachers

PROGRAMMES: Master‘s Bachelor‘s Postgraduate

Integrated Access to Information Resources: Funding INSTITUTIONAL LEVEL

Medical Library Budget 60% : 40% = Faculty of Medicine : University Hospital

NATIONAL LEVEL National Consortia (Blackwell, Elsevier, Proquest, Springer, Web of Knowledge, Wiley)

2004-2008 Duty to maintain journal collections & pay annual consortial fee (supported by

Central Library budget) Resources

– Subscription to 83 print journals opens online access to >1200 titles

Multi-institutional project „Information Resources for Biomedical Research in Czech R.“

2004-2008 3 universities + National Library of Medicine Prague Resources

– MEDLINE, EMBASE,SPORTDiscuss, COCHRANE LIBRARY, MICROMEDEX, LWW HIGH IMPACT COLLECTION

INTERNATIONAL LEVEL EU-supported projects

INNO-MED

INTERREG IIICNorth –East –South - West

EU-funded programme that helps Europe’s regions form partnerships to work together on common projects.by sharing knowledge and experience, these partnerships enable the regions involved to develop new solutionsto economic, social and environmental challenges.

Sub-project INNO-MEDDevelopment of an Innovative Evidence-Based Medical Information System for the

Improvement of Effectiveness and Quality of Medical Care

Lead Participant: University of Patras (GREECE)

Participants: Centro Multimediale di Terni Spa (ITALY)

University Hospital Olomouc (CZECH R.) CZ Team: 3 IT specialists, 3 clinicians, 1epidemiologist, 1administrator. 1 economist, 1 medical librarian

Module: Users requirements for Clinical Knowlčdge Retrieval & Analysis Resources: Current Opinion Series online (23 clinical specialties)

Summary: The need for this project is validated from the assumption that health care is largely information and

communication dependent, while ICT solutions can provide easily accessible and cost effective ways of meeting this increasing dependency

. The proposed system will provide a wide range of users (medical doctors, health care professionals, health policy makers, patients and citizens) with the opportunity to access, process and produce evidence-based medical information.

Sub-project web site: www.innomed-project.net

Integration of Information ResourcesOvid LinkSolver

Value-added library service Trained staff

Activate access to eelectronic journals Increase usage rate of resources

Databases Journals

Extend resources to the point of need Training end-users to master searching multiple

databases to get „the best evidence“.

Ovid Administrative ToolsLinkSolver

Activation

Ovid LinkSolver Options

Ovid LinkSolver Options

Ovid Multifile Searching for Best Evidence

„Go beyond MEDLINE“ philosophy EMBASE may return around 40% unique records

Multifile searching via Ovid allows to search multiple databases as if they were one database.

Having entered one search statement, Ovid carries that query across all databases of the multifile, retrieving results from each.

Deduplication functionality helps remove duplicate records before viewing, saving, or printing records.

Application of limits filters out Publication types (eg. reviews) Fulltext articles

Multifile SearchList of Resources for Palacky University

Information Retrieval Case Study

Clinical Question for Today

Does folic acid help prevent birth defects, in particular neural tube defects?

Search strategy Identification of search terms Use of Boolean operators Application of limits

Working with Search ResultsDeduplication, Application of Limits

Multifile Search ResultsDistribution across Databases

Teaching How to Find Best EvidenceChanges in Palacky University Medical Curricula

Medical Curriculum CourseBIOMEDICAL INFORMATION RETRIEVAL Mandatory course for 1st year international medical students Duration: 2 semesters Taught by medical librarians Organized in eight 90 min blocks Introduced 2004/2005

Outline:1. Fundamentals of evidence based medicine.2. Biomedical literature resources and hierarchy of evidence. 3. MEDLINE - the most important biomedical database. PubMed online training. 4. MEDLINE - sample searches. Search strategy tips, Boolean operators, application of limits

working with search results.5. From MEDLINE to the Cochrane Library - a reliable way to locate best evidence for healthcare. 6. Basics of medical literature critical appraisal. 7. Bibliometric Tools for Evaluating Medical Literature Quality. 8. Consolidation workshop (information retrieval, quality evaluation & analysis of selected

publication types). Feedback: highly appreciated, 2-year-experience

Teaching How to Find Best EvidenceChanges in Palacky University Medical Curricula

Medical Curriculum SubjectINTERNET RESOURCES FOR MEDICINE AND HEALTHCARE Elective course for 3rd-5th year medical students Duration: 1 semester Taught by medical librarians Organized in six 90 min blocks Introduced 2004/2005

Outline:1.Access to core biomedical information resources, 2. Clinical scenarios, formulation of searcheable questions, search strategy development.3. PubMed search features, use of MeSH and methodology filters.4. Working with search results: publication types, hierarchy of evidence, systematic vs.

narrative reviews.5. Moving beyond MEDLINE: Cochrane Library - a reliable way to locate best evidence for healthcare. 6. Tools for evaluating Medical Literature Quality.

Feedback: demand largely exceeds capacity of computer lab and teaching staff workload.

Teaching How to Find Best EvidenceChanges in Medical CurriculaNew Medical Curriculum SubjectEVIDENCE-BASED MEDICINE Mandatory course for 6th year medical students Duration: 1 week Taught by epidemiologists, clinician-teachers, medical librarians Organized in ten half-day blocks Introduced 2005/2006 as a substitute for traditional onsite practice in regional epidemiology and

prophylaxis centers. Total number of trainees: 119

Outline:1. EBM essentials – pros/cons. 2. Medical literature as a resource of best evidence.3. Diagnostic tests I – introduction.4. Diagnostic tests II – practical training.5. Therapy and other interventions.6. Therapy – practical training.7. Therapy and harm.8. Prognosis.9. Errors in epidemiologic research.10. From evidence to action: pediatric evidence-based case reports..

Feedback: very promising & challenging.

Student Evaluation Survey Teaching Staff Competencies

Parameter 1 : Teaching staff Competencies6-score-scale:

1 - excellent, 2-high, 3-average, 4-acceptable, 5-low, 6-can´t say

0

5

10

15

20

25

30

35

40

45

50

Vysoká 1 2 3 4 Nízká 5 Nevím

n=

119

Number of respondents: 119

27.7%

39.4%

26.8%

Student Evaluation Survey Professional Level of Practical Training

Parameter 2 : Professional level of practical training6-score-scale:

1-excellent, 2-high, 3-average, 4-acceptable, 5-low, 6-can´t say

0

5

10

15

20

25

30

35

40

45

50

Vysoká 1 2 3 4 Nízká 5 Nevím

n=

11

9

Number of respondents: 119

36.9%33.6%

15.9%11.7%

Student Evaluation Survey Overall Level of Subject

Parameter 3 :Overall Level of the Subject6-score-scale:

1-excellent, 2-high, 3-average, 4-acceptable, 5-low, 6-can´t say

0

10

20

30

40

50

60

Vysoká 1 2 3 4 Nízká 5 Nevím

n=

119

Number of respondents: 119

34.4%

44.5%

16.8%

Student Evaluation SurveyMotivation towards EBM

Parameter 4 :Increase in Motivation towards EBM6-score-scale:

1-remarkable, 2-high, 3-average, 4-slight, 5-low, 6-can´t say

0

10

20

30

40

50

60

Velmi zvýšil 1 2 3 4 Ztratil 5 Nevím

n=

119

Number of respondents: 119

8.4%

36.1%42.8%

Evaluating Training Programs

Kirkpatrick, D. L. Evaluating Training Programs.2nd Ed. San Francisco : Berret Koehler Publishers.1998.

Perspectives for Palacky University

New EU-supported project„INTRODUCTION OF EBM PRINCIPLES INTO UNDERGRADUATE MEDICAL

CURRICULA“

Just approved Period: July 2006 - June 2008

Lead Participant: Palacky University, Faculty of Medicine, Olomouc

Participant: Ostrava University,Faculty of Health Allied Professions,

Team: 8 clinician-teachers, 2 epidemiologists, 1 IT specialist, , 1 administrator, 2 medical librarians

Main Objectives: Re-engineering of curricula Training-of-trainers (critical appraisal skills) Enhanced access to EBM information resources

Conclusions

It is crucial to have a multidisciplinary team of professionals, enthusiastic teachers, information resources, funding, and institutional support for EBM curricula.

Students must learn a framework + see the practical aspects of EBM in a clinical setting.

EBM should be promoted as tool for better

patient care.

Acknowledgements

American International Health Alliance (Washington D.C.) for training in EBM

Prof. V. Mihal and prof. V. Janout of Palacky University for many years of collaboration and friendship.

THANK YOU VERY MUCH FOR YOUR INVITATION

AND ATTENTION !