Proactive Participation of Medical Librarians in EBM : Finding &Teaching How to Find Evidence Jarmila Potomková Medical Librarian Dana Šubová E-Librarian Vladimír Mihál Professor of Pediatrics & Vice-Dean for Clinical Education Vladimír Janout Professor of Epidemiology Palacky University Faculty of Medicine Olomouc, Czech Republic Contact:

PALACKÝ UNIVERSITY IN OLOMOUC 1573 founded 1573 (Jesuit College) 1946 restored faculties Medicine, Science, Law Philosophy, Theology, Physical Culture, Education

FACULTY OF MEDICINE 1,900 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)   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.“   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 IIIC North –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 solutions to economic, social and environmental challenges.

Sub-project INNO-MED Development 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:

Integration of Information Resources Ovid 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 Tools LinkSolver

Activation

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 Search List 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 Results Deduplication, Application of Limits

Multifile Search Results Distribution across Databases

Teaching How to Find Best Evidence Changes in Palacky University Medical Curricula Medical Curriculum Course BIOMEDICAL 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 Evidence Changes in Palacky University Medical Curricula Medical Curriculum Subject INTERNET 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 Evidence Changes in Medical Curricula New Medical Curriculum Subject EVIDENCE-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 Number of respondents: % 39.4% 26.8%

Student Evaluation Survey Professional Level of Practical Training Number of respondents: % 33.6% 15.9% 11.7%

Student Evaluation Survey Overall Level of Subject Number of respondents: % 44.5% 16.8%

Student Evaluation Survey Motivation towards EBM Number of respondents: % 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 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 !