September 18, 2005 Midwest Chapter/MLA Conference Road to Instruction with Pediatric Residents: EBM Journal Club Gurpreet K. Rana, MLIS Clinical Librarian Taubman Medical Library, University of Michigan

September 18, 2005 Background - UM Pediatrics 10 years ago: Journal Club10 years ago: Journal Club 7 years ago: EBM component added to residency education7 years ago: EBM component added to residency education 5 years ago: EBM Info sources/ Searching skills seminars5 years ago: EBM Info sources/ Searching skills seminars Past 2 years: decrease to 80 hour residents’ work week……Past 2 years: decrease to 80 hour residents’ work week……

September 18, 2005 UM Pediatrics Perspective: Why Request Librarian Collaboration? Division of Pediatric Education realized that residents significantly lacked relevant search skills in….Division of Pediatric Education realized that residents significantly lacked relevant search skills in….

EBM Journal Club: Resident’s Role 2 nd year Pediatric residents at UM are required to:2 nd year Pediatric residents at UM are required to: Perform a literature search on a topic of clinical interest Critically appraise a peer-reviewed clinical articleCritically appraise a peer-reviewed clinical article Present their critical appraisal Submit their written critical appraisal for review by a clinical faculty advisorSubmit their written critical appraisal for review by a clinical faculty advisor

September 18, 2005 EBM Journal Club: Faculty Advisor’s Role Clinical advisorClinical advisor Encourages librarian consultation Teach critical appraisal skillsTeach critical appraisal skills Reviews the finished critical appraisal

September 18, 2005 EBM Journal Club: Librarian’s Role? 2 tier involvement: Individual consultation During EBM Journal Club

Residents’ Search Trends No specific preference for PubMed or OvidNo specific preference for PubMed or Ovid Did not understand significance of MeSH searchingDid not understand significance of MeSH searching Did not consider broadening search beyond MEDLINE when could not find a topical articleDid not consider broadening search beyond MEDLINE when could not find a topical article e.g. CINAHL, EMBASE, Web of Science

September 18, 2005 Residents’ Search Trends Narrowed retrieval in “creative” waysNarrowed retrieval in “creative” ways Didn’t use age limits regularlyDidn’t use age limits regularly Often measured search success by the least number of citations.....Often measured search success by the least number of citations..... “When I searched using this keyword, I got 203 hits. When I searched with the other keyword, I got 15 hits!” she exclaimed triumphantly.

September 18, 2005 Residents’ Perspectives Unsure  GratefulUnsure  Grateful Some presenters started a trend among presentations that initiated discussion and furthered the groups’ education:Some presenters started a trend among presentations that initiated discussion and furthered the groups’ education: “My original search”“My original search” “My search after talking with our librarian”“My search after talking with our librarian” Asked relevant questions to improve search skills during journal clubAsked relevant questions to improve search skills during journal club

Clinical Faculty’s Perspectives Enthusiastic and appreciativeEnthusiastic and appreciative Prior to intervention, faculty advisors were directing individual residents in their searchesPrior to intervention, faculty advisors were directing individual residents in their searches Led to librarian collaborations with the Pediatrics beyond EBM Journal ClubLed to librarian collaborations with the Pediatrics beyond EBM Journal Club Led to continuing education for clinical facultyLed to continuing education for clinical faculty

September 18, 2005 Challenges Time intensive!Time intensive! Residents’ scheduling issuesResidents’ scheduling issues The challenge of consultation...The challenge of consultation... Weekly attendance at Journal ClubWeekly attendance at Journal Club Some very tricky clinical questions.....!Some very tricky clinical questions.....! “Clinical shorthand”“Clinical shorthand”

Successful project? 15 of 25 presenting residents requested librarian consultation from November 2004 to April of 25 presenting residents requested librarian consultation from November 2004 to April 2005 Furthered recognition and marketing for the Clinical Librarian ServiceFurthered recognition and marketing for the Clinical Librarian Service Recognition of a librarian’s role in the departmental clinical educationRecognition of a librarian’s role in the departmental clinical education Broadened my clinical knowledge in pediatricsBroadened my clinical knowledge in pediatrics selector and department liaisonselector and department liaison

September 18, 2005 Example excerpt: EBM Journal Club presentation

September 18, 2005 PICO Question P: Children and adolescents I: Frequent fast food consumption C: Infrequent fast food consumption O: Obesity/ Weight gain and insulin resistance In children and ad0lescents, does frequent fast food consumption affect weight gain and insulin resistance? ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 Search Strategy EMBASE: Biomedical database that focuses on international literature CINAHL: The Cumulative Index of Nursing and Allied Health Literature Web of Science: “the back door” to finding relevant literature ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 Search Strategy ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 Self-Assessment Choose a topic you are really interested in [the librarian] is a wonderful resource A shorter article does not necessarily mean an easier article to interpret ( Source : Strong, L.H., Fast food and childhood obesity. University of Michigan. April 27, 2005.)

September 18, 2005 Special Thanks to..... John G. Frohna, MD Clinical Associate Professor, Dept. of Pediatrics & Communicable Diseases, University of Michigan Lily H. Strong, MD House Officer III, Dept. of Pediatrics & Communicable Diseases, University of Michigan