1. Library-Curriculum Integration: It’s not just about searching anymore Laura Cousineau, MLS Director, Biomedical Libraries Assistant Professor, Anatomy & Medicine Geisel School of Medicine Pamela Bagley, PhD, MLS Interim Head of Education, Research and Clinical Services Biomedical Libraries Medical Education Committee 17 November 15

2. Philosophy Integrate teaching into the curriculum Minimize stand-alone lectures Reach students at point of need Assure relevance to what students are learning at the time Be flexible and adapt as curriculum changes

3. Scaffold Learning Laying foundation skills, adding to them and deepening them through the four years. Move students progressively towards deeper understanding and greater independence AWARENESS ACCESS APPRAISE APPLY

4. Match our learning objectives to medical school competencies

5. Competencies: Medical Sciences 4. Practice self-directed inquiry through framing a discrete question, identifying and synthesizing the relevant literature, and applying the knowledge gained to clinical care, teaching, research, or population health. 6. Integrate medical science knowledge and critical thinking into sound clinical reasoning.

6. Competencies: Clinical Care 4. Evaluate the appropriateness of diagnostic tests and studies for a particular condition(s). 7. Formulate a prioritized problem list, and develop and implement a management plan guided by the patient’s social context, evidence-based medicine, and critical thinking. 11. Use information technology effectively and wisely.

7. 1st Year: Awareness Orientation to the library – Understand the complex world of biomedical information and what resources are available Working on integration into year 1 PBL Workshop for students doing summer research after year 1 – Literature searching to support research – PDF and citation management

8. 2nd Year: Access Match information needs with appropriate resources In the context of questions raised in PBL – Understand the spectrum of questions from background to foreground – Use point of care resources and online textbooks – Critique sources for authority, reliability, currency – Cite sources (in the context of professionalism)

9. 3rd & 4th Years: AccessAppraiseApply

10. Family Medicine Clerkship Day-in-the-life activity Quick look-up using point of care resources Begin talking about “best evidence”

11. Should we image for acute back pain?

12. Pediatrics Clerkship Form a clear clinical questionPICO the question Discuss best evidence (study design) to answer a given question Identify appropriate literature In the context of patient care, students are able to:

13. Identify Appropriate Information Students are able to Choose among various information sources Search effectively and efficiently in each; e.g., Clinical Queries in PubMed Choose / select best evidence Identify resources for critical appraisal of the chosen study

14. Student Feedback Make changes Share goals, assess their level of experience on the first session. Flexibility with “meeting” times Shared feedback from clerkship director: “they all felt they learned an amazing amount” “they really, really love the sessions with you” Do more, earlier Present during orientation to “even the playing field.”

15. GAM Clerkship In the context of a clinical scenario: Review posing a clear clinical question, PICO and searching for best evidence (this year only) Appraise a RCT using a worksheetworksheet – Screen for PICO match – Methodology criteria – Calculate ARR, RRR, NNT

16. GAM Clerkship Follow up in Journal Club Present a paper addressing a question encountered in rotation Address strengths and weaknesses of the study methodology Discuss implications for practice – Applying the Evidence worksheetworksheet

17. EBM Elective 40 hour reading elective for 3rd and 4th year students

18. EBM Elective Objectives Acquire skills that can be applied throughout their career as a physician Develop well-designed and answerable clinical questions Identify appropriate information resources for answering clinical questions Create search strategies to effectively search information resources Develop skills in appraising and applying the medical literature

19. EBM Elective Readings and exercises to learn the content Practice using scenarios Teach back One-on-one time with librarian (2-3 hours per day) Cheat sheet Two critically appraised topics (CATs) on their own questions

20. EBM Elective " I feel that this elective was truly the refresher, and in many cases, the first time I finally understood some very key concepts in finding, reading and evaluating medical literature.”

21. EBM Elective " I feel much more confident in my ability to gather evidence to aid in my practice of medicine after this elective. I have already started to use those skills to help my HSP group. I knew I could take on research tasks efficiently and look at the information critically."

22. EBM Elective "I just found out today that during this rotation we are required to give an EBM talk!.... The site director started asking me if I knew about PICO and good evidence based medicine sources and with a huge smile on my face I said "Yes!" I briefly told her some of the things I had just learned during the elective with you and she seemed quite impressed. So an even bigger thank you! I feel so well prepared for this assignment! "

23. Year 4 Recap Awareness, Access, Appraise, Apply Advanced Medical Sciences Course: Preparing for Residency Questions to ask at your new library Tools and strategies to keep up in your specialty – ToC alerts – MyNCBI search alerts – Evidence Updates

24. Looking forward Co-facilitating an HSP course next term Patients & Populations “New Course” – Pamela Bagley on the curriculum committee and has helped design 1st year sessions – Librarian will be a mentor in the Leadership course – Plan to have librarians teaching in 2nd year More to offer; e.g.: Patient Communication – Identify well developed consumer heath literature. – Write and speak at an appropriate educational level Resume rounding in an appropriate clerkship