1. Preceptor and Medical Student Perceptions: Using an Online Evidence-Based Database at the Point of Care Harald Lausen, DO, MA Tracey Smith, PHCNS, MS Amber Barnhart, MD Society of Teachers of Family Medicine 36th Predoctoral Education Conference Jacksonville, Florida January 30, 2009

2. Background InfoPoem Worksheet PDDI Fellowship Pilot Study – Results –Presented 2008 Predoctoral Conference

3. InfoPoem Worksheet (Pilot) InfoPoem/InfoRetriever –Currently Available –Easy to Navigate –Rapid –Available to Preceptors –Activity Modeling

4. InfoPoem Worksheet (Pilot) One-Time Assignment Demographics Question, Search Terms Level of Evidence Brief Clinical Scenario InfoPoem Used Decision/Intervention

5. Worksheet Questions (Pilot) Student –Learn New Clinical Information? –Use the Resource Again? –Application Affect Patient Care? –# InfoPoems Reviewed? –Time Required?

6. Worksheet Questions (Pilot) Preceptor –Appropriate for Clinical Question? –Findings Affect Patient Care? –Exercise Useful? –Aware Resource is Available? –Use Resource in Future? –Application of Resource Feasible?

7. Research (Pilot) Interesting Responses PDDI Fellowship Surprising Review Collected 67 Worksheets –64 Complete Question Sets –3 Incomplete Question Sets –67 Complete for Time and #

8. Worksheet Questions (Pilot) Student –Learn New Clinical Information? 98.4% –Use the Resource Again? 93.8% –Application Affect Patient Care? 65.6% –# InfoPoems Reviewed? 3.1 –Time Required? 10.8 minutes

9. Worksheet Questions (Pilot) Preceptor –Appropriate for Clinical Question? 95.3% –Findings Affect Patient Care? 71.8% –Exercise Useful? 92.2% –Aware Resource is Available? 81.3% –Use Resource in Future? 84.4% –Application of Resource Feasible? 92.2%

10. Current Research Pre-Clerkship EBM Student Survey Pre-InfoPoem Preceptor Survey Revised InfoPoem Worksheet Post-InfoPoem Preceptor Survey Post-Clerkship EBM Student Survey

11. Current Research Worksheets –Required Assignment –Not Blinded –IRB Waived

12. Current Research Surveys –Blinded –Self-Assigned Unique Identifier –IRB Waived –Pre and Post Surveys – questions identical –Student – during orientation and testing –Preceptor – given and collected by student –Voluntary!

13. Worksheet Questions (Current) Student (N=60; 6 sheets incomplete) –Learn New Clinical Information? 98.3% –Application Affect Patient Care? 58.3% –# InfoPoems Reviewed? 2.9 –Time Required? 12.7 minutes

14. Worksheet Questions (Current) Preceptor (N=60; 6 sheets incomplete) –Appropriate for Clinical Question? 98.3% –Findings Affect Patient Care? 70.0%

15. Worksheet (Pilot vs. Current) Question Pilot; N=64 Class 2008 Student Current; N=60 Class 2009 Student Did you learn new clinical information?98.4% YES98.3% YES Did applying the InfoPoem affect patient care?65.6% YES58.3% YES Time required to find information and formulate decision. 10.8 minutes12.7 minutes Total number of InfoPoems reviewed.3.1 InfoPoems2.9 InfoPoems

16. Worksheet (Pilot vs. Current) Question Pilot; N=64 Class 2008 Preceptor Current; N=60 Class 2009 Preceptor Was an appropriate InfoPoem found for the clinical question? 95.3% YES98.3% YES Did the student’s findings affect patient care?71.8% YES70.0% YES

17. Surveys 43 Student surveys (pre / post) were matched 25 Preceptor surveys (pre / post) were matched Issues –23 Student surveys were unmatched, incomplete, or missing –41 Preceptor surveys were unmatched, incomplete, or missing –Self assigned anonymous unique identifier –Students responsible for collecting preceptor surveys –Voluntary participation

18. Student Surveys Open-Ended Questions What internet resource(s) or resource(s) do you use most often for retrieving EBM information? CategoryPre %Post %P-value Resource InfoPoem 8.1137.84.0045 Internet Resource InfoPoem 13.1644.74.0047

19. Student Surveys Multiple Choice Questions What are your barriers to using an internet EBM resource at the point of care? CategoryPre %Post %P-value Lack of Opportunity29.6914.06.0253 Time48.4468.75.0280

20. Student Surveys Multiple Choice Questions How do you answer clinical questions? CategoryPre %Post %P-value Textbooks71.8853.13.0143 Journals35.9451.56.0330 Peers31.2548.44.0116

21. Student Surveys Perception Strength – 5 Point Likert Scale QuestionPrePostP-value How effective do you find internet EBM resources?3.533.91.0247 How confident are you with using EBM terminology?2.883.48.0008 How confident are you with applying EBM information?3.073.86.0001 How confident are you in using internet EBM resources?3.443.98.0003

22. Preceptor Surveys Multiple Choice Questions How do you answer clinical questions? CategoryPre %Post %P-value Internet resources84.6265.38.0253 Consult65.3842.31.0143

23. Study Limitations Self-Reported Perceptions Sample Size / Loss to Follow-up No Control Group Comparison Varying Internet Accessibility / Speed Long Term Impact? Only 1 Medical School Studied Only 1 Online EBM Database Used

24. Thank You!