1. October 14-17, 2006 Integrating Evidence-Based Medicine with the Medical School Curriculum Russell Smith, russells@usc.edu Educational Support Librarian Norris Medical Library University of Southern California

2. Integrating EBM - Abstract  TITLE: Integrating Evidence-Based Medicine in the Medical School Curriculum  OBJECTIVE: To describe an evidence-based educational module for second-year medical students.  METHODS: Second-year medical students received one- hour instruction on basic principles of evidence-based medicine as well as searching techniques for selected evidence-based medicine resources. After instruction, worksheets were distributed to the students. Students were required to describe a patient encountered during clinical rounds, formulate a PICO-based question and then look for answers in designated resources. The worksheet also contained a checklist of resources and boxes for the students to record the number of hits in each resource. Worksheets were evaluated by librarians and individual feedback was given to the students.

3. Abstract (continued)  Results: Based on student evaluation, the majority of workshop attendees found EBM instruction to be a positive experience. Of the resources presented, students found UpToDate to be the most helpful. Interestingly MEDLINE ranked second among students in terms of usefulness.  Conclusion: Medical students can benefit from library instruction on searching evidence-based medical resources. Additionally, integrating EBM instruction with the curriculum of medical students effectively promotes the library as an active partner in learning with the School of Medicine.

4. Background & Setting  USC – Keck School of Medicine  Approximately 160 students per class  New curriculum introduced in Fall 2001 Case-based, self-directed learning  First year students MEDLINE search project Already familiar with information retrieval

5. EBM Workshop & Assignment  Introduced in Fall 2004  Second year medical students  One hour workshop (hands-on) Basic EBM principles Walk through resources  Online tutorial

6. Evidence Pyramid SUNY Downstate Medical Center© 2006. All rights reserved

7. Online Tutorial http://www.usc.edu/hsc/nml/lib-services/tutorials/ebm.html

8. Example question:  Is advice to stay active more effective than bed rest in the treatment of chronic low-back pain?

9. Resources covered  National Guideline Clearinghouse  Cochrane Database of Systematic Reviews  Database of Abstracts of Reviews of Effect (DARE)  Best Evidence – ACP Journal Club

10. Resources covered  MEDLINE Randomized controlled trials Meta-analyses  Clinical Evidence (BMJ)  UpToDate

13. Final Questions  Which of the above resources were the most useful?  Did you find any answers to your question? If so, where?  State the answer, if found. Conflicting evidence?

14. Which resource did you find most useful? *  UpToDate (23.5%)  MEDLINE – rcts (20.8%)  N.G.C. (15.3%)  C.D.S.R. (10.6%) *Most students listed more than one resource. Four students did not state a preference. Data was collected Spring 2006.

15. Inferences  Ranking of MEDLINE over knowledge bases (such as Cochrane Database of Systematic Reviews) seems to indicate: High comfort-level for searching Benefit of first year literature search project Confidence in analytical abilities Value-added resources may be too limited in scope

16. Conclusions  Students are learning how to search  Project has enhanced library’s status  Student evaluations of project Very positive  Worksheet adopted by other programs

17. Student Evaluations *  Instructor taught effectively 4.62  Information presented was clear & concise 4.67  I learned something useful 4.32 *5 =strongly agree, 4=agree, 3=neutral, 2=disagree, 1=strongly disagree