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

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Midwest Chapter/MLA ConfereMidwest Chapter/MLA Conferencence

Road to Instruction with Pediatric Residents:

EBM Journal Club

Gurpreet K. Rana, MLISGurpreet K. Rana, MLISClinical LibrarianClinical LibrarianTaubman Medical Library, University of MichiganTaubman Medical Library, University of Michigan

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Background - UM Pediatrics

• 10 years ago: Journal Club10 years ago: Journal Club• 7 years ago: EBM component 7 years ago: EBM component

added to residency education added to residency education • 5 years ago: EBM Info sources/ 5 years ago: EBM Info sources/

Searching skills seminarsSearching skills seminars• Past 2 years: decrease to 80 hour Past 2 years: decrease to 80 hour

residents’ work week……residents’ work week……

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UM Pediatrics Perspective: Why Request Librarian

Collaboration?

• Division of Pediatric Education Division of Pediatric Education realized that residents realized that residents significantly lacked relevant significantly lacked relevant search skills in….search skills in….

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EBM Journal Club:Resident’s Role

• 22ndnd year Pediatric residents at UM year Pediatric residents at UM are required to:are required to:• Perform a literature search on a

topic of clinical interest• Critically appraise a peer-reviewed Critically appraise a peer-reviewed

clinical articleclinical article• Present their critical appraisal • Submit their written critical appraisal Submit their written critical appraisal

for review by a clinical faculty advisorfor review by a clinical faculty advisor

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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

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EBM Journal Club:Librarian’s Role?

2 tier involvement:

• Individual consultation

• During EBM Journal Club

Residents’ Search Trends

• No specific preference for PubMed or No specific preference for PubMed or Ovid Ovid

• Did not understand significance of MeSH Did not understand significance of MeSH searchingsearching

• Did not consider broadening search Did not consider broadening search beyond MEDLINE when could not find a beyond MEDLINE when could not find a topical articletopical article

• e.g. CINAHL, EMBASE, Web of Science

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Residents’ Search Residents’ Search Trends 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 Often measured search success by the

least number of citations.....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.

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Residents’ Perspectives• Unsure Unsure Grateful Grateful

• Some presenters started a trend among Some presenters started a trend among presentations that initiated discussion presentations that initiated discussion and furthered the groups’ education:and furthered the groups’ education:• ““My original search”My original search”• ““My search after talking with our My search after talking with our

librarian”librarian”

• Asked relevant questions to improve Asked relevant questions to improve search skills during journal clubsearch skills during journal club

Clinical Faculty’s Perspectives

• Enthusiastic and appreciativeEnthusiastic and appreciative • Prior to intervention, faculty advisors were Prior to intervention, faculty advisors were

directing individual residents in their searchesdirecting individual residents in their searches

• Led to librarian collaborations with the Led to librarian collaborations with the Pediatrics beyond EBM Journal Club Pediatrics beyond EBM Journal Club

• Led to continuing education for clinical facultyLed to continuing education for clinical faculty

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Challenges

• Time intensive! Time intensive! • Residents’ scheduling issuesResidents’ scheduling issues• The challenge of email consultation...The challenge of email consultation...• Weekly attendance at Journal ClubWeekly attendance at Journal Club• Some very tricky clinical Some very tricky clinical

questions.....!questions.....!• ““Clinical shorthand”Clinical shorthand”

Successful project?• 15 of 25 presenting residents requested librarian 15 of 25 presenting residents requested librarian

consultation from November 2004 to April 2005consultation from November 2004 to April 2005

• Furthered recognition and marketing for the Furthered recognition and marketing for the Clinical Librarian ServiceClinical Librarian Service

• Recognition of a librarian’s role in the Recognition of a librarian’s role in the departmental clinical educationdepartmental clinical education

• Broadened my clinical knowledge in pediatrics Broadened my clinical knowledge in pediatrics • selector and department liaisonselector and department liaison

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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.)

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Special Thanks to.....

John G. Frohna, MDJohn G. Frohna, MD

Clinical Associate Professor, Clinical Associate Professor,

Dept. of Pediatrics & Communicable Diseases, Dept. of Pediatrics & Communicable Diseases,

University of MichiganUniversity of Michigan

Lily H. Strong, MDLily H. Strong, MD

House Officer III, House Officer III,

Dept. of Pediatrics & Communicable Diseases, Dept. of Pediatrics & Communicable Diseases,

University of Michigan University of Michigan