Effectiveness of a question formulation rubric with second-year medical students: a randomized controlled trial.

Objective: The FAC (Focus, Amplify, Compose) rubric for assessing medical students' question formulation skills normally accompanies our Evidence Based Practice (EBP) training. The combined training and assessment rubric have improved student scores significantly. How much does the rubric itself contribute to improved student scores? This study sought to measure student improvement using the rubric either with or without a linked 25-minute training session. Methods: Randomized Controlled Trial. The authors tested the hypothesis that a 25-minute training session combined with use of a rubric would lead to higher scores than a brief explanation of this rubric alone. All 72 participating second-year medical students had a question formulation rubric briefly explained to them following a pre-test. Students in the intervention groups were taught how to formulate EBP questions for 25 minutes using the rubric followed with another 30 minutes of EBP search training. Students in the control group only received the 30 minutes of EBP search training in their small group labs. All 72 students took the post-test in which they formulated a question in response to a clinical vignette. Statistical analysis to test the hypothesis consisted of a two-sample paired t-test to measure between-group differences. Discussion: Both the intervention and control groups performed significantly better on the post-test for question formulation skills than on the pre-test. When analyzed by extent of individual improvement between pre- and post-tests using a two-sample paired t-test for between group differences, the control group students receiving only a brief explanation of the rubric performed the same statistically (intervention 37.7 versus 37.4 control) as the intervention group students who received the same brief explanation followed by a 25-minute active learning training session. Thus, the results provided no support of the hypothesis that the extra 25-minute training improved post-test scores. The rubric itself contributed similarly to the intervention groups students' improvement as the combined rubric and training for control group students. This finding could potentially save scarce curricular time. Key Messages: The FAC question formulation rubric and training significantly improves medical students' EBP question quality. The FAC rubric coupled with only a 5-minute explanation can be effective. In a crowded medical school curriculum, the rubric and brief explanation might save valued time for other purposes.

Developing a Faculty Roles Crosswalk for Health Sciences Librarians.

Many Health Sciences Librarians (HSLs) affiliated with academic health centers in the US have faculty status. Faculty status enables HSLs to collaborate with their health sciences faculty colleagues as peers. Translating HSL faculty responsibilities into terms their faculty counterparts can understand represents an ongoing challenge for HSLs. This translation process becomes crucial when HSLs with faculty status seek a promotion or wish to secure tenure. The authors used job analysis to clarify faculty roles for HSLs to create a "Crosswalk" that enables the reader to identify an HSL role and find an equivalent health sciences faculty role.

Medical Residency Milestones: Competencies in Informatics, Library, and Evidence-Based Practice.

The Accreditation Council for Graduate Medical Education (ACGME) sets standards known as Milestones and monitors the progress of medical residents as they advance toward medical practice in their specialties. Health sciences librarians need to train medical residents in certain competency areas to help reach the Milestone standards. This project analyzed the Milestones related to informatics, library, and evidence-based practice (EBP) skills to identify core and optional library-related curricular elements that can be integrated into different medical specialty residencies. The authors collected key competency documents from ACGME and from those specialties representing 2% or more of the residencies in the United States. Then, they compared and contrasted those Milestones related to informatics, library, and EBP competency skills. Most relevant Milestones were categorized under the fifth broad ACGME competency area of "Practice Based Learning and Improvement." The Milestones followed developmental patterns, reflecting residents' increased sophistication in meeting these competencies as they advanced in their specialties. The curriculum was designed to meet the residents' learning needs at each progressive Milestone.

Trends in Controlled Vocabulary and Health Equity.

Medical librarians collaborate with physicians and other healthcare professionals to improve the quality and accessibility of medical information, which includes assembling the best evidence to advance health equality through teaching and research. This column brings together brief cases highlighting the experiences and perspectives of medical librarians, educators, and healthcare professionals using their organizational, pedagogical, and information-analysis skills to advance health equality indexing.

Hepatitis C virus care cascade in persons experiencing homelessness in the United States in the era of direct-acting antiviral agents: A scoping review.

The hepatitis C virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations since curative medications have been available. However, information is limited on care cascade outcomes in persons experiencing homelessness. The main objective of this study was to map the available evidence on HCV care cascade outcomes in people experiencing homelessness in the U.S. in the era of direct-acting antiviral agents (DAAs). Primary and secondary outcomes included linkage to care (evaluation by a provider that can treat HCV) and sustained virologic response (SVR) or cure. Exploratory outcomes included other cascade data, like treatment initiation, which precedes SVR. PubMed was the primary database accessed for this scoping review. We characterized the HCV care cascade in people experiencing homelessness using sources of evidence published in 2014 onwards that reported the proportions of persons who were linked to care, achieved SVR, and completed other cascade steps. We synthesized our results into a scoping review. The proportion of persons linked to care among chronically infected cohorts with unstable housing ranged from 29.3% to 88.7%. Among those chronically infected, 5%-58.8% were started on DAAs and 5%-50% achieved SVR. In conclusion, these results show that persons experiencing homelessness achieve high rates of linkage to care in non-specialist community-based settings compared to the general U.S. population pre-DAAs. However, DAA initiation was found to be a rate-limiting step along the care cascade, resulting in commensurate low rates of cure.

Learning while doing: program evaluation of the Medical Library Association Systematic Review Project.

OBJECTIVES: The Medical Library Association (MLA) Systematic Review Project aims to conduct systematic reviews to identify the state of knowledge and research gaps for fifteen top-ranked questions in the profession. In 2013, fifteen volunteer-driven teams were recruited to conduct the systematic reviews. The authors investigated the experiences of participants in this large-scale, volunteer-driven approach to answering priority research questions and fostering professional growth among health sciences librarians. METHODS: A program evaluation was conducted by inviting MLA Systematic Review Project team members to complete an eleven-item online survey. Multiple-choice and short-answer questions elicited experiences about outputs, successes and challenges, lessons learned, and future directions. Participants were recruited by email, and responses were collected over a two-week period beginning at the end of January 2016. RESULTS: Eighty (8 team leaders, 72 team members) of 198 potential respondents completed the survey. Eighty-four percent of respondents indicated that the MLA Systematic Review Project should be repeated in the future and were interested in participating in another systematic review. Team outputs included journal articles, conference presentations or posters, and sharing via social media. Thematic analysis of the short-answer questions yielded five broad themes: learning and experience, interpersonal (networking), teamwork, outcomes, and barriers. DISCUSSION: A large-scale, volunteer-driven approach to performing systematic reviews shows promise as a model for answering key questions in the profession and demonstrates the value of experiential learning for acquiring synthesis review skills and knowledge. Our project evaluation provides recommendations to optimize this approach.

Roles for librarians in systematic reviews: a scoping review.

OBJECTIVE: What roles do librarians and information professionals play in conducting systematic reviews? Librarians are increasingly called upon to be involved in systematic reviews, but no study has considered all the roles librarians can perform. This inventory of existing and emerging roles aids in defining librarians' systematic reviews services. METHODS: For this scoping review, the authors conducted controlled vocabulary and text-word searches in the PubMed; Library, Information Science & Technology Abstracts; and CINAHL databases. We separately searched for articles published in the Journal of the European Association for Health Information and Libraries, Evidence Based Library and Information Practice, the Journal of the Canadian Heath Libraries Association, and Hypothesis. We also text-word searched Medical Library Association annual meeting poster and paper abstracts. RESULTS: We identified 18 different roles filled by librarians and other information professionals in conducting systematic reviews from 310 different articles, book chapters, and presented papers and posters. Some roles were well known such as searching, source selection, and teaching. Other less documented roles included planning, question formulation, and peer review. We summarize these different roles and provide an accompanying bibliography of references for in-depth descriptions of these roles. CONCLUSION: Librarians play central roles in systematic review teams, including roles that go beyond searching. This scoping review should encourage librarians who are fulfilling roles that are not captured here to document their roles in journal articles and poster and paper presentations.

Nontyphoidal Salmonella Osteomyelitis in Immunocompetent Children Without Hemoglobinopathies: A Case Series and Systematic Review of the Literature.

Salmonella osteomyelitis is well-described in children with hemoglobinopathies, particularly infection with Salmonella typhi. To characterize nontyphoidal osteomyelitis in otherwise healthy children without hemoglobinopathies, we performed a retrospective review of children discharged from our institution with this condition, supplemented with a systematic literature review. Among the 46 subjects identified, common risk factors for Salmonella infection were frequently absent and complications were common.

Rural providers' access to online resources: a randomized controlled trial.

OBJECTIVE: The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. METHODS: In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. RESULTS: Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to "about right amounts of information" at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. CONCLUSION: Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.

How accurately does the VIVO Harvester reflect actual Clinical and Translational Sciences Award-affiliated faculty member publications?

OBJECTIVE: The research tested the accuracy of the VIVO Harvester software in identifying publications authored by faculty members affiliated with a National Institutes of Health Clinical and Translational Sciences Award (CTSA) site. METHODS: Health sciences librarians created "gold standard" lists of references for the years 2001 to 2011 from PubMed for twenty-five randomly selected investigators from one CTSA site. These gold standard lists were compared to the same twenty-five investigators' reference lists produced by VIVO Harvester. The authors subjected the discrepancies between the lists to sensitivity and specificity analyses. RESULTS: The VIVO Harvester correctly identified only about 65% of the total eligible PubMed references for the years 2001-2011 for the CTSA-affiliated investigators. The identified references produced by VIVO Harvester were precise yet incomplete. The sensitivity rate was 0.65, and the specificity rate was 1.00. CONCLUSION: While the references produced by VIVO Harvester could be confirmed in PubMed, the VIVO Harvester retrieved only two-thirds of the required references from PubMed. National Institutes of Health CTSA sites will need to supplement VIVO Harvester-produced references with the expert searching skills of health sciences librarians. IMPLICATIONS: Health sciences librarians with searching skills need to alert their CTSA sites about these deficiencies and offer their skills to advance their sites' missions.

Real-time peer review: an innovative feature to an evidence-based practice conference.

Many health sciences librarians as well as other professionals attend conferences on a regular basis. This study sought to link an innovative peer review process of presented research papers to long-term conference outcomes in the peer-reviewed professional journal literature. An evidence-based conference included a proof-of-concept study to gauge the long-term outcomes from research papers presented during the program. Real-time peer review recommendations from the conference were linked to final versions of articles published in the peer-reviewed literature. The real-time peer review feedback served as the basis for further mentoring to guide prospective authors toward publishing their research results. These efforts resulted in the publication of two of the four research papers in the peer-viewed literature. A third presented paper appeared in a blog because the authors wanted to disseminate their findings more quickly than through the journal literature. The presenters of the fourth paper never published their study. Real-time peer review from this study can be adapted to other professional conferences that include presented research papers.

Student peer assessment in evidence-based medicine (EBM) searching skills training: an experiment.

BACKGROUND: Student peer assessment (SPA) has been used intermittently in medical education for more than four decades, particularly in connection with skills training. SPA generally has not been rigorously tested, so medical educators have limited evidence about SPA effectiveness. EXPERIMENTAL DESIGN: Seventy-one first-year medical students were stratified by previous test scores into problem-based learning tutorial groups, and then these assigned groups were randomized further into intervention and control groups. All students received evidence-based medicine (EBM) training. Only the intervention group members received SPA training, practice with assessment rubrics, and then application of anonymous SPA to assignments submitted by other members of the intervention group. RESULTS: Students in the intervention group had higher mean scores on the formative test with a potential maximum score of 49 points than did students in the control group, 45.7 and 43.5, respectively (P = 0.06). CONCLUSIONS: SPA training and the application of these skills by the intervention group resulted in higher scores on formative tests compared to those in the control group, a difference approaching statistical significance. The extra effort expended by librarians, other personnel, and medical students must be factored into the decision to use SPA in any specific educational context. IMPLICATIONS: SPA has not been rigorously tested, particularly in medical education. Future, similarly rigorous studies could further validate use of SPA so that librarians can optimally make use of limited contact time for information skills training in medical school curricula.

Current practices in library/informatics instruction in academic libraries serving medical schools in the Western United States: a three-phase action research study.

BACKGROUND: To conduct a systematic assessment of library and informatics training at accredited Western U.S. medical schools. To provide a structured description of core practices, detect trends through comparisons across institutions, and to identify innovative training approaches at the medical schools. METHODS: Action research study pursued through three phases. The first phase used inductive analysis on reported library and informatics skills training via publicly-facing websites at accredited medical schools and the academic health sciences libraries serving those medical schools. Phase Two consisted of a survey of the librarians who provide this training to undergraduate medical education students at the Western U.S. medical schools. The survey revealed gaps in forming a complete picture of current practices, thereby generating additional questions that were answered through the Phase Three in-depth interviews. RESULTS: Publicly-facing websites reviewed in Phase One offered uneven information about library and informatics training at Western U.S. medical schools. The Phase Two survey resulted in a 77% response rate. The survey produced a clearer picture of current practices of library and informatics training. The survey also determined the readiness of medical students to pass certain aspects of the United States Medical Licensure Exam. Most librarians interacted with medical school curricular leaders through either curricula committees or through individual contacts. Librarians averaged three (3) interventions for training within the four-year curricula with greatest emphasis upon the first and third years. Library/informatics training was integrated fully into the respective curricula in almost all cases. Most training involved active learning approaches, specifically within Problem-Based Learning or Evidence-Based Medicine contexts. The Phase Three interviews revealed that librarians are engaged with the medical schools' curricular leaders, they are respected for their knowledge and teaching skills, and that they need to continually adapt to changes in curricula. CONCLUSIONS: This study offers a long overdue, systematic view of current practices of library/informatics training at Western U.S. medical schools. Medical educators, particularly curricular leaders, will find opportunities in this study's results for more productive collaborations with the librarians responsible for library and informatics training at their medical schools.

Library and informatics skills competencies statements from major health professional associations.

Every major health profession now provides competency statements for preparing new members for their respective professions. These competency statements normally include expectations for training health professions students in library/informatics skills. For purposes of this article, searches were conducted using various sources to produce a comprehensive 32-page Compendium that inventories library/informatics-related competency statements. This compendium should aid readers in integrating their library/informatics skills training into various health professions education curricula.

Reuniting public health and medicine: the University of New Mexico School of Medicine Public Health Certificate.

The University of New Mexico School of Medicine (UNMSOM) sought to train medical students in public health concepts, knowledge, and skills as a means of improving the health of communities statewide. Faculty members from every UNMSOM department collaborated to create and integrate a public health focus into all years of the medical school curriculum. They identified key competencies and developed new courses that would synchronize students' learning public health subjects with the mainstream medical school content. New courses include: Health Equity: Principles of Public Health; Epidemiology and Biostatistics; Evidence-Based Practice; Community-Based Service Learning; and Ethics in Public Health. Students experiencing the new courses, first in pilot and then final forms, gave high quantitative ratings to all courses. Some students' qualitative comments suggest that the Public Health Certificate has had a profound transformative effect. Instituting the integrated Public Health Certificate at UNMSOM places it among the first medical schools to require all its medical students to complete medical school with public health training. The new UNMSOM Public Health Certificate courses reunite medicine and public health in a unified curriculum.