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Engaging Med Students with Interactive EBP Instruction
- 1. Planes, trains and automobiles?* Nicole Capdarest-Arest, MLIS, AHIP Amy Studer, RN, MSN, MSLIS, AHIP Blaisdell Medical Library University of California, Davis MLA Annual Meeting '19 -- May 6, 2019
- 2. * Engaging medical students with interactive, skills-based, multimodal evidence-based practice instruction
- 3. Conflict of interest Nicole Capdarest-Arest & Amy Studer do not have any conflicts of interest to report. Author Support/Acknowledgements Nicole Capdarest-Arest: LAUC-D Research & Professional Activities Grant, University of California Research Grants for Librarians Program Amy Studer: LAUC-D Research & Professional Activities Grant, University of California Research Grants for Librarians Program
- 4. Learning objectives 1. Participants will be able to describe examples of ways to integrate various educational technologies into instruction. 2. Participants will be able to give examples of techniques to make instructional sessions more interactive and trigger learner engagement. 3. Participants will be able to outline the steps for designing structured learning assignments in a developmentally appropriate way. 4. Participants will be able to identify tools to provide immediate feedback to students in a classroom setting.
- 5. This presentation tells a story… Image source: https://pixabay.com/photos/ocean-starry-sky-milky-way-rest-3605547/
- 6. Where we started • Positive medical school faculty relationships (key) • Two course-integrated library instruction sessions in the first year Doctoring course, designed to support project-based learning activities, including: – Intro to the library – Resources for finding answers to background questions Image source: https://pixabay.com/vectors/bmw-car-roadster-sports-car-158704/
- 7. Where we started • Faculty increasingly valued active and engaged learning modalities, and were incorporating them into instruction • Librarians were providing “hands-on” learning sessions, yet still: – Mostly didactic, with – Students following-along on laptops during instructor demo, and – Minimal time for students to engage in activities Image source: https://somapp.ucdmc.ucdavis.edu/meded/scheduling/calendar.cfm
- 8. Curriculum Change Image source: https://pixabay.com/photos/rails-soft-gleise-railway-3309912/
- 9. A new opportunity • Collaborated with the faculty member charged with launch of new system science longitudinal curricular thread • Found a home -- Population Health & Evidence Based Medicine • Created a session focusing on specialized information resources relevant to “Ask” and “Acquire” components of the Evidence- Based Practice (EBP) framework • Based session activities on topics that were covered in the first month of medical school • High stakes -- aimed to deliver a robust integration Image source: https://pixabay.com/photos/sand-beach-footprint-moon-summer-1713787/
- 10. Charting the course • Identify final destination (goals) – Local graduation competencies & milestones – Core Entrustable Professional Activities for Residency (AAMC, 2014) – EBM core competencies consensus statement (Albarqouni et al, 2018) • Map touchpoints across curriculum – Session learning objectives – Skill-based: What do we want them to do? vs. What do we want them to know? – Developmental, building over time • Carefully unpack each component Image credit: Compass by Walt Stoneburner. CC-BY-2.0. https://flic.kr/p/apgpCT
- 11. Charting the course • Plan teaching modalities and tools – Ask: Is this the best mode for what you want them to be able to do? – Active learning works well for skill building; and, often works best with structure • Consider staffing, time, space, number of students (feasible) • Assess student learning / provide feedback • Evaluate instruction • Rapid iteration, as needed Image credit: Compass by Walt Stoneburner. CC-BY-2.0. https://flic.kr/p/apgpCT
- 12. Arrival at destination Image credit: “Old and New at East Croydon” by Julian Walker. CC BY-NC-ND 2.0 https://flic.kr/p/bzpfLN
- 13. EBP knowledge & skills The session focused on skill development related to “Ask” and “Acquire” components of EBP: • EBP definition (triad) • EBP cycle framework (4 A’s + 1 E) • Background vs. foreground questions • Focused questions: PICO framework • Evidence pyramid • Selected information resources: UpToDate, Dynamed Plus, AccessMedicine & Harrison’s, PubMed, Google / Google Scholar • Building advanced search strategies, incorporating synonyms/related terms • PubMed article type filters – review articles, primary studies, and syntheses
- 14. Quote: https://health.ucdavis.edu/nursing/about_us/hall/commons.html Image credit: “Orange and Blue Brain Anatomy Hoop Art. Hand Embroidered” by Hey Paul Studios. CC BY 2.0. https://flic.kr/p/fea2KK Confucius said, “I hear and I forget. I see and I remember. I do and I understand.”
- 15. Active learning modalities • Flipped classroom • Individual and small group activities • Large group engagement strategies • Skills-based learning • Highly structured activities, with built-in guidance • Required pre-class and in-class online assignment submission
- 16. Active learning vs. didactic
- 17. Tech tools • Active learning environment (propeller tables) • Audience response system (e.g., Poll Everywhere) • Online survey tool used to structure activities developmentally, submit answers, and organize data for skill assessment (e.g., Qualtrics) • Canvas (e.g., pre-class activity, post-class aggregate feedback, handout posted)
- 18. Assessment & evaluation strategies • Quiz based on pre-class activities (points assigned) • Online answer submission during activities provided us with the ability to provide real-time formative assessment and aggregated feedback (enables instruction iteration, focuses debrief, and makes assessment feasible) • Student feedback about the session – feedback form developed and deployed by librarians • Standard student evaluation of session delivered by Office of Medical Education
- 19. Now for the details… What did the session actually look like? Image source: https://health.ucdavis.edu/nursing/about_us/hall/commons.html
- 20. • Delivered and scored in Qualtrics • Flipped classroom for basic introductory content Pre-test
- 21. Classroom environment • Propeller tables • Engineered student groups (not self-forming) • 55 of students in two sessions: 6-7 students /group Image source: UC Davis Health. https://health.ucdavis.edu/nursing/about_us/hall/commons.html
- 22. Session Schedule* Time Activity 2:00 – 2:20 PM 1st didactic (overview, context, credibility, relevance, EBP, formulating questions, resource demo) 2:20 – 2:25 PM Introduce 1st activity 2:25 – 2:45 PM Activity (individual) 2:45 – 2:55 PM Wrap-up/debrief 1st activity 2:55 – 3:00 PM Break 3:00 – 3:20 PM 2nd didactic (structuring questions, sifting results, relevancy) 3:20 – 3:40 PM Activity (team) 3:40 – 3:50 PM Debrief and closure *The most important parts of this workshop are the two in-class activities
- 23. Audience response using Poll Everywhere
- 24. Interactive – Audience response via PollEverywhere Audience response using Poll Everywhere
- 25. Didactic #1 • Overview & information seeking in medicine context • Aspects of quality in a medical information source • EBP introduction background questions, and resource demo
- 26. Activity #1: Individual • Mini cases with questions related to course content drove structured exploration of resources for background questions • Included basic keyword searches, synonyms, and Boolean logic • Resources included: PubMed, Dynamed Plus, UTD, online textbooks, advanced Google • Answers submitted at end of activity (in class), followed by debrief in real time.
- 27. Debrief #1 • Asked students to share their observations and experiences • We shared what we noticed with students either as we interacted with them during the session or based on the online submissions. Highlights: – Frequently, students did not incorporate synonyms into search strategies, despite examples and written instructions – Finding publication dates for e-books was a challenge
- 28. Didactic #2 • Foreground questions & PICO • PubMed demo à sifting results using study filters • Evidence pyramid & hierarchy of evidence • Important synthesis sources: guidelines and systematic reviews +/- meta-analysis
- 29. Activity #2: Small group • Start with background question on a defined topic in UTD / DynaMed Plus • Turn it into a foreground question using PICO • PubMed searching with publication type filters • Sifting results based on relevancy, publication or study type • Identify study design (primary study) and cite three relevant articles • Provide a very brief synthesis of the three articles • Submit answers via online form (Qualtrics)
- 30. Debrief #2 • Students successful with PICO structure and basic PubMed searching • Students could use more practice with incorporating synonyms into their search strategies and distinguishing between narrative and systematic reviews • We awarded prizes for two groups that performed exceptionally well based on our in-class observations and the online form submissions • Students seemed on-task and engaged in the activity
- 31. Student Feedback • Students from a mix of backgrounds, with varying levels of sophistication/experience with this type of searching • Students like the activities! Positive comments about individual and team activities • Some wanted individual activity at home; others, didn’t want the very minimal flipped activity that was included • Some students thought sessions were too long; others too short; others just right • Students appreciated that we floated around to groups to answer questions
- 32. Conclusions Image source: “West Seattle Atmosphere” by Dennis Hamilton. CC BY 2.0. https://flic.kr/p/6SxRia Conclusion
- 33. Conclusion Student feedback • Overwhelmingly positive formal and informal feedback • “More time for the individual assignment” was the only suggested improvement, which may be remedied by offering students more context in advance of this component Student competency ü Understanding EBP process ü Developing their own PICO questions. q Distinguishing publication types q Identifying and incorporating synonyms into searches Overall • This session was a useful and engaging starting point to introduce learners to EBP skills and evidence resources • Opportunities to build on these skills can be reinforced and developed throughout the curriculum Will be reinforced in future instruction
- 34. Image credit: “Biplanes” by Andrew Fitzhugh. CC BY-NC-ND 2.0. https://flic.kr/p/LBjTn Future travels
- 35. Future travels • Pleasant surprise: Others began approaching us for collaboration in developing a framework for self-directed learning in the curriculum • We re-purposed elements of this session to two other first year TBL sessions (genetics and contraception) • Now that students have developed a base of EBP concepts and skills early in medical school curriculum, we are working on how to further develop EBP skills later in the curriculum (e.g., transition to clerkship)
- 36. We invite you to contact us to discuss further…
- 37. References Albarqouni, L., Hoffmann, T., Straus, S., Olsen, N. R., Young, T., Ilic, D., . . . Glasziou, P. (2018). Core competencies in evidence-based practice for health professionals: Consensus statement based on a systematic review and delphi study. JAMA Network Open, 1(2), e180281. doi: 10.1001/jamanetworkopen.2018.0281 Association of American Medical Colleges (AAMC). (2014). Core entrustable professional activities for entering residency: Faculty and learners' guide. Retrieved from https://members.aamc.org/eweb/upload/Core%20EPA%20Faculty% 20and%20Learner%20Guide.pdf Committee on Educational Policy (CEP), & UC Davis School of Medicine. (April 2013). Graduation competencies. Retrieved from http://www.ucdmc.ucdavis.edu/mdprogram/curriculum/graduation- competencies.html#page=page-3