A Centralized Practice-Based Learning and Improvement Curriculum for Residents and Fellows: A Collaboration of Health Sciences Librarians and Graduate Medical Education Administration
Bradley, Doreen R., Rana, Gurpreet K., Lypson, Monica L., Hamstra, Stanley J., Journal of the Medical Library Association
Health sciences librarians have been involved in the education of medical residents and fellows for many years, traditionally providing orientation to library resources or refreshers on MEDLINE searching [1-4]. With the increased focus on evidence-based medicine (EBM) in residency education, health sciences librarians have found a natural partnership in teaching EBM search skills in the postgraduate curriculum . However, even with EBM opening the door for increased librarian instruction, the level of librarian involvement in residency education varies greatly by institutional or departmental interest, institutional culture, program directors, librarian expertise, and marketing techniques.
In 2002, the Accreditation Council on Graduate Medical Education (ACGME) mandated the use of outcomes assessment in ACGME-accredited programs. One area of particular interest to librarians was the practice-based learning and improvement (PBLI) competency, which included information-searching and -management skills. Specifically, PBLI competencies include "the ability to locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems and to use information technology to optimize learning," as well as other competencies related to lifelong learning . Teaching and evaluating PBLI is challenging for many graduate medical education (GME) programs because it includes competencies in areas many medical school faculty do not possess expertise in and may themselves be in need of skill development [14-18]. In addition, few tools have been developed to measure resident learning in this area [17, 19, 20].
CREATION OF AN INNOVATIVE PARTNERSHIP
Over the past seven years, librarians at the University of Michigan (UM) Health Sciences Libraries (HSL) have had moderate success in partnering with several GME (residency) programs on a department-bydepartment basis. In general, it took several years to establish credibility before these partnerships began to flourish. Despite this integration, most programs remained unaware of how librarians were helping meet the ACGME competencies and could share their expertise. The librarians, too, focused on coordinating instruction in individual departments, with no broadscale approach in instruction.
DEVELOPMENT OF AN INFORMATION SKILLS CURRICULUM
With the goal of increasing collaboration in resident education, two HSL librarians and the assistant and associate deans of GME reviewed the manner in which instructional librarians were participating in GME programs. Through multiple meetings, the librarians and the assistant dean of GME decided to pursue a modular approach to instruction in information skills. A curriculum and evaluation tools were discussed that would allow the GME programs to meet, teach, and eventually evaluate residents in the ACGME competencies, in particular PBLI. This curricular development would also aid in ensuring the sponsoring institution requirements were met. The curriculum was based on prior teaching requests in GME programs, the new PBLI competency requirement, librarian expertise, and faculty input.
Using a team approach that captured each librarian's expertise and created a sense of ownership, the HSL librarians developed the description, content, and learning outcomes for each module. This iterative process led to many constructive discussions of what is taught, how it is taught, and what best promotes lifelong learning among clinicians. This process also allowed the librarians to take a more objective look at instruction, perhaps much more critically than in the past. Through this process, the librarians achieved consensus on each instructional module.
Although the HSL librarians have very different teaching styles and are encouraged to build on their strengths, it was essential that the core content remains consistent and the modular approach to GME instruction facilitate this consistency. At the conclusion of this process, the assistant dean provided feedback and suggestions for translating library terms into more accessible and relevant language that would be useful to clinicians. It was imperative that the document be useful to medical school faculty and appeal to their desires to improve residents' information-seeking skills. Relevant ACGME competencies were mapped to each module to highlight content and facilitate documentation for program directors, with an initial focus on PBLI. Mapping competencies to the modules facilitated understanding of the relationship between library instruction and residents' learning outcomes. This approach clarified how clinicians and program directors can partner with librarians to enhance the residents' educational experience. Several iterations of the modules were revised and enhanced before all eight modules were finalized. Finally, the modules were combined into one document: "Practice-based Learning and Improvement: Information Skills Curriculum for House Officer Education" (Figure 1).
A comprehensive course evaluation tool was developed with input from the UM Department of Medical Education, the associate director of curriculum evaluation in the medical school, and UM's Center for Research on Learning and Teaching. The purpose of this tool is to evaluate instructor competencies and the learner's experience. It can also be used to provide feedback for future revision of the modules, including development of new modules as needed.
IMPLEMENTATION OF THE CURRICULUM
In September 2007, the modular librarian-integrated instruction curriculum was presented and disseminated to the residency and fellowship program directors at a GME program directors meeting and was well received. The GME office sent copies of the document to directors of all eighty-six accredited residency and fellowship programs in the UM Health System. Dissemination of the information skills modules through the GME office was significant as it provided endorsement of the modular curriculum and librarian-integrated instruction in all residency education. In addition, the modules were disseminated to the UM GME Competency Assessment Working Group, instruction coordinators at other campus libraries, and university library administration.
The modules have also been used to illustrate liaison librarians' areas of expertise when they have met with department chairs, faculty members, and instructors in the medical school. The curriculum has been distributed at department faculty meetings to engage interest in and build awareness of the librarians' role in trainee education. An electronic version has also been sent to key medical school faculty who are involved in educational initiatives. As an added benefit, the modules have been utilized as a teaching tool and guide during individual consultations with faculty and residents. The aforementioned interaction has allowed a more productive discussion and standardization of residency education among the various GME programs and led to more relevant librarian-integrated instruction in medical education as a whole.
In 2006/07, librarians taught 40 sessions in GME programs, and in 2007/08, the number rose to 46 sessions, representing a 15% increase in the amount of information skills instruction provided within 1 year. These additional sessions were taught in 4 departments with which librarians had no prior instructional role, plus 2 sessions focusing on higher-level information skills for departments where librarians had existing partnerships. Accordingly, the number of GME programs including information skills instruction increased from 11 to 15. The number of librarians teaching in GME programs also increased from 5 in 2006/07 to 8 in 2007/08.
OBSERVATIONS ON THE BENEFITS OF THE CURRICULUM
The customizable nature of the instructional modules in an organized format linked with specific ACGME competencies heightened the GME programs director's awareness of librarian expertise and their role in residency education. This project has also demonstrated that the HSL can work systematically with university GME offices. Moreover, this partnership provided framework for institutional buy-in and illustrated how librarians can capitalize on their expertise at an administrative level. It bridged traditional educational silos that frequently occur due to a lack of communication between residency and fellowship programs, even at the interdepartmental level.
In developing the modules, it was important to use a team-based approach among the HSL librarians as a transition was being made to a new liaison services model while this project was underway. Even beyond residency education, the modules provided inroads in building liaison librarian relationships among clinical departments in the medical school and throughout the health system.
The liaison librarians have been encouraged to involve other librarians in teaching modules based on subject expertise. For instance, individual librarians have specialized expertise in varying areas from emerging technologies, to citation management, to systematic review searching. These partnerships have led to increased instructional collaboration and development of efficiency in instructional materials and design. Having predefined modules allowed the librarians to streamline planning as liaisons to GME programs. In the past, librarians replicated outlines, materials, and content while teaching residents in specific departments. The creation and maintenance of the information skills modules goes beyond being an informational or marketing tool and is a timesaving tool for liaison librarians. Because librarians are sharing more instructional materials, they have developed a trend toward more standardization in library instruction outside the module-based curriculum as well.
From the perspective of central library administration, the information skills modules detail the HSL librarians' instructional and subject expertise as well as their level of engagement in residency education. The HSL librarians are part of the UM Library system, which administers eighteen campus libraries. Due to the diverse nature of libraries in the system, the information skills modules provide a summary for library administration of the HSL librarians' roles in competency-based medical education. Specifically, the modules demonstrate librarian expertise in subject-based knowledge resources and medical education and the breadth and the advanced level of information skills instruction provided in GME.
The process of creating these information skills modules included the invaluable activity of assessing the instruction program. It not only required librarians to identify and evaluate what has been taught in the past, but also to focus on objectives and learning outcomes in a more consistent manner. From this point forward, all future instruction will be designed around a competency-based model. Just as significant in this process, librarians became more engaged and educated about the process of residency education as a whole. Librarians who were more experienced with the ACGME competencies mentored those librarians with less experience in GME. Based on the success of the information skills modules for GME, other HSL librarians wish to develop similar module-based information skills curricula for other disciplines, such as public health and the life sciences, and are considering creating online versions of some of these newly developed modules.
The ACGME competency category, "Practice-based Learning and Improvement," is a nebulous area and is hard to define and evaluate effectively. The information skills modules illustrate how librarianinstructors can collaborate in developing instruction and assessment tools for PBLI to fulfill this ACGME requirement. Thus, medical faculty can better understand how librarians fit more broadly into GME programs and recognize that librarian-integrated GME instruction extends beyond introductions to PubMed or electronic journals. The increase in information skills instruction over a one-year span represents an increase in librarian involvement in resident education and the opportunity to teach higher-level skills. Using the evaluation tool developed for this initiative, feedback is being carefully monitored to refine existing modules and examine the need for new modules that could be developed. The information skills modules illustrate the important role librarian-instructors can play in medical education through developing partnerships with GME.
1. Dimitroff A. Educational services in health sciences libraries: a content analysis of the literature, 1987-1994. Bull Med Libr Assoc. 1995 Oct;83(4):420-4.
2. Kelly JA, Nagle E. Educational initiatives in heatlh sciences libraries. Sci Tech Libr. 1993;14:23-34.
3. Teal JB. A library-based information skills rotation for internal medicine residents. Acad Med. 1998 May;73(5):602.
4. Vogel EW, Block KR, Wallingford KT. Finding the evidence: teaching medical residents to search MEDLINE. J Med Libr Assoc. 2002 Jul;90(3):327-30.
5. Atlas MC, Smigielski EM, Wulff JL, Coleman MT. Case studies from morning report: librarians' role in helping residents find evidence-based clinical information. Med Ref Serv Q. 2003 Fall;22(3):1-14.
6. Bradley DR, Rana GK, Martin PW, Schumacher RE. Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. J Med Libr Assoc. 2002 Apr;90(2):194-201.
7. Earl MF, Neutens JA. Evidence-based medicine training for residents and students at a teaching hospital: the library's role in turning evidence into action. Bull Med Libr Assoc. 1999 Apr;87(2):211-4.
8. McCarthy LH. Evidence-based medicine: an opportunity for health sciences librarians. Med Ref Serv Q. 1996 Winter;15(4):63-71.
9. Ryce A, Dodson S. A partnership in teaching evidencebased medicine to interns at the University of Washington Medical Center. J Med Libr Assoc. 2007 Jul;95(3):283-6. DOI: 10.3163/1536-5050.95.3.283.
10. Toedter LJ, Thompson LL, Rohatgi C. Training surgeons to do evidence-based surgery: a collaborative approach. J Am CoU Surg. 2004 Aug;199(2):293-9.
11. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16.
12. Schwing LJ, Coldsmith EE. Librarians as hidden gems in a clinical team. Med Ref Serv Q. 2005 Spring;24(1):29-39.
13. Accreditation Council on Graduate Medical Education. Common program requirements: general competencies (ACGME Outcomes Project) [Internet]. The Council; 2009 [cited 2 Feb 2006.].
14. Beasley BW, Woolley DC. Evidence-based medicine knowledge, attitudes, and skills of community faculty. J Gen Int Med. 2002 Aug; 17(8): 632-9.
15. Ely JW. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. BMJ. Mar 23;324(7339):710.
16. Slawson DC. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract. May;38(5):505-13.
17. Windish DM, Huot SJ, Green ML. Medicine residents' understanding of the biostatistics and results in the medical literature. JAMA. Sep 5;298(9):1010-22.
18. Ebell MH, Shaughnessy A. Information mastery: integrating continuing medical education with the information needs of clinicians. J Contin Educ Health Prof. 2003;23 suppl LS53-62.
19. Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M. Instruments for evaluating education in evidence-based practice: a systematic review. JAMA. Sep 6;296(9):1116-27.
20. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? a systematic review. BMJ. 2004 Oct 30;329(7473): 1017-9.
Doreen R. Bradley, MILS; Gurpreet K. Rana, MLIS; Monica L. Lypson, MD; Stanley J. Hamstra, PhD
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Doreen R. Bradley, MILS, email@example.com, Director of User Education Initiatives, University Library; Gurpreet K. Rana, MLIS, firstname.lastname@example.org, Clinical Education Librarian, Taubman Medical Library, Health Sciences Libraries; University of Michigan, Ann Arbor, MI; Monica L. Lypson, MD (corresponding author), email@example.com, Assistant Dean of Graduate Medical Education and Assistant Professor of Internal Medicine, Arbor VA Healthcare System and Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI; Stanley J. Hamstra, PhD, shamstra@umich .edu, Associate Professor of Medical Education, Department of Medical Education, Medical School, University of Michigan, Ann Arbor, MI
Received July 2009; accepted October 2009…
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Publication information: Article title: A Centralized Practice-Based Learning and Improvement Curriculum for Residents and Fellows: A Collaboration of Health Sciences Librarians and Graduate Medical Education Administration. Contributors: Bradley, Doreen R. - Author, Rana, Gurpreet K. - Author, Lypson, Monica L. - Author, Hamstra, Stanley J. - Author. Journal title: Journal of the Medical Library Association. Volume: 98. Issue: 2 Publication date: April 2010. Page number: 175+. © Medical Library Association Apr 2008. Provided by ProQuest LLC. All Rights Reserved.
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