This document summarizes a presentation given by Nicole Capdarest-Arest and Amy Studer about integrating interactive, skills-based instruction into evidence-based practice training for medical students. They developed a session focused on developing students' skills in asking and acquiring medical evidence. The session used active learning techniques like individual and group activities, polls, and online submission of answers. Student feedback was positive and suggested the session was engaging and helped develop important skills, though students could still improve in areas like incorporating synonyms in searches. The presenters plan to build on this foundation by reinforcing skills throughout the curriculum.
Similar to Planes, Trains, and Automobiles? Engaging Medical Students with Interactive, Skills-based Multimodal Evidence-Based Practice Instruction (20)
Planes, Trains, and Automobiles? Engaging Medical Students with Interactive, Skills-based Multimodal Evidence-Based Practice 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
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
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
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
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
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)
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
