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Improving Access to Information during Rounds through Librarian Support. Lisa Olsen Kilburn Information Resources Specialist Southern Regional AHEC October 2010. Accreditation Council for Graduate Medical Education . General Competencies Practice-based Learning and Improvement
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Improving Access to Information during Rounds through Librarian Support Lisa Olsen Kilburn Information Resources Specialist Southern Regional AHEC October 2010
Accreditation Council for Graduate Medical Education General Competencies • Practice-based Learning and Improvement • locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems (aka evidence based medicine) • use information technology to manage information, access on-line medical information; and support their own education
The Problem • Searching the literature takes time • Residents are very busy
Duke/Southern Regional AHEC Family Medicine Residency Program • MD and DO Family Medicine Residency • Fayetteville, North Carolina • 21 residents • 8 four week rotations on Inpatient Medicine seeing patients at Cape Fear Medical Center • Average 10 – 15 patients on service
Medical Rounds • Schedule • Residents start rounding on patients at 7 am • Meeting at 10 am to discuss assessment and plan • In attendance • Attending physician • 2 to 5 residents • Attending pharmacist • Pharmacy resident • Medical and pharmacy students
Intervention by the Information Resources Specialist • Attend rounds once a week • Prompt the residents to develop questions • Research the questions • Post links to relevant articles to a blog on the AHEC Digital Library • Post the search strategy used • Email the articles to the faculty and residents • Finish everything before the end of the day
Resident Requirements • Complete a search request form with the question in PICO format • Ask 2 questions per year • Review the posted articles • Post 2 comments • Present articles to medicine team • Deadline: Third quarter evaluation
Technical Challenges • Residents access to the internet and thus the blog was somewhat variable • Some links required tech support to create • Online textbooks were difficult to work with • Due to licensing agreements with publishers, rotating medical and pharmacy students usually did not have access to the blog
Participant Satisfaction Surveys • November 2009 (4 month) • 66% response rate • 68% of residents • June 2010 (1 year) • 59% response rate • 50% of residents • Handed out at noon conference • Missing participants were sent the survey via email and inter-office mail • Collected by the Residency Coordinator and the library
Survey Results in Aggregate • 97% were “satisfied” or “very satisfied” with the librarian presence • 94% rated the articles as “moderately” or “extremely” useful • 25% admitted they would not have done the research on their own • 85% voted to continue the program
Responses by Position Residents • Resistance due to the perceived increased workload • 2 votes to cancel the program (1 maybe) • 90% spent less than 30 minutes reviewing the articles • 100% spent less than 15 minutes commenting on the articles Faculty • Strong support from the Residency Director • Variable support from faculty • Presentation at rounds • Rotating faculty • Faculty turnover
Most Frequently Cited Journals • New England Journal of Medicine (9) • Annals of Internal Medicine (6) • Chest (5) • Cochrane Database of Systematic Reviews (4) • Journal of Thrombosis and Thrombolysis (4) • Lancet (4) • Annals of Emergency Medicine (3) • CDC website (3) • Critical Care Medicine (3) • Expert Opinion on Pharmacotherapy (3) • Neurology (3)
Outcomes Benefits • Questions regarding clinic patients as well as hospitalized patients • Questions outside of the weekly visit • Increased visibility for the library Challenges • Faculty and resident preference for review articles • Medically difficult questions • Articles not received in time to affect patient care • Medicine team personality
Conclusion • The program is ongoing • Benefits to both the residency and the library • Could easily to adapted to other institutions