The Search Principle blog

1. List the five (5) steps of EBM, and teach the first two.

2. Describe the librarian’s facilitation teaching role in EBM.

3. Help practitioners to develop clinical questions with PICO.

4. Understand the “wedge of evidence“, qualitative & quantitative study methods (where/how to search for them).

5. Put questions into domains (ie. diagnosis, harm/etiology, prognosis, therapy).

6. Teach targeted, efficient search skills – and searching strategies.

7. Be familiar with basic statistics, methodologies and assessment.

8. Engage in critical appraisal and reflective practice techniques.

9. Understand searching for systematic reviews, & the meta-analysis.

10. Assume expert searching role in MEDLINE, CINAHL, EMBASE, Web of Science, PsycINFO, ERIC, etc.); pre-appraised sources (Cochrane, DynaMed, FirstConsult); grey literature (Scirus, search engines).

A growing body of research has demonstrated that open access increases the impact factor of scientific journals. Now, this week’s BMJ article on search tools suggests Google, Yahoo and Windows Live increase readership and visibility of research papers.

“Oxford University Press allowed search engines and robots (systems that crawl the internet) to access the journal’s website from June 2003. “This opened the gates to the Google generation,” he said, speaking at a workshop on open access publishing organised by Oxford Open.

The study also showed that the introduction of open access publishing in January 2005 achieved a small further increase of about 19% in use of the journal. Most of this increase came from eastern European countries.”

In PubMed clinical queries, many residents and physicians use the search domains of etiology, diagnosis, therapy and prognosis. However, many do not know about clinical prediction guides – or their relation to Haynes’ search filters.

According to the National Library of Medicine, CPGs predict some aspect of a disease or condition. CPGs are advocated as a means to enhance clinical judgement. They develop or validate rules, guides, indexes, equations, scales, scores or models to predict diagnosis, prognosis, risk (etiology), therapeutic response or clinical outcome.

A good example of a CPG is the Ottawa ankle rule. Can Fam Physician. 1996 Mar;42:478-80. With respect to diagnosis, predictive value of tests is a MeSH used to increase recall in clinical queries. Note “validate” is used as a filter for specific studies that assist in prediction; see this search for “coronary heart disease” for an idea of what is retrieved and this list of CPGs from EBM Online.

Residents, EBM and decision support tools: discussion and exercises from the McMaster Workshop 2006 – Monday June 19th, 2006, 4-5pm

The UBC hospital libraries will be welcoming new residents throughout July 2006. As part of library orientation, health librarians might try some new teaching techniques to engage residents in learning how to find synthesized evidence in clinical decision support tools. This session will cover the McMaster workshop, why the focus seemed to be on residents this year, and how librarians can help teach residents to find information to support their work at “point of care”.

Central to the week at McMaster was the teaching of EBM concepts, trying new methods and learning EBM content. Small group work and self-directed learning is very important at McMaster – but interdisciplinary groups (ie. mix of clinicians, librarians and participants whose first language is not English) make learning a challenge as each member brings his/her skills (or lack thereof) to the workshop. From a pedagogical perspective, the week is enlightening; small groups have access to experienced EBM tutors whose teaching methods are finely honed.

Should there be a larger corpus in the medical literature around pedagogical techniques? Medical librarians should consider doing more research about best methods of teaching retrieval; in addition, it might be useful for librarians to mandate needs assessment and post-hoc teaching evaluation. Due to the lack of time, this may not always be feasible – perhaps it is unrealistic to suggest it.

Now, the question is “Did I meet my objectives for the week?” I will need to reflect on this for a while. If you are interested in participating in this rather special week, as either clinician or librarian, I encourage you to visit the CLARITY website and watch for the call in early 2007. You can e-mail me for personal dialogue.

When I return to UBC, I will probably schedule a session with some librarians to share some of my perspectives on the workshop, and to show some techniques that worked (or didn’t) in small group sessions. See you back in Vancouver…

My search session to my small group wasn’t entirely successful. However, one of the basics of the workshop is to create a safe environment to try new methods of teaching evidence based ideas. One of the benefits for me was that I had three knowledgeable physicians well-versed in EBM who could provide feed-back about my teaching of search techniques.

Most of yesterday’s work focussed on small group dynamics, linguistic and cultural differences within our group, and the framework and agenda for sessions. The plenaries delivered by Drs. PJ Deveraux and Shari Keitz were excellent.

I put together a simple handout on some of the EBM tools we have discussed in our small groups, and also realized that my handout leading to information sources by domain needs updating.

Take home message at the half way point? EBM and the teaching of EBCP principles is hard work. Health librarians must develop better understanding of their teaching to optimize the time we get with clinicians.

144 clinicians from around the world, twelve librarians, in-depth problem-based learning – I am at McMaster University for a week of evidence-based medicine, information retrieval and “How to teach EBCP“. Today, the librarians met to discuss information sources, and to strategize teaching roles.

Tonight, I met my small tutor group over dinner at the faculty club. Great group: Holger Scheunemann (tutor) from Italy; and Christopher Wittich from the Mayo Clinic (trainee), and even a second librarian, Kathy Skhal, University of Iowa. More during the week about the other eight clinicians (four residents, two rising chiefs).

My search class structure: 1) major EBM sources of information to which participants have access for the week; 2) how to do basic-intermediate level searches in PubMed, and 3) some of the information tools that synthesize, digest or analyze the evidence.

Midway, each clinician will select one tool to show the others; stating two facts about it; what evidence can be found there, and how it’s searchable (ie. keyword?)… in less than 5 minutes.

I am speaking to delegates at the BC Medical Association (BCMA) Continuing Medical Education conference this afternoon. A panel presentation plans to review the e-Health Library of BC (eHLBC), tools for evidence-based information retrieval, the CMA Osler Service and – big surprise – Google Scholar. Guess what I’m doing?

Points I plan to make:

At-point-of-care health professionals need access to the best, digested, summaries of the evidence, and they need to locate them — quickly.

Sample searches:

1. Is vitamin C effective in treating common cold? Best evidence?

Here’s a simple Google browse; Google scholar; link to PubMed (MEDLINE).

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2. Google search – limited to UpToDate.

3. Is there one-stop searching in medicine? Google Medicine is just an idea so far.

An enduring symbol of Canada’s heritage, and history, is our Parliamentary Library. The library was originally completed in 1876, less than a decade after Confederation, and a century after the United States Declaration of Independence.

The octagonal jewelbox of a library is the only part of Canada’s original Houses of Parliament to have survived the 1916 fire. A quick-thinking librarian by the name of Alpheus Todd and library clerk Connie MacCormac closed the iron doors to the library just as the fires raged through Centre Block, saving it and all the books from almost certain destruction.

A recent $136 million dollar renovation is a reminder to all open access advocates: long before digital, virtual libraries, the pillar of access was physical libraries.

Our Parliamentary Library is a case in point, and worth every penny of the hefty sum to preserve access to its treasures for future generations of Canadians, and researchers.

UBC Academic Search – Google scholar blog has written about Clusty, Healthline, Kosmix, and other search portals such as SumSearch, TRIP Database and – of course – Windows Live Academic Search, Google Health and Google Scholar.

Now, enter Healia – a new tool in beta, meant to direct searchers to high quality personalized, consumer health content.

Interestingly, a number of venture capitalists are moving into health portal searching for consumers. Healia in beta is headquartered in Bellevue, Washington. Its top brass and advisory are public health and business specialists. Founder Tom Eng has worked with the National Cancer Institute on the technology used in Healia.

My opinion of Healia? Healia’s search results for “heart attack AND aspirin” look alright: 1) links to the MEDLINEplus “heart attack” page is on the far right; 2) limiting results to HON accredited sites is on the far left; 3) links to advanced filtering at top for “professionals” etc. 4) helpful search suggestions to broaden or narrow at the top. Very helpful indeed. But what about limiting to Canadian health content?

Thanks to Melanie Wise, a former student librarian here at UBC, and now a Web Manager at the Canadian Lung Association in Ottawa, for alerting me to Healia.