Submitted by Paula Whannell
Health Sciences Library, Iowa Health, Des Moines, IA
Our health sciences library is part of a community teaching hospital in Des Moines, IA, which has 663 beds housed on 2 campuses. We support 5 residency programs with 87 residents. All residents attend a four-week evidence-based medicine (EBM) class during the fall of their first year of residency. One of these sessions is devoted to literature searching, and residents are introduced to various EBM resources and to searching strategies.
In the summer of 2006 the librarians were invited to work with the residents in the pediatric program to improve their literature searching skills. Their faculty had noted that residents tend to forget the searching skills they have learned and struggle to perform good searches. They often fall back to using Google for their searches when they aren't comfortable with the medical databases. The goal of this project is to help them gain confidence with the various databases, particularly PubMed, and to learn which database would be the best for answering certain types of questions.
The librarians attend pediatric rounds one day a week for fifteen minutes to help the residents search the answer to a question of their choosing from that week's practice. The group consists of first, second and third year pediatric residents; first year family practice residents; and third year medical students. Hospitalists, social workers, a pharmacist, case manager and dietician are also in the room. Usually, the group already has a question in mind to be searched. One person sits at the keyboard, and they work on their search together. The computer screen is projected onto a large screen so everyone can see the search in progress.
Librarians coach the group to frame their question using PICO, select the search terms and decide which database is best. The residents lack confidence in their searching skills at first. Because they work as a group, there are usually some people in the room who can coach the typist. The librarians step in as needed.
Over time, we have not been able to teach the variety of databases that we had hoped. The questions raised are often complex and very specific, and answers often are not in the literature or information is limited. Most questions lend themselves to PubMed rather than to Cochrane, the National Guideline Clearinghouse or other databases. Although we haven't been able to utilize other databases very often, the residents see the benefit of learning PubMed and gain confidence in its use. Occasionally, when the group does not have a question in mind, we use the time as an opportunity to review other databases.
In December of 2007 a second relationship was established with the family medicine residency program to do the same instruction. This is a smaller group of two residents, two third-year medical students, a faculty physician and faculty pharmacist. Again, the group comes up with complex patient scenarios and questions, and PubMed is used the most to find answers. Over time, residents' searching skills improve. In this group faculty members are very interested in learning the databases themselves and in finding the subsequent articles.
Both of these groups have accepted the library piece as part of their week's routine and have become more aware of the questions that come up in their practice. In addition to improving residents' literature searching skills, this project has developed a rapport between the librarians and physicians. The librarians have become more visible and more approachable to both faculty and residents, and we have more contact with them outside of rounds than we did before the project began.