Identifying the role of the medical librarian in clinical - PowerPoint PPT Presentation

Identifying the role of the medical librarian in clinical competency entrustment Medical Libraries Association Conference 2018 Association of Academic Health S ciences Libraries Competency-Based Medical Education Task Force

AAHS L Task Force Members  Nancy Adams - Associate Director, Coordinator of Education & Instruction, Penn S tate University Harrell Health S ciences Library  Emily Brennan - Research and Education Informationist, Medical University of S outh Carolina Library  Heather Collins - Assistant Director, Research and Learning Department, University of Kansas Medical Center A. R. Dykes Health S ciences Library  Megan von Isenburg - Associate Dean, Duke University Medical Center Library  Iris Kovar-Gough - Health S ciences Librarian, Michigan S tate University Libraries  Elizabeth R. Lorbeer - Chair, Department of the Medical Library, Western Michigan University Homer S tryker M. D. S chool of Medicine Library  Joseph Nicholson - Medical Librarian, NYU Health S ciences Library  Rikke Ogawa - Director, UCLA Louise M. Darling Biomedical Library and S cience and Engineering Library, S ciences Libraries  Neil Rambo - Director, NYU Health S ciences Library  Ruth Riley, AAHS L  Judy S pak - Assistant Director, Research and Education S ervices, Y ale Cushing/ Whitney Medical Library  Kelly Thormodson - Director, Library Resources, University of North Dakota S chool of Medicine and Health S ciences

What is CBME?  CBME is a learned-centered, time-agnostic, outcomes-based approach to the design, implementation, assessment and evaluation of medical education using an organizing framework of competencies (Frank et al. 2010, Boyd et al. 2017).  Competencies are predominantly in the literature as understood as observable and measurable abilities that, when actively integrated in practice, constitute physician competence. (Frank et al. 2010, Boyd et al. 2017).

What are EP As?  Core group of 13 activities that all residents entering their first year of residency should be able to complete without supervision.  EP As are units of professional practice, defined as tasks or responsibilities that trainees are entrusted to perform unsupervised once they have attained sufficient specific competence. EP As are independently executable, observable, and measurable in their process and outcome, and, therefore, suitable for entrustment decisions. (EP A Curriculum Designer Toolkit)

• Gather a history and perform a physical examination. EPA 1 • Prioritize a differential diagnosis following a clinical encounter. EPA 2 • Recommend and interpret common diagnostic and screening tests. EPA 3 • Enter and discuss orders and prescriptions. EPA 4 • Document a clinical encounter in the patient record. EPA 5 • Provide an oral presentation of a clinical encounter. EPA 6 • Form clinical questions and retrieve evidence to advance patient care. EPA 7 • Give or receive a patient handover to transition care responsibility. EPA 8 • Collaborate as a member of an interprofessional team. EPA 9 EPA 10 • Recognize a patient requiring urgent or emergent care and initiate evaluation and management. EPA 11 • Obtain informed consent for tests and/ or procedures. EPA 12 • Perform general procedures of a physician. EPA 13 • Identify system failures and contribute to a culture of safety and improvement.

CBME Taskforce Activities to Date  Formed S pring 2016 to evaluate how EP As were being implemented and potential new areas of engagement for librarians  Core tasks were to identify libraries participating in Core EP A activities and develop a methodology to characterize the nature of their participation.  A survey was developed in Qualtrics and sent to medical schools via the AAHS L listserv in fall of 2016.  The survey was distributed to all 164 AAHS L member libraries in S eptember 2016, garnering a 52% response rate or 85 members.  Results were analyzed using S PS S and with the expertise of a statistician.

S urvey Results: What Are Librarians doing in CBME & EP As? Q5. Is your library involved in implementing Core EPAs in the undergraduate medical curriculum at your medical school? n=82 I am unsure whether Core EPAs are being implemented at our institution. 19 23 Yes, librarians are working with individuals in the 39 No, Core EPAs are not % medical school to … being implemented at our … 15 % No, the library is not involved 1% 22 Yes, the library is working on its in implementing Core EPAs % own project to implement one or although Core EPAs are being more Core EPAs, without others at implemented at the institution. the institution. 1 18

S urvey Results: Which EP As are Being Implemented? Q6. Which Core EPAs are being planned and/or implemented in the undergraduate medical curriculum at your medical school? n=51 100% 18% 90% 20% 20% 20% 22% 22% 22% 24% 24% 24% 24% 25% 29% 2% 80% 2% 0% 4% 4% 2% 4% 2% 2% 2% 4% 4% 18% 70% 2% 60% 37% 50% 55% 67% 67% 65% 71% 67% 40% 73% 71% 59% 69% 67% 63% 30% 20% 37% 22% 10% 12% 12% 10% 10% 8% 6% 4% 4% 4% 4% 0% EPA 1 EPA 2 EPA 3 EPA 4 EPA 5 EPA 6 EPA 7 EPA 8 EPA 9 EPA 10 EPA 11 EPA 12 EPA 13 Insufficient information to answer Not being implemented or planned at the institution Implemented or planned but library is not involved Library is involved

S urvey Results: What Functions of EP A 7 Are Being Taught or Assessed?

S urvey Results: When are Libraries Teaching & Assessing? In What Part of the Curriculum Do Libraries Teach and/or Assess Functions of EPA 7? 90 80 70 60 50 40 30 20 Not at all 10 Both preclinical and clinical Clinical only 0 Preclinical only

S urvey Results: CBME/ EP A Assessment Modalities

Challenges teaching and assessing EP A 7: In the Literature  Not much research out there at all for EP A 7 especially, what there is demonstrates challenges.  Program Directors do not think that residents can proficiently form or answer clinical questions using the biomedical literature. (Pearlman 2017 and Lindeman 2015)  Pearlman: When program directors were asked for possible reasons for residents' lack of preparation for EP A 7 (form a clinical question), responses ranged from residents relying on online reviews and not using primary literature to the lack of modeling from senior residents and faculty. Because this skill is routinely emphasized during medical school, the low program director confidence rate is concerning and may reflect needed emphasis on assessment of this EP A in undergraduate medical education in a summative fashion  Lindeman: 38% of S urgery Residency Program Directors think students are competent in EP A 7 versus 87.0% of student self report of confidence in performance of the Core EP As.  UGME and GME literature does confirm what librarians have long known. This is a hard skill to teach, assess, and promote across learner contexts.  This is a skill being discussed in clinical frameworks.

Challenges and Barriers: The Librarian Perspective 100 90 80 70 60 50 40 30 20 10 0 No orientation Lack of time in Institution not No Lack of models Lack of Difficulty Difficulty Lack of S tudent or to Core EPAs the curriculum currently librarian/ staff from other resources (i.e. integrating integrating evidence of the faculty push- for librarians implementing training or libraries on time, funding) Core EPA- Core EPA- value of Core back regarding and/ or staff Core EPAs expertise in implementing in the library to related content related content EPAs the importance content related Core EPAs implement Core into the into the clinical of Core EPAs to Core EPAs EPAs preclinical phase of the vs. traditional phase of the curriculum basic science or curriculum clinical content Extremely S ignificant More S ignificant Less S ignificant Not Significant

Areas of Opportunity  Use the EP A framework to advocate for librarian’s role in medical education  Demonstrate where you are already teaching and/ or assessing these skills, what you are doing is transferable  Work with faculty champions to get involved in curricular renewal discussions particularly around CBME  Use the EP As to demonstrate that librarians are a valuable part of the clinical team and teaching Entrustable activities like question formation, appraisal, and critical thinking.

Where to go from here with EP As?  Pilot extended  LCME not requiring EP As as part of accreditation (yet! S till in pilot)  As EP As become a standard set of competencies for all medical schools, beyond the 10 pilot schools and early adopters, they can be a powerful tool to increase information literacy activities in a curriculum and lead to more teaching and assessment by librarians. Variability in responses notwithstanding, the data from the survey demonstrates that librarians are interested in how EP A's will change their role in medical education.

Questions?