TG#4 Information Science

Co-Chairs: Judy Littleford, Tania Gottschalk

Assignment: This TG will develop strategies to incorporate information literacy and

informatics into the UGME curriculum designed to support clinical practice following

graduation and to further the life-long learning capabilities. Informatics includes the abilities

surrounding the utilization of resources, devices & formalized methods for optimizing the

storage, retrieval & management of biomedical information for problem solving and decision-

making. Information literacy is an understanding and set of abilities enabling individuals to

recognize when information is needed and have the capacity to locate, evaluate and use this

information effectively.

Keywords: informatics, information literacy, evidence-based medicine, critical appraisal,

electronic health or medical record, telemedicine/health, computerized physician order

entry, clinical decision support, point of care tools, citation management, current awareness

strategies, mobile technologies.

Challenges for Medical Educators 2011

Explosion of new information

Digitization of information

Undeniable impact of the Internet, wireless technology and social networking

Emergence of a new generation of learners

Advent of new instructional technologies

Accelerated pace of technological change

Change in the public’s expectations of their physicians

Overflowing medical curricula and associated lack of enthusiasm for introducing biomedical informatics education.

CuRe TG4 Report to Steering Committee

November 22, 2011

EBM

Informatics

Information Literacy

Computer Skills

3 Definitions

Informatics - Biomedical informatics is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision-making, motivated by efforts to improve human health

Information Literacy - a set of abilities requiring individuals to recognize when information is needed and to have the ability to locate, evaluate, and use the needed information effectively

Evidence Based Medicine - the conscientious, explicit, and judicious use of current, critically-appraised best evidence in making decisions about the care of individual patients

I2L/EBM = Information Science

Information Science informs…

Evidence-based clinical practice

Recognize when information is needed, ask answerable questions and locate and evaluate the evidence

Integrate the best available external clinical evidence from systematic research with individual clinical expertise and patient preferences

Use informatics tools and technology with an understanding of both their power & vulnerabilities

Give pragmatic consideration to the resources available

Competent Physician & Lifelong Learner

Information Science

Clinical Science

Basic Science

5 Questions

How are information literacy, informatics, critical appraisal, and evidence-based medicine taught within the current curriculum?

Are there current published recommendations addressing these topics?

What is happening nationally/internationally in these domains?

How, where, when and by whom can these topics be best integrated into a new curriculum?

How should these topics be evaluated?

Myths & Realities

Myth #1 - Students of the net generation, also referred to as digital natives or millennials, enter medical school with a fully formed set of information literacy skills

Myth #2 – Students are a good judge of their own skills in I2L/EBM

Myth #3 – A student will absorb a global understanding of what constitutes their professional body of literature by osmosis and, as a result, access appropriate evidence-based resources

Myth #4 – Faculty model information literacy and evidence-based medicine skills in clinical practice

Myth #5 - Informatics competencies are not applicable during preclinical courses and there is no place in clerkships to teach them

Current UGME Curriculum

14 out of a total of 1841 Pre-clerkship curriculum hours are devoted to I2L/EBM. 90% of this content is delivered in Med I/Block I and never revisited

There are no informatics objectives in the curriculum

Information literacy and informatics skills are not formally examined in Pre-Clerkship

Clerkship has three isolated assignments and no curricular thread

Curricular hours are disconnected. Vertical and horizontal integration is lacking. Content does not appear at meaningful points thus relevance and applicability is unclear to medical students

Are there current published recommendations addressing these topics?

What is happening nationally & internationally?

To answer this question, the Task Group:

Conducted a literature review

Reviewed websites of Canadian medical schools and contacted individual faculty in medicine and library science

Surveyed UM PGY1 and PGY2 residents who graduated from other medical schools

Surveyed UM medical students

New Curriculum – Top 12

1. Place equal emphasis on Basic Science, Clinical Science & Information Science

2. Teach, model and evaluate I2L/EBM across all four years in a spiral fashion

3. Introduce I2L/EBM early and often and continue throughout PGME

4. Ensure sufficient integration and repetition in what is taught so the skills become second nature

5. Reinforce the concept that lifelong competencies in I2L/EBM are essential for professional practice

6. Include evaluation of I2L/EBM competencies in UGME examinations and assessments

New Curriculum – Top 12 cont’d

7. Offer a variety of teaching methodologies including face-to-face, online self-paced with milestones, and a blend of both

8. Expose medical students to a variety of informatics technologies and IT innovations in order to engage them now for active involvement in future development

9. Involve more faculty in teaching and modeling

10. Match teaching to required competencies

11. Recognize faculty development is critical to ensure faculty model, teach, and reinforce the same competencies required of the students

12. Recruit faculty or other experts to teach to an area of strength: information literacy, informatics, or evidence-based medicine

Curriculum Framework

Recommended Models

Hodges 2010 O’Connell 2009 AAMC 2007 Harden 2006 McGowan 1998

Faculty

“Do my teachers think I2L/EBM is important in their lives & how do they model it?”

There is great variability in faculty knowledge about I2L/EBM

There is great variability in practical application

These skills are rarely taught or assessed - seem to be the product of a variable path of self-discovery

Teachers usually don't take the time to reveal their own progress in learning, how they discover, evaluate and sort information or how I2L/EBM is of value to them in clinical practice and CPD

Faculty rarely critique students’ I2L/EBM skill set in the classroom setting or on the wards

Faculty tend not to question students’ sources of information nor recommend alternatives

A proportion of faculty are technologically naïve

There is lack of clarity regarding institutional commitment and resource allocation to I2L/EBM

It is difficult to practice I2L/EBM at the bedside without mobile devices and wireless connectivity

• Define an information literate physician

• Work from a curriculum with integrated I2L/EBM

• Provide targeted I2L/EBM training for faculty

• Provide opportunities for faculty to practice and model IL skills

• Offer training that fosters faculty skill in providing helpful I2L/EBM feedback

• Link student and faculty experiences as closely as possible

We can’t expect anything from students that is not taught and modeled by

faculty

Teaching and Evaluation

Task Group suggests adopting a mix of face-to-face, online, and blended learning strategies:

Discovery Projects

After Acceptance but Before First Day of Medical School

Pre-clerkship –Information Literacy focus

Link period between pre-clerkship & clerkship – Informatics focus

Clerkship – Evidence-based Medicine focus

Post CARMS finishing course

Goals of Information Science Education

1. Prepare physicians for the changing behaviors of patients, who are increasingly Internet-savvy, informed, networked/connected and questioning.

2. Provide physicians with tools to use in their interactions with patients to help them become more accountable for their health (empowerment).

3. Ensure physicians recognize the benefits of using Information Science to improve the quality of interventions, health care delivery (locally and remotely) and the organization of health care systems, and to advance global health initiatives.

4. Motivate physicians to develop expertise in using I2L and EBM in order to assume responsibility for their own continuing professional development.

5. Instill the notion that Information Science skill is mandatory because the volume and complexity of knowledge has outstripped the ability of health professionals to function optimally without the support of information management tools.

Recommendations

1. Address information literacy, informatics and evidence-based medicine topics in the curriculum

- Introduce concepts, supporting knowledge and skills at points in the UGME curriculum that will ensure progressive learning and maximum relevance

2. Embed information science throughout the curriculum rather than offering as a short course

- Fully integrate information science into preclinical and clinical courses rather than as a stand-alone module within any course

- Reinforce information competencies throughout the four-year program and in residency

3. Provide ongoing faculty development in I2L/EBM

- Include ‘information science’ faculty as part of the teaching team

4. Create an atmosphere that encourages and supports faculty to model the desired behaviors

- Accord appropriate faculty status within the educational environment of the institution

5. Examine students for competency in these skills

- Assess information science competencies as a routine part of student evaluation of any course

Judy Littleford - Co-chair Tania Gottschalk - Co-chair Karen Howell - Project Manager Sadeesh Srinathan - EBM Clare Ramsey - EBM Diamond Kassum - Informatics Jocelyn Advent - OPAL Greg Van de Mosselaer - Web applications Brenda Stutsky - CPD - Computer applications Dean Bell - Information literacy Ken Zimmer - Information literacy Timo Gosselin - Med II student Elizabeth Berg - Resident