We will assume in FCM that the first "A" for "ASSESS" is coming from a patient case you may have seen in class or perhaps from a patient seen in a hospital visit.
The student assigned to give the SDL Lecture the following week should briefly discuss a plan and draft a key clinical question (see Step 2: How to Ask a Clinical Question) with their Coach.
Using the 5A Framework will provide a nice formula to follow in completing this assignment.
Karen Knight, the Medical Education Librarian is available to provide assistance with forming the clinical question and conducting the literature search.
We use an acronym called PICO to be sure we have included all important factors to consider when forming a good searchable clinical question. PICO is a tool that clarifies and focuses questions that arise during a patient assessment, and helps to identify and organize the key aspects of a complex patient presentation.
Those key components include:
In ventilated patients (P), does the head of the bed elevation of 45 degrees (I) compared to 20 degrees (C) reduce the incidence of ventilated associated pneumonia (O)?
In an 86-year old man with coronary artery disease (P), is aspirin (C) a more effective agent than heparin (I) in reducing stroke risk (O)?
Students may use the MEDLINE Database (through Ovid or PubMed) to acquire the journal literature needed to answer their clinical questions. In addition to MEDLINE, there are links to other databases such as the Web of Science available from the Medical Student Library Portal.
SEARCHING THE LITERATURE
Having the clinical question in PICO format and knowing what TYPE of question it is, will help before developing the MEDLINE (or other database) search strategy.
Before beginning to search, ask yourself "What type of question is this?" because it will possibly impact your choice of Medical Subject Headings (MeSH), Subheadings, and Limits. There are 4 common types of clinical questions:
There are "BEST" (i.e. strongest) Study Designs for each type of question:
Articles are not necessarily reporting well done research and findings just because they are found through a literature search or appear in a prestigious journal. Articles need to be evaluated for their RELEVANCE to your question and the VALIDITY of the methodology and findings.
Learning how to critically appraise journal articles is a challenging and often time-consuming task. UVA medical students will learn and apply these techniques in the Epidemiology Thread, Clerkship Transition Week, and in the AIM Clerkship.
The appraisal piece for FCM is less ambitious, but provides a chance to learn and practice how to dissect a study - what key points to look for. The SDL Examples in the top box of the right-hand column will provide examples. I also think the following question checklist will provide a quick reference [from Critical Appraisal: A Checklist blog post by Robert Will]:
Critical Appraisal of ... the Introduction
Critical Appraisal of ... the Methods
Critical Appraisal of ... the Results
Critical Appraisal of ... the Discussion/Conclusion
APPLY TO YOUR PATIENT
Your last SDL slide should discuss how you would apply (or not apply) the article's findings to your patient or specific clinical question. It is important to take patient preferences into consideration when applying research findings.
UVA School of Medicine (SOM) students will have weekly opportunities to present self-directed learning (SDL) presentations to their small groups in the Foundations of Clinical Medicine course.
The SDLs should be guided by the 5A Framework in order to:
The SDL will include a 10-minute PowerPoint presentation that includes a screen shot of their final database (Ovid MEDLINE, PubMed, etc.) search strategy with search terms and results.
One primary journal article (no review articles) will be selected from the search results to be read and evaluated as to it's relevance for answering the PICO question. The citation reference should be included as a footnote and/or on a final Bibliography slide (contact me for help in using Zotero to create a bibliography).
SEARCH QUESTION: In an adult hypertensive male (P), does a low salt diet (I) reduce hypertension (O)?
This is a THERAPY question so I would really like to find a well-done Randomized Controlled Trial (RCT). Better yet - a Systematic Review or Meta-Analysis of multiple RCTs would provide even stronger evidence for answering my question.
This is what your Ovid MEDLINE SEARCH STRATEGY will look like for such a search:
[Right mouse click to open Image in new tab for a larger view]
A 27-year-old woman presents with low back pain. The patient asks if chiropractic treatment will help heal her quicker than just rest.
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