Karen Knight, M.S.L.S. Medical Education Librarian
Peter Ham, M.D. Associate Professor, Dept. Family Medicine
What is Information Mastery?
The "Information Mastery" concept was coined by Drs. David Slawson and Allen Shaughnessy in 1994 to describe a system for efficiently obtaining the most relevant and valid information for clinical care from the wide array of available information sources.
The UVa SOM Curriculum uses this concept more broadly to bring together the "12 UVa Competencies Required of the Contemporary Physician", USMLE, LCME and AAMC recommendations and standards for locating, managing, and applying information as lifelong learners.
Becoming an information master: a guidebook to the medical information jungle. Shaughnessy AF, Slawson DC, Bennett JH. J Fam Pract. 1994 Nov;39(5):489-99.
The School of Medicine established an Information Mastery/Information Sciences Thread that runs throughout the curriculum and is under the co-leadership of the Medical Education Librarian and Family Medicine Clerkship Director.
The Thread co-leaders actively participate on several curriculum committees that span planning for the pre-clerkship and clerkship years. The Thread approach of information mastery embraces the fact that students’ information needs and the sources and skills they use to meet those needs will change and grow as their medical knowledge and clinical skills increase.
To be as relevant as possible, information resources and skills are introduced to students at the point of need and within the curricular context to support assignments and learning in order to enable the students to learn, develop, and practice these skills as they move through the curriculum.
By graduation, students should be able to:
Phase 1: New Medical Student
New students are interested in the basics – where is the Library, both virtual and physical, what are its services and policies, and how can they use it all to be successful learners in the UVa “paperless environment” through the appropriate use of technology and attention to patient privacy/personal health information (PHI).
Each first year College visits the Library for one hour on students’ first day and receives a Library orientation. At the same time they are fitted for their white coats to be presented back to them in a week for the white coat ceremony.
During Library Orientation, Students:
Phase 2: The Beginner’s Mind: Laying the Foundations
Students in the first 18 months of the curriculum are learning content, usually for the first time. When learning something new or when operating at a beginner’s level – information needs are best answered by secondary sources that have been synthesized by others and presented in a clear, logical progression. Medical students rely upon synthesized information sources to develop their subject knowledge. Examples of secondary sources include textbooks and practice guidelines.
“Finding Answers to Your Questions”
In their first full week of medical school, the students attend a session called “Finding Answers to Your Questions” - part of the “Navigating the Paperless Environment” session. In this session they learn (a) the research process, (b) how to evaluate information, and (c) the broad array of information sources and search tools available from the Library and (d) their strengths and weaknesses for answering specific types of questions that are both background and patient-specific. They learn the evidence practice cycle known as the “5 As” – Assess, Ask, Acquire, Appraise & Apply. They also learn how to form a good clinical question using the PICO/PICOTTT model.
“Cells to Society”
Before students begin their first Systems course called Foundations, they participate in a week long learning experience called Cells to Society, using diabetes mellitus as a disease example of medical challenges from the cellular to societal levels. Several librarians serve as co-mentors for the small groups. The Library hosts a field trip to Historical Collections as part of this course. During their visit to Historical Collections, they are shown artifacts and historical books relevant to the history of diabetes to highlight knowledge in the experiences and developments of diabetes in the past.
Phase 3: Updating the Foundations
As students are learning the basics of a variety of disciplines and topics in the first 18 months of medical school and laying down a solid base of core knowledge, they also learn how to continuously “update” this knowledge by finding and reading the primary literature and apply it to answering patient-specific questions. Searching the MEDLINE database for journal articles is a technical skill that requires subject knowledge and logic in selecting appropriate search terms, applying limits and making appropriate combinations with Boolean operators. As a skill, it is best taught when it will be practiced and used with appropriate feedback provided to the learner real-time. Every search topic is different, so searching is best learned as an iterative process over time with guidance and where skills can progress to a higher level.
In our curriculum, students are introduced to the basic concepts of searching MEDLINE as part of the genetics content within their first month of the Foundations System. The genetics assignment “Directed Patient Letter” requires students to use a variety of secondary/textbook sources to learn the basics about an assigned condition. They are also encouraged to identify “time sensitive” information from the textbooks about their topic that might need updating through journal articles – things such as drug therapy or diagnostic techniques – things that develop rapidly and may have changed since the book was written. They also learn the basics of using a bibliographic management program (RefWorks) to capture their citations to create footnotes and bibliographies for writing the research paper.
Weekly Foundations of Clinical Medicine (FCM) sessions require each student to regularly identify a topic they want to learn more about, compose a PICO question, research it using primary sources, summarize, and then present their findings through an oral and written presentation accompanied by a bibliography to their small group.
During the Mind, Brain and Behavior System the Medical Education Librarian provides a 15 minute pre-recorded video for out of class review of how to do a good MEDLINE search. Class time the next day is spent in working through a variety of search questions to apply what they have learned and is followed-up by a short evaluative search quiz.
Phase 4: Summer Research Projects: Putting Knowledge into Action
Many students participating in summer research projects need MEDLINE searching skills that are more sophisticated than the introductory skills used for the genetics assignment. The additional search experience in the MBB System prepares them for their summer research with additional applied MEDLINE search experience. The questions being researched during the summer are often more complex and the students are also being asked to manage their citations on behalf of the research project team. The summer research experience has proven to be a key element in helping students cement their information searching skills, as they view their success in these projects to be high-stakes.
The research preceptors can schedule MEDLINE training directly for their students or the students will arrange one on one training with the Medical Education Librarian or in small groups with their research teams at the beginning of the summer.
Phase 5: Transition to Clerkships
Information Needs & Instruction Provided:
One targeted information training session is presented during Transition Week that students will apply almost immediately in their Clerkships – an introduction to a clinical drug information source. This year the training will be on LexiComp – the Health System’s new drug information system.
Phase 6: The Clinical Years
The Clinical Years provide daily opportunities to practice and hone the information mastery skills they have learned up to this point – to put it all together and select the correct tier of information to answer their patient care needs.
Specific Clerkships such as Emergency Medicine and Surgery provide frequent opportunities for students to practice forming a clinical question, obtaining information and presenting it to their colleagues in the clinical setting.
Other Clerkships have formal curricula that add new content to the students’ skills in Information Mastery, such as the Family Medicine and AIM Clerkships. Family Medicine Clerkship: The students attend a monthly workshop on Information Mastery that is meant to add contrast to the prior MEDLINE training by emphasizing that MEDLINE is not a very satisfactory tool for use at the point of care. Students are introduced to the concept of more evidence-based resources that grade the quality of evidence and again are encouraged to consult a wide range of sources when answering clinical questions. AIM Clerkship: Students gain experience in applying critical appraisal by evaluating articles’ weaknesses in experimental design, logic and conclusions.
Phase 7: Transition to Internship
Information Needs & Instruction Provided:
Students are provided an optional individual one to two hour session by the Medical Education Librarian after they match, called “One Foot Out the Door”. In these we discuss one on one their weaknesses and strengths in looking for information, how to transition to PubMed if they do not have Ovid MEDLINE during their residency, and anything else they might want to talk about – like taking RefWorks accounts with them after they graduate.