An Educator by Chance

13 10 2010

The topic of the oncoming edition of the blog carnivalMedical Information Matters“, hosted by Daniel Hooker, is close to my heart.

Daniel at his call for submissions post:

I’d love to see posts on new things you’re trying out this year: new projects, teaching sessions, innovative services. Maybe it’s something tried and true that you’d like to reflect on. And this goes for anyone starting out fresh this term, not just librarians!

When I started as a clinical librarian 5 years ago, I mainly did search requests. Soon I also gave workshops as part of evidence based practice courses.

Our library gave the normal library courses PubMed, Reference Manager etc. We did little extra for medical students. There was a library introduction at the beginning and a PubMed training at the end of the curriculum.

Thus, when the interns had to do a CAT (Critically Appraised Topic), they had to start from SCRATCH 😉 : learn the PICO, domains, study types, searching the various databases.  After I gave  a dozen or so 1-hour long introductions to consecutive interns, repeating the same things over and over, I realized this was an ineffective use of time. So I organized a monthly CAT-introduction with a computer workshop. After this introduction I helped interns with their specific CAT, if necessary.

This course is appreciated very much and  interns usually sigh: “why didn’t we learn this before?! If we had known this…”, etcetera.

Thus we, librarians, were very enthusiastic when we got more time in the newly organized curriculum.

We made e-learning modules for the first year, two for the second year, a Pubmed-tutorial, and a computer workshop (150 min!). In the 4th year we grade the CATs.

The e-learning modules costed me tons of time. If you read the post “How to become a big e-learning nerd by mistake” at Finite Attention Span you understand why.

We used a system that was designed for exams. On my request the educational department embed the system in a website, so students could go back and forth. Lacking any good books on the topic, students should also be able to reread the text and print whatever they liked.

I was told that variation was important. Thus I used each and every of the 10 available question types. Drop down menus, clickable menus, making right pairs of terms etc. Ooh and I loved the one I used for PICO’s, where you could drag words in a sentence to the P, I, C or O. Wonderful.

Another e-learning module consisted largely of Adobe Captivate movies. As  described in the above mentioned post:

Recognise that you are on a learning curve. First of all, it is vital that your software does not always remind you to save individual files before closing the program. It is especially helpful if you can demonstrate this three times inside a week, so that you end up losing the equivalent of about two days’ work: this will provide you with a learning experience that is pretty much optimised.

Swear. Vigorously.

Become a virtuoso of the panic-save, performing Ctrl+S reflexively in your sleep, every three minutes (…)

Correcting the callouts and highlight boxes and animation timings so they don’t look like they were put together by committee is complicated. Also, writing really clear, unambiguous copy takes time.

It sounds familiar. It also regularly happened to me that I started with the wrong resolution. Then I heard afterwards: “Sorry, we can only use 800×600.”

But workshops are also time-consuming. Largely because the entire librarian staff is needed to run 30 workshops within a month (we have 350 students per year). Of course it didn’t end with those workshops. I had to make the lesson plan materials, had to instruct the tutors, make the time tables, the attendance lists and then put the data into an excel sheet again. I love it!

The knowledge is tested by exams. This year I had to make the questions myself -and score them too (luckily with help of one or two colleagues). Another time buster. The CATs had to be scored as well.

But it is worth all the pain and effort, isn’t it?

Students are sooo glad they learned all about EBM, CATS, scientific literature and searching…

Well, duh, not really.

Some things I learned in the meantime

  1. Medical students don’t give a da do not care much about searching and information literacy.
  2. Medical students don’t choose that study for nothing. They want to become doctors, not librarians.
  3. At the time we give the courses, the students not really need it. Unlike the interns, they do not need to present a CAT, shortly.
  4. Most of our work is undone by the influence of peers or tutors that learn the students all kind of “tricks” that aren’t.
  5. It is hard to make good exams. If the reasoning isn’t watertight, students will find it. And protest against it.
  6. …. Because even more important than becoming a doctor is their desire to pass the exams
  7. If the e-learning isn’t compulsory, it won’t be done.
  8. You can’t  test information literacy by multiple choice questions. It is “soft” knowledge, more a kind of approach or reasoning. Similarly PICO’s are seldom 100% wrong or right. The value of PICO-workshops lies in the discussions.
  9. The students just started their study. They’re mostly teens. These kids will have a completely other attitude after 4 years (no longer yelling, joking, mailing, Facebook-ing, or at least they are likely to stop after you ask).
  10. Education is something I did by chance. I just do it “in addition to my normal work”, i.e. in the same time.
  11. Even more important, I’m a beginner and have had no specific training. So I have to learn it the hard way.

Let me give some examples.

This year I wanted to update one of my modules. I had to, because practically all interfaces have changed the last two years (Think about PubMed for instance).

I made an appointment with the education department, because they had helped me enormously before.

Firstly I noticed that my name had been replaced by those of 3 people who hadn’t done anything (at least with regard to this particular e-learning course). Perhaps not so relevant here. But the first red flag…

The module was moved to another system. It looked much nicer, but apparently only allowed a few of those 10 types of questions. The drag and drop questions, I was so fond of, were replaced by irritating drop down menus. With the questions I made, it didn’t make sense.

The movies couldn’t be plaid fast forward, back or be stopped.

And the girl who I spoke to, a medical student herself, couldn’t disguise her dislike of the movies. First she didn’t like the call-outs and highlight boxes, she rather liked a voice (me speaking, deleting the laborious call-outs ?!). Then she said the videos were endless and it was nicer when the students could try it themselves (which was in fact the assignment). She ignored my suggestion that Adobe is suitable for virtual online training.

Then someone next to her said: Do you know “Snag-it”, you can make movies with that too!?

Do I know Snag-it? Yes I do. I even bought it for my home computer. But Snag-it is nowhere near Adobe Captivate, at least regarding call-outs and assembly. I almost mentioned Camtasia, which is from the same company as Snag-it, but more suitable for this job.

Then the girl said the movies were only meant to show “where to press the buttons”, which I repeatedly denied: those movies were meant to highlight the value of the various sources. She also suggested that I should do some usability testing, not on my colleagues, but on the students.

Funny how insights can change over times. The one who helped me considered it one of the best tutorials.

While talking to her, it stroke me that the movies were taking very long and I wondered whether each single call-out saying “press this” was functional. Perhaps she was right in a way. Perhaps some movies should be changed into plain screenshots (which I had tried to avoid, because they were so annoying Powerpoint like). If my aim wasn’t that students learned which button to press, why show it all the time?? (perhaps because Adobe shows every mouse click, it is so easy to keep it in..)

It is a long way to develop something that is educative, effective and not boring….

But little by little we can make things better.

Last year one of the coordinators proposed not to take an exam the first year but give an assignment. The students had to search for an original study on a topic in PubMed (2nd semester) and write a summary about it (3rd semester). The PubMed tutorial became compulsory, but the two Q & A sessions (with computers) were voluntary. Half of the students came to those sessions. And the atmosphere was very good. Most students really wanted to find a good study (you could only claim an article once). Some fished whether the answers were worth the full 4 points and what they had to do to get it. The quality of the searches and the general approach were quite good.

In good spirits I will start with updating the other modules. The first should be finished in a few days. That is… if they didn’t move this module to the next semester, as the catalog indicates.

That would be a shame, because then I have to change all the cardiology examples into pulmonology examples.

Gosh!…. No!!

Credits

The title is inspired by the  post “How to become a big e-learning nerd by mistake”.
Thanks to Annemarie Cunningham (@amcunningham on Twitter) for alerting me to it.

Related Articles

Advertisements




PeRSSonalized Medicine – and its alternatives

27 02 2009

perssonalized_medicineA few posts back I just discussed that Personalized Genetics has not fulfilled its promise yet. But what about PeRSSonalized Medicine, just launched by Bertalan Mesko?

Bertalan Meskó is a medical student from Hungary, who runs the award-winning medical blog Scienceroll. According to the web 2.0 model of Hugh Carpenter, mentioned in a previous post, Bertalan (Berci) just finished his journey as a Web 2.0 jedi: he started a web 2.0 company: Webicina. Webicina offers a personalized set of web 2.0 tools to help medical professionals and patients enter the web 2.0 world.

To be honest I was a bit skeptical at first. When I think of web 2.0, I think of it as *open, *collaborative, *creative commons, *networking, ****collective intelligence (Elizabeth Koch). Web 2.0 exists by the mere fact that people want to share information for free. Later I realized that this initiative is comparable to individualized courses that you have to pay for as well. Webicina will also offer some free tools, especially for patients.

One such free tool is PeRSSonalized Medicine. The RSS in PeRSSonalized Medicine stands for Real Simple Syndication, which is a format for delivering regularly changing web content, i.e. from Journals. PeRSSonalized Medicine is a free tool meant to help those users who cannot spend much time online (e.g. medical professionals). It helps them track medical journals, blogs, news and web 2.0 services really easily and creates one personalized place where they can follow international medical content without having a clue what RSS is about (see post at Scienceroll)

persssonalized-medicine-tabs

PeRSSonalized Medicine has a beautiful and straightforward interface. There are 5 separate sources you can follow: (1) Medical Journals, (2) Blogs, (3) News and (4) Media (including Youtube channels, Friendfeed rooms or Del.icio.us tags), and (5) “articles” in PubMed (to setup this you have to perform a search in a separate toolbar).

The items included are partly of general interest -i.e. the Medical Journals includes 13 titles, including the BMJ, the JAMA and the Lancet-, partly it is very specialized, i.e. on the field of genetics. A lot of Journals are not included and Web 2.0 sources tend to be more represented than the official media/journals.Thus this tool seems most suited for the generalist and people wanting to follow web 2.0 tools. On the other hand – and this is a clear advantage- the content develops as wishes and suggestions are taken into account.

Each Tab can be personalized by simply hiding the titles you don’t want to include (under the button personalize it), but settings are only saved after registration.

The view of the personalized page is pleasant and neat. You see short titles of the 10 latest articles of the sources you have subscribed to. Moving your mouse over the titles will reveal more information and once you clicked the link it turns grey instead of blue. What I miss is the button: more, so you can catch up if you have missed older articles. Especially with media and journals that often have more than 10 new articles per issue, even more so if the first 10 titles consist of “obituaries” (BMJ).

The latest addition to PeRSSonalized Medicine (5) is the possibility to subscribe to a Pubmed search so “you can also follow the latest articles in your field of interest without going back to PubMed again and again and doing a search for your favourite term. Make this process automatic with PeRSSonalized Medicine.”
However, as most of you may know, you don’t have to go back to Pubmed over and over again to “do” your search, but you can easily subscribe to a search in PubMed either by email (My NCBI) or by RSS (see for instance this post in Dutch). Although the process of subscribing is not as intuitive as it is in PeRSSonalized medicine, PubMed is better suited to design a good search strategy. To keep abreast of the latest information in your field a good search forms the basis. It hurts my heart as a librarian that most web 2.0 people are more fixed on the technique of how to subscribe to a feed (RSS) than on good search results. Remember, it still is: garbage in, garbage out. RSS is just the drain.

As an example I show two RSS feeds below, one with more appropriate terms (pulmonary embolism and d-dimer) than the other (lung embolism and d-dimer). Pulmonary embolism is a MeSH. It is evident that with lung embolism articles will be missed just by choosing wrong/less optimal terms.

pubmed-search-rss-toelichting

Again the presentation of results is pleasant. Apart from the search restrictions I don’t find it very handy to look up each paper in HubMed (for that is where the link takes you).
Personally I prefer regular e-mail-alerts at specific intervals (via MyNCBI). I would like to look up citations either individually (if there is just 1 interesting hit) or all at once (10-50 hits). In PubMed, results can be selected, PDF’s directly downloaded from the library website and citations can be kept in My NCBI Collections or imported into a reference manager system. A RSS-feed of Pubmed searches is also handy (see below).

Alternatives

The idea presented on Webicina, although fancy, is not new. Consider the following alternative web tools, also build on data collected from RSS feeds.

Amedeo

Amedeo is dedicated to the free dissemination of medical knowledge. It is an international free service that will send you weekly literature updates in medical subjects of your choosing. At the same time a personalized website is made, with subscriptions to the journals you selected. You can retrieve the articles in text or in HTML-format. The HTML format brings you to the latest results for that Journal in PubMed. This service seems most suitable for specific medical disciplines. General topics (family physician) are not available, although it is possible to subscribe to for instance the American Journal of Family Physicians. As with all these free literature services, you will have to subscribe. It is easy to select or deselect journals in a category (tick boxes).
Amedeo also has Free Books For Doctors, but no podcasts or blogs. You can search the site, but you cannot easily look up individual journals.

amadeo

—————————————————–

emergency-medicine-2x

MedWorm (and LibWorm)

MedWorm is a free medical RSS feed provider as well a a search engine. It is meant both for doctor and patient. There are many medical categories that you can subscribe to, via the free MedWorm online service, or another RSS reader of your choice, such as Google Reader. The number of RSS-feeds is enormous: >6000. There are a publications directory, a blog directory, a blog tag cloud, consumer health news, discussion and several specific topics, like cancers, drugs, vaccines and education. Within the publications directory there is a further subdivision in: Consumer – Info – Journals – News – Organizations – Podcasts.

Many specialties are represented, including primary care and veterinary science. I tried it out and subscribed to some Addison’s disease related topics, Reuter’s Health and my own blog, which has recently been included. When you subcribe via the Medworm-RSS all news can be read in “My River of News”. It shows the titles and part of the abstracts (see Fig. below).

You can subscribe to single items or categories, but it is not possible to in- and exclude individual feeds within a topic or category by a single action. So within Endocrinology I cannot selectively exclude all diabetes journals, but (as far as I can see) I have to subscribe to each individual journal, if I don’t want the whole package. The loading of the River of News takes long, sometimes.

Together with David Rothman the builder/owner of MedWorm, Frankie Dolan, has also launched Libworm, which is a librarian’s version of MedWorm.

medworm2-home-page-favs

DO IT YOURSELF (or let the library do it for you)

Sometimes the library will set up a personalized start page. See for instance the Dermatology page created with Netvibes at the Central Medical Library, University Medical Center Groningen (UMCG). Doesn’t it look beautiful?

groningen-dermatology-netvibes

I-Google

And isn’t the tool below superb looking? Well, I constructed it myself on basis of what Ves Dimov wrote in the post “Make Your Own “Medical Journal” with iGoogle Personalized Page”, he submitted to the first MedLib”s round. And I had a little “life” help from Ves via Twitter, because things have changed a bit. All you need is a free Google mail (G-mail) account, just go to Google.com/IG (or search the web for I-Google) and subscribe. First you can create your start page with all kind of gadgets (like clock, G-mail inbox and weather forecast, see Figure below) and then you can add other tabs (encircled below). The Medical Journal and Journals Tabs I just took from Ves by clicking on the links he gave in his post: RSS feeds of the “Big Five” medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals and the podcasts of 4 major medical journals in iGoogle.

Once you have these tabs you can edit them (add, delete, move) as you like.

i-google

I-Google Medical Journals Tab

i-google-start-page-shape-top

I-Google Startpage

RSS-readers

All the above tools are based on RSS, which means Real Simple Syndication. It isn’t called Simple for nothing. You can easily do it yourself, which means that you have more freedom in what you subscribe to. Because I-Google doesn’t scale well beyond 50 or so RSS feeds, other RSS-readers are advisable once you subscribe to many different feeds (see Wikipedia for list and comparison) . I use Google-Reader, shown below, for this purpose.

Generally, adding Feeds is easy. In Firefox you often see the orange RSS-logo in the web browser (just click on it to add the feed) and most Journals and blogs have a RSS-button on their page, that enables subscription to their feed.

google-reader

rss-buttons-at-site-in-browser

As detailed in another (Dutch) Post, numerous Pubmed searches can be easily added to your RSS-reader. You build up a good search in Pubmed, for instance: (pulmonary embolism[mh] OR pulmonary embolism* OR lung embolism*) AND (“Fibrin Fibrinogen Degradation Products”[Mesh] OR d-dimer). In “the Results” you click on “Send To” and choose RSS-Feed and add it to your reader. That’s all.

pubmed-rss

Summary

PeRSSonalized Medicine is a free tool which lets you subscribe to a small and rather skewed selection of journals, news, media and blogs and (straightforward) PubMed searches. The strong points of this tool are: the beautiful design, the ease of use for people not used to web 2.0 tools including RSS, and its continuous development, seeking active input from its users. To speak with dr Shock’s: It is meant for a physician who is not web savvy, never heard of RSS and never wants to, not a geek, nerd, and still wants to stay up to date with health 2.0 or medicine 2.0.”

But there are other free tools around with more (subscription) possibilities and with a little more investment of time you can do it yourself and make subscriptions really perssonalized. Once you know it is simple, believe me.

You may also want to read:

https://laikaspoetnik.wordpress.com/2008/05/05/1-may-rss-day/ (about RSS)

https://laikaspoetnik.wordpress.com/2008/02/15/rss-feed-en-pubmed/ (about RSS and Pubmed – Dutch)





Google Reader and other free (learning) tools

27 08 2008

Lee LeFeverLee Le Fever, the founder and principal of the famous Common Craft video’s announced today at Twitter that the Google Reader team had hired Commoncraft to create this one minute introduction to Google Reader. (@leelefever on twitter)

It is an ultrashort but clear presentation in the well-known “Explanations in Plain English style”.

For those not familiar with Google Reader (an RSS-reader), it might be nice to see how this works. If you want to know more about RSS first see this post (again with a CC-video)

From the comments at The Commoncraft-blog I understand that Commoncraft no longer does custom videos. That is a pity. Always fun to look at the commoncraft video’s and I desperately need a very clear short and very plain English language explanation of Feedburner. So Lee, if you have such a backlog in stock??!

The Commoncraft video doesn’t show the new feature of Google Reader, that you can see the average posts per week and the number of subscribers, as I learned today from Gerard Bierens at Twitter. I didn’t see anything at first, but Gerard showed me that you have to look at the Expanded View Tab and click Details (see Figure).

If you’ve taste for more free learning/web2.0 tools, have a look at this 101 Free learning Tools Slide from Zaidlearn. One of the 101 Tools is Google_reader. Each slide has a link to the website where you can get/try the tool. There is more on slideshare and on Zaidlearn’s blog.

Vodpod videos no longer available.

This was a tip of @p.f. anderson (on twitter) again, who herself wrote a post about cool toys conversations (which is a kind of minutes of a “very very active Cool Toys Conversation lunch in a strange place far away”) on her blog Emerging Technologies Librarian. Her blog is full of other tips as well.

She is an expert in Second Life, as is the doctor/geneticist Bartalan (Berci) Meskó of Scienceroll. I knew I read an interesting overview today, somewhere, but it took me a while to find it back amidst all other interesting stuff. Here it is: 10-tips-for-how-to-use-web-20-in-medicine, for doctors ànd patients. From second life in the MRI to online registration of blood glucose, blogcarnivals and wiki’s. Well read all 10 Tips I would say.

Last but not least my Belgian colleague Patrick Vanhoucke (again at Twitter) gave the nice tip of a new free music library grooveshark.com, that resembles LastFM, except that it doesn’t stop after 30 seconds. There is even a possibility that you can sell your music via grooveshark (you can load your music and if someone loads it you receive “credits”). The Grooveshark tip was not really a learning tip, but it might make learning somewhat more pleasant. You can read more here (Dutch)





New OvidSP release (planned August 5th 2008) will allow more flexible searching

5 08 2008

Update 2010-08-14: I see many people going to this post because of recent changes to OVID SP. This post is NOT about the 2010 changes. Thus I added 2008 in the title.

I wrote before (see here) that ‘OVID-SP gave me RSI’, because I had to scroll too much between last search and new command. A huge TIP-box is in the way and the last search and command bar are too far apart.

Friday, I finally decided to write to OVID’s customer service, asking them if they could do something about the TIP-box and the way the search box and search history are placed relative to each other.

The same day I got an answer from a very kind Technical Support Engineer writing:

“I am really sorry but we can not remove the Tip box. However the interface is going to change next week, the search history box will be more customizable.”

YES!
Never mind the TIP-box (for the moment).
I’m very happy that OVID does take his users seriously. This means a real step ahead for heavy OVID-users. Thanks!

He also gave me the official communication about the new release, shown below (or follow this link)

By the way the new OvidSP version 2.0 is scheduled to be launched TODAY instead of July 31st.

Want to become acquainted with the new features and functionality in the latest version of OvidSP than follow this link to register for a (webex) course (choice from 20 dates!)

Transforming the Way You Search with More Flexibility and Customization of OvidSP Workflow Tools

Dear Ovid Customer:

The next release of OvidSP on July 31st is all about flexibility and enabling users to search the way they want to search. In our third weekly email introducing what you and your users will see on July 31st, learn more about new user-configurable customization enhancements to OvidSP’s workflow tools that further deepen the search experience and help users get to the results they need quickly.

  • Search Aid – Now users can expand or collapse this search refinement feature based on their preferences for managing the results screen.
  • Search History Many users perform complex searches, some involving as many as 60-80 lines of search. Now, the Search History can be placed above or below the main search box, so there’s no need to spend time scrolling up the page to review search strategies. Plus, you can sort all your searches in either ascending or descending order so that the last search statement is always viewable.
  • Results Manager – To accommodate for a wide variety of user behavior and to minimize scrolling when it comes to managing results, the Results Manager is now located in two places, above and below the results set. You can minimize it in both places to save valuable screen real estate.

Plus, now you can customize the “common” limits—those available on the main search page. These settings will act as defaults for users who are able to login via a personal account.

Like all of the upcoming enhancements and new features, those illustrated above are based on extensive feedback from and interviews with customers and users.

Coming soon to the OvidSP Resource Center will be screenshots, an updated training schedule, Frequently Asked Questions, and more. Be sure to contact your Ovid Account Representative or support@ovid.com with any questions.

Regards,

Wolters Kluwer Health – Ovid


©2008 Ovid Technologies

Eerder schreef ik dat OVID mij RSI bezorgde, omdat ik teveel moest scrollen bij langdurige searches. Er staat een enorme “OVIDSP TIP” hinderlijk in de weg en de zoekregel staat te ver van de laatste search.

Vrijdag besloot ik eindelijk om OVID’s klantenservice te mailen. Of ze niet de tip weg konden halen en iets aan de plaatsing van zoekgeschiedenis en de zoekregel konden doen (ik verwees daarbij naar mijn blog).

Diezelfde dag nog kreeg ik antwoord van een zeer attente mijnheer van de helpdesk (die getuige latere correspondentie ook inhoudelijk het een en ander weet). Hij schreef:

“I am really sorry but we can not remove the Tip box. However the interface is going to change next week, the search history box will be more customizable.”

YES!
Laat de OVIDsp-TIP maar even zitten (voor nu).
Erg goed dat OVID zijn gebruikers serieus neemt. Ze doen tenminste wat met de feedback! De aanpassingen zijn echt een stap vooruit. Bedankt, OVID!

De officiele aankondiging van OVID staat hierboven. U kunt ook deze link volgen.

Belangrijkste punten:

  • Je kunt naar wens de zoekgeschiedenis boven of onder de zoekbalk plaatsen en de searches in opklimmende of dalende volgorde plaatsen. Deze flexibiliteit lost mijn probleem dus al grotendeels op!
  • Je kunt de “Search Aid” in- of uitklappen.
  • De “Results Manager” staat nu zowel boven als onder de zoekresultaten en kunnen ook weer ingeklapt worden. Hierdoor hoef je ook weer minder te scrollen als je iets met de resultaten wilt doen.

Tussen 2 haakjes: De nieuwe OvidSP version 2.0 staat VANDAAG op de planning, niet 31 juli

Wil je vertrouwd raken met de laatste versie van OvidSP dan kun je je opgeven voor 1 van de 20 (!) online (webex) trainingen via deze link.





Webex meeting Clinical Evidence

26 05 2008

After I’ve learned so many new internet communication tools I’m about to discover yet another: webex.
As many other information specialists I’ve been invited to participate in a Webex meeting, organized by BMJ Clinical Evidence, a database with appr. 200 evidence based syntheses of evidence (critical appraisals of a subject). This is a kind of an online training. I have to dial in, and use the computer as well.

I’m kind of curious, because I never joined such a meeting before. I also hope to learn a lot from it. Expect that it will be rather efficient, because the training takes only 20 minutes an it will deal with the following:

“We will be showcasing the newest features that have been added to BMJ Clinical Evidence and also highlighting some of the most exciting hidden gems that your users may not know about.

What you can expect to hear about:
– Our new GRADE scoring system
– Our advanced search and browse functions
– Our published inclusion-exclusion forms for new reviews
– The extra resources that we have created for you as information specialists to help make your lives easier”

So it seems they will give as a peep behind the scenes.

Well at least I hope to take the first hurdle: being able to follow the session.





BMI bijeenkomst april 2008

21 04 2008

Afgelopen vrijdag 18 April was de Landelijke Dag BMI, CCZ, PBZ en WEB&Z. De BMI is afdeling Biomedische Informatie van de Nederlandse Vereniging voor Beroepsbeoefenaren (NVB). De andere afkortingen staan voor werkgroepen/commissies binnen de NVB: CCZ = Centrale Catalogus Ziekenhuisbibliotheken, BPZ = Bibliothecarissen van Psychiatrische Zorginstellingenen en WEB&Z = voorheen Biomedische werkgroep VOGIN.

Het programma bestond uit 3 ALV’s, van de CCZ, de BPZ en de BMI, afgewisseld met 3 lezingen. Een beetje lastig 3 ALV’s en 1 zaal. Dat betekende in mijn geval dat ik wel de BMI-ALV heb bijgewoond, maar tijdens de andere ALV’s (langdurig) in de koffieruimte annex gang moest wachten. Weliswaar heb ik die nuttig en plezierig doorgebracht, maar het zou wat gestroomlijnder kunnen. Ook vond ik het bijzonder jammer dat er nauwelijks een plenaire discussie was na de lezingen en dat men geacht werd de discussie letterlijk in de wandelgang voort te zetten. En stof tot discussie was er…..

Met name de eerste lezing deed de nodige stof opwaaien. Helaas heb ik deze voor de helft gemist, omdat ik in het station Hilversum dat van Amersfoort meende te herkennen 😉 . Gelukkig heeft Ronald van Dieën op zijn blog ook de BMI-dag opgetekend, zodat ik de eerste punten van hem kan overnemen.

De eerste spreker was Geert van der Heijden, Universitair hoofddocent Klinische Epidemiologie bij het Julius Centrum voor Gezondheidswetenschappen van het UMC Utrecht. Geert is coördinator van het START-blok voor zesdejaars (Supervised Training in professional Attitude, Research and Teaching) en van de Academische Vaardigheden voor het GNK Masteronderwijs. Ik kende Geert oppervlakkig, omdat wij (afzonderlijk) geinterviewd waren voor het co-assistenten blad “Arts in Spe” over de integratie van het EBM-zoekonderwijs in het curriculum. Nu ik hem hier in levende lijve heb gehoord, lees ik zijn interview met heel andere ogen. Ik zag toen meer de overeenkomsten, nu de verschillen.

Zijn presentatie had als titel: “hoe zoekt de clinicus?”. Wie verwachtte dat Geert zou vertellen hoe de gemiddelde clinicus daadwerkelijk zoekt komt komt bedrogen uit. Geert vertelde vooral de methode van zoeken die hij artsen aanleert/voorhoudt. Deze methode is bepaald niet ingeburgerd en lijkt diametraal te staan tegenover de werkwijze van medisch informatiespecialisten, per slot zijn gehoor van dat moment. Alleen al het feit dat hij beweert dat je VOORAL GEEN MeSH moet gebruiken druist in tegen wat wij medisch informatiespecialisten leren en uitdragen. Het is de vraag of de zaal zo stil was, omdat zij overvallen werd door al het schokkends wat er gezegd werd of omdat men niet wist waar te beginnen met een weerwoord. Ik zag letterlijk een aantal monden openhangen van verbazing.

Zoals Ronald al stelde was dit een forse knuppel in het hoenderhok van de ‘medisch informatiespecialisten’. Ik deel echter niet zijn mening dat Geert het prima kon onderbouwen met argumenten. Hij is weliswaar een begenadigd spreker en bracht het allemaal met verve, maar ik had toch sterk de indruk dat zijn aanpak vooral practice- of eminence- en niet evidence-based was.

Hieronder enkele van zijn stellingen, 1ste 5 overgenomen van Ronald:

  1. “Een onderzoeker probeert publicatie air miles te verdienen met impact factors”
  2. “in Utrecht krijgen de studenten zo’n 500 uur Clinical Epidemiology en Evidence Based Practice, daar waar ze in Oxford (roots van EBM) slechts 10 uur krijgen”
  3. “contemporary EBM tactics (Sicily statement). (zie bijvoorbeeld hier:….)
  4. “fill knowledge gaps met problem solving skills”
  5. EBM = eminence biased medicine. Er zit veel goeds tussen, maar pas op….
  6. Belangrijkste doelstelling van literatuuronderzoek: reduceer Numbers Needed to Read.
  7. Vertrouw nooit 2e hands informatie (dit noemen wij voorgefilterde of geaggregeerde evidence) zoals TRIP, UpToDate, Cochrane Systematic Reviews, BMJ Clinical Evidence. Men zegt dat de Cochrane Systematic Reviews zo goed zijn, maar éen verschuiving van een komma heeft duizenden levens gekost. Lees en beoordeel dus de primaire bronnen!
  8. De Cochrane Collaboration houdt zich alleen maar bezig met systematische reviews van interventies, het doet niets aan de veel belangrijker domeinen “diagnose” en “prognose”.
  9. PICO (patient, intervention, comparison, outcome) werkt alleen voor therapie, niet voor andere vraagstukken.
  10. In plaats daarvan de vraag in 3 componenten splitsen: het domein (de categorie patiënten), de determinant (de diagnostische test, prognostische variabele of behandeling) en de uitkomst (ziekte, mortaliteit en …..)
  11. Zoeken doe je als volgt: bedenk voor elk van de 3 componenten zoveel mogelijk synoniemen op papier, verbind deze met “OR”, verbind de componenten met “AND”.
  12. De synoniemen alleen in titel en abstract zoeken (code [tiab]) EN NOOIT met MeSH (MEDLINE Subject Headings). MeSH zijn NOOIT bruikbaar volgens Geert. Ze zijn vaak te breed, ze zijn soms verouderd en je vindt er geen recente artikelen mee, omdat de indexering soms 3-12 maanden zou kosten.
  13. NOOIT Clinical Queries gebruiken. De methodologische filters die in PubMed zijn opgenomen, de zogenaamde Clinical Queries zijn enkel gebaseerd op MeSH en daarom niet bruikbaar. Verder zijn ze ontwikkeld voor heel specifieke onderwerpsgebieden, zoals cardiologie, en daarom niet algemeen toepasbaar.
  14. Volgens de Cochrane zou je als je een studie ‘mist’ de auteurs moeten aanschrijven. Dat lukt van geen kant. Beter is het te sneeuwballen via Web of Science en related articles en op basis daarvan JE ZOEKACTIE AAN TE PASSEN.

Wanneer men volgens de methode van der Heijden werkt zou men in een half uur klaar zijn met zoeken en in 2 uur de artikelen geselecteerd en beoordeeld hebben. Nou dat doe ik hem niet na.

De hierboven in rood weergegeven uitspraken zijn niet (geheel) juist. 8. Therapie is naar mijn bescheiden mening nog steeds een belangrijk domein; daarnaast is gaat de Cochrane Collaboration ook SR’s over diagnostische accuratesse studies schrijven. 13. in clinical queries worden (juist) niet alleen MeSH gebruikt.

In de groen weergegeven uitspraken kan ik me wel (ten dele) vinden, maar ze zijn niet essentieel verschillend van wat ik (men?) zelf nastreef(t)/doe(t), en dat wordt wel impliciet gesuggereerd.
Vele informatiespecialisten zullen ook:

  • 6 nastreven (door 7 te doen weliswaar),
  • 9 benadrukken (de PICO is inderdaad voor interventies ontwikkeld en minder geschikt voor andere domeinen)
  • en deze analoog aan 10 opschrijven (zij het dat we de componenten anders betitelen).
  • Het aanschrijven van auteurs (14) gebeurt als uiterste mogelijkheid. Eerst doen we de opties die door Geert als alternatief aangedragen worden: het sneeuwballen met als doel de zoekstrategie aan te passen. (dit weet ik omdat ik zelf de cursus “zoeken voor Cochrane Systematic Reviews” geef).

Als grote verschillen blijven dan over: (7) ons motto: geaggregeerde evidence eerst en (12) zoeken met MeSH versus zoeken in titel en abstract en het feit dat alle componenten met AND verbonden worden, wat ik maar mondjesmaat doe. Want: hoe meer termen/componenten je met “AND” combineert hoe groter de kans dat je iets mist. Soms moet het, maar je gaat niet a priori zo te werk.

Ik vond het een beetje flauw dat Geert aanhaalde dat er door één Cochrane reviewer een fout is gemaakt, waardoor er duizenden doden zouden zijn gevallen. Laat hij dan ook zeggen dat door het initiatief van de Cochrane er levens van honderd duizenden zijn gered, omdat eindelijk goed in kaart is gebracht welke therapieën nu wel en welke nu niet effectief zijn. Bij alle studies geldt dat je afhankelijk bent van hoe goed te studie is gedaan, van een juiste statistiek etcetera. Voordeel van geaggregeerde evidence is nu net dat een arts niet alle oorspronkelijke studies hoeft door te lezen om erachter te komen wat werkt (NNR!!!). Stel dat elke arts voor elke vraag ALLE individuele studies moet zoeken, beoordelen en moet samenvatten….. Dat zou, zoals de Cochrane het vaak noemt ‘duplication of effort’ zijn. Maar wil je precies weten hoe het zit, of wil je heel volledig zijn dan zul je inderdaad zelf de oorspronkelijke studies moeten zoeken en beoordelen.
Wel grappig trouwens dat 22 van de 70 artikelen waarvan Geert medeauteur is tot de geaggregeerde evidence (inclusief Cochrane Reviews) gerekend kunnen worden….. Zou hij de lezers ook afraden deze artikelen te selecteren? 😉

Voor wat betreft het zoeken via de MeSH. Ik denk dat weinig ‘zoekers’ louter en alleen op MeSH zoeken. Wij gebruiken ook tekstwoorden. In hoeverre er gebruik van gemaakt wordt hangt erg van het doel en de tijd af. Je moet steeds afwegen wat de voor- en de nadelen zijn. Door geen MeSH te gebruiken, maak je ook geen gebruik van de synoniemen functie en de mogelijkheid tot exploderen (nauwere termen meenemen). Probeer maar eens in een zoekactie alle synoniemen voor kanker te vinden: cancer, cancers , tumor, tumour(s), neoplasm(s), malignancy (-ies), maar daarnaast ook alle verschilende kankers: adenocarcinoma, lymphoma, Hodgkin’s disease, etc. Met de MeSH “Neoplasms” vind je in een keer alle spellingswijzen, synoniemen en alle soorten kanker te vinden.

Maar in ieder geval heeft Geert ons geconfronteerd met een heel andere zienswijze en ons een spiegel voorgehouden. Het is soms goed om even wakkergeschud te worden en na te denken over je eigen (soms te ?) routinematige aanpak. Geert ging niet de uitdaging uit de weg om de 2 zoekmethodes met elkaar te willen vergelijken. Dus wie weet wat hier nog uit voortvloeit. Zouden we tot een consensus kunnen komen?

De volgende praatjes waren weliswaar minder provocerend, maar toch zeker de moeite waard.

De web 2.0-goeroe Wouter Gerritsma (WoWter) praatte ons bij over web 2.0, zorg 2.0 en (medische) bibliotheek 2.0. Zeer toepasselijk met zeer moderne middelen: een powerpointpresentatie via slideshare te bewonderen en met een WIKI, van waaruit hij steeds enkele links aanklikte. Helaas was de internetverbinding af en toe niet zo 2.0, zodat bijvoorbeeld deze beeldende YOU TUBE-uitleg Web 2.0 … The machine is us/ing us niet afgespeeld kon worden. Maar handig van zo’n wiki is natuurlijk dat je het alsnog kunt opzoeken en afspelen. In de presentatie kwamen wat practische voorbeelden aan de orde (bibliotheek, zorg, artsen) en werd ingegaan op de verschillende tools van web 2.0: RSS, blogs, gepersonaliseerde pagina’s, tagging en wiki’s. Ik was wel even apetrots dat mijn blog alsmede dat van de bibliotheker even als voorbeeld getoond werden van beginnende (medische bieb) SPOETNIKbloggers. De spoetnikcursus en 23 dingen werden sowieso gepromoot om te volgen als beginner. Voor wie meer wil weten, kijk nog eens naar de wiki: het biedt een mooi overzicht.

Als laatsten hielden Tanja van Bon en Sjors Clemens een duo-presentatie over e-learning. Als originele start begonnen ze met vragen te stellen in plaats van ermee te eindigen. Daarna gaven ze een leuke introductie over e-learning en lieten ze zien hoe ze dit in hun ziekenhuis implementeerden.

Tussen en na de lezingen was er ruim tijd om met elkaar van gedachten te wisselen, aan het slot zelfs onder genot van een borrel voor wie niet de BOB was. Zeker een heel geslaagde dag. Hier ga ik vaker naar toe!

**************************************************************************************************

met de W: ik zie dat de bibliotheker inmiddels ook een stukje heeft geschreven over de lezing van Geert van der Heiden. Misschien ook leuk om dit te lezen.

N.B. VOOR WIE DE HELE PRESENTATIE VAN GEERT WIL ZIEN, DEZE IS MET ZIJN TOESTEMMING GEZET OP

http://www.slideshare.net/llkool/bmi-18-april-2008-geert-van-der-heijden/





The best moment teaching EBM-searching skills?

6 04 2008

When you are a (future) doctor you will obviously need to look for publications at one stage or another. PubMed is the place to look for relevant medical papers. Usually medical students begin to feel the urge to learn the ins and outs of PubMed (and searching in general) once they do their scientific training (4th year) or their internship, especially when they have to perform a CAT, critically appraised topic. Then it turns out their superficial knowledge of PubMed is one of the main hurdles. They find too many hits or too few and/or miss the relevant ones.

To help them I started a monthly class of 2 hours in which I learn interns (at the dept. Gynaecology) the basics of EBM, at least the first two steps: constructing a well answerable question using the PICO method (including defining the domain/levels of evidence) and finding the evidence in PubMed as well as in aggregate resources. (these two steps are called EBS or evidence based searching). Interns are asked to prepare 4 questions, all based on previous CATs. The first question is answered during an interactive power point presentation (first hour), the other 3 are practised ‘hands on’. If needed I give them personal aftercare.

It is a highly appreciated course, and it helped to improve the quality of the CATs. So that’s very encouraging.

I often get the same feedback from the user surveys:

  • well structured and informative
  • why didn’t we get this earlier?
  • too much information at once (especially at the end of the day)

To meet their wish my colleagues started a short introduction in PubMed prior to this ‘advanced’ class. As a result, the students are better acquainted with PubMed and we can delve more in depth into the subject. Last session they even prepared all questions. I wasn’t aware and asked one of the students (quite disappointed) why he still put the words in one string in the search bar instead of looking up each word separately and checking whether the words mapped correctly to the appropriate MeSH. He replied: “But I already did this at home. I checked out all the words.” showing his notes. And I must admit his search was quite good. So I was very satisfied with this group of students.

But the feedback remains the same. well structured and informative – why didn’t we get this earlier? – too much information at once. (especially at the end of the day)

Thus one would be inclined to think there is a need to teach students earlier on.

Now coincidently, a new curriculum has started in our academic hospital, in which EBM is incorporated into the clinical modules. The 1st year students learn about information resources and study designs. In the 2nd year they learn the basics of PubMed, EBM, PICO’s, Evidence Based Searching and Systematic Reviews.

Our library is involved in the educational process with respect to information resources, PICO’s and searching. Most of the teaching is in the form of e-learning (Dutch: COO, computer ondersteunend onderwijs) using the QMP (question mark perception) system, which is basically designed to test knowledge.

We have made a tutorial for PubMed (a-basic-learn-the-buttons-and-MeSH-course) and I prepared an e-learning module on PICO’s, study-designs and aggregate evidence, for the Cardiology block. This took me 6 weeks! It was reasonably well received by the students… That is, who bothered to give feedback.

During the course “Pulmonology” (february/march) we gave 30 “Finding the Evidence Search Workshops” to 6-12 students.
I had quite high expectations, since in theory these students should have a good theoretical basis (considering the earlier e-learning tutorials).

However their knowledge was quite disappointing, and even more so were their motivation and attitude. They were just a bunch of kids, most of them not very interested in PubMed, searching, EBM or whatsoever. They were often giggling and chatting, which I find rather distracting, or were passive, silent and gazing, which is even more distracting. And when I took a glimpse at their screens I often saw g-mail and unfamiliar colourful sites instead of PubMed.

I wondered at what point these students would pupate and transform into the butterflies called interns? And at this stage I couldn’t imagine them sitting on my bedside as a doctor I would trust unconditionally.

Was it really this bad? No, I’m a bit exaggerating. When I sound them out it appeared that they find the scientific methodology courses to fragmented, too basic and not the core of their study: firstly they want to pass their exams and secondly they want to become a doctor(!), not a scientist nor a librarian. I suppose E-learning and tutorials are not the ideal tools, not even for the computer generation. E-learning has to be dosed and is not as inspiring as a good tutor (at least that is what I think).

Anyway after one hour yawning, sighing and bewildered looks and after a much needed coffee break with cookies (a brilliant move of two of my collegues) I got the impression the penny finally dropped. Some students mumbled: “Mmm, I think I come to understand it” others smiled and uttered “Yes!” and the remaining questions were answered rather swiftly by most students. It even turned out that some of the glossy sites I had seen were on-line medical dictionaries, they used to look up the correct terms. Yes, this young generation is capable of multitasking.

If these courses were evaluated the same way as the above mentioned CAT-course, I guess the outcome would be as follows:

  • not particularly interesting
  • why do we have to learn this now? can’t it wait?
  • too much information….

We still need to find the ideal timing for these courses and also a better dosing. The best timing is when they need it the most, I suppose. The students who absorbed the information best were those who needed the information right now or found out that needed it before (i.e. they now realized that their previous searches were far from ideal). The form is also something to workat. Especially the e-learning modules should be better integrated into the clinical blocks. It is not sufficient to tune in with the subject. For students to appreciate and retain information, searching skills need to be taught in tandem with assignments. Students need to see the relevance of what they learning.