Jessica Cole, MLIS, AHIPNorthern Arizona University

At Phoenix Biomedical Campus

Library InstructionPhysician Assistant (PA) Program

About the PA ProgramO NAU’s PA program is 24 continuous months.

O Phase I of the curriculum is didactic, with students on campus for the first year.

O Phase II consists of several clinical rotations, with students mostly off- campus.

O Library instruction is integrated into the Evidence-Based Medicine curriculum over multiple sessions throughout the first year and facilitates active learning based on clinical cases.

EBP in PA Curriculum

Evidence-based practice (EBP) instruction is required by PA

program accreditors.

“The curriculum establishes a strong foundation in health information technology and evidence-based medicine and emphasizes the importance of remaining current with the changing nature of clinical practice.”

http://www.arc-pa.org/acc_standards/

PA Curriculum: Library Instruction Needs

NAU PA Graduate Competencies /Outcomes:• Transfer clinical information needs into

answerable clinical questions.• Identify the best available evidence to

answer clinical questions.• Critically evaluate the available clinical

evidence for its validity and usefulness.• Apply the findings of the appraisals to the

specific clinical scenarios/questions.• Demonstrate skills necessary for life-long

learning.

Fall 2012 Lib Inst (PHA 520) Fall 2012 PHA 520 Evidence-Based Practice Graduation Competencies Spring 2013 Lib Inst (PHA 560) Spring 2013 PHA 560Library Session Outcomes Related Course Objectives 5 Basic Steps of EBP Outcomes Library Session Objectives CAT Requirements

Formulate a focused clinical question

Define evidence-based medicine

1) Ask a focused clinical question

Transfer clinical information needs into answerable clinical questions

Where can I find general information to better understand a condition or intervention?

Case presentation/ clinical question

Retrieve abstracts and citations with basic keyword searches in PubMed.

Describe the process of critical appraisal

2) Search the literature for evidence

Identify the best available evidence to answer clinical questions

Which database can I search for complex questions? (foreground questions, i.e. PICO)

Background information, including relevant practice guidelines

Limit search results to specific article types that correspond with levels of evidence.

Formulate a clear clinical question from a practical clinical problem

3) Critically appraise the evidence

Critically evaluate the available clinical evidence for its validity and usefulness Where can I find answers fast?

Search strategy used to retrieve evidence

Manage information sources retrieved from PubMed for future access

Perform an electronic search of the potentially relevant literature

4) Integrate evidence with clinical expertise & patient values to apply in practice

Apply the findings of the appraisals to the specific clinical scenarios/questions

Which library resources are considered “evidence-based?”

Study selection methodology

Build a multi-line PubMed search with Boolean operators using the Advanced Search Builder Select studies to review 5) Evaluate performance

Demonstrate skills necessary for life-long learning

How do I find systematic reviews?

Summary of study/studies with highest level of evidence

Determine whether full text is available through the library

Critically evaluate review scientific evidence

How do I find practice guidelines?

Discussion and conclusions - clinical bottom line

Translate keyword concepts into medical subject headings using the MeSH Database and understand the difference between a keyword vs. a MeSH search

Differentiate between scientific evidence and popular knowledge

Where can I find materials to support my critical appraisal process?

AMA-formatted references

Summarize findings from the articles reviewed

How can RefWorks help me manage references and format papers?

Apply the knowledge gained to for the eventual purpose of improving clinical practice and specific patient outcomes

Curriculum-Integrated Library Instruction

PA Library SessionsYear 1 (Didactic Phase)Fall Semester

O Librarian partners with PHA 520 Foundations faculty to teach:

O Basic PubMedO Advanced

PubMed (Search PICO questions)

O In-class group activities Individual assignments

O Final exam questions at end of semester

Spring SemesterO PHA 560: Clinical

Decision Making O Instruction supports

student development of Critically Appraised Topics (CATs)

O Groups work on multiple CATs throughout semester to address clinical questions

O Faculty, student peers & librarian evaluate group CATs

Classroom: Learning Studios

Display presenter’s monitor or one connected device per table. Great for displaying case-based group work to whole class! https://www.youtube.com/watch?v=pOggHOaYFJ4

Active LearningClinical Case Example

The public has lost confidence in vaccines over time. The mother of an infant less than two months old asks about vaccines being linked to autism. This possibility makes her very nervous, and she wants to

know if there is proof that vaccines can cause autism. Can you ease her

mind?

Case: The public has lost confidence in vaccines over time. The mother of an infant less than two months old asks about vaccines being linked to autism. This possibility makes her very nervous, and she wants to know if there is proof that vaccines can cause autism. Can you ease her mind?

PICO Question to search: In infants, does MMR vaccination increase the prevalence of autism?Group Activity

Online Library Resources for PAsYears 1 & 2

Online content is also available for students:• Search Tutorials• Resource Guides

(Sources for background vs. foreground questions, etc.)

• Evidence-Based Practice Modules

Online

content

Online content