INTEGRATING �VETERINARY SUBJECT EXPERTISE� WITH INFORMATION LITERACY EXPERTISE �TO TEACH AND ASSESS �THE STUDENT SKILLS IN �EVIDENCE-BASED VETERINARY MEDICINE

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Heather K. Moberly, MSLS, AHIP, AFHEA�hmoberly@tamu.edu�@vet_ed_brarian��Virginia Fajt, DVM, PhD, ACVCP�vfajt@cvm.tamu.edu�@VirginiaFajt

LOCAL COMPETENCIES AND NEW GRADUATE OUTCOMES

Competencies in Texas A&M veterinary program

2014 Critical analysis of new information and research findings relevant to veterinary medicine and appreciation for role of diversity, continuing education, & professional participation in furthering the veterinary profession�

• Improve scientific literacy by reading and interpreting information/data from research papers (clinical, basic science, epidemiology, etc)

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• Improve scientific literacy by reading and interpreting information/data from research papers (40)

Competencies in Texas A&M veterinary program

2015 Critical analysis of new information and research findings relevant to veterinary medicine�

• Apply evidence from peer-reviewed literature to a clinical case (5)
• Create a PICO-based clinical question that addresses a knowledge gap (5)
• Critically appraise published references (5)
• Search CAB Abstracts and identify potentially useful references to address a knowledge gap (5)
• Search PubMed and identify potentially useful references to address a knowledge gap (5)

Competencies in Texas A&M veterinary program

Preparing veterinary students for entry-level practice by identifying new graduate outcomes. ��Kenita S. Rogers, Eleanor M. Green, Kristin P. Chaney, Maria L. Macik, Jacqueline S. Turner, Lisa M. Keefe, Elizabeth M. Scallan, Jodi A. Korich, and Debra Fowler. ��Journal of the American Veterinary Medical Association, April 1, 2016, Vol. 248, No. 7 , Pages 751-753 �doi:10.2460/javma.248.7.751

http://vetmed.tamu.edu/dvm/ngos

Competencies in Texas A&M veterinary program

2016 Critical analysis of new information and research findings relevant to veterinary medicine�

The graduate will identify, review, and critically evaluate biomedical literature and apply it to the practice of contemporary, evidence-based veterinary medicine.

The student can:

• Recognize the importance of evidence-based medicine and apply its principle-s to the practice of veterinary medicine,
• Identify a knowledge gap, formulate a relevant question to address the knowledge gap and identify and utilized appropriate resources (e.g., PubMed, CAB Abstracts) to address the knowledge gap,
• Critically appraise the relevant information and published evidence
• Integrate and apply new knowledge to the practice of veterinary medicine

SURVEY OF�AVMA SCHOOLS

2015 Survey:�AVMA accredited veterinary colleges

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• Project Team: Virginia Fajt and four veterinary librarians
• AAVMC Survey Committee approved survey and distributed to colleges for distribution internally
• Surveyed veterinary faculty and librarians

“Teaching Evidence-Based Veterinary Medicine in the US and Canada”, Shurtz, Fajt, Heyns, Norton, & Weingart, Journal of Veterinary Medical Education, 2016, ahead of print, doi: 10.3138/jvme.1215-199R

2015 Survey:�AVMA accredited veterinary colleges

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Questions focused on:

• What EBM skills are currently included in the curriculum
• How they are taught
• Extent to which librarians are involved in the process

“Teaching Evidence-Based Veterinary Medicine in the US and Canada”, Shurtz, Fajt, Heyns, Norton, & Weingart, Journal of Veterinary Medical Education, 2016, ahead of print, doi: 10.3138/jvme.1215-199R

2015 Survey:�AVMA accredited veterinary colleges

Respondents: 106 individuals representing 22 institutions

Key findings:

• No standard teaching methodologies
• No standard learning activities
• Librarians appear to be an underutilized resource

“Teaching Evidence-Based Veterinary Medicine in the US and Canada”, Shurtz, Fajt, Heyns, Norton, & Weingart, Journal of Veterinary Medical Education, 2016, ahead of print, doi: 10.3138/jvme.1215-199R

2015 Survey:�AVMA accredited veterinary colleges

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Major barriers:

• Perceived lack of time in an already crowded curriculum
• Lack of high-quality evidence
• Lack of point-of-care tools

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“Teaching Evidence-Based Veterinary Medicine in the US and Canada”, Shurtz, Fajt, Heyns, Norton, & Weingart, Journal of Veterinary Medical Education, 2016, ahead of print, doi: 10.3138/jvme.1215-199R

2015 Survey:�AVMA accredited veterinary colleges

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Suggestions for overcoming barriers:

• Use new, freely available EBVM online teaching resources
• Create new graduate outcomes explicitly supporting EBVM skills
• Collaborate with librarians
• Support creation of national level EBVM competencies

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“Teaching Evidence-Based Veterinary Medicine in the US and Canada”, Shurtz, Fajt, Heyns, Norton, & Weingart, Journal of Veterinary Medical Education, 2016, ahead of print, doi: 10.3138/jvme.1215-199R

LEARNING THEORY

Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

Maggio LA¹, Cate OT, Irby DM, O'Brien BC. �Acad Med. 2015 Nov;90(11):1457-61. �doi: 10.1097/ACM.0000000000000769.

Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools.

Maggio LA¹, ten Cate O, Chen HC, Irby DM, O'Brien BC. Acad Med. 2016 Jan;91(1):101-6. doi: 10.1097/ACM.0000000000000814.

Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model.

Maggio LA¹, Cate OT, Irby DM, O'Brien BC. �Acad Med. 2015 Nov;90(11):1457-61. �doi: 10.1097/ACM.0000000000000769.

Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools.

Maggio LA¹, ten Cate O, Chen HC, Irby DM, O'Brien BC. Acad Med. 2016 Jan;91(1):101-6. doi: 10.1097/ACM.0000000000000814.

2VM PHARMACOLOGY �SPRING SEMESTER

Specific Course Objective Addressed:�To use the principles of evidence-based veterinary medicine to make defensible clinical decisions about drugs �

PICO questions about clinical lecture material (EBVM Step 1)

You will write clinical (PICO) questions. These will be evaluated on the quality and relevance.

Search strategies (EBVM Step 2)

You will work with librarians and then on your own to develop search strategies for 3 of the PICO questions that you write.

Critical appraisal (EBVM Step 3)

You will practice critically appraising the literature, and you will be responsible for appraising at least three of the articles you find in each of the 3 searches of the literature described above (for the first assignment, you only need to appraise one article).

Apply the literature (EBVM Step 4)

You will answer 3 clinical questions based on the evidence you find and appraise.

†Reflection assignments: due at midnight the day the assignment is listed

DUE DATES and QUIZZES

Weekly Reflection Assignments

About 200 words

Demonstrate well-formed thoughts 

Specific question prompts provided to students in eCampus system

Examples

• Week 1:
• Larson and White, “Importance of the role of the scientific literature in clinical decision-making”
• Week 2:
• Petrie and Watson: Chapter 16, “Evidence-base veterinary medicine,” pp. 243-250
• Larson and White, “First steps to efficient use of the scientific literature in veterinary practice”

Rubric: Reflection Assignments

Step 1: Formulate clinical questions�

In class, we will practice formulating clinical questions about some case scenarios that will be handed out in class.

One excellent way to guide your search for evidence to support a clinical decision is to formulate a clinical question and use it to build keywords for your search strategy.

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(Searching will be discussed in a later session.)

Step 1 assignment: Formulate clinical questions for clinical scenarios handed out in class�

The table below outlines the pieces of a thorough clinical question, which include Patient/Population/Problem (P), Intervention (I), Comparison (C), and Outcome (O), leading to PICO as the acronym for these questions.

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To be helpful and complete, P should have multiple specific and relevant descriptors; I should include a specific intervention of interest; C should identify a specific alternative of interest (or the comparator could be “nothing”); and O should be specific as well as objective and meaningful to the patient.

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Step 1 assignment: Formulate clinical questions for clinical scenarios handed out in class�

A question can be easily built in several steps:

• Define the patient (e.g., signalment, disease or condition of interest)
• Define the outcome, with a focus on specifity and clinical relevance.
• Avoid words like “better” or “more effective” – you need to be specific as to what outcome you’re interested in, such as “decreased fever” or “negative bacterial culture” or “increased appetite.” Also, avoid the non-specific phrase “adverse effects”; you should be able to specify which adverse effects you’re interested in.
• By thinking about how you would know that the outcome occurs and how you would measure the outcome, you will be more clearly delineating what you will be looking for in terms of evidence to support your decision-making.
• Describe the intervention. For the question you will write and investigate for this course, you will focus on interventions that involve treatment, but intervention can also be an exposure (like disease risk factor) or a diagnostic test.
• Consider the comparison you are interested in. The comparison could simply be with nothing (which would answer a question about an intervention having any effect on the outcome), or it could be compared with an existing treatment, diagnostic test, or risk factor.

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Step 1 Rubric: Clinical Questions

Step 2: Locate the best evidence to answer the question �

During this week’s Monday Exercises, you will work with the librarians to search for evidence for one of the clinical questions you wrote last week based.

In the search strategies you turn in, you will include the keywords and how they were combined to develop your preliminary list of published literature related to your clinical question.

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Step 2 assignment: Description of search strategy based on a clinical question from lecture�

A successful assignment will include the following:

Write the PICO question you are attempting to answer

Describe the search strategy you used to get a list of potentially relevant articles.  You may use screen shots of your searches or you can copy and paste, depending on the interface you used.  You may include searches that didn't work or that had to be refined or broadened, as long as the final "working search" is included at the end. Do not change your PICO question just because you can't find the perfect set of articles to review.

Include the list of potentially relevant articles at the end (no specific format for citations - whether you use PubMed or CAB Abstracts, you should be able to copy or export a list of articles).  You will be selecting articles from this list to appraise in the next phase.

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Step 2 Rubric: Searching

An excellent search strategy will include the PICO question being addressed and will include a variety of keywords, phrases and truncated words to create a highly sophisticated Boolean search strategy.

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Strategies with no search terms or that do not attempt to create an appropriate Boolean strategy or to use phrases or truncated words if appropriate will not be acceptable and will result in loss of points.

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Step 3: Critically appraise literature found during search for validity, impact, and applicability��

Reading from Petrie and Watson: BEFORE Monday Exercises, read pp. 269-273, Chapter 18, Critical appraisal of reported studies.

Other sections of Petrie and Watson may also be very helpful when reading your articles, particularly in the area of types of statistical tests and their appropriateness for the type of data being analyzed.

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Step 3 assignment: Critically appraise one article found during search performed for PICO question��

During this week’s Monday Exercises, you will use the literature evaluation form as a way of appraising the evidence in published articles.

This form will then be used to evaluate articles that are thought to provide evidence for the clinical questions you write.

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Step 3 Rubric: Critical Appraisal

Step 4: Integrate appraisal to make decision about using a drug��

During this week’s Monday Exercises, we will talk about the final step in practicing in an evidence-based manner: applying the evidence to answer a clinical question. The point of this step is to make a decision about a patient or group of patients. We would like the data to provide clear evidence that the desirable consequences of an intervention clearly outweigh the undesirable consequences, with the result that a “strong recommendation” can be made. The alternatives are “weak recommendations” or “no recommendations,” which are less useful and require more equivocation on the part of the clinician.

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Step 4 assignment: Answer a clinical question (“apply evidence”)����

Describe or explain the answer to your clinical question, and include a citation for the article that you reviewed as evidence for your decision (the citation does not have to be formatted in any particular way; it needs to include the title of the article, the journal, the year, and the issue and page numbers).

Make sure to include your clinical question, so I know what the answer relates to.

Your answer can be simple, but you must explain WHY you are convinced of the answer.

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Step 4 assignment: A successful assignment will include the following:�����

 The PICO question you are addressing

Citation for the evidence you appraised (citation should include the first author, title of article, title of journal, year of publication, and issue/page numbers)

FINAL quality assessment of the article you appraised (options are high, moderate, low, very low) - you do not need to include the entire literature evaluation form

The answer to your clinical question based on your appraisal of the evidence, and the recommendation you would make to a client based on that answer

The strength of the recommendation (options are either strong recommendation or weak

Step 4 Rubric: Applying Evidence

Future of this 2VM Pharmacology Class

• Changes to the curriculum mean that this class will be taught in the current format in 2017 & 2018
• Changes in physical facilities mean that lectures, labs, and computer labs may be reconfigured in 2017 & 2018

4^th year clinical rotations�(dermatology and food animal)

Learning objectives:�By evaluating two papers and making a clinical recommendation, you will fulfill New Graduate Outcome (NGO) 9 and improve your ability to:

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1. Integrate the practice of evidence-based medicine into your daily practice.

2. Apply the evidence you find to clinical decision-making.

4^th year clinical rotations�(dermatology and food animal)

1. Review “Making Therapeutic Decisions: Evidence for Effectiveness or Adverse Effects”

2. Each pair of students will write a clinical question about food animal drugs or therapeutics

3. Dr. Fajt will email you pdfs of two papers related to your clinical question by 8:00 a.m. on the 2nd Monday of the rotation. (She may ask you to revise your PICO question if it is not specific enough for searching for evidence.)

Critically appraise the papers in pairs using the Form for Evaluating Evidence for Therapeutics to answer your clinical question and make a clinical recommendation

Write a short report

4^th year clinical rotations�(dermatology and food animal)

4. Present your report in pairs to your classmates and faculty. Rounds will consist of each pair of students presenting a clinical question, discussing the evidence from the papers to help answer that question, and making a clinical recommendation. Rounds will be one hour, so be succinct.

5. After rounds, each student will separately submit a short written report

4^th year clinical rotations: Rubric

15% Clinical question (as originally posed by the student)

An excellent clinical question includes all PICO elements, and they are specific and complete; the question is highly relevant to clinical practice (that is, it takes into consideration mechanisms of action and known usages of drugs)

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4^th year clinical rotations: Rubric�

85% Assessment of the study is the report:

1.Accurate description of the study type (randomized controlled trial, case series, etc.) and appropriate assessment of the quality of the paper, with a BRIEF description of the reason for your assessment (for example, major flaws, applicability of study design and outcomes) [50%]

2. Reasonable answer to your clinical question based on your appraisal [15%]

3. Clinically relevant recommendation you would make to a client related to this clinical question, including an estimate of treatment effect [15%]

4. Defensible strength of recommendation (options are only WEAK RECOMMENDATION or STRONG RECOMMENDATION) [5%]

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Thank you.�Questions?