Value of the Librarian in PedsICU Education

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamatand my name is Rahul Damania and we come to you from Children's Healthcare of Atlanta Emory University School of Medicine. Today's episode is dedicated to optimizing your Pediatric Critical Care Knowledge and study skills by utilizing your medical librarian.We are delighted to be joined by Ms. Carrie Price a health Professions librarian. Carrie was formerly at the Welch Medical Library, serving the faculty, students and staff of Johns Hopkins Medical Institutions. Ms Price is currently at the Albert S. Cook Library of Towson University in Towson, Maryland.Ms Price is an expert searcher with a strong interest in user-centered and instructional design, evidence-based medicine, and inter-professional education.Ms Price also maintains and updates a YouTube Channel with videos about citation management, searching, and evidence-based medicine. Carrie is on twitter @carrieprice78Q1. Carrie welcome to PICU DOC on Call Podcast. Our topic today— Value of the librarian in PedsICU education and it is one of the first in our series of how learners can organize their study habits while rotating in the PEDS ICU.Carrie: Thanks Rahul and Pradip for having me on PICU DOC on Call podcast. I have no conflicts of interest or financial disclosures.Q2. Carrie tell us your story and how you came to be an expert medical librarian ?Carrie: I came into librarianship as a second career, after a first career in nonprofit development. I was fortunate to start my work in libraries at Johns Hopkins University, where I worked as a library assistant in access services while getting my masters degree in library science. During this time my mom was diagnosed with appendix cancer, a rare cancer, (she's okay now), and through the time we spent together in the hospital, I noticed there was a medical library in the building. I had this epiphany that librarians weren't limited by traditional career paths. From then I started focusing on health and consumer health classes. Later, at a work all-staff meeting, I literally bumped into the former director of the Welch Medical Library, and the rest is history! I applied for an open position, was hired, and started working at the Welch Medical Library in 2012. It has been an incredible experience. I am fortunate to work extensively with a number of departments and divisions at Johns Hopkins and now at Towson University, so my experiences have been really multidisciplinary. In the past I worked as a physical therapy technician, which was awesome and helped inform the knowledge I brought to the profession. I've taken a lot of professional development in the field. I just never stop learning, and I love sharing information on Twitter, YouTube, and on my website, which is carrieprice78.github.io.This is such an amazing story!Q3: Carrie the practice of critical care medicine requires that learners in the Peds ICU remain current in their knowledge of the literature. Given an overwhelming amount of information out there how should these learners drink from that fire hydrant without being blown away?Carrie: I think that's an excellent question. Prior to the arrival of internet, most additional knowledge was acquired from physically going to a library and perusing through peer reviewed journals and textbooks. Now, things are digital and even "born-digital" — and there is so much information available online and on your phone.... I understand that given how much information is out there, a learner can feel overwhelmed and have difficulty trusting the information they see. That's why critical appraisal is a key part of evidence-based practice. Studies have shown the value of readily-available information in patient care and have highlighted the role of the library and librarian in support of clinical practice.In 1996 Sackett et al (BMJ 1996). defined evidence based medicine (EBM) as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient." It's come to be seen as a combination of sound research evidence, clinical expertise, and patient preference. While the Accreditation Council for Graduate Medical Education (ACGME) requires peds residents to have formal training in EBM, there is considerable variation in what constitutes EBM training. This is where learners can pull from the expertise of medical librarians, who are experts in searching and evaluating literature. I suggest reaching out to your medical librarian right away. They can help you set up search alerts for topics of interest and journal tables of contents from PubMed and other resources. There are also apps, there is an app called QxMD that can help you be more aware of current literature in fields you follow. There's another app called Browzine, which you may have access to through your institution, where you can subscribe to journal table of contents. You can also find clinical, evidence-based, frequently-updated summaries with tools like UpToDate and DynaMed, depending on what you have through your institution.Having comprehensive resources such as UpToDate and Dynamed can help you curtail individual studies into a concise review!Q4. Carrie: now that you brought out the concept of Evidence-Based Medicine, what are some of the appropriate venues for teaching evidence based prospects in the Peds ICU environment?Almost all pediatric critical care medicine fellowships have a fellow conferences where learners have "protected time" for their education. Fellows conferences can have journal clubs, lectures, chapter reviews and case reports. Fellows conference could be one of the best venues for teaching EBM, where faculty and learners can interact. I think EBM practices should be a part of the peer-peer sign out after a call or service, or morning report. Programs can invite librarians to attend meetings, or seek help of a librarian while preparing for presentations. I also want to emphasize that with daily patient care rounds in the PICU — most fellows should question practices on rounds, which are handed down from previous trainees but don't always have sound evidence behind the practice, or some new research may have changed practice or knowledge. You can reach out to your librarian with these kinds of queries. Librarians can also help with PICO question formulation, searching for and appraising the evidence, and translating evidence into practice—all critical aspects of EBM.As trainees we are always wanting to optimize our clinical skills and understanding by asking the Why, the How, and the Why Not behind certain clinical scenarios in children! Asking these PICO questions, which stands for isolating the Population, Intervention, Comparison, and Outcome can help us ascertain key clinical questions which come up in our training!Q5. Carrie: How are librarians utilized by the pediatric residency programs ?There is an excellent study by Boykan and Jacobson (2017) which evaluated this exact question by surveying ~ 91 Program Directors of Pediatric Residency Programs in the US.In their study, Boykan and Jacobson reported that 80% of programs utilized medical librarians. Most of these librarians assisted with scholarly or research projects (74%), addressed clinical questions (62%), and taught on any topic — not necessarily EBM (58%) — it might be something like citation management or workflow tools. Only 17% of program directors stated that librarians were involved in teaching EBM on a regular basis. Size of the program mattered the most when it came to the use of librarians. Smaller programs (≤29 residents) were more likely to utilize librarians (100%) than were medium (30-59 residents) (71%) or large programs (>60 residents) (75%). The authors concluded that while most pediatric residency programs have an EBM curriculum and engage medical librarians in various ways, librarians’ expertise in teaching EBM is underutilized. It is important to stress that regardless of the program size, the cost of utilizing librarians did not appear to be a barrier.Q6. Carrie: How can librarians help the Peds ICU fellow and other learners in the PICU with respect to clinical practice?In the clinical practice arena with the PICU: As librarians, understand the Peds ICU fellow and other learners, especially in their first year of training, will be very busy from the get go. The peds ICU fellow and other learners, such as the advance practice nurses, serve the role of team leaders within the picu: managing residents, medical students, and the clinical care team, and report to their PICU attending. Some programs are very busy and leave very little time to adequately prepare for gathering the evidence necessary for making informed clinical decisions. Research has shown that when clinical librarians are involved in providing information in the patient care setting, answers to clinical questions can be obtained more quickly and efficiently. (McGowan et al Plos One 2008; Oliver et al. J Med Libr Ass 2011). The Value Study by Marshall et al. noted that clinicians who had used their librarian had changed patient care based on the information they received. This was spread across patient education, diagnosis and differential diagnosis, choice of medication, and... overall they felt that they had made more informed clinical decisions because they were able to receive timely, high-quality information. Your librarian can efficiently and effectively search for evidence, which can be quickly appraised and put to use by busy Peds ICU fellows or others. Librarians can provide information for fellows/faculty during morning reports, grand rounds, committees, morbidity and mortality conferences,...