Patients and Populations: Medical Decision-Making

Information Retrieval Thread

Lecture #1: The Value of Uncertainty

By the end of this lecture, students will…

1. have a better understanding of how new medical knowledge is created and applied
2. understand how common diagnostic testing can lead to uncertainty in diagnostic reasoning
3. demonstrate an understanding of Bayesian probabilistic rules, as they apply to a basic diagnostic question
4. develop an appreciation for how uncertainty in diagnostic reasoning interacts with trust of the practitioner

Lecture #2: The Information Cycle

By the end of this lecture, students will…

1. demonstrate an understanding of the difference between background and foreground clinical questions
2. appreciate how individual targeted searches for the answers to clinical questions drive self-directed learning that is crucial for all practitioners
3. be able to craft foreground questions for both diagnosis and treatment, using the PICO format

Computer Sessions Learning Outcomes

Knowledge Outcome #1

Each student should gain a basic understanding of the medical information environment, in order to lay a foundation for lifelong information management skills.

Background/Significance

The knowledge of medicine continues to evolve at a rapid pace with the development of new therapies, improved diagnostic tools, better understanding of the mechanisms of disease, and expanded emphasis on psychosocial aspects of health care. It is imperative that clinicians are able to access and manage this new knowledge. At the same time, information resources will continue to be redesigned and new resources will be developed. In order to navigate through this complex and dynamic environment, students must gain a solid understanding of the types of resources available to them and be able to match the appropriate resources to the information need at hand.

How learning will occur:

1. Lectures
2. Demonstrations and group discussions of a variety of information resources
3. Hands-on practice exercises
4. Assignment

How learning will be demonstrated:

1. Take home assignment to compare and contrast information resources, including evaluative comments and identification of foreground and background aspects.
2. Participation in group discussions and debriefing of practice exercises and assignment.

Skills Outcome #1

Each student should be able to formulate clinical questions that facilitate locating appropriate information to answer patient care questions.

Background/Significance

The ability to take a complex clinical scenario and from it, formulate a well-built clinical question is considered a basic competency in today’s practice of medicine. The student should be able to identify the key components of the clinical question from a clinical scenario. This allows the student to understand and execute the process of (1) identifying the relevant information from a clinical scenario quickly, (2) searching the medical literature efficiently and (3) addressing the clinical problem in a timely manner. Therefore students must have the skills to construct a clinical question because it is a primary building block in creating effective search strategies and locating information.

How learning will occur:

1. Lecture on the PICO question format and concepts of background and foreground information
2. Group discussion and formulation of several clinical questions based on a patient scenario

How learning will be demonstrated:

1. Participation in group discussion and formulation of several clinical questions
2. In class practice exercises

Skills Outcome #2

Each student should be able to search for biomedical journal literature using MEDLINE.

Background/Significance

MEDLINE is the largest and most comprehensive database of biomedical journal literature in the world. While textbooks provide much of the background information that students need, the MEDLINE database is the core resource for primary biomedical literature. As clinicians and future physicians, students must know how to search MEDLINE effectively in order to locate information for patient care, research, teaching, and continuing education for lifelong learning.

How learning will occur:

1. Demonstration and discussion of PubMed and Ovid MEDLINE.
2. Hands-on searching exercises, with assistance from instructors, to answer clinical questions generated through group discussions.
3. Take-home practice searching assignment.

How learning will be demonstrated:

1. Participation in group discussions of developing effective search strategies and differences between the two search interfaces
2. Hands-on searching exercises, observed by instructors
3. Take-home practice searching assignment

Skills Outcome #3

Each student should be able to identify and to search sources of background information as appropriate.

Background/Significance

Early in their medical education, students tend to ask far more background questions than foreground questions. As students progress in their education, they increasingly ask more foreground questions. However, there will still be instances throughout their careers when they will need to consult background resources to fill in gaps in their knowledge base. Therefore, it is essential that students are able to identify and to search sources of background information as needed. These background resources, such as electronic textbooks, provide basic biomedical information, assist in answering general clinical questions, and also introduce complex clinical information.

How learning will occur:

1. Demonstration and discussion of MD Consult Books, Stat!Ref, and the PubMed Bookshelf.
2. Take-home practice searching assignment.

How learning will be demonstrated:

1. Take home assignment to compare and contrast information resources.
2. Participation in group discussions and debriefing of practice exercises and assignment.

Biostatistics and Clinical Epidemiology Thread

Lecture #3: Introduction to Biostatistics

Lecture #4 and 5: Observational Studies

Small Group session #1: Observational Studies and Basic Biostatistics

By the end of this set of lectures and small groups, students will…

1. be able to define, understand the differences between, and recognize cohort studies, case control studies and prospective studies
2. identify potential confounders in a cohort study and understand how they impact interpretation of scientific study results
3. understand the concept of statistical significance and how it differs from clinical significance
4. define and interpret statistically significant findings and confidence intervals
5. understand how hypothesis generation, testing and sampling all contribute to the creation of new knowledge
6. apply principles of biostatistical interpretation to basic scientific abstracts

Diagnostic Reasoning Thread

Lectures #6 & 7: Diagnostic Reasoning

Small Group session #2: Diagnostic Reasoning

Small Group session #3: Diagnostic Reasoning Applied to Colon Cancer

By the end of this set of lectures and small groups, students will…

1. be able to define and distinguish between prevalence and incidence, and understand how they relate to prior probability
2. list the important features of a well-constructed diagnostic study, recognizing the importance of a well accepted gold standard and blinded assessment
3. define and calculate sensitivity and specificity for certain diagnostic tests from results in a diagnostic study
4. apply these test characteristics to diagnostic reasoning using Bayesian probability theory
5. understand that test predictive values are linked to prevalence, where sensitivity/specificity are relatively prevalence-independent