Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat

and 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 @carrieprice78

Q1. 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, and more. One case controlled study has (Banks DE, Shi R, Timm DF, et al. J Med Libr Assoc. 2007;95(4):381-387) demonstrated that librarian support was associated with saved resources and reduced costs beyond a health practitioner’s time savings; a librarian’s presence at morning report correlated positively with shorter length of stays and lower hospital charges in 55 cases with 136 matched comparisons.

This is such a key point, leveraging your instutitions libarian can serve to be a bimodal learning process! As both trainee and librarian collaborate learning can be optimized and this can ultimately affect patient outcome!

Q7. Carrie: How can librarians help the Peds ICU fellow and other learners in the PICU with respect to research and their scholarly activities?

At most institutions, Librarians and library professionals choose what resources and databases to buy: they negotiate prices; ensure that electronic resource vendors have the information they need to provide access; ensure remote access through proxy servers; organize the information on digital portals and guides; build interfaces and education to facilitate searching; and collect and analyze usage data to validate use of institutional resources.

Most PedsICU fellows require some scholarly activity (research/publication) during their fellowship. Besides talking early on with the statistician, Peds ICU fellows and learners could really benefit talking to a librarian about their research question prior to initiation of the research project. Medical librarians are your research partner! A 2015 publication by Rethlefsen et al. showed that librarian involvement on systematic reviews in general internal medicine correlated with higher quality reported searches. Additionally,y our librarian can update you with new references from your literature search, and over time, help you understand your research impact. And like I said, they can help you set up alerts and understand what's out there and how the literature is trending in your areas of interest. The librarians can help with organizing references needed for the project. If a full text article is not available, the librarians can help you obtain it through inter-library loan. Librarians are invaluable to decreasing the stress of fellow/learner embarding on a research project.

Q8. Carrie: Do you see a role for the healthcare librarian in patient safety and quality initiatives?

Yes! Many institutions will also have fellows on a committee or two within the PICU based on their interests such as the airway safety committee, vascular access committee etc. Librarians have an increasing role in providing patient- and family-centered information and can help the fellows acquire the latest information and evidence, which may be necessary to update protocol or guidelines commonly used in the PICU. Fellows and learners should approach librarians when faced with the task of updating a previous protocol, guidelines, standard of care, algorithm or best practice documents used in their PICUs to get the best and the latest available evidence.

Q9 Ms Price: whats your advice to the fellows with respect to online databases use to access medical information:

I think fellowship programs should invite their librarian to speak to the fellows and the PICU team to inform the learners of what resources their institutional library provides. Most libraries, especially in the healthcare setting, have a number of resources free and easily accessible, with access to content that you wouldn't have otherwise. The most commonly utilized is the free resource PubMed, from the U.S. National Library of Medicine. It's considered one of the premier databases for health and biomedical literature, containing over 32 million records. It does not include full text journal articles; however, links to the full text are often present when available from other sources, either through your university or institution, or through the publisher's website or PubMed Central. Your institutional library will have its own collections of journals and databases provided to you free of charge. Even Google Scholar can be helpful for finding hard-to-locate articles and interfacing with citation management tools. I should also mention that good collection of the latest articles from the Peds ICU literature is provided by Dr. Hari Krishnan at picujournalwatch.com.

Q10. Carrie what are some good resources to store articles, citations for future use? (Carrie please add/delete stuff as you want)..

There are a lot of good resources for storing references collectively called reference or citation management software: there are Zotero, Mendeley, EndNote, and actually a lot more. They all kind of compete with each other so they're all pretty good, and the ones I just mentioned are either completely free or have free versions. Most reference management software programs have the same functions: importing references, organizing, storing, and creating citations and bibliographies in a manuscript. These can be a huge time saver for the busy pedsICU fellow — and your librarian can help you get set up and get started with the tool you select. Personal preferences, type of operating software used, and pricing may factor in choice of reference management software. I cant stress enough to save your work, hopefully to the cloud, for ready access anywhere, but also in case there is a malfunction or loss of your device. Another great tool — not a citation management tool, but one that everyone who has published or hopes to publish should sign up for is ORCID. ORCID is open researcher and contributor ID. It's a free researcher profile system that is increasingly being used and even required for grant applications and article submissions. This researcher profile system can help you save all your research products in one place, update your CV, speed up the process of creating your Biosketch or applying for grants, and help disambiguate you from other researchers. You can check it out at orcid.org.

OK to summarize, have a reference manager which can quickly capture and organize key articles — as you delve into your research project utilize this reference manager and their respective integrations to streamline your manuscript process!

Q11 Carrie we appreciate your insights on today's podcasts, as we wrap up, would you mind highlighting your personal clinical pearls?

I think I would say that the medical librarian is your friend. Set up a meeting with them early on in your fellowship. Make use of this invaluable resource for not only to improve on your clinical work, patient outcomes, and decreasing costs but also for research, systematic and scoping reviews, quality and safety initiatives within the PICU. We can save you time doing literature searches, getting you the latest and best evidence, helping you organize citations, requesting the reference/article you need for that case report or lecture presentation, even finding Creative Commons medical images for use in posters and presentations. We can be there at the point of need, at morning report, journal clubs, department meetings, and we can help faculty with creation of medical education and EBM instructional materials. Librarians should be included in development of educational curriculums, written into grants, considered co-authors as a part of an author research team, and included in-class teaching for PICU fellow conferences. Faculty can and should coordinate with medical librarians for optimal training of the peds ICU fellows and other learners.

To summarize today's episode...

We learnt today the immense value, which the medical librarians bring to the learning environment of the Peds ICU. Medical librarian Carrie Prices would like to see more involvement of medical librarians in the development and maintenance of PedsICU learning curriculum. A collaborative approach between the librarians, faculty, fellows and other allied health personnel my be a win win for all including the patients and their families.

This concludes our episode today on Value of the Librarian in PedsICU Education. We hope you found value in this short podcast. We welcome you to share your feedback & place a review on our podcast. PICU Doc on Call is co-hosted by me Pradip Kamat and my cohost Dr. Rahul Damania. Please visit our website picudoconcall.org

Stay tuned for our next episode! Thank you

References:

Quesenberry, A. C., Oelschlegel, S., Earl, M., Leonard, K., & Vaughn, C. J. (2016). The impact of library resources and services on the scholarly activity of medical faculty and residents. Medical Reference Services Quarterly, 35(3), 259-265.

Rethlefsen, M. L., Farrell, A. M., Osterhaus Trzasko, L. C., & Brigham, T. J. (2015). Librarian co-authors correlated with higher quality reported search strategies in general internal medicine systematic reviews. Journal of clinical epidemiology, 68(6), 617–626. https://doi.org/10.1016/j.jclinepi.2014.11.025

Sollenberger, J. F., & Holloway, R. G. (2013). The evolving role and value of libraries and librarians in health care. JAMA, 310(12), 1231-1232.

Boykan, R., & Jacobson, R. M. (2017). The role of librarians in teaching evidence-based medicine to pediatric residents: a survey of pediatric residency program directors. Journal of the Medical Library Association : JMLA, 105(4), 355–360. https://doi.org/10.5195/jmla.2017.178

Ullah, M., & Ameen, K. (2019). Teaching information literacy skills to medical...

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