‘Mirror, mirror, on the Ward’: on the need for focused, polished and reflective practitioners

Andrew Booth, Reader in Evidence Based Information Practice, University of Sheffield

The requirements

• Focused (i.e. specialist characteristics)

• Polished (i.e. professional characteristics)

• Reflective (i.e. lifelong characteristics)

Or to look at this another way…

• Contextual knowledge [Specialist]• Managerial skills [Professional] • Professional skills [Professional] • Learning and teaching[Professional] • Interpersonal [Professional] • & NHS Context [Specialist] • Technical [Professional]

= COMPLIANT (Lacey & Booth, 2003)

Perhaps now COMPLIANCE with CE (Continuing Education i.e. Lifelong learning) replacing time-limited Technical skills?

Let us put to one side…

• Generic/ Professional Skills and concentrate on:•Specialist

skills

and

•Lifelong learning skills

Specialist (SPECTRAL)

Aim: To develop detailed proposals for specialist training in clinical question answering for informaticists / librarians

Commissioned by: National Knowledge Service as one of series of projects on clinical question answering services (CQAS)

Carried out by: ScHARR, University of Sheffield (January-March 2006)

(Booth, Beecroft & Lynch, 2006)

Essential? Desirable? Not required?

Understanding clinical questions 93% 7% 0%

Conducting reference interview 64% 36% 0%

Focusing question 79% 21% 0%

Mapping question to research design 43% 36% 21%

Referral to specialist sources 79% 21% 0%

Using methodological filters 50% 50% 0%

Essential? Desirable? Not required?

Literature searching 100% 0% 0%

Bibliographic databases 93% 7% 0%

Boolean logic 86% 14% 0%

Evidence Based Sources 93% 0% 7%

The Internet 93% 0% 7%

Using methodological filters 50% 50% 0%

Essential? Desirable? Not required?

Identifying for relevance 79% 21% 0%

Critical appraisal 79% 21% 0%

Ranking items for validity 50% 43% 7%

Summarising evidence 57% 36% 7%

Producing CATS/Digests 43% 50% 7%

Statistical measures 57% 36% 7%

Essential? Desirable? Not required?

Synthesising the evidence 64% 36% 7%

Identifying implications 36% 50% 14%

Presenting methods/results/

identifying limitations 36% 50% 14%

Communicating answers 79% 14% 7%

Assuring quality of CQAS 86% 7% 7%

Auditing/Evaluating CQAS 57% 43%0%

Evolution of roles

Where they are now1. Asking2. Finding3. Appraising4. Acting5. Evaluating

Where they want to be1. Asking2. Finding3. Appraising4. Acting5. Evaluating

1. Asking2. Finding3. Appraising4. Acting5. Evaluating

1. Asking2. Finding3. Appraising4. Acting5. EvaluatingGeneral

CQAS

Training needs (n=17)

Top 5 Top 3 Number One

Assuring quality of CQAS (10)

Statistical measures (7)

Assuring quality of CQAS (3)

Statistical measures (10)

Summarising the evidence (7)

Statistical measures (2)

Summarising the evidence (8)

Assuring quality of CQAS (4)

Summarising the evidence (2)

Auditing/Evaluating CQAS (8)

Auditing/Evaluating CQAS (4)

Presenting methods/results (2)

Identifying implications (7)

Identifying implications (4)

Presenting methods/results (6)

Presenting methods/results (4)

Extract from Review of Current Training Provision

Using methodological filters• Finding the Evidence [BMA]• Online searching course (advanced) [BMA]• ADEPT/PrECEPT Programme [ScHARR]• Pragmatic searches to address clinical

questions [Clinical Evidence]Identifying articles for relevance• PrECEPT Programme [ScHARR]• Pragmatic searches to address clinical

questions [Clinical Evidence]

Extract from Review of Current Training ProvisionCritical appraisal

• Critical Appraisal Workshops – Basic and Advanced [BMA/ScHARR]

• CASP Appraising Workshop• CASPUK Week• CASP Workbook• EBHC Residential workshops• Introduction to Evidence-Based Health

Care [University of Oxford] • Postgraduate Certificate in EBHC

[University of Oxford]

Case Study 1 – ADEPT/ PrECEPT Programme

• Commissioned on a regional basis• Run since 1998 (ADEPT by elearning/

PreCEPT by monthly face to face)• Focuses on methodological filters (Applying

Diagnosis Etiology Prognosis & Therapy filters – now also includes Secondary Sources & Qualitative)

• PrECEPT also includes “Introduction to clinical effectiveness” (Part One) and Getting the Most out of MEDLINE (Part Two)

• Problem based using scenarios and feedback

Case Study 2 – the CLINICOS (FOLIO) Course Title: Understanding the Business of Clinical Care

Objectives: By end of course participants able to:Understand how information can be harnessed for key clinical

processes like diagnosis, treatment and prognosis. Gain confidence in working with clinicians to meet their

information needs…. Apply innovative techniques such as narrative based medicine and

decision making to clinical situations. Engage in debate about skills needed by clinical librarians.

Format: Eight week (30 days) e-learning course including interviews, exercises, guided readings and briefings (Contributions from Paul Glasziou & Glyn Elwyn)

What is wrong with current training provision?

(1) Co-ordination - need for co-ordination of courses into a single training programme, emphasising continuity and minimising overlap.

(2) Tailoring to specific context – how can generic courses be adapted to specific needs of the clinical librarian?

(3) Management, organisation and delivery - (e.g. standards, monitoring etcetera) for subset of CQAS providers.

(4) Specification of competencies - no formal attempt to map these against course objectives.

What might a Training Programme look like? - 1Module Zero [Local]

Understanding the Health ServiceModule One [Core]

Understanding context of clinical questionsModule Two [Core]

Formulating the questionModule Three [Core]

Finding Evidence – Bibliographic DatabasesModule Four [Core]

Finding Evidence – Specialist SourcesModule Five [Core]

Filtering the EvidenceModule Six [Core]

Critical Appraisal

What might a Training Programme look like? - 2Module Seven (Pt 1) [Core]

Synthesising/ Reconciling MessagesModule Seven (Pt 2) [Optional]

Interpreting/Explaining Numerical Results

Module Eight [Core] Presenting/Communicating Results

Module Nine [Optional] Organising/Delivering a CQAS

Module Ten [Optional] Evaluating Your Service

The Wider Picture?

• Declarative (What to do)

• Procedural (How to do it)

• Contextual (What the context requires)

• Each requires different training formats/techniques (e.g. contextual – mentoring/shadowing/secondment)

Evidence Based Library and Information Practice (EBLIP)• Evidence based in supporting the practice

of others• 8. Practicing evidence-based librarianship

Being explicit about the resources and search strategies used.  Providing a commentary on the quality of the evidence available to answer the question.  Keeping copies of these

• Evidence based in engaging with the knowledge base for our own practice (e.g. information needs, clinical questions, methodological filters, critical appraisal, implementing change)

Reflective Practice

• “Evidence based practice is about best practice and reflective practice, where the process of planning, action, feedback and reflection contributes to the cyclic process of purposeful decision making and action, and renewal and development”.

(Todd, 2003)

Reflective Practice

• “The clinical librarian kept a reflective practice diary throughout the period of the evaluation (November 2003 – January 2005). A reflective diary aims to provide a record of the feelings, actions, reflections, and outcomes of reflections on professional development”. [North Wales]

• “Evaluation of the LISCE (Library and Information Support for Clinical Effectiveness) project, at University College London Hospital Trust (2000-2003)…used an action research framework as the researcher was also the clinical librarian in two clinical teams. Methods included a reflective practice diary kept by the researcher” [UCL London]

The future of EBLIP

• “the long-term future of evidence based [library and] information practice probably lies…in a more encompassing approach that embodies reflective practice….the ability to critically analyse, make informed judgements and direct actions can be triggered by any number of catalysts, of which research evidence may be just one….”

Booth (2003).

In other words…..

If you give a MAN a fish…..

…..You feed him for one day

The Ultimate Goal

• But if you empower a multi-faceted, professionally competent, technically proficient and reflective practitioner to produce a state-of-the-art hatchery you feed HER (and stock the lake) for Life!!

References - 1

Booth, A. ( 2003 ) Where systems meet services: towards evidence-based information practice. Vine 33 (2): 65-71

Booth A, Beecroft C & Lynch C. (2006) SPECialist TRaining in clinical question Answering for informaticists/Librarians (SPECTRAL). Sheffield: School of Health and Related Research (ScHARR), University of Sheffield.

Lacey, T., & Booth, A. (2003). Education, training and development for NHS librarians: supporting e-learning. A review commissioned by the National electronic Library for Health Librarian Development Programme. Sheffield: University of Sheffield, ScHARR (School of Health and Related Research

References - 2

Todd, R (2003) Learning in the Information Age School: Opportunities, Outcomes and Options. International Association of School Librarianship (IASL) Annual Conference Durban, South Africa, 7-11 July 2003 .