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Starting from Scratch: Establishing a Role for an Informationist on Rounds
Alison Aldrich, MSI MPH
Stephanie Schulte, MLISThe Ohio State University
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Background
• OSU HSL has a good history of collaboration with the College of Medicine and College of Nursing
• A Clinical Informationist position was created to improve HSL services to clinical faculty and staff
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Health Sciences Library
photo: medicalcenter.osu.edu
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OSU Internal Medicine Residents 2011-2012
photo: http://internalmedicine.osu.edu/education/welcome/our-residents/index.cfm
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10 patientsAttending
PGY-3
PGY-1
MS-3
MS-3Pharm
Pharm
CCM
Informationist
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Challenge: Who are you?
• Don’t expect to be introduced• Master the elevator speech• Repeat as necessary• Act like you belong
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Challenge: Encouraging Questions
attending59%
resident18%
intern9%
ccm6%
student6%
pharm2%
Percentage of Questions Asked by Team Role
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Challenge: Encouraging Questions
January
Febru
aryMarc
hApril
MayJune
July
August
Septem
ber
October
November
December
0
5
10
15
20
25
30
35
Questions by Month
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Challenge: Encouraging Questions
• Go back mid-afternoon• Take advantage of down time• Listen, listen, listen
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Challenge: Resident Burnout
Survey of US internal medicine residents, 2008-2009:• Overall burnout = 51.5%• Emotional exhaustion = 45.8%• Depersonalization = 28.9%
West, C. P., Shanafelt, T. D., & Kolars, J. C. (2011). Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA : The Journal of the American Medical Association, 306(9), 952-960.
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Challenge: Resident Burnout
• Empathize• Archive articles from rounds for residents
to access later• Send the best, include search strategy for
the rest
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May 2012 survey
• To all residents plus students and staff from rounds (n=22)
• 77.8% of respondents had interacted with the informationist on rounds
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May 2012 survey
• Did information/instruction provided by the clinical informationist allow you to handle a clinical situation differently than you would have otherwise?
77.8% yes
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May 2012 survey
• Did informationist services save you time?
78% yes
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May 2012 survey
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Challenge: Fishing vs. Teaching
McGinn, T., Seltz, M., & Korenstein, D. (2002). A method for real-time, evidence-based general medical attending rounds. Academic Medicine, 77(11), 1150-1152.
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Challenge: Fishing vs. Teaching
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Challenge: Fishing vs. Teaching
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Challenge: Fishing vs. Teaching
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Challenge: Fishing vs. Teaching
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The Main Challenge: Culture
“Culture trumps strategy every time.”
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The Main Challenge: Culture
“Culture trumps strategy every time.”
“Accreditation standards trump culture every time?”
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ACGME Milestone 15
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Year in Review
• Approximately 10 hours/week spent rounding
• 232 questions, 96.6 hours spent searching• Familiarity with culture, pace, and
frequently encountered clinical problems on rounds
• Preliminary evidence that it’s helping
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More to Try
• Develop evaluation strategies for milestones
• Round to multiple services• Promote it as a novelty - have attendings
sign up for informationist service• Electronic feedback options