Evolution of a Medical Information Management Seminar

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Evolution of a Medical Information Management
Seminar

• Mark C. Wilson, MD, MPH
• Wake Forest University
• School of Medicine

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Background

• Journal Clubs rarely - if ever - beloved by
  residents
• Journal Clubs often only focus on critical
  appraisal skills
• Journal Clubs have doubtful impact on effective
  life-long learning
• Continually resuscitating Journal Clubs is
  fatiguing and demoralizing for directors

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MIMS Objectives

• 1) Address breadth of skills required to
  Practice EBM
• formulate focused, answerable questions
• efficient retrieval of best available evidence
• critical appraisal of evidence for validity
• integration of evidence with other knowledge
• application of evidence in patient care decisions
• 2) Emphasize practicing the Process

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MIMS Logistics

• Each wednesday over noon hour
• Case-Based with feeders from morning report,
  wards, clinic
• 1-2 clinical problems per session
• Content issues in clinical epi or numeracy
  addressed as need arises
• Periodic, planned, content-related interactive
  sessions

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1996 Year

• Abandoned Journal Club label (although it was
  already case-based)
• MIMS launched
• Mainly program director facilitated with cautious
  resident involvement
• Concurrently began a weekly small group EBM
  tutorial to help introduce basic content

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1997 Year

• Chief Residents increasingly facilitate sessions
  with more resident volunteers
• PGY-II/IIIs motivated to tailor MIMS to allow
  periodic study of classic articles in addition
  to articles found to answer a specific patient
  problem

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1998 Year

• Resident rumblings that smaller sessions would be
  more productive
• Two concurrent MIMS started with specific chief
  resident ownership (PGY-I/II/III represented in
  each group)
• Periodic combined MIMS held to address specific
  EBM skills
• Healthy competition cross-fertilization emerges
  between groups (eg. CAT Bites)

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General Observations

• 1st year required regular cultivation by program
  director as many residents
• a) did not grasp relevance of these survival
  skills
• b) could not see power of self-directed format
• Inherent gravitation to content area (cardiology)
  article type (Rx Dx)
• Accept that OK and monitor so can push
  residents to address other under-represented
  specialties and article types

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Observations of Concurrent Groups

• Abandoned having all levels of learners in each
  group by mid-year now have PGY1/2 group PGY3
  group
• Program Director freed from weekly grind
• Needed more than just Chief Resident to shoulder
  weekly organization/mentoring
• Use of hot articles with crafted scenarios gtgt
  Use of those that arise from the feeder streams
  of morning report, wards, or clinic

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Conclusions

• MIMS Can
• Be FUN
• Mirror reality of independent clinical problem
  solving process
• Become learner-driven require less program
  director oversight
• Be flexible and responsive to resident needs

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Where To From Here

• Obtain separate room for each PGY class
• Handpick faculty sponsor/mentor to affiliate with
  each class MIMS
• Push residents/chief residents to use patient
  problems from feeder streams
• Experiment with program director using 10-15min
  chunks for special content (eg. informatics,
  applicability) in smaller groups to ensure range
  of skills covered

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