1
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

2
The requirements

• Focused (i.e. specialist characteristics)
• Polished (i.e. professional characteristics)
• Reflective (i.e. lifelong characteristics)

3
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)

4
Perhaps now COMPLIANCE with CE (Continuing
Education i.e. Lifelong learning) replacing
time-limited Technical skills?
5
Let us put to one side

• Generic/ Professional Skills and concentrate on
• Specialist skills
• and
• Lifelong learning skills

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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)

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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
8
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
9
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

10
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

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Evolution of roles

• Where they want to be
• Asking
• Finding
• Appraising
• Acting
• Evaluating

• Where they are now
• Asking
• Finding
• Appraising
• Acting
• Evaluating

CQAS

1. Asking
2. Finding
3. Appraising
4. Acting
5. Evaluating

• Asking
• Finding
• Appraising
• Acting
• Evaluating

General
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Training needs (n17)
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)
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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

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Extract from Review of Current Training Provision

• Critical 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

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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

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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)

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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.

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What might a Training Programme look like? - 1

• Module Zero Local
• Understanding the Health Service
• Module One Core
• Understanding context of clinical questions
• Module Two Core
• Formulating the question
• Module Three Core
• Finding Evidence Bibliographic Databases
• Module Four Core
• Finding Evidence Specialist Sources
• Module Five Core
• Filtering the Evidence
• Module Six Core
• Critical Appraisal

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What might a Training Programme look like? - 2

• Module Seven (Pt 1) Core
• Synthesising/ Reconciling Messages
• Module 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

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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)

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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)
  

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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)

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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

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The future of EBLIP

• the long-term future of evidence based library
  and information practice probably liesin 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).

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In other words..

• If you give a MAN a fish..
• ..You feed him for one day

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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!!

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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

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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 .