Exploring e-readers to support clinical medical education: two case studies

Question:

Can e-readers loaded with medical textbooks and other relevant material benefit medical students, residents, and preceptors in clinical settings?

Settings:

The settings are North Carolina community clinics served by Duke University Medical Center and St. Joseph''s Hospital in Bryan, Texas, and Scott and White Memorial Hospital in Temple, Texas.

Methods:

Duke University: Twenty second-year medical students and fourteen family medicine clerkship preceptors used Kindle e-readers in clinics during eight months of rotations. Students and preceptors provided feedback through an anonymous online survey. Texas A&M University: Nine fourth-year medical students in an elective compared medical textbooks in print, online, and on a Kindle. Six residents at a local hospital completed an anonymous online survey after a three-week loan of a Kindle loaded with medical textbooks.

Results:

The e-reader''s major advantages in clinical settings are portability and searchability. The selected e-reader''s limitations include connection speed, navigation, and display. User preferences varied, but online resources were preferred. Participants suggested additional uses for Kindles in medical education.

Conclusions:

The selected e-reader''s limitations may be resolved with further development of the device. Investigation of other e-readers is needed. Criteria for evaluating e-readers in clinical settings should include portability, searchability, speed, navigation, and display. Research comparing e-readers and mobile devices in clinical education is also warranted.     

Outcomes of an Institutional Quality and Safety Residency Program Initiative

Although there are challenges in delivering a quality improvement initiative at academic medical centers, the potential benefits to resident physicians‐in‐training, hospitals, and patients are significant. This article describes the effects of an institution‐wide effort. Resident physicians‐in‐training from four medical specialty programs partnered with hospital staff while working on team quality‐improvement projects. We tracked clinical outcomes and used validated assessments. The results showed improvements in learning and organizational culture.     

Student Ratings and Professor Self-Ratings of College Teaching: Effects of Gender and Divisional Affiliation

Twenty female and 23 male professors at a liberal arts college participated along with their 803 undergraduate students in a questionnaire study of the effects of professor gender, student gender, and divisional affiliation on student ratings of professors and professor self-ratings. Students rated their professors on 26 questions tapping five teaching factors as well as overall teaching effectiveness. Professors rated themselves on the same questions as well as on nine exploratory ones. On student ratings, there were main effects for both professor gender (female professors were rated higher than male professors on the two interpersonal factors) and division (natural science courses were rated lowest on most factors). These patterns were qualified by significant interactions between professor gender and division. Although professor self-ratings varied by division, there were few significant correlations between professor self-ratings and students' ratings. Implications for future research are discussed.Appreciation goes to Laura Capotosto and Julie Phelan for their research assistance.Suzanne Montgomery is now at Widener Law School, Philadelphia, PA, USA.     

French by osmosis

The typical nursery school in the province of Quebec, Canada, is conducted in French, the official language of schools and business. Even so, it is not unusual to find English- as well as French-speaking students at many of these schools. Both languages are spoken in the province.     

Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence

Objectives:

Standards for evaluating evidence-based medicine (EBM) point-of-care (POC) summaries of research are lacking. The authors developed a “Critical Appraisal for Summaries of Evidence” (CASE) worksheet to help assess the evidence in these tools. The authors then evaluated the reliability of the worksheet.

Methods:

The CASE worksheet was developed with 10 questions covering specificity, authorship, reviewers, methods, grading, clarity, citations, currency, bias, and relevancy. Two reviewers independently assessed a random selection of 384 EBM POC summaries using the worksheet. The responses of the raters were then compared using a kappa score.

Results:

The kappa statistic demonstrated an overall moderate agreement (κ = 0.44) between the reviewers using the CASE worksheet for the 384 summaries. The 3 categories of evaluation questions in which the reviewers disagreed most often were citations (κ =  0), bias (κ = 0.11), and currency (κ = −0.18).

Conclusions:

The CASE worksheet provided an effective checklist for critically analyzing a treatment summary. While the reviewers agreed on worksheet responses for most questions, variation occurred in how the raters navigated the tool and interpreted some of the questions. Further validation of the form by other groups of users should be investigated.

Highlights

• Few critical appraisal tools have been evaluated with inter-rater reliability testing.
• The ways that users of evidence-based medicine (EBM) point-of-care (POC) tools interpret how to appraise an evidence summary—particularly when defining the grading of evidence, currency, and bias—may vary even when a standard evaluation sheet is used.
• The Critical Appraisal for Summaries of Evidence (CASE) worksheet had a moderate level of inter-rater reliability, similar to previous evaluative studies of critical appraisals tools.

Implications

• Medical librarians can develop tools useful for librarians, students, and clinicians to guide them in appraising clinical evidence summaries.
• The CASE worksheet can be a valuable tool to consider the quality of individual evidence summaries and to see patterns of overall quality in EBM POC tools.