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Elizabeth C. Whipple, MLS Peggy Richwine, MS, MLS, AHIP Frances A. Brahmi, MLS, PhD, AHIP

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Title: Elizabeth C. Whipple, MLS Peggy Richwine, MS, MLS, AHIP Frances A. Brahmi, MLS, PhD, AHIP


1
"
Teaching First-year Medical Students Where to Go
First Connecting Information Needs to
E-resources
Elizabeth C. Whipple, MLS Peggy Richwine, MS,
MLS, AHIP Frances A. Brahmi, MLS, PhD,
AHIP Indiana University School of Medicine, Ruth
Lilly Medical Library, Indianapolis, Indiana
CASE STUDY QUESTIONS
MS I INFORMATION RESOURCES
OBJECTIVE
CASE STUDY
http//medicine.iu.edu/msiresources
To introduce first-year medical students to
e-resources that are best for different types of
background questions. The goal is to go from a
specific question, generalize it into a type of
question, and then identify the best e-resources
for that type of question. This is their first
introduction to the lifelong learning competency
in the school competency-based curriculum.
Initial Clinic Visit Subjective Mr. Roberto
Martinez is a 55 year old male, currently
employed by a landscaping firm in Indianapolis,
who presents with back pain. He came to the US
from Mexico approximately 10 years ago on a
seasonal agricultural worker (H2A) visa. For
the first 5 years of his stay in the United
States, Mr. Martinez worked as a farm laborer in
rural northern Indiana. Four years ago, he was
in an automobile accident and injured his back.
Mr. Martinez has been troubled by chronic back
pain ever since. At that time he underwent a
3-level lumbar fusion for an L-2 burst fracture,
but the pain never completely resolved and is
worse on some days than others. For the past
year he has been driving a truck for a
landscaping and yard care service. Mr Martinez
had been seeing his regular physician for this
condition, but unfortunately the physician
recently retired. He is coming to your clinic for
an initial visit because he is out of the NSAID
he takes for pain and because he has noted some
new numbness on the outside of his left thigh for
the past couple of weeks. He has three children
whom he still supports, and his mother and sister
live in Mexico (part of his income goes to their
support as well). His wife passed away last year
of complications of diabetes at age 52. In the
past he had had health insurance benefits through
his wives work. His present job does not offer
health insurance. Objective GEN Middle-aged
Hispanic man with salt-and-pepper hair and
sun-beaten skin resting comfortably on the exam
table somewhat anxious but in no acute
distress. HEIGHT 74 inches WEIGHT 311 pounds
BMI 39.9 VITALS BP132/72 (large cuff) HR
76/min RR 28/min. T 98.6 F oral. MUSCULOSKELETAL
Lumbar spine has limited range of motion in
all planes secondary to some muscle tightness and
surgical fusion. Mild to moderate muscle spasm
of the paraspinous muscles LR but no trigger
points. No bony tenderness. Moderate
tenderness to palpation over the left sacroiliac
joint with positive pelvic compression. Patrick
and Gaenslen tests both positive. Straight leg
raising reproduces pulling in the bock on the
left side but no radiation into the leg.
Strength, sensation, and reflexes are normal in
both lower extremities except for decreased
sensation to light touch over the distribution of
the lateral femoral cutaneous nerve on the left.
No thigh tenderness. Assessment and
Plan Meralgia paresthetica, probably aggravated
by tight belt and obesity. Unlikely to be caused
by lumbar disk disease or spinal nerve root
impingement. Patient reassured that this will
likely resolve with weight loss and the avoidance
of constrictive garments and belts. May need
dietary consultation if weight loss efforts
fail. Left sacroiliitis with paraspinal muscle
spasm. Refill Naprosyn 375 mg BID for use on a
regular schedule and begin Vicodin for
breakthrough pain, particularly at night. Use
heat and ice as symptomatically helpful. Will
avoid muscle relaxants for now because of
potential sedating effects. Degenerative disease
of the lumbar spine is most likely the cause of
patients chronic pain. Will obtain plain xrays
today and consider MRI if symptoms worsen or
become more suggestive of disk disease or spinal
stenosis. Begin an exercise program and possibly
physical therapy after the S-I joint inflammation
subsides. Will also review the evidence for the
use of glucosamine and chondroitin for
osteoarthritis prior to next visit. Schedule
follow-up appointment in 4 to 6 weeks.
IU MEDICAL CAMPUSES
Indiana University School of Medicine is the only
medical school in the state. In order to serve
the entire state, the School has eight regional
campuses across the state, in additional to the
main campus in Indianapolis. From the north end
of the state to the south GaryIU
Northwest South BendNotre Dame Fort
WayneIPFW West LafayettePurdue MuncieBall
State IndianapolisIUPUI Terre HauteIndiana
State BloomingtonIU EvansvilleUniversity of
Southern Indiana
CONCLUSIONS
TYPES OF BACKGROUND INFORMATION AND BEST
RESOURCES
The different kinds of information needed and
which e-resources to use are more important than
the intricacies of the searching mechanism. As
digital natives, finding information
electronically is second nature to the students
our training session focused on identifying broad
categories of information and the corresponding
e-resource to enhance the efficiency and
relevancy of their search. An online annotated
list of the e-resources that were introduced at
the campuses was made available on the librarys
website (http//medicine.iu.edu/msiresources).
Traffic to the library website continues months
after visiting the campuses. Plans are being
developed to collect information on the value of
the training sessions.
METHODS
First- and second-year medical students at the
Indiana University School of Medicine are located
at nine campuses across the state with varying
methods of instruction. First-year medical
students need a baseline understanding of the
resources available and which resources are best
for certain types of questions. At our training
session, they were presented with a case study
with specific questions to answer, utilizing
e-resources that we presented to them earlier in
the session. The case study and questions had
been used previously to demonstrate searching
features of the various resources. Students
divided into groups that each took a question and
searched the various resources highlighted, then
shared which resources worked best for their type
of question. Our educational emphasis was on the
process of identifying the types of background
information, not the specific answer to a
question. Drug information, lab test normal
values, calculators, physical exams, and
differential diagnoses comprise types of
background information.
ACKNOWLEDGEMENTS
Special thanks to Deborah Griffith, EdD, Kathleen
Zoppi, MPH, PhD, Jennifer Custer, BA, and Javier
Savilla Martir, MD, who created the case study
used for the first year medical students at
Indiana University School of Medicine.
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