Intro to PBL Information Resources
by College of Medicine Inquiry Coil team (updated 8/5/2019)
Warning: If you are using Internet Explorer, please STOP now! 1. Open another Internet browser (we recommend Firefox), 2. In the new browser, go to http://list.unmc.edu/gots/tutorial/pbl • Continue working on the tutorial in the new browser.
Instructions: 1. Resize this instruction window so that it is as long as possible. Resize the resource window so that it can be seen adjacent to the instruction screen. 2. Use the Arrow icons at the bottom of the guide to go forward and backward in the tutorial. 3. Avoid working ahead of the instructions. 4. Use the "Menu/Contents" button above the instruction screen (red arrow in screenshot below) to show the tutorial's "Table of Contents".
5. Clicking the "single-page view" link (purple arrow in the screenshot above) will produce a transcript of the entire tutorial that can be viewed, printed, or saved.
This tutorial is part of the Inquiry Coil that runs throughout your four years of medical education. It uses the case of John Smart, your "Introduction to PBL" patient, to introduce you to the information resources you can use to address your learning issues.
The purpose of this tutorial is to prepare you to • quickly find resources needed to deal with the learning issues that arise during your medical education • quickly find needed information within those resources.
We expect you to spend 60-90 minutes on the tutorial and to locate the materials you need for tomorrow's "Introduction to PBL" session when you have finished the tutorial.
You are required to complete a post-test after you complete this tutorial. The link is on your Canvas class site. We expect completion of the required post-test to take less than 5 minutes.
After completing this tutorial, you will be able to:
1. Identify a database, ebook, or website you can use to research a learning issue.
2. Search the resource to find information for your learning issue.
3. Create a simple PubMed search strategy.
4. Contact a librarian when you need more help.
There are two ways to access to the information resources covered in this tutorial: 1. Through the PBL Resource Research Guide: http://unmc.libguides.com/pbl 2. Or through the library homepage, • either directly https://www.unmc.edu/library , or by using the library link at the bottom of all unmc.edu pages. • Go to the Quick Links section of the library homepage. o AccessMedicine, VisualDX, and UpToDate are in the Clinical Resources section. o PubMed is in the Literature Databases section, listed as “MEDLINE via PubMed”.
• If asked to do so, login with your UNMC e-mail username and password (UNMC Net ID)
Earlier today, you were introduced to John Smart, a 24 year-old, male, medical student with pain. You and your colleagues listed learning issues. These learning issues are topics about which you need more information.
During tomorrow's PBL session, and most PBL sessions, you will be asked to summarize the case. You will be asked to present the case in the format used by M3 and M4 medical students presenting to supervising physicians during attending rounds. Are there any resources to help you determine the expected format?
All medical students will learn to summarize cases during the course of their studies. When you encounter this type of learning issue, something every medical student will learn, consider consulting a printed or electronic book. When you're not sure what book you need, try searching the library's largest e-book collection, AccessMedicine, which includes: • Many standard clinical texts • The Lange series of basic science and clinical medical texts. These Lange texts cover basic and clinical sciences and have been very popular with medical students. • Diagnosaurus: a tool that lists alternative diagnoses (differential diagnoses) for specific, individual symptoms/signs. • Drug information monographs • Various medical calculators
We'll start by looking for resources on summarizing your case. Information on the best way to present at attending rounds can be found in AccessMedicine. • Click on the "Clinical Resources" button under Quick Links. • Click on the "AccessMedicine" link. • Type in the keywords – attending rounds – in the search box.
The search results will appear. Note the result that deals with Attending Rounds: So You Want to be a Scut Monkey?
Now search AccessMedicine for other learning issues you have identified, and evaluate the results. Are they useful? Pay close attention to the date the resource was last updated or published.
During today’s PBL session, your group listed some of the possible diagnoses in a differential diagnosis list for upper abdominal (epigastric) pain. Should additional diagnoses be added to your list? Resources you can use to create a differential diagnosis list are: VisualDX, AccessMedicine’s Diagnosaurus, and UpToDate. You will explore VisualDX first.
Click here to open Visual Dx on the right-hand side of the window.
To reach VisualDx in the future, go to the library homepage and click on Clinical Resources in the Quick Links box.
One of your learning issues may be the causes of abdominal pain. Type in Abdominal, choose Abdominal Pain. This takes you to the workup for Abdominal Pain.
Pick the relevant type of abdominal pain from the options offered to you: Epigastric pain. • Look to the right. • Notice that "Epigastric pain" has been added to the findings of the differential diagnosis you are building.
• If necessary, correct the age range and the gender selections that are shown.
• Now direct your attention to the left. • Click on "GI Symptoms". Does John have any of these symptoms? • Click on "Physical GI Signs". Does John have any of the listed signs? • Click on "Onset of Findings" Are any of the available options relevant? The "Developed chronically" option could be relevant.
• Next, click on "Appearance of patient" and select the relevant option. • Continue working your way down the panels listed on the left, making any relevant selections. • When you click on "Additional Findings", you will be offered a search box. • Try searching for burning Are any of the offered options relevant to John's burning pain?
• Try searching for stress Is a relevant option offered? If so, click on it. • Now look to the right again.
• Click on the "View This Differential" button.
Small images of the synopsis pictures will appear.
Perhaps you should consider adding some of the listed diagnoses to your differential diagnosis list?
Some common symptoms/signs are shown on the picture of each diagnosis. It's important to remember: • many patients do not experience all of the common symptoms. • you may find that a diagnosis with many matching symptoms is actually unlikely when you read the additional information available. • you need to keep a range of diagnostic possibilities in mind.
Place your cursor over a picture, John's symptoms/signs that match the condition description are shown.
Click on a picture to see a synopsis.
More information on each condition is available • You can click on the "See full article" link to see more information. • Alternately, you can click the "UpToDate" link and read an article in UpToDate.
Next you will explore UpToDate, which typically provides very useful differential diagnosis lists.
UpToDate is an online collection of frequently updated, peer-reviewed articles about clinical topics.
It includes articles of great interest to • primary care physicians • subspecialists (for instance, articles relevant to specialists in high risk obstetrics, pediatric cardiovascular surgeons, etc.) • pharmacists and other allied health care professionals
This resource can also be used to locate a differential diagnosis list.
Click here to open UpToDate. Remember that you can find it on the library homepage in the Clinical Resources section of Quick Links.
Type abdominal pain in the search box. Hit the "Search" button.
• Note the many relevant links. • To see a differential diagnosis list, click "Causes of abdominal pain in adults".
Scan the page that appears. Note the topic outline on the left side of the page, including the graphics and tables lists.
Before moving on to a new UpToDate article, scroll up to the top of the article and look at the information about updating, authors and editors.
How does this information affect your comfort in relying on this resource as opposed to a textbook resource in AccessMedicine?
After you reach the search results page, click on the "Evaluation of the adult with abdominal pain" result, and scan the outline in the navigation panel to review the sections relevant to John's care.
AccessMedicine also has a differential diagnosis tool for you to explore, Diagnosaurus.
To use this tool: o Go to AccessMedicine o Click on the "Quick Reference" drop-own menu o Select "DDx"
PubMed makes searching the journal literature relatively easy. It is best used to locate the most recent information on a learning issue topic and to find types of information that are only published in the journal literature.
Developed and maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine, PubMed is made up of over 30 million citations, covering life sciences, public health, behavioral sciences, animal sciences, chemical sciences, and bioengineering. It is updated daily, and contains records dating back to 1966. The developers are selectively adding earlier records, going back to the 1800's.
Each student is expected to bring at least one journal article to one of the sessions for each of your future PBL cases. It's worth taking some time to practice PubMed search techniques and methods for obtaining full-text articles now. Note: Always enter PubMed through the library website, either through Quick Links or Resources, to connect to UNMC’s full-text articles The first step in conducting a PubMed search is formulating your question. Please visit this UNMC video tutorial https://youtu.be/ll2jUo3RiuQ to learn how to: 1) create a concept table that lists your search concepts, and 2) use Boolean operators to focus your search.
We created a simple search using the lessons taught in the UNMC video tutorial. We used the AND Boolean operator to connect the two concepts. We also created a searchable phrase by using quotation marks: "medical students". Using quotation marks around a multi-word phrase makes PubMed search the entire phrase, rather than separate individual keywords.
The search in PubMed ends up being: “medical students” AND stress.
Review the results for appropriate citations. Check for full text by clicking on a citation title. You will see a red GetIt@UNMC button - click it to see if it is available.
An important hint: if the first button says ‘free’ or ‘open access', like the left button in the example below, click it instead of the red GetIt@UNMC button.
Continue searching for your other learning issues, and be prepared to share a full-text article during Tuesday’s session.
Next, you will explore how to request articles through Interlibrary Loan.
You may click on a citation’s red GetIt@UNMC button and see a message that says: “Sorry, this item is not available…”.
This means it isn’t in the UNMC collection. If it is an article you want to read, you can order it by clicking on the blue “Order item through Interlibrary Loan” button, and login using your UNMC netID. It generally takes up to 2 business days to receive an article you have requested, though some articles can take longer.
As you seek to answer your learning issues and increase your inquiry skills, UNMC librarians are ready to assist you. You can reach out for help through the following channels:
• Calling 402-559-6221 (M-F, 8-4:30pm CT) • Texting 402-370-5016 (M-F, 8-4:30pm CT) • Chat at https://www.unmc.edu/library/ • Emailing askus@unmc.edu • Filling out the AskUs Form
NOTE: Your assignment requirement is the 4 question quiz on the Canvas site.