Use of Web-based library resources by medical students in community and ambulatory settings

Abstract

Purpose: The purpose was to evaluate the use of Web-based library resources by third-year medical students.

Setting/Participants/Resources: Third-year medical students (147) in a twelve-week multidisciplinary primary care rotation in community and ambulatory settings.

Methodology: Individual user surveys and log file analysis of Website were used.

Results/Outcomes: Twenty resource topics were compiled into a Website to provide students with access to electronic library resources from any community-based clerkship location. These resource topics, covering subjects such as hypertension and back pain, linked to curriculum training problems, full-text journal articles, MEDLINE searches, electronic book chapters, and relevant Websites. More than half of the students (69%) accessed the Website on a daily or weekly basis. Over 80% thought the Website was a valuable addition to their clerkship.

Discussion/Conclusion: Web-based information resources can provide curriculum support to students for whom access to the library is difficult and time consuming.

INTRODUCTION

Medical student education has changed over the past several years from a primary focus on inpatient hospital training to clerkships in community and ambulatory care settings [1]. Ambulatory and community clerkships are designed to provide educational experiences that bring students into contact with patients in outpatient settings, under the supervision of preceptors. The 1999/2000 academic year was the first year for a revised third-year medical school clerkship curriculum at the University of Pittsburgh.

The Community/Ambulatory Medicine Clerkship (CAMC) is a twelve-week multidisciplinary clerkship experience designed to allow students to spend one morning a week on campus and the rest of the week at clinical sites. The clinical rotations included three weeks each in internal medicine, pediatrics, family practice, and a selective, which could be sports medicine, adolescent medicine, or emergency room pediatrics. Frequent contact with course faculty, mentors such as residents and interns, medical student peers, and a medical library are often missing in community settings.

To address the problem of lack of physical access to a medical library, a Website was developed by reference librarians. The Website was designed to link students to library information resources at their community-based clerkship locations. This paper evaluates the use of this Web-based library resource by third-year medical students.

LITERATURE REVIEW

The recent literature examined community-based clerkships from the perspective of the students' satisfaction [2–4] and community preceptor productivity [5, 6]. The literature also addressed the need for access to the medical literature in any setting involving clinical teaching. Friedman discussed pilot research that suggested, for each patient seen in a community setting, a student will have 1.6 questions that require access to the medical literature [7]. A study published by Cogdill and colleagues examined the information needs of community-based preceptors with and without their students [8]. They found that the most frequent questions for both preceptors and students related to diagnosis and drug therapy. However, students also required information about the general management of patients. Only half of the clinical questions in medical teaching rounds that included attending physicians, residents, interns, and students could be answered with the patient's medical record [9]. The other half of the questions might be answered by colleagues and textbooks and through database searches. The literature review, however, offered little information about how to provide library and information resources to students in community-based settings.

METHODOLOGY

As noted above, the twelve-week CAMC for third-year medical students provided three-week-long community experiences in internal medicine, pediatrics, family medicine, and a selective. There were four twelve-week sessions, during the 1999/2000 academic year. Thirty-five to forty students were in each session.

The CAMC Website† was created by librarians from the Health Sciences Library System (HSLS) and faculty from the School of Medicine at the University of Pittsburgh. The purpose of the CAMC Website was to bring information resources in support of the course curriculum directly to the students, either on campus, from home, or at their clerkship sites. The Website originally contained twenty resource topics defined by the clerkship curriculum; examples of resource topics include back pain, hypertension, and cough (Figure 1). Each resource topic provided links to full-text journal articles, MEDLINE searches developed by a librarian, chapters in Harrison's Online, authoritative Web resources, and curriculum training problems. Curriculum training problems were used to help students define a core knowledgebase, encourage mastery of basic skills, and advance professional attitudes and behaviors. The curriculum and curriculum training problems were developed by faculty in the School of Medicine based on the “Core Medicine Clerkship Curriculum Guide,” a cooperative project of the Society of General Internal Medicine and the Clerkship Directors in Internal Medicine. It was created with partial funding support from the Health Resources and Services Administration's Bureau of Health Professions as part of the Undergraduate Medical Education Project (UME-21). Librarians used the curriculum as a guide when selecting articles and Web resources or developing a MEDLINE search. Course faculty also made suggestions regarding articles or Web resources.

Figure 1.

The Community/Ambulatory Medicine Clerkship (CAMC) Website

All the links on the resource topic pages, except for Harrison's Online, were available from any computer with Internet access, on or off campus. Students needed to be on campus to access Harrison's Online. Email links to librarians were available from each page to answer student's questions or address problems. Either a librarian or course faculty member demonstrated the Website on the first day of each session. The CAMC Website contained 203 pages of information.

EVALUATION

Server log statistics

Use of the CAMC Website was followed for the entire 1999/2000 academic year. The WebTrends™ software package was used to read the server log file to determine usage. Use of the CAMC Website increased with each of the four twelve-week sessions, from 2,700 page views in the first session to 6,900 page views in the fourth session. The average number of page views over the academic year was 4,500 (Figure 2). The number of MEDLINE searches run, as well as full-text journal articles and curriculum training problems viewed, also increased during the academic year (Table 1). The number of MEDLINE searches run increased from 41 in the first twelve-week session to 123 in the fourth twelve-week session. In the first twelve-week session, 820 full-text journal articles were viewed, increasing to 2,061 articles viewed in the fourth session. The number of times the curriculum training problems were accessed increased from 22 in the first twelve-week session to 281 in the last session.

Figure 2.

Website use

Table 1 Number of MEDLINE searches and full-text journal articles and curriculum training problems

Post-class evaluation

The students completed an evaluation at the end of each session (Appendix). Of the 150 students in the clerkship, 147 students completed the evaluation. The response rate was 98%.

Based on survey results, 64% of the students owned a computer with Internet access. Access to a computer in the community settings varied by clinical site. At family medicine sites, 56% of the students had a computer with Internet access available. Internal medicine and pediatric sites had less computer availability, 38% and 24%, respectively. At selective sites, 63% of the students had access to a computer with Internet access. A number of students (13%) never had access to a computer with Internet access at any clinical site during the twelve-week clerkship. Students without computer access at home or at a clinical site stated they used the computers in the library or, less often, used a friend's computer.

Students were asked to identify their use of the Website. The CAMC Website was accessed on a weekly or daily basis by 69% of the students (Figure 3). Only three students claimed never to have used the Website.

Figure 3.

Student-identified use

Students were asked to rate the parts of Website by their value, on a scale from 1 to 5, with 5 being the most valuable. Almost 90% of the students rated the full-text article links at 3 or greater. The Website overall was second with 82%, links to curriculum with 72%, and links to other Websites with 57%, and 49% of the students placed value on the textbook chapters (Figure 4).

Figure 4.

Student-identified value

CONCLUSION

Results of this study indicated the students used and found value in the CAMC Website as an information resource. Full-text journal articles and links to the curriculum were the most valued part of the Website; Harrison's Online was the least valued. Conceivably because Harrison's Online was not accessible from all the clinical sites, it had limited use when compared to the other resources on the CAMC Website.

Faculty feedback suggested that as students progressed through their third year, they became more comfortable with clerkships. Initially, students found it difficult to combine the clinical experience with the academic requirements. Results of the study suggest that as the clerkship year progressed, the use of the CAMC Website increased.

Clearly, the availability of computers with Internet access at all the clinical sites and at home may make the CAMC Website more useful to students. The study shows Web-based information resources can provide curriculum support to students for whom physical access to the library is difficult and time consuming.

APPENDIX Community/Ambulatory Medicine Clerkship (CAMC) Web survey