Helping a dental school put the “e” in evidence-based dentistry

INTRODUCTION

Evidence-based dentistry (EBD) was officially recognized in the United States in 2001 with the adoption of the American Dental Association's (ADA's) Policy on Evidence-Based Dentistry, which provided a definition of EBD and clearly defined guidelines. EBD's recognition has since grown, and, in 2006, ADA's representative, Daniel Meyer, stated, “the need for an evidence-based approach to oral healthcare and the practice of dentistry is greater than ever” [1]. In this spirit and in the same year, the Alumni Medical Library at Boston University joined the Boston University School of Dental Medicine's (BUSDM's) initiative to strengthen the role of EBD in its curriculum. The library's efforts focused specifically on the first two steps of the ADA's EBD process: (1) defining a clinically relevant question and (2) conducting searches for evidence [2], as these steps call for library-related information skills. This article describes the role of the library in helping BUSDM faculty and students find the evidence to be successful EBD practitioners.

LIBRARY INTEGRATION PROPOSAL AND COURSE PREPARATION

In preparation for increased collaboration with BUSDM, more than 200 print and electronic dental books were added to the library's collection. Prior to this expansion, the education librarian met with the BUSDM associate dean for academic affairs in February 2006 to learn more about the BUSDM curriculum and inform purchasing. Guided by the ADA's emphasis on the 2 library-related EBD steps, the librarian also presented a detailed lesson plan for a possible basic library skills training designed for first-year dental students. The lesson plan mirrored the type of course proposal a BUSDM faculty member would submit, complete with learning objectives, hands-on activities, and training logistics. Although librarians commonly create such lesson plans at Boston University, it was especially important in this case because they were hoping to request course hours for the training and wanted to demonstrate that the librarians could be held to the same standards as BUSDM faculty. Lastly, while preparing for the meeting, the librarian performed an Internet search that revealed the dean's significant involvement in ADA EBD activities and his strong support for initiatives that foster lifelong learning, interests that the proposed training would support.

The dean was receptive to the collection expansion and the plan for introducing library training to the student curriculum. In line with professional experience in libraries demonstrating that information literacy training is most effective when it is integrated into a curriculum [3], the dean suggested expanding the library's role in the fall of 2006 through partnering with the mandatory first-year course, “Evidence-based Dentistry” (course outline in Table 1 online).

MEETING WITH THE COURSE FACULTY

The EBD course has been offered since 2000 and is led by a well-respected course director who had several valid questions about integrating an information skills session into their established course. These initial concerns were addressed in several joint meetings between the librarians and course faculty. The first concern regarded incorporating a 90-minute training session into an already packed curriculum. Fortunately, the dean quickly added the necessary time to the course, eliminating any adjustments to existing course content. The course director also questioned whether the students would take the session seriously. To address this concern, the librarians and faculty added an in-class assignment to the library training worth 10% of the student's final grade. The librarians readily integrated the assignment, agreeing that it would help focus the students. The training was also structured to emphasize the importance of information skills for a practicing dentist, thereby reinforcing the workshop's lasting value and importance to students who would potentially be distracted by more immediate course concerns.

PREPARING FOR THE LIBRARY TRAINING

To complement the EBD course and emphasize its key principles, the librarians made modifications to the original lesson, which ranged from updating search examples to integrating an in-class assignment. These modifications were implemented in coordination with BUSDM faculty, which allowed both groups to leverage each other's subject expertise. For example, to guide the librarian's search examples, faculty wrote a case that described a pregnant woman with periodontal disease and her potential increased risk of delivering a low-birth-weight child. Throughout the case-development process, the faculty consulted with the librarians to ensure that issues arising in the material were compatible with available resources such as MEDLINE.

Similarly, as the librarians modified their lesson plan, they sought faculty feedback to ensure that the content was appropriate for the students. For example, as search terms were selected for examples drawn from the case study, the librarians verified these terms with the faculty to ensure that they would be understood by students just beginning their dental training.

The librarians' expertise was also utilized in creating online forms to capture in-class assignment submissions. This collaborative relationship was especially valuable as it allowed misunderstandings to be immediately addressed. For example, at first, the faculty were uncomfortable with the amount of time the librarians' lesson plan dedicated to general library skills, such as online catalog searching, and asked for a focus on journal literature to complement the EBD skills, such as critical appraisal and study design, introduced in the course. Through communication and revision of the plan, the faculty and librarians reached a balanced compromise that included both basic and EBD-focused information skills.

Librarians also leveraged the expertise of the Boston University Center for Excellence in Teaching (CET). Approximately one month prior to the official training, the librarians taught the complete lesson for the CET director, who then offered constructive feedback on teaching styles and the overall lesson plan. This process improved the training considerably.

TRAINING

Faculty training

Prior to the student training, the BUSDM faculty were trained by librarians. As Haden et al. point out, “faculty development is not optional—it is a necessary condition for change and innovation in dental education” [4]. Team-taught by two librarians, this ninety-minute hands-on faculty training reached fifteen faculty members, who were granted continuing education credits for participating. This training was requested by BUSDM administration to synchronize the information skills of the BUSDM faculty and first-year students and to further infuse EBD across the curriculum. The training was based on the rationale that faculty members familiar with information resources and confident in their skills would more likely integrate EBD information resources into their courses.

The faculty training employed the lesson plan designed for the student training, which allowed the librarians to test technology, integrate feedback from the CET, run search examples, and become familiar with the training materials. This session also acquainted the librarians with the specialized vocabulary used by faculty for dental concepts introduced in the periodontal disease case, providing an opportunity for further refinement of the content of the student training. In addition to these logistical benefits, the training was valuable because it allowed the librarians to demonstrate their teaching abilities, showcase library's resources, and interact with busy teaching faculty.

Student training

In October 2006, 5 librarians conducted 12 ninety-minute hands-on EBD skills sessions over a period of 2 days in 3 computer labs. All students had access to a computer during the training. These combined resources enabled all 115 first-year students to be trained in groups of 10 to 12 over 2 days, during which all other BUSDM classes were cancelled.

Due to the students' varying information literacy levels, the training began with a basic search demonstration using the Ovid MEDLINE system and was designed to provide students with a baseline understanding of searching. Following this demonstration, the assignment was introduced using online forms created by the library's web coordinator. These web pages included the case and input fields for the student's patient, intervention, comparison, and outcome (PICO) and clinical questions. Upon completion of the in-class assignment, students electronically submitted their assignments to the BUSDM faculty for grading. Because the assignment focused on PICO and clinical question formation, BUSDM faculty and the librarians decided that, as subject experts, it was appropriate for the BUSDM faculty to grade the assignments.

Following the assignment, students volunteered their PICO and clinical questions. The librarians then guided students to the BUSDM's “gold standard” clinical question. Once a searchable clinical question was formed, the students researched the question using the Ovid MEDLINE system and techniques introduced earlier. During this time, the librarian circulated through the classroom, answering questions and providing suggestions for improving the students' searches. After approximately ten to fifteen minutes, the students were asked to present their strategies. Using the SMART SynchronEyes classroom management software, the librarian projected each volunteer's search on the main teaching screen. This exercise was well received by both students and librarians. In several cases, the librarians found that projecting student searches provided natural teaching moments by allowing the introduction of valuable information that may not otherwise have been covered. Additionally, librarians found that this component generated high levels of student conversation and interest.

EVALUATION

In the session's final five minutes, librarians distributed evaluations created by the BUSDM Office of Education Research and Evaluation (OERE), a step that again mirrored a faculty-led course (Appendix online). Completed by all 115 students, these evaluations were collated by the OERE and provided general feedback on the training and each library instructor. Table 2 provides a sample of the evaluation results. The authors acknowledge that these evaluations represent self-reported data and have plans to enhance the assessment to collect objective evidence of the training's efficacy.

Table 2 Student responses to the evaluation question, “The time spent in the library training was worthwhile”

CURRENT STATUS AND FUTURE DIRECTIONS

The future looks bright for increased collaboration between BUSDM and the library. For example, librarians were invited to provide increased training to students and faculty during the 2007/08 academic year. This training will include an additional ninety-minute mandatory hands-on basic information skills training for all first-year students, allowing more advanced EBD search techniques to be introduced in the subsequent EBD session. In addition to increased training opportunities, the information services and education librarian has joined several curriculum subcommittees, which has been valuable in keeping the library's education program current and relevant. For example, during a committee meeting, the BUSDM faculty communicated that the school was adopting a case-based curriculum and that cases were to be paper based. With this knowledge, the librarians volunteered to host BUSDM cases on their website with the value-added feature of linked relevant information resources. The BUSDM faculty enthusiastically accepted this offer, and the project is ongoing.

CONCLUSION

Through its 2001 policy statement, the ADA made EBD a priority and identified the ability to formulate clinical questions and search the literature as essential steps in this process [1, 2]. This top-level emphasis on developing information skills provides opportunities for librarians serving dental schools to offer their unique expertise [5]. While the authors acknowledge that their experience may not be directly transferable to other libraries, this collaboration suggests several ideas for those considering similar initiatives. For example, librarians seeking to begin such collaborations should identify key players at their dental schools and actively pursue all opportunities, ranging from serving on curriculum committees to offering faculty research assistance. Additionally, librarians should propose a realistic integration plan—incorporating librarian, faculty, and student perspectives on key skills— and be flexible to changes suggested by their collaborators. Also, looking internally at their own departments, librarians should ensure that they have administrative support, as demands on staff and resources may be extensive. In the current project, for example, librarians dedicated more than fifty hours preparing and teaching the BUSDM training sessions. Lastly, librarians should identify unique value-added elements, such as online support, to demonstrate their ability to move beyond traditional library services and generate enthusiasm for library and faculty collaboration. Just as librarians play essential roles in helping medical schools meet medical accreditation requirements [6], they can also help dental schools integrate the EBD process defined by the ADA.