Teaching First-year Medical Students Where to Go
Teaching First-year Medical Students Where to Go First: Connecting Information Needs to e-resources
Elizabeth C. Whipple, Margaret (Peggy) W. Richwine, Kellie N. Kaneshiro, and Frances A. Brahmi
Indiana University School of Medicine, Indianapolis, IN
ABSTRACT
The purpose of this project was to introduce first-year medical students to electronic resources that are
best suited for different types of background questions. Specific questions from a case study were
presented, and the students generalized them into a ‘‘type’’ of question. They then identified the best eresources for that type of question. This is their first introduction to the lifelong learning competency in
the Indiana University School of Medicine competency-based curriculum.
KEYWORDS
Electronic resources, medical education, medical students, problem-based learning
Full reference can be found at:
http://www.tandfonline.com/doi/abs/10.1080/02763860902816909#.Um_SrVMntaU
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Teaching First-year Medical Students Where to Go
INTRODUCTION
Different information resources are useful at different stages throughout the formal education of
medical students. During the fall semester of medical school, the Ruth Lilly Medical Library introduced
first-year medical students at the Indiana University School of Medicine (IUSM) to the electronic
resources (e-resources) available to students. The method of dissemination employed a problem-based
learning style. Information was presented in a didactic setting, followed by hands on exploration,
discussion, and evaluation of the resources.
BACKGROUND
IUSM 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 addition to the main campus in Indianapolis. First- and secondyear medical students attending IUSM are located at these nine campuses and receive varying methods
of instruction, including didactic lecture, problem-based learning, and team-based learning. In addition,
the IUSM curriculum is a competency-based curriculum, with students having to achieve certain levels
within each of the nine competencies—Effective Communication; Basic Clinical Skills; Using Science to
Guide Diagnosis, Management, Therapeutics, and Prevention; Lifelong Learning; Self-Awareness, SelfCare, and Personal Growth; Moral Reasoning and Ethical Judgment; Problem Solving; Professionalism
and Role Recognition; Social and Community Contexts of Health Care—to successfully matriculate. Each
IUSM campus (see Figure 1) possesses its own unique characteristics and strengths, as well as unique
ties with each location’s host university and community.
The Ruth Lilly Medical Library (RLML) in Indianapolis is the home library with extensive resources for the
medical students all across the state. To support the lifelong learning competency in the first year, the
librarians at RLML meet with the first-year students during their first semester to introduce them to e-
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Teaching First-year Medical Students Where to Go
resources that are best for different types of background questions. Background questions are often
generated from case studies and focus on definitions and general knowledge to fill one’s basic level of
knowledge. During their first two years in medical school, students complete their basic science classes,
regardless of their campus. They are in the process of building their knowledge base before moving into
the third and fourth years, typically more focused on clinical experience.
METHODS
First-year medical students need a baseline understanding of the resources available and which
resources are best for certain types of background questions. The authors had one hour with the
students to cover the material and provide them time to work in groups. The training sessions began
with an explanation of background questions and the importance of these background questions when
building a knowledge base. The authors highlighted 11 types of background questions they may
encounter during their first two years of medical school (see Table 1). A presentation of available eresources that would provide information for these types of background questions followed, complete
with screenshots and highlights of some unique features for each e-resource. The students were then
presented a case study (see Appendix) with specific questions to answer, utilizing e-resources presented
to them earlier in the session. Students were divided into groups; each group was assigned a question
and searched the various resources highlighted, and then shared which resources worked best for their
type of question. Students found these highlighted e-resources via a Web site
<http://library.medicine.iu.edu/body.cfm?id=39> designed specifically for them by RLML librarians; this
specialized Web site listed the highlighted resources with a brief annotation for later reference and
clarification. Each group informally shared findings with the class for its particular question; the students
shared their specific question, the type of question (background information), and the resource(s) they
thought were most appropriate, easy to use, answered the question the best, and so forth. Librarians
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Teaching First-year Medical Students Where to Go
were able to provide the high quality and useful resources for the students, and the students, in turn,
shared their findings with their peers and learned from each other. Students were directed to a
summary Web page<http://library.medicine.iu.edu/body.cfm?id=247> created by RLML librarians that
categorized the relevant e-resources for the different types of background questions. This page
reinforces what the students discovered during their exploration and is intended to be used as a
reference for the students throughout medical school.
DISCUSSION
The educational emphasis was on the process of identifying the types of background information, not
the specific answer to a question. Medical students will encounter many questions throughout their
medical career, and the questions will certainly be more varied than the 11 presented to them in this
instance. Medical students need to be equipped with skills to generalize their question to a type of
question, know where to look for answers, and be able to use this basic information-seekingmethod to
find answers to the kinds of background questions they will encounter early in their medical school
careers. Being able to apply information-seeking skills is also a component of the Lifelong Learning
Competency, which addresses recognizing ‘‘personal limits in knowledge and experience and
energetically pursuing information necessary to understand and solve diagnostic and therapeutic
problems.’’1
RESULTS
A short evaluation was distributed at four of the remote campus locations. From the student responses
(n¼71), the following adjectives described the e-resources session: informative (89%), useful (82%),
well-organized (79%), practical (69%), technology contributed to learning (62%), interesting (56%), and a
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Teaching First-year Medical Students Where to Go
friendly, networking atmosphere (49%). Selected snippets from the students’ comments concerning the
most helpful information they received included:

Learning how to search using the different databases and what they were ‘‘good’’ for.

Introduction to library resources—‘‘it’s what I’ve been looking for (and actually asked a
professor about without results) for a while.’’

Doing the hands-on work on the computers.
LIMITATIONS OF THE STUDY
There are a plethora of e-resources available to the students that may answer background questions
they will encounter throughout medical school. It would be impossible to highlight all of these resources
in the time allotted and may only contribute to greater information overload. In addition, an hour limits
the resources that can be introduced in a meaningful way. While students may Google and find
something (or millions of hits), this educational program showed them resources specifically tailored for
medical students (electronic textbooks, medical calculators, anatomy images, and normal laboratory
values) during their first two years.
CONCLUSION
Informing medical students about e-resources available to them during their first semester of medical
school gives them the tools to build their knowledge base. Teaching medical students which types of eresources are best suited for which type of question prepares them to successfully find information for
the many questions they will encounter and teaches lifelong learning skills.
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Teaching First-year Medical Students Where to Go
REFERENCE
1. IUSM Competency Curriculum. IV. Lifelong Learning. From ‘‘The Indiana Initiative: Physicians for the
21st Century.’’ (September 16, 1996). Available:
<http://meded.iusm.iu.edu/Programs/Competencies/Compt4.htm>. Accessed: December 10, 2008.
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Teaching First-year Medical Students Where to Go
ABOUT THE AUTHORS
Elizabeth C. Whipple, MLS (ewhipple@iupui.edu) is Research Informationist/Assistant Librarian;
Margaret (Peggy)W. Richwine, MS, MLS, AHIP (mrichwin@iupui.edu) is Director, Outreach Services;
Kellie N. Kaneshiro, AMLS, AHIP (kkaneshi@iupui.edu) is Coordinator, Information Services Team; and
Frances A. Brahmi, MA, MLS, PhD, AHIP (fbrahmi@iupui.edu) is Curriculum and Education Director; all at
Indiana University School of Medicine, 975 West Walnut Street, IB 100, Indianapolis, IN 46202-5121.
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Teaching First-year Medical Students Where to Go
TABLE 1 Type of Background Information
Definition, basic facts
Practice of medicine
Disease – description, diagnosis, and treatment
Drug – indications, interactions, etc.
Differential diagnosis
Diagnostic examination
Laboratory test values
Calculators
Guidelines
Images
Review article
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Teaching First-year Medical Students Where to Go
FIGURE 1 Indiana University School of Medicine Campuses.
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Teaching First-year Medical Students Where to Go
APPENDIX—CASE STUDY
Initial Clinic Visit:
Subjective: Sr. Roberto Martinez is a 55 year old diabetic 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, Sr.
Martinez worked as a farm laborer in rural northern Indiana. Four years ago, he was in an automobile
accident and injured his back. 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. Sr. 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.
Past medical history is significant for type II diabetes diagnosed 8 years ago which has been reasonably
well-controlled with metformin. Social and family history: He currently drives a truck for a landscaping
and yard care service. 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 due to
complications of diabetes at age 52. In the past he had health insurance benefits through his wife’s
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: BP:132=72 (large cuff) HR: 76=min RR: 28=min. T: 98.6 F oral.
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Teaching First-year Medical Students Where to Go
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 L>R 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 back 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:
1. Meralgia paresthetica, probably aggravated by tight belt and obesity. Numbness 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.
2. 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.
3. Degenerative disease of the lumbar spine is most likely the cause of patient’s chronic pain. Will
obtain plain X-rays 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.
4. Type II diabetes mellitus, uncertain control. Obtain hemoglobin A1C.
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Teaching First-year Medical Students Where to Go
Schedule follow-up appointment in 4 to 6 weeks.
Questions regarding Sr. Martinez to research:
1. What is meralgia paresthetica and how is it treated?
2. What are paresthesias? What are other possible causes (i.e., the differential diagnosis)?
3. What is the Patrick test and what does a positive result mean?
4. What is hemoglobin A1C, and what is the normal reference range?
5. What are some adverse effects of metformin? Does it interact with Vicodin?
6. Given Sr. Martinez’ history of diabetes, how would you calculate his risk of stroke over the next
10 years?
7.
Where can you find an image of the sensory distribution of the lateral femoral cutaneous
nerve?
8. Where can you find an easy-to-read authoritative Spanish language article on losing weight to
give Sr. Martinez?
9. Where can you find local financial assistance programs that may be able to help Sr. Martinez?
10. Where can you find a review article that discusses the use of both glucosamine and chondroitin
for osteoarthritis?
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