Center for Information Mastery
The mission of the Center for Information Mastery at the University of Virginia is to be a center of excellence and leadership, locally, nationally and internationally, in developing processes to create, access, and evaluate knowledge, and efficiently deliver that knowledge to health care professionals, patients, and the community; and by so doing, insuring that physicians have the information they need to deliver the highest quality care available to all.
The Center for Information Mastery will help academic faculty from all health care disciplines develop the skills necessary to teach the concepts of information mastery to medical students, residents, faculty, and practicing clinicians. This includes designing formal curricula for specific specialties and health care disciplines, as well as specific evaluation techniques to assess the success of these efforts. The Center will also guide clinicians and educators to further develop their own scholarship skills, and to share what they learn and discover with others, including colleagues, staff and patients. In addition, The Center for Information Mastery will help guide the expansion and development of courses and information sources for the public.
A major focus of the Department of Family Medicine at the University of Virginia has been to practice and teach Information Mastery, a methodology for providing clinicians with the best possible information available at the "point-of-care" to assist in caring for their patients. Information Mastery allows physicians to maximize the value of their services by paying close attention to costs and balances with information evaluating the quality of their interventions as they relate to the patient, patient's family, and the entire community.
From 1996 to 2005, our Department hosted an annual conference aimed at training academicians to learn the skills they need to teach Information Mastery, and over 500 individuals have attended the course since its inception. Most recently we have developed an "implementation into clinical practice" focus track for practicing clinicians wishing to develop information mastery skills aimed at guiding their everyday practice of medicine. We are enthusiastic about our ability to continue offering the yearly conference at Tufts University.
For a detailed listing of the slides, articles, and handouts from the University of Virginia/Tufts University Information Mastery Course, as well as a summary of the recent redesign of the Department's weekly Information Mastery Practicum, please visit this link.
Health care professionals rely on many sources of medical information- journal articles and reviews, textbooks, colleagues, continuing medical education conferences, practice guidelines, videotapes and audiotapes, and pharmaceutical representatives- yet most of us have had little formal training in assessing the clinical usefulness of the information obtained from each source. Although most physicians rate journal articles as their preferred source of new information, this source is rarely employed by busy clinicians. Even when physicians do turn to the research literature to answer clinical problems, in a recent study of MEDLINE use in clinical settings, less than 1% of citations retrieved on questions of clinical management contributed to a new or changed decision. Former Vice-President Al Gore has summarized the current state of information management as "resembling the worst aspects of our agricultural policy, which left grain rotting in thousands of storage files while people were starving".
The Evidence-Based Medicine Working Group's Users' Guides to the Medical Literature focuses on developing skills for critical reading of the research literature: the How to read journal articles. Being a truly "informed consumer" of medical information will require guidelines for evaluating the many other sources of information available to us.
When physicians read journals, attend conferences, or consult with colleagues, our goal is to spend the least amount of time and energy finding the best information. Let's face it- we're all busy with other important aspects of life besides medicine (the three "fs"-family, friends, fun), yet we want to always do the best possible for our patients! The ultimate in useful information must have three attributes: it must be relevant to everyday practice, it must be correct, and it should require little work to obtain. These three factors can be conceptually related in the following manner:
Relevance, the initial aspect of this equation, focuses on what should be our ultimate destination- finding information on how to help our patients live long, functional, satisfying, pain- and symptom-free lives. We have incredible amounts of information about disease: etiology, prevalence, pathophysiology, pharmacology. These "intermediate level" studies are absolutely crucial to medicine. We must understand how a disease "works" before we can diagnose, treat, or prevent it with any certainty. Little of this information, however, tells us with certainty how to accomplish our ultimate goal. What we are looking for is patient-oriented evidence. This type of evidence evaluates the effectiveness of interventions that patients care about and that we, as physicians, care about for our patients. This concept of "real-world" research- the so-called "outcomes" movement- has surfaced only in the last few years. These studies focus on interventions that are used in clinical practice and their effect on significant outcomes that matter.
Validity defines to what extent the knowledge gained as a result represents the "truth". Well-designed clinical trials that minimize bias are more likely to provide valid conclusions.Validity assessments of research articles are best performed by applying the excellent guides for critical reading published by the Evidence-Based Medicine Working Group. Although this task can be delegated to an "expert", each of us must accept responsibility for assuring that validity has been critically assessed. It is not enough to accept evidence at face value simply because it has been published in a well-known journal or comes recommended from a specialist.
Work is the negative attribute that we must consider when evaluating the usefulness of information. Working too hard to establish the validity or relevance of information will lower the usefulness. On the other hand, a low work-factor source may also have low validity or relevance. The best source of information would provide highly relevant and valid information with minimal effort required to obtain it. Unfortunately, sources such as this are rarely available. Thus it is necessary to look for balance among the three factors.
Using relevance as the primary screen before determining validity results in the least amount of unnecessary work. Answering "yes" to the following three questions will help us identify information of relevance requiring validation:
1) Will this information have a direct bearing on the health of my
patients, i.e. is it something they care about?
For research articles the conclusion section of the abstract will usually give all the information necessary to answer these three questions.
When all three of these questions are answered with a "Yes", we call this type of study a POEM.
POEM stands for Patient-Oriented Evidence that Matters. POEMs have to meet the three criteria in the questions above.
Because POEMs are valid, improve important patient outcomes and change what we do, we have an obligation as physicians to know about them. Evidence-Based Practice makes sure that you know about all the POEMs, all the time.
Clinicians are faced with incredible amounts of information about disease: etiology, prevalence, pathophysiology, and pharmacology. These "intermediate level" studies are absolutely crucial to medicine. We must understand how a disease "works" before we can diagnose, treat, or prevent it with any certainty. Little of this information, however, tells us with certainty how to accomplish our ultimate goal. What we are looking for is patient-oriented evidence. This type of evidence evaluates the effectiveness of interventions that patients care about and that we, as physicians, care about for our patients.
For example, an article about prostate cancer screening with the PSA (prostate-specific antigen) assay may report the sensitivity, specificity, and predictive values for identifying men with prostate cancer. Another article may report survival rates for different treatments and stages of prostate cancer. Neither of these tell us, however, what we and our patients really want to know: whether they will be better off (live a longer, healthier, happier life) as a result of identifying the cancer. Only a randomized trial evaluating the overall effect of early detection on the mortality and morbidity of prostate cancer will provide this information.
The Center for Information Mastery focuses on three different components of delivering information to health care clinicians. The goal of the information delivery system is to place the best possible information into the hand of the clinician at the point of care when they are in contact with patients. The four components of this system include:
1) The Research Division: This includes both original research and "refined" or "secondary" research. The focus on the development of the original research component will be on outcomes-based research, in coordination with clinical experience. This goal is being supported by the establishment of a community practice based research network. Refined/secondary research will entail taking products of original research and refining them into usable products for practicing clinicians. This includes systematic reviews/ meta-analyses, evidence based reviews of important clinical questions, decision analyses, cost analyses, CARE products (Comprehensive Assessment of Research Evidence) on important primary care issues and first alert "POEM" systems for newly published information.
2) The Informatics Division is focused on creating products, including handheld computer software, web-based tools, and push/pull electronic medical record technology to make clinicians aware of important information and provide it to them at a "just in time" focus, right when they need it when they are seeing patients. This Division is collaborating with the Family Practice Inquiries Network to develop systems capable of answering a significant component of physicians' questions in sixty seconds or less.
3) The Education Division is focused on
training faculty to both use the information products and be involved
in the actual creation of the products themselves, including being part
of a practice based research network and/or helping to write systemic
reviews and other refined/secondary sources of information. By so
doing, faculty will become more effective scholars.
Dr. David Slawson, the B. Lewis Barnett, Jr. Professor of Family Medicine, Director of the Center for Information Mastery. He holds a joint appointment as Professor in the Department of Health Evaluation Sciences. Dr. Slawson is a graduate of the University of Michigan School of Medicine and completed his postdoctoral training in Family Medicine at the University of Virginia. He returned to the University of Virginia in January 1994. Dr. Slawson is one of the innovators and creators of the Information Mastery paradigm used for teaching the application of best evidence to clinical practice. Dr. Slawson has published extensively in this area and directs an annual course at the University that attracts medical educators and practicing clinicians from around the world. He also serves as assistant editor for The Journal of Family Practice and is a member of the editorial board for The Journal of the American Board of Family Practice, the American Family Physician, and BMJ USA. The design and focus of the Center for Information Mastery project builds upon Dr. Slawson's work in the area of information and evidence-based medicine.
Fern Hauck, MD, MS, Director of Research. Dr. Hauck serves as the leader of the Research Division and coordinates the Department efforts at developing publishable scholarly work, both as original research and refined research, including systematic reviews and meta-analyses.
Lisa Rollins, PhD has extensive experience in both curriculum development and in the evaluation of teaching methods. Dr. Rollins will lead both the educational and evaluation divisions of the Center. This will include the designing of courses that will offer high-quality "evidence-based" CME to practicing clinicians in Virginia.