A Team Approach to Teaching Skills Required for an Informationist Role in Evidence-Based Clinical and Public Health Practice*†

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Bringing evidence to practice: a team approach to teaching skills required for an informationist role in evidence-based clinical and public health practice*†

Kathleen Burr Oliver, MSLS, MPH; Prudence Dalrymple, PhD, AHIP; Harold P. Lehmann, MD, PhD, FACMI; Deborah Ann McClellan, PhD; Karen A. Robinson, MSc; Claire Twose, MLIS

See end of article for authors’ afﬁliations. DOI: 10.3163/1536-5050.96.1.50

Objective: The objectives were (1) to develop an Intervention: A 1.5-credit, graduate-level course, academic, graduate-level course designed for ‘‘Informationist Seminar: Bringing the Evidence to information professionals seeking to bring evidence Practice,’’ was offered in October to December 2006. to clinical medicine and public health practice and to In this team-taught course, a series of lectures by address, in the course approach, the ‘‘real-world’’ course faculty and panel discussions involving time constraints of these domains and (2) to further outside experts were combined with in-class specify and realize identiﬁed elements of the discussion, homework exercises, and a major project ‘‘informationist’’ concept. that involved choosing and answering, in both oral and written form, a real-world question based on a Setting: The course took place at the Division of case scenario in clinical or public health practice. Health Sciences Informatics, School of Medicine, Johns Hopkins University. Conclusion: This course represents an approach that could be replicated in other academic health centers Participants: A multidisciplinary faculty, selected for with similar pools of expertise. Ongoing journal their expertise in the course core competencies, and clubs that reiterate the question-and-answer process three students, two post-graduate National Library of with new questions derived from clinical and public Medicine (NLM) informationist fellows and one health practice and incorporate peer review and NLM second-year associate, participated in the faculty mentoring would reinforce the skills acquired research. in the seminar.

INTRODUCTION Highlights

● Interdisciplinary faculty designed and offered a grad- Current and accurate information is a critical compo- uate-level course to teach the skills required by an nent of good health care practice, and the role that information professionals can play in facilitating the informationist in clinical and public health practice, transfer of evidence into practice is continuing to ex- further elaborating a model for preparing information- pand. Over thirty years ago, Lamb drew attention to ists. the gap that can exist between the published clinical literature and the knowledge that individual physi- Implications cians bring to bear on a patient’s care [1, 2]. As part ● This scalable approach to teaching skills for the trans- of her work in this area, she established the first clin- fer of evidence into practice could be replicated in ical librarian program at the University of Missouri– academic health centers with similar pools of exper- Kansas City School of Medicine in 1971. In the 1990s, tise; such replication could contribute data toward val- Giuse and her colleagues at Vanderbilt University Medical Center expanded this concept by redefining idating this training approach. the clinical librarian’s role, implementing and evaluat- ● Greater clarity on an appropriate, or ‘‘good enough,’’ standard of evidence for supporting point-of-action decision making is needed. * The authors acknowledge with appreciation the contributions that ● Based on the assumption that practicing skills in- funding from the National Library of Medicine (NLM) made to the training programs described (1F37LM008608-01, 1F38LM008610-01, creases confidence and the likelihood that skills will and the second-year associate fellowship). Kathleen Burr Oliver ac- be applied, this course included mentored practice of knowledges the Centers for Disease Control and Prevention Information oral and written evidence presentation skills. Further Center and its director, Jocelyn Rankin, AHIP, FMLA, for funding an research could determine whether a course that in- Oak Ridge Institute for Science and Education (ORISE) fellowship that cludes such mentored practice increases the likeli- led to the one of the NLM informationist fellowships described above and enabled some development and testing of the public health infor- hood that students will apply their newly acquired mationist concept. skills. † Based on a presentation at the ‘‘Evidence Based Library and In- formation Practice Conference (EBLIP4)’’; Chapel Hill, NC; May 6– 9, 2007.

50 J Med Libr Assoc 96(1) January 2008 Bringing evidence to practice ing innovative practice with intensive care and other contributed positively to the team’s ability to respond teams that emphasized acceptability by clinicians and effectively to those needs. demonstrated competencies of medical librarians [3– From this literature emerges an implicit mandate to 6]. train informationists. In 2005, the Welch Medical Li- In 2000, Davidoff and Florance [7, 8] expressed con- brary at Johns Hopkins University responded to this cern about inadequate inclusion of new knowledge need by sponsoring two National Library of Medicine from the published literature in clinical decision mak- (NLM) informationist fellows, designing individual- ing and called for development of a new professional ized curricula to provide training in the skills required to address this gap. To respond to clinical realities, for their new roles as informationists. This paper de- they proposed developing a ‘‘national program, mod- scribes the design and content of this approach to in- eled on the experience of clinical librarianship, to train, formationist training and discusses the results and les- credential, and pay for the services of information spe- sons learned from the first offering of this seminar in cialists’’ [9]. These ‘‘informationists’’ would be cross- the fall of 2006. trained specialists who have specific content knowledge, could provide in-depth information services, and COURSE DESIGN AND OVERVIEW would be uniquely qualified to apply their expertise to information problem solving in a specific domain The ‘‘Informationist Seminar: Bringing the Evidence to [9]. Practice’’ course was a 1.5-credit, graduate-level course The name, the role, and even the need for such in- offered through the School of Medicine at Johns Hop- formation specialists are topics under debate in the lit- kins. Taught for the first time in October to December erature. Whether the informationist is really a new 2006, this seminar was designed for information pro- professional category or just a new word for a clinical fessionals seeking to develop the core competencies re- librarian, whether the informationist can be seen as quired of an informationist in the fields of clinical naturally evolving from the clinical librarian’s histori- medicine and public health: how to identify a ques- cal role, and what might be the distinguishing char- tion; how to search for and critically appraise the avail- acteristics of the informationist are just some of the able, relevant evidence; and how to effectively present questions being asked [7, 8, 10–19]. that evidence in response [18]. In particular, the goal Models in which information specialists facilitate the of this first course presentation was to address the spe- application of evidenced-based answers to questions cific curriculum needs of two NLM informationist fel- arising in clinical practice have been tested interna- lows: a senior fellow whose focus was clinical and a tionally as well. In 2002, Greenhalgh and colleagues junior fellow whose focus was public health. Both of [20] at the University College London Medical School these NLM informationist fellows were medical librar- described and compared two models of ‘‘informati- ians. A third student, a second-year NLM associate cist’’ service: one, ‘‘more academically rigorous with a fellow and medical librarian, audited the course. All research component and little personal contact with three either had completed or were currently taking practitioners,’’ and the other, ‘‘based in a general prac- basic classes or coursework in statistics. tice and one that took a more flexible, facilitative ap- The course faculty, chosen on the basis of their ex- proach.’’ pertise in the required competencies, consisted of a Considerable attention has been paid to the appli- librarian with public health training, who served as cation of the informationist concept to the clinical set- course director and recruited the other participating ting, and the importance of such a role in basic re- faculty; an NLM post-doctoral informatics fellow, who has been a faculty member and administrator in a search has been considered [21, 22]. However, less at- graduate school of library and information science; a tention has been paid to the role of the informationist clinician educator, who practices medicine and teaches in the public health setting, although there is a grow- evidence-based medical care; a systematic review ex- ing need for research into roles that combine the pert, who serves as co-director of the Johns Hopkins unique attributes of public health expertise (i.e., the Evidence-based Practice Center; an expert searcher, focus on a population versus an individual, the drive who has post-graduate training and several years of to advance prevention, and the need to evaluate pro- experience conducting searches and teaching search grams and activities) with expertise in library and in- methodology; and a scientific editor, who teaches bio- formation science and technology. In 2003, Swain and medical writing. The involvement of faculty with a colleagues [23] reported an early exploration of a team wide range of expertise reflected the recognition that role for information professionals in public health as the skills needed by informationists are multifaceted. part of a training exercise for bioterrorism prepared- The faculty worked together as a team to develop and ness and response at the US Centers for Disease Con- teach the course, meeting extensively in the months trol and Prevention (CDC). For the training exercise, preceding the course to read and discuss the relevant they demonstrated strategies to meet the needs of pub- literature, to arrive at a concerted understanding of the lic health professionals working in the field, with all informationist concept, and, especially for the nonli- its associated information retrieval and connectivity brarian faculty, to fully appreciate and acknowledge challenges. In an independently administered evalua- the merit in training information professionals for a tion of the exercise, team members stated that the in- role in facilitating the transfer of evidence into practice. formationist’s expertise as an information professional Based on their discussion, the faculty agreed on the

J Med Libr Assoc 96(1) January 2008 51 Oliver et al. competencies to be taught and identified the most ef- seek an exception to the required professional infor- fective didactic approaches to meet the objectives of mation degree. the course. Evaluation of student performance was based on class participation, completion of reading assignments Competencies and homework exercises, and satisfactory completion of a major project (described below) that involved Skill in identifying and searching resources relevant to choosing and answering, in both oral and written a particular question is an essential part of librarian- form, a real-world question based on a case scenario ship. The faculty chose to include searching as a com- in clinical or public health practice. petency for the course because the students’ experience in searching the literature varied, with some being Course format more experienced than others. The faculty reasoned that at a minimum, this approach would offer a valu- In this team-taught course, a series of lectures by able review, provide a context for the subsequently course faculty and panel discussions involving outside taught competencies, and could conceivably improve experts were combined with in-class discussion and already-acquired skills. homework exercises. In general, each class session in- Traditional training in clinical librarianship enables cluded a didactic lecture or panel discussion, labora- students to understand the clinical context and theory tory exercises applying the principles articulated in the of levels of evidence but not how to identify, evaluate, didactic presentation, a discussion of the previous and effectively present evidence in response to a clin- week’s assignments, and a class component related to ical or public health question. Medical residents often each student’s major project. The final class was de- gain such competency in applying evidence-based voted to the students’ oral presentations and the re- medicine principles to the bedside during the course sponse of the course faculty, students, and invited of months of clinical care and rounds. To provide in- guests to those presentations. formationists with a comparable level of skill in identifying and presenting relevant evidence in a shorter Course content period of time, the course faculty made these core competencies a focus of this team-based course [24]. Introductory sessions. The course began with an introduction to the concept and evolution of the informationist role, which was followed by panel discus- Course objectives sions involving several invited clinical and public The course objectives were to teach students to (1) un- health experts who described their work environments derstand and demonstrate the evidence-based answer- and the types of questions that are asked in their work ing cycle, which includes the ability to define a tax- settings. The panel members elucidated their need for onomy of questions; (2) describe the answer process evidence, including the timeframes in which they and identify a question domain; (3) learn to search, needed questions answered and the types of evidence screen, and evaluate evidence to support a query; (4) they required. During the first class session, course demonstrate appropriate skills for presenting evi- participants were also given a one-hour overview of dence-based data; and (5) demonstrate team member- the overall process for developing a systematic review ship and participation in a framework defined by real- of the literature, as the ‘‘gold standard’’ for assessing world time constraints. the state of the published literature addressing a clinical or public health question [18, 25–29]. Educational strategies The major course project: answering a real-world A modified seminar format, combining lectures and question. A major focus of this course was a project laboratory exercises with in-class discussion and a ma- designed to give the students hands-on experience in jor project, was used to teach the skills involved in analyzing and presenting evidence to support decision finding, analyzing, and delivering evidence for clinical making by health practitioners in a particular situa- and public health decision making: the identification tion. Because it was such an integral part of the course, of a question embedded in a case presentation, devel- the project was woven into each class session. opment of effective search strategies for relevant evi- At the beginning of the course, the students began dence to address the question, evaluation and synthe- work on this major course project by selecting a pri- sis of the identified evidence, and effective presenta- mary question from a list of real-world questions con- tion of that evidence. The course followed the eight- tributed by several members of the clinical and public week format typically used by the schools of medicine health faculties at Johns Hopkins. These questions in- and public health, with the class meeting once weekly volved health care scenarios that were of particular for three hours per week. professional interest to the experts who had posed Course prerequisites included a master’s degree them. Examples included: ‘‘There was a recent review from an accredited library and information science article that salmeterol can kill patients. How should we program or permission of the instructors. Evidence of be using it in pediatric asthma?’’ and ‘‘Provide a back- an applicant’s training and experience in literature ground literature review for a randomized controlled searching was considered an important factor in the trial (RCT) being undertaken with methamphetamine- instructors’ evaluation of course applicants who might using youth in Thailand. Specifically: what is the hu-

52 J Med Libr Assoc 96(1) January 2008 Bringing evidence to practice man immunodeficiency virus (HIV) risk among drug- and depth so as to avoid introducing bias into the pro- using youth?’’ cess. While the clinical informationist program at Van- The selected questions were then used as real-world derbilt has developed standards of practice, such as examples for the class exercises and formed the basis determining the best articles representing multiple of the students’ final oral and written presentations. viewpoints found to address a question under exam- The students were given contact information for the ination [6, 33–35], there is currently no widely estab- person who had originated the question they had cho- lished standard for a sufficient search-and-screening sen, and they were encouraged to establish ongoing process. The focus of a sufficient search, as presented contact with the question originator to allow them to in this course, was on identifying pre-appraised evi- obtain feedback and, as necessary, to refine the origi- dence. nal question and their answer. Students were first advised to identify the highest Students’ progress in carrying out the major project, quality evidence available, starting with a search for including oral and written presentations at the conclu- evidence-based guidelines from the National Guide- sion of the course, was monitored on an ongoing basis line Clearinghouse [36] and websites of relevant pro- during class sessions. They received periodic feedback fessional societies. They were then instructed to look from the faculty and their fellow students with regard for systematic reviews through searches of The Coch- to the formulation of their question, their search strat- rane Library, PubMed, and Embase. Then students egy, and their analysis of the evidence they obtained. were instructed to look for primary studies. For ques- Homework exercises and each assignment related to tions addressing therapy or treatment, students were the major project (defining a search strategy, conduct- advised to seek RCTs, which are considered the gold ing the search, evaluating the search results, and pre- standard of evidence for such questions. For other senting the results in written and oral form) were re- sorts of questions, faculty and students discussed what viewed by the appropriate faculty members. The stu- they considered to be appropriate sources. For in- dents’ presentations at the end of the course were eval- stance, for questions about incidence or prevalence of uated by course faculty, with additional input from the diseases, the recommendation was made to seek pop- clinical and public health practitioners who posed the ulation-based studies or surveys from the appropriate questions addressed by students. In addition, each stu- agencies. For each of these types of evidence, clear def- dent acted as a peer reviewer of another student’s initions and suggestions for screening results were search strategy and final written presentation. provided. Some of the criteria for screening that were discussed with the students related to recentness and Course sessions. The remaining class sessions— directness, that is, how closely the article matched the ‘‘Question and Context Specification,’’ ‘‘Searching and question being asked. Screening,’’ and ‘‘Effective Presentation of Search Re- As a homework exercise, the students were asked to sults’’—were designed to address a series of identified develop a search strategy for their primary question learning objectives related to the core skills needed by and for a classmate’s question and to present them informationists. The approach taken to help students orally at the next class session. During the following achieve each of these objectives is described in the fol- session, the students presented their own search strat- lowing sections. egy and reviewed and critiqued each other’s strategies. Objectives 1 and 2: To understand and demonstrate the Objective 3, part 2: To evaluate and synthesize evidence evidence-based answering cycle, including the ability to lo- to support a query. In these sessions, the faculty re- cate the question at hand in an established taxonomy of ques- viewed how to identify different types of guidelines tions, to describe the answer process, and to identify a ques- and studies and pointed out the potential sources of tion domain. Ely and Osheroff have articulated the con- bias for each of these sources of evidence. This discus- cept of a taxonomy of questions that are relevant to sion led to an overview of critical appraisal, including clinicians [30–32]. The course faculty used this concept the identification of existing forms and resources for to raise the students’ awareness of the attributes of completion of appraisals. The standard critical ap- possible questions, not only their domain (e.g., cardiac praisal forms for therapy, diagnosis, etiology, and versus endocrine), but also their type and purpose, as prognosis studies are available from a number of suggested by the Ely-Osheroff taxonomy. Echoing the sources, including the Evidence Based Medicine Tool working hypothesis underlying these two researchers’ Kit produced by the University of Alberta and the investigations, the faculty pointed out the need for in- Center for Evidence-based Medicine tools [37]. The formationists to match the resources and the type of JAMA user guides to the medical literature [38], cov- evidence summary to the type of questions being ering a broader range of article types, are also avail- asked. able freely online. Through feedback on their presen- Objective 3, part 1: To learn to search and screen evidence tations, the students reviewed the appropriate lan- to support a query. Two class sessions were devoted to guage to use to describe the results of studies and the searching, screening, and evaluating the literature. recommendations from guidelines. While teaching the mechanics of good searching is rel- Objective 4: To demonstrate appropriate skills for pre- atively straightforward, the challenge for information- senting evidence-based answers. As preparation for their ists is to define a ‘‘sufficient search’’: a search that, final presentation, the students first drafted a written while not a comprehensive search of the kind per- synthesis of the evidence they identified as addressing formed for a systematic review, is of sufficient scope their real-world question. The students then partici-

J Med Libr Assoc 96(1) January 2008 53 Oliver et al. pated in a class session on effective writing, which fo- the pragmatics of answering questions was based on cused on stylistic approaches to achieving accuracy, the faculty members’ experiences with clinical servic- brevity, clarity, and responsiveness to the question and es, both as librarians and as attending physicians con- its context. Illustrative examples drawn from the stu- cerned with teaching evidence-based medicine. The dents’ drafts and other related documents were used students were advised to base their presentations on as a starting point for a discussion that underscored the following outline: common errors that can interfere with comprehension — Restatement of the question: This restatement and emphasized the importance of technical accuracy would remind the group of the question, focus their and sensitivity to the readers’ expectations. The stu- attention, and indicate the clinical assumptions that in- dents then read each other’s drafts and offered con- formationists intuited because of their domain knowl- structive suggestions for their improvement. The edge, which would further serve to increase credibility course instructors also provided feedback regarding (e.g., a request for information about tympanograms both content and writing style. On the basis of these implies that pneumatic otoscopy has already been at- comments, the students produced a revision for which tempted). they received a grade. Before their final oral presen- — A brief mention of the sources searched: The pur- tation to the faculty and the practitioners who had de- pose here was to point out that there is more to search- veloped the case scenarios, the students’ written syn- ing than just consulting PubMed. theses were edited for grammar and style by one of — A brief summary of the ‘‘answers’’ provided in the the faculty members. The students used these sugges- resource and any critical-appraisal issues or conflicts tions to polish their final written syntheses that were between the sources: This type of summary served to distributed during the oral presentations. temper the perception that a single article answers the Objective 5: To demonstrate team membership and par- clinical question. ticipation through oral presentation of an answer, within a The videotaped final oral presentation simulated a framework defined by real-world time constraints. In the rounds experience, with the audience standing and the context of the learning environment, the students had presenter expected to present the highlights with cred- several weeks to work with one question and prepare ibility, reserving details for requests only. Immediate an answer. However, decisions about sources to search, constructive criticism and suggestions were offered by types of evidence to consider, and specific content and the faculty and fellow students. First, the audience’s format of the answer were made based on the premise visceral reaction was sought: Was the presentation con- that, in the real world, the students would have a very vincing? Did the audience feel that it got an answer? limited time to prepare and present an answer. In a Was it an authoritative answer? Was it the right an- lecture and laboratory session addressing the oral pre- swer? Then, both the style and content were discussed. sentation of an answer in the clinical or public health The videotapes were not only useful for discussions context, specific attention was paid to the challenge of with students during the practice sessions, but they garnering the respect of those asking a question. Prac- proved, and will continue to prove, useful for other tice presentations were videotaped and replayed as reasons as well. For example, one faculty reviewer was needed during the discussion that followed. A recur- unable to attend the final presentation but later used ring theme in the class was the necessity for the infor- the videotaped presentation to provide feedback and mationist to balance the rapid response time needed comments to one of the fellows. The course faculty will by the clinical team with the desire for complete and draw on the videotaped practice and final presenta- correct results. In particular, the faculty pointed out tions by the students from the first course in planning the lack of research to guide the informationist in mak- the next course offering (scheduled for spring 2008). ing this tradeoff: There is currently no available evidence- or principle-based method to help clinicians, MAIN OUTCOMES librarians, or informationists decide when to stop a search and to summarize what has already been Three students enrolled in this first offering of the found. Learning the art of successfully achieving this seminar: two NLM informationist fellows and an tradeoff between completeness and rapid turnaround NLM second-year associate fellow. All three students is a key goal in on-the-job learning, and that future were active participants in the class, and they success- goal was pointed out to the students. More concretely, fully completed the assigned exercises and delivered the presentation itself was done with the entire class final oral and written presentations of evidence for standing, to model the pressured environment and im- their chosen real-world cases. mediacy of clinical information exchange on the ward. At the conclusion of the course, the students were Particular emphasis was placed on understanding asked to complete an anonymous online evaluation the context of the clinical group, because this is one of adapted from a standard Johns Hopkins course eval- the most stressful, high-pressure environments in uation form. The course received an overall evaluation which informationists might be asked to function. Stu- of 4.66, with 5 (‘‘excellent’’) being the highest possible dents were advised that they could gain respect in score. Student comments ranged from ‘‘this was a re- such situations by finding clinically relevant resources ally good course’’ to suggestions for improvement in that the medical residents and attending physicians workload pacing, timing for synthesis instruction— had not found and by demonstrating knowledge of the one suggested it start earlier—and concern about mid- clinical context and its constraints. Advice regarding course revisions of the syllabus. All students rated the

54 J Med Libr Assoc 96(1) January 2008 Bringing evidence to practice course content goals and the usefulness and practical- who could train or act as role models for its fellows, ity of the content as 5 out of 5. The degree to which this informationist training course was developed by the goals were achieved received an average score of assembling an interdisciplinary team of faculty mem- 4.3 out of 5. Clarity of goals, organization and se- bers, each of whom had expertise in one or more of quence of content, and style of education all received the required skills. The varied backgrounds of the fac- an average rating of 4.3. All students said they would ulty, along with the prior clinical and public health recommend the course to other fellows, agreed that experience of the students, enriched the classroom dis- the course would improve their professional effective- cussions and highlighted differences in disciplinary ness, and found the course intellectually challenging. approaches to information gathering and evidential Positive feedback was also received from the clinical problem solving. For example, the clinical approach to and public health practitioners who provided the information seeking tends to focus on issues related to questions addressed by the students in their major applying results of a systematic review of RCTs to a project. One of these practitioners commented that the specific patient, where the degree of fit between the search turned up articles he had previously not seen patient and the evidence must continually be consid- and that he had subsequently retrieved them for re- ered by the clinician. In public health, on the other view. There was also a general consensus among the hand, decisions regarding a particular treatment ap- course planners that the course, as taught, was clearly proach may be applied to large populations compris- only introductory in nature. The course faculty sensed ing thousands of individuals and representing a mul- that the competencies presented in the course would titude of personal situations and contexts. actually merit a full graduate degree program, in The faculty members all brought expertise in differ- which expanded coursework in each competency ent aspects of the skill set needed for the information- would be combined with mentored internships and ist role, but their exposure to the concept of this new ongoing seminars. In recent months, other librarians professional role varied. During the sessions on at Johns Hopkins have expressed interest in the course, searching and screening, several of the course faculty which will next be offered in the spring of 2008. One shared additional insights with the class that ad- of the enrolled NLM informationist fellows reported dressed searching in their own particular domains of use of the skills he acquired in the course: Shortly after expertise, and the exchange that ensued demonstrated the seminar concluded, he was called on to respond the iterative nature of question formulation and search to a question from a clinician and to present the rele- development. vant data found. The clinician soon returned with an- An interesting feature of the planning process for other question and request for available evidence. The this course was the extensive discussion of the litera- fellow interpreted the second request as indicating the clinician’s satisfaction with the first response and as ture that was required as part of the course develop- illustrating the usefulness of the skills he had acquired ment process. This continued discussion among the in the course. faculty led to an evolving course design but also pro- The course faculty met at the conclusion of the moted faculty buy-in to the concept and role of this course to assign grades and reflect on the lessons new professional, the informationist. learned from the course, the most important of which The fellows enrolled in this first offering brought are discussed below. varying levels of background in statistics, epidemiology, search skills, and critical appraisal. During their LESSONS LEARNED AND CONCLUDING post-course evaluation, the faculty agreed that future REMARKS offerings of the seminar should include prerequisites pertinent to the searching and evaluation section of the course: (1) introductory coursework in epidemiology The course described here represents the efforts of an and statistics, (2) more hands-on critical appraisal ex- interdisciplinary faculty—drawing on the evidence in the literature and their own teaching, research, and ercises, and (3) participation in peer-reviewed, search- clinical experience—to develop the informationist con- skill seminars or extensive experience with in-depth cept by designing a course to teach the skills required searching, such as that associated with systematic re- by an informationist to bring evidence to clinical and views. The additional coursework and/or experience public health practice. At present, many of the skills would help ensure that the students were at a com- involved in facilitating evidence-based practice are parable level of understanding and would allow for taught individually and are scattered across a range more in-depth discussions of the issues of bias as well of separate courses offered by library schools, in as avoid some of the issues surrounding the descrip- schools of medicine or public health, and in continuing tion of study results. It would also help ensure that education venues at professional meetings. The new students were advanced in their searching skills. These seminar described here combines a range of such skills additions to the course design would help increase the in one course and supplements other existing resourc- students’ sensitivity to the importance of having rele- es for informationist training, such as Vanderbilt’s re- vant domain knowledge, using language appropriate cent (2006) initiative in publishing case studies of in- to their particular context, and demonstrating superior formationist practice [27]. search skills. Such contextual sensitivity and search ex- Because, like many other academic medical institu- pertise not only help informationists convey knowl- tions, Johns Hopkins had no practicing informationists edge about the topic effectively, but also help them fit

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