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Practice Gives Skill: Preparing Students to Present Evidence in Clerkships

(2021)

Practice Gives Skill: Preparing Students to Present Evidence in Clerkships 

Amy C. Studer, RN, MSN, MSLIS, AHIPa and Nicole Capdarest-Arest, MA(LIS), AHIPa  

aBlaisdell Medical Library, University of California – Davis, Sacramento, CA  

ABSTRACT 

Idea:  

Building an evidence-based practice module using principles of self-directed learning to prepare medical students to present evidence in clerkship.  

Need & Rationale:  

Our Transition to Clerkship (T2C) course occurs immediately prior to starting of clerkship rotations and includes an evidence-based medicine (EBM) module. T2C had been synchronous and in-person for all Year 3 medical students, but due to the COVID-19 pandemic, content needed to be revised to be delivered virtually. This prompted the instructors of the EBM module to re-envision the content to increase emphasis on the main module deliverable: a practice oral evidence presentation. This deliverable was also identified for increased emphasis from prior years’ students and course faculty leaders. Furthermore, it addresses Core Entrustable Professional Activities 1 and identified needs to practice oral presentation 2-4. The content was revised to be asynchronous and to further develop learner skills in finding evidence related to a clinical question, synthesizing that evidence, and then supportively practicing 5 the new skill of presenting an oral evidence synthesis for a clinical setting.  

Methods:  

Learning objectives for the EBM module focused on: 1) identifying tools for finding evidence at the point of care, 2) using effective search strategies for finding evidence, including guidelines, 3) synthesizing evidence into a brief oral evidence presentation, 4) practicing delivery of an oral evidence presentation, including giving and receiving feedback. Instructors provided learners with frameworks and instructions to support their success with the activities, which were designed to be accomplished in 2 - 3 hours. The module consisted of pre-work and a paired activity. The pre-work focused on context for clinical oral evidence syntheses and on finding quality evidence. The paired activity consisted of selecting from a menu of topics, finding a relevant guideline and a primary study, synthesizing evidence found, recording and presenting a brief oral update to a peer, and providing peer feedback. To encourage self-direction as well as teamwork5, learners were asked to complete the pre-work and organize with their pre-assigned partner an online meeting to practice presenting the oral brief as well as providing feedback according to a rubric for one another. Learners each submitted and recorded a video of themselves delivering their brief evidence oral presentation. In this format, learners are able to deliberately practice an oral evidence presentation in a safe environment assuring a supported practice opportunity before moving into the clinical environment 2,4. 

Evaluation Plan:  

Instructors reviewed each student’s submitted video based on the peer feedback rubric and then provided aggregate feedback to the students. Instructors also reviewed all of the submitted peer feedback forms with an eye to how learners analyzed each other’s performance. Both instructors agreed that this was a more effective way to assess the quality of student work related to the activity and their ability to provide constructive peer feedback. Instructors also asked learners to provide (optional) immediate feedback about the EBM module. Students responded that the instruction was effective and that they appreciated the overall organization and structure, learning how to find guidelines, and the opportunity to practice presenting in a safe environment. The School of Medicine also solicited student feedback about the EBM module, with largely positive results. In preliminary feedback, most students who rated the module rated it as very effective (in line with or better than other sessions in T2C). There were many favorable student comments such as, “I loved the EBM project and found it especially useful specifically to 3rd year.” Instructors were impressed by the high level of engagement that students demonstrated for the activities in this module, as compared with prior years’ in-person sessions. In the future, instructors hope to seek additional feedback from learners once they are further along in clerkship rotations and integrate further goal-directed practice.  

Potential Impact on the Field or Beyond:  

Synthesizing and orally presenting evidence in the clinical space is a core skill 1 requiring practice and feedback. Providing measurable, skills-based learning activities immediately applicable across all clerkships will help learners more readily succeed and perform in clinic.  

Keywords: third-year medical students; medical education; evidence-based practice; presentation skills; peer feedback; asynchronous learning; transition to clerkship; use of technology; online learning  

References 

1. Association of American Medical Colleges. Core EPA Publications and Presentations. 2020. 2020; https://www.aamc.org/what-we-do/mission-areas/medical-education/cbme/core-epas/publications.Accessed September 25, 2020.

2. Van Ginkel S, Gulikers J, Biemans H, Mulder M. Towards a set of design principles for developing oral presentation competence: A synthesis of research in higher education.Educational Research Review.2015;14:62-80. 

3. Ireland C. Apprehension felt towards delivering oral presentations: a case study of accountancy students.Accounting Education.2020;29(3):305-320. 

4. Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications.J Gen Intern Med.2001;16(5):308-314. 

5. Lerchenfeldt S, Mi M, Eng M. The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review.BMC medical education.2019;19(1):321. 

6. Aronowitz P, Chen D. Daily Update Oral Presentation Podcast [Internet]: podtail; 2016. Podcast. Available from: https://podtail.com/en/podcast/mountainlion/daily-update-oral-presentation-podcast/

  • 1 supplemental PDF
Cover page of Protocol for a Scoping/Systematic Review: Scoping Review Prevention of Shipping Fever in cow-calf operations

Protocol for a Scoping/Systematic Review: Scoping Review Prevention of Shipping Fever in cow-calf operations

(2020)

Background: The judicious use of antimicrobials in the livestock industry has become a topic of increasing interest over the last few years. Bovine respiratory disease (BRD) is considered mainly a problem of feedlot cattle or dairy calves, but a survey on the use of antimicrobials in California cow-calf operations revealed that BRD is in the top three diseases that ranchers treat most frequently with antimicrobials. There are both viral and bacterial causative agents that are associated with BRD. The pathogenesis of these agents often depends on the immune status of the animals and stress is considered to play major role in exacerbating the problem. In cow-calf operations these stressors can be in the form of management procedures such as processing of calves where they may be castrated, vaccinated, receive ear tags or being branded. Weaning is another stressful event in the life of a calf where the effects can be synergized if the calf is also transported at the same time. Due to the climate and landscape in California, cattle are often transported to different pastures in the summer and winter to take advantage of availability of feed year-round in different parts of the state at different times of the year. Vaccination, immune modulation, improving immune status through mineral supplementation and good colostrum[1] can all play a role in prevention of the disease relative to transportation. In this review we explore the available literature for evidence of effective methods to prevent BRD in cattle in California after transportation.

Objectives:  The objective of this scoping review is to examine and describe the existing literature on methods for the prevention of BRD that can be implemented in cow-calf operations in California and therefore reduce the use of antimicrobials due to BRD.

Design: Primary research on prevention of BRD due to shipping stress will be considered for inclusion. The process for selection and inclusion of the studies will be reported in a flow chart according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The results will be summarized in tables and charts describing study types, interventions and outcomes.

Cover page of <strong>Protocol for a Scoping/Systematic Review: Non-antimicrobial approaches for the prevention or treatment of infectious bovine keratoconjunctivitis applicable to cow-calf operations</strong>.

Protocol for a Scoping/Systematic Review: Non-antimicrobial approaches for the prevention or treatment of infectious bovine keratoconjunctivitis applicable to cow-calf operations.

(2020)

Antimicrobial stewardship promotes best practices for the prevention, treatment and control of diseases that require antimicrobial treatment such that development of antimicrobial resistance is prevented and/or reduced. Infectious bovine keratoconjunctivitis (IBK, pinkeye) is one of the most important diseases requiring use of antimicrobials in cow-calf operations in California according to a recent survey of ranchers in this state conducted by the California Department of Food and Agriculture. The efficacy of antimicrobial treatments for the disease have been well documented and summarized. However, less information is available on non-antimicrobial measures to prevent, control or treat the disease. In order to inform best practices for the judicious use of antimicrobials on cow-calf operations, this review explores the literature for evidence of effective methods to prevent pinkeye as well as of effective non-antimicrobial treatments.

Cover page of Protocol for a Scoping/Systematic Review: Scoping Review of Vaccination for the Prevention of Calf Scours in Cow-Calf Operations

Protocol for a Scoping/Systematic Review: Scoping Review of Vaccination for the Prevention of Calf Scours in Cow-Calf Operations

(2020)

Background: The use of antimicrobials in the livestock industry has been a topic of increasing concern in the last  few years. Calf scours is one of the main causes of mortality among calves younger than 1 month and affects the development of the animal, representing severe economic losses to the producers. The causes of the disease include a variety of viral, bacterial and protozoal pathogens, and other non-infectious causes. The treatment efficacy, in particular of antimicrobial therapy, depends on the type of infection. Blanket antimicrobial treatment for calf scours without identification of the pathogen may contribute to antimicrobial resistance. In this review we explore the available literature for evidence of effective methods to prevent calf scours in cow-calf operations in California through the use of vaccination.

Objectives:  The objective of this scoping review is to examine and describe the existing literature on vaccination for the prevention of calf scours that might reduce the incidence of calf scours by different causes, and therefore reduce the use of antimicrobials due to calf scours.

Design: Primary research on vaccination for pathogens that cause calf scours will be considered for inclusion, such as studies conducted in pre-weaned calves that report the efficacy of vaccines for the prevention of calf scours. The process for selection and inclusion of the studies will be reported in a flow chart according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The results will be summarized in tables and charts describing study types, interventions and outcomes.

Cover page of  <em>Effectiveness of Antimicrobials in the Treatment of Neonatal Diarrhea in Calves: A protocol for a Systematic Review and Meta-analysis. </em>Authors:  Bernal Cordoba, Erik Davis Fausak, N. Silva del Rio

 Effectiveness of Antimicrobials in the Treatment of Neonatal Diarrhea in Calves: A protocol for a Systematic Review and Meta-analysis. Authors:  Bernal Cordoba, Erik Davis Fausak, N. Silva del Rio

(2019)

Background:Neonatal diarrhea affects nearly 25% of pre-weaned calves. Prevention through management practices is the preferable approach to control diarrhea. Once calves experience diarrhea, fluids, electrolytes and acid-base balance need to be restored. Severe cases of diarrhea should be treated with antimicrobials but the need of antimicrobials in mild and moderate clinical cases it is still under debate.

Objectives:The objective of this study is to evaluate the efficacy of antimicrobial treatments or the comparative efficacy of antimicrobials treatments in calves with mild, moderate and severe diarrhea.

Design: The search strategy will be based on population (calves with diarrhea), and intervention (antimicrobial therapy). The following data bases will be used: Medline, CAB abstracts, Scopus, and Biosis. The outcomes of interest will be the occurrence and persistence of clinical signs of diarrhea, rate of growth, weight gain, feed efficiency or mortality.