Center for Information Mastery
Information Mastery is the application of the principles of evidence-based medicine concepts and techniques to the day-to-day practice of medical care. The concepts were developed in the early 1990s by Allen F. Shaughnessy, PharmD, MMedEd of Tufts University and David Slawson, MD of the University of Virginia.
There are two main principles of Information Mastery. The first principle is that some information sources are more useful to practicing clinicians than other information sources. Conceptually, the usefulness of any information source depends on the relevance of the information in the source, the validity of this information, and the time, effort, and money required to access the information. These three characteristics can be related in this way:
Usefulness = (Relevance x Validity) / Work
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Concept 1: Patient-Oriented Evidence that Matters (POEMs)
A POEM is information that helps clinicians to help patients live longer and better. It is direct evidence that a medical intervention, on average, lengthens life, decreases symptoms, and/or improves life quality.
POEM information contrasts with “disease-oriented evidence,” information about the nature of disease and treatments that does not directly demonstrate improvement in patient-oriented outcomes. The distinction is important since there are numerous examples of disease-oriented evidence that are contradicted by POEM information.
Disease-Oriented Outcome vs. Patient-Oriented Outcome
Disease-Oriented Outcome: Antibiotic treatment can sterilize the middle ear of children with acute otitis media.
Patient-Oriented Outcome: Antibiotic treatment does not decrease the duration or intensity of symptoms and increases the likelihood of a subsequent episode of acute otitis media.Disease-Oriented Outcome: Intensive glucose lowering can decrease A1c, blood glucose.
Patient-Oriented Outcome: Intensive glucose lowering does not decrease mortality.Disease-Oriented Outcome: Beta-carotene and vitamin E are good antioxidants.
Patient-Oriented Outcome: Neither vitamin prevents cancer or cardiovascular disease.Disease-Oriented Outcome: Erythropoietin in patients with chronic renal failure increases hemoglobin.
Patient-Oriented Outcome: Erythropoietin increases mortality in patients with chronic renal failure.Disease-Oriented Outcome: Varenicline can help some patients stop smoking.
Patient-Oriented Outcome: Varenicline increases the likelihood of cardiovascular disease.While disease-oriented evidence is important for forwarding medical science, changing practice based on this preliminary evidence may result in causing harm to patients.
Article: Becoming a Medical Information Master: Feeling Good About Not Knowing Everything
Concept 2: The Usefulness Equation
Just as all medical information is not equally important, so too is there a difference between sources of information. The Usefulness Equation relates three attributes of information sources:
Usefulness of any info source = Relevance of info x Validity of info
Work needed to obtain info
Relevant information is applicable to one’s practice and is also focused on patient-oriented evidence that matters.Validity is where evidence-based medicine techniques are helpful. Differences in study design and study conduct influence our comfort in the validity of the results.
Work is the time, energy, and money needed to find the needed information. A benchmark for low work is that answers can be found in less than one minute.
Article: Becoming a Medical Information Master: A Guide to the Information Jungle
Concept 3: Two Tools Are Needed to Become an “Information Master”
Tool #1: An information resource to hunt for information at the point of care
Concept 4: “Clinical Jazz”
“Clinical freedom implies doing what is best for patients, not simply doing whatever the clinician wants.” - North of England Guidelines on the Treatment of Asthma
Clinical jazz is a mix of the structure provided by the best available evidence coupled with the clinical experience necessary to understand what each patient needs.
Article: Clinical Jazz: Harmonizing Clinical Experience and Evidence-Based Medicine
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Longitudinal Curriculum
Information Mastery is one of nine key themes that run through all four years of the medical curriculum. In this way, the concepts and practices of information mastery and evidence-based medicine are incorporated in both didactics and on clerkships.
- Year 1: Evidence-based medicine course (See TUSK)
- Year 2: CAP (Competency-based Apprenticeship in Primary care)
- Year 3: Information Mastery Workshop and Information Mastery presentations during the Family Medicine Clerkship
- Year 4: Family Medicine Exploration Elective
- Tufts University Family Medicine Residency at Cambridge Health Alliance: A three-year curriculum continues information mastery with practical experience in using information at the point of care.
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Introduction to Information Mastery
Presentations:
Comprehensive version
Short versionExercise:
Is it a POEM?Readings:
Introduction to Information Mastery
Evidence-Based Medicine: Should We Be Teaching Information Management Instead?Evaluating Research about a Therapy
Presentations:
Comprehensive version
Short versionExercise:
Article to evaluate (Riboflavin for the Prevention of Migraine)Worksheets:
Evaluating Articles About a Therapy
Answers for the article (Riboflavin for the Prevention of Migraine)Reading:
Understanding Treatment ArticlesIntroduction to Basic Statistics
Presentations:
Comprehensive version
Short versionReading:
Statistics DefinitionsEvaluating Research about a Diagnostic Test
Presentations:
Comprehensive version
Short versionWorksheet:
Evaluating Research About Diagnostic TestsReading:
Teaching the Importance of Prevalence: The Case of Baby JeffJust-In-Time Information at the Point of Care
Presentation:
Foraging ToolsWorksheet:
Foraging ToolsReading:
Developing a System for Keeping Up with New InformationForaging and Hunting Live Workshop
Worksheet:
Hunting ToolsReading:
How to Find Answers to Clinical QuestionsUsing Expert-Based Resources
Presentations:
Evaluating Information from Experts (Including CME)
Evaluating Review Articles
Evaluating Clinical Practice GuidelinesWorksheets:
Evaluating Review Articles
Evaluating Clinical Practice GuidelinesReadings:
Obtaining Useful Information From Expert-Based Resources
Finding Relevant and Valid Review Articles
Finding and Using Good Practice GuidelinesThe True Mission of Information Mastery: Using “Medical Poetry” to Remove the Inequities in Health Care Delivery
Presentation:
Using Medical Poetry to Reduce Health DisparitiesEvaluating Decision Analysis
Worksheet:
Decision AnalysisClinical Jazz: Harmonizing Clinical Experience and EBM
Presentations:
Comprehensive version
Short versionReading:
Clinical Jazz: Harmonizing Clinical Experience and Evidence-Based MedicineEvaluating Information from Pharmaceutical Representatives
Presentation:
Evaluating Information from Pharmaceutical RepresentativesWorksheet:
Evaluating Information from Pharmaceutical RepresentativesReading:
Separating the Wheat from the ChaffEvaluating Qualitative Research
Presentation:
Evaluating a Qualitative Research PaperWorksheet:
Evaluating Qualitative ResearchExercises:
Evaluating a Qualitative Research Article (Scenario for article, Freeman J, Loewe R. Barriers to communication about diabetes mellitus. J Fam Pract 2000;49:507-512.)
Completed worksheet (for Freeman J, Loewe R. Barriers to communication about diabetes mellitus. J Fam Pract 2000;49:507-512.)Reading:
Evaluating Qualitative ResearchProblems Teaching Information Mastery
Presentation:
“Bumps in the Road”: Problems and Solutions to Teaching Information MasteryDecision-Making and Information Mastery
Presentation:
Making Decisions Better: Information MasteryTechniques for Teaching Information Mastery
Exercises:
Mythbusters Overview and Exercise
Look-up Conference
The POEM Exercise and Evaluation
Overview of the Information Mastery Practicum at the University of Virginia -
Basic Overviews
- Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master: Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13.
- Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):489-99.
- Slawson DC, Shaughnessy AF. Becoming an information master: Using POEMs to change practice with confidence. The Journal of Family Practice 2000:49:63-7.
- Slawson DC, Shaughnessy AF. Becoming an Information Master. Using “medical poetry” to remove the inequities in health care delivery. The Journal of Family Practice 2001;50:51-6.
- Grandage KK, Slawson DC, Shaughnessy AF. When less is more: a practical approach to searching for evidence-based answers. Journal of the Medical Library Association 2002;90:298-304.
- Ebell MH, Shaughnessy AF. Information Mastery: Integrating continuing medical education with the information needs of clinicians. Journal of Continuing Education in the Health Professions 2003;23:S53-62.
- Slawson DC, Shaughnessy AF. Evidence-Based Medicine: Should We Be Teaching Information Management Instead? Academic Medicine 2005; 80:685–689.
- Hurwitz SR, Slawson DC, Shaughnessy AF. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcomes while saving orthopaedists’ time. The Journal of Bone and Joint Surgery 2000; 82-A:888-94.
- Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools for lifelong learning? British Medical Journal 1999 (13 Nov).
Specific Application
- Ebell MH. How to find answers to clinical questions. Am Fam Physician. Feb 15 2009;79(4):293-296.
- Shaughnessy AF. Keeping up with the medical literature: how to set up a system. Am Fam Physician. Jan 1 2009;79(1):25-26.
- Lin KW, Slawson DC. Identifying and using good practice guidelines. Am Fam Physician. Jul 1 2009;80(1):67-70.
- Slawson DC, Reed SW. Finding high-quality review articles. Am Fam Physician. May 15 2009;79(10):875-877.
- Shaughnessy AF. Evaluating and understanding articles about treatment. American Family Physician 2009;79(8):668-670.
- Shaughnessy AF, Slawson DC, Becker L. Clinical Jazz: Harmonizing Clinical Experience and Evidence-Based Medicine. Journal of Family Practice 1998;47:425-8.
- Shaughnessy AF, Slawson DC, Bennett JH. Identifying Fallacies in Pharmaceutical Advertising: Separating the Wheat from the Chaff. The Journal of General Internal Medicine 1994;9(10):563-8.
- Slawson DC, Shaughnessy AF. Obtaining Useful Information from Expert-Based Sources. Obtaining Useful Information from Expert-Based Sources British Medical Journal 1997 (Mar 29);314:947-9.
- Shaughnessy AF, Bucci KK, Slawson DC. How to be selective in reading the biomedical literature. American Journal of Health System Pharmacy 1995 (May 15);52:1116-8.
- Slawson DC, Shaughnessy AF. Teaching information mastery: the case of baby Jeff and the importance of Bayes' theorem. Fam Med. Feb 2002;34(2):140-142.
Evaluation of Information Mastery Teaching
- Shaughnessy AF, Gupta PS, Erlich DR, Slawson DC. Ability of an Information Mastery Curriculum to Improve Residents’ Skills and Attitudes. Family Medicine 2012;44(4):259-264.
- Slawson DC, Shaughnessy AF. Teaching information mastery: creating informed consumers of medical information. Journal of the American Board of Family Practice 1999 Nov-Dec;12:444-9.
- Shaughnessy AF, Slawson DC, Bennett JH. Teaching information mastery: evaluating information provided by pharmaceutical representatives. Fam Med. Oct 1995;27(9):581-585.
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Worksheets for Determining Relevance and Validity
Diagnostic Test Research Worksheet
Decision Analysis Worksheet
Education Research Worksheet
Foraging Tools Worksheet
Hunting Tools Worksheet
Pharmaceutical Representatives Worksheet
Prognosis Research Worksheet
Practice Guidelines Evaluation Worksheet
Qualitative Research Worksheet
Review Article Worksheet
Treatment research Worksheet -
Tutorials
- Evidence-Based Medicine tutorials at the University of Massachusetts
- Using Evidence at the Point of Care video from the University of Wisconsin
Other Resources
- Greenhalgh, T. How to Read a Paper: The Basics of Evidence-Based Medicine. London, BMJ Books, 2010.
- Grobe HR, Kunathy R, Tramer MR, et al. Evidence-based anesthesiology . Anaesthetist 2011;60(6):407.
- Haines SJ, Nicholas JS. Teaching evidence-based medicine to surgical subspecialty residents. J Am Coll Surg. Aug 2003;197(2):285-289.
- Hurwitz SR, Slawson DC. Should we be teaching information management instead of evidence-based medicine? Clin Orthop Relat Res. Oct 2010;468(10):2633-2639.
- Hutchinson A, Maskrey N, Slawson DC, Shaughnessy AF, Underhill J. Information Mastery: Decision-making and dealing with information overload. In: Mehay R, ed. The Essential Handbook for GP Training & Education. www.essentialgptrainingbook.com, 2012.
- Longyhore D, Ference K, Nansitel B. An Elective Course in Information Mastery. American Journal of Pharmaceutical Education 2011; 75(2).
- Rosser WW, Slawson DC, Shaughnessy AF, eds. Information Mastery: Evidence-Based Family Medicine. 2nd ed. Hamilton, Ont, BC Decker Inc, 2004.
- Sevdalis N, McCulloch P. Teaching evidence-based decision-making. Surg Clin North Am. Feb 2006;86(1):59-70, viii.
- Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology. A Basic Science for Clinical Medicine. New York: Lippincott Williams and Wilkins, 1998.
- Strauss SE, Glasziou P, Richardson WS, Haynes RB. Evidence-Based Medicine: How to Practice and Teach it. New York: Churchill Livingstone, 2000.