METHODS
Parkinson Disease, tremors, slowness, rigidity, apathy
PARKINSON DISEASE
Second year medical students (CONSORT Flow DiagramCharacteristics of ParticipantsOn the first full day of the Quantitative Medicine Block, all 72 participating students present were given a one-hour introduction to Evidence-Based Practice (EBP). About ten minutes into the EBP introductory session the authors administered an ungraded, timed pre-test that the instructors referred to in a non-intimidating, matter-of-fact way in the BrightSpacetm learning management system to as a “Baseline Assessment” to gauge each student's individual skills level in formulating EBP questions. All medical students were already well acquainted with the BrightSpacetm learning management system. The students were given five minutes to complete the Baseline Assessment online prompted by a clinical vignette in the “Quizzes” segment of the “Activities” area of the BrightSpacetm learning management system.On the first full day of the Quantitative Medicine Block, all 72 participating students present were given a one-hour introduction to Evidence-Based Practice (EBP). About ten minutes into the EBP introductory session the authors administered an ungraded, timed pre-test that the instructors referred to in a non-intimidating, matter-of-fact way in the BrightSpacetm learning management system to as a “Baseline Assessment” to gauge each student's individual skills level in formulating EBP questions. All medical students were already well acquainted with the BrightSpacetm learning management system. The students were given five minutes to complete the Baseline Assessment online prompted by a clinical vignette in the “Quizzes” segment of the “Activities” area of the BrightSpacetm learning management system:You are at a rural clinic gaining practical experience. Today you are enjoying the work, although you miss your student friends back at the University of New Mexico School of Medicine. Manuel Garcia, age 73, is in the clinic. During the last two months Mr. Garcia's has experienced recurring leg tremors, complaints of “weakness,” apathy, slowness in his movements, unilateral rigidity, shuffling gait, and instability when walking. Your preceptor is seeing him today about Mr. Garcia's recent fall in his kitchen. Mr. Garcia appears to be fine, yet shaken from the fall. Your preceptor has diagnosed Mr. Garcia as having fairly advanced stage Parkinson Disease. You know about Parkinson Disease based on your courses at the University of New Mexico School of Medicine. The discussion expands to include possible drugs that might improve the quality of life for Mr. Garcia. Your preceptor discusses possibly prescribing Levodopa or a dopamine agonist.Formulate a single-sentence question, based on this clinical vignette that, when answered by either you or other colleagues, will lead to the best treatment of this patient. Take no longer than five (5) minutes.This is an ungraded exercise to help us evaluate your baseline skills so try your best.Following a discussion of student observations on the challenges of formulating questions that they experienced during the pre-test exercise, the first author gave a five-minute overview of the FAC question formulation rubric (FAC Rubric for Evaluating Formulated EBP QuestionsThe intervention group students on December 8, 2020 received their EBP search skills training. They also accessed their labs by assigned online Zoom links. In contrast to the control group students, however, the intervention group students received a 25-minute practical, active learning training with the FAC question formulation rubric. The online session consisting of about 12-14 students per lab began with the opening solo thought question: “Why do you think that formulating answerable questions will be important for your individual professional education and for your career?” Students later offered their answers. The instructor (JE) described studies that revealed that practicing physicians, on average, raise questions at the rate of about one per every other patient. Using the FAC rubric the instructor walked through the elements of Focus, Amplify, and Compose. They were asked to analyze a sample question and determine the ways that it did or did not adhere to the elements of the rubric. The instructor displayed eight sample questions composed by medical students the preceding year to instill confidence in their own emerging skills. Students were presented with possible topic areas and asked to compose their own question using the rubric. They were then paired in a Zoom breakout room for 5 minutes to evaluate each other's question using the rubric. The instructor tried to visit each room, but usually made it to only two rooms before the five-minute period had expired. When they returned from their online breakout rooms, several students typically would share their refined questions and a few offered what they learned from the experience.The next morning on December 9 all 72 participating students present were given a timed five-minute “Spot Check” (post-test) on their question formulation skills prompted by the same vignette, consistent with standard pre-test post-test [Once all pre- and post-tests were scored, the data sets were transmitted to the statistician on an Excel spreadsheet with the identities of the intervention and control datasets removed in order to prevent the possible unconscious bias in her analysis. The scores generated during the pre-test compared to the post-test for the question formulation skills, and analyzed for differences between the intervention or control groups, are the basis of this study that received Institutional Review Board ethics approval (20-588) from the University of New Mexico Health Sciences Center on October 11, 2020.