ADAPTATION TO SPANISH-SPEAKING COUNTRIES OF INFOCRITIQUE – SELF-DIRECTED LEARNING

MODULES ON EVIDENCE-BASED PRACTICE SKILLS

J. Alvarez Argote1, C. Burbano1, MP Gagnon2, M. Cauchon2, J. Asua3, M. Labrecque2

1Universidad del Valle (COLOMBIA)2Université Laval (CANADA)

3Health Technology Assessment Program, Basque Country (Spain)

E-mails: juliana621@gmail.com, cocamil@yahoo.com, marie-pierre.gagnon@fsi.ulaval.ca, michel.cauchon@mfa.ulaval.ca, jasua@ej-

gv.es, michel.labrecque@mfa.ulaval.ca

INTRODUCTION: The EBM cycle

Advances in the biomedical sciences

Given the continuous advances in the biomedical sciences, health care professionals need the skills to rapidly recognize and integrate the most relevant and valid information in their practice. These skills are the foundation of lifelong learning and evidence-based clinical practice. As self-directed learning program named InfoCritique was developed to acquire these competencies, at Laval University, Québec, Canada.

What is InfoCritique?

http://infocritique.fmed.ulaval.ca

Cauchon M, Labrecque M, Baillargeon L, Légaré F, Frémont P. Web site: Modules d'auto-apprentissage des habiletés de lecture critique et de gestion de l'information, [Online]. http://InfoCritique.fmed.ulaval.ca Accessed on May 7th, 2011)

Infocritique is an online educational program available since 2002, composed of several modules that mainly focus on the critical appraisal of scientific information. As of 2011, InfoCritique offer modules in the following disciplines: medicine, nursing, reproductive health, physical therapy, and complementary and alternative medicine. Infocritique is integrated in the academic program in Family Medicine, Internal medicine, and Nursing Sciences at Laval University in Quebec City, Canada, as well as in Family Medicine at University of Montreal, Canada. In addition, all health professionals may register to the program as a continuing professional development activity.

The InfoCritique Founders

The modules were originally created by five professors from the Family Medicine Department at Laval University. Since the first version of the modules in 2002, several other health professionals from different disciplines collaborated to create new modules or enrich existing modules.

InfoCritique Features (1)

Interactivity Clinically “grounded” Dedicated platform for “friendly

user” creation and updating of modules

Monitoring of learning progress by users themselves and by supervisors

Abstracts book. 2nd International Congress of Evidence-Based Healthcare teachers & Developers. Sign posting the future in EBCH. Utveggio Castle, Palermo (Italy), 10th – 14th September, 2003. (Available online at: http://www.ebhc.org/2003/abstracts_book.pdf Accessed on May 8th, 2011)

All or some of the following modules are included in each discipline: 1) Web information retrieval strategies; 2) interaction with pharmaceutical industry including physician-drug representative encounter 3) appraisal of drugs/interventions effectiveness 3) appraisal of review articles; 4) appraisal of clinical practice guidelines; 5) clinical diagnostic strategies and appraisal of diagnostic test validity, 6) appraisal of clinical decision rules, and 7) appraisal of qualitative research.

Infocritique features all elements required to maximise effective learning.

InfoCritique Features (2)

Pedagogical resources in each module :Baseline information Critical appraisal exercise

based on a clinical scenarioInfo + (theory related to

each appraisal criterion)Evaluation test Additional educational

materialEvaluation of the module

Abstracts book. 2nd International Congress of Evidence-Based Healthcare teachers & Developers. Sign posting the future in EBCH. Utveggio Castle, Palermo (Italy), 10th – 14th September, 2003. (Available online at: http://www.ebhc.org/2003/abstracts_book.pdf Accessed on May 8th, 2011)

Each module proposes various educational activities: theoretical baseline concepts, clinical scenarios, critical appraisal worksheets, appraisal exercises with interactive feedback, post-test evaluation, hyperlinks to relevant Internet resources, a glossary and an evaluation form. Each interactive module takes 2 to 3 hours to complete.

METHODS: Adaptation of Infocritique for Latin America and Spain

Two grants offered by the Canadian government (Emerging Leaders in the Americas Program - ELAP) through Université Laval

Offered to Universidad del Valle, Cali, Colombia

Two grants from the canadian government were offered through the Université laval to the Universidad del Valle to begin the adaptation of the modules of Infocritique in Spanish. One grant was offered for a Meducal Student and another one for Nursing Sciences. Thus, Infocritique could be available in spanish speaking countries, including latin america and spain.

Before Starting the Adaptation…

Before adapting the modules, the students completed the online course in French to get familiarized with InfoCritique. Some of the sections of the modules were similar in all disciplines namely: introduction, objectives, background theoretical information (info+), description of the criteria of the appraisal worksheet, post-test self-evaluation, additional resources, glossary, and module evaluation form. These sections were translated and adapted according to the Latin American and Spain healthcare context.

RESULTS: The First Modules of InfoCrítica

The first modules adapted in Spanish in both disciplines were on appraisal of therapy/prevention effectiveness. Over the six-month scholarship, six additional modules, three in medicine and three in nursing, were translated/adapted using a similar methodology. These modules cover review articles, practice guidelines, diagnostic tests (medicine), and qualitative research (nursing). They are yet to be validated in various Spanish-speaking countries regarding regional specificities.

The First Exercice of InfoCrítica …

The appraisal exercises were completely new and were adapted to the clinical context of Latin America and Spain. Nonetheless, the structure from the French version was preserved and used as a model to create the exercises in Spanish: 1) a clinical scenario ending with a clinical question leading to a search for information to answer the question, 2) the critical appraisal exercise itself where the learner uses the appraisal worksheet, answers questions, compares his/her answers to those given in the modules, and goes through complementary theoretical information given for each question (info+), 3) a conclusion to the clinical scenario based on the results of the appraisal.

A Selected Article…

Finding and selecting a relevant RCT was somewhat difficult due to the paucity of research published in Spanish compared to English.

The clinical topic finally chosen for the Medicine module was the prevention of urinary tract infection recurrences with antibiotics in children who suffered a febrile urinary tract infection and, for the nursing module, the local treatment of neuropathic ulcer in patient with diabetes.

The Evaluation Grid

The relevance and validity of the article were analyzed using an evaluation grid, translated in Spanish. This grid allowed fast assessment of: 1) the relevance of the article to clinical practice, 2) the validity of the results, and 3) the significance of the results.

Interactive Exercice…

The evaluation grid question must be answered online. Feedback is immediately provided and additional theoretical information is made available through Info+. These info+ are the same for every module on the same theme whatsoever the discipline.

DISCUSSION

• Potential users agreed to work along with Université Laval to implement InfoCritique in Spanish- speaking countries

• New learning materials should be developed according to regional educational needs

• InfoCrítica has the potential for large implementation in Spanish-speaking countries

Results from this project were beyond expectations, fulfilling the objectives of the Emerging Leaders in the Americas Program from the Canadian government.

The first modules on therapy/prevention effectiveness are currently under review by the family medicine program at the Universidad del Valle and the Health Technology Assessment program of the Basque country in Spain.

We look forward to seeing InfoCrítica being largely implemented in Spanish-speaking countries and new learning material created according to the regional educational needs.

THANKS…