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Playing with FIRE: Librarian Integration in Graduate Medical Education at Dartmouth-Hitchcock Medical Center

Dartmouth Hitchcock Medical CenterAs part of the Formal Instruction in Resident Education (FIRE) rotation in the Internal Medicine Residency curriculum at DHMC, each second year resident is required to observe clinical rounds with a librarian and gather clinical questions for those patients’ care. After rounds, the librarian works with the resident to refine the clinical questions using the evidence-based medicine procedures of creating a well-built clinical question, searching for the best evidence, and choosing an article to present. Ashley reviews critical appraisal points and tools with the resident, and goes over the process of presenting an article in journal club. She participates in the journal club the following week, prepared with learning points related to critical appraisal that reinforce the evidence-informed-medicine process. Working with a librarian during this rotation reinforces the importance and process of evidence-based practice; how to form, search, and answer clinical questions is vital to patient care the resident provides.

Programming N’ Pizza

Students, staff, and faculty have been gathering to talk about programming while enjoying a few slices of pizza at Programming N’ Pizza. Programming N’ Pizza (or “PNP”) is a monthly event organized jointly by the Library and Research Computing to help anyone in the Dartmouth community to share, teach, and learn programming skills and meet others with programming interests. Christian Darabos (Research Computing, ITC), one of the organizers, says, “To me, the most exciting aspect about PNP is the “crowd-learning” element there is to it. I love that most people who want to learn or have questions and those who have knowledge to share are one and the same. It really creates a positive dynamic where all participants are peers, and everyone can grow in a relaxed atmosphere.” 

The next Programming N’ Pizza event is scheduled for Thursday, February 22 from 6-8pm in the Frantz Classroom in Byrne Hall and is open to everyone. Email for more information.


On the Road with Active Learning

Students working with a librarian in an active learning session in Rauner Library.Dartmouth librarians have been widely sharing their knowledge of and commitment to active learning. This past fall, a group of Maine librarians and archivists gathered at Bates College to participate in Dartmouth's Active Learning Institute (LALI) focused on Archives and Special Collections. Led by three Dartmouth facilitators, Peter Carini and Laura Barrett from the Library and Cindy Tobery from DCAL, participants explored evidence-based principles and practices that maximize student learning. One of the Maine attendees described the experience as, "Exhausting, inspiring, and thought provoking!" 

Last month, Jay Satterfield and Morgan Swan traveled to the Newberry Library in Chicago to inspire Newberry staff to incorporate active learning strategies in their instruction. In his talk "Learning by Doing," Jay described his own evolution as an instructor and shared anecdotes that exemplify the values of active learning pedagogies. Jay and Morgan then ran class sessions, with Newberry staff in the role of students, so the participants could experience first-hand the effectiveness of student-centered instruction with primary sources.


Contributors: Ashley Duguay (Playing with FIRE), Katie Harding (Programming N' Pizza), Laura Barrett (Active Learning)
Editors: Pamela Bagley and Laura Barrett

Guest post by Amanda Albright, Educational Technology Support Specialist at Geisel School of Medicine Computing Services


In the fall of 2012, each incoming student at the Geisel School of Medicine at Dartmouth received an iPad as well as a variety of productivity and content apps to aid learning. As part of the iPad initiative, faculty willing to investigate the educational value of the iPad also received a device. A number of faculty, after attending iBook Author workshops facilitated by Apple educators, decided to create iBooks.

The following are excerpts submitted by faculty describing the rational for creating iBooks, the experience of creating iBooks, and student reaction to the iBooks. For more information, please contact

SBM Cardiology (Yr2) – James Bell, M.D.Myocardial and Pericardial Diseases

I give approximately 20 hours of lecture in the 2nd year Fall SBM Cardiology curriculum.  These lectures are supplemented by a series of fairly extensive lecture notes and PowerPoint slides.

In the past, some students have been confused as to where they should spend their study time: the notes, the slides, or reviewing the lecture on video. In an attempt to resolve student confusion, I constructed a series of iBooks for each of my lectures to integrate the key aspects of both the lecture notes and the most important illustrations from the PowerPoint slides.

I'm a bit of a visual learner, so I put a lot of emphasis on the juxtaposition of text and graphics on each page.  I particularly appreciated the ability to use video (e.g., echocardiogram) and sound recordings (especially helpful in describing heart sounds and murmurs).  I tried to make each page a separate entity, to minimize page turning when trying to make a point.  I was on a pretty steep learning curve, but I really enjoyed learning to create what for me was a work of science and art.

There were, of course, some problems.  I think the biggest was that none of the other (SBM Cardiology) lectures had iBook counterparts, leaving students with the previous dilemma of how to distribute their study time.  Another was that, despite my hope that students could just use the iBook and not worry about the notes and slides, many of them saw the iBooks as just one more study object to occupy their time.

Still, I think the iBooks were generally well-received.  The student evaluations were quite positive (mostly excellent or very good) with a 4.55 out of 5 on the evaluation form.  We asked specifically for comments on the iBooks, which proved quite insightful:

“The iBooks were incredible. The integration of pictures and audio files for the heart murmurs made for an excellent studying resource. Couldn't be happier with this use of the technology; it really made a difference.”

“They could be improved by incorporating "test your understanding" questions along the way. It would break them up a bit and help to reinforce important concepts.”

“The iBook is the perfect modality for presenting information, as it seamlessly blends notes and slides. I wish there was an iBook for every lecture.”

Medical Virology (Yr1) – Edward Usherwood, Ph.D.Enveloped Viruses

For the 2012 – 2013 academic year, I created two iBooks for the Medical Virology course for Year 1 medical students.  The books synthesized lecture notes and slides from the lecture, so they are together in one integrated document.

The ability to insert sets of sides as galleries in the iBook allowed students to review all the visual material together with the pertinent section of the text.  It also removed the inconvenience of switching between Word and Powerpoint files when reviewing notes and slides, respectively.

There was something of a learning curve when I began to create the iBooks, but the online tutorials on were an invaluable resource when learning the interface.

Student feedback was overwhelmingly positive, the most common comment being they liked the format as a single, integrated document containing all the relevant material in one place.  In response to this, for the 2013-2014 classes, we are converting all lecture notes in this class to the iBook format.  Currently, I am exploring inserting more video and internet-based content into the iBooks to enrich the experience for the students. The recent release of Apple’s OS X Mavericks will make iBooks even more accessible since they will run on a Mac laptop as well as an iPad.

Medical Physiology (Yr1)– Andy Daubenspeck Ph.D., Eugene Nattie M.D., Donald Bartlett M.D.Fick Principle and Mass Balance

The fall 2013 semester was the first year that the Medical Physiology 110 faculty were able to effectively prepare lecture notes (13 iBooks) and concept-specific materials (7 iBooks).

Lecturers were responsible for producing the lecture note iBook for their assigned topics. The responsibility for developing the concept iBooks that covered more basic material pertinent to multiple lectures was assumed by Andy Daubenspeck.

An essential aspect of the development of these lecture note iBooks was the summer assistance of Jason Laurita, a rising 2nd year medical student, who was able to massage the material from various lecturers into quite impressive iBooks. Hermes Yeh, chairman of Physiology and Neurobiology, was very supportive of this and found the funds for Jason’s efforts.

Based upon discussion with the Year 1 curriculum representatives, who gave us thoughtful insights about the effectiveness of the iBooks, we realize that preparing these materials is a process of continuing improvement. We may have unconsciously made the content of some iBooks unnecessarily difficult for first year students to follow and grasp. In addition, we may have underutilized linkages to available web-based resources that students found useful. We also have not fully responded to the difficulties facing incoming students for whom English is not their first language.

As a result, we anticipate substantial revisions to the iBooks for next fall to simplify the verbiage, to incorporate improved guidance as to the overall goals for each iBook and of each iBook within the overall course, and to incorporate more of the useful, web-based resources (e.g., Khan Academy offerings).

Human Anatomy and Embryology (Yr1) – Virginia Lyons, Ph.D.Human Anatomy and Embryology

Creating an iBook is not difficult, and you do not have to start from scratch as your existing notes and PowerPoint slides can easily be imported. The training videos on provide everything you need to get started with iBooks Author.

I think what I like best about presenting our course materials in this format is the ability to make the material interactive. In other words, as students are reading the content you can insert questions along the way or diagrams for them to label so they are not just passively reading. The students really love having all the material in one place, and especially seem to like review questions at the end of the chapters. A typical comment from our course evaluation reads:

“The presentation of material in iBook format was extremely helpful. I really liked the scrollable galleries and the end-of-chapter review questions.”

If you plan to incorporate iBooks into your course be forewarned: once you provide some of your content in iBook format, the students will want all of your content in this format. Creating iBooks takes time and we were fortunate to have the assistance of Aaron Steen, a medical student who had recently completed our course.  However, once you create your books, it would be naïve to assume that you are done; iBooks offer so much potential for creativity in content delivery, you will find yourself spending your evenings tweaking your iBooks…but you won’t mind because it is fun!