The health sciences librarian in medical education: a vital pathways project task force

Objectives:

The Medical Education Task Force of the Task Force on Vital Pathways for Hospital Librarians reviewed current and future roles of health sciences librarians in medical education at the graduate and undergraduate levels and worked with national organizations to integrate library services, education, and staff into the requirements for training medical students and residents.

Methods:

Standards for medical education accreditation programs were studied, and a literature search was conducted on the topic of the role of the health sciences librarian in medical education.

Results:

Expectations for library and information services in current standards were documented, and a draft standard prepared. A comprehensive bibliography on the role of the health sciences librarian in medical education was completed, and an analysis of the services provided by health sciences librarians was created.

Conclusion:

An essential role and responsibility of the health sciences librarian will be to provide the health care professional with the skills needed to access, manage, and use library and information resources effectively. Validation and recognition of the health sciences librarian''s contributions to medical education by accrediting agencies will be critical. The opportunity lies in health sciences librarians embracing the diverse roles that can be served in this vital activity, regardless of accrediting agency mandates.In response to reported closings of and staff reductions at hospital libraries, the Medical Library Association (MLA) and the Hospital Libraries Section of MLA agreed to study the state of hospital libraries and librarians under the auspices of the Task Force on Vital Pathways for Hospital Librarians. The task force''s Health Sciences Librarian in Medical Education Task Force (METF)^* was charged with reviewing the accreditation standards regarding libraries for residency programs and with working with national organizations to integrate library services, education, and staff into the requirements for training medical students and residents.     

The Health Information Literacy Research Project

Objectives:

This research studied hospital administrators'' and hospital-based health care providers'' (collectively, the target group) perceived value of consumer health information resources and of librarians'' roles in promoting health information literacy in their institutions.

Methods:

A web-based needs survey was developed and administered to hospital administrators and health care providers. Multiple health information literacy curricula were developed. One was pilot-tested by nine hospital libraries in the United States and Canada. Quantitative and qualitative methods were used to evaluate the curriculum and its impact on the target group.

Results:

A majority of survey respondents believed that providing consumer health information resources was critically important to fulfilling their institutions'' missions and that their hospitals could improve health information literacy by increasing awareness of its impact on patient care and by training staff to become more knowledgeable about health literacy barriers. The study showed that a librarian-taught health information literacy curriculum did raise awareness about the issue among the target group and increased both the use of National Library of Medicine consumer health resources and referrals to librarians for health information literacy support.

Conclusions:

It is hoped that many hospital administrators and health care providers will take the health information literacy curricula and recognize that librarians can educate about the topic and that providers will use related consumer health services and resources.

Highlights

• Health care providers responded positively to a health information literacy curriculum offered by librarians and to related resources and services, namely MedlinePlus and the information referral system known as Information Rx.
• Participation in a curriculum increased health care providers'' knowledge of health information literacy, awareness of available consumer health information, and referral of patients to the library for additional assistance.
• Librarian involvement in health information literacy increased the profession''s visibility and perceived value.

Implications

• Consumer health information services and resources offered by librarians can improve the health information literacy skills of health care providers and their patients.
• Training by librarians can increase knowledge of the importance of health information literacy and usage of MedlinePlus and Information Rxs.
• Hospital-based administrators and health care providers can be champions in support of health information literacy and consumer health information services offered by libraries.

     

Vital pathways for hospital librarians: present and future roles

Objectives:

The research objectives were to (1) describe the current and future roles of hospital librarians and the challenges they face and (2) find evidence supporting the hypothesis that librarians are essential to hospitals in achieving the organizations'' mission-critical goals.

Method:

The authors used results from a previous research study that identified the five organizational mission-critical goals important to hospital administrators and then searched the literature and solicited examples from hospital librarians to describe the librarian''s role in helping hospitals achieve these goals.

Results:

The literature supports the hypothesis that hospital librarians play important roles in the success of the hospital. Librarians support quality clinical care, efficient and effective hospital operations, continuing education for staff, research and innovation, and patient, family, and community health information needs.

Conclusion:

Hospital librarians fulfill many mission-critical roles in today''s hospital, providing the right information at the right time in a variety of ways to enhance hospital and medical staff effectiveness, optimize patient care, improve patient outcomes, and increase patient and family satisfaction with the hospital and its services. Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian.

Highlights

• A review of the literature supports the hypothesis that services of the professional librarian result in:
  • enhanced staff effectiveness,
  • optimized patient care,
  • improved patient outcomes, and
  • increased patient and family satisfaction with the hospital and its services.

Implications

• Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian.

     

Trends in hospital librarianship and hospital library services: 1989 to 2006

Objective:

The research studied the status of hospital librarians and library services to better inform the Medical Library Association''s advocacy activities.

Methods:

The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis.

Results:

The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years.

Conclusions:

Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends.

Highlights

• Data support reported trends in the decrease in the number of hospitals and hospital libraries.
• About 44.0% of hospitals had some level of onsite library service in 1989, compared with between 33.5% and 29.1% of hospitals in 2005/06.
• More electronic services and resources, such as Internet access and online materials, are being offered by hospital libraries, in addition to more traditional services
• Library staffing appears to be more unstable today than in 1989, with more libraries reporting a decrease in the number of staff.

Implications

• Hospital libraries continue to change in response to changes in the health care environment as health care administrators respond to financial pressures, library staff are downsized, degreed librarian positions are eliminated, and reporting structures change.
• MLA must continue to track the status of hospital librarians and libraries in light of the changing environment with surveys and other means, in partnership with others such as the National Network of Libraries of Medicine.

     

Miles to go before we sleep: education,technology, and the changing paradigms in health information

Purpose:

This lecture discusses a philosophy of educating health information professionals in a rapidly changing health care and information environment.

Discussion:

Education for health information professionals must be based upon a solid foundation of the changing paradigms and trends in health care and health information, as well as technological advances, to produce a well-prepared information workforce to meet the demands of health-related environments. Educational programs should begin with the core principles of library and information sciences and expand in interdisciplinary collaborations. A model of the health care environment is presented to serve as a framework for developing educational programs for health information professionals.

Conclusion:

Interdisciplinary and collaborative relationships—which merge health care, library and information sciences, and other information-related disciplines—should form the basis of education for health information professionals.

Highlights

• Educational pathways for the creation of future health information professionals are charted through the discussion of four major roads.
• A model of the health care environment sets the framework for building educational programs for health information professionals.

Implications

• The presented pathways can inform educational decision making at all levels, including the need to revisit the accreditation bodies of programs educating health information professionals.
• The National Library of Medicine is encouraged to create a workforce center to identify the needs of the profession.
• Interdisciplinary and collaborative partnerships are vital to produce quality graduates who are prepared to handle the complexities of the health care and information environment.

     

Examining care navigation: librarian participation in a team-based approach?

Objective

This study investigated responsibilities, skill sets, degrees, and certifications required of health care navigators in order to identify areas of potential overlap with health sciences librarianship.

Method

The authors conducted a content analysis of health care navigator position announcements and developed and assigned forty-eight category terms to represent the sample''s responsibilities and skill sets.

Results

Coordination of patient care and a bachelor''s degree were the most common responsibility and degree requirements, respectively. Results also suggest that managing and providing health information resources is an area of overlap between health care navigators and health sciences librarians, and that librarians are well suited to serve on navigation teams.

Conclusion

Such overlap may provide an avenue for collaboration between navigators and health sciences librarians.     

A pathway for hospital librarians: why is it vital?

Objectives:

By the mid 2000s, reports of hospital librarians losing jobs and hospital libraries closing were rife. In 2005, Vital Pathways: The Hospital Libraries Project was established by 2005/06 MLA President M.J. Tooey, AHIP, FMLA, to assess the truth of these reports and to study and develop strategies to support hospital librarians. Throughout this long-term project, opportunities were sought to understand the issues more clearly.

Methods:

A steering committee, along with three task forces, was established to carry out the work of the project. The steering committee provided oversight and had responsibility for promoting and marketing the project. The three task forces were responsible for conducting a survey on the status of hospital librarians, determining the involvement of librarians in medical education and accreditation, and researching and writing a document reviewing current and future roles for hospital librarians. Along the way, these responsibilities grew and evolved.

Results:

After a little more than three years, the Task Force on Vital Pathways for Hospital Librarians Steering Committee presented a final report regarding its accomplishments to the MLA Board of Directors. A sampling of these accomplishments includes the status of hospital librarians survey, a website, a position document with an accompanying executive summary, a short promotional brochure, and a final culminating activity, this symposium.

Conclusions:

Although these are difficult times for all libraries, hospital librarians and libraries seem particularly affected. In a competitive health care environment that is driven by the bottom line, influenced by real estate hunger, and affected by the belief of hospital administrators that access to health information comes from the Internet and is free, the hospital librarian seems doomed. However, even in these difficult times, there are hospital librarians who are not only surviving, but thriving. Is it because they are entrepreneurial? Opportunistic? Innovative? Flexible? All of the above? None of the above? There are no clear predictors of success or of failure. However, the Vital Pathways Project has shed light on some of the issues and identified opportunities and strategies for the future.

Highlights

• This introduction serves as overview of the MLA Vital Pathways Project and its accomplishments, outcomes, and recommendations.

Implications

• This symposium will lead to increased focus on hospital librarians'' issues and future.
• Increased focus will result in conversations and actions regarding new and emerging roles for hospital librarians.

     

Linking research to practice: the rise of evidence-based health sciences librarianship

Purpose:

The lecture explores the origins of evidence-based practice (EBP) in health sciences librarianship beginning with examples from the work of Janet Doe and past Doe lecturers. Additional sources of evidence are used to document the rise of research and EBP as integral components of our professional work.

Methods:

Four sources of evidence are used to examine the rise of EBP: (1) a publication by Doe and research-related content in past Doe lectures, (2) research-related word usage in articles in the Bulletin of the Medical Library Association and Journal of the Medical Library Association between 1961 and 2010, (3) Medical Library Association activities, and (4) EBP as an international movement.

Results:

These sources of evidence confirm the rise of EBP in health sciences librarianship. International initiatives sparked the rise of evidence-based librarianship and continue to characterize the movement. This review shows the emergence of a unique form of EBP that, although inspired by evidence-based medicine (EBM), has developed its own view of evidence and its application in library and information practice.

Implications:

Health sciences librarians have played a key role in initiating, nurturing, and spreading EBP in other branches of our profession. Our close association with EBM set the stage for developing our own EBP. While we relied on EBM as a model for our early efforts, we can observe the continuing evolution of our own unique approach to using, creating, and applying evidence from a variety of sources to improve the quality of health information services.     

Development of the research lifecycle model for library services

Question:

Can the niche services of individual librarians across multiple libraries be developed into a suite of standard services available to all scientists that support the entire research lifecycle?

Setting:

Services at a large, research-intensive state university campus are described.

Method:

Initial data were collected via concept mapping by librarians. Additional data were collected at conferences and meetings through interactive poster presentations.

Main Results:

Services of interest to scientists for each of the stages in the research lifecycle were developed by the team to reflect the wide range of strengths of team members in aggregate.

Conclusion:

Input from researchers was the most effective tool for developing the model. A flexible research lifecycle model can be developed to match the needs of different service groups and the skills of different librarians.     

Metropolis revisited: the evolving role of librarians in informatics education for the health professions

Objective:

The authors'' goal was to assess changes in the role of librarians in informatics education from 2004 to 2013. This is a follow-up to “Metropolis Redux: The Unique Importance of Library Skills in Informatics,” a 2004 survey of informatics programs.

Methods:

An electronic survey was conducted in January 2013 and sent to librarians via the MEDLIB-L email discussion list, the library section of the American Association of Colleges of Pharmacy, the Medical Informatics Section of the Medical Library Association, the Information Technology Interest Group of the Association of College and Research Libraries/New England Region, and various library directors across the country.

Results:

Librarians from fifty-five institutions responded to the survey. Of these respondents, thirty-four included librarians in nonlibrary aspects of informatics training. Fifteen institutions have librarians participating in leadership positions in their informatics programs. Compared to the earlier survey, the role of librarians has evolved.

Conclusions:

Librarians possess skills that enable them to participate in informatics programs beyond a narrow library focus. Librarians currently perform significant leadership roles in informatics education. There are opportunities for librarian interdisciplinary collaboration in informatics programs.

Implications:

Informatics is much more than the study of technology. The information skills that librarians bring to the table enrich and broaden the study of informatics in addition to adding value to the library profession itself.     

Eliminating traditional reference services in an academic health sciences library: a case study

Question:

How were traditional librarian reference desk services successfully eliminated at one health sciences library?

Setting:

The analysis was done at an academic health sciences library at a major research university.

Method:

A gap analysis was performed, evaluating changes in the first eleven months through analysis of reference transaction and instructional session data.

Main Results:

Substantial increases were seen in the overall number of specialized reference transactions and those conducted by librarians lasting more than thirty minutes. The number of reference transactions overall increased after implementing the new model. Several new small-scale instructional initiatives began, though perhaps not directly related to the new model.

Conclusion:

Traditional reference desk services were eliminated at one academic health sciences library without negative impact on reference and instructional statistics. Eliminating ties to the confines of the physical library due to staffing reference desk hours removed one significant barrier to a more proactive liaison program.     

Time to rethink the role of the library in educating doctors: driving information literacy in the clinical environment

Question:

Can information literacy (IL) be embedded into the curriculum and clinical environment to facilitate patient care and lifelong learning?

Setting:

The Australian School of Advanced Medicine (ASAM) provides competence-based programs incorporating patient-centred care and lifelong learning. ASAM librarians use outcomes-based educational theory to embed and assess IL into ASAM''s educational and clinical environments.

Methods:

A competence-based IL program was developed where learning outcomes were linked to current patients and assessed with checklists. Weekly case presentations included clinicians'' literature search strategies, results, and conclusions. Librarians provided support to clinicians'' literature searches and assessed their presentations using a checklist.

Main Results:

Outcome data showed clinicians'' searching skills improved over time; however, advanced MEDLINE searching remained challenging for some. Recommendations are provided.

Conclusion:

IL learning that takes place in context using measurable outcomes is more meaningful, is enduring, and likely contributes to patient care. Competence-based assessment drives learning in this environment.     

Current status of information literacy instruction practices in medical libraries of Pakistan

Objectives:

The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan.

Methods:

A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff.

Results:

The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used.

Conclusion:

IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction.

Implications:

Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum.     

The value of library and information services in patient care: results of a multisite study

Objective:

The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care.

Methods:

The study used: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care.

Results:

Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%).

Conclusions:

Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.

Highlights

• Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.
• Electronic access to information resources from multiple locations has increased the ability of health professionals to use these resources for improved patient care.
• The roles of librarians are diversifying to include management of electronic resources, user instruction and support, specialized research and clinical information search services, and involvement in institution-level quality improvement.
• It is possible to conduct a large-scale, multisite study on the value and impact of library services on patient care.

Implications

• Ongoing studies of the value and impact of library and information resources will be important for advocacy and quality improvement.
• Community-Based Participative Research methods hold promise as a way of ensuring the relevance of future research.

     

Developing health information literacy: a needs analysis from the perspective of preprofessional health students

Objective:

The research identified the skills, if any, that health preprofessional students wished to develop after receiving feedback on skill gaps as well as any strategies they intended to use to address these gaps.

Methods:

A qualitative approach was used to elicit students'' reflections on building health information literacy skills. First, the students took the Research Readiness Self-Assessment instrument, which measured their health information literacy, and then they received individually tailored feedback about their scores and skill gaps. Second, students completed a post-assessment survey asking how they intended to close identified gaps in their skills on these. Three trained coders analyzed qualitative comments by 181 students and grouped them into themes relating to “what skills to improve” and “how to improve them.”

Results:

Students intended to develop library skills (64% of respondents), Internet skills (63%), and information evaluation skills (63%). Most students reported that they would use library staff members'' assistance (55%), but even more respondents (82%) planned to learn the skills by practicing on their own. Getting help from librarians was a much more popular learning strategy than getting assistance from peers (20%) or professors (17%).

Conclusions:

The study highlighted the importance of providing health preprofessional students with resources to improve skills on their own, remote access to library staff members, and instruction on the complexity of building health literacy skills, while also building relationships among students, librarians, and faculty.

Highlights

• After receiving feedback on skill gaps, most preprofessional health students intend to develop their information literacy skills.
• Some students report that a trip to the library is a barrier to using library resources.
• Students see the need to build their information evaluation skills, knowledge of citations and plagiarism, and library skills, which they differentiate from Internet skills.
• Students are more likely to identify librarians as sources for assistance in finding information than faculty or peers after receiving individual feedback explaining the role of libraries and library staff members.

Implications

• Students'' health information competencies can be built through assessment and feedback that reveals skill gaps, highlights misconceptions, and offers ideas on how to improve.
• Access to professionally designed self-study resources is needed for students who intend to develop health information competencies on their own.