Health Science Library Studies

Comments on

Kronenfeld, Michael R., “Trends in Academic Health Sciences Libraries and their Emergence as the ‘Knowledge Nexus’ for their Academic Health Centers.
 Journal of the Medical Library Association, Vol. 93, No. 1 (January 2005) p. 32-39

Kronenfeld identifies several trends in academic health sciences libraries, after first identifying some trends in health care generally.

In health care generally, there was a “strong shift” to managed care in the 1990s, but costs “continued to climb” (p. 32), and employers passed on costs to their employees.  The “development of the Web,” freeing “knowledge-based information”  (“KBI”) from physical locations, has increased expectations that clinicians will have access to current scholarship.  This in turn, warns Kronenfeld, may have malpractice implications (p. 33).

In academic health sciences libraries, Kronenfeld notes shifts

·         in spending from print to digital collections

·         in librarians’ duties from reference and collection development to liaisons with faculty and faculty instructional support

·         in use of library space toward more group workspace both for patrons and for librarians (meeting rooms)

·         in websites toward “full-text KBI”

·         in document delivery toward digital format (ease and speed of delivery making use more practical for clinicians)

·         in KBI from monographs and peer-reviewed journals toward Web format, enabling greater currency

·         in operations of academic health centers (AHCs), toward “standardized and integrated computer-based operation” (p. 37) in patient records, quality control, and “ ‘just in time’ access to KBI for clinicians” (p. 37).

The development of digital databases and full-text availability “has made the system implemented by NLM  [to create bibliographies on clinical subjects and obtain copies of the material] obsolete” (p. 37).  Librarians should continue to improve access to KBI, Kronenfeld says.  He suggests

·         Improvement of information literacy among clinicians

·         Development of more efficient access to knowledge in the AHC

·         Integration of access to KBI, making the systems institution-wide

·         Support of “the knowledge component of research” in funding proposals (p. 38)

Kronenfeld suggests further research into how best to improve clinicians’ information competency.

Writing in 2003, Kronenfeld says “we are in the initial stage of a major transition of what we do and how we do it.” 

The changes Kronenfeld outlines are indeed profound, and it is easy to see from his article how a career in health sciences libraries in the present time would be highly interesting, exciting, and fulfilling on many levels.

Comments on

Doyle, Jacqueline Donaldson, “A Job with a View:  Perspectives from the Corporate Side of the Hospital.”  Journal of the Medical Library Association, Vol. 91, No. 1 (January 2003) p. 12-17

            This article is a speech that was given at an annual meeting of the Medical Library Association in 2002.  It was the “Janet Doe Lecture on the history of philosophy of medical librarianship.” The author had recently shifted from librarianship to hospital administration, and she explained her librarian’s philosophy from her new vantage point. 

            Her view that libraries and librarians are important to health care is confirmed by her new experience.  So is her belief that librarians are rarely understood.

            She points out that medical librarians have to find out what matters to administrators, what information they value, and what challenges they face.  That, she says, will make the librarians’ positions and ability to carry out their mission more secure.  This, of course, should not be seen as unique to librarianship.  Members of any profession or occupation should consider the needs of the people for whom they provide a product or service.

            The author focuses on three ideas:  service, technology, and professionalism.

            “Service” to whom is the obvious question in a corporate setting.  Do those who pay for the library service wish to provide it for the entire public?  The author is pleased to note that her hospital’s library is not just for the physicians and the administrators but also for the patients.

            Technology to librarians is a necessary tool, something that one must make constant effort to keep up with.  To some administrators concerned with its costs, the author says, it is “an unnecessary toy,” often “baffling.” (p. 15).

            Professionalism is a concept the author compares to “vocation,” citing a speaker at a medical librarians’ regional conference.  That speaker said that the librarians had a vocation rather than a profession because they had a “mission in life to provide the right information at the time and in the format needed,” whether or not the person needing it was on the hospital staff.  The author mused on this for more than a full page, pleased with the “belief in what we do” aspect of librarianship.

            The speech reads like a pep talk such as one hears at annual meetings of professional organizations, but it does resonate:  I have even used the word “mission” recently in describing what I do as a librarian and why I do it.  I don’t, however, think we have to say we have a vocation rather than a profession.

Comments on

Holst, Ruth and Carla Funk. “State of the Art of Expert Searching: Results of a Medical Library Association Survey.” Journal of the Medical Library Association Vol. 93, no. 1 (January 2005) 45-52.

Online medical information vendors have made their product increasingly available to end users, but end users’ searches are still far inferior in quality to those of “experienced librarians,” (p. 46) according to the results of a survey of MLA members. Thus, leaving aside the issue of whether the results are self-serving, health sciences librarians still “play[] a valuable role in searching, particularly in answering questions about treatment options for patients and in providing education for health care providers, patients, and their families” (p. 50).

Health sciences librarians must continually improve their skill and knowledge as the tools and the content change, and they must continually market their services to those in their organizations who can benefit from them.

Expert online searching for medical information is a skill many medical professionals do not have the time to develop. They can do their own work better if they look to skilled health sciences librarians for this service.  There is no reason to think busy doctors will ever find time to develop this skill to the level of “experienced librarians,” but librarians could still find the call for their services diminishing if they do not keep their skill level high and current and keep their patrons aware of what they can do.

Comments on

MacCall, Stephen L. “Clinical Digital Libraries Project:  Design Approach and Exploratory Assessment of Timely Use in Clinical Environments” Journal of the Medical Library Association 94(2) April 2006

Can librarians organize their digital information so that it can be accessed quickly enough for clinicians to use it?  One of the obstacles to this goal, Prof. MacCall notes, has been the inconsistency of structure among online sources, in contrast to the consistency of book index structure.  He asks whether the library community can provide “consistent structuring in their digital library collections of online resources.” (p. 191)

Prof. MacCall reports on a study of the use of searches referred to the Clinical Digital Libraries Project (CDLP) clinical topic pages by search engines that “originated in medical education, hospital, or clinic environments” in a one-year period.  Searches of over 5 minutes were excluded as “information gathering” rather than “information seeking” (“to satisfy a perceived need”). (p. 193)  Of these searches, completion time for 48% was less than a minute, for 41% it was one to three minutes, and for 11% it was three to five minutes.

The conclusion drawn from these and other data is that the CDLP collections provide timely access to specific clinical information for the specified users.

The inconsistency among online resources continues to be a problem for end users and for librarians.  Prof. MacCall’s description of this inconsistency as an “obstacle” was refreshing.  Rather than simply tell library students to get over it and learn all the different systems, he points out that this is a problem for end users as well.  Librarians can try to provide consistency and ease of use of their collections, and publishers can do the same.

Comments on

Coletti, Margaret H. and Howard L. Bleich.  “Medical Subject Headings Used to Search the Biomedical Literature.”  Journal of the American Medical Informatics Association.  Vol. 8, no. 4 (July/August 2001) 317-323.

                MEDLINE, now available free to the public via the Web, originated in the 19th Century with the book collection of the Surgeon General.  Through successive efforts to index medical writings, and to make them retrievable, we now have access to medical information via a system of subject headings known as MeSH.

                In the early 1970s, searching MEDLINE was difficult and laborious.  Searching was mediated and expensive.  Searchers needed training, reference manuals, and arcane knowledge of special syntax, grammar, and abbreviations in prescribed forms.  An end-user would not even know the size of an initial search’s result until it was printed and shipped, by which time the information need might be long past.

                Progress in MEDLINE and other databases has made them much more accessible to end-users.  Spelling and word-order variations may now “map” to the accepted spelling and word order.  Instant and free results now enable the user to refine a search immediately for better results and even find descriptors via a preliminary search to use in a subsequent search.

                The authors caution against expecting the same results from MEDLINE  that a user gets from other databases:  MEDLINE is indexed with greater uniformity, accuracy, and attention to the hierarchy of terms than are most free databases on the Web.  Thus, a user failing to use the most specific subject term for an article may fail to retrieve it.  Also, MeSH does not “resolve ambiguity or … offer alternatives.” (p. 322). 

                MeSH is a “polyhierarchic” system of “tree structures” (p. 319).  That is, a subject term may be found in more than one hierarchical place in the system.  This may increase the likelihood of a user’s finding the term, but the user will not, by finding the term in one place, know what other terms are immediately adjacent to the term in its other locations.  That is, there may be broader or narrower terms the user does not find by searching this way.

The authors complain that MEDLINE does not display results with the “best medical journals first.” (p. 322).  They would subordinate articles “in a priority 3 journal,” not in English,” or lacking an abstract online.  It may be valid to exclude “priority 3 journals” from “the best,” (it is apparently an NIH indexing term the authors presumed there was no need to define for their readers) or to require an abstract online.  However, to exclude articles not in English sounds provincial and might result in the failure to retrieve important information.

Although I am skeptical about the authors’ complaint, I agree with their “caution.”  That is, I would study the arrangement, vocabulary, etc., of MeSH before expecting to be able to use it to good effect. 

Comments on

Hesse, Bradford W., et al.  “Trust and Sources of Health Information:  The Impact of the Internet and Its Implications for Health Care Providers:  Findings from the First Health Information National Trends Survey.”  Archives of Internal Medicine vol. 165 (Dec. 12/26, 2005) 2618-2624.

                “[M]ore patients are looking for information online before talking with their physicians.”

                Hesse and his colleagues describe the telephone survey on consumer use of the Internet for health information, their levels of trust of various sources of health information, and what sources they prefer.  With more information made available to consumers online, the consumers are finding and using it.  Most physicians are seeing some patients arrive with printouts of information they found on the Internet.  The doctors have to be prepared to comment on the information and meet patients who have some information before they get to the doctor’s office.  There may be “more shared decision making.” (p. 2619).

                Respondents were asked to rate their trust in various health information sources:  “physicians, family or friends, newspapers, magazines, radio, television, and the Internet.”  It seems odd that the Internet and other media are labeled “sources” of information, but the respondents may think of them that way.  Younger people expressed more trust in the Internet than older people did.  Those with at least a high school diploma expressed more trust for the Internet, magazines, and newspapers than those without.  Physicians enjoy the greatest level of trust.

                The authors suggest that insurance reimbursement policies may have to be adjusted to account for time necessary for physicians to interpret information the patients have gathered, to participate in shared decision making with the patients, for “steering consumers to credible information source.”  (pp. 2622-2623).

                I do not expect physicians to embrace the opportunity to instruct patients on how to find credible and appropriate medical information, and I do not expect them to hire librarians to do this.  The most I expect in this vein is that doctors may steer patients away from bad or unreliable information.  I think it is more likely that doctors will present what they consider appropriate conclusions and diagnoses to patients and then move on to the next patient without engaging in any more than the briefest mention to the patient of the various available data, opinions, and new treatments.

Comments on

Blansit, B.D. “Making Sense of the Electronic Resource Marketplace:  Trends in Health-Related Electronic Resources.”  Bulletin of the Medical Library Association Vol. 87, No. 3 (July 1999) pp. 243-250.

                “Over time, mediated searching evolved into end user searching,” says Blansit, describing a trend in librarianship that requires a shift of focus toward “educating users and improving access to information.” (p. 243)  Blansit writes of how a library can “leverage [its] influence and position within the organization” in spite of this trend.  Distribute information;  do not distribute control over it, he advises. (p. 243)

                Librarians should be aware of health care practitioners’ need to know how to find information rather than to memorize facts, and that “patient-oriented evidence that matters” is more relevant and useful to practitioners than “disease-oriented evidence.” (p. 244)

                With the “shift away from variable online costs towards fixed costs” and the shift “from mediated online searching to local data storage [and from there] to accessing online information on an as-needed basis” (p. 244), librarians can “regain the original promise and potential of the Web by selecting, organizing, and adding value to library resources.” (p. 244)

                Blansit describes some of the trends in electronic publishing, and some of its pros and cons.  Librarians save the overhead costs of “receiving, filing, and sorting, but they have to negotiate user access, provide systems support, authenticate user access, and consider archival rights.  The librarian has to distinguish between different versions of an article published in different media, where the electronic publisher may have added enhanced graphics, searchability, and interactive features not feasible in print.

                “The future will be focused on filtering and interpreting,” Blansit writes, citing Stead.  Librarians will have to “stay ahead of the electronic resource curve.”  Ways to do this include “taking advantage of free trials from publishers;… working with aggregators or republishers; …” comparing competing vendors, and negotiating and purchasing through consortia of libraries. (p. 249)

                Blansit has summarized some of the important trends of librarianship today.  Focusing at the outset on maintaining the position and influence of the library within a parent organization, he shows how the unchanging goal of matching users with the information they need and want is reinterpreted through the rapidly and constantly changing information environment.  There is no reason to think the changes will stop any time soon, so librarians must include learning new systems, languages, formats, and methods as part of their day-to-day work for the duration of their careers.

The following are comments on:  Burrows, Suzetta. “A Review of Electronic Journal Acquisition, Management, and Use in Health Sciences Libraries.” Journal of the Medical Library Association Vol. 94, No. 1 (Jan. 2006), pp. 67-74.

Authors are getting more and earlier exposure, and readers are getting more choice and more availability of information. 

From her perspective as director of the library at University of Miami’s medical school, Suzetta Burrows provides a retrospective view of electronic journals in health sciences libraries. Facts I learned from this article include that the period from 2000 to 2002 was one of unusual growth in ejournals. The number of ejournal subscriptions in the author’s library during this period grew 750%. Also, although students’ preference for online materials over print materials is well known, the author provides a ratio: quoting (at pp. 70-71) a 2003 study by Obst, she tells us that during the first 2 years after online journals were introduced, they received 10 times the use that print journals received.

Burrows describes a solution to the problem of maintaining “perpetual access” to ejournals when a subscription lapses or publication of a journal ceases: maintenance of backfiles by other entities.

Some of the trends Burrows lists in her conclusion (p. 73) are:

• availability of articles in both PDF and HTML
• elimination of password restrictions
• continuing mergers of publishers of scientific, technological, and medical “STM” articles and the resulting availability of many more journals from a single website
• library participation in ensuring “perpetual” access to backfiles

Patrons and librarians have accepted ejournals, and the information in them is now available at any time of day or night for clinical, educational, or research use. Physical visits to the libraries has waned. Librarians have gained enough confidence in “perpetual access” mechanisms to cancel many print subscriptions.

“Changes in scholarly communication” also continue. Authors are paying to have their articles immediately available in “open access,” and “[t]he acceptable timeframe from publication to public access in an institutional repository” is getting shorter. (p. 73).

What is fascinating about this change in the “acceptable timeframe” is that although the information will be out there sooner, some of its indicia of reliability, importance, uniqueness, and value will be lost if there is no time for the peer review process or the editorial enhancements by publishers or even for putting articles on the same topic together in an issue. Evidently an author’s need to be acknowledged for being first with an idea or with research results is more important.

Shedlock, James, and Linda J. Walton.  “Developing a Virtual Community for Health Sciences Library Book Selection:  Doody’s Core Titles.” Journal of the Medical Library Association, Vol. 94, no. 1 (January, 2006), pp. 61-66.

                For many years the medical library community relied, for assistance in collection development, on the Brandon/Hill list, published 1965-2003.  Publication of that list ceased on the retirement of Hill, leaving a deeply felt gap.  Doody’s Electronic Journal (DEJ), coming out of Doody’s Book Review Service, already listed 95% of the health sciences output and provided reviews for nearly a fifth of them.  Doody Enterprises was encouraged “to develop a suitable replacement for the Brandon/Hill list” (p. 62).

                What came out of this is a system using group judgment by

·         subject specialists,

·         content specialists, and

·         library selectors

to solve the common purpose.

To produce DEJ, Doody’s editors select titles to be reviewed and find a subject specialist to provide the review in return for a copy of the book.  Reviews must fit the format of description, purpose, audience, features, and assessment.  Reviewers give the book points for various criteria such as whether the author’s objectives are met, whether those objectives are worthy, and whether the book is written at the appropriate level (p. 63).

To produce DCT, the content specialists select titles “that meet DCT’s criteria for core titles” (p. 63).  To recommend a title, the content specialist must “believe [that the title] should be recognized as essential to the discipline’s literature” (p. 63).

Library selectors, health sciences librarians recruited from among Medical Library Association members, recommend titles to be included in DCT.  They begin by “reviewing the titles recommended by the DEJ content specialists” (p. 64), but they may recommend additional titles.  Library selectors then rate their recommended titles on five criteria, using a scale of zero to three:

·         Authoritativeness of the author / publisher

·         Scope and coverage of the content

·         Quality of the content,

·         Usefulness

·         Quality relative to price

The content specialists do not participate in this scoring, so the resulting list is “peer-driven” (p. 64). 

Shedlock and Walton list these uses of DCT:

·         Collection development

·         Collection assessment

·         Source for textbook selection

·         Entry point for “the literature of an unfamiliar discipline” (pp. 64-65)

They point out that although any core list “can fail to take into account important local factors” for collection building or for deselection, “[t]he sum total of the group’s judgment may be DCT’s best qualification as a selection guide” (p. 65)  They note that at the time of their writing, only a year after DCT December 2004 launch, DCT’s impact cannot yet be known, but MLA members wanted the Brandon/Hill lists to continue and volunteered for this effort.  Shedlock and Walton take that volunteer effort as “evidence that DCT will play a role in the work of building useful collections…” (p. 65)

Shedlock and Walton have written a useful description of DCT, showing its history, its manner of functioning, and its likely usefulness. 

Kruger, Justin, et al. “Egocentrism Over E-Mail:  Can We Communicate a Well as We Think?”  Journal of Personality and Social Psychology 2005, Vol. 89, No. 6, 925-936

                Kruger and his co-authors show through a series of experiments that people are, in general, less clear in their communications than they think they are.  This shows up in several kinds of communication, with email communication the focus of this article.  Inability to see written communication from a point of view other than one’s own as writer, referred to here as “egocentrism,” is one of the causes.  (We think the reader will see a situation as we do, and we fail to realize that we have provided only a partial picture.)  We fail to realize the importance of “paralinguistic cues” (p. 926) such as gestures and tone of voice, and we believe that our mood and intent will be correctly understood by the reader of our emails. We underestimate our own ambiguity of meaning, mood, and intent.  Whether we are “sarcastic or serious, disrespectful or deferential, sanguine or somber” (p. 926, citing Abrahams and others) is a question we unintentionally leave to our readers. 

The authors state that no one has yet studied the difference between our ability and our perceived ability to communicate via email (p. 926), but they confidently assert that however able to communicate we may be, we are less able than we think we are (p. 927).

Overconfidence in one’s own clarity reduces the quality of communication (p. 934).  “To the extent that people overestimate the obviousness of the fact that they are ‘just kidding’ when they poke fun or criticize, they may unwittingly offend,” (p. 934) and that is poor communication indeed.  “[O]verestimating the obviousness of one’s intentions can lead to insufficient allowances for ambiguities in communication – with occasionally destructive results,” they say (p. 934, citing “Kruger, Gordon, & Kuban, in press.”)

The authors allow for the possibility that “reflection and reconsideration of one’s communication before transmission” (p. 934) may help a writer see ambiguity and “increase communication calibration.”

The authors raise valid points, and it is interesting that they have shown the phenomena they describe through experimentation.

However, they miss two very easy ways of “increasing their communication calibration”:  They could give examples of what to do to compensate for email’s lack of visual and vocal cues, and they could use simple language when it can carry as much meaning as complex language.  They could say: 

Wait a day before sending anything negative, to see if it is still what you want to say.  Add words or phrases that convey warmth or whatever mood you intend to convey, along with examples or explanation if necessary.  Your message and your intent will have a better chance of getting through.