a new role for the clinical librarian as educator

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This article was downloaded by: [University of Illinois Chicago] On: 23 November 2014, At: 18:35 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Medical Reference Services Quarterly Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wmrs20 A New Role for the Clinical Librarian as Educator Lynne U. Turman a , Jodi L. Koste a , Andrea S. Home a & Claire E. Hoffman a a Access Services, Tompkins-McCaw Library, Medical College of Virginia Campus , Virginia Commonwealth University , P.O. Box 980582, Richmond, VA, 23298-0582, USA Published online: 17 Oct 2008. To cite this article: Lynne U. Turman , Jodi L. Koste , Andrea S. Home & Claire E. Hoffman (1997) A New Role for the Clinical Librarian as Educator, Medical Reference Services Quarterly, 16:1, 15-23, DOI: 10.1300/J115v16n01_02 To link to this article: http://dx.doi.org/10.1300/J115v16n01_02 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.

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Page 1: A New Role for the Clinical Librarian as Educator

This article was downloaded by: [University of Illinois Chicago]On: 23 November 2014, At: 18:35Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Medical Reference ServicesQuarterlyPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/wmrs20

A New Role for the ClinicalLibrarian as EducatorLynne U. Turman a , Jodi L. Koste a , Andrea S. Homea & Claire E. Hoffman aa Access Services, Tompkins-McCaw Library, MedicalCollege of Virginia Campus , Virginia CommonwealthUniversity , P.O. Box 980582, Richmond, VA,23298-0582, USAPublished online: 17 Oct 2008.

To cite this article: Lynne U. Turman , Jodi L. Koste , Andrea S. Home & Claire E.Hoffman (1997) A New Role for the Clinical Librarian as Educator, Medical ReferenceServices Quarterly, 16:1, 15-23, DOI: 10.1300/J115v16n01_02

To link to this article: http://dx.doi.org/10.1300/J115v16n01_02

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

Page 2: A New Role for the Clinical Librarian as Educator

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

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Page 3: A New Role for the Clinical Librarian as Educator

A New Role for the Clinical Librarian as Educator

Lynne U. Turman Jodi L. Koste

Andrea S. Home Claire E. Hoffman

ABSTRACT. The Clinical Medical Librarian (CML) Program of the Tompkins-McCaw Library is a special instructional initiative to teach third-year medical students the use of information resources in the clinical setting. Librarians spend one week with selected internal medicine teams participating in work rounds and instructingteam members in the use of the medical literature. The librarian assists team members to identify and retrieve relevant information through computer workstations located in the hospital. Photocopies of jour- nal articles are made available to team mcmbcrs through the CML document delivery program. [Article copies available J i m The Haworth Document Delivery Sewice: 1-800-342-9678. E-mail address: gelinfo@ haworlh.com]

INTRODUCTION

Since the mid-1980s the Tompkins-McCaw Library has conducted end- user instructional sessions for third-year medical students on the Medical College of' Virginia Campus of Virginia Commonwealth University (MCVIVCU). These instructional sessions have focused on the use of

Lynne U. Turman is Manager, Education Services, Jodi L. Koste is Archivist, Andrea S. Home is Manager, Information Services, and Claire E. Hoffman is Manager, Access Services, Tompkins-McCaw Library, Medical College of Vir- ginia Campus, Virginia Commonwealth University, P.O. Box 980582, Richmond, VA 23298-0582.

Medical Reference Scrvices Quarterly, Vol. 16(1), Spring 1997 D 1997 by The Haworth Press, Inc. All rights reserved. I S

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Page 4: A New Role for the Clinical Librarian as Educator

16 MEDICAL REFERENCE SERVICES QUARTERLY

MEDLINE to retrieve medical information. At MCVlVCU the third-year curriculum has consisted of a year-round clerkship program where stu- dents rotate through medical services in the university's teaching hospital and other satellite facilities. Library instruction was offered in numerous formats throughout the years but was not able to be intcgrated into the curriculum. Most sessions consisted of a lecture presented to thc entire third-year class during the orientation week prior to the students' initial clerkship rotation. As technology advanced, these lectures were accompa- nied by online demonstrations, and later were combined with hands-on instruction.

Despite the variety of presentation methods over the years, library and School of Medicine faculty observed that many students did not retain the knowledge and skills taught in these sessions and required additional training when they needed to consult the literature for clinical problem- solving. Library faculty became interested in exploring other methods for effective instruction with this group. As adult learners, these students are more likely to retain new information if they perceive a direct relation to present needs.] With this in mind, librarians reasoned that providing instruction directly in the clinical setting, where students were con- fronted with patient cases, would lead to a more valuable learning experi- ence. By using actual cases as examples in their instructional sessions, librarians hoped to increase the relevancy of the learning experience. Librarians began to look for ways to integrate instruction into this arena and proposed a modified version of a clinical medical librarian (CML) program.

The idea of a CML service was not new to MCV/VCU. The Tompkins- McCaw Library conducted a CML program from 1977 to 1983 at a time when end-user searching was not widely availablc. Like most other pro- grams of this era, the purpose was to provide information quickly, to intcgrate the librarian as a member of the health care team, and to influ- ence the information-seeking behavior of health care ~rov iders .~ The librarian attended rounds, identified information needs of the medical team, and returned to the library to search for and retrieve relevant in- formation. Staff and budget cuts in the early 1980s forced the library's administration to discontinue what had been a successful but costly pro- gram. Medical libraries across the country were compelled to take similar action.

Support remained for certain aspects of the CML concept, specifically the provision of information in the clinical sctting and the participation of the librarian as a member of the health care team. In late 1993, the library used this background as a frame of reference to propose changes to the

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Page 5: A New Role for the Clinical Librarian as Educator

School of Medicine for the instructional program for third-year medical students. From these discussions emerged a CML program in which the librarian instructed students to access the medical literature during their internal medicine rotation. The existence of computer workstations in hospital clerkship sites would enable library faculty to provide training directly in the clinical setting at the point of need.

The CML program was designed as an instructional initiative with the librarian serving as educator. This role was a departure from the tradi- tional CML program where the librarian searched, selected, and provided information to the health care team. With the new model, the librarian evolved from service provider to instructor. The newly defined role ad- dressed one of the concerns noted by library directors and medical faculty in a survey on CML programs conducted by Demas and Ludwig in 1 9 9 1 . ~

Another issue raised by the Demas and Ludwig study was the cost of CML programs., Since neither the School of Medicine nor the library could individually afford to support a CML program, a collaborative initiative was undertaken. The Tomvkins-McCaw Librarv. the School of Medicine. the MCV Hospitals, and university ~ o m ~ u t i n g ~ e r v i c e s all provided per: sonnel. equipment, and resources for the oroaram. No positions were added or ieailocated to implement the CML program, and ;xisting staff in each of the areas would contribute the necessary support for this educa- tional initiative.

PROGRAM IMPLEMENTATION

The MCVNCU CML program has three essential components: com- puter workstations in clinical areas, document delivery services, and librarian educators. A number of these elements were already in place and were adjusted to meet the needs of the CML program.

One existing component was the Student Educational Workstations (SEWs), purchased by the School of Medicine in the fall of 1993 with funds from the Commonwealth of Virginia's Higher Education Equipment Trust Fund. These workstations. maintained bv the School of Medicine. consisted of state-of-the-art personal computers with high-resolution mon- itors, modems, and laser printers. MCV Hospitals provided funding for the dedicated telephone lines for modem access. The computer workstations connected users to the library's databases, including a locally mounted MEDLINE file, the School of Medicine's e-mail system, several decision support software programs, word processing, and thc Internet. SEWs were installed in thirteen locations in the MCV Hospitals, including the internal

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18 MEDICAL REFERENCE SERVICES QUARTERLY

medicine team teaching rooms, the satellite Hospital Library, and several other in-patient areas. The computer workstations all had software manu- als, instructional aids, and MeSH tools purchased by the School of Medi- cine.

Another integral element of the CML program is a document delivery service. To encourage use of the medical literature, librarians created a service which allowed students to request articles at no personal expense. The School of Medicine's Annual Alumni Fund subsidized the cost and was billed $3.00 per article for up to ten pages and $.lo a page for each additional page. The Interlibrary Loan (ILL) Office at the Tompkins- McCaw Library furnished copies of articles to the third-year medical students, removing the librarians from the "fetch and carry" role that characterized earlier CML programs.

With support services in place, librarians conducted a one-week pilot to test the CML concept. Using this experience, the librarians designed instructional goals and objectives for the program, which began in August 1994. The primary goal of the MCV/VCU CML program is to develop information management skills for usc in the clinical setting. Specific learning objectives are outlined in Table 1. Although the program was designed for third-year medical students, instruction was offered to all members of the internal medicine team, including: attending physician, resident, interns, nurse case manager, social worker and pharmacist. Librarians reviewed programs and applications available on the SEWS, taught team members how to access the library's catalog and databases remotely, demonstrated effective searching techniques for the MEDLINE and MICROMEDEX databases, and taught procedures for obtaining hl l - text documents.

A faculty member from the library sewed as coordinator and managed the administration of the CML oroeram. Regular duties included schedul- . " ., ing the weeks, assigning staff, assembling instruction materials, maintain- ing files, and handling correspondence. Prior to each rotation, the coordi- nator contacted the attending physicians to inform them that their team would be working with a clinical librarian and distributed copies of the program goals and objectives.

THE CML WEEK

Every month two to three librarians participated in the CML program by working with an internal medicine team for one week. All the librarians on the MCV Campus completed at least one rotation in the program. At the beginning of the week, the librarian described the program and library

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Page 7: A New Role for the Clinical Librarian as Educator

TABLE 1 CML GOALS AND OBJECTIVES FOR INTERNAL MEDICINE TEAMS

1995-96

1 God I: Introduce members of the mternal medicine real lo information resources and services.

Objectives: Team members will be able to:

I. Locate through print or electronic sources 1 information on services at Tomotins. McCaw Library.

2. Locate the Hospital Library and identify sources and services available from this location.

9. Idcnrify programs and applications on the Student Educational Worksfations (SEWs).

4. Locate user aids and identify key personnel for assistance.

5. Search the library cal log and locate books and journals.

Goal 3: Introduce tenm members to the MICROMEDEX drug information database.

Objectives: Team members will be able to: I--- Identify available drug informalion databases and search terms appropriate to each. Log on to computer and sign on to applicable database. Use function keys apprapriately. Find.information an drug specific questiors. Identify l i i lat ions of the system. Produce hard copies andlor download meterial as necded.

G o d 2: Introduce team members to the Medical Subject Headings (MeSH) and the MEDLINE database on NOTIS.

Objectives: T e m members will be able to:

I. Log on to the computer and sign on to the MEDLINE database.

2. Corstnrct a search stratcgy using Medical Subject Headings (MeSH).

3. Use keyword searching to qualify searches by age, language, publication type. subheadings, major concept, and journal subsers.

1. Switch belween databases, review and edit search strategies.

i. Find information on a case-related topic. i. Interpret MEDLINE record and holdings

information.

h d 4 : nlraluce team members to document delivery ~ptions.

)bJecl lv~~: Team members will be able to:

. Obtain anicles through the CML document delivery program during the CML week.

. Order anicles from Tompkins-McCaw Library document delivery program aher CML week.

services to the team and distributed information packets. These packets consisted of document delivery forms, teaching aids, and brochures detaii- ing information-related services of the Tompkins-McCaw Library, the Hospital Library, and the School of Medicine's Computer Based Instruc- tion Lab.

On a typical day, the librarian attended morning report and accompanied ., the team on walking work rounds. The librarian scheduled several instruc-

tional sessions for the week to meet the learning objectives listed in Table 1. These sessions were held in the internal medicine team rooms. Using the SEWs, librarians taught the use of MEDLINE and MICROMEDEX, incor-

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Page 8: A New Role for the Clinical Librarian as Educator

20 MED/CAL REFERENCE SERY(CES QUARTERLY

porating search examples from the team's'case load. The librarian also met informally with team members during the week to provide additional instruction and search advice. In these informal sessions, librarians worked individually with students who required specific information related to a patient. In addition, the librarians answered questions about general library services, computing services, remote access, and the Internet.

During the CML week, team members requcsted photocopies of ar- ticles by completing a special document delivery form. This form was delivered or faxed to the Tompkins-McCaw Library ILL Office, where the requests were filled within ten hours and returned to the Hospital Library for pick-up. Articles from journals not owned were obtained from other libraries. Internal medicine teams requested an average of sixteen articles per month (see Table 2).

Each librarian compiled a weekly report and narrative account of CML activities. The report detailed the time the librarian spent with the team, patient load, training opportunities, and equipment issues. In addition, the librarians recorded observations about team interactions, perceived effec- tiveness of instruction, and overall success of the program. These statistics and observations were used in evaluations of the program.

TABLE 2 CML PROGRAM DOCUMENT DELIVERY

August

September

October

November December

February

March

April

TOTALS

Requests Filled n' 1994195 - Filled -

10

I2

14

13

26

8

1 I

4

12 - 110 -

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Page 9: A New Role for the Clinical Librarian as Educator

OBSERVATIONS

After the first few CML rotations, the librarians discovered that every weekly experience with a team was unique. Each team was shaped by the personalities involved, the patients' medical conditions, and a host of other factors. Scheduling issues and the involvement of the attending physicians affected the achievement of program objectives.

The selection of the CML week resulted in different scenarios for each librarian. Internal medicine teams worked together for approximately one month, and librarians wcre assigned to the team during either the first or second week of the third-year students' rotation. In thc first week, there were often changes in the composition of the teams as residents, interns, and occasionally, even an attending physician rotated to another service. Some librarians expressed a preference to be with the team during this initial week when relations are being formed. Others noted that participa- tion during the second week was preferable because the team members have developed working relationships, have established a clinical routine, understand the expectations of the attending physician, and appeared to be more receptive to library instruction.

Librarians found that they had to be extremely flexible to accommodate the team's schedule and patient load. The time available for training was greatly affected by factors such as the number of patients assigned to the team, scheduled lectures and exams for students, and other commitments such as clinic duty for residents and interns. Although the librarians antici- pated spending each morning with the team, they often found they had to return to the hospital at various times in the afternoon to hold a training session. This required a schedule free from other assignments such as reference desk work or meetings.

The attending physicians had a major influence on the outcome of the CML program. Librarians reported greater success when the physician actively supported the educational role of the librarian. Physicians demon- strated support by their own use of the literature in decision-making. In addition, several attendings invited the librarians to use the daily lecture time for training and suggested topics for the students to search.

Initially, librarians had concerns about the document delivery service, but they observed that this aspect of the CML program was well received. Many team members expressed their appreciation for the service. This service did not prove to be a burden for the ILL staff. The use of a specially designed form for document delivery during the CML week alerted the staff to urgent requests. Although the stated turnaround time for photocopics of articles was ten hours, the majority of the requests were

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22 MEDICAL REFERENCE SERVICES QUARTERLY

actually filled in five hours or less. Good communication between the clinical librarians, the ILL staff, and the Hospital Library staff contributed to the success of the service. Possible enhancements being investigated include the capability to transmit articles directly to the team rooms via fax or the Internet. Implementation of these improvements hinges on the con- nection of the SEWS to the university network.

While a preliminary survey revealed that there was general satisfaction with the CML program by the attending physicians and residents, no formal evaluation of the program has been conducted to date. No conclu- sions can be made about the effcctiveness of this education initiative. Present staffing levcls will not permit the library to offer CML service to every medicine team. As a result, less than half of the third-year medical class receives instruction. Dcspite these shortcomings, librarians have ob- served a number of benefits.

Librarians have witnessed that team members have exhibited an en- hanced awareness of information resources and an increased understand- ing of the librarian's role as information specialist and educator. Several ~hvsicians and students have commented that thev are excited at the oros- . . pect of having a librarian as a team member.

The CML rotation has proved to be especially useful for staff develop- ment and training for librarians new to the health care field. Librarians have a better understanding and insight into the demands of the patient care team. They are better able to anticipate the information needs of health care practitioners as a result of their participation in this program.

Finally, the MCVNCU CML program has been a positive public rela- tions venture. It has increased the visibility of the library and reinforced its commitment to integrated library instruction.

SUMMARY

Faculty at the Tompkins-McCaw Library continue to explore the CML model as a vehicle for bibliographic instruction. Advances in technology have brought electronic resources into the clinical setting, allowing librari- ans to teach at the point of need. Building on a traditional service-oriented program, librarians created a new CML model that centered on user education and emphasized the role of the librarian as information special- ist and instructor.

ACCEPTED FOR PUBLICATION: APRIL 1996

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REFERENCES

I . Knowles, Malcolm S. The Addl Leart~er: A Neglecled Species. 4th ed. Houston: Gulf Pub. Co., 1990.

2. Cimpl, Kay. "Clinical Medical Librarianship: A Review o f the Literature." B~dlelin of the Medical Library Associatio~~ 73 (January 1985):21-8.

3. Demas, Jean M., and Ludwig, Logan T. "Clinical Medical Librarian: The Last Unicorn?" Bullelir~ of lhe Medical Libvary as so cia ti or^ 79 (July 1991):17-27.

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