health information literacy in canadian medical curricula: an opportunity for librarians?

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This article was downloaded by: [University of California Davis] On: 10 November 2014, At: 11:58 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Hospital Librarianship Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/whos20 Health Information Literacy in Canadian Medical Curricula: An Opportunity for Librarians? Lorie A. Kloda a a McGill Life Sciences Library , McGill School of Information Studies , Montreal, Quebec, Canada Published online: 07 Sep 2008. To cite this article: Lorie A. Kloda (2008) Health Information Literacy in Canadian Medical Curricula: An Opportunity for Librarians?, Journal of Hospital Librarianship, 8:3, 314-322, DOI: 10.1080/15323260802209450 To link to this article: http://dx.doi.org/10.1080/15323260802209450 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

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Page 1: Health Information Literacy in Canadian Medical Curricula: An Opportunity for Librarians?

This article was downloaded by: [University of California Davis]On: 10 November 2014, At: 11:58Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Journal of HospitalLibrarianshipPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/whos20

Health Information Literacy inCanadian Medical Curricula: AnOpportunity for Librarians?Lorie A. Kloda aa McGill Life Sciences Library , McGill School ofInformation Studies , Montreal, Quebec, CanadaPublished online: 07 Sep 2008.

To cite this article: Lorie A. Kloda (2008) Health Information Literacy in CanadianMedical Curricula: An Opportunity for Librarians?, Journal of Hospital Librarianship,8:3, 314-322, DOI: 10.1080/15323260802209450

To link to this article: http://dx.doi.org/10.1080/15323260802209450

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 or

Page 2: Health Information Literacy in Canadian Medical Curricula: An Opportunity for Librarians?

indirectly in connection with, in relation to or arising out of the use of theContent.

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: Health Information Literacy in Canadian Medical Curricula: An Opportunity for Librarians?

Journal of Hospital Librarianship, Vol. 8(3) 2008Available online at http://jhspl.haworthpress.com

© 2008 by The Haworth Press. All rights reserved.314 doi:10.1080/15323260802209450

WHOS1532-32691532-3277Journal of Hospital Librarianship, Vol. 8, No. 3, June 2008: pp. 1–13Journal of Hospital Librarianship

INTERNATIONAL LIBRARIES

Health Information Literacy in Canadian Medical Curricula: An Opportunity

for Librarians?Lorie A. KlodaJournal of Hospital Librarianship Lorie A. Kloda

ABSTRACT. As medical and other health professional school curriculaevolve to include new outcomes centered on the patient, librarians can andshould take the opportunity to integrate the subject of health informationliteracy into program objectives. This article identifies justification for theimportance of teaching health professionals about health information liter-acy and reports on the findings of an exploratory survey to determine whatis already being done in Canadian medical schools in this regard. It is

Lorie Kloda, currently on leave of absence from her position as InstructionalTechnology Librarian at the McGill Life Sciences Library, is a doctoral student atMcGill School of Information Studies, Montreal, Quebec, Canada (E-mail:[email protected]).

The author thanks Jim Henderson and Erica Burnham, McGill Library, fortheir contributions in the design and conduct of the survey. The preliminaryresults of the survey were presented at the Annual Conference of the CanadianHealth Libraries Association, Vancouver, British Columbia, Canada, May 2006.

Comments and suggestions should be sent to the Column Editors: GraceAjuwon (E-mail: [email protected]); Peggy Fong (E-mail: [email protected]); and Amanda Ross-White (E-mail: [email protected]).

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concluded that more research is required to address how to teach information-gathering for patient education, as well as methods for communicating anddisseminating patient-appropriate information.

KEYWORDS. Health information literacy, consumer health, Canada,medical schools, curricula, library instruction

INTRODUCTION

In North America, health information literacy is gaining popularityamong librarians and health professionals alike. While the provision ofconsumer health information for patients is perceived as an accepted rolefor librarians, the same cannot be stated with certainty regarding theteaching of health professionals on the subject of health information literacy.As medical and other health professional school curricula evolve toinclude new outcomes centered on the patient, librarians can and shouldtake the opportunity to integrate the subject of health information literacy(and librarians themselves) into program objectives. At McGill Universityand its affiliated teaching hospitals, health librarians are trying to do justthat. As part of this attempt, we decided to survey librarians at otherCanadian medical schools to see what types of activities, if any, werealready taking place in this regard. This article identifies justification for theimportance of teaching health professionals—specifically physicians—about health information literacy, and reports on the findings of the survey.

HEALTH INFORMATION LITERACY AND HEALTH PROFESSIONALS

One of the biggest hurdles in attempting to incorporate the concept ofhealth information literacy into the curriculum of medical and otherhealth professional schools is convincing faculty members and adminis-trators of its relevance and importance. Several research studies and com-mentaries have addressed this issue and serve as useful starting points fordiscussion. At McGill, during workshops on providing information forpatients, and during meetings with administrators, librarians emphasizethe importance of patient information in healthcare. For example, a JAMAarticle regarding physician-patient communication asserts that “[i]nformedpatients are more likely to participate actively in their care, make wiser

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decisions, come to common understanding with their physicians, andadhere more fully to treatment” (1). Another article goes further to arguethat not only is health information a motivator for patient behavior andcompliance, but that it also influences patient satisfaction:

The emotional climate is not the only factor that predicts patientsatisfaction. The strongest predictor is how much information isgiven to the patient about diagnosis, the causes and course of a dis-ease, or possible treatments and what they entail. Patients who getmore information are more satisfied than patients who get lessinformation.(2)

The importance and impact of health information literacy in medicinehas been reported in various publications (3–7) but does not necessarilyaddress the issue of educating health professionals for dealing with healthinformation literacy in clinical practice. Helpful guidelines do exist forcreating and sharing health information for patients (8–11) but whatappears to be lacking are guidelines or recommendations for providinginstruction to students in health professional schools for assessing andaddressing the issues surrounding health information literacy.

SURVEY OF CANADIAN MEDICAL SCHOOL LIBRARIES

In the spring of 2006, librarians at McGill University conducted atelephone survey of Canadian universities with undergraduate medical pro-grams about teaching and activities related to consumer health information.The summaries below include information reported from a representativefrom each library with an emphasis on what is being done in the medicalschools. The survey collected information about the teaching of healthinformation literacy and finding consumer health information in profes-sional schools, as well as other initiatives for providing health informationthrough health professionals (rather than librarians). The university healthsciences libraries are described in geographical order, from the west toeast coast. Due to time constraints, we were only able to collect informa-tion from 14 of the 17 eligible institutions. Those that are not included areUniversity of Western Ontario, Allyn and Betty Taylor Library (London,Ontario), Université de Montréal, Bibliothèque de la Santé (Montreal,Quebec), Université de Sherbrooke, and Bibliothèque – Sciences de laSanté (Sherbrooke, Quebec).

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University of British Columbia, Woodward BiomedicalLibrary (Vancouver)

Training students to find consumer health information is a componentof the Woodward Biomedical Library’s liaison program at the Universityof British Columbia. The training is provided to various groups in thehealth professional schools and is included in the evidence-based medicinecurriculum, for which the library has input. At this time, the provision ofinstruction about consumer health information is not a part of the curricula.

University of Alberta, John W. Scott Health Sciences Library (Edmonton)

At the University of Alberta’s medical school, teaching students howto provide quality information to patients is a part of the curriculum.Library instruction in the schools of pharmacy and nursing also include anintroduction to sources for patient information.

The public health sciences department is active in programs on healthpromotion, most notably through their Centre for Health Promotion. TheJohn W. Scott Health Sciences Library, in support of a two-year-old pro-gram in complementary and alternative medicine in the department ofpediatrics, participates in selective collection development activities.This program is the first of its kind in Canada. A librarian was hiredspecifically to address the needs of staff, patients, and patients’ familymembers. As other departments besides pediatrics are interested in com-plementary and alternative health, which is strengthened by an increasein emphasis on multidisciplinary healthcare teams and on the need foraboriginal healthcare information, the need for library support isexpected to grow.

University of Calgary, Health Sciences Library (Calgary, Alberta)

The University of Calgary’s Health Sciences Library involvement inthe medical school curriculum has evolved from first being incorporatedin the medical informatics course, and subsequently in the research methodscourse. At present, it is included in evidence-based medicine. A course on“Healthy Populations” is included in the first year of undergraduate medicaleducation, and the library participates in this. The intention of the courseis to provide students with social awareness and accountability. TheHealth Sciences Library expects an increased interest in consumer healthinformation and is rethinking the library’s contribution to the course to

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include consumer health information, considerations of social and economiccontext, and website evaluation.

University of Saskatchewan, Health Sciences Library (Saskatoon)

The University of Saskatchewan’s medical school includes a medicalinformatics program in the first year of the curriculum. Included in themedical informatics program is a component on patient information. Aspart of an assignment, students must find information that includes aconsideration of the patient’s perspective. In the School of Pharmacy,library instruction, which is incorporated during all four years of theprogram, also includes the objective of searching for information forpatients, which is incorporated into an assignment.

Occasionally, the Health Sciences Library offers programs for helpingclinicians to find and apply information, including patient information, aspart of a continuing education program. In addition, librarians providetraining to all types of health practitioners in the province as part of theSaskatchewan Health Information Resources Partnership (SHIRP) initiative.Trainers provide handouts on how to find and use consumer health infor-mation. In addition to SHIRP, which provides all healthcare practitionerswith access to databases, including consumer health databases,Saskatchewan also has a Cochrane Initiative, which provides access to theCochrane Library for every resident.

University of Manitoba, Neil John MacLean Health Sciences Library (Winnipeg, Manitoba)

Librarians at the Neil John MacLean Health Sciences Library assiststudents in finding consumer health information at the library informationdesk. Librarians also provide instruction to first year students enrolled inthe course “Health and Health Professions” on searching for credibleconsumer health information online.

Northern Ontario School of Medicine, Health Information Resource Centre (Thunder Bay and Sudbury, Ontario)

The Health Information Resources Centre (HIRC) of The NorthernOntario School for Medicine has branches on the Thunder Bay and Sudburycampuses of the school, and also serves Lakehead and Laurentian Universitiesthrough reciprocal agreements. The medical school does not incorporate

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consumer health in the curriculum. The HIRC delivers instruction tostudents on searching the literature, including the use of resources such asMDConsult and UpToDate which include patient information modules.

In addition, HIRC offers a series of 12 one-hour long virtual trainingsessions throughout the academic year. Each of these virtual sessions,which includes a webcast, has a different focus, and one made availablefor the first time in March 2006, is on the subject of consumer health infor-mation. The session on consumer health information includes informationabout websites such as the Canadian Health Network and MedlinePlus, aswell as search strategies for locating information for patients. Thesesessions are open to all faculty, health professionals, and students, but arenot mandatory. Virtual sessions are saved and remain available on theinternet for future viewing.

McMaster University, Health Sciences Library (Hamilton, Ontario)

At McMaster University, the medical school follows the problem-based learning approach. Librarians serve as resource people to smalltutorial groups composed of seven to eight students. Database instructionand other information skills are taught by request from the individualgroups. The library also offers workshops in the library which studentsmay attend. There is no required component on consumer health informa-tion in the medical school curriculum.

In the past, a librarian from the Health Sciences Library served on theaffiliated hospital’s patient education committee, which among otherthings, was tasked with adapting materials to an easier to understand read-ing level. The librarian is no longer involved with the committee,although the library maintains a guide to consumer health information andoccasionally receives requests from the public via e-mail or telephone.

University of Toronto, Gerstein Science Information Centre (Toronto, Ontario)

At the University of Toronto, much of the medical school curriculum istaught on-site in the hospitals. As such, what is taught is often site-dependant.There is no guarantee that consumer health information is incorporatedinto the instruction offered by hospital librarians, and the academic librariansare not involved in this. Interestingly, the School of Pharmacology doesincorporate teaching on providing drug information to patients, but again,the library is not involved.

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Queen’s University, Bracken Health Sciences Library (Kingston, Ontario)

Queen’s University health sciences librarians are very involved in thecurricula for medicine, nursing, and rehabilitation schools. Students learndatabase searching skills and well as evidence-based practice. For thenursing program, there is some emphasis on consumer health information;in a first-year nutrition course, students have an assignment to develop apatient handout. The Bracken Health Sciences Library would like toeventually broaden the instruction offered in the life sciences, includingthe schools of medicine, nursing, and rehabilitation, to include more onpatient communication and consumer health information.

University of Ottawa, Health Sciences Library (Ottawa, Ontario)

The University of Ottawa’s Health Sciences Library has been activelyinvolved in addressing health literacy in the medical curriculum throughits work as part of a research team, although at the moment no instructionon consumer health information is included.

The library does provide outreach outside the university communitythrough different initiatives. As part of University of Ottawa’s Mini MedicalSchool education program for the public, the Health Sciences Libraryinvites participants to visit the library and consult its collection.

Université Laval, Bibliothèque Scientifique (Laval, Quebec)

At the Université Laval, the library provides curriculum-integratedinstruction in the Schools of Medicine, Nursing, Rehabilitation Sciences,and Pharmacy. While the nature of the instruction varies—the nursingschool, for example, has a separate course for students on informationliteracy—none explicitly include the provision of patient information.

McGill University, Life Sciences Library (Montreal, Quebec)

McGill’s Life Sciences Library has integrated basic literature-searchingwell into the curriculum in the medical, rehabilitation, speech-languagepathology, and nursing schools. Less established is instruction on findinginformation to share with patients. There is some information provided onthis topic to undergraduate students in the rehabilitation sciences in rela-tion to an assignment on creating a handout for patients. In addition, aresource guide has been created on the library’s website and is referred toin workshops offered to graduate students in nursing, rehabilitation, and

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dentistry. Specific workshops on finding consumer health informationhave been conducted with the departments of family medicine, and facultyin general. It is the Life Science’s Library’s hope to incorporate this typeof instruction in the undergraduate medical curriculum.

In addition, the library is involved in the Faculty of Medicine’s Mini-MedSchool program, a public education initiative. Librarians facilitate anoptional workshop for Mini-Med School participants on searching forhealth information on the internet.

Dalhousie University, W. K. Kellogg Health Sciences Library (Halifax, Nova Scotia)

Dalhousie University’s Faculty of Health Professions includes patienteducation in its school’s curricula. For some, such as the School of Health andHuman Performance and the School of Nursing, this component plays acentral role. The W. K. Kellogg Health Sciences Library primarily participatesin end-user training for students and healthcare providers. There is modestdemand for training health professionals on health education or health promo-tion. The evidence-based dentistry program, in which the library is heavilyinvolved, includes instruction about patient information. The School of Phar-macy also has a significant component that covers this topic. The library is notdirectly involved, but does receive questions and referrals from the program.

Memorial University of Newfoundland, Health Sciences Library (St. John’s, Newfoundland and Labrador)

At Memorial University of Newfoundland, nursing students createpamphlets in general health. Pharmacy students are required to completeassignments for the library each semester; however, there is a componentin their instruction on providing information for patients. The medicalstudents, in the context of learning about patient communication, partici-pate in an interdisciplinary program with nursing, pharmacy, and socialwork students which included a component on disseminating informationto patients. In the past, the Health Sciences Library was involved in thisprogram, but is no longer participating.

CONCLUSION

The results of this exploratory survey reveal that while Canadianlibrarians are aware of the importance of including health information

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literacy-related outcomes in medical curricula, there is much to be done inthis area. At this time, it appear as though the majority of students in thehealth professions are not learning how to find and convey the best infor-mation to patients. Those libraries involved in such efforts are encouragedto share their experiences, and evaluate the success of their programs.More research is required to address how to teach information-gatheringfor patient education, as well as methods for communicating and dissemi-nating patient-appropriate information.

REFERENCES

1. Epstein RM, Alper BS, Quill TE. Communicating evidence for participatorydecision-making. JAMA. 2004;291:2359–2366.

2. Roter DL, Hall JA. Patient-provider communication. In: Glanz K, Lewis FM, RimerBK, eds. Health behavior and health education: theory, research and practice. 2nd ed. SanFrancisco: Jossey-Bass; 1997, p. 213.

3. Burnham E. Libraries as partners in health literacy. J Consum Health Internet.2003;7(4):7–15.

4. Rootman I. Health literacy: Where are the Canadian doctors? CMAJ. 2006;175:606.5. Taking health literacy seriously. Lancet 2005;366:95.6. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient-

physician communication. Fam Med 2002;34:383–389.7. Woolf SH, Chan ECY, Harris R, Sheridan SL, Braddock CH, Kaplan RM, Krist A,

O'Connor AM, Tunis S. Promoting informed choice: transforming health care to dispenseknowledge for decision making. Ann Intern Med. 2005;143:293–301.

8. Bradley DW, Currie BF. Writing patient education materials. In: Taylor RB,Munning KA, eds. Written communication in family medicine, New York: Springer-Verlag; 1984, pp. 159–172.

9. Estey A, Musseau A, Keehn L. Comprehension levels of patients reading healthinformation. Patient Educ Couns. 1991:165–169.

10. Safeer RS, Keenan JK. Health literacy: The gap between physicians and patients.Am Fam Physician. 2005;72:463–468.

11. Shepperd S, Charnock D, Gann B. Helping patients access high quality healthinformation. BMJ. 1999;319:764–766.D

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