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New and Emerging Roles for MedicalLibrariansS. Layla Heimlich aa William B. Glew, MD, Health Sciences Library, MedStar WashingtonHospital Center , Washington , DC , USAPublished online: 12 Feb 2014.

To cite this article: S. Layla Heimlich (2014) New and Emerging Roles for Medical Librarians, Journalof Hospital Librarianship, 14:1, 24-32, DOI: 10.1080/15323269.2014.859995

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Journal of Hospital Librarianship, 14:24–32, 2014Published with license by Taylor & FrancisISSN: 1532-3269 print/1532-3277 onlineDOI: 10.1080/15323269.2014.859995

New and Emerging Roles for Medical Librarians

S. LAYLA HEIMLICHWilliam B. Glew, MD, Health Sciences Library, MedStar Washington Hospital Center,

Washington, DC, USA

In this current environment, where fiscal uncertainty seems to bea constant and budget and personnel cuts are a frequent con-cern, librarians are exploring new and exciting ways to helptheir patrons and institutions. Although traditional services—theswift and timely delivery of up-to-date and accurate informa-tion—should continue to be performed with the uniform excellenceon which library patrons depend, librarians can add value to thesecore services by seeking out additional functions applicable to theirpatrons’ needs, and embracing these new and emerging roles.

KEYWORDS clinical librarian, library space, medical librarianroles, systematic review

INTRODUCTION

Medical librarianship is endlessly changing, as is the field of health careitself, with new technologies and new participants continually coming intoplay. In the current environment, where fiscal uncertainty seems to be a

© S. Layla HeimlichReceived 7 October 2012; accepted 25 October 2013.This article is based on discussion at a Chapter Council Sharing Roundtable on New and

Emerging Roles for Medical Librarians at the Medical Library Association’s Annual Meetingin Boston, MA, on May 5, 2013, with Helen-Ann Brown Epstein, MLS, MS, AHIP, ClinicalLibrarian, Weill Cornell Medical Library, Cornell University as Facilitator. S. Layla Heimlich,MILS, Medical Librarian, MedStar Washington Hospital Center acted as Recorder. Lynda Hartel,MLS, Associate Director, Health Sciences Library, Ohio State University; Maylene Qiu, MSLIS,Evidence-based Healthcare & Clinical Liaison Librarian, Biomedical Library, University ofPennsylvania; and Lauren Wojcik, MSLIS, Public Service Librarian, McLane Children’s HospitalScott & White, participated in the discussion.

Address correspondence to S. Layla Heimlich, Medical Librarian, William B. Glew,MD, Health Sciences Library, MedStar Washington Hospital Center, 110 Irving Street, NW,Washington, DC 20010, USA. E-mail: Layla.Heimlich@medstar.net

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constant and budget and personnel cuts are a frequent concern, librariansare exploring new and exciting ways to help their patrons and institutions.Although traditional services—the swift and timely delivery of up-to-date andaccurate information—should continue to be performed with the uniformexcellence on which library patrons depend, librarians can add value tothese core services by seeking out additional functions applicable to theirpatrons’ needs, and embracing these new and emerging roles.

In particular, finding new partners and collaborators is key to developingnew roles for the librarian, and in keeping the library active, vital, and valued.Librarians should always be on the lookout for new audiences, seeking outwhat these potential patrons need and what value-added services the librarycan provide. New patron populations may be found by reaching out tounderserved groups, such as nurses and other nonphysician clinicians; byapproaching nonclinical and administrative departments who may not bepart of the library’s traditional patron base, such as development and grantsoffices; and by keeping abreast of new programs, departments, and outsidepartnerships being developed by their institutions.

In today’s fiscally tenuous times, librarians especially need to look atthe priorities of their institutions’ administrators, such as enhancing patientsafety, reducing readmissions, and improving patient satisfaction scores, anddevise measurable ways to help accomplish those goals. For example, two ofthe possible librarian interventions discussed below, clinical librarian roundsand the information prescription, may not be new roles for the librarian, butmay be new for an administrator seeking concrete ways the library can helpachieve patient care standards.

ENHANCING LIBRARY SERVICES

Following are a few examples of areas that are becoming increasinglycommon ways for librarians to enhance their traditional services.

Highlight the Role of the Clinical Librarian

The role of the clinical librarian places biomedical librarians in patient caresettings for the immediate provision of literature searches and relevant schol-arly articles to clinicians. The first clinical librarian program was launched in1971 at the University of Missouri–Kansas City School of Medicine, with thehelp of a grant from the National Library of Medicine (1), but this tradi-tional librarian role has recently received increased attention, particularly bylibrarians seeking to affect patient care. Research to date has, however, beenlimited. One 2007 study at Louisiana State University (LSU) Health Shreveportfound decreased length of stay for patients whose cases were discussed atresidents’ morning report, with accompanying librarian literature search and

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support (2), whereas a second study, also at LSU Health Shreveport, found noeffect when a clinical medical librarian (CML) accompanied internal medicineinpatient teams on patient rounds, and a slight increase in readmission ratesfor the CML intervention group (3). Research is somewhat confounded bythe fact that the intervention of a clinical medical librarian does not lenditself easily to a randomized controlled trial, particularly since informationis generally requested on complex patient cases that do not match easilyto a control group, and that many factors, such as the skill of the physi-cians involved and whether they use the information provided, are beyondthe control of the librarian. A 2011 systematic review also noted that veryfew studies on clinical librarians collected data on specific effects on patientcare, choosing instead to look at time saved by physicians or increased useof library services (4). Further research is still needed to determine whetherclinical librarians can affect patient outcomes.

Prescribe Information

Advances in technology allow an Information Prescription to be filled online,at the public library, or at a local bookstore, all interventions that can benefitfrom librarians’ expertise in selecting books and Web sites with high-qualitymedical information. The United Kingdom’s Society of Chief Librarians, forexample, announced an initiative in January 2013, backed by the RoyalCollege of General Practitioners, to stock every public library with a desig-nated list of books to be prescribed to patients suffering from mental healthissues. Subjects included social phobias, sleep problems, and binge eating,as well as a second list of “mood-boosting books” such as Bill Bryson’s Notesfrom a Small Island and Frances Hodgson Burnett’s The Secret Garden (5).

Open Up the Library’s Space

Just like the library staff, the library space itself also needs to remain flexible.The library can respond to new patron needs for different kinds of space,such as more collaborative spaces for small-group interaction required bychanging medical school class instructional methods, or new institutionalneeds, by welcoming nonlibrary staff and functions into library space. Somelibrarians have noted that proactively offering space, particularly when itwas clear library space was already being eyed by administration, means thelibrary staff are not only seen as good team players, but also have input intothe selection of tenants. Describing the renovation and repurposing of spacein the Health Sciences and Human Services Library, University of Maryland,Baltimore, M.J. Tooey wrote, “By offering up space and becoming involvedearly in the process, the library had a better chance of influencing whomight come into the library.” She concluded, “By far the most positive result

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of this renovation was the good will the library engendered at all levelsof the campus and the ‘points’ we accrued for being involved, positive,proactive participants in the renovation process.” She also noted that “ournew cohabitants attract users we would not normally see. Once these usersare in the library they stay and use library resources and services” (6).

Indeed, rather than jealously guarding space for the sake of keepingspace, librarians should look for opportunities to collaborate with potentialnew neighbors. Writing about the redesign of the Library and Center forKnowledge Management, University of California, San Francisco (UCSF), GailPersily said, “The library led an inclusive, consultative process of identifyingnew functions for library space and suitable locations for those functions.”That process was guided by the recommendation from the UCSF advisorycommittee on library space planning that “New functions proposed for theLibrary should . . . allow for new partnership and collaboration with librarystaff and programs” (7).

Participate in Systematic Reviews

The librarian’s expertise in literature searching is a major component of thesuccess of a systematic review, and many librarians are valued membersof systematic review teams at their institutions. The Agency for HealthcareResearch and Quality (AHRQ) defines a systematic review as “a criticalassessment and evaluation of all research studies that address a particularclinical issue” (8). Both the Cochrane Collaboration and the Evidence forPolicy and Practice Information and Co-ordinating Centre (EPPI-Centre), twoorganizations that develop and publish systematic reviews and train othersto do them, emphasize their comprehensive nature, the focus on a partic-ular clinical issue, and the importance of using explicit, transparent, andreproducible methods to find as much of the relevant research on the topicas possible (9, 10). In particular, AHRQ notes that “[T]he researchers [in asystematic review] use an organized method of locating, assembling, andevaluating a body of literature on a particular topic using a set of specificcriteria,” and EPPI-Centre writes that a systematic review “is accountable,replicable and updateable” (8, 9).

Systematic reviews have been engendering more and more attention,not only from librarians, but also from clinicians, researchers, and educa-tors, not all of whom fully understand what is involved in a systematicreview. Some patrons say they want a “systematic review” when what theyreally want is “a review of the literature, done systematically.” EPPI-Centre’sWeb site notes that “[m]ost reviews of research take the form of traditionalliterature reviews, which usually examine the results of only a small part ofthe research evidence.” Sometimes the most important service a librarian canprovide is a thorough explanation of what is involved in a true systematicreview, highlighting the comprehensive nature of the search, the focused

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clinical question, and the rigorous critical assessment of the studies found inthe search.

Librarians, with their expert searching skills, can create a high-quality,comprehensive search strategy for identifying all relevant studies. Librarianscan also assist in formulating the research question, documenting thesearches, helping to organize the results, and writing up the search method-ology for publication (11). Additional recommendations from librariansexperienced with systematic reviews include document everything (exactlywhat was searched, where, and when, so that the search can be repro-duced); have the search peer-reviewed (perhaps coordinating with librariansat another institution to mutually review search strategies); ask whether thepatron has budgeted money for the literature review (to look at additionaldatabases and other resources not in the library’s collection); insist on eitheracknowledgement or co-authorship credit; and perform a thorough refer-ence interview before doing the full search to confirm the scope of what thepatron needs.

Librarians who have been asked to participate in a systematic reviewfor the first time, or who are considering offering this service, may wish torefine their searching skills in order to meet the unique demands of searchingfor a systematic review. There are several excellent continuing educationworkshops that can assist the interested librarian (Appendix 1).

Engage in the Medical School/Nursing School Curricula

Librarians have always been a part of the curriculum, but with increasedemphasis on evidence-based practice, many librarians are finding new waysto enhance their roles in both individual courses and the entire course ofstudy. Librarians can teach or co-teach full courses, single lectures and work-shops, and anything in between. For the most successful results, teachinglibrarians recommend that literature searches be included in end-of-term clin-ical examintions and as part of students’ research projects, because studentstend to care most about the activities on which they are graded. Hospitallibrarians in particular can partner with the program directors overseeingrotating medical and nursing students to assist students with case presen-tations, attend medical student morning report, and offer workshops andmini-classes on searching the literature, evidence-based medicine and nurs-ing, and publication pitfalls (such as predatory open access journals). Sincespace is usually at a premium in hospitals, many librarians have foundthat being flexible and opening up library space to small group study anddiscussion, increasingly an important part of medical and nursing schoolcurricula, has enabled them to offer a valuable service that puts them inmore contact with students and their instructors.

Students often come to the library with a mindset that they came toschool to learn to be doctors and nurses, not librarians. Librarians can show

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students how better literature searching makes them better clinicians byhelping them keep up on current research, practice evidence-based medicineand nursing, and even helping them learn how to talk to patients. TheMedical Library Association (MLA) brochures on “Deciphering Medspeak,”which include Plain Language (low literacy) and Spanish versions, are idealfor helping new clinicians talk to patients without resorting to medical jargon(12). Some brochures focus on specific common diseases, such as dia-betes and heart disease, whereas another, Rx Riddles Solved!, translates theabbreviations used frequently on prescriptions in instructions to patients (12).

Other librarians participate in arts and humanities programs forclinicians, in which medical students, residents, and other clinicians regu-larly discuss literature as a way of improving their ability to empathize andcommunicate with patients.

Insert the Library into Electronic Health Records

As the deadline for the meaningful use of the Electronic Medical Recordmandate approaches, electronic health records have become an issue ofincreasing importance for both clinicians and administrators. Librarians canprovide important information for both clinicians and patients throughthe electronic health record. Some librarians have successfully integratedevidence-based resources into their hospital’s electronic medical records,providing information on point-of-care resources and evidence for specificorder sets (13). One frequently mentioned resource for linking electronichealth records (EHRs) to patient health education is MedlinePlus Connectfrom the National Library of Medicine, recommended as easy to use,accurate, up-to-date, well written, and free.

However, injecting the library into the EHR development process can bedifficult and intimidating, and often requires navigating unwieldy interfacesand complex internal politics. Although there have been a number of recentmedical library workshops and continuing education programs on electronichealth records, the process is still challenging.

Reach Out Through Consumer Health Education

As both clinicians and the public devote increasing attention to preven-tive care, librarians can provide an important service through consumereducation. Libraries have engaged in outreach through health fairs andtraveling community health vans sponsored by their home hospitals anduniversities, through partnerships with public libraries, and even throughlibrary school initiatives. Public libraries can be especially useful partners formedical libraries, as public librarians can learn about medical resources, andmedical librarians can learn about talking to nonclinicians and the generalpublic.

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Manage Faculty Repositories

The library’s ability to help here varies widely. There are many wayslibrarians can help to organize and classify information relating to facultypublications and activities, including Vivo, eCommons, institutional reposito-ries, and the semantic Web. However, many of these require active advocacyon behalf of both repositories and librarians’ roles in them.

These are just a few of the tasks and responsibilities assumed by librari-ans in today’s changing health care landscape. A handful of other “new andemerging” roles include taking positions on the institutional review board(IRB), on Magnet or nursing research councils, as liaison, embedded, orclinical librarians, or as “big data” curators. Although not every role may berelevant to every library, librarians can examine what is important to the clin-icians, researchers, educators, and administrators in their own institutions toforge new collaborations and remain relevant and vital partners with patronsand prospective patrons.

Many librarians advocate creating a higher profile for the library byvolunteering for almost anything one is asked to do, and more. Connectionsmade in one area can lead to roles in other areas. Participation in a FlorenceNightingale birthday party, for example, led to semiregular appearances inthe Surgical Intensive Care Unit (SICU) lunch and learn program for thisauthor.

A recent article analyzed the wide range of committees in which librar-ians participate—many of which, such as Human Resources or Facilities,are well outside traditional library roles—and concluded that participation incommittees frequently led to increased visibility for the library and increasedopportunities for collaboration (14).

CONCUSION

Every day, librarians do committee work, talk with patrons, invite new part-ners into library space, and step outside the library into classrooms, patientfloors, health fairs, and even cafeteria space, and in doing so they lay claimto new and exciting roles for librarians and the library.

REFERENCES

1. Algermissen V. Biomedical librarians in a patient care setting at the Universityof Missouri–Kansas City School of Medicine. Bull Med Libr Assoc. 1974;62:354–358.

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2. Banks DE, Shi R, Timm DF, Christopher KA, Duggar DC, Comegys M, McLartyJ. Decreased hospital length of stay associated with presentation of cases atmorning report with librarian support. J Med Libr Assoc. 2007;95: 381–387.

3. Esparza JM, Shi R, McLarty J, Comegys M, Banks DE. The effect of aclinical medical librarian on in-patient care outcomes. J Med Libr Assoc.2013;101:185–191.

4. Brettle A, Maden-Jenkins M, Anderson L, McNally R, Pratchett T, Tancock J,Thornton D, Webb A. Evaluating clinical librarian services: a systematic review.Health Info Libr J. 2011;28:3–22.

5. Furness H. (31 Jan 2013). GPs to prescribe library books to combat anxiety,depression and relationship problems. http://www.telegraph.co.uk/news/uknews/9839458/GPs-to-prescribe-library-books-to-combat-anxiety-depression-and-relationship-problems.html (6 Oct 2013).

6. Tooey MJ. Renovated, repurposed, and still “one sweet library”: a case study onloss of space from the Health Sciences and Human Services Library, Universityof Maryland, Baltimore. J Med Libr Assoc. 2010;98:40–43.

7. Persily GL, Butter KA. Reinvisioning and redesigning a “library for the fifteenththrough twenty-first centuries”: a case study on loss of space from the Libraryand Center for Knowledge Management, University of California, San Francisco.J Med Libr Assoc. 2010;98:44–48.

8. Agency for Healthcare Research and Quality. (n.d.). Effective Health CareProgram: glossary of terms: systematic review. http://effectivehealthcare.ahrq.gov/index.cfm/glossary-of-terms/?termid=70&pageaction=showterm(5 Oct 2013).

9. Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre). (n.d.). What is a systematic review? http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=67 (5 Oct 2013).

10. The Cochrane Collaboration. (2013). About Cochrane systematic reviewsand protocols. http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html (5 Oct 2013).

11. Dudden RF, Protzko SL. The systematic review team: contributions of the healthsciences librarian. Med Ref Servi Q. 2011;30:301–315.

12. Medical Library Association. (2007). Deciphering MedSpeak. http://www.mlanet.org/resources/medspeak/ (6 Oct 2013).

13. Brandes S, Wells K, Bandy M. Invite yourself to the table: librarian contributionsto the medical record. Med Ref Servi Q. 2013;32: 358–364.

14. Zeblisky KA, Birr RA, Aguiaga AL, Drachman D, Mathieson K. Rethinkingyour involvement: a survey on hospital library committee participation. J HospLibrariansh. 2013;13:47–58.

APPENDIX 1: LEARNING MORE ABOUT SYSTEMIC REVIEWS

There are a number of recommended classes on searching for systematicreviews. Some are online, whereas others are live Continuing Educationclasses. Your regional medical library or a consortium of local libraries or

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libraries in your hospital chain may be able to sponsor a live class in yourarea. Here are a few:

“Supporting Systematic Reviews: Beyond the Basics,” taught by Jan Glover,6-hour MLA CE class (http://cech.mlanet.org/node/681).

“Searching in Support of Systematic Reviews,” taught by Jan Glover (Yale)and Karen Odato (Dartmouth), 4-hour MLA live CE class.

Health Sciences Library System at University of Pittsburgh, systematic reviewworkshops for librarians, offered live (most recent course in October 2013;http://www.hsls.pitt.edu/systematicreview/index.html).

Also recommended are courses taught by Connie Schardt (formerly at DukeUniversity) through MLA; courses at the Australian EBP Librarians’ Institute,and the Supporting Clinical Care: An Institute in Evidence-Based Practicefor Medical Librarians.

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