Partnering for Better Health Care: The Role of Academic Health Sciences Librarians
By Karen Grandage and Linda Watson
Ask a group of health sciences librarians why they are in this specialty, and you are likely to hear at least one of the following: "The information I provide could help save a patient's life." "I feel I am making a real contribution to the progress of medicine." "I like to be where the action is." "I'm proud of the leadership role medical libraries have taken in library automation and computer services for clients." "Medicine is an exciting and challenging environment." And indeed, when walking down the halls in an academic health sciences center, one notices that the pace is seldom slow. There is a palpable sense of urgency and energy--reflecting perhaps, the pace of scientific discoveries and their application to medicine, as well as the increasing capabilities of computer technology in medical diagnosis, therapy, and information management. Academic health sciences libraries reflect the unique health care institutions they serve where users might arrive in scrubs or business suits and where research mingles with teaching and the delivery of health care by physicians, nurses, and the many different allied health professions.
Information at the Bedside
The academic health sciences center is a setting where information is often put to immediate use with potential impact on life and death situations. The library serves as an important link in providing access to information that trains health care providers and supports daily health care decisions. The library's goal is to make information resources more readily available to clinicians at the point of need. The Internet and, more specifically, the World Wide Web, have enabled librarians to develop linkages and deliver information within the health professional schools, the hospitals and clinics, and to geographically remote community-based primary care sites around the state. At the Claude Moore Health Sciences Library, an ever-expanding Web site (http://www.med.virginia.edu/hs-library/) serves as a single, convenient access point for databases, links to full-text books and journals, and even online forms for requesting information that the Library doesn't have in its collection. Customized "portals" or Web front doors to library resources and services are now being developed to allow clinicians and researchers to further individualize the essential information they access on a daily basis.
Teaching Information-Seeking Skills
The explosion of the medical literature and the influx of new information technologies have increased the opportunities for health sciences librarians to get involved in education and curriculum-related activities in the health sciences center. Busy health care practitioners are shifting away from being memory repositories to becoming efficient information seekers and managers. Many of the facts learned in medical school today will be irrelevant, or even wrong, five years from now. An evolving approach toward "evidence-based healthcare" emphasizes that not all information is good or relevant, and promotes the idea that the literature must be passed through a filter of critical evaluation to become evidence used in medical practice. Health sciences librarians are becoming instrumental in working with clinicians to identify and manage the "best" information for clinical care. Librarians are now involved in training students and practitioners to convert information needs into focused questions, to determine appropriate information sources and search strategies, and to critically appraise studies and results. This approach is also playing out in consumer health information, where librarians are creating and promoting guidelines for consumers on how to separate good information from bad on the Internet.
Medical school libraries share the dilemma of other academic research libraries in trying to cope with the publication of unprecedented amounts of new knowledge. The volume of biomedical information is estimated to double every 10 years with millions of medical articles published annually in more than 70 languages. It has been claimed that if you managed to read two biomedical articles every single day, you would be 55 centuries behind each year! This glut of information (someone likened it to drinking from a fire hose) is coupled with the increasing expectations of users that "everything is online, for free". This, of course, is not true. Medical library budgets are strained to the breaking point trying to balance the purchase of both print and electronic materials. The shifting publication landscape now requires the careful negotiation of license agreements with online vendors to permit optimum access for library users. Librarians are also fighting hard to protect fair-use and preservation rights in the electronic environment. Long-established resource sharing networks such as the National Network of Libraries of Medicine could be at risk, or will need to change with the new models of publication.
The Cycle of Discovery, Practice, and Learning
A researcher in molecular genetics has an idea. She seeks the assistance of a health sciences librarian to formulate a comprehensive literature review through resources such as MEDLINE, as well as the Internet, to include with her grant proposal. The researcher receives the grant, makes significant discoveries, and publishes several articles in prestigious journals to which her library subscribes. Other researchers build on her discoveries which eventually result in a new way to test for genetic disease. A genetic counselor at the academic health center attends a class at the library that teaches how to identify information that makes a difference in patient care. He puts that knowledge to work and finds an article based on the research of the molecular geneticist. The next day he suggests the test to a patient, and later, teaches a group of 2nd year medical students about what he was able to do with the information he found.
This is part of the satisfaction of being a health sciences librarian - playing an integral role in the cycle of scientific communication as knowledge navigators and teachers. The discovery of new information, the dissemination of that information and its synthesis into knowledge, the application of that knowledge to benefit a patient, and finally, the transfer of knowledge to the next generation of health professionals: this is the environment in which health sciences librarians thrive, and make their contribution to society.
In 1997/98 there were 159 medical school libraries (both allopathic and osteopathic) in the United States and Canada. Most of these libraries are part of an academic health center which often includes schools for other disciplines such as nursing, dentistry, public health or allied health, as well as one or more hospitals. Collectively, these libraries hold more than 32 million volumes, employ 5,000 total librarians and support staff, and have annual expenditures of nearly $306 million. In Virginia, the three academic health sciences libraries (at Eastern Virginia Medical School, Virginia Commonwealth University and the University of Virginia) together have 606,000 volumes, 127 staff and $7.5 million in annual expenditures.
[Figures from Annual Statistics of Medical School Libraries in the United States and Canada 1997/98, Seattle: Association of Academic Health Sciences Libraries, 1999.]
Karen Grandage is the Educational Services Coordinator and Linda Watson the Director of the Claude Moore Health Sciences Library - University of Virginia Health Sciences Center, Charlottesville Virginia.