Medical Librarian in Transition

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The Medical Librarian in Transition
“The only limit to our realization of tomorrow will be our doubts of today.”
Franklin D. Roosevelt, 1945

Florence M. Paisey

2 “If you think the information profession has changed over the last few years, you ain’t seen nothing yet,” quips Scott T. Plutchak, Associate Professor and Director of the Lister Biomedical Library at the University of Alabama, and Editor of the Journal of the Medical Library Association (2005). He states that dramatic changes are going to take place in medical librarianship and “you’ll have to adapt and lead or be left behind.” He believes the transition will be momentous and compares its significance to Gutenberg’s invention of movable type. The advancement of technology, particularly electronic storage, search, and retrieval of information, forms the basis for Plutchak’s view. Digitally stored information has affected and will continue to affect the traditional spatial relationship that both patrons and professionals have had for decades, even centuries. The Information Age, driven by technology, augurs this spatial change. The traditional relationship to space that previous generations of librarians have maintained is pivotal, in Plutchak’s view. Though Plutchak allows that some large buildings will continue to house print documents, these buildings will gradually diminish in number and a few key buildings will have the mission of preserving print documents for historical and archival purposes. Library buildings or spaces that preserve and archive documents will have an entirely different mission from that of spaces where librarians await questions from those actively using the space for research, whether its purpose is academic, informational, or recreational. As technology advances and digital information becomes ubiquitous, traditional forms of libraries will change. Information can and will be increasingly available to access anywhere at any time.

3 Plutchak maintains that medical librarians will need to reassess their role, bringing information to places where their expertise is needed, rather than assuming the traditional role of passively waiting for users in the library. He predicts that information specialists – or the traditional term, librarian, as he prefers – will be performing searches and identifying the highest quality of information available on a subject in situ. Imagine a librarian accompanying an archeology team to an excavation, an architectural team to a building site, or a clinical team in a hospital. Books, journals, and papers will not have to be carted. Rather, one will carry portable computers and access any published information electronically in a fraction of the time previously possible, organized by objectives, and evaluated for peak efficiency and insight. Plutchak admits seeing a great deal of fear, anxiety, and frustration among those who have been in the profession for many years. He handles their frustration and fear by turning the situation on its head, reassuring librarians that this is really a “fabulous time to be in this business.” He sees the transitions and challenges as exciting and interesting, but requiring creative thought from temperamentally suitable individuals. He acknowledges that many librarians currently in the business are temperamentally incompatible with current and future demands. He states that although this is a wonderful time to be in the profession, …it does require perhaps a greater degree of experimentation and risk-taking than has been the case in the past. And I'm not sure that people who got into the library profession, say, 10 to 15 years ago are always the most temperamentally suited to that kind of environment (Plutchak, 2005).

4 Challenges that necessitate experimentation and risk-taking pose possible problems for those who entered the profession with a need for predictable, stable work. Plutchak cautions that these are the individuals who may find the changes distressing. He has observed that it has been very hard for many people. That being so, exciting, new, complicated opportunities requiring traditional skills in addition to learning new skills are at hand. Information needs and their effective management have become so significant that every organization, entity, and business needs a professional to handle information optimally. He describes the librarian who is well suited to this work as having an ability to “identify the needs of the organization and create solutions” (Plutchak, 2005). Those creative librarians, he believes, will find themselves “indispensable,” but such work requires rethinking one’s role and relationship to the organization. A profound change Plutchak sees is in the librarian’s relationship to the use of space. Librarians, he believes, still identify with the traditional spatial relationship where patrons and researchers come into the library to obtain the expertise of librarians. This aspect of one’s professional identity is where he foresees the most change and advises librarians to analyze their roles in relationship to state-of-the-art resources and peak performance. This will require a “disconnect” from some aspects of one’s professional identity. He states, Again, as an example from the area that I'm most familiar with, I often hear hospital librarians being frustrated in trying to figure out ways to get people into the library. And I think that's absolutely the wrong approach. We have technology tools that make it possible for them to not come into the

5 library to get the information, so they shouldn't have to come into the library to get our expertise either (Plutchak, 2005). This is the area where he views the changes as most profound. As Director of the Lister Library, he prefers that Lister librarians spend less time in the building and expects others to prefer librarians working in their space, whether in a lab, office, or classroom. Plutchak wants librarians to maintain the knowledge of a traditional library space and building, but believes it is essential for librarians to take on a role that would require them to leave the library building and go to a lab or classroom and provide services there. One example he offers relates to medical school accreditation. He notes that accreditation agencies are emphasizing that graduates have sound information management skills. They want graduating physicians to know how to retrieve information, evaluate it, and integrate it into their decision-making. At the Lister School, the biomedical library is working with the school of medicine’s curriculum and identifying appropriate places where librarians will go to a medical class and conduct a session related to information management. Plutchak offers the example of first-year medical students developing search skills in Medline. The second year may be a session related to evaluating web sites, and third-year students may work with PDA’s, not as independent tools, but integrated with the curriculum and its objectives. Information management skills within the health sciences community have been related to the concept of the “informationist,” or in current terminology, “information specialist in context (ISIC)” (Plutchak, 2000), rather than librarian, as they were previously termed. The responsibilities of the information specialist have a broad scope

6 and can range from being on a clinical care team based in a ward, to going on rounds with physicians to identify clinical informational needs, to someone who works in a genetics lab helping researchers use complicated information tools (Press & Hobson, 2005). While librarians may work directly on a clinical team, they also help educate people who are becoming a specialist in any category: medicine, physics, or English history (Moore, 2005). This new role raises the issue of how information specialists in context should be educated. The Medical Library Association (MLA) has contracted with the medical library at Vanderbilt University for two years (Guise, 2005). The MLA’s objective is to explore how a subject specialist would become expert in information management and how librarians can be brought up to speed in specialized knowledge. Questions being addressed include: • • • Can the conversion be made with an added certificate? How much training is involved? Can it be done on the job?

Although it is not yet clear how the training process will take place, those information specialists working in bioinformatics generally have, at least, a hard science master’s that is related to the field they are supporting. However, Plutchak points out that he has spent his entire career in academic medical centers and he doesn’t believe there is anything more complicated about learning the knowledge base in medicine than in any other profession. Plutchak believes that physicians have sought to create the perception of a “mystique” associated with medical practice in the past, but believes the profession is now changing

7 radically. Doctors do not finish medical training with all the knowledge they need to practice. Information skills and the understanding that one needs to manage information on one’s own or call in an expert have become part of medical training. The extent of data smog requires the skills of information professionals in distinguishing quality information from hocus-pocus. Plutchak sees enormous opportunity and need for information specialists to retrieve and assess information for professionals in general, the physician in particular. The information specialist in context (ISIC) would work directly with physicians, retrieving the most current information related to specific clinical issues. The informationist would not need to know medicine as a doctor would, and the doctor wouldn’t need to know information management as an information specialist would. What is important is that both have enough knowledge to work together effectively. While librarians realize the limitations of search engines and the extent of poor information online, most users, professional or otherwise, do not. One of the challenges for librarians will be to debunk the notion that quality information of any kind, including medical, can be obtained with simple searches. Rather, expert skill is required to ferret out the nuggets of quality, relevant information. This is not as easy as one might think. Technologists have built search and retrieval tools that are simple, such as Google, but these tools retrieve information that may be quite deceptive. Often, people, including professionals, believe they are getting accurate information when they aren’t. Plutchak coined the term “an inept, but satisfied end user” (2005). This expression refers to the persons who believe they conduct good searches and retrieve quality

8 information, when, in fact, they don’t. He uses the concept of a quadrant to describe the four types of users he finds: 1. Users who are using tools very well and are satisfied 2. Users who are not satisfied, but aren’t using the tools well. 3. Users who are dissatisfied, but are using the tools as well as they could be used. These are users who find some of the databases or other tools too limited; they either didn’t have all the publication years covered or didn’t have the scope. Basically, they wanted the tools to do something they weren’t designed to do. 4. Users who are conducting poor searches, getting poor retrieval, yet are satisfied because they don’t know how to evaluate what they are doing. The fourth type of user Plutchak views as the most problematic; this is the group that he refers to as the “an inept, but satisfied end-user.” These users are not aware of their own limitations and nonchalantly base decisions on poor information. A great challenge for information professionals is helping people understand what they don’t know and then when they need to get the advice of a professional. This revisits the view that librarians require a very different temperament from what was suitable years ago. Librarians will have to take a pro-active stand and address information issues with subject specialists, rather than withdraw in timidity. In addition, they are going to need to be willing to take risks. Such risks would include: • Developing a new program for which there is no model and the outcome will be uncertain. One may invest a lot of time and energy in a project that fails.

9 • Deciding whether to cancel all print versions covered in an online database. This is a difficult decision from several vantage points. Can one trust the online provider to archive down the road? How will faculty react? Those faculty members who are still not using online databases may resist such change. • Talking with faculty and persuading them that an information specialist really can help. Then, once a faculty member is persuaded, developing a plan, showing up in the classroom, and meeting their objectives and needs. This is a bold step and will initially require some bravado. • Taking risks at a time when librarians are being asked to prove their value and preserve their jobs. All of these risks may be viewed as marketing concerns, yet one needs to be careful that marketing does not translate into creating clatter about something that isn’t really valuable when, in fact, it is very valuable. Plutchak suggests that one way of “marketing” oneself effectively is to identify what keeps the boss awake at night, then come up with a solution to that problem. He emphasizes that whatever problem one addresses has to be key or it will not be funded no matter how clever it is. Plutchak continues and states that unless one approaches key problems, those in charge should not fund it or their behavior would be irresponsible. Plutchak gives an example at the Lister Library. He points out that the Lister Library supports a university that is eager to maintain its research portfolio, concerned about increasing the qualifications of students entering, and making sure that graduating health professionals meet a specific set of objectives. If one approaches him with a great idea that is not

10 directly related to those concerns, the provost will not fund the project. One has to “figure out what the organization’s mission or strategic plan is” (ibid). This kind of planning is necessary before marketing. One must be sure that one is coordinating one’s services with the mission of the university. Plutchak stresses that the objective is not to build a better library; rather, it is to figure out the key concerns of the university and where information specialists have unique skills and talents that will move the university forward. Those objectives may be traditional things, innovative, or dismissing activities formerly associated with library work within a setting because those skills or resources aren’t needed any more. Though the previous summary is one man’s view, there can be no doubt that there will be a fundamental transformation of the nature of libraries and their mission. Traditional skills will still be relevant. The time spent performing these skills will change as new resources emerge and needs change. The librarian of today will need traits that can deal with constant change and its resultant instability, the energy and interest to learn new technologies as they rapidly develop, the enthusiasm to develop programs that teach these technologies, and the commitment to work with subject specialists in helping them manage new information tools. The librarian quietly tapping shelves of books, passively sitting at a reference desk, roaming the stacks, deferring to and independent of faculty while working safely within the guard of brick and mortar is, indeed, a dying role extraordinarily transformed by the power of technology and the scientific, social, and humanitarian gains it can bring.

11 References Blumenthal, J. L., Mays, B. E., Weinfeld, J. M., Banks, M. A., & Shaffer, J. (2005). Defining and assessing medical informatics competencies. Med Ref Serv Q, 24(2), 95-102. Boorkman, J. A., Huber, J. T., & Roper, F. W. (2005). Introduction to Reference Sources in the Health Sciences: an interview with Jo Anne Boorkman, Jeffrey T. Huber and Fred W. Roper. Interview by Elizabeth Connor. Med Ref Serv Q, 24(3), 1-15. Braude, R. M. (1997). On the origin of a species: evolution of health sciences librarianship. Bull Med Libr Assoc, 85(1), 1-10. Cardina, C., & Wicks, D. (2004). The changing roles of academic reference librarians over a ten-year period. Reference & User Services Quarterly, 44(2), 133-142. Choldin, M. (2000). A globetrotter librarian discusses her role in a changing world. American Libraries, 31(9). Ezzell, J. R. (1998). It was the most uncertain of times: Academic reference librarianship at the end of the century. North Carolina Libraries, 56(97). Flinner, B. E. (1988). A scenario of the reference librarian in a small university library. The Reference Librarian, 19(343). Grandage, K., & Watson, L. (1999). Partnering for better health care: the role of academic health sciences librarians. Virginia Libraries 45(2), 8-9. Guise, N. (1997). Advancing the practice of clinical medical librarianship. Bulletin of the Medical Library Association, 85(4), 1-2. Guise, N., Koonce, T. Y., Jerome, R. N., Cahall, M., Sathe, N. A., & Williams, A. (2005). Evolution of a Mature Clinical Informationist Model. J Am Med Inform Assoc, 12(3), 249-255. Haynes, B., & Haines, A. (1998). Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ, 317(7153), 273-276. Keeling, C., & Lambert, S. (2000). Knowledge Management in the NHS: positioning the healthcare librarian at the knowledge intersection. Health Libraries Review, 17(3), 136-143. Klein, M. S., & Ross, F. (1997). End-user searching: impetus for an expanding information management and technology role for the hospital librarian. Bull Med Libr Assoc, 85(3), 260-268.

12 Moore, M. E., Vaughan, K. T., Hayes, B. E., & McLendon, W. (2005). Developing an interdisciplinary collaboration center in an academic Health Sciences Library. Med Ref Serv Q, 24(4), 99-107. Ojala, M. (2002). Rediscovering new skills and changed roles. Online, 26(6). Perry, G. J., & Kronenfeld, M. R. (2005). Evidence-Based Practice: a new paradigm brings new opportunities for health sciences librarians. Med Ref Serv Q, 24(4), 1-16. Plutchak, S. (2000). Informationists and librarians. Bulletin of the Medical Library Association, 88(4), 1-3. Plutchak, S. (2005). If you're flexible, adaptable, and willing to take risks: It's a great time to be an information professional. Information Outlook, 9(5), 23-29. Press, N., & Diggs, H., M. (2005). Providing health information to community members where they are: Characteristics of the culturally competent librarian. Library Trends, 53(3), 397-410. Rettig, J. R. (1995). The convergence of the Twain or Titanic collision? BI and reference in the 1990s sea of change,. Reference Services Review, 23(1), 7-20.

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