MLA-Phil

Summary of panel discussion on October 17, 2000, Philadelphia Regional Chapter of the Medical Library Association first fall program, Federal Reserve Bank Auditorium, Philadelphia.

Title of program: The Medical Informationist and other roles for the librarian in the 21st Century

Contents:

• Introductory Remarks
• Introductions of Panelists
• What is an Informationist?
• What are the attributes of a successful clinical librarianship program?
• What are your ideas for beginning an Informationist pilot?
• What are some other career paths for librarians beyond the Informationist?
• Where do we go from here?

Linda Rosenstein introductory remarks:
In the Annals editorial, Drs. Davidoff and Florance assert that a vast amount of the medical literature is left unexplored and underutilized by physicians and other members of the modern healthcare team in the delivery of direct patient care. The Informationist would be a new member of the healthcare team, responsible to clinical directors and chiefs of staff. This is not a librarian as we know her to be. As medical librarians we consider ourselves essential to the delivery of healthcare information to our constituencies, yet in many healthcare institutions we are secondary or even marginal to healthcare delivery.

The Informationist proposal is a chance for us to redefine our role. What are the roles for information professionals in the 21st Century? How will these people be recruited? How will they be trained? Perhaps more important for those of us in this field now, how do we educate ourselves for these changes? We have joined Dr.ís Davidoff and Florance with Dr. Ellen Detlefsen, who directs the Medical Librarianship and Medical Informatics Department at the University of Pittsburgh School of Information Sciences, and Dr. Julie McGowan, Professor of Knowledge Informatics at the Indiana University School of Medicine and a Medical Library Association Board Member. From their perspectives as educators they will help us address some of the questions related to the changing field and how we can gain the knowledge and skills to thrive in it.

Scott Plutchak, the editor of the Bulletin of the Medical Library Association, states in his October editorial, that the Medical Library Association should ìbe right out front in responding to Davidoff and Floranceís challenge.î As he sees it, the Informationist is a librarian but much more. He notes that partners in this discussion should include the Association of American Medical Colleges, the American Hospital Association, library schools, and the National Library of Medicine. The Philadelphia Regional Chapter of the Medical Library Association is pleased to be a part of these discussions and MLA’s call to action on this important and timely topic.

In the past few weeks, a lively e-mail discussion has taken place among the panelists. The list of questions you have in your hands was developed out of these discussions. We do not expect to cover them all. Hopefully, this discussion will spark your interest and you will continue to think about this issue.

Introductions of panelists:
Dr. Frank Davidoff, is the Editor, of the Annals of Internal Medicine. He received his MD degree from Columbia University in 1959. He was Director of the Diabetes Unit at Beth Israel Hospital in Boston from 1965 to 1974, during which time he was on the faculty of the Harvard Medical School. From 1974 to 1987, Dr. Davidoff served first as Chief, Division of General Medicine and then as Chief, Department of Medicine, at the New Britain General Hospital in New Britain, Connecticut. In 1987, he became Senior Vice President for Education at the American College of Physicians, and remained in that position until his appointment as Editor, Annals of Internal Medicine, in March 1995. Dr. Davidoff has published more than 60 papers on a range of subjects including lipid metabolism, diabetes, molecular pharmacology, medical education and medical decision making, and editorials on a variety of topics related to clinical medicine, medical editing, and the environment of medical practice.

Dr. Ellen Detlefsen is a tenured faculty member in the School of Information Sciences at the University of Pittsburgh, with joint appointments in the Womenís Studies Program and the Center for Biomedical Informatics. She was educated at Smith College and Columbia University, and holds her doctorate from the Columbia University School of Library Science. Her areas of expertise and teaching competence include biomedical and health sciences information, medical informatics, and resources and services for special populations such as patients and health care consumers, and the aging and their caregivers. The Departmental program in Medical Librarianship and Medical Informatics, which she directs, was ranked #1 in the nation in the 1999 U.S. News & World Reportís Guide to Graduate Study. She is an active member of the Medical Library Association where she is Chair of the Medical Library Education Section. Her paper on ìEducation for Health Sciences and Biomedical Librarianship: Past, Present, Future,î won the 1988 Eliot Prize from the Medical Library Association. In 1996 and 1997, she was Co-Principal Investigator on a National Library of Medicine Planning Grant for the Education and Training of Health Sciences Librarians.

Dr. Valerie Florance, is the Project Director for better health@here.now at the Association of American Medical Colleges, and principal investigator of IAIMS: The Next Generation, a contract between the AAMC and the National Library of Medicine. Dr. Florance holds graduate degrees in library science and medical anthropology, and completed her doctoral studies in information sciences from the University of Maryland, College Park. Her dissertation work involved development of the clinical extract, an online surrogate for biomedical journal articles. Dr. Florance began her health information sciences career at the University of Utah, as editor of MEDOC: Computerized Index to Government Documents in the Health & Information Sciences, and has been involved in Integrated Advanced Information Management (IAIMS) initiatives at three different academic medical centers. In 1993, she received MLAís Ida and George Eliot prize for her article, ìThe health sciences librarian as knowledge worker,î co-authored with Nina Matheson. In 1995, she received the Eliot prize again for her article ìEducating physicians to use the digital library,î co-authored by Sherrilynne Fuller, Robert Braude, and Mark Frisse. She has held the position of Deputy Director at the William H. Welch Medical Library, Johns Hopkins University, followed by the Directorship of Academic Computing at the University of Rochester Medical Center. She is a member of the Biomedical Library Review Committee of the National Library of Medicine.

Dr. Julie McGowan holds a Ph.D. in medical education, an M.A. in medical iconography, and an M.L.S. degree. A Professor of Knowledge Informatics, she serves as Director of Information Resources and Director of the Ruth Lilly Medical Library at Indiana University School of Medicine. Dr. McGowan has adjunct professorships in the Department of Pediatrics and the Schools of Nursing and Allied Health Sciences. Formerly Associate Dean for Health Sciences Informatics and Library Resources at the University of Vermont, she is credited for the development of VTMEDNET, the first comprehensive, state-wide health information network in the country. Dr. McGowan is the author of numerous publications and her research interests include the use of clinical decision support systems and telemedicine for rural health care delivery and the impact of applied medical informatics education programs on information acquisition and decision-making.

Linda Rosenstein: What is an Informationist? The Annals editorial observes that several studies show that clinical librarianship programs are efficient and effective, yet the concept has failed to take root. What are the attributes of successful clinical librarianship programs? How might these characteristics be incorporated into an Informationist curriculum?

Valerie Florance: I think of the Informationist as an information professional who is crossed trained. I would like to refer to something that was published in 1982, that says, “needed are professionals who by virtue of cross training in medicine, computer science, information science can cross professional boundaries” — this quote is from the Matheson-Cooper report published in 1982 — though the concept was mentioned even prior to that. Valerie adds that she has done this type of work — crossing boundaries herself as have members of the audience, and we should build on this experience. Reference:Academic Information in the Academic Health Sciences Center. Roles for the Library in Information Management. Matheson, NW and Cooper, JAD. J Med Educ 57 (10), Pt. 2, Oct. 1982. This report is funded, in part, by the National Library of Medicine through contract NO1-LM-9-4716.

Frank Davidoff: Worked with Gertrude Lamb in Hartford, U. Conn. Health Sciences Library, hired Georgia Scura, Frank and Georgia published on topic. Curious thing is why hasnít it been more widely supported and become more universally present. What is an Informationist? One definition along with Valerieís — An Informationist is a person whose primary job is to bridge the gap between a caregiverís and a patientís information needs with the best information resources. There is an enormous body of information into which we put financial and research resources and there is an enormous need for information. Yet, we have failed to make the connection. Basic function of an Informationist would be to bridge that gap.

Julie McGowan: First obvious question might be, “Isn’t that what we do on the reference desk?” But the difference between an Informationist and reference librarian is the setting. We take the information to the point where it is needed: morning report, rounding in hospital, patient conference. The Informationist would be a core, central member of the healthcare team. One obvious reason it hasn’t taken root is that we don’t get reimbursed for it.

Ellen Detlefsen: If you look at the law, lawyers have faced up to the electronic provision of information (which has profoundly changed the way how legal research is done) by establishing a new profession — the paralegal. The paralegal may not have the same level of background and education as a medical librarian, but the paralegal’s time can be billed back to the client. Perhaps Informationist skills can be reimbursed. This is key to success — take the research team, as an example, who are faced with information dissemination requirements set by the NIH. Yet, they haven’t a clue how to deal with information. We need them to buy into the idea of information officer. (Informationist term reminds Ellen of the Alienist — 19th Century Psychiatrists were known as Alienists).

Even hospital administrators ought to be persuaded to add an informationist to his/her team– Ellen urges us to broaden term beyond the clinical setting, to administrative and research.

Ellen urges the use of the Annals of Internal Medicine as a bully pulpit to try to get people in the world of reimbursement to consider having insurance companies pay for these services.

Valerie Florance: Valerie makes the suggestion to write Informationists into grants, for instance as research consultants: example at U. Wash., several informatics-related grants include information specialists. UW also has a Ph.D. trained scientist on the library staff who consults on specialized information needs of researchers.

Julie McGowan: Julie has been at two institutions where this was written in. However, Julie sees an obstacle as lack of publishing on cost effectiveness and improvement of healthcare. Suggestion to take to HCFA to prove that this will reduce cost and improve outcomes. So far, the provision of information has not been proven effective. The ball is in our court to do that.

Ellen Detlefsen: Telemedicine may be a model. There is a small track record in area of telemedicine delivered to underserved areas as being reimbursed. For instance, the primary care physician using telemedicine receives 25% of the fee that the telemedicine professional charges.

Frank Davidoff: Interested in the research issue raised earlier: articles that come into the Annals are sometimes lacking in background research — straw man syndrome. Even an ethical issue, according to Iain Chalmers. IRBís should be require more background research before research is approved — researchers should comb literature to see what is available on a topic before they propose to spend money.

Ellen Detlefsen: Can proponents of EBM assist with this?

Frank Davidoff: This is more on the consumer end but they should reinforce each other.

On issue of reimbursement issue, Frank has wondered for a long time why the service of providing literature to a patient’s chart or team, has not been reimbursed. One hypothesis involves Unit of Service which is not clearly defined. There is a double standard involved here — lab studies haven’t been shown to improve patient care and yet insurance companies don’t hesitate to pay for them. There is no demonstrable evidence that in a particular case, there is real value added. Yet electrolytes and radiologic tests are reimbursed and charged to a billing code.

Ellen Detlefsen: What about clinical pharmacists, clinical dieticians, clinical social workers — these professional schools seem to imply that graduates are going to be reimbursable health professionals. How did reimbursements come into play for these professionals?

Frank Davidoff: A good number of letters to his and Valerie’s editorial were from clinical pharmacists.

Linda Rosenstein: What are the attributes of a successful clinical librarianship program?

Julie McGowan: What are qualifications prior to training? Should we try to recruit health care professionals into the Informationist profession? Or how do we provide the health care background for library students? The librarians that Julie gets today are not prepared to go to morning report and do not feel comfortable working with clinicians. Perhaps a Residency program for certification.

Audience: What is going on nationally? We are currently performing this function in our hospital so it is unclear what is meant when it is asserted that clinical librarianship hasn’t taken root. What does it mean that it hasn’t taken root?

Frank Davidoff: Basically a matter of numbers — couple of hundreds [is estimate]. [Small number compared with the total of] 6,500 acute care hospitals not blessed with clinical librarian services. Every in-patient team needs this service. Even if in 10 years, 25% of those units had an Informationist, that would be fantastic and he would consider that the profession had succeeded in ìrooting.î

Julie McGowan: One word: quality. There’s a dichotomy between two groups of librarians: those who are incredible clinical librarians who are doing wonderful jobs and other people who are librarians who do not make much effort, who do not get continuing education, who sit in hospital libraries trying to get two-week turnarounds on Interlibrary Loans. Unfortunately, hospital administrators don’t know the difference between these two groups.

Ellen Detlefsen: Where there is a success, it has more to do with the individual than anything global about the profession. As physicians change from information memorizers to information managers over the next 20 years, two very different approaches to information will emerge and will need to be served by two generations of librarians. Ellen thinks it may be a 20-year scenario that will evolve.

Audience comment about time and money, and comparison in serving people at a reference desk where we can serve many people over the course of time and with an informationist who may serve fewer people for the same time expended.

Julie McGowan: Julie has an MD on staff, as well as a public health nurse, and an approach Julie has taken to staffing is a triage method of highly trained staff at the reference desk, with librarians on call, enabling librarians to serve as faculty in clinical departments, to attend clinical conferences and become colleagues with other members of healthcare team.

Frank Davidoff: What are the information needs in the clinical services? There are a variety of ways that the needs can be met — one idea is to use a model that builds on [a professional knowledge base with] certificates of added qualifications. Initially Informationists might receive certificates of added qualifications and then eventually become a whole career path.

Linda Rosenstein: What are your ideas for beginning an Informationist pilot? Would we start with a successful clinical librarian program and supplement this with National Library of Medicine grant funds? Has anyone contacted any of the panelists about participating either individually or institutionally in an Informationist pilot?

Audience comment: Time and workforce constraints. What about some states with few MLS medical librarians?

Frank Davidoff: Notion that there needs to be funded demonstration project to serve several purposes: as a proving ground for development of curriculum and training experience, but also to gather information to help demonstrate effectiveness and financial impact of having informationist type programs. How to get the pilot is another question.

Ellen Detlefsen: Discussion of a longitudinal study of the prevention of depression in elderly. The study places depression specialists in group practices and over 5 years, what are the outcomes? Nurse clinicians, master’s level social workers, are being paid by grant. After five years, will the practice pick up the salary check? Can we take that model and study a funded Informationist vs. continuing with funding after the study period? Some suggestions for agencies that might fund: AHRQ (Agency for Healthcare Research and Quality) or NLM?

Julie McGowan: Most large hospitals have deposit accounts with information brokers. Medical librarians are frequently better qualified to answer these questions and yet hospitals don’t think of their own medical libraries as their primary resource to answer questions about administration, quality assurance, etc. Librarians need to find a hook that proves value to their administrations. Usually done in terms of dollars.

Ellen Detlefsen: We need to talk at the case report level, and need to get success stories into non-library science literature read by others.

Audience:

Librarian identifies herself as having 2 years of experience. She goes to morning report.

She fell into the medical librarianship area rather than planning to go into medical librarianship. She expresses her need to improve clinical knowledge, and she is not comfortable, at this time, reading and summarizing articles.

Ellen Detlefsen and Valerie Florance: talk about Vanderbilt’s program. Students sit in on medical school classes and some nursing classes. They summarize literature and get feedback from members of the healthcare team about whether the summary is useful, as well as receive coaching from the Library Director. The Director at Vanderbilt (Nunzia Giuse) has a degree from University of Pittsburgh and has an MD. Biggest issue is remuneration because they are coming out of fields where they can make more money with the other degree and have to be willing to choose to take a financial hit at least while going to information schools, and maybe longer term. Are we prepared to pay equally — perhaps these clinically trained and educated people can pull up salaries. Most don’t come directly from college interested in medical librarianship, but come into Ellen’s office uncertain about what they want to be. Her advising service centers mostly on what they don’t want to be. Coursework for medical librarianship requires 3-4 courses and one field placement. She has to actively recruit students.

An audience question about number of Ellen’s students from scientific backgrounds.

Ellen Detlefsen: 25% come in with science/health science background.

Frank Davidoff: Librarians might be teachers and quality monitors of Informationist programs rather than themselves becoming Informationists. Frank sees this as a great professional opportunity for us to be leaders of the development of this program. Leadership would involve work with all kinds of other organizations, curriculum development, standard setting, certification which he gathers is an issue in libraries, and that would take advantage of the unique background and professionalism that librarians have. [vs.] getting out there in trenches [although this wouldn’t be precluded].

Ellen Detlefsen: Suggestion for those planning to enter the medical library field — need medical terminology, need to have biostatistics, or enough statistics to read research articles to assess the quality of statistical measures used in it. Public health might be model. One-two semester baby medical school experience for non-medical types. Example at Pitt. of clinical bootcamp. There are models from other training traditions that can help us get through some of these issues about medical background.

Julie McGowan: Julie asks Frank to clarify something — is he suggesting that medical librarians teach health professionals skills without requiring health professionals to pursue a degree? Is that correct?

Frank Davidoff: Yes, a new creature, that might be one of the major things that might happen.

Ellen Detlefsen: Somewhat like informatics community. Ellen has been quite happily surprised by medical informatics community — people don’t seem to let barriers stand in way. What can we take from this experience in developing training programs in informatics?

Julie McGowan: Audience, what do the clinical librarians in the front row do in respect to training residents and physicians?

Audience response: we work with medical informatics residents, we see that as a logical extension. Most hospital librarians wear many hats. We are very interested in taking the next step. Another librarian in the audience used an example of residents who needed to learn how to limit search results.

Frank Davidoff: It is important to create well-informed consumers. Time is a major factor. Difficult to keep up with skills. There need to be people who have a combination of clinical background and informatics skills. How would this whole thing get started? I’m interested in people’s thoughts. There is a notion that this is an innovation, although it has been around for a long time. Innovations diffuse slowly. There is a whole science on the diffusion of innovations, a book by Everett Rogers which is a summary of the field. Basically has many technical messages: the innovation has to be an improvement and testable. Important point that diffusion of innovation doesn’t happen because it is a better idea but it happens when it is an intensively social process.

Ellen Detlefsen: NEJM small study of prescribing habits by residents in a hospital. Provision of pizza during rounds by drug rep. correlated positively with increase in prescriptions.

Frank Davidoff: Partly gastronomic study.

Frank continues with his discussion of diffusion of innovation as an intensive social process — The concept needs to be bought into at the outset by a wide range of disciplines — hospital administrators, physicians, nurses, library community. This process will take awhile as people come together from diverse professional communities. It is critical that these groups come together and that someone takes a leadership role, without leadership, it isn’t realistic that these disciplines will start to explore this concept. The Library community is the logical group to get these people together.

Audience:

Librarian is troubled by teaching physicians to do our jobs, giving away our best stuff so someone else can make a lot more money at it.

Frank Davidoff: I donít see them as being incompatible. Everyone will have to set aside a piece of their professional discipline and perhaps take on additional functions. There could be a risk at things getting lost but it doesnít necessarily have to be the case.

Valerie Florance: There is no control anyway in the complex information environment — no profession ‘owns’ the territory.

Audience:

Librarian says we are already doing this but we need more money and time. Point relates to the fact that many librarians are already performing these tasks and that we lack time and money to institutionize it. Librarian doesnít see poorly paid librarians going back to school.

Valerie Florance: But we need case studies. I can count on one hand, two at most, documented data that help us show concretely that we have shortened the length of stay, showed that patients come back fewer times to the Emergency Room, or changed patient behavior resulting in improved health of patient. We need more proof.

Audience comment: We donít need whole new profession. We just need proof.

Valerie Florance: But the training for this kind of information professional is different. Informationists need cross-training and/or some kind of certification.

Julie McGowan: AHIP is a peer recognition program. If you think about credentialling, physicians get credentialed in certain procedures, they take tests. In fact, medical librarians used to have to take tests. That is a form of credentialling. AHIP doesnít carry the same weight as real credentialling and licensing.

Ellen Detlefsen: There is no proof that salaries increase if one is a member of AHIP.

Linda Rosenstein: Question: In the old days, did the certification make a difference?

Julie McGowan: Yes, it did.

Ellen Detlefsen: Iím not sure this is the case.

Audience:

In healthcare climate today we have to provide cost effectiveness. Receiving more financing for information might not be supported in current healthcare economic climate.

Ellen Detlefsen: The State of New York has just begun a program in recent months on reimbursement that differentiates the amount of reimbursement based on the board certification status of physician. All of a sudden, physicians see a penalty being paid for not being board certified. [again, a suggestion that there needs to be some meaning attached to information by insurance industry].

Frank Davidoff: [mention of credentials based on self-study and industry-created certification in computer science and the Microsoft certification program — tie-in with computer industry approach to certification vs. education-based training.]

Ellen Detlefsen: MLIS student last year was instructor for MSCE program. Now informatics trainee at Oregon H.S. University.

Audience:

Self-credentialling is meaningless unless recognized by others outside of profession.

Ellen Detlefsen: comment about an ALA Masters — There is still no proof that this degree will offer you access to better salaries.

Audience:

A question for Davidoff — What is the physician perception of the idea presented in the Annals editorial. What are people saying?

Frank Davidoff: Responses were mixed. Glad to be asked the question. It isnít an accident at all that clinical librarianship hasnít taken off. A system is perfectly designed to get the results it gets. In other words, if the system has not supported the rapid diffusion of clinical librarianship, then that canít be an accident. One of the reasons is that physicians have had a mixed reaction to it. And even though medical students are being pushed by AAMC to know how to search the literature, even those with the best intentions find it difficult to find time.

Physicians do think it is part of the job, yet they donít have time to do it. However, [professional position] expectations change over time and as an example, in Davidoffís early career, physicians were expected to have much more hands-on experience with lab results — expected to do own blood counts as house officer, but this doesnít happen anymore. This type of change hasnít flowed through medicine and information science yet. Thatís what we are trying to do with the Informationist role. To give it a push, using laboratory work as a model. It is a blow to pride a little bit for physicians who donít feel that others can do it as well as they can. Very mixed reaction to editorial. The bright side is that if clinical librarians are any good at all, physicians go nuts for it.

Valerie Florance: Notes that there are plenty of cases where physicians say they get packets of information with a large amount of irrelevant information. Have we done a good job showing that we can filter materials appropriately?

Linda Rosenstein: Where does medical liability fit with this?

Ellen Detlefsen: Latch (Literature Attached to Charts) — in some hospitals, this is welcomed because it proves we have done everything possible and therefore protects the hospital in cases of liability; in other instances, it has not been allowed because it proves we didnít know what we were doing, that we had an information gap, and we donít want to let that fact out — [in other words, both sides of argument pro and con based on perception of vulnerability to liability cases]

Frank Davidoff: no simple answer because people will always sue. –but it is analogous to consultants, where liability rests with the primary healthcare provider.

Linda Rosenstein: husband is an attorney and he wouldn’t rely on anyone else to do his research because it is his obligation to know what is in the literature.

Frank Davidoff: True but physicians rely on other people all the time. They can’t look at all x-rays, and lab results, [but the ultimate responsibility for care rests with the primary physician]

Ellen Detlefsen: mention of QMR and use of expert systems for decision making.

Julie McGowan: Two lawsuits found against healthcare provider — in 1980ís found that ignorance of new modalities of treatment was no excuse and healthcare providers were held liable.

Ellen Detlefsen: but in two non-federal courts and this holds only in jurisdiction where decision was rendered.

Audience:

Comment by member of audience about previous experience with online information system accessed by bedside. Physicians wouldnít consider any summarized presentation of information unless a physician or other healthcare professional wrote it.

Frank Davidoff: [refers to] Experience at Vanderbilt. [Librarians] must earn your stripes. [Librarians] must prove that clinicians can trust information.

Linda Rosenstein: What are some other career paths for librarians beyond the Informationist? Would any of the panelists like to talk about any/all of the following: infomediary, knowledge engineer, decision analyst or biblioresearcher, evidence educator, chief knowledge officer, information architect?

Valerie Florance: When you talk about career paths, sometimes people think of management trajectory, but maybe not everyone takes that trajectory. One of Valerieís paths was a knowledge engineer: one of her positions was digitizing Principles of Ambulatory Medicine into searchable, SGML coding. Worked with editors and publishers, dealt with structural issues in building databases. Anthropology skills were important in talking with editors on how they did their work. Training was involved there too helping the editors and their staff learn to work with the software, understand SGML, and so on.

Ellen Detlefsen: A lot to be said for anthropological aspect of this. Before we can talk about curriculum and recruiting, what is the information behavior of healthcare professions? How do they come to know they need information in the first place, how to find, how to store in order to use it again. Models of information behavior not just information seeking. Need more ethnographic studies on information behaviors. Crucial thing for Ellen happened when she understood that physicians make decisions within the context of a certain degree of uncertainty. Understanding information behavior is where the whole thing gets started.

Julie McGowan: Notes Gorman work coming out of Oregon H.S. University about information behavior, and wealth of literature on ambiguity in primary care that deals with decision-making under ambiguous circumstances.

Julie McGowan: Knowledge engineer, another role for librarians. Notes work of Larry Weed in Vermont, father of problem-oriented medical record, and CEO of Problem Knowledge Coupler Corp, clinical decision support software. Has 45% clinicians, 45% librarians, 10% I.T. people. Clinicians and librarians work hand in hand to support the product, which has been bought by the military for med techs. It would not happen without librarians. Librarians do searches, read, pull out factoids and provide them to physicians.

Frank Davidoff: Evidence educator — pick up on educator part of this — U. Connecticut librarians frequently discovered how people didnít know how to ask questions. Thatís curious when you think about it because you would think that knowing how to ask questions is a basic skill especially after 4 years of college and 4 years of medical school.

Ellen Detlefsen: Notes that the Problem-oriented approach to learning the practice of medicine seems to appeal most to women students. The majority of people who engage in this practice at present are women. Also notes that there are increasing numbers of women going into medicine. Womenís studies specialists say that groups of women interact around decision making work with question formulation and question building differently than mixed groups or groups of men only. So perhaps we can select a female-dominated specialty, and work at this in an environment that will be most comfortable for both sides. Sometimes gender does have a place to consider in all this.

Julie McGowan: But thinks there would be so much built-in bias that it wouldnít get funded.

Ellen Detlefsen: But perhaps womenís studies could fund. Gender is still important. As is age — goes back to earlier discussion of twenty-year span as older generation of physicians and librarians move into electronic era of information delivery.

Frank Davidoff: [Picks up earlier discussion of gender.] One aspect of gender is power. Knowledge is power and the person who controls knowledge controls the power. Used to be that physicians used Latin in writing and speech.

Ellen Detlefsen: Would like to see clinical nurses and clinical librarians who are empowered.

Audience:

Speaking of career paths, I think Iím in the position right now in my career, where I would like to learn more about clinical topics, what do panelists recommend? Person in audience is definitely interested and ìwants in on it.î How can she get the knowledge when and where she is now? How to get started?

Valerie Florance: Points to Vanderbilt experience. Librarians in the program are associated with a particular area, and prepare to work in it like going to classes with nursing students for specific specialties, or with medical students.

Linda Rosenstein: what about CE courses? Can we get AHIP credit for going to AMA CE courses.

Julie McGowan: Julie will check into it. Two-pronged approach. Become involved in your institution and take advantage of what is available there. Secondly, via MLA, Michael Homanís idea is for informatics certification courses via distance learning program.

Ellen Detlefsen: Stanford and Oregon Health Science University both have distance learning programs for medical informatics.

Julie McGowan: Notes her program in Indiana which is a 15 hour-certificate program geared specifically for medical librarians, with final project in the medical library community and within your own institution. In process now of going through AHIP.

Linda Rosenstein, wrap-up:

1. One of most important issues is related to how we are doing things and why clinical librarianship hasnít gone any further — there is no reimbursement in place and no unit of service that gets paid.

2. There is no credible evidence that what we do is cost-effective. Though there may be little studies here and there and we have anecdotal evidence…there is still no hard data, no formal studies, rigorously tested demonstration that having a librarian on the team actually makes a difference.

3. Linda notes that many practitioners are very happy when they have it and couldnít live without it if they have it.

4. We have to start now in some manner or other proving our value and we have to prove this outside of our own ranks. At the same time there are skills that the medical librarian needs to develop, such as terminology and biostatistics, so we are in synch with the way the healthcare professionals are doing their work and fit into the mode and thought processes.

Linda Rosenstein: Where do we go from here?

Valerie Florance: the NLMís current long-range plan includes this particular topic, improving the training and advancement of specialty expertise and this is one of the three areas: research, health policy and clinical areas. So actually, we already have someone who is listening. Iíve had preliminary conversations with people at NLM and so has Frank.

Frank Davidoff: it seems to me that a lot of this discussion has indicated that if informationists didnít exist, weíd have to invent them because people are already doing this. May not be called this, but they are [performing] at least variations on a common theme. How to get started? Maybe we should forget about a training pilot, and start with an appropriate research agenda and nail to the wall the fact that the work we are all doing is effective. Call together a group of people from the various organizations and disciplines, maybe under NLMís sponsorship or leadership. Plan to have at that get-together a goal for coming up with a coherent plan or decide not to proceed, if that is the outcome of the discussions.

Julie McGowan: The MLA is very interested in this topic and new roles for academic medical librarians, and we really want to solicit your input. We would like to know if you have found this session valuable. We would like to hear from you, and to figure out ways to help foster this among members.

Ellen Detlefsen: Wake up people already in the education training business to frame education of the next generation in ways that allow people to reflect positively about specialization. Until we can recruit, educate and graduate a generation of colleagues who buy into specialization, we wonít make progress. These schools need to hear from their constituents — alums, others, that we value specialization. They need to hear from you as a community of practice. They need to hear a message from the field.

Transcription of audio tapes

Barbara Shearer

October 28, 2000