Cobertura y calidad

In this section, several suggested solutions to the problems mentioned above are described, including new job roles and the use of Evidence-Based Practice, as a way to strengthen the persuasive abilities of librarians in their work settings.

2.1.7.1 New Roles?

Current problems related to the economy and changes in technology and the delivery of information are far from unique in the history of medical libraries. While it is not the intention of this work to convey the entire history of the profession, brief mention of historical concerns with staffing, education, and the graying of the profession provide additional context for our own examination. In delivering the prestigious Jane Doe lecture to the members of the Medical Library Association at the 1989 annual meeting, Columbia University Augustus C. Long Health Sciences Library Director Rachel Anderson quoted John Scully, keynote speaker at the

EDUCOM ’87, in saying: “The key strength of twenty-first century organizations will not be their size or structure, but their ability to simultaneously unleash and coordinate the creative contributions of many individuals” (p. 323). Anderson traced decades of concern expressed about problems with recruitment of medical librarians beginning after World War I, quality of library school graduates, and overall, the “paucity in both the quantity and caliber of recruits to medical librarianship” (Anderson, 324), and citing studies in 1969 (Kronick, 1972) and the

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creation, in 1981, of a study group to consider the problems of recruiting quality candidates to the profession (Mirsky, 1982). In particular, the Kronick study concluded that while graying of the profession, a trend observed in the early 1980s, was of concern, the greater issue was that of “a growing, critical, unmet need for qualified health sciences librarians” (Kronick, in Anderson, 1989, p.324). Referring to an ongoing theme in the literature of medical librarianship, Anderson described the lack of educational preparation by medical librarians, at that time educated largely in the humanities and social sciences, without particular focus on health sciences, and the

mismatch to current positions in medical libraries, which called for subject backgrounds in health topics. Kronick found lack of substantive representation in the profession by those whose

degrees or coursework included the “hard sciences” to be a disturbing trend with serious

consequences, “indicat[ing] that we have a fairly narrow educational perspective from which to examine issues or approach problems” (p.296). That librarians’ educational preparation tended to reflect humanities more than sciences was no surprise, stated Anderson, who suggested parallels between educational focus and medical librarians’ historical and ongoing “invisibility” and “lack of appreciation and low valuation” (Anderson, p. 325) by physicians, exacerbated by the often clerical nature of library work and a historically female-predominant workforce. In that address, Anderson called for increased efforts toward professionalism and new roles, including that of “knowledge counselor”, “information counselor”, “database manager”, and “information manager” (p.328).

In an editorial by Davidoff and Florance (2000), a “new” role for medical librarians as clinical librarians was suggested as a way to assist healthcare professionals in locating evidence-based literature in support of patient care. Claiming that, while advances in

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skills to benefit from them, the authors stated that this gap could be addressed by information professionals:

In sum, the medical profession falls far short in its efforts to make the critical link between the huge body of information hidden away in the medical literature and the information needed at the point of care. This failure means not only that many opportunities for improved patient care and continued learning are missed but also that much of the effort, creativity, and money that goes into biomedical research is simply wasted (Davidoff & Florance, 2000, p. 996).

Seven years later, Journal of the Medical Library Association (JMLA) editor Giuse again urged expansion of medical librarian roles toward a new breed of expert evidence consultant termed the informationist or information specialist in context (ISIC), defined as “an individual with a thorough understanding of both a health care domain and information seeking and appraisal, who employs that combination of expertise as part of a health care or research team” (Sathe, Jerome, & Giuse, 2007, p.270). Claiming that ISICs’ “immersion in activities outside the library ha[ve] become the new modus operandi [that can] aid in the transformation of health care practice,” Giuse allowed that the present structure and available roles did not yet not allow for growth beyond the more “traditional mechanisms of

recognizing talent through managerial positions” (Giuse, 2007, p.1). Perceived barriers to the implementation of ISIC roles were identified as the result of an MLA-supported study

conducted at the Eskind Biomedical Library included a lack of funding (89%); problems with acceptance of the new role by stakeholders (67%); insufficient education (56%); and “lack of qualified candidates (52%)” (p.271). Respondents to the survey, which compared reactions to scenarios where ISIC participation might occur, were more likely to agree to the likelihood of scenarios if they worked in academic medical libraries (40%) than in hospitals (30%), although the total number of survey participants was small (“274 librarians and 39 healthcare/research professionals” (p.iv)), and may not have been generalizable (Giuse,

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Sathe, & Jerome, 2006). The authors concluded that the idea of this particular role for medical librarians was not yet acceptable by either librarians or healthcare practitioners, and indicated the need for “evidence-based training and models for ISIC practice” (p.67) before this new role might find fruition.

2.1.7.2 Evidence-Based Practice?

Evidence-based practice (EBP) is recommended by the Medical Library Association (Grefsheim, Eldredge, Russo, et al., 2007) and the Special Libraries Association (Abels, Jones, Latham, et al., 2003) as a way to ensure the continued viability of information professionals and the profession itself. The objective of EBP in LIS (also referred to as Evidence-Based Librarianship (EBL) or Evidence-Based Library and Information Practice (EBLIP)), as in other disciplines in which it has been applied, is to encourage the practice of rigorous and comprehensive research in the approach to important questions in practice (Eldredge, 2000) as opposed to the utilization of 'expert opinions' which may be based upon anecdote or local narrative (Booth and Brice, 2004).

Evidence-based medicine (EBM), from which the model for EBL is derived, is a newer permutation of efforts through history to employ increased rigor in research, and to unite the results of bench research to clinical practice more closely. In medical practice, clinicians were discovered to generate two questions per every three patient encounters, with less than one third resulting in an information seeking process beyond peer consultation, the preferred first resource for clinical questions (Covell, Uman, & Manning, 1985; Osiobe, 1985). Intended as a way for information professionals to support their practice-oriented decision making, EBL emulates EBM in providing a model for decision making in practice, with the intention of supporting decisions focused upon the best available evidence combined

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with clinical expertise and consideration of the local environment.

The objective of evidence‐based practice in libraries, as in other disciplines in which it has been applied, is to encourage the practice of rigorous and comprehensive research in the approach to important questions in practice (Eldredge 2000), as opposed to the utilization of “expert opinion” which may be based upon anecdote or local narrative (Booth and Brice 2004). Early efforts rose from medical librarian involvement with the EBM initiatives that led to role redefinition (Scherrer and Dorsch 1999), and in response to continued calls for increased quality in, and use of, research. Support for this initiative was expressed by the Medical Library Association in 1995 and again in 2007 (Grefsheim et al.); the Association of College and Resource Libraries (2000); and the Special Library Association (2001). Key publications include a manual for practice (Booth and Brice 2004) and an online, open access journal that incorporates formal critical evaluations of peer reviewed research in LIS.

In this section, I have briefly summarized what is known about the environment of hospital librarians, although because so little is known, data have been taken from sources that measure medical librarians across all types of libraries. The education and continuing education of hospital librarians, which occurs mainly post-MLS, is insufficiently measured because data are restricted to responses from a voluntary survey of MLA members. Using these figures, medical librarians participate in a wide range of CE opportunities, both MLA- sponsored and through other organizations. Little is known about hospital librarians’ use of published research, but more casual means of communication may be preferred over formal dissemination of information. Electronic mailing lists are used in a number of ways,

including survey distribution and discussion about issues in the profession, but hospital librarians are underrepresented in journal publications.

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The roles of hospital librarians are shifting in response to changes in a broader healthcare environment, which has responded to cost control, technological, and other trends and initiatives with shortened LOS, movement toward a more highly- regulated and

increasingly outpatient centered health system, affecting overall health sector employment. In hospital libraries, the Vital Pathways survey reports increased closures and shrinking

budgets, while at the same time, hospital librarians are aging and expected to retire at rates that will peak between 2015-2019. Changes suggested for this population include increased involvement with patient care teams and a more rigorous support for decision making, but solutions have not been tested sufficiently to determine whether these models are viable or practicable.