Library Research

EBL’s research interests include integrating evidence into the patient care and research workflow using informatics applications; evaluating and formalizing the informationist concept; education, skills development, and leadership development of librarians; optimal selection and use of information resources; and digital library development.

The EBL’s 2005-2007 funded research projects include:

The Clinical Informationist: Does the Model Work? (NLM 5 R01 LM07849; completed May 2007)
A Health Sciences Librarian Pre-Professional Integrated Learning Model (IMLS RE-01-03-0052; completed May 2007)
Envisioning the Information Specialist in Context: A Multi-center Study to Articulate Roles and Training Models (Medical Library Association contract; completed September 2005)

The Clinical Informationist: Does the Model Work?

Background

To evaluate the role of the Clinical Informatics Consult Service in clinical decision-making, the EBL was awarded a 3-year grant from the National Library of Medicine (5 R01 LM07849). The CICS is a well-established program that facilitates evidence-based practice by delivering targeted information in answer to complex, patient-specific questions. The CICS places librarians with specialized training in medical subject areas and in information retrieval (“clinical informationists”) on clinical teams in intensive care settings. Acting as expert consultants, they analyze the biomedical literature to identify, filter, and present the best examples of each clinical viewpoint expressed about key problems.

Evaluation Project

Working in cooperation with the Center for Evaluation and Program Improvement (CEPI) at Peabody College of Vanderbilt, the investigators formally evaluated the role of CICS in clinical decision-making and evidence-seeking behavior using a randomized pre/post design. While past studies have evaluated clinical medical librarians’ roles, few if any studies have examined the effectiveness and utility of the new clinical informationist approach in sites where informationists are well-established.

Through a combination of observation and interviews, investigators examined librarian involvement in three existing Vanderbilt CICS intensive care units, collecting detailed information about the ways in which clinicians incorporate CICS-provided information into their workflows. The project also included a randomized trial to evaluate the effects of CICS on clinical decision-making. Investigators compared clinicians’ intended course of care vs. actual care when CICS results are provided and when clinicians seek information themselves.

In the randomized trial, CICS questions were randomized to receive either a full evidence synthesis as is customarily provided, or no results (in which case clinicians could look for information themselves). Requestors completed a pre-request form, detailing their intended use of the information requested (support treatment decisions, etc.) as well as a post-request evaluation form, detailing how the information (if provided) affected the patient's treatment course or whether/how they sought information themselves for the question. To ensure patient safety, clinicians had the option of overriding a "no results" randomization in cases in which they felt the CICS results were critical for patient care decisions and they had no other means of locating information. The randomized phase of the study ended in May 2006, and the team will be publishing results of the study.

The project also included the development of “virtual cases" incorporated into training tools that can be used to export elements of the CICS model to other locations. The Evidence Based Knowledge Portal incorporates cases that set tenets of EBM in the context of a clinical setting to facilitate understanding and application of techniques such as NNT and absolute risk. The tool also contains assessments to allow users to gauge their level of readiness to adopt EBM practice and an EBM tutorial.

Demonstration of the utility of the clinical informationist approach can foster widespread adoption nationally and increase the degree to which clinical practice becomes evidence-based.

Dr. Nunzia Giuse, Director of the EBL and Professor of Biomedical Informatics and Medicine, is the project’s principal investigator. Doctors Leonard Bickman and Shelagh Mulvaney, project co-investigators, head the team of external evaluators from Vanderbilt University’s Center for Evaluation and Program Improvement (CEPI).

Advisory Board

EBL has also worked with a team of external evaluators well known for their expertise in informatics evaluation to provide input on the study:

• William Tierney, M.D. Indiana University School of Medicine
• Eta S. Berner, Ed.D. University of Alabama at Birmingham
• Prudence W. Dalrymple, Ph.D. Dominican University

Presentations and Publications

The project team has also presented results from a pilot study funded by the grant at the May 2004 Medical Library Association Annual Meeting; results from this pilot study were published in Academic Medicine in 2005 (Rosenbloom ST, Giuse NB, Jerome RN, Blackford JU. Providing evidence-based answers to complex clinical questions: evaluating the consistency of article selection. Acad Med. 2005 Jan;80(1):109-14. Abstract)

The team also presented a poster outlining the preliminary development of the virtual case tool at the 2005 annual meeting of the Medical Library Association (Cahall M, Sathe NA, Todd P, Jerome RN, Giuse NB. Capturing Knowledge Management Practices of Local Expert Librarians to Inform the Development of a Virtual Case Training Tool. Presented at Medical Library Association Annual Meeting, San Antonio, TX, May 2005. (Poster)) and tool content at the 2006 Medical Library Association annual meeting. (Sathe N, Todd P, Clark J, Gregg W, Giuse NB. Virtual Cases as a Tool To Promote the Incorporation of EBM Techniques into Housestaff Training. Medical Library Association Annual Meeting, Phoenix, AZ, May 2006.)

In addition, the team has also conducted pilot studies to assess the effects of targeted communication strategies on expert information provision uptake:

Jerome RN, Giuse NB, Rosenbloom ST, Arbogast P. Customizing implementation of a novel evidence request feature in an electronic medical record system. Submitted for publication to the Journal of the Medical Library Association (JMLA). May 2007.

Jerome RN, Cahall M, Potter S, Todd P, Williams AM, Giuse NB. Scaling evidence-based services through integration with informatics tools. Medical Library Association Annual Meeting, Phoenix, AZ, May 2006 (poster).

The team has also discussed elements of the study's results regarding clinician-perceived barriers and facilitators of EBM:

Mulvaney S, Bickman L, Lambert W, Sathe N, Jerome R, Giuse NB. Barriers to and Facilitators of Evidence Based Practices in Physicians. Rapid Communications Poster presented at the Society for Behavioral Medicine 28th Annual Meeting. Washington, DC. March 21-24, 2007.

For more information contact the study project manager:

A Health Sciences Librarian Pre-Professional Integrated Learning Model

Background

At a time when a shortage of professional librarians has been identified, EBL has been exploring recruiting for the medical library segment of the profession from within medical libraries. In 1995, the National Library of Medicine (NLM) issued a request for proposals to develop formal education and training programs. EBL at Vanderbilt and the Department of Library and Information Science at the University of Pittsburgh were two of seven institutions to receive a one-year planning grant. The model internship program developed at EBL gives new librarians the opportunity for advanced training in health science librarianship and biomedical informatics. Since its inception, the internship has been constantly refined to reflect changes in librarianship and has enrolled 23 individuals. Designed in conjunction with educators at Vanderbilt’s Peabody College, the program balances formal training modules with informal mentoring activities designed to foster the lifelong, proactive approach to learning that is crucial in any rapidly changing environment. This program helps bridge the existing distance between health sciences library staff and health care professionals by facilitating roles outside the traditional boundaries of medical librarianship.

Model Development

Through the Institute of Museum and Library Services-funded project (RE-01-03-0052), EBL developed a model for the recruitment and/or retention into librarianship of pre-professional staff. The model program created and evaluated an educational pathway that draws on the strength of a well-established library internship and a long-distance degree program through the University of Pittsburgh’s DLIS. While in the past much of the training has occurred in the classroom, it has become clear that the breadth and depth of the formal curriculum is often limited by program constraints. This collaborative model offers an exciting alternative to the traditional model for the education of librarians. It is often the case in other health sciences professions such as medicine, nursing, and pharmacy, that students are offered the opportunity to constantly verify during clinical and research encounters with faculty whether the skills that they acquire in the lecture hall are being internalized. This training model emulates the same level of interaction between the pre-professional trainees and librarians, thus providing a means of applying theory to the work environment.

The overall design included a three-year period to develop the model and establish a comprehensive plan for evaluation. The training model underlines three distinct phases designed to represent a method of matching individual and partner institutions’ goals. During Phase I, candidates completed a Level I EBL Learning Plan which represents a pre-requisite designed to aid in identifying qualified candidates. The DLIS coursework and EBL practica constituted the main components of Phase II. At the end of this phase, the candidates earned a Master of Library and Information Science degree.

The third and final phase culminated with an EBL internship designed to provide the newly graduated librarian with the necessary working credentials. Throughout the process, evaluation tools previously implemented and tested as part of EBL’s internship program were used to evaluate knowledge and skill acquisition of candidates and to refine the proposed integrated model. The creation of a successful model and subsequent dissemination means that other similar institutions could also partner with a distance library/information science program for this educational initiative for the transition from pre-professional to professional librarian, and thus share the pathway to an increased number of professional medical librarians.

The team officially ended the grant project in May 2007 and is developing a website to disseminate elements of the model.

Publications and Presentations

For more information contact the study project manager:

Envisioning the Information Specialist in Context: A Multi-center Study to Articulate Roles and Training Models

Background

• Results from an exploratory role delineation study (Web survey and focus groups) outlining skills, desired practice outcomes, and practice parameters and settings for the ISIC
• Pilot ISIC competency framework
• Continuing education and quality assurance strategies for ISIC education
• Framework for gauging the institutional processes underlying ISIC programs
• Analysis of funding avenues for ISIC programs
• Strategies for collaboration and promotion

Advisory Board

• Andrea Ball, M.L.S. Legacy Good Samaritan Hospital Medical Library
• Richard Bankowitz, M.D., M.B.A. University HealthSystem Consortium
• Prudence Dalrymple, Ph.D. Dominican University
• Sherrilynne Fuller, Ph.D. University of Washington
• Shirley Gronholm, M.L.I.S., R.N., A.H.I.P. Hartford Hospital
• Brian Haynes, M.D., Ph.D. McMaster University
• Carol Jenkins, M.L.S. University of North Carolina - Chapel Hill
• Julie McGowan, Ph.D. Indiana University
• Michelynn McKnight, Ph.D., A.H.I.P. Louisiana State University
• Nancy Roderer, M.L.S. Johns Hopkins University

Current Activities

Sathe NA, Jerome RN, Giuse NB. Librarian-perceived barriers to the implementation of the informationist/information specialist in context role. J Med Libr Assoc. 2007 Jul;95(3):270-4.

For more information contact the study project manager:

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Last modified: Thursday, 20 October 2005