Issues in Science and Technology Librarianship	Fall 1997

Developing and Delivering Medical Reference Source Instruction in a Special Library

James H. Walther
Education Services Librarian
Nancy Speisser
Health Care Reference Librarian
The Advisory Board Company, Washington DC

The medical researcher of today has a variety of research tools in multiple formats available for information fact finding. Medical researchers can study the financial or organizational management, the clinical services experienced by the care receivers, or the operational infrastructure of health care organizations. The strategic use of information services forces the need for the development and delivery of bibliographic training for front-line researchers.

The goal of this article is to present science librarians with a model, not only for the basic, command-based parameters of what and how to search information, but to create a level of information strategy and assessment. An exhaustive list of Internet sites is excluded, but representative information is included. The focus of this article is how to identify audiences, user assessments, models of training, methods of training delivery, and goals for the future. Having users learn how to balance the availability of databases, journals, services and sources by articulating the features and advantages of each choice, should be the focus of all training initiatives.

Identifying the Potential Audiences

While the focus of this paper is on medical reference source instruction, all instructors should take the time to address the following tactical issues in order to find the target audience for bibliographic training for all specialized source information:

Understanding the audience will determine what you train your users to accomplish. Keeping an eye on reference question statistics and research lab questions are effective ways of knowing simultaneously what users are researching and what information skills they have yet to develop.

Identify subgroups within research areas. In our organization, we have a distinct division between substantive medical information versus the need for cumulative, financial information on the health care industry. Group training with broad examples might not be effective in our setting, whereas targeted, small group or topical training by issue is more effective as the audience's interest has a greater range.

Ask questions of user groups before training sessions to identify which topics and areas should be covered. This will create natural, topical parameters within your training plans.

Conducting User and Information Assessments

Three functional guidelines for creating user assessments are: type of information needed, evaluation of the source of information, and usage of the information. Clinical terminology can be found in basic reference tools and the Internet, whereas higher-level DIALOG searching could be accomplished in coordination with a librarian rather than conducted by a front-line researcher. This would depend on user needs, abilities, and institutional access. Asking questions about what boundaries of how much information is needed should assist in directing trainers to key sources to highlight. Surveys identify knowledge of print collections or web-based reference materials effectively and provide a place to start building a training platform. Next, offering an Internet evaluation course is essential in today's research environment to show the value of web-based sources and demonstrate the differences of fee-based services. Users need to understand what they are choosing to search just as much as how to search for it. Finally, using class evaluations of the value of the training provided will give instructors ample indicators of the success of the conducted training. If poor attendance or marginal evaluations are received, step back from the process and evaluate if the training was appropriate for the audience. Did you know enough about their information needs? Were the examples and delivery of instruction appropriate for what was instructed? Is the usage of the information directly connected to the model of training conducted and sources selected?

Creating Models of Training

The Internet

Provide a basic "Evaluating the Internet". Identify key Internet sites in a pathfinder or Intranet format and use the class experience to develop the evaluation of this research tool.

Accurate Information:
Look at value of the data, writing level and errors
Authority to Present the Information
Look for sponsors, expertise and qualifications of writers
Current Information:
Look for web page dates and working links
Objective Presentation of Information:
Look for the clear purpose of the information provided, especially bias and/or slant
Scope of the Information:
Look for the clear service, topics and value of information provided.

LEXIS-NEXIS

LEXIS-NEXIS training will be command-based, search specific training in most settings. This training should focus on strategy as opposed to sources. Examples both highlighting where and what to search should be a focus of the training initiatives.

"Health Sources on LEXIS-NEXIS"

Health-related libraries on LEXIS-NEXIS

General Medical Library (GENMED)
Contains full-text medical journals and newsletters, as well as information on drug interactions, cancer, poison, disease, trauma, and medical administration.
Health Law Library (HEALTH)
This library, developed in consultation with the American Academy of Hospital Attorneys, addresses broad health care issues as they apply to providers, insurers, regulators and suppliers
Medical Malpractice Library (MEDMAL)
Contains both federal and state medical malpractice case law, as well as pertinent statutory materials and authoritative publications.
MEDLINE Library (MEDLNE)
Contains bibliographic information from the National Library of Medicine for more than 3,500 worldwide clinical and research journals dating back to 1966.
Legislation Library (LEGIS)
Provides access to sources which monitor the progress of emerging federal and state legislation via full text bills, bill tracking reports, the Congressional Record and publications specifically oriented to Capitol Hill and state legislatures.
Company Library (COMPNY)
Contains business and financial information, including thousands of in-depth company and industry research reports from leading national and international investment and brokerage houses as well as full-text and abstracted filings from the Securities and Exchange Commission.

Examples include:

Check the BNA Health Care Daily for the most current information on the health care industry.
Library: health and File: bnahcd
This is an automatic display file. Press the cite key or type .ci to see "today's edition". Type .ns if you wish to search all the documents in "back issues".
To retrieve articles regarding the liability of hospitals for the negligence of independent contractor emergency room physicians:
Library: health and File: ahalaw
Search: liab! w/20 negligen! w/20 independent w/3 contractor w/10 emergency room
To retrieve recent final regulations on Medicare:
Library: genfed and File: fedreg
Search: medicare and action (final) ***Always add a date restriction.
To find allowable Medicare costs as are discussed in 42 C.F.R. § 413.17 (b). Update this section of the Code of Federal Regulations in the Federal Register:
Library: genfed and File: fedreg
Search: cfr (42 and 413)
For brokerage house reports on the health industry:
Library: compny and File: ind
Search: industry(health) ***Always add a date restriction.
To find 8-Ks which mention enforcement actions by the FDA:
Library: compny and File: events
Search: fda or food drug
To follow the debate on physician ownership and self-referral in the press:
Library: legis and File: allnws
Search: (physician w/5 own!) or self referral
To retrieve hearings discussing health reform:
Library: legis and File: fednew
Search: headline(hearing and health) and health w/3 reform
To find expert witnesses on asbestos or asbestosis:
Library: lexref and File: expert
Search: asbestos!
To review full-text medical articles on fluoextine and suicide:
Library: genmed and File: jnls
Search: fluoxetine and suicide
To find a full discussion of depression:
Library: genmed and File: diseas
Search: title(depression)
To find the uses of albumin in the treatment of shock:
Library: genmed and File: conslt
Search: albumin and shock

Drug Information Fulltext (DIF)

DIF is produced by the American Society of Hospital Pharmacists (ASHP) for use by pharmacists and the pharmaceutical industry. The DIF group file houses over 1500 fulltext drug monographs from the American Hospital Formulatory Service Drug Information (AHFS) and the Handbook on Injectable Drugs (HID). Each drug monograph provides information on:

preparation
toxicity
therapy and use
cautions
drug interactions
dosing/administration
chemistry and stability
references and more

The caveat with searching the LEXIS-NEXIS will be local, institutional access, whether by librarian or front-line researcher. Individual libraries or files may or may not be available within a given library's collection and your LEXIS-NEXIS representative should be contacted to clarify both your options and opportunities to change the availability of services with the LEXIS-NEXIS Information Services.

The Internet Sources Course and Internet Evaluation Class

As part of the health care resource introduction module, a short list of selected Internet sites is provided to new researchers. The purpose of this list is to introduce new researchers to some of the better known and more reliable Internet health care resources. The focus of this training should be on sources and not strategy. An important factor in the consideration for inclusion on this site list is the credibility of the sponsoring organization. Sites should leave no ambiguity about the organization sponsoring the site and should provide relevant contact information including both e-mail and telephone numbers. Researchers often require relevant healthcare statistics. Sites included on this list are intended to provide new researchers with access to several of the best known medical statistics sites. The Centers for Disease Control (CDC), the Health Care Financing Administration (HCFA) and the National Committee for Quality Assurance (NCQA) are examples of the sites included for this purpose.

Other sites are included because they provide online access to serials and databases. The National Library of Medicine provides free access to MEDLINE. Varying degrees of access to online journals is provided. The American Medical Association (AMA), New England Journal of Medicine and Modern Healthcare sites are included because of the access they provide to well known professional journals. Providing researchers with the option of accessing online publications can be beneficial to the organization by decreasing the demand on limited computer laboratory facilities. Online access to professional journals does have several limitations. Availability using online access to professional journals is not uniform. Some publications provide full text and some provide tables of contents and abstracts. Along this same line, not all features of the print journal are available online. An article might be listed in the table of contents, but the full text may not be accessible. Most online publications extend back only to 1995 thus providing researchers with a limited archive.

These and other issues represent the limitations of online access with which researchers will become familiar as they develop their online research skills. As online access to professional journals becomes more ubiquitous, some of these issues will be resolved while others emerge to take their place.

Internet Healthcare Sites

(September, 1997)

Agency for Health Care Policy and Research (AHCPR)
http://www.ahcpr.gov
sponsored by the Department of Health and Human Services [Note: Unable to connect 3/27/02]

American Medical Association
http://www.ama-assn.org
retrieve abstracts, content listings, JAMA, editorials, press releases, policy statements, legislation

Centers for Disease Control
http://www.cdc.gov
provides the latest in health information and press releases from the Centers for Disease Control in Atlanta. In addition, links are provides to NIH, NLM, AHCPR, WHO, DHHS, LOC and state and local health departments.

Connecticut Healthcare Information Network
http://www.chime.org
select "Other Sites" to access links to Hospital Network Healthcare Associations, Connecticut hospital/healthcare institutions, healthcare provider sites, consumer healthcare sites, government healthcare sites and HTML help.

Hospital+Net
http://www.hospital.net/
index of available healthcare resources. Over 200 links to sites for diseases, medical practices, health care products, specialties, services and hospital related materials. [Note: Broken link removed 3/27/98 by ald]

National Committee for Quality Assurance (NCQA)
http://www.ncqa.org/
[Note: Link moved; URL changed 5/6/99, 7/19/00, 1/5/01 by ald] latest in NCQA news, information on accreditation, performance measurement, report cards, NCQA publications and conferences.

Health Care Financing Administration (HCFA)
http://www.hcfa.gov
Medicare/Medicaid, managed care information

Healthcare Association of New York State (HANYS)
http://www.hanys.org
select "Resource Locator" then "Links to Other Sites" to access 800 links in 39 categories including clinical issues, disease related information, physicians, mental health, and more. [Note: Link corrected 3/28/98]

Healthfinder
http://www.healthfinder.gov
links to over 700 sites including databases, clearinghouses, online publications, web sites, government agencies, not-for-profit organizations.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
http://www.jcaho.org
information about the Joint Commission's services and products. JCAHO evaluates and accredits more than 18,000 health care organizations in the United States including hospitals, health care networks and health care organizations that provide home care, long term care, behavioral health care, ambulatory care and laboratories.

Michigan Electronic Library (MEL)
http://mel.lib.mi.us/health/health-index.html
Health Information Resources page. This site links to other sites for resources, stats and other health topics including women's health, aging, sports medicine, health policy, surgery, statistics and more.

Modern Healthcare
http://www.modernhealthcare.com/index.php3
site for journal of the same name. Current issue is posted every Wednesday at 12 p.m. (Eastern time). [Note: Link moved; URL changed 11/1/99, 7/19/00 by ald]

National Institutes of Health (NIH)
http://www.nih.gov
access to NIH resources such as CancerNet, AIDS information, Clinical Alerts and the Women's Health Initiative.

National Library of Medicine (NLM)
http://www.nlm.nih.gov
provides access to Medline, a database of 8.8 million references to articles in 3800 biomedical journals. From this site you can use PubMed or Internet Grateful Med to search Medline free (use link for free Medline).

International Classification of Disease (ICD-9-CM)
http://www-informatics.ucdmc.ucdavis.edu/icd9/refs.htm
Site provides ICD-9-CM classifications. Also allows keyword search for classifications.

Delivering Models of Training

The "How To" approach of delivery for each of these three courses with depend on local capabilities and the requirements of users.

The LEXIS-NEXIS Medical Resource Class

The desire of most users for a hands-on, computer assisted approach to training makes this a good course to offer in a laboratory setting. The highly specialized nature of the course in terms of subject expertise makes it an ideal candidate to be conducted by a researcher or librarian who also desires to be an internal trainer. Such a presentation may make this course exceptional. Consulting with your LEXIS-NEXIS or other online database representative provides an excellent way to create a balance of information resources. Vendors are often excellent training resources. Ask for Options! Total Time: 60 minutes.

The Internet Sources Course and Internet Evaluation Class

This class could be divided into two sessions depending on the time allowances for training within your organization. In our organization it is usually easier to have the material presented in two sessions, delivering the sources section after evaluation skills have been clearly established in each researcher.

The list of URLs is presented to new health care researchers as part of the training module for the introduction of health care resources. The URLs for these sites are formatted as hot links within a document that is distributed to the new researchers' desktops via e-mail. This provides researchers with the opportunity to open the e-mail and explore the links at their convenience. They can then bookmark the sites. This approach provides two advantages. One, it is more convenient than distributing lists with the URLs at the training session. With that approach, researchers are more likely to lose the list amid all of the other information handouts they acquire during orientation. Second, users do not have to retype the URLs. This reduces the possibility of entering the URLs incorrectly and also saves time.

Logistically, this course could be delivered with a flipchart/overhead combination; however the Microsoft PowerPoint software is a great option, if available. Total time: 30 to 45 minutes.

Goals for the Future

Our organizational goals for delivering additional training are to advance the knowledge base among researchers of the variety of access points for online information access. This will create a "higher level" information usage. We believe in working in conjunction with practicing researchers (although this is not currently an option within our organization) and disseminating elements of the training through front-line researchers to keep our program relevant and timely.

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