Medical Librarians in the Quest for Best Evidence

J. Potomková1, H. Bouzková2, E.S.Lesenková3

1   Palacký University  Faculty of Medicine, Olomouc, Czech Republic                   
2   National Medical Library,  Prague, Czech Republic
3   Institute for Postgraduate Medical Education, Prague, Czech Republic

INTRODUCTION
Evidence-based medicine (EBM) has close links to health sciences librarianship sharing the same goal of applying the best clinical research to efficient medical services. Health and medical librarians can serve as advocates of EBM providing training to end-users how to access and interpret evidence. Obviously, they need to acquire necessary skills and competencies through continuing education.
Since 2001, Institute for Postgraduate Medical Education in Prague (Czech Republic)  has been offering 2 types of EBM training courses to medical librarians taught by extramural facilitators, mostly affiliated with medical faculties. 
Type (1) : Introductory basic sessions  oriented on EBM history and principles, Cochrane Library, MEDLINE methodology filters, librarians´ roles in providing best evidence.
Type (2): workshops for advanced trainees comprising interactive multiple  database searches followed by assessment of the retrieved documents.
Based on our experience, there are three major pre-requisites for EBM advocacy:
•	Multiple medical resources.
•	Qualified library staff with sufficient skills to provide up-to-date, accessible, understandable and realtime information.
•	Inter-professional collaboration including clinicians, clinician-teachers, medical students, hospital managers, and librarians.  

HYPOTHESIS
Information made accessible online has exploded in variety and volume during the last years, but a question arises whether the frequency and effectiveness of usage is following the same trend. 

OBJECTIVES
The purpose of the current investigation has been to gain knowledge about the users in 28 Czech healthcare settings  and their use of Ovid Collection of 9 databases including the Cochrane Library. By database users we mean both medical librarians and healthcare workers, mostly clinicians.

MATERIAL
In January-March 2004 we conducted a survey among 28 Czech medical libraries with access to OVID Collection comprising  9 databases:

•	OVID MEDLINE (1966-present)
•	OVID OLDMEDLINE  (1951-1965)
•	OVID MEDLINE DAILY UPDATE
•	OVID MEDLINE IN PROCESS
•	EBM REVIEWS FULLTEXT
•	COCHRANE DATABASE OF SYSTEMATIC REVIEWS
•	COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS
•	DATABASE OF ABSTRACTS OF REVIEWS OF EFFECTS
•	ACP JOURNAL CLUB (1991-present).

The Czech Ovid Consortium was established by the National Medical Library in Prague which is responsible for project management and fund-raising. 
The consortium consists of 28 member-organizations:
•	2 institutes for postgraduate medical and nursing education,
•	11 University hospitals, 
•	8 clinical research institutes  covering various specialties, including endocrinology, rheumatology, hematology, ob-gyn, experimental medicine cardiology, traumatology, and oncology,
•	7 state-based health institutions  oriented on public health, epidemiology/hygiene, drug control,  psychiatry, healthcare policy.

Fig.1: 
28 Ovid Consortium members

Czech Republic

Members of the Czech Ovid consortium in 6 geographical  regions   
          of the country.

The Czech Ovid Consortium based in larger healthcare settings has had access to OVID Collection for 3 years in succession (since 2001).  
The consortium was established by the National Medical Library in Prague that is the main manager of the whole project including funding. In addition, it is responsible for monitoring the cost-effectiveness of database usage. 
The results of the present survey will be used, among others, to raise funds for future access to OVID collection in the near future as part of a new Develepment Strategy of the Czech Medical Library Network for the period of 2005-2010.

METHODS
The survey was performed by means of a questionnaire distributed among medical librarians and health personnel in the 28 organizations of the OVID consortium.
The questionnaire consisted of 2 sections. Section A was focused on the usage rate of the databases contained in Ovid Collection and it was shared by all database users, i.e. librarians and staff who were asked how often they were accessing the databases (weekly – monthly – infrequently – never). 
Section B contained 10 specific questions for librarians and staff each. All medical libraries involved in the project were required to fill in at least one questionnaire preferably by a search specialist and distribute 20 relevant questionnaires among health personnel selected by random. The completed questionnaires were statistically evaluated  at the Palacky University Department of Biometrics (Olomouc) using SPSS statistical package, version 10.1. 

RESULTS
Out of the total number of 500 distributed questionnaires, 425 were returned. Of this number, 56 not meeting the required criteria were excluded. The remaining 369 (28 received from librarians, 341 from health personnel) were used for statistical analysis. 

Analysis of database usage
Nearly 90% of librarians reported they were using OVID Collection on a weekly basis, mostly several times a week. 10%  of them admitted they preferred other resources, in particular PubMed and ScienceDirect (Fig. 1). In contrast,  only 51% of staff reported searching databases on their own (Fig 2). The remaining 46.3% of the respondents declared they either preferred other resources (44.6%), in particular PubMed , others did not know Ovid Collection at all, and  submitted their information requests to the medical library (55.4%).
We observed that both the categories of respondents (librarians and staff) were using Ovid Medline and EBM Reviews Fulltext most frequently (Tables 1-2, Figures 2-3). Similarly, these 2 categories of database users showed the least frequent usage of the same databases, namely Cochrane Central Register of Controlled Trials, Database of Abstracts of Effects and ACP Journal Club.  (Tables 1-2, Figures 5-7). Figure 4 demonstrates the usage rate of Cochrane Database of Systematic Reviews. The percentage of users on a weekly basis is not very high, there are fewer librarians (8.3%) than staff (16.1%). It is alarming that  only 37.5% of librarians and 64.5% staff have never used this outstanding resource .

LIBRARIANS

Fig.1: Permanent usage of Ovid databases by librarians and staff.

STAFF

 

Table 1: Databases with the highest usage frequency among 
               librarians. 

1. Ovid MEDLINE	66.7 %	
2. EBM Reviews Fulltext	20.8	
3. Ovid OLDMEDLINE	20.8	
4. Ovid MEDLINE in Process	12.5	
5. Ovid MEDLINE Daily Update	12.5	
6. Cochrane Database of Systematic Reviews	  8.3	
7. Cochrane Central Register of Controlled Trials	  4.2	
8. Database of Abstracts of Reviews  of Effects	  4.2	
9. ACP Journal Club	  4.2 	

Table 2: Databases with the highest usage frequency among staff.

1. Ovid MEDLINE (1966-present)	67.7 %	
2. EBM Reviews Fulltext	17.7	
3. Cochrane Database of Systematic Reviews	16.1	
4. Ovid MEDLINE Daily Update	16.1	
5. Ovid OLDMEDLINE	14.5	
6. Ovid MEDLINE in Process	  4.8	
7. Cochrane Central Register of Controlled Trials	  3.2	
8. Database of Abstracts of Reviews  of Effects	  1.6	
9. ACP Journal Club	  1.6 	

Fig. 2: Database usage frequency with librarians and staff.
            OVID MEDLINE (1966-present).  

Fig.3: Database usage frequency with librarians and staff. 
          EBM REVIEWS FULLTEXT.

Fig. 4: Database usage frequency with librarians and staff.
           COCHRANE DATABASE OF SYSTEMATIC REVIEWS. 

Fig.5: Database usage frequency with librarians and staff.
          COCHRANE CENTRAL REGISTER OF CONTROLLED TRIALS.

Fig. 6: Database usage frequency with librarians and staff.
           DATABASE OF ABSTRACTS OF REVIEWS OF EFFECTS

Fig.7: Database usage frequency with librarians and staff.

          ACP JOURNAL CLUB.

SPECIFIC QUESTIONS FOR LIBRARIANS AND STAFF

Question for librarians:
Are you interested in the purpose of information requests?

Question for librarians:
Are you able to evaluate retrieved documents by hierarchy of evidence?

Question for librarians:
Do you discuss information requests with your clients?

Question for librarians:
Have you organized training courses for staff in the past 3 years?

Question for librarians:
Have you participated in training courses in the past 3 years?

Question for staff:
Have you participated in training courses organized by your library in the past 3 years?

Question for staff
What is the main purpose of your searches (information requests)?

Question for staff:
What  criteria do you use for sorting  the retrieved documents?

Question for staff:
In your opinion, what is the quality of the Ovid Collection?

Question for staff:
What is the level of library services in your organization?

CONCLUSIONS
Our survey has confirmed that the usage rate of the Ovid Collection varied across the databases in favour of OVID MEDLINE, a traditional bibliographic database for medicine and healthcare. The results have shown that the frequency of access to  the Cochrane databases on a weekly basis was rather low. The authors of the present study believe that it would be practical to offer more training opportunities for database users. Therefore, we elaborated a proposal for a guideline "Teaching and learning EBM" that was inspired by a sophisticated report  written by Prof. P. Matzen of the Faculty of Health Sciences, University of Copenhagen (Denmark).

Guidelline subtopics:
•	Didactic setting for teaching and learning EBM.
•	Multiple information resources for medicine and healthcare.
•	Asking well-built clinical questions.
•	Ability to retrieve literature.
•	Critical appraisal of literature.
•	Knowledge of systematical collection and appraisal
•	Hierarchy of evidence.

REFERENCES
Burrows S (2003) Developing an evidence-based medicine and use of the   biomedical literature component as a longitudinal theme of an outcomes-based medical school curriculum: year 1. J Med Libr Assoc 91(1): 34-41.
Evidence based medicine curriculum and assignment. State University at New York. Upstate Medical University. available  at: http://www.upstate.edu/fmed/rmed/ebm_curric1.pdf
Evidence pyramid. Medical Research Library of Brooklyn. available at: http://library.downstate.edu/ebm/2100.htm. 2004.
Harder JM et al. (2000) Best evidence medical education. Adv Health Sci Educ 5: 71-90.
Matzen P et al. Evidence-based medicine in the medical curriculum - a guideline. available at: http://www.sund.ku.dk/. 2004.

Acknowledgements
The authors would like to express their thanks to Ms. K. Langová and Ms. J. Zapletalová of Palacký University in Olomouc for technical assistance.