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IL & Health Libraries

Where does information literacy fit in within the health sector?

The term “information literacy” is not widely used in the health sector, but the concept is widely recognised as it forms a major component of evidence based medicine (EBM - also known as evidence based practice). EBM 1 was first coined in the early 1990s, by David Sackett 2 and his colleagues at McMaster University. It means “integrating individual clinical expertise with the best available external clinical evidence from systematic research” to achieve the best possible patient management. In simpler terms this means clinical expertise together with best research evidence and patient preferences. For health professionals, it means that they have to back up their clinical decisions with the best evidence available. And this is where information literacy skills are essential. Health professionals need to be aware of how to search for good quality information, and they need to be able to appraise the content they find. This takes a long time, and it is a difficult skill to learn. Therefore, health librarians have a key role to play. They either deliver searching and critical appraisal skills training or they carry out the literature searches on behalf of the health professionals. As a consequence, the health librarian role has significantly changed over the past few years, with the  introduction of clinical librarians and outreach librarians 3.

Clinical librarians work within hospitals, often accompanying ward rounds or being attached to clinical teams. Outreach librarians tend to work within a primary care setting, visiting GP surgeries to deliver training or to provide literature searches. Both roles mean that the health professional does not have to physically visit the library, which can save them considerable time.

The Centre for Evidence Based Medicine (CEBM), in Oxford, was set up to help health professionals to become evidence-based. Since the late 1990s, medical librarians have played an integral part in supporting the work of the CEBM. Initially, they delivered searching skills training to health professionals at EBM workshops. However, for the past 5 years, librarians have been employed as Librarian Tutors at the workshops and work with Clinical Tutors to teach searching and critical appraisal skills to health professionals and also to teach them how to teach these skills to their staff when they return to their workplace.

Barriers to information literacy in the health sector
There are two main barriers to information literacy in the health sector:

Time
During a consultation, a number of clinical questions might arise. However, immediately after the consultation, there will be more patients to see and then there is paperwork to do. So, when do health professionals get the chance to find the evidence to support their decision-making?

A number of resources have been developed to improve access to the best evidence. Databases and journals containing secondary research (summaries or reviews of primary research) have been developed to make it easier to identify the general consensus. Examples of these are the Cochrane Library and the Evidence Based journals, and guideline databases, which contain the latest guidance for treating a condition. Other examples include the NHS Evidence National Library of Guidelines, and the NHS Evidence Specialist Collections, which contain the best available evidence on a range of clinical and non-clinical topics. NHS Evidence is a new database, launched as a result of Lord Ara Darzi’s Higher Quality Care for All report. All of these resources make it easier for health professionals to find the best evidence, and do save time, but health professionals still need to know how to use these resources. By involving librarians in their day-to-day work, eg as clinical or outreach librarians, the onus of travelling to the library is taken away from the health professionals. They can just concentrate on learning how to find the evidence from their own workspace. This actually makes it a lot easier for them to apply EBM because they will be learning on more familiar grounds and they can bookmark the relevant resources on their own computers, rather than having to go out to a training session, and then return to their computer and find the resources again. In addition, by being at the “frontline”, librarians can improve their clinical knowledge and provide a more relevant service to their users.

Resources
Access to resources, or lack of, can also be a barrier. Throughout healthcare, there are variations in access to resources. Hospitals attached to universities have greater access to resources, compared to the local GP surgery. The NHS does subscribe to a set of key databases, including the Cochrane Library, and a number of medical journals, but it is beneficial to be attached to university resources too, particularly journal collections. There are also differences in the levels of information technology available. The majority of health organisations, in England, are attached to NHSnet, the NHS Internet connection, which was designed to transfer patient data. As patient data is the priority, searching databases and journals in the NHS can be quite a slow process, which is frustrating for the user. Again, health organisations with links to universities, fare better as they can also search using the university networkk.>

Diverse customers
In the health sector, information literacy skills are taught at all levels, medical students, frontline staff, healthcare managers, researchers, service improvement staff, allied health professionals, etc. They all have different requirements. Researchers will need to be taught how to search comprehensively, whereas healthcare managers will need access to other resources such as databases with literature on policy, leadership, and finance, and of course doctors and nurses will need to learn about searching the clinical literature. And it isn’t only the different professions that have variable needs. Health professionals work in a variety of settings - hospitals, primary care, mental health institutions, teaching hospitals, ambulance trusts, etc, and these all require specific searching skills.

Approaches to teaching information literacy
It has been challenging for librarians to introduce IL training into the healthcare environment, because there is so little time and also because there are different levels of IT experience. Some health professionals did their original training without access to the Internet, or even computers. For them, information literacy can be very daunting, but they may need it to progress in their careers.

Information literacy training can be on a formal basis and is becoming increasingly more a part of the medical student curriculum. For staff working in healthcare environments, training has historically, taken place in the medical library, in groups, at specific times. However, now, with the introduction of clinical/outreach librarians, training is taking place more frequently at a time and location convenient to the health professional. In some cases, information literacy, or at least contact with library staff, is included in the induction process.

Depending on resources available, training can take a variety of forms, - formal lectures, one-to-one or groups, in libraries or hospitals or GP surgeries, online tutorials, quick ten minute introductory sessions or half-day Finding the Evidence workshops. The Librarian Tutors for the Centre for Evidence Based Medicine have a Wikispace where they store all their training materials, including lesson plans, handouts, and PowerPoint presentations.

Where possible the sessions are focused around a clinical scenario, preferably chosen by the health professionals being trained so that the session is relevant to them.

A key feature that needs to be taught, is the application of search filters. These are search strategies that have been developed by expert searchers – the original ones were developed by RB Haynes and his team at McMaster University. They identify specific levels of evidence/publication types such as randomised controlled trials (RCTs), or systematic reviews. For example, PubMed Clinical Queries allows you to search for results on the Diagnosis, Aetiology, Treatment, or Prognosis of a condition or to find only Systematic Reviews on a topic, just by applying the search filters.

Measuring impact
Increasingly, the impact of information literacy interventions in the health sector is being measured as part of a formal curriculum with medical students. The actual impact will be the outcome for the patient. 4

What can you do?
If you are already developing information literacy programmes in the health sector, particularly the NHS, then we want to hear from you. If you are thinking of developing a programme, then we may be able to put you in touch with others who have experience that can help you. This site collects and makes available information literacy practise that can help you, including practitioner research. Some of this is from other sectors, but there are common lessons.

Please contact us with recommendations for inclusion on this website.

Written by Caroline De Brún, Health Sector representative, CILIP CSG Information Literacy Group.
8^th October 2009