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Abstract

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Aim:  This article will describe a survey carried out in February 2004, the aim of which was to summarize the form and content of clinical librarian (CL) and other similar outreach information services to UK health professionals in the acute (secondary or tertiary) sector.

Objectives: (i) To survey the activities and views of UK information professionals offering information services involving the librarians’ presence in the clinical setting, (ii) to develop a tool to explore critical aspects of this form of information work, (iii) to create a contacts database for UK CLs, to be made available on the Internet.

Methodology:  All known information specialists/librarians offering CL or similar services were surveyed. The semi-structured questionnaire was piloted. Respondents were asked to consider their activity over a period of 4 weeks.

Results:  Twenty-six people responded to the invitation to take part and met the inclusion criteria.

Conclusions:  A summary of a ‘typical’ clinical librarian revealed by this survey is given, with a major conclusion that there is a very mixed picture of activity. Opinion on how far CLs should go in fully appraising search results is uncertain. The survey suggests reasons for this and the developments that may influence change are discussed. Recommendations for future research and development are offered.


Background

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Health librarians and health service managers in the UK are embracing the concept of clinical librarianship, developing new programmes in response to local needs, adapting or adding to existing library and information services. Anecdotal evidence suggests that there is wide variation in what is meant by a ‘clinical librarian service.’ There is no single model of service and ‘what is a clinical librarian?’ has been one of the most frequently asked questions by librarians and health professionals alike.

A recent systematic review of clinical librarianship1 concluded that, although these services are well received and used, there is little research evidence to establish their effectiveness. A second review2 concluded that the research evidence ‘is not great and most of it is descriptive rather than comparative or analytically qualitative’. The authors suggested that a ‘carefully structured multi-programme study, including three to five of the best current programmes, is needed to define the true value of these services’.

Before such evidence can be established, it is necessary to have a firmer understanding of what is meant by a clinical librarian service in practice in the UK. Against such a baseline, we will be able to measure new or improving services, thus moving towards the possibility of designing a multi-programme study as suggested and an evidence base for effectiveness.

Similar services aimed at health professionals in primary care are currently being evaluated.3 This survey is complementary, considering outreach services to UK health professionals in the acute (secondary and tertiary) sector. This research focuses on the views of information professionals, the views of users of clinical librarian services having been sought elsewhere.4 It was beyond the scope of this work to consider international perspectives, although this is also of interest.

Throughout this report, for convenience, the term clinical librarian (CL) will be used to represent any person whose job description fits the criteria outlined below.

Aim

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

To summarize the form and content of clinical librarian and other similar outreach information services to UK health professionals, in the acute (secondary or tertiary) sector. To establish a baseline against which to measure new or developing services.

Objectives

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages
  • • 
    To survey the activities and views of UK information professionals, with key determinants of recruitment as follows:
    • (i) 
      that the information services are offered as an outreach service involving the librarians’ presence in the clinical setting;
    • (ii) 
      excluding those working with primary care, whose views and activities are researched elsewhere.3
  • • 
    To develop a tool to explore critical aspects of this form of outreach information work.
  • • 
    To describe the characteristics and modes of operation of existing UK clinical librarian and similar information services.
  • • 
    To model the findings so that defining clinical librarianship in the UK can encompass a range of activity.
  • • 
    To create a contacts database for UK CLs, to be made available on the Internet.

Methodology

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Surveys are used to make general statements about a group wider than that studied.5 They are descriptive rather than analytical and cannot usually provide explanations or establish effectiveness. To meet the aim of this research, a descriptive methodology was adequate and illustrated the pattern of provision of CL services.

All known information specialists/librarians offering outreach information services in the clinical setting to UK health professionals in the acute (secondary and tertiary) sector were surveyed. The total number of CLs in this area was not estimated to be very large and it was therefore reasonable to survey all those identified, rather than a representative sample. Identifying what representative means was implicit in the aims and objectives of the research.

To identify health information professionals offering a CL type service, contact with all UK health librarians was attempted. Librarian and Information Service (LIS) workers who met the survey criteria were invited to complete a semi-structured questionnaire.

Sampling

Key determinants of recruitment were as follows:

  • (i) 
    That the information services are offered as an outreach service involving the presence of the CL in the clinical setting.
  • (ii) 
    Those working with primary care, whose views and activities were researched elsewhere3 were excluded.

The questionnaire, a poster advertising the survey plus a covering letter was sent to all UK health libraries. Messages were also posted to relevant UK LIS professional e-mail discussion lists6,7 inviting all health-information professionals to consider whether their work met the criteria for inclusion. Reminders were also posted to the discussion lists at various time points during the data-collection phase.

The criteria, questionnaire and supporting documentation were available on the Internet8 along with contact details in case of any query. Additional contacts were made by advertising at professional events and by snowballing (word of mouth, contacts via those recruited). This purposive sampling identified the broadest range of service providers. Responses were received by both post and e-mail.

Design

The questionnaire design was semi-structured, including both ‘open’ and ‘closed’ questions, allowing qualitative and quantitative analysis as appropriate.

Respondents were asked to consider their activity over a period of approximately 4 weeks to be able to complete part of the questionnaire. Recognizing that this might be a deterrent to completion, responses from people who could only estimate their activity were encouraged.

At six pages (41 questions), this was a long questionnaire, but all aspects addressed were important and it was felt that people doing this kind of work would be highly motivated to take part. Collection of contact details and the creation of a contacts database were considered to be another motivating factor.

The development of the questionnaire was guided by the experiences of several practising CLs and piloted. Acknowledging the variability in CL practice meant that it was especially important to include open questions and to pilot it with health-information professionals both locally and in other geographical areas. Some who helped with the pilot phase were not actively working as CLs but had an interest in the topic and research experience.

During the analysis phase of the research, respondent checking (via e-mail) helped to clarify responses where there was potential for misinterpretation.

The data collected included information about:

  • • 
    the management of the service, including funding arrangements;
  • • 
    the user group(s) supported;
  • • 
    activity;
  • • 
    the views and opinions of the information professionals on various topics.

Analysis of the data was done using SPSS version 12 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2000.

Results

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Twenty-six people responded to the invitation to take part in this survey and met the inclusion criteria.

CLs and their posts

From 26 respondents, there were 14 distinctly different job titles reported, with 24 unique employing organizations.

Ten respondents had been in post for more than 2 years. At least five respondents, judging from their job titles, have a library management role and the free-text data in the responses indicate that several are involved in pilot projects for this kind of work in addition to their main role.

The majority (22) work full time; 18 were on permanent contracts, eight on fixed-term contracts with a modal length of contract of 24 months (four people). The whole-time equivalent annual salary ranged over the 4 categories offered, with a mode of £20 000–24 000.

The proportion of respondents’ posts focused on ‘outreach’ work, providing information services to staff, in person, in their workplace, i.e. outside the library, is illustrated in Fig. 1.

image

Figure 1. The proportion of respondents’ posts focused on ‘outreach’ work. Figures are % of role and actual numbers of CLs.

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Because of the potential for misinterpretation of this question, respondent checking was carried out to ensure that the answers given related to the proportion of the role, not the proportion of time spent in the clinical setting.

When asked about the funding for the outreach aspect of their post, 16 had a single source of funding, eight had two sources and two had three sources of funding.

When the average percentage of funding from each source was compared, NHS trusts provide one-third of funding with the remainder from other sources (Fig. 2).

image

Figure 2. Overall proportion of funding from each source.

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CLs and their users

When asked to identify their main service users by professional group, there was a fairly even spread of support for four key groups (Medical staff, Nursing and Midwifery, Allied Health Professionals and Clinical Governance and related staff). Other groups supported were identified as bioengineers and social workers.

When asked to identify the clinical specialties supported, the range of answers covered most clinical areas.

When asked to rate, in order, the most frequent method of contact with their users during the survey period, e-mail was rated first by 10 respondents, with clinical meetings first for seven and personal/informal contacts first for five.

Whilst attending clinical meetings features prominently, joining ward rounds to pick up information needs was most often rated 4th, 5th or 6th (12 respondents in total). Two people rated ward rounds higher, as the second-most frequent method of contact.

CLs and their activity

To try and estimate the time spent on different activities during the survey period, respondents were asked to keep a diary or estimate their activity. Table 1 illustrates how time is spent in key categories of activity, firstly using data from all respondents; secondly using data only from those whose CL role was 50% or more of the total (n = 10).

Table 1.  Percentage of time spent on listed activities
 All (n = 26)CL role 50% or more of total (n = 10)
Literature searching19%29%
Teaching11%11%
Meeting with health professionals12%16%
Other information services, e.g. current awareness 3% 5%
Administration related to service20%14%
Other library activity, including CPD29%19%
Other 6% 6%

Considering the data for all respondents combined: literature searching represents an average of 19% (range 0–60%) of CL activity, and teaching 11% (0–45%). The latter combines three categories of teaching offered as options in the questionnaire; information skills, critical appraisal and ‘other’ (an example offered was SPSS).

On average 12% (range 0–30%) of Clinical Librarian time is spent meeting with health professionals in the clinical setting. On average, 3% of time (0–28%) is spent on other information services, such as preparing current awareness alerts and best-practice bulletins. This activity was reported by 10 respondents.

Reasons given for atypical responses to questions about their activity were:

  • • 
    extra study leave/CPD/training course during the period;
  • • 
    would normally attend more ward rounds but [lots of] searches to do;
  • • 
    clinical meetings are variable; this figure fluctuates as do my other activities;
  • • 
    expect to do more training (in future);
  • • 
    true at the moment but will be changing as another post created and new projects taken up.

CLs and information sources

To try and identify the resources most useful to CLs, respondents were asked to choose only six from a list of information sources to:

  • (i) 
    answer a range of questions for their users (Use);
  • (ii) 
    to teach health professionals to use themselves (Teach).

They could add their own suggestions. The results are presented in Fig. 3.

image

Figure 3. Choices of resources to use (◆)/teach (▪).

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CLs and their service

The majority of online information searching is done by CLs within their library [96% (25)]. Fifteen per cent (4/26) of CLs are routinely using a laptop; 19% (5/26) report using a Personal Digital Assistant (PDA). The value of PDAs in the clinical setting (including their use by CLs) in support of evidence-based practice is being investigated elsewhere.9

When asked what is typically sent to the requester to answer a clinical question, everyone sends at least a list of bibliographic references. Fifty per cent of respondents (13) always send a search strategy. Sixty-five per cent (14) reported that they always or sometimes send a digest or summary of the results found.

Asked about the content of any digests or summaries sent, Fig. 4 orders the responses according to content that is always sent.

image

Figure 4. Included in summaries. *Criteria for including or excluding search results, **a breakdown of the clinical question (into Population/Intervention/Comparison/Outcome).

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Lack of time is clearly the major reason why CLs do not routinely construct fully appraised search results, with lack of clinical knowledge a second important reason (Fig. 5).

image

Figure 5. Reasons for not providing fully appraised results.

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There was some uncertainty about whether constructing critical appraisal summaries should be a role for CLs with 10 indicating that they should, seven that they should not and nine undecided.

Formal standards for the provision of their outreach service are set by 42% (11/26), usually minimum response times which ranged from a same-day response to 14 days. Most respondents negotiated response times with users.

Other standards cited were:

  • • 
    standard range of databases searched for each question;
  • • 
    standardized covering letters and disclaimers.

Fifty-four per cent (14/26) of respondents reported formal mechanisms for evaluating their outreach service, either internal or external. These included:

  • • 
    evaluation forms sent out following service delivery, either immediately or after a short time delay;
  • • 
    formal questionnaires/surveys;
  • • 
    action research and focus groups;
  • • 
    interviews;
  • • 
    suggestions from users.

CLs and their CPD and marketing

Training needs were identified and are summarized in Table 2.

Table 2.  Summary of training needs
Advanced search skills including MeSH/Emtree, PDAs and electronic resources (cited six times)
Critical appraisal (cited three times)
Health services research/Evidence-based practice/Biomedical Statistics (cited three times)
Clinical knowledge, e.g. anatomy and physiology (cited twice)
Project management
Publicity and promotion
Web development
Presentation
Training the trainer

There is evidence of a mixed experience with marketing; for some, e-mails and postal flyers work very well, but others do not agree. Talks to staff are seen as helpful by some but, again, not by others.

Some generalized statements can be derived from data about marketing initiatives:

  • • 
    personal contacts work well, putting a name to a face;
  • • 
    being in the clinical setting, CLs can begin to understand the jargon used;
  • • 
    time is important, both in recognizing that health professionals have limited time (e.g. for drop-in sessions) and also managing the timing of marketing approaches.

Discussion

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

There was a great variability in the job titles of the respondents and of their line managers. As each service has developed independently and responds to local needs, this is not a surprise. This adds to the difficulty of distinguishing CL services from other library and information services.

The geographical spread of respondents demonstrated a negative finding; that CL services are not concentrated in any one geographical area.

Arguably, the most important question in the survey was about the proportion of respondents’ posts focused on ‘outreach’ work, providing information services to staff, in person, in their workplace, i.e. outside the library. The majority have a CL role for 10% or less of their time, reflecting the project-based nature of many of the services. However, ten CLs spend at least 50% of their role on CL activity, with proportionately more time spent on literature searching for this subgroup.

Data about funding illustrates the importance of external funding sources (on average providing two-thirds of the total) in supporting these new ‘dedicated’ outreach services.

Identifying service users by professional group and specialty confirms the multi-disciplinary nature of the services offered and the wide range of clinical disciplines supported.

Contact with users is done in a variety of ways, both directly and indirectly (e.g. clinical meetings and e-mail). This reflects the nature of this kind of work, establishing personal contacts out in the clinical setting, but also stimulating requests from users via other methods.

When asked to select the most useful resources, it is not surprising that clinical librarians favour medline and the Cochrane Library for use most. Other databases (e.g. embase, PsycInfo, amed, etc.) are less likely to be taught than used, possibly because librarians feel that teaching one database (medline) equips users to search others. The impact of resources available via the National Electronic Library for Health is clear; with many selected by as many (or more) respondents for teaching as well as using. How far ease of access is an important issue in relation to teaching about information sources cannot be established by this research. However, it would seem to confirm anecdotal evidence of the benefit for training in bringing together such resources into one portal.

Considering the activity reported by respondents, the average amount of time spent on administration related to the service (20%) is high and this may be because:

  • • 
    two respondents gave particularly high figures (90 and 70%). The standard deviation for this mean was 23;
  • • 
    most of these services are project based, evaluation is important and time to administer this is likely to have been included in this figure.

Using averages will conceal the variation within a small group of subjects and so it is useful to consider the range of answers to the question about activity. The data revealed that a CL can spend between 0 and 60% of their time literature searching and preparing material to answer clinical questions and from 0 to 45% of their time teaching. That some report no literature searching and some no teaching activity confirms the wide spectrum of activity that defines the role of the CL in the UK at present.

In search of other defining characteristics, early writers on clinical librarianship (Acari and Lamb) wrote:

‘The review of the actual journal article for its appropriateness sets the clinical librarian apart from a library service that provides a bibliography or a list of citations in response to a question’.10

Sixty-five per cent (17/26) of CLs report always or sometimes providing a digest or summary of their search results. These include indicators of appropriateness, such as levels of evidence, and constitute a ‘value-added’ service for busy clinical staff.

Opinion on how far CLs should go in fully appraising search results is uncertain. This survey suggests that the major reasons why CLs might not routinely construct fully appraised search results are lack of time and clinical knowledge. Lack of availability of full-text material (and its impact on the time taken to produce evaluated summaries) may not be as much of an issue as initiatives such as the NHS National Core Content Project11 and the National Electronic Library for Health12 are established.

As services mature and clinical knowledge is acquired, the confidence of CLs is likely to grow. Continuing professional development (CPD) opportunities (e.g. in basic anatomy and physiology, research methodology and critical appraisal) could influence change in this respect. Davidoff's introduction of the concept of the ‘informationist’13 has opened the debate about the new roles that health librarians/health information professionals could (some would say should14) take on. The training needs identified by respondents could form the basis for the development of training packages for CLs and encourage a change in opinion concerning the provision of evaluated search results.

This survey has shown the extent of CL services in the UK at the beginning of 2004. Nearly half of them have no formal mechanism for evaluation. As with any library service, the need to prove value is paramount, if only to achieve continued funding. The two recent systematic reviews1,2 both concluded that good-quality, comparative research is needed to prove the effectiveness of clinical librarianship. Work is currently being carried out to develop a generic toolkit for evaluating a range of information services that support clinical practice in the NHS. It is hoped that this work, the IMPACT Project15 can form the basis for a more structured and comparable evaluation of CL services in the UK.

Although the international dimension has not been addressed by this study, it is important to note here the current investigation in the USA of the roles, skills and training of the Information Specialist In Context (ISIC)16 including those working in a clinical environment.

Limitations of this study

There was some potential for bias in the way that recruitment was carried out, relying on participants to volunteer. It was hoped that motivation to participate would be high, but it is not possible to know how many CLs might have been missed. This was minimized by the use of more than one approach, i.e. postal, e-mail discussion lists and events, but we cannot know about non-responders and whether they would change the pattern of data.

It is known (anecdotally) that, since the study, there are at least three more CLs who have been employed whose data was not captured. A longitudinal study would have included these changes and allowed an estimate of the rate of new CL type posts being created. This would be useful to know in such a fast changing area.

It is possible for important topics to have been overlooked in the questionnaire, and that interviews or focus groups might have provided a richer picture. Within the resource limitations of this study, these alternative approaches were not possible. However, given the example of current awareness alerts (not explicit in the questionnaire but raised in the free-text sections) it is likely that the respondents would have raised additional important issues.

Because personal details were collected, the questionnaire was clearly not anonymously completed and this may have been off-putting to some. However, given that the nature of this kind of work requires the CL to be alert to issues around marketing their service, it was felt that the impact of this was minimal.

Conclusions

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

The aim of this research was to ‘summarize the form and content’ of CL services in the UK. Asked to describe a ‘typical’ clinical librarian revealed by this survey, it is possible to say that a CL:

  • • 
    Is likely to be working in any geographical area in the UK.
  • • 
    Supports the information needs of all the multi-disciplinary clinical team in a wide range of clinical areas.
  • • 
    Might spend 10–100% of their time dedicated to this role, but typically combines it with other responsibilities.
  • • 
    Might spend up to 30% of their time meeting with health professionals in the clinical setting.
  • • 
    Might spend up to 60% of their time working on literature searches and preparing material to answer clinical questions.
  • • 
    Might spend up to 45% of their time teaching.
  • • 
    Might spend up to 28% of their time on other information services such as preparing current awareness alerts and best practice bulletins.
  • • 
    Might sometimes send a digest or summary of their search results but be uncertain about whether it is the role of a CL to construct critical appraisals.

These, of course, are very broad generalizations and a major conclusion of this research is that there is a very mixed picture of activity. For example, some CLs do no teaching; others do mostly teaching. That the variability of practice has been captured is illustrated by this and by the different views expressed about the best place to contact clinical staff.

Key issues arising from this survey include the question of whether CLs should provide evaluated summaries of their search results and, related to this, the need for continuing professional development. Evaluation of existing and new services using robust methods will be paramount in maintaining and expanding the current levels of service.

Having measured a baseline for service structure, activity and CL views, it would be valuable to repeat the process in a year or two. We know that it is a changing picture, with new posts being created/filled since this survey was conducted.

Recommendations

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages
  • 1
    That this survey should be repeated in a year or so to identify changes or confirm the current findings. The potential advantages of carrying out in-depth interviews, as part of this follow-up should be considered.
  • 2
    That consideration should be given to formalizing CPD opportunities for CLs.
  • 3
    That the CL community should give urgent attention to ways of evaluating CL services. This should ideally be research with a multi-programme, analytic approach as recommended by systematic reviewers.
  • 4
    That the results of this survey be shared with the wider librarian community via journal publication.
  • 5
    That a database of contacts17 is posted on the Internet to facilitate networking.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

This work was funded by the NHS Information Authority, on behalf of the National Electronic Library for Health. The researchers would like to thank all the participants for their contributions.

References

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Key Messages

  1. Top of page
  2. Abstract
  3. Background
  4. Aim
  5. Objectives
  6. Methodology
  7. Results
  8. Discussion
  9. Conclusions
  10. Recommendations
  11. Acknowledgements
  12. References
  13. Key Messages

Implications for Policy

  • • 
    This descriptive study establishes a baseline against which to measure new or developing Clinical Librarian or similar services.
  • • 
    The survey should be repeated to identify changes over time or confirm the current findings;
  • • 
    The potential for carrying out in-depth interviews as part of this follow-up should be considered;
  • • 
    A contacts database has been created to facilitate networking.

Implications for Practice

  • • 
    Consideration should be given to formalizing continuing professional development opportunities for CLs;
  • • 
    The CL community should give urgent attention to ways of evaluating their services. This should ideally be research with a multiprogram, analytic approach as recommended by systematic reviewers.