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J Med Libr Assoc. Apr 2004; 92(2): 209–217.
PMCID: PMC385302

Metropolis redux: the unique importance of library skills in informatics

Samuel Bishop King, MLS, Assistant Professor and Pharmacy Librarian1 and Kate MacDonald, MAT, Assistant Professor and Director of Instructional Design Services1

Abstract

Objectives: The objective is to highlight the important role that librarians have in teaching within a successful medical informatics program. Librarians regularly utilize skills that, although not technology dependent, are essential to conducting computer-based research. The Metropolis analogy is used to introduce the part librarians play as informatics partners. Science fiction is a modern mythology that, beyond a technical exterior, has lasting value in its ability to reflect the human condition. The teaching of medical informatics, an intersection of technology and knowledge, is also most relevant when it transcends the operation of databases and systems. Librarians can teach students to understand, research, and utilize information beyond specific technologies.

Methods: A survey of twenty-six informatics programs was conducted during 2002, with specific emphasis on the role of the library service.

Results: The survey demonstrated that librarians currently do have a central role in informatics instruction, and that library-focused skills form a significant part of the curriculum in many of those programs. In addition, librarians have creative opportunities to enhance their involvement in informatics training. As a sample program in the study, the development of the informatics course at the Massachusetts College of Pharmacy and Health Sciences is included.

Conclusions: Medical informatics training is a wonderful opportunity for librarians to collaborate with professionals from the sciences and other information disciplines. Librarians' unique combination of human research and technology skills provides a valuable contribution to any program.

INTRODUCTION

The recently restored version of Lang's seventy-five-year-old silent epic, Metropolis, available in theaters and on DVD, is a joy to behold, and the opportunity to see it should not be missed [1]. It is interesting; however, to note that the film could not accurately predict the technology of the world of 2026. Like the best science fiction of the twentieth century—including Star Trek, The Day The Earth Stood Still, and Babylon 5Metropolis's strength lies not in its prediction of specific technological advances but in its ability to examine the human condition. In this light, “technology” is a secondary consideration, a transitory entity that, although it may be a focus of a film's entertainment value, is not central to its ultimate importance. It is the “human element” that is at the core of science fiction as an enduring film genre.

So what does science fiction have to do with medical informatics and librarians? Like science fiction, informatics is a forum where the “human element” intersects with technology. Of interest is the fact that most definitions of informatics are weighted toward the “technology” aspect of the field. For example, Haux defines “medical informatics” as “the discipline concerned with the systematic processing of data, information and knowledge in medicine and health care” [2]. Bawden quotes the National Library of Medicine's definition of informatics as “an interdisciplinary field that combines medical science with several technologies and disciplines in the information and computer sciences” [3]. To a lay person, such definitions evoke images of computers rather than people or libraries.

BACKGROUND

As the field of informatics developed, why has there been an ongoing emphasis on the “technology” rather than the “human element?” Part of the fixation on “equipment” is a result of the swift pace of technological change and the resulting need for ongoing skill renewal by everyone (the Web was officially born in 1990, and now personal digital assistant devices are commonplace). Evolving computer infrastructures also require significant financial investment by institutions. It is therefore not surprising that health care executives often view informatics issues as problems of information technology rather than education [4]. Another factor is that so many people involved in information-related developments hail from the computer and information technology fields. As a result, they have a general lack of knowledge of existing library services, specifically in relation to health care and informatics [5]. A look at programs developed during the 1990s reflects an emphasis on technology and administrative skills, including administrative information systems, medical records, image processing, and general computer literacy.

Teaching technical skills is important but must be weighed against three factors:

  1. the fleeting nature of specific technical skill sets (will Windows or PC skills be applicable in 10 years?)
  2. the actual use of these skill sets by large numbers of health care practitioners (an understanding of computer network design, for example)
  3. the level of computer literacy among the population being taught—increasing numbers of students enrolling in programs now have basic computer skills [6] (this trend will only increase as younger persons enter their professional training)

Consideration of the “human factor” in informatics training is crucial for health care professionals. Are “human-centered” courses being included in informatics training? There are some interesting examples.

One human-centered approach to medical informatics was demonstrated by an elective offered through The Michigan State University Kalamazoo Center for Medical Studies, which presented skills within the context of practical problems faced in medical practice [7]. Their course required students to solve problems in a simulated patient-care environment. Information technology was utilized for specific patient-related issues.

The University of Maastricht in the Netherlands has attempted to increase the practical relevance of informatics training by incorporating it within the medical and health sciences curricula [8]. This can establish a positive connection between informatics skills and actual applications that students may utilize in their future careers.

In 1992, the American Nurses Association designated informatics as a nursing specialty. The minimum competencies developed two years later correlated skill sets to the nursing care of patients [9]. Sample topics included the analysis and interpretation of patient information, issues of confidentiality and privacy, and the management of nursing care information.

A ROLE FOR LIBRARIANS

Where do librarians come in? There are additional informatics skills, which may be technology related but not technology specific. This factor is of crucial importance to health care students and practitioners as well as of prime interest to librarians.

The American Heritage Dictionary defines information as “knowledge derived from study, experience or instruction” [10]. Note that “technology” is not mentioned in this definition. Information is apart from and independent of the technology that provides it. It is important to understand that the management of information is a crucial skill set in its own right and should be the end result of any information technology. In that light, the skill of managing information may be viewed as more important to health care practitioners than knowledge of the technology that produces it [11]. The specific information skills include:

  1. effectively sorting through the volume of information available by utilizing research skills
  2. evaluating information based on the specific clinical or health care need
  3. transforming that information into productive results (via a presentation or decision)

Librarians are specifically trained to research, locate, evaluate, and present information. Because these skills are not technology dependent, they are enduring. In fact, greater access to a larger volume of information in a more technology-dependent environment can only increase the importance of quality researching. Teaching a student the most effective way of performing a search in MEDLINE is an enhanced skill beyond demonstrating the “technical skills” of operating the MEDLINE interface.

Increased computer literacy on the part of health professionals and patients, as well as more friendly system interfaces, has resulted in unprecedented opportunities for them in an end-user searching environment. These opportunities also translate into an increased importance of the librarian's unique role in education.

Clinical librarianship is a good forum in which to view this evolution in action. A classic scenario involves the participation of the clinical librarian during morning rounds in, for example, an intensive care unit. Based on information requests related to specific cases, the librarian performs a series of literature searches, selects relevant articles, and delivers them to the practitioners. Greater end-user computer literacy has had an important impact on this service. Because residents, physicians, and nursing staff now perform many of their own searches, the clinical librarian must take on the additional role of searching coach and mentor. This trend has been happening for some time, as reflected in a 1997 survey of fourteen clinical librarian programs conducted by one of the authors [12]. In thirteen of fourteen institutions, clinical staff performed their own searches (10 of these 13 institutions had terminals in the clinical units). Thirteen of the fourteen institutions also included end-user MEDLINE training as part of their clinical programs, nine of these directly in the clinical area.

Librarian support of end-user searching is also reflected in the increased teaching roles of librarians in a variety of other venues, for example, the training services offered to physicians through Area Health Education Centers (AHECs). Library skills training has become a standard part of most academic, public, and large health sciences libraries. At the Massachusetts College of Pharmacy and Health Sciences, librarians participate as teaching faculty in full-credit courses offered by the library as well as the pharmacy, health sciences, and arts and sciences schools. The proliferation of librarian-mediated Web directories and portals to assist end users (MEDLINEplus and Librarians' Index to the Internet being obvious examples) illustrates how creative options can effectively serve the needs of independent researchers. As an extension of this concept, the advent of virtual reference services has made real-time librarian coaching of searchers a reality.

The inclusion of evidence-based practices and problem-based learning skills in informatics courses indicates that knowledge areas traditionally requiring library expertise are being recognized [13].

SURVEY OF INFORMATICS PROGRAMS

As seen above, successful informatics education must incorporate a combination of “human information management skills” and technical training. Librarians are equipped to play an effective role in the nexus of these two areas. What are the levels of librarian involvement in informatics education, particularly in health care programs?

During the summer and autumn of 2002, a survey of programs was conducted by staff of Sheppard Library at the Massachusetts College of Pharmacy and Health Sciences (Appendix A). Copies of the survey were sent via email to informatics programs listed on the National Library of Medicine Website. In addition, the survey was distributed on two email discussion lists: MEDLIB-L and the list for library directors belonging to the Association of Academic Health Sciences Libraries.

Survey results were received from eleven states, representing all corners of the United States as well as one Canadian province. Of the thirty-five institutions that responded to the survey, twenty-six offer informatics courses. Among the institutions with programs, twenty-one identified themselves as academic (including 11 universities and 10 at the college level), one was a teaching hospital, two were hospitals, and two identified themselves as “other” (a National Network of Libraries of Medicine branch and a medical library). Appendix B provides a detailed summary of the survey results.

A number of institutions incorporated evidence-based practices into their teaching programs, often offering training to more than one professional group. One library was involved with teaching evidence-based skills in medicine, neurology, psychiatry, pediatrics, family medicine, and surgical blocks (anesthesiology, obstetrics/gynecology, and surgery). One hospital has just started a program to introduce evidence-based medicine or health care to nursing and allied health staff. The planned sequence of classes for that program includes:

  • an introduction to searching on the Internet
  • evaluation of Web-based resources
  • an introduction to using PubMed
  • an introduction to evidence-based medicine
  • formulation of the clinical question for searching the literature

One library has collaborated with the curriculum for the third year of the school of medicine to incorporate an evidence-based literature searching or review class into the obstetrics/gynecology rotation. They meet once a week for two hours for a total of five weeks (10 hours total time with students in small groups). They report positive feedback from students on the format and content of the course.

As indicated above, medical schools serve as a focus for a number of informatics programs. The school of medicine at one large university has adopted a competency-based curriculum, with the class of 2003 being the first to graduate under this system. Their standards require that all students achieve level 2 for nine competencies and level 3 for three out of nine competencies to graduate. One of the identified competencies is lifelong learning, although it is not clear how it would be evaluated. Another institution is developing a sequential informatics curriculum for all four years of undergraduate medical education based on the Medical School Objectives Project recommended by the Association of American Medical Colleges. One library teaches a noncredit elective for its institution's college of medicine. Another example is a one-credit elective offered to third- and fourth-year medical students in which the informatics components are taught by librarians.

A different approach was implemented at one institution during the spring of 2003. It has a strictly bioinformatics focus and does not include either medical or general informatics. The library does not provide actual training for this program but is involved in curriculum development and information support through standard library services.

In general, however, respondents display strong library involvement in informatics training. In one institution, a collaborative project between the health sciences libraries and the telehealth department provides a common portal for the provision of library-licensed resources and diagnostic or hospital support tools. Other responders reported successful programs in collaboration with their institutions' pharmacy, physician assistant, or nursing departments. Library involvement has expanded to include topics such as the creation of Web pages, use of personal digital assistants, and “border health” (from an institution on the Mexican border).

KEY SURVEY CONCLUSIONS

  1. Librarians currently do have a central role in the provision of informatics training. Twenty-two of the twenty-six institutions with informatics programs have library involvement. Of these twenty-two institutions, more than half (14) offer library-based informatics programs, either as the sole method of training or in addition to courses offered through other departments. In addition, librarians serve a significant role through guest speaking and other support to informatics courses offered outside of the library.
  2. Library-focused skills form a significant part of the curriculum of many of these programs. Twenty institutions identify “knowledge-based content” as part of their informatics training (13 of these spend at least 50% of their program time on knowledge-based content). Examples of core library-focused skill sets include researching the literature and biomedical databases (23), evaluating Websites (21), and using search engines (18). Evidence-based medicine and problem-based learning skills are identified by respondents as important parts of their informatics training.
  3. Hands-on computer experience is an important aspect of informatics training. Twenty-five out of twenty-six respondents dedicate some time in informatics courses to hands-on computer activities. Eleven of these programs dedicate 50% or more of their class time to online activities.
  4. There are creative opportunities for library involvement in informatics training. Librarians can enhance their profile and increase their involvement in informatics training through cooperative efforts with other departments. A number of libraries have reported effective working relationships with their medical, nursing, or other faculties in providing informatics training. In addition, a creative approach to the curriculum can enhance the teaching of library-related skills. Interesting topics noted by responding institutions include the Visible Human Project, consumer health, border health, personal digital assistants, and bibliographic support programs such as EndNote.

INFORMATICS PROGRAM AT THE MASSACHUSETTS COLLEGE OF PHARMACY AND HEALTH SCIENCES

The Sheppard Library at the Massachusetts College of Pharmacy and Health Sciences has, over time, developed a significant teaching role in the institution. The five librarians in the reference department each have faculty status, teaching being a significant part of their responsibilities. Librarians teach regularly scheduled classes in the Drug Literature Evaluation and Introduction to Pharmacy Experiential Program (IPEP). In addition, librarians are frequently asked to present in other classes that require their expertise. Librarians also serve on the curriculum committees of the various faculties.

The course “Informatics for the Pharmaceutical or Health Sciences Professional” was originally conceived by Laurie Kelly of the School of Pharmacy-Boston and two reference librarians, Mou Chakrabourty and Julie Whalen. An initial syllabus was developed and subsequently approved as an elective on a trial basis.

The course pilot was conducted using three students during the spring of 2002. In implementing the course, a deliberate decision was made to provide students with a clear profile of “informatics” as an independent discipline, separate and apart from their individual course of study. The goal of this approach was to provide them with important practical skills, which would be applicable regardless of their eventual career path. These skills place an emphasis on utilizing knowledge-based information.

It was decided that a “term project” would be used to tie the skill sets together. The topic of the project was informatics related and negotiated between the student and instructor. The term project required the application of various skills learned throughout the semester culminating in a twenty-minute presentation accompanied by bibliographic documentation (literature searches, MS Access databases, MS Excel files) and multimedia support (Websites and PowerPoint). The topics of the term projects were “Radiopharmacy,” “Web Based Pharmacies,” and “Internet Based Surgery.” The presentations were attended by the other students, course faculty, and members of the library staff. Evaluation forms were distributed, providing an opportunity for those attending the presentations to give constructive feedback.

In addition to the term project, students were given four additional assignments: the analysis and evaluation of a Website, an analysis of a disaster resulting from a mishandling of information, a timeline of one aspect of computer technology, and a quiz on Internet knowledge.

A bonus feature of the course was a field trip to the Massachusetts Institute of Technology Museum where students had the opportunity to view actual examples from the history of information science.

Class content centered on topics within specific blocks: (1) historical topics, (2) Internet resources for locating information, (3) research databases, (4) analyzing information, (5) programs for formatting and storing information, and (6) skills for presenting information. A list of these topics is included as Appendix C.

In addition to the authors of this article, guest faculty participated in sections on statistics and public speaking. The college Web designer also visited the class to provide her perspective on the Web design portion of the course.

Class content notes and supporting documentation were provided through a Blackboard online course site.

Students taking the course provided positive feedback. They believe they received a solid basic skill set for utilizing knowledge-based information. They suggested that the course could be expanded by including classes on clinical information systems as well as discipline-specific topics (pharmacy and health sciences). In reviewing the course, the authors believe that less time could have been spent teaching MS Access and MS Excel. A working knowledge of those systems could have been made a course prerequisite.

The course was again offered during the fall 2003 semester. The class size has been expanded to nine students. Because the course is project based, a further increase in the number of students would require a substantial revision of the course content. In addition to their term presentations, students must complete a series of mini projects, including a film review of an informatics-related topic (yes, Metropolis is one of the films on this list). The topics included in the informatics course have been expanded to include classes on telemedicine, decision analysis, digital medical records, and bioinformatics, all taught by librarians.

Since this course was offered, a number of faculty members have become interested in the topic. The Massachusetts College of Pharmacy and Health Sciences has recently formed a task force (chaired by King) to recommend relevant competencies and a vision for informatics training at the institution. We are certain that a variety of ideas will be brought to the table during this discussion. Whichever direction is chosen for informatics education at the college, we are confident that knowledge-based content will be included and that the library will have an important role as a partner in this training.

SUMMARY

This paper discusses the role of librarians in informatics training. The importance of a human-centered approach, particularly the acquisition of knowledge-based skills, argues for significant participation by this profession in informatics curricula. The survey conducted for the paper (albeit a small sample) reflects not only the broad inclusion of knowledge-based topics in current informatics programs, but also a general acceptance of a role for librarians in teaching those skills. The initial experience at the Massachusetts College of Pharmacy and Health Sciences conforms to these trends.

The authors were disappointed that more responses from the hospital environment were not received. The importance of informatics skills should result in a significant continuing education role in hospitals. At a time when many libraries, particularly those in small community hospitals, are being undervalued, informatics training can serve as a timely focus on the importance of library professionals at those institutions.

The library connection to informatics training is within that area where librarians have traditionally excelled: leading patrons to the information they need. In this venue, librarians have the opportunity to move increasingly into a mentoring/teaching role. Among information professionals, librarians have a unique perspective, offering enduring, interpersonal informational skills that are not technology dependent. To the contrary, the successful implementation of knowledge-based technology is dependent on effective librarian support.

Returning to the science fiction theme, the best examples of that genre have a firm connection between a futuristic vision and the human spirit. Similarly, successful informatics education directly relates to the subsequent ability of students to use theory and technique in the context of their own information needs. As was foretold in Metropolis: “The mediator between the head and hands is the heart” [14]. The “heart” of informatics training is the librarian.

Acknowledgments

The authors thank Laurie Kelly of the School of Pharmacy Boston and Mou Chakrabourty and Julie Whalen, reference librarians, for the important groundwork they laid in developing the syllabus and initial course content for the Massachusetts College of Pharmacy and Health Sciences informatics program.

APPENDIX A

Informatics survey by Samuel King at the Sheppard Library, Massachusetts College of Pharmacy and Health Sciences

Instruction in literature searching and the utilization of databases are regular services provided by libraries. This survey is directed to those institutions that offer formal structured courses in informatics. For the purposes of our survey, medical informatics is defined as: “A field of study concerned with the broad range of issues in the management and use of biomedical information, including medical computing and the nature of medical information.” (American Heritage Dictionary of the English language. Boston, MA: Houghton Mifflin Company, c. 1992:927.)

Our survey is not, however, exclusive to “medical” informatics and may include general informatics courses, as well as programs in nursing informatics and health informatics.

  1. What is your library type:
    1. academic
    2. hospital
    3. public
    4. government department
    5. other (please identify type) _________
  1. Does your institution provide informatics training?

(If the answer is no, you need not complete the rest of the survey)

Yes _________

No _________

  1. What is the primary mission of your informatics training (select only one):
    1. to prepare students to function more effectively in their chosen profession _________
    2. to provide a general introduction to the field of informatics _________
    3. to provide students with applicable research skills regardless of their eventual career choices _________
  1. What is the duration of this training (course):
    1. 1 complete semester (20 plus classes) _________
    2. 10 to 20 classes _________
    3. 6 to 10 classes _________
    4. 1 to 5 classes _________
  1. What is average size of your class in this course:
    1. 1 to 10 students _________
    2. 10 to 20 students _________
    3. over 20 students _________
  1. Is the library involved in this training?

Yes _________

No _________

  1. If yes to 6, does that involvement include:
    1. the provision of a library-based course taught by librarians _________
    2. guest speaking by librarians in classes based in other departments _________
    3. library support to informatics classes other than guest speaking (please identify) _________
  1. In your institution's informatics course, what percentage of time is dedicated to the following content:
    1. knowledge-based learning (library and research focused skills, including utilizing knowledge-based databases) _________
    2. computer skills (not including knowledge-based databases) _________
    3. telecommunication skills _________
    4. other topics (please identify) _________
  1. Does your knowledge-based learning content include the following:
    1. history and structure of the Internet _________
    2. evaluating Websites _________
    3. search engines (comparing, evaluating, and utilizing) _________
    4. theory and structure of databases _________
    5. research and literature searching _________
    6. biomedical databases (MEDLINE, CINAHL, and others) _________
    7. utilizing statistics _________
    8. copyright _________
    9. bibliographic referencing _________
    10. support program knowledge (EndNote, PowerPoint, Access, Excel, etc.) _________
    11. PDAs _________
    12. other course content (please identify) _________
  1. What percentage of your class is spent “hands on” with computers:
    1. 1% to 10% _________
    2. 11% to 30% _________
    3. 31% to 50% _________
    4. over 50% (identify) _________
  1. Are there any accomplishments, innovations, or details related to your particular informatics program that you would like to share? Additional comments?

Contributor information (optional)

Name:

Library:

Institution:

Thank you for participating in this survey. The general results may be used in a paper for publication. The names of persons, libraries, or institutions will not be used without prior consent (we will contact you in advance).

APPENDIX B

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APPENDIX C

Spring 2002 course content

“INF 212: Informatics for the Pharmaceutical or Health Sciences Professional,” Massachusetts College of Pharmacy and Health Sciences

  1. Historical topics
    Historical review of computers
    Introduction to the Internet
    Field trip to the M.I.T. Museum
    Current trends in informatics
  2. Internet resources for locating information
    Evaluating Websites
    MEDLINEplus and consumer Websites
    Utilizing, comparing, and contrasting search engines
    Online discussion groups and email discussion lists
    Virtual reference services
  3. Research databases
    Introduction to research databases
    PubMed and Ovid MEDLINE
    Research databases in other disciplines
  4. Analyzing information
    Discussion of the Challenger disaster as an information issue; Tufte Challenger report [15]
    Statistics in analyzing information
  5. Programs for formatting and storing information
    MS Access
    MS Excel
    EndNote
  6. Skills for presenting information
    PowerPoint
    Web design (HTML and specialized programs: Dreamweaver and FrontPage)
    Public speaking and designing or delivering a presentation

REFERENCES

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  • Bawden D. Health informatics education; an information-related undergraduate perspective. Educ Inf. 1996.  Mar. 14(1):1–6.
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  • The American heritage dictionary of the English language. 3rd ed. Boston, MA: Houghton Mifflin Company, 1992:927.
  • Brittain JM, Norris AC. Delivery of health informatics education and training. Health Libr Rev. 2000.  Sep. 17(3):117–28. [PubMed]
  • King SB, Frumento KS. User independence—the end of the clinical librarian or a new beginning? Paper presented at the 1998 MLA Annual Meeting, Philadelphia, PA.
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