A new breed of doctor

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A new breed of doctor?

• Lessons learned and changes made to library
  services for the MBBS Program at the University
  of Queensland.
• Karen Joc and Kaye Lasserre
• The University of Queensland Library

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The University of Queensland An Overview

• Large comprehensive traditional University
• Sandstone
• Multiple campuses, Islands and Farms
• 7 Faculties
• Highest employment rate of graduates
• Research intensive

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The University of Queensland Library (UQL) an
overview

• 14 branches
• Located on St Lucia, Gatton and Ipswich campuses,
  in 3 major teaching hospitals and in the Dental
  School
• Electronic Information Centre
• University Archives and Warehouses
• UQL Mission We link people with information,
• enabling The University of Queensland to achieve
• excellence in teaching, learning and research

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We link people with information
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UQLs Customers

• Over 29,000 students, 20 of whom are
  postgraduates.
• 4,500 academic and general staff.
• Staff of major teaching hospitals.
• Staff and students of other Institutions with
  which special agreements have been negotiated.

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Facts About UQL

• Over 2 million volumes.
• 12,000 videos.
• 22,000 journal titles (8,000 electronic).
• 125,000 e-books.
• 450 networked databases.
• Microform, manuscripts pictorial materials.
• Almost 1000 computers.
• 230 staff.
• Annual budget of 22 million.

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The Cybrary Website

• Single interface to resources and services.
• Award-winning Cybrary represents the integration
  of physical space and cyberspace in the delivery
  of library and information services.

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• http//www.library.uq.edu.au

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Hospital libraries

• 3 teaching hospital libraries managed by UQL
• Herston Medical Library at the Royal Brisbane
  Hospital (RBH).
• Princess Alexandra Hospital Library at the
  Princess Alexandra Hospital (PAH).
• UQ/Mater McAuley Library at the Mater
  Misericordiae Hospitals (Mater).
• These libraries, are funded jointly, but not
  equally by the hospitals and the University.
• Together with the Biological Sciences Library at
  St Lucia support the staff and students of the
  School of Medicine.

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School of Medicine

• Operates at centres throughout Queensland and
  Brunei.
• Clinical Divisions carry out Schools teaching
  and research activities
• Central (RBH)
• Southern (PAH)
• Establishing a Rural Clinical School in 2002
• Staff are based throughout Queensland.
• Offers the MBBS Program

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MBBS Program

• Four-year Bachelor of Medicine/Surgery (MBBS)
  graduate entry program.
• In 2001 there are approximately 835 students
  enrolled over the 4 years.
• The problem-based learning (PBL) curriculum is
  designed to produce doctors able to meet the
  challenges of the 21st century.
• The Program is primarily delivered by the MBBS
  Intranet.

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• http//www.gmc.uq.edu.au

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MBBS Program Structure
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MBBS Program Curriculum

• Years 1 2 focus on set weekly problems.
• They work in small groups with a tutor and meet
  for PBL twice a week.
• The students own learning objectives drive the
  process.
• Years 3 4 students are encouraged to base their
  learning around their patients.

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Library Involvement

• Prior to the Programs launch in 1997 both
  Queensland Medical Education Centre (QMEC) and
  UQL recognised that a librarian would need to be
  appointed to help facilitate the flow of
  information between the two groups.
• Appointment was made in 1995 and jointly funded
  by QMEC and UQL.
• This librarian was actively involved in both the
  design phase of the curriculum and in identifying
  resources to support the Program.

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Major Changes to MBBS Program

• Prior 1997 the medical course was a 6 year
  undergraduate degree.
• 1st 3 years at St Lucia 2nd 3 years Mayne Medical
  School.
• Current Program is decentralised with students
  throughout Queensland and Brunei.
• Method of teaching has changed from didactic to
  PBL.
• These changes have had major implications for the
  Library in providing resources and services.

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UQL Involvement

• Purchased new books for BSL, HML, PAH, Mater and
  selected Queensland Health libraries.
• Development of a print and electronic articles
  collection of recommended readings for the weekly
  problems.
• Incorporation of additional resources such as
  websites.
• Information skills programs.
• Provision of electronic access to journals,
  e-books and databases.

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4 Years On

• The involvement of the Library in the Program has
  increased greatly.
• The number of branch libraries supporting the
  Program has grown from two to four.
• The number of librarians supporting the Program
  has grown from one to four.

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Action Group

• In 2000 a Library Action Group was formed to
  support the MBBS Program.
• All four branch libraries are represented in this
  group.
• Reflective practice theories influence the group.
• The group has increased the liaison role with the
  School of Medicine.
• These librarians meet regularly with academics
  who support the Program.

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The Survey

• In 2000 the Action Group surveyed all 4 years of
  the MBBS Program
• This was the first formal opportunity for the
  Library to assess if it was meeting the teaching,
  learning and research needs of the Program
• The survey focused on
• The Print and Electronic Collections
• Remote student access to services
• Information skills classes
• Evidence-Based Medicine

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The Survey Response Rate
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The Survey Overall Trends

• Students strong reliance on textbooks.
• Lack of awareness of location of resources.
• Popularity of e-books.
• Advantages disadvantages of electronic journal
  articles.
• ? attendance at information skills classes by
  year 1.
• Greater confidence in database searching by years
  3 4.
• High interest in EBM tools and training.

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Survey Results Print Collection

• 60 of Year 1 wanted increased access to
  textbooks and shorter loan periods.
• Year 1 students expressed that those who started
  PBL later on a Monday had advantage over those
  who started earlier.
• Years 2, 3 and 4 were unaware that copies of
  textbooks and journal articles were held in each
  of the 4 branch libraries that support the
  Program.
• Insufficient numbers of textbooks in the 3
  hospital libraries.
• Lack on resources available on remote rotations.

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UQL Changes Made

• Resources are now housed in selected Queensland
  Health Libraries (including 12 core textbooks and
  journal articles).
• Funds for textbooks have been redistributed.
• Each branch library has reviewed their
  collections and items have been culled or
  redistributed.
• Textbooks recommended for weekly problems have
  been entered into an endnote database.
• A library guide is being produced to raise
  students awareness of resources. This guide
  will eventually become a tailored web-based
  package for the my generation.

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Electronic/Web-based Resources an Overview

• Majority of the Program is web-based.
• In Years 1 and 2 UQL contributes to the MBBS
  intranet by providing e-access to library
  resources, such as articles, textbooks and
  websites.
• Years 3 and 4 are provided with set information
  resources relevant to each rotation.

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Electronic Articles Collection

• In 2000 the Library digitised the MBBS
  photocopied article collection .
• Where possible articles were linked via PURLs
  (Persistent Uniform Resource Locators).
• When PURLs were unavailable articles were
  scanned and transferred into PDFs.
• These resources are maintenance intensive for the
  Library.

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Electronic/Web-based Resources Survey Results

• In year 1, 93 of the students found the
  resources useful, with 66 using them wither
  daily or weekly.
• In Year 2, 59 found the resources useful with
  55 using them either weekly or daily.
• The introduction of on-line resources was
  excellent

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Electronic vs Print Articles
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Electronic/Web-based Resources changes made

• The Library has decided to keep both the
  electronic and print format of the articles.
• The photocopied article collection for all 4
  years has been rationalised.
• Year 2 articles have been distributed throughout
  the 3 hospital libraries.
• Year 1 resources have become dated and have been
  updated by using canned searches in fulltext
  databases.
• Canned searches allow you to provide a dynamic
  link to a particular title, article, journal
  issue or set of records relevant to your query.

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E-books

• Harrisons online was the most popular.
• The usage of this title has increased by 97,
  from 76158 in 1999 to 131711 in 2000.
• Other popular e-books include
• Scientific American Medicine
• Merck Manual
• Textbooks housed in the Virtual Hospital

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E-books Changes Made

• The Library has purchased the internet version of
  Stat!Ref.
• Other e-book packages are being evaluated such as
  MDConsult and Up-to-date.
• Access to e-books has increased by the Library
  purchasing a program called ezproxy.
• Ezproxy is an authentication program which
  facilities easier access to online resources by
  the customers only having to remember one
  password.

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Authentication
Login/password details available after
authentication
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Information Skills An Overview

• The personal development component of the MBBS
  Program involves the development and commitment
  to life-long continued education and evaluation.
• A component of this is the recognition by the
  students that they need the ability to
  effectively manage information.
• MBBS graduates as new doctors will need to
  collect, analyse and organise information
  efficiently to answer clinical questions.

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Key Components of Information Skills Classes

• Information Skills Classes should be
• Grounded in adult learning theory
• Informed by the aims of self-directed and life
  long learning
• Problem based and
• Developed in collaboration with outside experts
• A sound knowledge of the curriculum assists the
  librarians in seeking opportunities to integrate
  information skills classes into the curriculum of
  the program. e.g. training in EBM tools.

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Information Skills - UQL

• The Library plays a key role in developing the
  skills of information management and computer
  literacy.
• Information skills classes have been integrated
  into the MBBS Curriculum for Year 1.
• Training needs to be clearly linked to the
  clinical setting with real examples drawn from
  contact with patients.

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Information Skills Survey Results

• In Year 1 students are offered a general overview
  class searching the internet (medical focus)
  class and databases class.

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Information Skills Survey Results

• 92 of the students responding to the survey
  found the sessions useful.
• One student commented "Excellent - if only I had
  used the databases more I wouldn't forget how to
  use them!.
• Due to the dispersed student population of years
  2,3, and 4 it has not possible to successfully
  integrate information skills classes into the
  curriculum for these years.

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Information skills overall survey trends

• Year 1 attend more information skills classes
  than other years.
• Year 1 are more interested in training
  opportunities.
• Years 3 and 4 are more confident in their ability
  to search databases.

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Information Skills lessons learned

• Flexible learning resources have been
  established. These include
• Library Guides
• Use its (basic guides on how to use resources)
• Find its (guides on how to find information in
  a subject area)
• Assistance is available via the two virtual
  reference services Ask a Cybrarian (for library
  and information help) AskIT (information
  technology help and training)
• The Library is investigating visits to rural and
  regional centres to deliver information skills
  classes.

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Evidence Based Medicine An Overview

• The library recognises the importance of EBM to
  the MBBS program. Some examples
• Resource collected (Cochrane Library, Best
  Evidence, Clinical Evidence).
• Provision of value added tools such as clinical
  queries filters incorporated into both Medline
  and CINAHL.
• Information skills classes offered.
• Staff development of librarians.

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Saved EB queries
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EBM Survey Results

• Year 1 and 2 students were presented with a list
  of potential information skills classes to
  enhance their knowledge of EBM.

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EBM - Survey Results

• 75 of Year 1 students felt that a librarian
  visiting them during PBL and talking about EBM
  would be useful.
• Year 3 and 4 students felt they had developed the
  ability to use a range of information resources
  to support EBM.

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What EBM resources utilised

• Medline and Pubmed Clinical Queries
• Cochrane Library
• Cliniweb
• Up-To-Date
• MDConsult
• Stat!Ref

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EBM - Changes Made

• In response to Years 1s feedback a new programme
  of information skills classes has been developed
  and trialled. These include
• Introduction to the Cybrary and the MBBS Program
  Intranet.
• Internet and WWW with Medical Focus.
• Searching for Best Evidence using databases
• Cochrane Library.

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Searching for Best Evidence

• This class covers
• PICO (patient, intervention, co-intervention/com
  parison, outcome) to formulate the clinical
  question.
• Medline/Pubmed Clinical Queries to search for
  best evidence.
• Co-taught with academic. Additionally, follow
  up and drop-in sessions have been incorporated
  into the curriculum for Year 1.

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EBM - Opportunities

• EBM is an opportunity for the Library to
  collaborate with Academic staff.
• The Library markets its expertise in finding the
  evidence.
• Librarians undertake professional development
  activities to increase their skills in other
  facets of EBM such as critical appraisal,
  research methodologies and biostatistics.
  Examples
• EBM and the Medical Librarian .
• Cochrane Library Training.

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Priorities for the Library

• Establishment of laptop access.
• Work collaboratively with other librarians in the
  provision of information services to students.
• Further integrate information skills into the
  curriculum.
• Develop information resources and services with
  emphasis on electronic resources.

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Priorities for the Library

• Explore student access to the CKN.
• Continue to monitor the collection and review the
  provision of journal articles.
• Work collaboratively with Queensland Health
  librarians in the establishment of the Rural
  Clinical Schools.

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Conclusion

• Information is now available for the Library to
  determine future directions in the areas of
• collection development and management
• electronic resources
• information skills
• evidence based medicine
• Another survey will be conducted in September 2001

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For More Details Contact..

• Karen Joc k.joc_at_library.uq.edu.au
• Kaye Lasserre k.lasserre_at_library.uq.edu.au
• http//www.library.uq.edu.au