Clinical Librarian Study Day - Report
Carsten Mandt
Clinical Librarian Study Day, Leicester, 24th June 2003
Not content with resting on their laurels from hosting last year’s 1st UK Clinical Librarian Conference, the good people at Leicester’s University Hospitals have recently held a Clinical Librarian Study Day. Being new to the profession, I did not attend last year’s conference (in fact, I was still at university day-dreaming about being a working librarian…) but if this study day is anything to go by, it must have been good. In brief, the day was well organised, local staff were very helpful and friendly, the venue was a pleasant change from the dubious charm of portakabins and neglected Victorian buildings that I am used to, and, most importantly, the speakers were interesting and the workshops provided ample food for thought. The catering was excellent, too…
The day kicked off with the ubiquitous tea and coffee and socialising that precedes every such event, followed by a series of lectures and related workshops. Representatives of the NHS Centre for Reviews and Dissemination in York gave the first two lectures. First, Alison Booth, introduced the “Hitting the Headlines” service that is available on the NeLH website. She described their process of selecting news stories and appraising the clinical evidence behind these stories. The service focuses on providing a quick (the turnaround time is 48 hours from the publication of the news report) and unbiased service to busy health care professionals. Nerys Woolacott then went on to provide more insight into the behind-the-scene processes of this service by detailing the basic steps the CRD team take when they appraise clinical evidence. She explained what makes good evidence and how checklists, which are becoming increasingly popular, can be useful tools for critically appraising the evidence. Following these presentations, we split into four groups for the first workshop where we got a chance to test our own appraisal skills - a test, which, at least in my group, we all passed…
After a short coffee break had provided more opportunities for networking, Jon Brassey, initiator of the TRIP and ATTRACT services, talked about a way of answering clinical questions quickly without creating extra work for the enquiring clinician. He described how he had analysed the information needs of the GPs he was aiming the service at, and explained the assumptions underlying his service design: that in practice, clinicians do not do anywhere near as much literature searching and critical appraisal as they should to fulfil the promise of evidence-based healthcare; that they are often not interested in acquiring or honing the skills needed to do this; and that, in fact, they want to be ‘spoon-fed’ straightforward answers to their clinical questions at fast turnaround times. In practice, this means that ATTRACT does not offer in-depth systematic reviews in reply to a clinical question. After a question is received (and has been clarified if necessary) a quick search of secondary sources like the Cochrane Library, Clinical Evidence and guideline producers’ web sites (such as NICE or Prodigy) is done and if this is inconclusive, primary sources like Medline or Embase are searched as well. Then, the relevant abstracts are appraised and a summary of one or two pages is compiled. If needs be, this can be done within six hours of the initial request. Immediately, this raises several concerns about the quality and reliability of the results of this ‘quick and dirty’ approach, which Jon Brassey seemed well aware of. An independent evaluation of the ATTRACT service is going to be carried out later on this year. So far, the informal impression based on user feedback and an in-house evaluation of random samples of work seems to suggest that the ATTRACT approach compares well with other methodologies that are generally regarded as solid and high quality, like, for example, the Cochrane Collaboration systematic review process. And this, Jon Brassey, was quick to point out, for just around £100 per appraisal and within 6 hours!
It may have been his dry wit, it may be the remit of my own post, but this presentation was by far the most inspiring on this day. Nevertheless, I remain sceptical about ATTRACT, despite the obvious benefits of giving clinicians access to the knowledge base within just hours and at no cost to them other than spending five minutes on the phone and reading a short digest. No time-consuming critical appraisal, no long waiting times for a comprehensive literature search resulting in 5000 references. This is bound to go down well with clinicians working way above the 40-hour/week mark. However, I would still like to see some reliable proof that this does not sacrifice too much quality for the sake of speed and cost-effectiveness. Especially if we share Jon Brassey’s assumption that clinicians want to be ‘spoon-fed’ ready answers, a lack of quality could be dangerous because then we must also assume that these clinicians are likely to translate the bottom line of a digest directly into treatment decisions. Even disregarding legal liabilities (which probably still lie with clinicians rather than librarians) this puts more pressure on us to provide high quality literature searches and appraisals.
Again, this presentation was followed by a related group workshop, which this time was more of an exchange of ideas around issues like the definition of a good clinical question, appropriate search strategies, good clinical answers and the problem of speed versus comprehensiveness. This was a useful brainstorming exercise, but despite the efforts of the facilitators (who were doing a great job in all the workshops) it drifted slightly aimlessly because there were no clear outcomes we could work towards.
After two more presentations by Alison Turner, library partnership co-ordinator for the NeLH, who gave an overview of the plans for the 2nd UK Clinical Librarian Conference in 2004 (this time in London), and Sarah Sutton, who shared her experiences of what it’s like being a new clinical librarian in an acute care hospital, the day ended with a short session of ‘speed debating’. Topics picked out of a hat (well, envelope) were discussed in small groups and within a limited amount of time. Again, this was inspirational and each group finally presented one of their speed debate topics to the whole group to share their views and ideas.
All in all, this was a useful and inspiring day and certainly time well spent. It was good exchanging ideas with other professionals in similar roles, and the speakers were knowledgeable and interesting representatives of current developments within health librarianship, which made the day an insightful experience. I would certainly recommend the next study day in Leicester to anyone whose job touches upon any of the issues commonly discussed within the context of clinical librarianship.
Carsten Mandt
Clinical Librarian
Greater Glasgow Primary Care Trust