Increasing information competence in medical school faculty.

Abstract

This article compares two approaches to increasing information competence in faculty at an academic medical center and looks at possible reasons for their varying success. Approach A started with formal instruction in a classroom setting and included hands-on work by the faculty-participants. An assignment involved followup interaction between the faculty-participants and the instructing librarian via email. In Approach B we went to the faculty when they had already gathered for a conference. Two librarians set up a computer workstation at the site and were available to answer individual attendees' questions before the conference. We have done this once, and it was very popular, so we are now promoting our "Reference Express" service as the approach has come to be called.

Introduction

Instruction librarians continually look for ways to make their teaching most effective for their varying classes. This is true for other teachers as well, but instruction librarians have an added challenge: most library instruction is confined to a single class, usually only one, or at most two, hours. This means that the topic and the approach must be chosen very carefully in an attempt to fit that audience and optimize the instructional impact. Methods for doing this are an ongoing topic of discussion in the literature(1-6) and on library instruction listservs. The following descriptions are two approaches conducted at the University of Arkansas for Medical Sciences (UAMS), an academic medical center which includes both clinical and basic science degree programs. Our particular aim was to study ways that might be most effective specifically in teaching faculty, knowing that there is no one class style that can fit all situations and audiences. One group (Approach A) included teaching faculty from the UAMS colleges of nursing, medicine, pharmacology, health related professions, public health and basic sciences. The other group (Approach B) comprised clinical medical faculty.

Approach A

We took a formal, classroom approach to information competence among our faculty upon the request from a special education program for faculty. This is a Teaching Scholars program which is institution wide, and there are similar programs at universities throughout the United States. Faculty must apply and be accepted in order to enter the program. It comprises lecture and working session classes, assignments, and development and implementation of an education related project. There are strict rules about completing all segments in order to graduate and receive the diploma-certificate. The program is highly recognized enough that the diploma-certificates are personally given by the Chancellor of UAMS.

A director of the Teaching Scholars program asked if we would teach a class on searching the literature to include the Ovid interface (MEDLINE and CINAHL being the databases most appropriate for this group) plus an introduction to ERIC searching. A participant requested information about the CRISP database, so we included a brief look at that also. The lecture-demonstration would be followed by hands-on practice at the same class session. Our formal classes always include both lecture and demonstration to accommodate both auditory and visual learners as much as possible.(7-8) Whenever possible, we also include hands-on time since so many people have told us they learn well by trying a search themselves when there is a teacher present to guide them. Although an actual discussion per Dean's Affective Domain(9) does not usually occur in our classes on database searching, we do ask questions and try to get people talking about the process and results in addition to the listening and watching that constitutes much of the class. For this class, there would be a required assignment to send the instructing librarian a search strategy and some example citations. These would be reviewed with feedback given to the searcher. The class went well. Students asked questions to clarify concepts and techniques during the demonstration. During the hands-on practice students worked on their research topics, displaying various levels of expertise and experimenting with new approaches (techniques and topic refinement). The class was too short for much practice, so we encouraged them to contact us with questions aside from their assignment. We emphasized that sending a search strategy and results was to help them develop new skills through interaction. Performing a search and sending documentation was required, but the strategy and results would not be graded, just reviewed. Results came quickly from a few students. These early results appeared to be reasonably skilled searches. At least we could see that they incorporated several of the tools and techniques available. Many of the later returns were less skilled; they did not demonstrate much retention of the material covered in class.

After the initial returns, the completed assignments trickled in, one or two each time their primary instructor reminded them of their assignment incompletions for the Teaching Scholars program. This puzzled us since we knew most were working on their projects and doing literature research. We think there may have been several reasons. First, shyness about having their attempts seen by another faculty member as they knew they lacked expertise in searching. However, that is why we gave them a class and offered email to a single librarian for privacy. Or perhaps they are perfectionists and were trying to create a perfect search strategy before submitting it. Second, some had already done part of their research but had not documented the strategy and results. They did not want to have to repeat their work, and we certainly understood that. But we also wondered about research that did not include a record of the search path. Third, some were not very computer literate and could not remember how to email the documentation or tried and failed. We had demonstrated emailing but at that time did not realize the extent of computer illiteracy of some students.(10) If they let us know they had tried and could not do it, we suggested that they print the required results and send a paper copy via our campus mail. Emailing was not a required part of the assignment; it was intended to be an easy delivery mode. This pulled in one more completed assignment.

Another problem was that people would give us incomplete information so that we did not really know exactly what they had tried. For example, they would write "I searched critical thinking" but not show or tell whether they had used a subject heading, text words with/without proximity operators or truncation and in what database. If they did not respond to queries about this, we fell back to an assumption that they used straight text words. We had included two evaluation questions within their assignment. These were: 1. Did you change your search techniques as a result of the class on searching? 2. Did you retrieve better results with your second {post-class} search? Out of twelve students who attended class, only a few responded to these directly. There were three positive responses and one negative response to each of the questions. Also, one of the students sent a comment with his assignment that he thought he understood the search process better than he had before the class. With such a low response rate, we could not draw any definite conclusions from their feedback. For several of the students we provided lengthy feedback on their search strategies. We may contact these individuals and ask whether that feedback from us further helped their understanding and would affect their future search strategies. With this information we could draw better conclusions about whether we had increased their information competence through this process.

Approach B (Reference Express)

For some time, librarians at UAMS had had concerns that faculty, especially clinical faculty, might not take time for formal instruction or even to ask a question as their schedules are usually very tightly dictated by clinic hours or surgery schedules. Several studies have shown that accessibility (including time needed and ease of use) is an important factor in physician information seeking.(11-15) We have given some classes for them, but inevitably some cannot attend at all, and some are called away during the class. Thoughts about ways to do an "out in traffic" reference service had been brewing for a long time with one teaching librarian, the major hurdle being how to chose a good location and time so there would be a reasonable chance of many interactions. Any space outside of our library has to be scheduled with room reservations, so it had to be a planned event. Students were not a good target market since library related work is very scattered and sparse in their curriculum. The amount of time we would need to spend in advertising to the whole campus by sending and posting flyers seemed too high a price for an unknown return. We finally settled on every week's Grand Rounds (GR). Grand Rounds are conferences that are held weekly (in most hospitals) for the continuing education of the physicians and residents. In each session, a specific clinical issue is formally presented by a speaker with expertise in that clinical area. These are highly attended by faculty in the College of Medicine, and some of the residents are required to attend. We talked to the person setting up the brochures and sign-in book one day and found that the person to contact was a department head for whom we had previously done some instruction. When we contacted him with our plan, he was very supportive.

We wanted to give advance notice with the hope that people would factor this into their time at GR and think about what questions they might want to ask, so we designed a flyer and had the assistant put copies next to the sign-in book the week before our event. Our motto was "you supply the questions, we will supply the answers". At a recent regional conference, another library had reported doing something similar to this, so we called to ask their advice on our ideas. They recommended that two librarians be there the whole time to avoid burnout in case of high traffic. We also knew double coverage could be very helpful if there were any equipment problems: one person to deal with the problem and the other to keep the program going. We asked about handouts and whether we should try to create a special one for that event. The other library said they had not but had taken copies of a wide variety of their existing handouts. We decided to take that advice to reinforce our verbal answers and ensure that requestors got solid information even if they could not spend quite enough time with us for extensive explanation.

We made a large sign for Reference Express, and at the event we put it next to our computer station and handout table so people wouldn't miss us. We had a wide variety of questions. Some were simple, "Is there a way for me to access electronic journals from home?" Some were more complex, "I have tried this literature search several times and cannot find what I need. Can you help me?" (This one turned into a mini-class on searching since he was mis-using some of the database tools.) As people walked by to enter the auditorium, if they did not approach us with a question, we asked if they had any or whether they'd seen Medweaver (a new program for us at that time). We answered questions from 24 people in about one hour. They were pleased that we had made it so easy for them, and we were glad we had reached that many people and added to their information skills in different respects.

Discussion

Approach A, which we used with the Teaching Scholars, can cover more material, in more depth so there is a greater chance of increasing information competence whether the audience is at a novice level or moderate level of experience. The down-side is that they may not come with active questions. Often they have not scheduled the class themselves; it is more likely to be a departmental chairperson's decision. They may come expecting a passive, lecture only environment and not he willing to engage in the concepts presented and to respond to questions or give input. We also think that timing of this class and assignment is important. In our case, it probably should have been earlier in the Teaching Scholars program before people had done any or much of their own research. At that point, they might have been more open to assessment and input from others. We have previously described the low response rate and our postulated reasons. A change in the timing of instruction could have a major impact.

This approach is quite time and energy intensive. In addition to preparation for the class itself, there is the hands-on coaching, so a second librarian is usually needed, and finally, the assessment of the strategies and construction of clear feedback to the participants. In this case, since there were fewer than twenty people in the class, all assessments and responses were done by one librarian. Despite the lower than hoped-for interactive responses, we would use this approach again with some modifications. The Reference Express approach is a direct positive hit for those who do have questions. Some of the questions may not be very complex. However, if a useful answer is received, we postulate that the questioner will substantially increase his or her information competency level because that sought information will be used and retained. We think that information competence is a building process so each new skill, no matter how small, is a plus(13). However, we theorize that the Reference Express approach will work best for groups that already have at least a moderate level of competence.

In conclusion, these methods each have a place and their individual strengths should be considered as various instruction opportunities occur. Both of these methods will be useful at UAMS and we think that both could very well fit situations other than clinical vs. non-clinical medical center faculty. We looked at clinical vs. non-clinical faculty because these were situations that we needed to address at UAMS during the past year. What is more important is to look at the other factors we discussed, such as amount of time the potential attendees have and how well that can be scheduled or would they have any motivation for completing an assignment or attending a followup consult session. It seems to us that the formal Approach A is more applicable to non-clinical teaching faculty in any discipline. Unfortunately, at UAMS, we don't foresee many situations other than the Teaching Scholars program where a required assignment could be given to faculty. We may try modifying this approach so that, instead of an assignment, we actively encourage participants to make an appointment right then for a followup consult with a librarian. Appointments made at the moment are more likely to be kept, but librarians could also email or telephone attendees later directly offering consult time. At the end of any class, we always state that attendees are welcome to call us for help, but we've never tried actively making appointments with all attendees. We think that Approach B also could be aimed at groups other than clinical faculty and might be useful at universities other than academic medical centers. Two factors that we think are particularly important for this approach: 1.) location and 2.) that the target audience be a group likely to have "active" questions, not people needing instruction in foundational material.

Note

All students in this paper are faculty. Thank you to Susan Steelman, M.L.I.S. for creating the name Reference Express.

References

(1.) Fast M, et al. Bibliographic instruction committee report. [?Wichita] Kansas: Wichita State University; KS Libraries; 1992. 43 p. ERIC Document ED359972.

(2.) Ormondroyd J. Course integrated library instruction. ERIC Digest. Syracuse, NY: ERIC Clearinghouse on Information Resources; 1988. 3 pgs. ERIC Document ED306960.

(3.) Rabine J, Cardwell C. Start making sense: practical approaches to outcomes assessment for libraries. Res Strat. 2000;17(4):319-335.

(4.) Sanford CC. The census in one hour?: the development of an effective one-shot BI session. Res Strat. 1991;9(4):202-205.

(5.) Allen MB. Focusing the one-shot lecture. Res Strat. 1989;7(3):100-105.

(6.) Hinchliffe J. Faculty-directed library use instruction: a single class, retrospective study. Res Strat. 2000;17(4):281-289.

(7.) Aken RA. Meeting the patron at the OPAC crossroads: the reference librarian as an online consultant. RQ. 1988;28(1):42-45.

(8.) Barbe WB, Swassing RH, Milone MN Jr. Teaching through modality strengths: concepts and practices. Columbus, Ohio: Zaner-Bloser, Inc.; 1988. 117 p.

(9.) Dean GJ. Designing instruction for adult learners. Malabar, Florida: Krieger Publishing Company; 1994. Exhibit 8.2, Matching selected learning activities with learning domains; page 85.

(10.) Hang JD. Physicians' preferences for information sources: a meta-analytic study. Bull Med Libr Assoc. 1997;85(3):223-232.

(11.) Robinson G. Do general practitioners' risk-taking propensities and learning styles influence their continuing medical education preferences? Med Teach. 2002;24(1):71-78.

(12.) Slotnick HB. Physicians' learning strategies [Translating guidelines into practice: implementation and physician behavior change]. Chest. 2000; 118(2 Suppl): 18S-23S.

(13.) McClaran J, Snell L, Franco E. Type of clinical problem is a determinant of physicians' self-selected learning methods in their practice settings. J Contin Educ Health Professions. 1998;18:107-118.

(14.) Connelly DP, Rich EC, Curley SP, Kelly JT. Knowledge resource preferences of family physicians. J Fam Pract. 1990;30(3):353-359.

(15.) Casebeer L, Bennett N, Kristofeo R, Carilla A, Centor R. Physician internet medical information seeking and on-line continuing education use patterns. J Contin Educ Health Professions. 2002;22:33-42.

Rena A. Sheffer, M.L.S., Associate Professor, is the Information Resources Instruction Librarian at the University of Arkansas for Medical Sciences Library