Sunday, 7 April 2013

Getting evidence into practice: the challenges, the ideas and the labour of an information specialist

By Vasumathi Sriganesh.

Vasumathi is a librarian by training, a medical information specialist and an avid campaigner for Evidence-informed Health Care and The Cochrane Collaboration. She was recently awarded the International Clinical Librarian Conference Evidence into Practice Award for 2013. 

Scenario 1: 
You are a doctor. If you are in a government hospital, you probably do not get to breathe in between seeing two patients or you may even be seeing several at a time. If you are in private practice, you may still be seeing far more patients than what seems a reasonable number. So how on earth do you stay updated? Or practice EBM (Evidence based medicine)?

Scenario 2:
You are a health consumer or a patient. You are flooded with information or advice or both, on what is the latest or presumably best on health or disease. How do you know what really works? You need information from Evidence Based resources!

EBM – recalled.
EBM or “Evidence Based Medicine is all about finding the best available evidence (of what works) and then applying the evidence specifically for the patient, by the doctor, using his or her clinical knowledge and skills.

Do we notice that finding the best available evidence figures as an important part of EBM?

The Best Evidence of what works? Where and how does one find that?
Enter – the role of a “Medical Information Specialist”. Huh! What on earth is that? Here is a simple and complex answer. The simple answer is “a medical librarian”. The complex answer is – “one who specialized further into understanding and finding evidence based resources”. Such a professional, in the advanced countries actually goes on rounds with doctors and is a part of the medical team.

Finding such evidence involves searching several databases and sometimes even print resources, in a very structured and scientific manner, which requires specialized training.

Myths / ignorance about librarians and what they can do
But doesn’t a librarian only manage a library collection? Many wonder “does one really need any training to be a librarian”?  The answer is YES and education in this field goes up to a doctorate degree!

Me: A medical information professional or informationist:
I am a medical information professional or informationist. After studying library sciences (getting a Masters) and having worked in a couple of medical libraries, I have further specialized in finding and understanding the Information Contained in Library Books, Journals and more! Which means, I help health sciences students and professionals, not just with the “Knowledge Resources”, but with the information embedded inside them.

Okay – so librarians are qualified, but how much would they know about the content of collections?

“But – isn’t it only doctors (or paramedics) who can understand the content inside the resources? How can you – as a librarian understand it?” – you may ask. The answer is that we learn how much we need to (learning more as we go) and for the rest we have discussions with doctors and health professionals. It is the joint effort that produces results.

Teaching people to find stuff? What’s the big deal?
As a specialist, I currently do the main job of “teaching people to find the best evidence”. After all – they cannot really practice EBM if they do not find the best available evidence – right? And at a first level, I teach them how to find relevant stuff systematically.

I know your next question – “What is so hard about finding anything today, - with the Internet being available at our fingertips”? A less polite variation of this question has been “What can YOU teach us that we don’t know” J

Well – we learn a LOT about how information is organized, standardized and more. And that helps us do a structured, systematic activity of searching

So here is more about my journey in learning Systematic Searching
In the 1990s, as a hospital librarian, I wished that I could learn how to not just stop with getting “relevant references” for the doctors, but be able to assess their utility too. I learned these skills through an Online program conducted by three medical librarians in the US (a big thank you to Connie Schardt, Julie Garrisson, and Julia Kochi) and also by interactions with more medical librarians (far too many to name)  through a Listserv – “Medlib-L”.  Additional learning was from CE programs, vendor sessions, posters & oral presentations and interactions with international librarians, in three “International Congress on Medical Librarianship”, the Annual Meeting of the Medical Library Association of the US and the Cochrane Colloquium. (Thanks to Andrew Booth, Carol Lefebvre and Julie Glanville who taught at these events.) A course in Critical Appraisal at an ICML workshop, one at CASP-UK, Oxford and later a lecture by Dr Arjun Rajagopalan from Chennai helped me learn some skills in this area, but I still need to sharpen these.  Within India major learning has been from the sessions in the South Asian Cochrane Network & Center, where I have learned more than I could imagine, about what it takes to write a piece called the Systematic Review, which ultimately becomes the best source of Evidence.  (Drs. Prathap Tharyan, Thambu David and team...heartfelt thanks to all!). This has been a long journey from 2000 till now and one that has a long way to go!

Why am I doing all this?
Having observed the medical domain since 1992, I have a few dreams. I believe that if we can produce great “medical informationists” and medical librarians in India, we can contribute to the doctor patient ratio problem! Imagine, if those really interested in health sciences, but could not get a degree in them, took up such a career, (we could create a customized course) and they actually worked with the medical team, finding the right evidence quickly and helped doctors stay updated, wouldn’t this be a boon for both doctors and consumers? And if some of these professionals also helped patients understand evidence, it would be a cycle completed. Another dream is to have country wide access to more sources of evidence – Evidence Summaries like Best Evidence, Clinical Evidence, Dynamed,  UpToDate (I have named them alphabetically having no bias towards any),  and also the journals that are recommended for Postgraduate courses, so that sources that health professionals are used to are available to them even if they do private practice.

I dream that Indian doctors and consumers not only have access to such resources, but are trained an assisted by high quality informationists who are rated as intellectuals with an important role in healthcare.

The most important activity “now”!
If someone asked me “what do you think is the most important activity you do?” – my answer would be “Spreading the message that the Cochrane Library is free to everyone in India, thanks to a country wide license paid for by the ICMR”. This message is something that I pass on during every lecture I deliver, or workshop that I conduct. While the lectures and workshops are important in themselves – I believe that with this access and the efforts by the SASIANCC to increase its utility, it really is a responsibility of every medical student and professional to ensure that they use this resource to the fullest!

Rewards and Accolades!!
I will admit – that ever since I went on a “mission to spread my knowledge” after resigning my library jobs, working on my own and finally setting up QMed Knowledge Foundation – a  Not for profit Trust – there have been several times I have wondered “Am I nuts? Why am I doing all this, not having taken a salary for years, taking a marginal one now and very often actually spending family money most of the time?”  Interestingly for a cause where the target audience are not people who cannot pay to learn!

Well there have been the “highs” too. Last year a group of doctors in Chennai who formed the SMLRT (Society for Medical Learning & Resources Transfer) agreed to partially fund some of our activities. Which does give us some relief! And the best came recently. A librarian from the US, Ann Glusker who knew about my work nominated me for the “International Clinical Librarians’ Conference Evidence Into Practice Award”. This award was established this year, to honour a practising librarian or informationist who has made outstanding contributions to bringing evidence into practice in the field of healthcare. And, I got chosen for it!! I will receive it at a conference in Boston in May 2013.

Going ahead
An award like this comes with responsibilities! And what do I choose as mine? To ensure that “information literacy” and “literature searching” becomes part of the medical school curriculum. Only then, will students find it easier to search for evidence, understand it and use it to treat patients. I also wish to teach health consumers to understand Cochrane Summaries so that they become more informed and help doctors with their own treatment. I have a great team supporting me at QMed Knowledge Foundation. I need support from medical students – to learn from me, from faculty – to encourage this learning and from bodies like the MCI / ICMR / MOHFW to strongly support this!

Can’t we have more “Me’s” in India? Sure – as in many academic professions, the scenario regarding librarians in India has been declining in the last few years, with many bright youngsters not choosing this path. Most of the good librarians are in the Corporate libraries. And the good ones in Academic libraries are bogged down by their “management jobs” and not encouraged to be part of core academic activities. We need to change this. It will be an investment. Get the right people and create more medical informationists who will surpass what I have done!

Are there people to support my dream? And actually volunteer to help? If the answer is yes, my email id is – do get in touch with how you will help. And then let us brainstorm and discuss with all those who matter, make a to-do list and get them done!