Health Libraries as Joint Use Libraries: Serving Medical Practitioners and Students

Libraries, whether medical or healthcare, in higher education (HE) institutions or the National Health Service (NHS), provide services to all types of healthcare students and professionals. Many of these are delivered through contracts, in the form of service-level agreements, between the two key organizations. The challenge to librarians is ensuring that users are provided with access to the resources they need and the skills to use those resources to the benefi t of a patient-centered environment. External drivers such as developments in education, a continuously modernizing health service, and new technology have infl uenced the development of services. Issues regarding the access to electronic information for the different user groups still exist. Librarians have to support the differing user groups, who may have varying levels of computer and library skills, and provide skills training on a wide variety of resources from their own institution and from nationally provided content. Introduction The dual use of health libraries by practitioners and students has been a recognized practice going back many years, although there is very little documentation to support it. What there is often describes the establishment of multidisciplinary library services in UK National Health Service (NHS) Trust hospitals, such as that described by Sue Childs (1996), or partnership arrangements between higher education (HE) institutions and NHS Trusts (Black and Bury, 2004). Health professionals, both clinical and nonclinical, whether practitioners or students, require access to library and information services throughLIBRARY TRENDS, Vol. 54, No. 4, Spring 2006 (“Dual-Use Libraries,” edited by Sarah McNicol), pp. 596–606 © 2006 The Board of Trustees, University of Illinois dorrington/health libraries as joint use 597 out their education, training, and continuing professional development. These services are primarily provided by libraries in the health care and higher education sectors. The changes that have taken place, many of which are still ongoing, in the NHS and in healthcare education in the UK have made major impacts on libraries and on the services they deliver and have raised the expectations of their users. Medical and other staffs working in the NHS require access to libraries for their day-to-day work, for educational purposes, for research, and for the planning of services. Many professions working in the health service are required to attain further skills and qualifi cations for career advance. The NHS also undertakes a great deal of primary research, independently or in collaboration with higher education. Information is also essential for management decision making, with the current emphasis on clinical governance. The education of health professionals primarily takes place within the higher education sector but relies heavily on the NHS for the practical aspects, whereby clinicians often deliver training and students observe and practice. Healthcare education has seen a fundamental change in recent years following the transfer of nurse education into the academic sector, where students can take either a diploma or degree course, lasting three and four years respectively, to qualify as a nurse. Education is provided by universities, with placements in local hospital and community settings. The course is 50 percent practical and 50 percent theoretical. A Common Foundation Programme is followed by a chosen speciality in adult, children’s, mental health, or learning disability nursing. Midwifery education is also provided at diploma or degree level, and allied health professionals such as physiotherapists and radiographers follow similar courses. All these students at various stages of their placements will use the libraries of the hospitals to which they are attached. Recent Changes in the Education of Health Professionals The education of nurses has seen profound changes. “Project 2000” (UKCC on Nursing Midwifery and Health Visiting, 1987) was introduced in the 1990s to give nurse education a higher academic content resulting in a new diploma to replace the old State Registered Nurse (SRN) and State Enrolled Nurse (SEN) qualifi cations. This required an amalgamation of small schools of nursing into fewer, but larger, institutions, often in liaison with existing polytechnics. The change from polytechnics to universities in 1992 embedded nurse education more fi rmly within higher education. It thus became a degree-based profession with training commissioned by Strategic Health Authorities (SHAs), and a portion of the course is based within NHS hospitals. The most recent changes followed the publication of the UK government report Making a Difference (Department of Health, 598 library trends/spring 2006 1999), which outlines the government’s strategic intentions for nursing, midwifery, and health. One aim was to strengthen nurse education and training. The effects of this change were reviewed by the University Health Sciences Librarians group in a report whose recommendations include that “Library staff from the HE and NHS sectors should work together to ensure adequate library provision for nursing students and those that work with them, at Trust level” and that “Workforce Development Confederations should work with NHS and HE library staff to facilitate and where necessary ensure funding for collaborative working” (Walton, Wakeham, & Gannon-Leary, 2002). These changes caused other librarians working in both the HE sector and the NHS to be concerned that barriers were being created, so in 2000 the British Library funded a research project to look at cross-sectoral collaboration between the NHS and HE in the fi eld of health care. The aim of the project was “to develop a model which would offer an integrated approach for improving inter-sectoral co-operation in the NHS and higher education sectors to improve access to library and information services for health professionals and students” (Childs & Banwell, 2001, p. 15). It concluded that the hybrid library should provide access to electronic and print resources and physical space for study and use of information technology (IT). The education of doctors is a continuous process. Medical school courses normally last fi ve years, or four for graduate entrants and a year as pre-registration house offi cers. This is followed by training in the particular speciality chosen by the doctor. The latest developments in undergraduate medical education and the introduction of new curricula followed the publication in 1993 of Tomorrow’s Doctors (General Medical Council, 2003). This was subsequently revised and laid the foundation for a fundamental change in the way medical students were to be taught, with the emphasis shifting from the acquisition of knowledge to the learning process, including the development of skills to communicate effectively with patients. The emphasis in curricula on problem-based learning (PBL) and informatics has meant libraries also need to review the way they deliver information skills training. A survey conducted amongst medical school librarians concluded that they are likely to be more heavily involved in both the planning and teaching process (Murphy, 2000). It is necessary to teach basic information retrieval skills to enable students to locate and access the material they use in the problem-based case studies that begin in the fi rst year and continue in most curricula until the fourth or fi fth years. Current challenges include the need for students to be able to search for, appraise, and use the best available evidence, including the ever-expanding resources available on the Internet. Following the publication of Tomorrow’s Doctors, UK medical schools have been reviewing their curricula, their learning resources, and their teaching methods to ensure they meet the General Medical Council’s demands. A shortage of doctors in the UK has been met by an increase in student numbers, either by a rise in the student intake at established medical schools or by creating new medical schools such as the Peninsular and Brighton and Sussex medical schools (HEFCE, 2001). In other parts of the UK, joint medical schools have been established with existing institutions, such as Newcastle/Durham (Harbord & MacFarlane, 2002) and York/Hull. Changes in NHS Structures The NHS has not stood still either. Continuing reorganization has seen the structure of library provision change, expand, and move toward a service provided both locally and nationally. The establishment and expansion of postgraduate medical centers in the 1960s and 1970s led to the development of regional library networks. Today the network, based on Strategic Health Authorities, coordinates NHS library services throughout England. Since the mid-1990s a number of government reports and strategies have been published, starting with Working for Patients (Department of Health, 1989) and followed by The National Health Service: A Service with Ambitions (Department of Health, 1996), The New NHS: Modern, Dependable (Department of Health, 1997), Information for Health (Department of Health, 1998), Health Service of all the Talents (Department of Health, 2000), Building the Information Core (Department of Health, 2001), Funding Learning and Development for the Healthcare Workforce (Department of Health, 2002a) and Making Information Count (Department of Health, 2002b). Although not explicitly, these reports have been important drivers in infl uencing the context in which library services are provided, especially in supporting clinical governance and evidence-based practice. For libraries the 1997 Health Service Guidelines (NHS Executive, 1997) for Library and Information Services laid down the key concepts that are a “key resource for clinical effectiveness, for research and for training and education.” Without doubt one of the most important developments has been the emphasis in healthcare on evidence-based decision making, supported and promoted by government policy. It has led to librarians reviewing their role in information handling and information skills, especially to support systematic reviews and critical appraisal (Palmer, 1996, 2000). The Library and Its Users Within the higher education context, the key groups of users of medical libraries are undergraduate medical students, taught course and research students undertaking master’s and doctorate programs, and academic research and teaching staff, all of whom will be members of their respective institutions. In addition, there will also be students on placement, the biggest group being nurses, who are attached to an NHS Trust for the practical element of their course but members of another higher education institudorrington/health libraries as joint use 599 600 library trends/spring 2006 tion, and all the staff of the associated NHS Trust—doctors, nurses, allied health professionals, management, and support staff. In addition there will also be staff from other local Primary Care and Mental Health Trusts. In NHS libraries the groups are very similar, with the NHS staff belonging to the parent organization and students on placement, including medical students. Library Funding Funding for health libraries is still a complex issue. Higher education institutions are funded through the Higher Education Funding Councils (HEFCE) with additional funding for research-based libraries to facilitate access for postgraduate students and other research staff. NHS libraries are funded through their Strategic Health Authorities through MADEL (Medical and Dental Education Levy) and NMET (Non-Medical Education and Training) levies. In addition, trusts that support undergraduate medical students receive SIFT (Service Increment for Teaching) funding from academic institutions, although in the past it was often not clear if any of this funding was included in library allocations. Academic libraries that provide library services to the NHS are usually funded through contracts between the parent institution and its associated NHS Workforce Development Confederation. A recent survey undertaken by SCONUL’s (Society of College, National and University Libraries) Advisory Committee on Health Services (2003) reveals that nearly half of the contracts were negotiated without direct involvement of the library; the range of the value of contracts is great; and a signifi cant number of contracts are based on service-level agreements. A service-level agreement will specify the type and level of service to be provided and which groups of NHS staff it covers. The survey found that many contracts were for three or fewer years. Resources The new curricula developed by medical schools have meant librarians are rethinking their approach to the provision of resources. Student numbers are large; for example, Imperial College London’s annual intake is 326. With the course taking six years, the total medical student body numbers nearly 2,000. Textbooks are still an integral requirement, and Imperial has refi ned its annual call for reading lists to ensure lists are submitted, core texts are correctly identifi ed, and the requisite number of individual titles purchased. The inclusion of problem-based learning cases as part of the course requires students to use a wide range of materials—textbooks, journal articles, and Web sites. The material has to be available for the period the case is being studied; therefore, it is essential for a system to be in place so that students have easy access to it. The use of the physical library by research staff is decreasing, as more of the library resources they use are being made available electronically.