EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Category Archives: Library 2.0

Academic Libraries, News, Current Reports: Storehouses, Tool Sheds and Peripheral Brains

Returning from a blogging-break, I found several links in my email account to a variety of newly-published library-related reports or scholarly articles. Two that I enjoyed reading are referenced below.

We do not yet understand the scholarly significance of large swaths of the digital universe.”

So wrote Dan Hazen, associate librarian of collection management at Harvard College, in his 2010 article, “Rethinking Research Library Collections: A Policy Framework for Straitened Times and Beyond“, available through open access to anyone, and published in 2010 in Library Resources & Technical Services (citation link below).

I especially liked his caption “Libraries as Storehouses, Libraries as Tool Sheds”.  As a mid-career librarian, the life work of my generation have been the planners, implementers and fixers for this migration of library collections from the Real (hold it in your hand, be in the library to read it) to the Virtual (it’s online 24×7 from anywhere you are). Another central issue for research libraries also focuses on historical archiving and reliable preservation of generations of printed, and digital, collections.  The excerpt below from Dr. Hazen’s article summarizes such concerns much more eloquently than I can:

” The mass of information resources now available on the Web, many of them free, is fundamentally changing the library community’s thinking about collections….  Links to freely available digital content, meta-search capabilities that cut across products and platforms, and local aggregations of electronic resources, will all play a growing role in libraries’ collections and content strategies. This in turn will also reduce the physicality of library holdings and alter the functionalities of their spaces.  But we need to go further.  Three aspects of Web-based content require close attention. First, the search engines that today allow users to find materials on the Web are neither transparent nor fully revealing of useful content in predictable ways. Google Scholar, for example, relies upon opaque search algorithms and relevance rankings that appear not to fully exploit the wealth of standards-based metadata that libraries routinely provide. But most libraries do little better, investing their cataloged resources with robust metadata that our discovery tools rarely handle well. Second, sources on the Web—whether websites themselves or the  data, images, objects, and documents embedded within them—are notoriously unstable. Content is added, changed, and removed; links shift around and disappear. Scholarship relies on enduring access to constant content, a goal which remains elusive in the digital domain. Capture, curation, and digital preservation are all implicated in this conundrum.  Third, dispersed and disparate Web content requires tools that can work across amalgamated sets of sources in predictable and repeatable ways. Some of the uses are well-understood, while others reflect a new realm of inquiry that includes text mining, pattern recognition, visualization, and simulation. The needs are perhaps most pressing around massive accumulations of raw data. Libraries, working together and also with academics and information technologists, have an evolving role in creating and supporting the tools that will enable students and scholars to take full advantage of the digital world. It is not yet clear whether lead roles can or should be pre-ordained: arrangements that embody flexibility and contingency seem most likely to succeed. “

Source: Library Resources & Technical Services – Vol.  54(2), pages 115-121. (2010)

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Staff at OCLC collaborated on a report published in 2010, entitled Perceptions of Libraries 2010: Context and Community .  The 59-page report is an update of a 2005 edition, and is available free online from this link. Below is an excerpt from the Conclusion:

Love for librarians remains. Like the library brand, it grew stronger. It seems that self-sufficient information consumers still appreciate expertise and a passion for learning—but they like it best on their time, with their tools. It’s cool to ask an expert—online. It was not cool to ask a librarian for help in 1950 (Public Library Inquiry, 1950); it’s still not cool. Many more perceptions and attitudes have remained the same for the information consumer in the last five years. She still wants to self-serve and self-navigate the info sphere. She discovered the benefits of surfing the Internet by 2003 and, by 2010, was using more powerful tools. She is creating her own apps. She still knows good information when she sees it. She takes her information habits, and perceptions, with her as she ages. While she may be a bit less impressed with online information resources as they have become commonplace, nothing has yet replaced the value and speed of a search engine. And, her personal device connects her to a network where she can share the knowledge gained. She shares her info sphere with older information consumers but does not welcome information gates or gatekeepers. Her advice for libraries: more hours, more content, more computers and of course—more books.


And any librarian in 2011 would not be surprised by this chart (also from the OCLC report):

Source: Both excerpts from OCLChttp://www.oclc.org/reports/2010perceptions/2010perceptions_all.pdf – All rights reserved – Copyright 2011

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* I prefer to believe that our users still have a need for reference librarians who are seasoned … a term much preferable to “old” (!).  However canny, shrewd and wise will also win a smile from those behind that desk.

Just like Dr. Rose, librarians have large peripheral brains too!

News, Health Science Literature: Elsevier introduces SciVerse

Wow! For those of us who use information resources produced by Elsevier on a daily basis, it’s been a bit of a shock to tune into Scopus®, SciTopics® or ScienceDirect® this week to see how different they now look. (Or as a corny analogy, that figurative, proverbial 800-pound gorilla sitting in the corner of the room has decided to move house in September 2010.)

On Monday, Aug 30 2010, Elsevier announced their plans to combine and morph these sites into one platform named SciVerse Hub®. Read their press release here. First, I wanted to provide some definitions from the company as to which resources will be combined by this single search engine:

Image Source: http://www.scitopics.com/faq.jsp – All rights reserved – Copyright 2010

In plain terms, SciVerse Hub is an entry point for library users to simultaneously search the contents of:

  • Scopus (a subscription database indexing 18,000 titles from more than 5,000 international publishers including coverage of 16,500 peer-reviewed journals in the scientific, technical, medical and social sciences literature)
  • Science Direct (a subscription access point for searching 10 million articles from over 2,500 journals and 6,000+ e-books, reference works, book series and handbooks issued by Elsevier)
  • SciTopics.org (a free online expert-generated knowledge sharing service for the global research community)

Scirus.org® is a scientific search engine (created and maintained by Elsevier).  Scirus currently indexes 38 million websites found on open-access and mostly educational, scientific or government sites, incorporating what librarians refer to as grey literatureScirus will search these sources separately and bring back a sorted list of retrievals (with duplicate citations removed) to the SciVerse Hub site.

(Note: When I teach a Google Scholar class, considerable time is spent comparing along with the class participants why retrievals using Scirus.org to search for scientific information tend to produce “better” results than G–gle Scholar. Time well-spent, IMHO.)

Following are two screenshots from the SciVerse site:

Image Source: http://www.info.sciverse.com/what-sciverse – All rights reserved – Copyright 2010

And this page:

Image Source: http://www.scopus.com/home.url – All rights reserved – Copyright 2010

Note that the capability of searching each individual resource separately has been retained.

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An informational video on SciVerse is well worth watching (and short at 3.5 minutes in length)… link to it here.  Another helpful reference resource: an 8-page training handout for using the new site which can be downloaded here.

In promotional materials, Elsevier refers to SciVerse as a “new knowledge ecosystem“. Their information products are integral to the daily work of clinical, health science and scientific research library users worldwide. Here’s hoping this migration runs seamlessly (as in: invisibly and glitch-free).

Image Source: http://www.info.sciverse.com/what-sciverse – All rights reserved – Copyright 2010

News, Academic Libraries, Medical Literature: For Wiley Journals, A New Look

Image Source:  http://info.onlinelibrary.wiley.com/view/0/index.html – All rights reserved – Copyright 2010.

In a next week, those who rely on subscription journals or database content from John Wiley Company – one of the largest sci-tech-medicine international publishers – will notice a major redesign of their website.

The familiar Wiley Interscience page is going to be replaced by their new portal, Wiley Online Library. While plans are put into place for the switch-over on Saturday, Aug 7, 2010, users may notice some downtime on the Interscience site.  (Both sites cannot run simultaneously.)

Following is a screenshot of the company announcement made in April 2010:

Image Source:  http://info.onlinelibrary.wiley.com/view/0/index.html – All rights reserved – Copyright 2010

Note:  The implementation of the new portal includes our subscription to the Cochrane Library.

Any major migration in technology can present some access or usability challenges.  (Forewarned is forearmed, the old saying goes.)  If you have bookmarked specific links to Wiley journal articles or e-textbooks, you will need to update the URLs to the new site…  as the old links will stop working within a few weeks.

Here’s hoping for a smooth transition for Wiley!

Teaching & Learning in Medicine, Research Methodology, Biostatistics: Show Me the Evidence (Part 3)

This post is the third in a series entitled Show Me the Evidence. It is about the evidence gained from bibliometric data and journal impact factor analysis.

Let’s start with an excerpt from an 2008 article:

The assumption that Impact Factor (IF) is a number absolutely proportional to science quality has led to misuses beyond the index’s original scope, even in the opinion of its devisor*. When the IF is inappropriately attributed to all articles within a single journal, it leads to false applications regarding the  evaluation of individual scientists or research groups. This is, unfortunately, a common practice, especially among governmental funding boards and academic institutions entitled to judge scientists for positioning and grant allocation. The IF has thus accumulated huge strength and importance, mainly implied by its, at least to a degree, undue application as an index of overall scientific quality“.

Excerpt on page 1 from “The Top-Ten in Journal Impact Factor Manipulation” by ME Falagas and VG Alexiou, published in Arch Immunol Ther Exp (Warsz). 2008 Jul-Aug;56(4):223-6 – All rights reserved – Copyright 2010

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This post was sparked by a recent reference question from a retired professor who needed some assistance on how to find and search the Journal Citation Reports® database*, which is described by its’ producer, Thomson Reuters,  in this way:

Journal Citation Reports® (JCR) offers a systematic, objective means to critically evaluate the world’s leading journals, with quantifiable, statistical information based on citation data. By compiling articles’ cited references, JCR® helps to measure research influence and impact at the journal and category levels, and shows the relationship between citing and cited journals. “

Text source: Thomson-Reuters –http://wokinfo.com/products_tools/analytical/jcr/ – All rights reserved – Copyright 2010

So let’s take a look ways to find current evidence about publication patterns in the biomedical literature.

There were two things about JCR® that needed explanation for the professor.  First, the latest annual edition of JCR® was released in June 2010 and indexes journal citation data for the 2008 calendar year only (not 2009).  Second, only those journal titles indexed in the Web of Science database* are searchable in JCR®.

As one example: Let’s say that you’re a scientist working on stem cell research and you subscribe to ten international journals that are critical to your continuing professional knowledge, lab work and research.  It’ll be a good idea to check the list of 6,600+ journals that are included in the Web of Science database in order to determine if your “best” journals are searchable in Journal Citation Reports®.  If those titles are not covered in JCR®, you’ll be missing essential facts for comparing bibliometric data.

Here is a screenshot of a search done on the 2009 JCR® database for journals indexed under Cell and Tissue Engineering:

Image source: Thomson-Reuters – All rights reserved – Copyright 2010

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Some folks assume that “every journal in the world” is included in Journal Citation Reports, but that’s not the case.  9,100 journal titles were indexed in the 2009 edition.

Another thing to know is that there are six subsets available for annual subscription from  JCR® and UConn Libraries subscribes only to these two: Science Citation Index Expanded (indexing of 7,100 major journals across 150 disciplines and Social Sciences Citation Index (2,474 journals across 50 social science disciplines).

Below is a screenshot from an online tutorial about ways to search Journal Citations Reports® (with my added comment in the upper left-hand corner):

Image source: Thomson-Reuters – http://thomsonreuters.com/products_services/science/science_products/a-z/journal_citation_reports – All rights reserved – Copyright 2010

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Next, the professor asked: “I have a manuscript to submit for publication.  Is this the only place I should use to look at statistics about specific journal titles? “.

While JCR® is an important reference resource, it’s neither free or the only one available worldwide for researchers to search.  Below are sites which provide evidence that there are other ways to do citation analysis in year 2010 (some are free, some are via subscription).

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SCImago Journal & Country Rank Indicator (SJR). I like this site – it is easy to learn to use.  There are many ways to search their datasets (ranked by country, by journal title, by countries grouped by continent, etc.).  I also found their Map generators intriguing, which show comparative relationships between discipline or subject-specific citations.

Below is a screenshot of the SCImago Journal & Country Rank page showing a search done on Year “2008”,  “Medicine” as a general category, “Emergency Medicine” as a specialty and USA for the “country, with a limit for displaying journals that had at minimum 12 citable documents over 8 years:

Image source: http://www.scimagojr.com/journalrank.php – All rights reserved – Copyright 2010

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Link here to a 2007 paper written by the creators of SCImago which describe the process by which journals are ranked on their site.

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Those who have access to the Scopus database* through their library may have already discovered the Scopus Journal Analyzer, where allows one to select a discipline (shown below as “Biochemistry, Genetics and Molecular Biology”) and a journal title (“Cell” was searched below) and then choose method of analysis to determine journal impact.  Elsevier is the producer of the Scopus database. 15,000 journal titles are indexed for inclusion in Scopus analytics.

A screenshot below shows results of a search performed in Scopus Journal Analyzer recently for the broad topic of Biochemistry, Genetics and Molecular Biology.  The journal Cell holds the most-cited place in the list (no surprise there):

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The journal analyzer can be sorted using the following criteria: SJR versus SNIP.  I  found out that four years of data are necessary for sorting results using these filters.  Below, see a different screenshot:  rankings by SJR and SNIP for the same subject area:

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Explanations for SJR and SNIP were easily found in the Scopus Help section (screenshots shown below):   

Credit for all Scopus Images shown above: Elsevier B.V. – All rights reserved – Copyright 2010

Want a different way to search Scopus analytics for evidence? Use the search feature in Journal Analyzer to select and compare up to ten Scopus sources on number of citations, documents, and percentage not cited.

A 12-page PDF white paper (from 2006) is available to download from Scopus, entitled “Using Scopus for Bibliometric Analysis: A Users’ Guide“.  Following is an excerpt from that document:

Introduced in January 2006, the Scopus Citation Tracker enables users to easily evaluate research by using citation data. This tool offers at-a-glance
intelligence about the influence of a set of articles, an author or group of authors over time, so users can quickly spot trends using a visual table of citations broken down by article and chronology
. “

Text Source:  Courtesy of Elsevier B.V. – All rights reserved – Copyright 2010

Two other Scopus pages which I found useful were the Scopus Top Cited page and Scopus Journal Metrics Factsheet.

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No use trying to make this post pithy.  It would be an error not to mention the following means of assessing the scientific literature:  Eigenfactor, h-index and JANE.

University of Washington biology professor Carl Bergstrom and colleagues created the  Eigenfactor Project™.   The main webpage is  http://www.eigenfactor.org.

Give the interactive map a try: click here. Here is an example for Molecular & Cell Biology Map:

Image Credit:  http://www.eigenfactor.org/map/ –  All rights reserved – Copyright 2010

Following is an excerpt from a May 2007 article that Dr. Bergstrom wrote for the Association of College and Research Libraries publication, College & Research Library News:

We can view the Eigenfactor score of a journal as a rough estimate of how often a journal will be used by scholars. The Eigenfactor algorithm corresponds to a simple model of research in which readers follow citations as they move from journal to journal. The algorithm effectively calculates the trajectory of a hypothetical “random researcher” who behaves as follows: Our random researcher begins by going to the library and selecting a journal article at random. After reading the article, she selects at random one of the citations from the article. She then proceeds to the cited work and reads a random article there. She selects a new citation from this article, and follows that citation to her next journal volume. The researcher does this ad infinitum.

” Since we lack the time to carry out this experiment in practice, Eigenfactor uses mathematics to simulate this process.

” Because our random researcher moves among journals according to the citation network that connects them, the frequency with which she visits each journal gives us a measure of that journal’s importance within network of academic citations. Moreover, if real researchers find a sizable fraction of the articles that they read by following citation chains, the amount of time that our random researcher spends with each journal may give us a reasonable estimate of the amount of time that real researchers spend with each journal.

Text source: College & Research Library News – Vol 68:5 (May 2007) – All rights reserved – Copyright 2010

A slideshow presentation created by Dr. Bergstrom and presented at a conference hosted by Microsoft in 2009 can be viewed here.

Professor Alan Fersht wrote an article in 2009 published in PNAS Vol. 106(17):6883-4 (Apr 28 2009) entitled “The Most Influential Journals: Impact Factor and Eigenfactor” which is available free online on the PubMedCentral website.

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Physics professor Jorge E. Hirsch wrote a paper published in 2005 in PNAS entitled “An Index to Quantify an Individual’s Scientific Research Output“, in which he outlined the algorithm known as the Hirsch Index (or h-Index).

And – LOL – according to Scopus, that PNAS paper by Dr. Hirsch has been cited 575 times!

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JANE (or Journal Author/Name Estimator) is a software tool created in 2007 by members of the Biosemantics Group, a collaborative group at the Medical Informatics department of the Erasmus MC University Medical Center of Rotterdam and the Center for Human and Clinical Genetics of the Leiden University Medical Center.  Following is  how the creators of JANE describe the purpose of the tool:

Have you recently written a paper, but you’re not sure to which journal you should submit it? Or are you an editor, and do you need to find reviewers for a particular paper? JANE can help!  Just enter the title and/or abstract of the paper in the box, and click on ‘Find journals’ or ‘Find authors”.  JANE will then compare your document to millions of documents in Medline [over 10 years] to find the best matching journals or authors. ”  —

Source: http://www.biosemantics.org/index.php?page=jane – All rights reserved – Copyright 2010

M. J. Schuemie and J.A. Kors – two of the creators of JANE – published a paper about the software in the journal Bioinformatics – Vol 24:5 (Mar 1 2008).

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* Dr. Eugene Garfield was a co-founder of the Institute for Scientific Information, the producer of Science Citation Index.  A professor at the University of Pennsylvania and a prolific author, Dr. Garfield is now 85 years old.  Here is a link to his website.

In 1955, he wrote a paper titled “Citation Indexes to Science: A New Dimension in Documentation through Association of Ideas“, published in the journal Science (Vol. 122:108-111).  The online version is available to be read at this link.

From looking around on his Library website (url above), I think he has a sense of humor and the soul of an archivist. A great deal of his professional life has been taken up thinking about information management, and the ways in which scientists use their literature. I – and other librarians everywhere – should thank him for being an early adopter!

For example, in a commentary he wrote in 1963 published in the journal Science (Vol. 141:3579 – Aug 2 1963), titled “Citations in Popular and Interpretive Science Writing“, he admonishes mainstream periodical editors for not including basic volume and issue information.  Here is a direct quote: ” Librarians and scientists spend hundreds of hours tracking down precise literature citations which are missing in articles published in otherwise reputable publications like Scientific American, the New York Times, or The Sciences-a task that could be eliminated if brief but complete citations were given. This is certainly false economy and annoying “.  Garfield… You go!

The text of a presentation he gave at the International Congress on Peer Review And Biomedical Publication (2005) can be read online at  “The Agony and the Ecstasy: The History and Meaning of the Journal Impact Factor“.

I performed an author search on PubMed for his publications and created a small group of citations, those search results can be viewed here.

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In addition to thanking Dr. Garfield for creating this field of citation analysis, there are many fellow health science or academic librarians whose work has helped me understand this complex subject, or who have made public their own instruction for others to benefit from. These folks deserve recognition (and applause!).

Thanks to UCHC collection management librarian, Arta Dobbs, for her suggestions and explanations of sources and methods of bibliometric analysis.

Thanks to Janice Flahiff and Jolene Miller, librarians at Mulford Health Science, University of Toledo (Ohio) who have written a great fact sheet on the uses and misuses of interpreting journal impact factors.

Props to Kathi Sarli, health science librarian at Bernard Becker Medical Library of Washington University of St. Louis,  wrote a very useful library guide called “Tools for Authors“… check the section-tab for “Preparing for Publication“.

I enjoyed watching an excellent tutorial on Journal Impact Factors produced by librarians at the Ebling Library for the Health Sciences, University of Wisconsin-Madison.

Finally, remember this is all about Publish or Perish.


* Subscription via UCHC Library.  If off-campus, use your library proxy number to connect.

News, Medicine, Librarians, Blogosphere: Participate in Medlib’s Blog Carnival – June 2010

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

Big News!

EBM and Clinical Support Librarians@UCHC has been invited to host Medlib’s Round Blog Carnival for the month of  June 2010. How does this work?  Here is an excerpt from the Blog Carnival FAQ page:

Welcome to the Blog Carnival page! We love the idea of blog carnivals where someone takes the time to find really good blog posts on a given topic, and then puts all those posts together in a blog post called a “carnival”… Carnivals are an edited (and usually annotated) collection of links that lets them serve as “magazines” within the blogosphere…

Since blog carnivals include lots of posts on specific topics, they also serve as a place to connect with those who are expert (or at least highly opinionated!) and those who are interested in that field. Blog Carnival simplifies carnivals for two kinds of people:  People who read and contribute to blog carnivals, and  people who organize and publish blog carnivals.

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What is the subject for Medlib’s Round Blog Carnival?

As a reference and public services librarian, over the years I have assembled a group of classic questions or library patrons in my mind that could be summarized as:  Questions (or People) I’ll Always Remember at the Health Science Library“.

This intent of this collaboration is learn more about the unique experiences of others librarians worldwide, or from those who work with health science librarians to teach, train and find medical information.  

Who should submit to the Medlib’s Round?

Bloggers from around the world

Medical/reference  librarians, folks who blog about clinical reasoning, evidence-based medicine, teaching and learning medicine (or practicing medicine).  I would appreciate hearing from physician- or scientist-bloggers who collaborate with health science librarians, medical students and others as they use digital library collections.

What should I write about?

Funny, sad, poignant, teachable moments (or people) encountered in your health science library.

  • Librarians: Please share some positive “memorable” encounters that took place in a public service/reference desk setting, over your career.
  • Clinicians, researchers,  pharmacists, graduate students, nurses: If your clinical or educational work as a scientist or care-provider has been positively enhanced by working with a librarian or librarian-instructors in health science library settings, please share your stories with us.

Is there a deadline to submit an entry?

Yes – please write your article, post it to your blog and send it to BlogCarnival.com no later than Tuesday, June 8th.

OK – I have an article to share.  Now what do I do?

First, go this link at BlogCarnival.com and paste the URL of your blog post using their online form.  You’ll need to also type in your name and email address.  (See screenshot below).  BlogCarnival will manage it from there.

Image/Photo Credit: http://blogcarnival.com/ – All rights reserved – Copyright 2010

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Questions – I have Questions. Who do I ask? Send an email message to ebmblog@gmail.com.  Thanks in advance!

Academic Medicine, Teaching & Learning in Medicine: Announcing a New Series called Learning Medicine

It’s looking more like spring each morning in the Northeast, after a nasty late winter. There are daffodils poking out of the ground. The days are growing longer. This morning I saw a green bagel in the cafeteria because tomorrow is St. Patrick’s Day*.

This makes it a good time to try something new on the blog. Today marks the first post in a series which I have titled Learning Medicine: Ten Questions.

The series is intended as an open dialog between current and former medical students, educators, clinical researchers, PBL facilitators, librarians (and anyone else I can rope into answering 10+ questions!). The content or questions in the interview may vary, depending on the background and professional experience of the interviewee.

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Today, please welcome esteemed veteran blogger and physician Graham Walker!

A Background Question – Who Are You?

Graham Walker describes himself in this way:

I’m a second-year Emergency Medicine resident at St. Luke’s-Roosevelt Hospital System in New York City. I was originally a medical school blogger (at the now-defunct Over  My Med Body! ) blog. Recently I’ve returned to blogging as a contributor to The Central Line, the official blog of the American College of Emergency Physicians.

My interests include: surviving residency, technology and web design, simulation medicine, informatics, health policy and caffeine highs.  I’m originally from Kansas, went to undergrad at Northwestern in Chicago, studying social policy/health policy, then went to Stanford for med school with a concentration in Community Health.

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Making the transition from undergraduate/or pre-med to graduate medical student

Can you name 4 or 5 key things that (in retrospect) you wished you had known before you began your first day of medical school?

Oh boy. Hopefully I can still remember anything about being a premed!  Here goes:

1) Know how you study, and develop good study skills in undergrad. Medical school is tough — they say it is like trying to drink water out of a firehose — so make sure that you’ve got a system in place to organize information in your head and commit it to memory.

For some people that’s flashcards, for others it’s study groups; for me, I *still* find I have to write things down in a notebook to get them to stick.

2) Know how you relax, and don’t give up doing that. For some people, that’s going to the gym. For others, that’s playing the guitar. Or doing a hobby. Or keeping in touch with your family. Medical school (and residency even more-so) requires copious coping mechanisms so have yours ready.

3) Get by with a little help from your friends. Don’t be a gunner in medical school. You’re in — You get to be a doctor — Yay!  Med school will be much easier if you work together with your classmates rather than view them as competition — *especially* once clinics start.

4) It is normal to feel overwhelmed. Accept it and embrace it, and it won’t be so stressful. There are parts of it that you’re going to hate, that are not going to be intuitive. But it will get better!

5) Try to get yourself all figured out. Know yourself by the time medical school starts, because while you’re in the thick of things, it’s easier to have as many of your own internal issues worked out before trying to ascend Mt. Medical School. “

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Being a Person AND a Medical Student

Please tell us about some moments in medical school or clerkship that:

Made You Angry: I remember two instances that made me upset: one was the way some OB-Gyn residents were talking disrespectfully about a terminal cancer patient. (I actually kind of understand their perspective as a resident now, but still don’t agree with it.)

The other was a grossly abnormal physical finding in a patient that I found that a group of residents chose to ignore, because I was a medical student. As the medical student, you are — more than anyone — your patient’s advocate. Know when to speak up.”

Made you wish you had Studied More: “ The Boards. But you always wish you could memorize more. Do your best, and move on “.

Brought Tears to your Eyes:  “ I remember it like it was yesterday. It was on my medicine rotation, one of the first patients that I really felt was “mine.” My residents let me “be in charge” as much as I could, and I fought for him to get a much-needed foot amputation. I was off or post-call one day, and I remember coming back the next morning and finding out he had died.

I wrote up the experience: Wonderful, Just Wonderful, Dr. Walker at: http://www.grahamazon.com/over/2006/02/wonderful-just-wonderful-dr-walker/ “.

Made you Roll on the Floor Laughing:  “ Slap-happy post-call. I’m known for being a little hyper and a bit of a morning person, which usually drives people crazy. Also any shift in the Emergency Department “.

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Learning Medicine, Becoming a Doctor. Empathy, gravitas, demeanor, honesty

Part A:  How does one learn to “act like a physician”?   (It’s not really in a textbook.)

I certainly steal bits and pieces from different mentors and heroes of mine. A phrase from this attending, a style from that one. Tips and tricks along the way.

There’s no one way to “act like a physician,” and often it changes for the situation and the patient. I’m a different type of doctor when I’m seeing an infant compared to when I’m evaluating a trauma patient or interviewing a 95 year-old. Being able to adapt and change: maybe that’s the ticket. ”

One area the third-year medical students are concerned with is effective communications with patients and their families when managing someone with a terminal illness, in palliative care or especially when attending unexpected deaths due to accidents, homicide, military, etc.

Part B:  How does a physician learn to “deliver bad news” to a patient or their family members?

Get at or below the patient or loved one’s level. Empathize. Speak in private. Speak their language, if you can. (Learn as many languages as you can.) Make eye contact. Be direct, calm, and compassionate. Tell them however they’re feeling or reacting is normal and okay: everyone reacts differently.

Be present in the moment.  This is one of the hardest things for me to do now, and I have to remind myself of it, especially in a busy emergency department. Don’t worry about what’s happening to the rest of the team, or the other patients, or the rest of the department. Just be there, if only for a few minutes.   Apply the Golden Rule “.

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Congratulations – You are now a resident!  Choosing a specialty.

Match Day is Thursday, March 18, 2010. Can you describe the process that allowed you to select a medical specialty (Emergency Medicine) and why?

Man, it’s hard to remember, because my view of the specialty has changed so much as a resident. I remember really connecting with the type of attendings and residents who went into Emergency Medicine.  My type of people, I guess.

They say it’s much easier to rule out specialties than rule any in, and that’s very true. I was the type of medical student who enjoyed most of my clerkships, but in the end, I chose the one that I thought I’d enjoy, be challenged by, and excel at. ”

What advice would you give fourth-year students as they learn their Match and prepare for residency?

Get excited, relax, and get scared. Residency is not anything like a harder version of medical school, like I imagined it to be.  Enjoy your last few free months. Travel. Get married. Spend time with the people who are important to you.

Do. NOT. Study. And most of all: learn Spanish “.

Do you ever get enough sleep?

Yes, I do. My program is pretty resident-friendly in that regard, and I think it makes us all better, happier, more efficient, and more compassionate doctors. It’s hard to go the extra mile (which is what you realize you have to do as a resident) when you’re exhausted and cranky. ”

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Since this blog is written to inform readers about health science literature, trends in medical or scholarly communications, effective search strategies and sources, the next question focuses on your experience in learning to effectively use health science literature, sources for evidence-based practice or anything digital.

Have your information needs and/or searching behavior(s) changed between medical school and residency?  Are mobile computing resources and technologies important to you?

Definitely.  In medical school it’s all about learning about the basics, and the basics of how you treat X.

In residency, it’s much more about management, when to use what, finesse, and pattern recognition. I think it’s different for every specialty, too.

Regarding searching for clinical evidence, which sources, journals or databases have you found most-useful in answering clinical or patient care questions over time?

Great question. If I’m going to anything, it’s usually either UpToDate or E-Medicine or straight to actual papers, via Pubmed.

I really like JAMA’s Rational Clinical Examination series, as well as BestBets, The TRIP Database, Cochrane Reviews, and often just… Google.  I also keep a private little blog of things I’ve learned and journal articles I want to hold onto for future reference.”

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What aspect of medicine/science digital communication and/or particular use of the Web for medicine or patient care interests you the most? (This is a completely open-ended question.)

I love Podcasts, Videos, Image Banks and clinically-useful blogs. It’s a whole other style of learning that helps you learn more when you’re tired of reading journal articles, review articles, or textbooks. ”

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Bonus Question: What question would you like to ask the readers? – or – What do you want medical students who read the EBM and Clinical Support Librarians@UCHC blog to learn from our interview?

I’d love to know how the students think medicine is going to change in their lifetime.

What do they think of the blurring of private/public life through [social media sites such as] Facebook?  Should we as doctors hide our private lives — that is, is it inappropriate for a patient to see a doctor, say, smoking or drinking on a site like Facebook?

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And that’s the first interview for Learning Medicine: Ten Questions series.  Special thanks again to Graham Walker for sharing his time, expertise, advice and experiences.

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Happy St. Patrick’s Day!

Scholarly Publishing, Research, Academic Libraries, Content Management: Seismic Changes, the We and the It (Part 1)

Read this (and then perhaps LOL):

Y2K in the Wider World… Come January 1, 2000 will we have power? Will we be able to get money out of our bank accounts? Are cities preparing for chaos and civil commotion, or are they assuming all will be well? We talk with representatives of the power, banking, and air travel industries, as well as San Francisco city government to find out how concerned they are and what preparations they are making for the roll-over to the next millennium. “

Found on the Internet Archive – Excerpt take from a feature on Y2K including a 29-minute video, shot in March 1999, in which City of San Francisco administrators and officials from commerce discuss their preparations for Y2K.

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As we approach the end of the first decade of the 21st century, one can only marvel at how fast these ten years have gone by.

For those who were working in 1999, do you remember it in this way: as a brief and unique historical period when many otherwise rational and deliberate people working in professions governed by highly-computerized, networked environments (which includes anyone working in an academic library) were bugging out over Y2K ?

Here is an extreme example of what some feared would happen on the first day of the New Millenium: link to a classic Nike Y2K commercial (filmed in San Francisco) that is still great to watch:

Video Credit: http://www.youtube.com – All rights reserved – Copyright 2009
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Happily, the actual Y2K disruptions proved to be minor. And the power didn’t go out on January 1 2000!

As year 2010 approaches, a potential action-list for academic libraries in the near-term is described in a recent report from folks at OCLC with input from members of the RLG Partnership Research Information Management Roadmap Working Group.

Following is an excerpt from this November 2009 report:

Researchers are drowning in a deluge of raw data and published information, and face a bewildering array of options for disseminating and sharing their work. The choices these researchers make have implications on intellectual ownership, potential audience, ways of measuring impact, potential re-use, and long-term preservation. ”

Source Credit:  “Support for the Research Process: An Academic Library Manifesto“, posted November 2009 online by OCLC – All rights reserved – Copyright 2009

This position paper is available full-text (at no cost) from this link.  Here is a Wordle cloud created today, using key words or phrases plucked from the report:

Image Credit: http://www.wordle.net/ – All rights reserved – Copyright 2009

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As 2009 winds down, I offer no predictions as to new directions or demands which the academic  library and library staff will meet.  Only that each year, the physical impact of the “real” library will shift to accommodate ever more virtual resources.  The monies and staff time spent in providing links to the “digital” library presence will increase.

But I’m an optimist.  Having been a librarian since 1991, I truly believe that our professions’ highest skill and value lies in our unique abilities to serve our faculty, clinical staff and students in the “librarians-as-educational-midwives” mode.

Consider the “we” and the “it“. By this,  I mean “it” as a Reference Transaction conducted between a librarian and an individual (or a group) with the purpose of addressing a unique question or research requirement… it makes little difference whether the persons are standing together in the library, or talking on a phone or using email (or Meebo).

Any reference librarian can tell you that the “it” query is a conversation unique to those two individuals.  One of the fun parts of being a reference librarian is that the questions are always different, and often you learn as much as the library user when doing the research with them!

Who is the “We“?  A group of people with diverse functions and roles, all of which are necessary to make an academic library operate efficiently… humans who buy materials, teach users, circulate and shelf books physically or digitally, maintain the electronic infrastructure, put paper in the copy machines.

We (the librarians) consider what in the world is available to collect, of what value these resources will be to our users.

We buy appropriate, comprehensive and current materials to be added to the library collection (real or virtual).

We sign contracts with information providers based on our needs as an institutional library, and in accordance with strict fiscal rules and conditions.  There is never enough money available for all that we need to collect, but we do the very best with what monies are available, and we evaluate the collections annually.

We provide the intellectual organization as well as maintain the physical environment as well as the systems architecture or framework by which to search for these materials.

We get that information out onto the virtual (or real/actual) shelf to be found by the user.  We index, evaluate, weed.  We keep the real machines (and lights) running and also the website or information portals.

We get the call at 2:00am when the machines wink out.  We get to contact the publisher(s) to report – and resolve – problems with digital access or missing subscriptions.

In the library of 2010, “we” represent the experienced staff who instruct, demonstrate and train those who ask about what (of many) resources to search, how to search these to retrieve relevant information.

We ask our users to consider the relevancy of their retrievals, and if needed, to begin the process again using other literature sources (that “we” suggest).

Once information that is deemed “good” by the user has been found (because we don’t decide that… the user does!), we select and provide software and instruction to effectively manage the accumulating output of these searches.

The “it” and the “we” are not services that will ever be provided by a quick search on Google (or Google Scholar).

The “We” can teach practically anyone to search effectively and competently on PubMed in under an hour and that is a point of pride among our profession, whether the particular we is a health science librarian in Seattle, Cleveland, Munich or Mexico City.

We provide the person-to-person answer for those questions.  While machines are essential to the work of the academic-research libraries, for now only humans can complete the educational role.

In spite of free search engines, open access journals, tons of virtual points of access to content or social-networking opportunities, the services and collections provided by a formal academic health science library (and staff) remain integral to the pursuit of scientific research.

This discussion is Part 1… other threads in the mix will be followed up in Part 2 (TBA later this week).

Please let me know what you think.

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As to non-library predictions for the coming year, this article from the Dec 29 2009 Wall Street Journal (digital edition) examines a few controversial ideas from a Russian professor, Igor Panarin, about the future of the United States.  The content is available (at no cost) at: http://online.wsj.com/article/SB123051100709638419.html

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* As a former Californian and resident of San Francisco, where The Big Quake hit on April 18-23, 1906, I’ll verify that it is unsettling to live in earthquake country.  Here is a link to an eyewitness account of that disaster written by Dr. George Blumer, among many other descriptions of events written by those who lived through it, posted on The Virtual Museum of  the City of San Francisco site. Bay Area public health officials continually prepare their rescue personnel (and citizens) for future earthquakes by practicing a staged mock-disaster each year.  Also see public service/public health promotion and emergency preparedness tips at: http://72hours.org/.

Instruction, Information Seeking Behaviors, Clinical Evidence: Teaching with EBM Databases

This has been a busy month. The final first-year PBL class will be wrapping up, as the semester ends on Friday, Dec 18 2009.

On Monday, I taught an evidence-based medicine class for 28 third-year medical students (which I’ve done since 2001).  It is part of a week-long curriculum that all third-years attend as regular breaks from their clerkship rotation schedules.  They come back to the Health Center (for “Home Week”).

This 90-minute course represents a real opportunity for a librarian to connect with advanced students who are already savvy users of the medical literature.  They have completed two years of basic science and human systems curriculum, and have participated in four semesters of problem-based learning.  Each has passed the USMLE Step 1.  By this point in their graduate education, they are dedicated users of PubMed and Up to Date.

The location is one of the large classrooms equipped with computers, or students use their own laptops so that everyone gets to use a resource together.  Sometimes it gets pretty loud in that room!  The instructional challenge is to keep the content fast-paced and interesting enough for these experienced searchers while introducing (and convincing them to test out) some new clinical resources and search techniques.

Utilizing a PICO strategy (Patient or Problem-Intervention-Comparison of Treatments-Outcome) is briefly discussed.  The first half of the class is devoted to locating and applying MeSH headings and subheadings for effective search strategies and showing them ways to use the Clinical Queries search engine.  The student are asked to register for their own MyNCBI account in order to begin to organize their searches or create collections of documents in the future.

Always I ask this group if any are currently searching the SCOPUS database in addition to PubMed.  Their response?  Most are not, and that surprises me a bit.  However, once they view the links to online reference lists and “cited reference searching” capability in SCOPUS*, I’d venture a guess that 100% of this group will be using it from that day forward!  It is a database that generates instant loyalty for most users.  

Other EBM resources covered briefly are the five segments and uses of Cochrane Library, ACP Journal Club, JAMA Evidence-Guide to the Medical Literature (a digital subscription resource), and the classic BMJ series on How to Read a Paper (open access).  Ideally I end up with sufficient time to demonstrate using the TRIP (Turning Research Into Practice) clinical search engine.

The LibGuide used for the class is linked here.

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During their clerkship year, third-year students favor putting as many of the subscription resources as are available onto their PDAs.  Having drug-interactions databases, clinical DDx or algorithm calculators and a disease photo-atlas in their coat pocket comes in very handy (no pun intended) as they travel to different hospitals for their clinical rotations.

PDA resources popular with this group include Lexi-DrugsDynaMed and Diagnosaurus (which is free).

Two of the databases that I featured in the EBM class this week were ACP-PIER (American College of Physicians-Physicians Information & Education Resource) which UCHC library subscribes to via Stat!Ref, and Essential Evidence Plus (EEP) from Wiley-Blackwell.

Here’s a screenshot from EEP:

Image credit: http://www.essentialevidenceplus.com/content/eee – All rights reserved – Copyright 2009

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A press release from the company, issued Dec 14 2009, describes their new ‘point of care’ product:

Wiley-Blackwell today announced the launch of Essential Evidence (EE), a new product for PDAs which has been added to its online evidence-based, peer-reviewed subscription Essential Evidence Plus, a source which provides access to: Practice Guidelines, Decision Support Tools, History and Physical Exam Calculators, Diagnostic Test Calculators, the Derm Expert, ICD-9 Lookup Tool, Patient Education Handouts, links to Cochrane Systematic Reviews, and 950+ high quality photographs. Essential Evidence Plus links to Daily POEMs (Patient Oriented Evidence that Matters).

EE for PDAs is a topic-oriented clinical resource tool designed to help clinicians to effectively make diagnoses, chart treatment plans, and determine prognoses.  EE can be searched via the web or loaded onto a handheld computer (Pocket PC or Palm OS). EE currently features 700 structured medical topics and approximately 100 more are in development and will be added to the site soon…”

Text Source: http://www.essentialevidenceplus.com/articles/EE_Launch_12.09.pdf – All rights reserved – Copyright 2009

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And that’s my final formal class for 2009!

( Happy! )

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* How did we (i.e., those of us in academic-health science libraries) function without SCOPUS?  It’s like thinking about the days before cell phones – a time dimly remembered, difficult to recall… sort of like pre-historic times.

News, EBM, Library Resources: JAMA Evidence now available

For those interested in learning strategies for practicing evidence-based medicine, check out the latest digital subscription from UCHC Library:

JAMA Evidence

JAMAEvidence
Image Credit: http://www.jamaevidence.com/ – All rights reserved – Copyright 2009

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Produced by American Medical Association editors and publisher McGraw Hill, content from the digital textbook is also available for mobile applications.

I particularly liked the JAMA Evidence glossary.

If off-campus, connect via your UCHC library proxy account.