Clinical librarianship in Canada

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Last Update

This entry is out of date, and will not be updated, June 2017

Introduction

See also Advocacy | Clinical librarianship | Health libraries | Information needs of users | Informationists

What does a clinical librarian do? "... my job involves actually going out of the library to the wards to see the doctors, nurses, physiotherapists, occupational therapists and other clinical staff doing their job. Where they have a decision to make regarding a patient, they are expected to use “evidence based” information. That’s where I come in. I can help find the evidence for them to base their decisions on. Because I’ve been to the wards and the meetings, I have an understanding of what it is they want to know, and so I can get back to the office and use the medical databases we access to find up to date articles and research..." — Pip Duvall, Clinical Librarian, NHS United Kingdom

Clinical librarians throughout the world are governed by many of the same principles and practices of health librarianship articulated by clinical librarians from the United States and United Kingdom. However, judging from the large literature that has been amassed in the area in the past two decades, we thought it might be useful to examine clinical librarianship as it is practiced in Canada, and set out to review the literature as well as any innovative projects and websites we could find in our investigations. To cumulate relevant studies, we searched PubMed, CINAHL and Google scholar as well as a number of library and information databases. Surprisingly, as of 2012, there seemed to be no real survey done about clinical librarianship in Canada (although there were articles outlining recent projects). In 2005, however, a systematic review of clinical librarianship was conducted by Brettle et al. Their well-conducted study was international in its scope, but its emphasis was squarely on the US and UK, which is unsurprising given that these two countries are the leaders in the area. Canada was mostly excluded from the discussion.

As researchers and health librarians, we are interested in exploring what the reasons are for this paucity of published papers about clinical librarians in Canada? Can the absence of published research be extrapolated further to indicate insufficient critical mass of practitioners? Or, is it simply due to the fact that we do not have the same publishing tradition in Canada? Some Canadian health librarians may indeed list aspects of clinical librarianship in their regular job duties and on their vitaes; however, some might otherwise eschew the job title of clinical librarian. So what are the reasons for this? Given the lack of research, it goes without saying that there will be little to no information that might provide insight into our questions. Any consensus about appropriate models of practice, standards and competencies for clinical librarians who practice in Canada will also be lacking. It's with this frame of reference in mind that we begin this exploration.

For a review of this topic, see Halbert H. The state of clinical librarianship in Canada: a review of the literature, 1970–2013. JCHLA/JABSC. 2013;34(02):69-74..

Professional jobs titles & clinical librarianship

Before we examine job titles used for clinical librarians in Canada, a good working definition of the field would be useful as a starting point. At the first UK Clinical Librarian Conference in 2002, clinical librarianship was defined as "...a proactive approach to supporting evidence-based medicine in the clinical setting by providing highly specific, quality filtered, patient-centred information to clinicians." Even though ten years old, this definition uses many cue-words that resonate with descriptions of health librarianship, especially its reference to evidence-based medicine in the clinic and highly-specific quality filtered information. These concepts are central to the work of health librarians not just in Canada but throughout the world. Further, many general reference librarians working in academic health and hospital libraries in Canada would likely use similar kinds of language to describe the work that they do.

In surveying the landscape, its various websites and research, there seems to be a lack of understanding about clinical librarianship and how it might differ from health librarianship. A lack of consistency in terminology across various countries who use the job title is certainly an obstacle. While there is clearly recognition that clinical librarians provide valuable services to clinicians, especially those working at point-of-care, there is considerable room for raising awareness. Health library associations in a number of countries (but especially in Canada) may want to consider marketing the profession and perhaps even sponsoring proper research into the field.

Literature review

In the 1990s, the Canadian health librarian Joanne Gard Marshall engaged in a variety of projects and worked with other librarians and physicians to produce a report on the impact of hospital libraries on clinical decision-making. Marshall's groundbreaking Rochester Study led to other studies using similar methodologies. (Marshall has updated her study on the value of health libraries to clinical decision making in 2011.) In 1991, Groen .... In 1994, also in the Bibliomedica Medica Canadiana, Makowski wrote one of the earliest articles about clinical librarianship in Canada from the perspective of a health librarian. In it, she outlines.... More recently, in 2009, Aitken et al conducted a study of the general internal medicine inpatient medical teaching unit of a large, tertiary care teaching hospital in Calgary, Alberta. Their study involved a direct comparison between an intervention group, whose members were given access to a clinical librarian, and a control group, who did not receive the intervention. The results showed that ...etc

A history of clinical librarianship in the UK says the resurgence of the role in the 1990s is due to its perception “as way to support the busy clinician in meeting the requirements of initiatives such as EBP and clinical governance.” While past research focused on the ‘effectiveness’ of clinical librarianship, evaluation has been limited with one-off doctor-patient interactions used as the basis of assessment, rather than longitudinal studies that seek to address the extent to which attitudes towards and practices of evidence-based medicine are affected over time.

In Canada, the reason for poor awareness of clinical librarianship may be due to our inability to provide an environment “to enable research evidence to drive decisions, either at the clinical level or at the institutional level.” While research on diffusion of innovation and implementation concerns specific settings required for effective outcomes, the difference between Canada and the US in developing clinical librarianship cannot be attributed to funding and privatization alone. The UK also provides universal health care and is at the centre of production for most of the research and studies in clinical librarianship.

One such longitudinal study of clinical librarianship in the UK considers the education, training, workplace, and workload of professionals in order to determine a “definite identifiable” role for clinic librarians and, if so, whether it could provide a ‘blue print’ to enable replication of the role elsewhere. Though the findings report a range of qualifications and clinical specialties, feedback from the survey of NHS librarians indicates that a majority (62% of respondents) had received training about their role and many felt it “increased use and development of Clinical Guidelines” as well as promotion of clinical governance, critical for an environment of clinical librarianship to flourish. It is less clear then how efforts to export the UK model to other countries would be received without these necessary provisions for evidence-based practice.

In 2013, the U.S. Library of Congress published Clinical medical librarians: an annotated bibliography or review of the journal literature discussing the role of library and information professionals known as clinical medical librarians. According to the report, the "...bibliography addresses the dialogue that has ensued since the publication of the Davidoff-Florance editorial with regard to both the merits and applicability of their concept, including specific examples of librarians working in hospitals and in medical research as informationists".

Conclusion

While Canada lags behind other countries in the area of electronic health records, it is often cited as an early adopter for developments in telemedicine. (See Barron et al, 2011). Given the changing and asynchronous nature of online information retrieval, which allows for reference requests from clinicians to be submitted remotely rather than in person, virtual systems and technologies have been theorized as a potential technology that will in time replace models of ‘in person’ clinical librarianship that feature librarians who accompany physician teams on their rounds.

References

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