evidence-based medicine

There seem to be two dichotomous theories of academic librarianship–the camp of making it easy and the camp of making it good.  By “it,” I am of course referring to searching.

In medical librarianship, this is even more divisive.  There is federated search and there is evidence-based medicine.  You sure can’t have both, unless by evidence-based medicine, you mean using any piece of evidence that you stumble across.  But, it is completely legitimate to want federated search.  Our search tools are incredibly difficult to master, not to mention even to choose between.  Perhaps it is our failing as librarians that our patrons don’t know which tool to use or how to use it, but to be honest, even the best librarians who go out and teach, create excellent and user-friendly guides, and try to make their web presence as easily navigable as possible cannot possibly reach everyone.

Where do I fall in this mess?  I often believe that teaching people how to do complex searching is completely pointless.  I taught a class recently to a group of MD/PhD students where I was primarily teaching RSS and information management strategies.  Now, this same group had gone through a self-paced PubMed tutorial at the beginning of the school year, and each and every one of the students had passed the quiz.  Nevertheless, I rather suspected that aside from one or two of the students, who clearly took the assignment very seriously, most of the students wouldn’t remember a thing.  And of course, since I had opted to teach PubMed instead of Ovid’s MEDLINE, I pretty much knew the whole MeSH terms thing would be long forgotten.  So, I decided to include in this class an hour and a half on searching, so that the students would learn how to build reasonably decent searches to put in their RSS readers.

I suspected correctly, as it turned out.  I don’t think a single one of them even remembered that the MeSH Database existed.  We went through about an hour of PubMed searching–finding and using MeSH terms with the MeSH Database and citation view, Boolean searching (that, at least, makes inherent sense to these students–last year, when I taught the incoming class Ovid MEDLINE, one of the students asked if it just wouldn’t make sense to type 1 and (2 or 3) instead of combining the or’s first and then the two sets, and I nearly fell over, I was so surprised), using the Clipboard, My NCBI, etc.  I stressed over and over the importance of MeSH and subheadings, and rather insulted PubMed quite a bit for its flaws in search interpretation.

I taught Scopus next.  Searching Scopus, as any of you who are lucky enough to have access to it, involves no subject headings, just straight keyword searching.  It also has those fancy little extras like sorting by citedness that make it sort of a “wow” database.  But, I stressed how Scopus was good for some things, like finding classic articles and also having RSS feeds, but not so good for most stuff.  Yet, by the end of my mere half hour on Scopus, one of the students asked me why anyone would use PubMed if you could use Scopus instead.

Now, this student is no dummy.  He is biomedical engineer who will graduate (eventually) with an MD and a PhD (his engineering focus is one major reason why Scopus appealed to him, I am sure).  He wasn’t alone–the entire rest of the class went simply ga-ga for Scopus.  I launched into a spiel on how if I could choose only one database to spend the rest of my life with, it would be PubMed, not Scopus, but I think I had lost them the second no MeSH terms were involved.

Since the main point of my class was getting them to use RSS readers efficiently, I didn’t worry too much about it, but I certainly had my suspicions reconfirmed–even if taught the right way to search, people gravitate to whatever is easiest.  Of course, we all know that what appears to the be easiest just isn’t.  Keyword searching is a pain, especially if you need to be comprehensive.  Searching a database like Scopus is infinitely more complex, because you need to guess at every possibility for keyword combinations unless you are satisfied with surface results.  Sadly, though, I am starting to fall into the easy mindset myself.  I found myself just not finding what I wanted for a recent search (it was hideously broad) using Ovid’s CINAHL, and in frustration, turned to PubMed, where I resorted to keyword searching and the handy and ever-faithful Related Results.  It turns out that MeSH was completely useless for my search.  None of the stuff I found was even remotely similarly indexed.  People come up to me and confess all the time that their searching is terrible; they search PubMed for what they think will work, but it doesn’t even pull up papers they know exist.  I can’t blame these people for being discouraged.  Usually, in such situations, I advocate coming in and talking to me, or relying on the chaining method, depending on the scenario.

There is an evidence-based medicine class that spans quite a time period for the medical students here.  The current instructional method for this class involved a one-hour session on literature searching taught by a physician (no medical librarian involvement whatsoever).  So, is it remotely surprising the students have been coming to me in droves begging for help finding articles?  The last time they had searching taught, they were first years; the second time, they got a whole hour on evidence-based medicine searching.  I am genuinely curious as to what that hour entailed.  Apparently, it didn’t involve clinical queries or EBM filters, because that is a revelation to each student I talked to.  Explode and Focus, also a total mystery.  Subheadings–what are those?

Yet, I cannot wholly disagree with keeping the library out of the EBM educational process.  Apparently, in years past, when librarians were teaching the searching bits, students came out glassy-eyed and bewildered.  And who can blame them?  EBM searching is dry.  And hard.  And, no matter what studies have said, I just don’t believe that group bibliographic instruction actually produces results–one-time group bibliographic instruction, that is.  Librarians who have worked to become entrenched into the very fabric of the curriculum–now, that probably works.  What I find works is meeting with students one on one and getting to know them.  Then, they might learn something when it is meaningful to them, plus they know that I am always there for them.

One of my very favorite students got a residency at our institution for next year, and he asked me if it would be okay if he kept coming to ask me for help, since he knew me.  After saying that certainly, he was always welcome to come to me for help, I got to thinking that, really, I won’t always be there.  Now, I am sure that this student will be chief resident and asked to stay on permanently, so as long as we are both here, I will be there to help–but who knows how long that will be.  But, is it my failing that he still needs that help?  Shouldn’t he have been taught to be self-reliant?  Is it necessary for a neurosurgeon to be able to track down the correct citation to a journal article published in the 1800′s that even I couldn’t verify for two hours?

If our students really need to learn how to do good research on their own, it seems to me that dumbing down the resources they use is a mistake.  A big, big mistake.  But, if they can’t use the resources we have to find anything, much less good evidence, wouldn’t it be better to make our resources easier to use?  For now, I will just hope that there will always be medical librarians who are there to help when people get stuck.

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One response to “evidence-based medicine

  1. “But, is it my failing that he still needs that help?” No, that’s not failure. Failure is when he doesn’t come to you when he needs help. As you said yourself, searching isn’t easy. It is a skill we learn and practice everyday. We shouldn’t expect our patrons to become expert searchers (particularly in one-and-done sessions [I agree, much gets lost in those sessions]), just like I am not a chemist simply because I took general chemistry in college. We have an expertise, and even though I believe anyone can become an expert searcher, not everyone has the time (or desire).

    Don’t get me wrong, I more often than not fall into the “make it good” camp, but the limitations of one-and-done library instruction mean I have limited expectations for the instruction I am able to offer.

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