The Search Principle blog

My selective list of influential medical librarian and physician blogs neglected the fine folks at the EBM and Clinical Support Librarians@UCHC blog. How is that possible? (Dunno, except I wish they’d leave a librarian’s name Kathleen Crea? for me so that I could at least have more than a creaking idea 🙂 Another person I’d like to meet is omg tuna is kewl, who visits here regularly…

Health librarians can potentially save their hospital administrations thousands of dollars by closely examining (and teaching) the Apple iPhone (see wiki entry). The beating heart below can be viewed via HeartIt and the iPhone.

Normally, viewing medical images requires getting access to dedicated computers that cost tens of thousands of dollars. These stand-alone systems in turn are connected to proprietary picture archiving communications and storage (PACS) systems – costing millions.

To view medical images in 2008, physicians must physically walk to or access these workstations in hospitals or tertiary facilities. Some recent advances in technology can challenge these inefficient models of access for the medical community.

Perhaps the iPhone (or, other mobiles) can provide answers to this access problem? I am planning on getting an iPhone so that I can teach it to docs here at UBC.

My American health librarian colleagues get riled about the U.S. Digital Millennium Copyright Act, but my goodness check out Canada’s Bill C-61 – tabled in the Canadian House of Commons yesterday – and the firestorm of protest it is generating.

For months now, I’ve been surmising that we’d have an anti-digital backlash at some point. Where would it come from? Governmental reaction against Google’s hegemony – and pushing the limits of copyright? Against some other giant in the digital age, like Microsoft or Yahoo? Or, even going after the conveyors of illegal music downloading via the iPod (Apple)?

We had our answer yesterday in Canada at least: Bill C-61.

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Bill C-61 is a real pig of a copyright bill. It trumps even publishers’ resistance to Google book digitization in its inability to acknowledge changes in the way that people live and work in the digital age. What is irksome is how it rules out exceptions to fair dealing (like doing scholarly research) in favour of protecting the rights of copyright holders (i.e. record companies, multinational publishers, software companies, etc.).

For health librarians, Bill C-61 has a direct impact on our plans to introduce desktop delivery of interlibrary loans – something we have been waiting for, for some time. It is blatant in how it ignores the 2004 CCH / Law Library, Supreme Court ruling permitting libraries to copy materials for reseach and to offer desktop delivery.

What are the implications of ruling out desktop delivery? Bill C-61 forces us back to delivering interlibrary loans on paper, thereby slowing down the research process and putting barriers between users and information.

None of this had to happen, of course. As one blogger put it “the music industry allowed this to happen by being obsessed with controlling technology rather than embracing it. A generation has grown up believing that downloading is “normal” – this will only change when people are enticed to design better delivery systems. All the digital locks and laws in the world won’t change that”.

Reference
* The Canadian DMCA: A Betrayal
http://www.michaelgeist.ca/content/view/3029/125/
* The Digital Millennium Copyright Act (DMCA)
http://www.anti-dmca.org/

“Today’s digital youth are in the process of creating a new kind of literacy; .. an evolving skill beyond the traditions of reading and writing into a community of expression and problem-solving …changing [our] world. …the ability to negotiate and evaluate information online, to recognize manipulation and propaganda and to assimilate ethical values is becoming basic to education…”

– Jonathan Fanton, President John D. & Catherine T. MacArthur Foundation

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This UBC Town Hall must have been quite the afternoon. As I am at the hospital, I missed it 🙁
However, check out the presentations, and other information:

“Adventures In Wikipedia”
* Jon Beasley-Murray – UBC Professor
* Brian Lamb, Abject Learning weblog
* Wyeth Wasserman – Professor, Medical Genetics, UBC

Some of you e-mailed me for an opinion about Nicholas Carr’s Atlantic Monthly article about the influence of Google, entitled “Is Google Making Us Stupid”?

The wise T. Scott has discussed the piece, and Marcus is working on his views. It’s interesting how this week seems to be filled with ‘ah-ha’ moments: Richard Smith’s comments about web 2.0, contextualizing web 2.0 in a world of ideas and evidence, and now Googlization.

Isn’t technology’s march inevitable? Isn’t this one of the issues raised by Marshall McLuhan decades ago?

There is always a downside to technology, and a dumbing down of our thought processes, when machines do the work for us. Isn’t this true for many things we used to do for ourselves? manual writing (mentioned by Scott), doing our taxes, making our own clothes. Do I advocate a return to those activities? No, but it’s inevitable that this is happening is my point.

Whether it’s Google, the widespread adoption of social software (i.e. try Twitter as an example) or Facebook – our attention spans are being fragmented, and we need to resist falling into a ‘million little pieces’. Not just for what it does to sustained thinking but also for what it does in terms of eating into our work and private lives.

Reference
. http://www.googlizationofeverything.com/

“Systematic reviews seek to identify as many potentially relevant studies as possible that meet the research question for a given topic.”

Systematic reviews (SRs) are often described as ‘papers that summarize other papers’ – and may be defined as “overviews of primary studies that use explicit and reproducible methods”. Typically, SRs synthesize findings from key, high-powered trials and reports of therapies and interventions using explicit inclusion and exclusion criteria, which may or may not include a meta-analysis.

Over the next few weeks, I am teaching in several residency programs here at Vancouver hospital – and, I’ll be trying to articulate librarians’ roles in the process.

Health librarians’ roles in searching

Information retrieval plays a significant (and even central role) in the formulation of research questions. The goal in the initial stages of finding evidence is to find as many potentially relevant studies as possible. At an early stage, as many sources of information are searched as possible (including the deep or hidden web for grey literature). The goal in the SR is to maximize recall and minimize publication bias. Comprehensive searching for all potentially relevant studies is critical as is the use and documentation of explicit strategies.

Health librarians play a critical role in the creation of SRs, and must carefully document and report their search strategies. Hand-searching and snowballing are recommended for SRs as is searching for the grey literature. The latter involves a number of techniques that can help to locate studies that are not indexed in the major databases such as MEDLINE or EMBASE.

Former BMJ editor, Richard Smith, has written an important blogpost (during a week when I have been thinking about all of these issues). See Smith’s post at the BMJ blog:

‘ Get with Web 2.0 …or become yesterday’s person‘

Dr. Smith is a highly-respected speaker, medical author and thinker. When I read his post, the first thought that crossed my mind was ah-ha! – ‘paradigm shift’. I don’t know many physicians who have written so definitively about the importance of web 2.0 and the information revolution that is engulfing us.

Do physicians need to be purposeful, targeted and strategic in their use of social software? Yes, I believe they do. Physicians are busy professionals, and face enormous challenges globally. In Canada, we face a shortage of them across a range of disciplines. Dr. Smith suggests starting at Facebook, which I think is a great idea (and seems bolstered by the evidence).

However, health librarians can teach the tools of web 2.0 (see the wiki entries, far left) and interrogate the underlying social processes of this revolution. This is why we need to build the evidence-base for the application of web 2.0 tools.

My hope is that I can conduct some seminal research in this area, and I would welcome the opportunity to do a multi-centre trial or survey with a cadre of physicians and health librarians.

I am working on an entry for the UBC Health Library wiki on evidence-based web 2.0 (~700 hits in one day!).

I realize it may be too early for this sort of culling and cumulation of research particularly since the evidence-base is scant – but why not try? Take a look and let me know what you think – do you have some studies you can point me to?

All the best to you, good readers. Dean

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Research questions

* What research or evidence exists that web 2.0 tools are useful in the context of medicine? (We all know they are, but is there evidence, right?)
* What kinds of studies have been done thus far (i.e. surveys, case studies, etc.)?
* Is there any research being conducted within health librarianship?
* Do medical school programs require this kind of information & web fluency?
* Is effective use of social software mentioned in medical informatics?
* What are differences between med students who are digital natives and digital immigrants? (Can this sort of interrogation inform our teaching efforts of social software?)

What does the medical literature tell us?

*Sandars et al (2008) – see also 2007 Sandars study
** 212 first year medical students; survey
**90% med students used instant messaging and social networking sites (70%). No significant difference between males and females;
**Blogs are read by 1/5th of med students; small number (8%) write their own.
**1/5th of men said they used media sharing and contributed to wikis.
**Social bookmarking rarely used by either
**Medical educators need to recognize potential of social software in medical
**Essential that med students maintain informality, and privacy of
**The major challenge is how to integrate social software into current curricula.

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* Tantawi E. (2008):

**case study evaluated blog use for a dental course;

**blog set up using free software; set up to get feedback about course;

**instructor posted multiple choice/true/false questions inviting students to publish

**149 comments were left on blog in response to thirteen posts over three

**users considered blog useful; main reason not to use blog? lack of

**statistically significant difference between students using/those who did not use

**further research re: blogging, and its potential in dental education is needed.

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* Feeney et al (2008):

**article is an introduction to technologies (including social software) for

**Technology pioneers did not expect to replace person-to-person interaction or communication.

**Whole pedagogies have evolved over past few decades that drive and support appropriate and effective use of technology and media in learning and teaching

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* Sandars et al (2007)

**survey; use of web 2.0 tools by medical students and medical practitioners

**semi-structured online questions of 3000 medical students and 3000 medical practitioners

**groups had high familiarity, but low use, of podcasts; ownership of digital media players was higher among med

**high familiarity, but low use, of other web 2.0 tools except high use of instant messaging and social networking by med students.

**groups stated they were interested in using Web 2.0 in education but there was lack of knowledge about how to use new technologies.

**high awareness of web 2.0 but its potential will only be achieved if there is increased training.

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* Bouldin et al (2006):

**Blogs used in reflective journaling exercises in second-professional year of University of Mississippi School of Pharmacy

**To encourage students to reflect on course concepts and apply to environment outside classroom, and assess communication performance.

**Blog entries (2) per week were required for full credit; evaluated at three points during term.

**End of the course, students evaluated the assignment using a 2-page survey instrument.

**Assignment contributed to student learning and increased awareness level for ~40% of class.

**Blogs are useful for reflective journaling; future versions of assignment will benefit from student feedback from this study.

Sim MG, Khong E, Jiwa M. Does general practice Google? Australian Family Physician. 2008 Jun;37(6):471-4

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BACKGROUND Searching websites during consultations with patients has been anecdotally reported to be useful by some medical practitioners. We aimed to investigate how and to what extent medical practitioners use the internet to aid clinical consultations.

METHODS A descriptive study of general practitioners in the Osborne Division of General Practice in Perth, Western Australia (N=132), using a postal questionnaire sent in May and June 2007.

RESULTS Ninety-three percent (93%) of those surveyed had broadband access. The majority used the computer for clinical tasks such as prescribing, ordering tests and writing letters. Fifty-six percent used the internet during consultations. The search engine ‘Google’ was the most commonly cited website. The most frequently mentioned reason for internet use was finding medical information for patients.

DISCUSSION Computers are available in most general practices. The internet has impacted upon the traditional doctor-patient relationship. More research is needed into how GPs can better search and use information on the internet.

I taught a MEDLINE class today in respiratory medicine (at the unkind hour of 0800 hrs), but jump at every chance I get to meet health professionals and engage them in useful discussion around retrieval practices and behaviours. Inevitably, the conversation turns to open access, web 2.0, blogs, wikis and ‘cool tools’.

What evidence do I have that web 2.0 tools are useful? or even effective at doing what they are supposed to do? I am often asked.

This is a question that generally stumps me because I enjoy experimentation (and see it as part of my work). And, I also recognize that our evidence base in this area is non-existent at this point. However, I found an interesting survey of medical students and their use of social software, and will continue to look for others. Once a critical mass of surveys is reached perhaps a savvy health librarian will review the studies, and derive a typology of the most useful web 2.0 tools. Clearly, not all tools are useful in medicine – and some are more useful than others. So, which ones?

This research is timely (and, may even be essential as we move forward) for Canadian and American health librarians. I understand that the issue came up at the recent 2008 MLA Conference in Chicago in the context of how do we know that social software is useful? Don’t we take it on faith that books are useful?

Another question came: “What evidence do we really have that reading books increases knowledge?”

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With respect to the MLA debate of ‘evidence’ around cool tools, I have not heard or seen the MLA webcast, but I remember when the idea came over the Twitter feed.

I assume the point is that both social software tools and books are conveyors of ideas (and knowledge) and that there is little evidence to prove that either increases knowledge. In other words, it is assumed ‘a priori’ that both are potential conveyors of knowledge, and can do so equally.

An elegant idea if it worked, but I don’t believe it stands up to scrutiny. First, books are a kind of technology. However, we can’t separate what books contain – facts, ideas and knowledge synthesis – from the technology. Books are both technological innovations, and containers of ideas.

A better analogy might be that social software tools are more like impromptu discussions, conversations over coffee and one-on-one/group discussions with colleagues. Helpful, enlightening even – but not comparable to book-learning.

In those contexts, information may be useful and even ‘evidence-based’ – but much is not. With books, we know that authors do research before they take up our time; a lit review is done; books are edited for concision by qualified experts. The content is peer-reviewed (and reviewed post-facto by other ‘objective’ domain experts).

This is why we know books increase our knowledge because of what they are.

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So, legitimately, what evidence do we have that physicians (or health professionals) should be using cool software tools over meeting in the hospital cafeteria? Why are web 2.0 tools powerful and link us to the social, collaborative aspects of the digital? Can we quantify the learning that takes place there? Of course, we can.

In the coming years, health librarians (not just MLA members) will need to point users to the evidence that social software tools make a difference to clinical care and clinical practice. Clearly, not all tools are useful – and not all tools provide opportunities for learning efficiently.

Health librarians need to define their roles as we move forward in the exciting information revolution that is web 2.0 – but let’s not shy away from inevitable evaluation processes integral to our work. It would be foolhardy when it is expected by those we serve and those we report to….