Aniversario, Joshua

2005-37431
LIS 199
CONCEPT PAPER

A study on clinical librarianship in medical libraries in the Philippines

towards the integration of a Clinical Medical Librarian program

In an era where innovations in science and technology are quickly evolving, influx of

information increases exponentially and poses a lot of challenges. It has always been the struggle

of many librarians to keep up with the changes brought about by these developments. Traditional

library practices cannot be the only role one must play in times where information can be readily

available online with just a click of a finger. As a consequence, librarians have long been finding

ways in order to adapt for survival.

Much like in the health sciences, advancements in the field of medicine make the

management of information become more taxing and crucial as evidence-based researches

increase in quantity. With the technology that allows users to store and retrieve huge volumes of

information, medical professionals may need to come up with a strategy in conducting an

effective and efficient time-sensitive searching and accessing skills since they do not have the

luxury of time given their workload and hectic schedule. The access to tons of information as a

product of these medical advancements may also require them to stay well-informed with the

most recent developments especially in treatments that concern patient care.

The need for medical librarians to mediate between the infinite amount of information

available and the demanding nature of the medical profession has risen and prompted for a

reform in their roles. Alongside the emergence of Evidence-Based Medicine (EBM) and

Evidence-Based HealthCare (EBHC) practice in the medical profession, the roles of medical
librarians intensified as the interaction with medical professionals became stronger, but are yet to

be solidified.

Clinical librarianship is a concept pioneered by Dr. Gertrud Lamb in 1971 at the

University of Missouri, Kansas City (UMKC) in an attempt to answer her question, “Can the

medical librarian with special skills and training in tested methods for approaching the medical

literature serve as a valuable interface between the professional who is taking care of patients

and the knowledge explosion in medicine wherein lies the key to better patient care?” (Lamb,

1975) This brought about the creation of the Clinical Medical Librarian (CML) Program wherein

medical librarians who are knowledgeable in both library science and medical librarianship

participate in medical rounds in order for them to know clinicians’ information needs and

contribute to the improvement of patient care. According to Lamb, the CML role bridges the gap

between volumes of information and its relevance to the health care professional.

Several systematic reviews regarding clinical librarianship have already been written

through the years since its inception. In 1985, Cimpl’s review of the literature stated that the

reason why CML services were offered was “to provide information quickly, to influence the

information-seeking behaviour of clinicians and to establish the medical librarian’s role as a

valid member of the health care team.” In 2000, Davidoff and Florance labels clinical

librarianship as a new and hybrid health care professional called ‘informationist’, who would

“bridge the literature-practice gap”. In 2003, Winning’s systematic review of literature about

clinical librarianship described the clinical role as a “support in clinical decision-making and/or

education by providing timely, quality-filtered information to clinicians at the point of need.” In

2013, Tan and Maggio’s exploratory study of clinical librarian roles defined clinical librarians as
“individuals with a library science degree who, in the context of a patient care team, provide

customized services to meet information needs related to patient care.”

Literatures regarding the concept of clinical librarianship were consistent in defining it as

a role of a medical library professional that extends library services to health care professionals

in a hospital setting, provides relevant and current medical literatures using reliable health

information sources, and contributes and actively participates in the improvement of patient care

as a part of the healthcare team.

The CML Program started to gain popularity after Dr. Lamb’s announcement of the

concept at the 1972 annual Medical Library Association (MLA) meeting in San Diego. (Cimpl,

1985) Several other CML programs were conceived that were customized depending on the

status of the medical library. After 1986, studies have been conducted accordingly after quite a

few years of implementation focusing on measuring the value and importance of these programs

in the provision of health care and raising awareness of the role of CML services in medical care.

One significant research known as the “Rochester Study” was conducted in 1992 by

Joanne G. Marshall, Ph.D., an assistant professor in the Faculty of Library and Information

Science in University of Toronto. This study concluded that the information provided by the

library is perceived by physicians as having a significant impact on clinical decision making and

was seen as making a positive difference in patient care. In 2007, a follow up on the Rochester

Study was conducted which indicated that physicians who receive clinical information services

are more likely to try a new or different treatment than physicians who do not receive clinical

information services. Furthermore, librarians’ presence at morning reports, followed by a

literature review, can reduce the length of stay of patients in a hospital.

 In 1993, Royal described the success of a CML program in an academic autopsy

pathology service where the results of the survey over an eleven-month period indicated that the

use of a CML program increased efficiency in evaluating the literature as perceived by the

pathologists.

In 2004, a systematic review of the evidence from 30 years of literature evaluating CML

programs prepared by Cimpl showed that 89% of users in twelve out of thirty-five studies

published between 1974 and 2001 found CML services useful and of high quality and 65% of

users in another (overlapping but not identical) twelve studies said these services contributed to

improved patient care.

In the Philippines, the practice of clinical librarianship remains a novelty concept. There

are limited studies that explore the idea of medical librarians delivering relevant, useful, updated,

and evidence-based information to the point of care that could possibly change clinical decisions

made by medical professionals. In 2013, a study on EBHC practice revealed that most medical

librarians play an important role in the healthcare setting by “helping the busy clinicians to find

clinically relevant information that could contribute to the treatment of patients’ conditions as

expert searchers, and in educating patients through health literacy.” (Roque, 2013)

According to Joenabie Encanto-Arevalo, the current president of Medical and Allied

Health Librarians Association of the Philippines (MAHLAP), clinical librarianship has not taken

a solid position in medical institutions yet because it is relatively a new concept that requires the

involvement of and support from the institution itself.

Mark Santos, a clinical librarian at St. Lukes Medical Center (SLMC), shares the same

viewpoint. According to Santos, institutionalizing the concept of clinical librarianship is still

underway at SLMC and the possibility of implementing a CML program entails the acceptance
of physicians (which are the usual clients of medical librarians in terms of patient involvement)

and the interest and willingness of medical librarians to assume such roles. The components of a

training program for clinical librarianship also arise as an issue in introducing CML. Santos

claims that the success of a CML program will depend largely on the part of the medical

librarian in proving the value of having an information specialist to be an integral part of a

clinical team responsible for patient care management.

Studies regarding clinical librarianship in the Philippines are yet to be explored. Experts

exposed in the field suggest that this emerging concept can be successfully undertaken with the

help and cooperation of the institution and medical and allied health professionals. Foreign

studies suggest that CML programs can be an important part of the clinical team that is

responsible for providing a clinical decision in the treatment of patients. Evidences from these

researches show that clinical librarianship presents a positive impact and potential not only to

medical librarians that seek an established role and participation in patient care, but also to

medical professionals who struggle finding time in performing efficient and effective searches of

relevant and up-to-date information that may help them in coming up with a sound clinical

decision.

It is in this light that studies on clinical librarianship in the Philippine setting must be

undertaken in order to keep up with these emerging roles amidst technological advancements as

well as vast changes in the medical field. With its presented potential in the international scene, it

is a worthy endeavour to determine its potential and feasibility here in the Philippines.

Consequently, this undertaking may contribute in solidifying the position and role of medical

librarians as trusted individuals taking part in clinical decisions, together with medical and allied

health professionals, who save lives.

STATEMENT OF THE PROBLEM

The evolving practice of Evidence-Based Medicine and Evidence-Based HealthCare in

medical institutions have been an essential foundation of clinical librarianship as this concept

aims to provide evidence-based information to point of care leading to a sound clinical decision.

Studies of Futalan (2011) and Roque (2013) explore the perception of librarians towards EBM

and EBHC practices in academic and hospital medical libraries. These studies show that medical

librarians are in full support of these practices and demonstrate awareness of their importance in

helping medical professionals, armed with necessary skills set in assuming its roles.

Evidences from these studies present the point of view of medical librarians toward

Evidence-Based practice and reflect a great potential in accepting the introduction of clinical

librarianship in medical institutions. However, the real answer lies, in part, on how the people

actually involved in making clinical decisions view medical librarians as part of the team. The

current status of clinical librarianship in the country is in need of further analysis as to how it can

bring about a positive impact in the changing roles of medical librarianship. In the local setting,

there have been minimal attempts in taking this challenge.

This study is geared towards determining the future of clinical librarianship in the

Philippines and explores the concept as a vital part of the clinical team alongside medical

professionals in academic and hospital libraries. In particular, it aims to answer the following

questions:

1) What is the current status of clinical librarianship in the Philippines?

a) How do medical librarians perceive/define clinical librarianship?

 b) What is the level of awareness of medical librarians regarding the concept of clinical

librarianship?

c) What is the level of competency of medical librarians in performing roles related to

clinical librarianship?

2) Being a part of the clinical team that is responsible in making sound clinical decisions,

how are medical librarians perceived by:

a) Medical and allied health professionals?

b) Medical institutions?

c) Patients?

3) What is the impact (level of acceptance) of the concept of clinical librarianship and a

Clinical Medical Librarian (CML) program on:

a) medical librarians as a tool for establishing an emerging role and a career?

b) medical and allied health professionals as a valuable member of the clinical team?

c) medical students as an educational support?

d) the institution as an arm that upholds their mission and goals?

e) patients as an aid in improving patient care?

4) What are the challenges that hinder the institutionalization of clinical librarianship?

a) What are the steps needed in establishing a CML program?

OBJECTIVES OF THE STUDY

To be able to identify the current status and determine the future of clinical librarianship

in the Philippines, this study seeks:

1) To establish the current status and definition of “clinical librarianship” in the Philippines
 2) To perform a perceptual analysis on medical librarians as a vital member of the clinical

team that is responsible for making sound clinical decisions

3) To determine the impact of introducing the concept of clinical librarianship and having a

Clinical Medical Librarian (CML) program

4) To identify the barriers that hinder the institutionalization of clinical librarianship

SIGNIFICANCE OF THE STUDY

This study intends to establish a clear perception and definition of clinical librarianship in

the Philippines and how it can thrive as a concept in bringing a positive outcome in patient care

management. It is geared towards creating a comprehensive understanding of how clinical

librarianship can be a vital part of the clinical team. Determining how medical librarians are

perceived as a part of the clinical team will help identify whether or not clinical librarianship will

be successfully established in the country. The result of this study hopes to serve as an initial step

towards proposing a Clinical Medical Librarian (CML) program which will be beneficial to

medical librarians, medical and allied health professionals, medical institutions, and patients.

As a consequence, the CML program may not only serve as an information aid, but may

also function as an accrediting tool in providing medical librarians the necessary skills in

performing the roles for practicing Evidence-Based HealthCare (EBHC) and Evidence-Based

Medicine (EBM). This will not only make up for the lack of experience in performing emerging

roles of medical librarians brought by EBHC as reported by theses of Futalan (2011) and Roque

(2013), but will also create an established ground that can possibly garner institutional support.

Having a structured platform such as a CML program that supports clinical librarianship will
eventually help medical professionals gain the trust that medical librarians deserve in rendering

service for the improvement of patient care.

This study aspires to encourage medical librarians in exploring the potentials of this

concept as a tool in adding value and affirming their role in the medical field as information

experts and as a vital member that can affect clinical decisions.