The Future of Medical Libraries: Evolving Roles in Research, Education and Clinical Support

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute Podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello. Welcome to today's episode of MedEd Thread: An Education Institute Podcast, exploring the challenges and opportunities facing medical libraries now and in the future. I'm your host, Tony Tizzano, director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today, I am very pleased to have Michelle Kraft, director of Library Services at Cleveland Clinic here to join us. Michelle, welcome to the podcast.

Michelle Kraft:

Thank you.

Dr. Tony Tizzano:

In today's segment, we will focus on the rapidly evolving field of medical library science that provides critical support to Cleveland Clinic caregivers in their research, education, and clinical endeavors. So to get started, Michelle, if you could give us some sense of your perspective. I understand that you're the past president of the Medical Library Association, currently serve as co-editor and chief of its journal. So help us frame this very fast-moving, fast-paced area.

Michelle Kraft:

Well, thank you. A lot of people don't always think of libraries as fast-paced and moving. But when you think of medical knowledge, it's estimated to be doubling every 73 days. Finding of that information is actually very fast-paced. And, of course, now, we have the emergence of artificial intelligence in the finding of information.

And over the past couple of years, we've also seen hospital closures and mergers, which has actually impacted medical libraries and serving their community and caregivers' information. And medical libraries actually have been transitioning for quite a while from being the keepers of information to being the enablers of finding information. We no longer are holding on to all the books and keeping them as the medical knowledge. We are actually directing people outside of the virtual library walls to find that information.

Dr. Tony Tizzano:

Yeah. I think that is really a key point for us to consider and for our listeners to consider. There is so much at our fingertips. And how do you pick and choose? So I can't wait to hear more about this. So to begin, what sparked your interest in library science, and, and how has your role evolved?

Michelle Kraft:

I actually just love finding things. To me, being a medical librarian is like getting paid to be on a scavenger hunt. It's finding that information. And the harder it is to find, the more (laughs) interesting it is for me to do it. But my role has evolved over the years. Our primary focus isn't collecting information and collecting books and journals. It's more along the lines of enabling people to get access to the online resources and promoting that access to the information. There is so much information out there. People don't know where to find it. So we're building guides and directing people to that information.

We're also helping people evaluate the quality of resources and information. As you know, everything is online. And not everything is good and quality. So we're always working to evaluate that kind of information. We've transitioned from paper to electronic resources and embedding those electronic resources into point of care tools so that when you're working with patients or seeing somebody, it's in those tools that you are using on a day-to-day basis to find that information.

We're helping people and researchers with systematic reviews of evaluating the body of literature out there to systematically review it and come up with information. We're also looking at emerging technologies and trends. As I mentioned a little bit ago, artificial intelligence is a technology that is definitely have emerged onto the scene, but there are other trends like in publishing with open access and trying to help people steer their publications, their article outputs to proper journals that are reputable, have peer review that could either be open access or traditional types of journals. And we're helping people with grants and c- you know, continuing medical education. And I think this is all wrapped together. Really, we saw it come to the forefront during COVID, how all of those things really were touching the caregiver's information needs on a day-to-day basis.

Dr. Tony Tizzano:

Yeah, that's true. COVID forced us to drink from a different fountain.

Michelle Kraft:

(laughs) Yes.

Dr. Tony Tizzano:

No, no two ways about it, and, and we had no choice. But, you know, we came out of that with a new skill set-

Michelle Kraft:

Yeah.

Dr. Tony Tizzano:

... I hope, I think. So I assume that medical librarians pursue additional specialized training. What does this look like? And are these programs in abundance, or is it a more rarefied group?

Michelle Kraft:

Good question. Most of your medical librarians don't always start with a background in medicine or nursing, but we all have our master's degree in library and information science. I went to the University of Missouri and graduated with my master's in Library and Information Science. It was unique in that program actually had a program with medical librarianship, and I focused on medical librarianship.

With the closure and mergers of hospitals, there are fewer people becoming medical librarians, and there are fewer accredited programs in librarianship that offer medical library specialty. So it becomes more challenging for people who are in the library field to be aware that there is a profession of medical librarianship, and they must enter into more emphasis on internships, practicums, to gain an experience for entering into the program.

Dr. Tony Tizzano:

Yeah, that's intriguing. You know, you mentioned this whole idea of the importance of the library. And, you know, when you look at universities, one of the things that is a criteria for weighing and measuring a university is its library. Yet, getting funding for the library can be an enormous challenge.

Michelle Kraft:

Yes.

Dr. Tony Tizzano:

We want what it has to offer. But it's out of sight, out of mind. And I think that, you know, persons in an administrative capacity really need to think about how do we support the library. It's behind us in everything we do. And that information is the foundation of everything we do.

Michelle Kraft:

Well, it's like the electric company. You really don't think about the lights being on until you try and flip the light switch, and they don't come on.

Dr. Tony Tizzano:

No.

Michelle Kraft:

We need to flip our perspective from the library of being a cost center or a non-revenue source. We need to break free of that mindset and look at the services and resources that we provide as ultimately saving the institution money regarding to patient care, education, liability, research productivity, developing best practices where librarians work with doctors, nurses, and researchers to create best practices of care.

Dr. Tony Tizzano:

Absolutely. Couldn't agree more. So what do you think are some of the most pressing trends in librarianship?

Michelle Kraft:

Well, as I mentioned, the funding, that is difficult. As you said, people... They want the resources of the library, but they don't really realize how expensive some of these resources are. It's not unusual for a medical library to see anywhere from a five to 15% annual increase on the products that they buy. So funding from that is always challenging, especially when people don't even realize what they need to pay for those (laughs) things. Then other areas that are pressing AI and understanding what kind of quality information that that AI is receiving to provide information. And also whether it's providing good information as a result, and then the areas of information becoming freely available. That's a double-edged sword.

It's important that it's freely available, but we also have to evaluate to make sure that information is good even though it's freely available. Open access is a really great tool for making published research freely available so that people can have access to it to treat patients and develop best practices of care. However, with open access, we've started to see some things where we get bad actors and exploiting that kind of opportunity.

Dr. Tony Tizzano:

So is it that it's less looked at or less editorialized or-

Michelle Kraft:

Open access isn't less looked at or less editorialized. It's actually good quality open access journals go... undergo the same type of peer review as a traditional type of article that's published in a journal that is available only to subscribers. Open access charges authors to make their article free to people to read. Traditional publishing, you would publish an article in a journal, and then people who subscribe to it would read it. Publishers made their money off of the subscription of those journals.

Open access, because it's free to everybody, there is no subscription dollars for the publishers to make money. So they have changed it so that the author pays for the publishing of the article. And that's where they see the revenue. Open access articles, there's been studies that look at whether they're read more or less. There's some evidence that they can be that they are read more because they're available to everyone, but they're definitely a viable method for publishing information, just like the traditional way of publishing information.

Dr. Tony Tizzano:

Yeah. Well, that really helps understand that better. So what is the role of your professional association, the Medical Library Association? And how has that influenced your journey and the quality of the information that we receive?

Michelle Kraft:

The Medical Library Association and the community of medical librarians all around me has been crucial in my journey to be a librarian. I would not be the librarian I am now today without MLA and all of the librarians that I work with and who are part of the community.

MLA provides professional development such as continuing education, conferences where we can present papers and posters, and discuss and learn about trends in the profession. We also have several peer-reviewed journals where we publish our research. And as the co-editor of the Journal of the Medical Library Association, we're always seeking to advance the knowledge base and practice of health sciences librarianship.

The Medical Library Association is interested in always holds diversity, equity, and inclusion as a core value. We work to support an inclusive environment where all have equal access and opportunities within libraries and within the medical resources and information we provide. So the Medical Library Association, along with the community of librarians, the community of medical librarians is a small little community. As a result, we tend to know each other, and we even consult with each other informally. And we enjoy collaborating. It's not unusual for a librarian who is stuck on something to reach out to one of our many listeners to ask for help, and then they get several different emails supporting help them and informing them and giving them answers.

Dr. Tony Tizzano:

Yeah. Our professional associations, they really deserve a lot of credit. I don't think our patients realize that, you know, membership in those things can become important, you know, the American College, what have you, this way, that way. I also think that we probably have, at our doorstep, better information because of it and certainly don't take it for granted. Earlier, we discussed PubMed. So if you could tell our listeners what that is and help us understand how investigators can leverage limits within PubMed to their advantage.

Michelle Kraft:

Yeah, great. PubMed is an interface that sits on top of the MEDLINE database. MEDLINE is a database that collects information and articles from peer-reviewed journals and makes them available to search for anybody in the world. And PubMed is how people are able to search it. So it's a database where you search using keywords, medical subject terms to find information that's within the published literature.

Dr. Tony Tizzano:

Okay. Excellent. And leveraging that is done how?

Michelle Kraft:

There are a lot of ways that you can leverage it. One of the ways that I think people don't always realize is to use the medical subject headings, which are called MeSH terms. MeSH is an extremely strong way of searching for things. It standardizes the search terms that you put in there. So you can find articles, regardless of the British or American spelling, plurals, synonyms for terms. So for example, if you search for breast neoplasm, you get all of the articles on breast cancer without having to type breast cancer, breast tumors, breast carcinoma, et cetera. If you don't use the MeSH and you just search breast cancer, you might miss all the articles that use all those other terms. So it's helpful to use mesh to actually get a lot of articles on a typical topic that has many terms.

The other thing to look at is the left-hand side of your search page when you are searching PubMed. The left-hand side has ways to limit to specific publication types like practice guidelines. You can limit by age group, and then you can also limit by languages and gear, all types of ways of limiting to things like that. I would also say, put in a personal little plug, consult your librarian. (laughs) We went to school. We learned how these databases work and how they search. Every time the National Library of Medicine changes PubMed, we know about those changes. We study how those changes are impacted within the database and how things change. And, you know, databases are all different. Searching PubMed is different than searching something like Embase.

Dr. Tony Tizzano:

Yeah. I'd like to emphasize that point even more. Consulting with your librarian, the complexity of healthcare is so extraordinary that we're beyond all of us being able to do everything well. So we have all these various niches that we should take advantage of, and that's what you're here for. So, you know, in an earlier discussion as well, you discussed this notion of predatory publishing in journals. And maybe, this isn't for the everyday listener. But for researchers, I think, it's good to understand. Could you expand upon this phenomenon and, and the related concerns?

Michelle Kraft:

Yeah. Predatory publishing comes from the increase in open access publishing. Open access publishing, I mentioned earlier, is a method of publishing where the author pays to have their article available for everyone to read. Historically, articles were published and could only be read by those who subscribe to a journal, and the journal publishers would make their money from selling the subscriptions to the journal.

With open access publishing, the journal makes their money off of the article processing charges that are paid to publish that article instead of using subscriptions. This has inadvertently led to bad actors who launch fake journals, non-peer-reviewed journals, and the hopes of luring authors to pay them to publish their article. It's kind of like the Nigerian Prince email scam, but for scientific publications.

So if you're publishing an article and want to make it open access and there are a lot of valid reasons for doing that, it's always a good idea to research the publisher, check to see what databases that journal is indexed in. Predatory published journals are not indexed in databases. So if you check some of those things, where it's indexed, who the publisher is before submitting your article, that can alleviate a lot of the problems. You also want to ask your librarian to double check for you because, sometimes, the bad actors can be very sneaky and dream up some very similar names to journal titles that are legit. And it's very easy to fall prey to that. And they can create some very convincing websites.

Dr. Tony Tizzano:

Boy, so there again, another reason to touch base with your librarian. So Michelle, what are some actionable strategies and rationales for medical librarians to engage in efforts to combat fake news and its impact?

Michelle Kraft:

Oh, my gosh. So fake news or misleading information presented as news can have a serious impact on medical and health information. I mean, not only is it potentially dangerous information that is presented as fact, but it also erodes the trust of patients and the public over time. And we saw this really come to light with all of the misinformation that came out during the COVID epidemic. That is a prime example of misinformation and fake news and having an impact on health information.

Dr. Tony Tizzano:

Boy, that's a glaring example. So what are some actionable strategies then or rationales for medical librarians to engage in efforts to combat fake news and its impact?

Michelle Kraft:

Well, I think for medical librarians and also medical professionals, I think it's important to help with the fact checking. Don't immediately spread the information. Check it. See what the information has. Does it ring true? Check the sources that they are citing. Is that a legit source? Is that source something that you would be comfortable reading about? But don't spread the misinformation. Check, check, check.

Librarians can help by curating their collection, their library collection, getting rid of old information that's no longer valid. Medicine has changed. Treatments have changed. Drugs have changed. And we need to make sure that we have those changes reflected in the resources that we collect, both in the library and virtually. We also should subscribe to services like Retraction Watch and SciCheck. Retraction Watch actually looks at journal articles to see what's have been retracted due to simple errors or actually more complex bad things that could happen.

Dr. Tony Tizzano:

Sure.

Michelle Kraft:

And then SciCheck is a really great resource that actually looks at scientific information and checking to see if it's misinformation or fact. And then librarians can also create webpages listing educational resources such as Retraction Watch, SciCheck, and other things for medical professionals on how to combat fake news or how to talk to their patients who believe fake news.

Dr. Tony Tizzano:

Boy, interesting points, and something that we need to think about more and more. Is it adequate to look at your professional organization, your college, and look at information that comes from them as practice advisory tips, and what have you? Is that a place to start or does that-

Michelle Kraft:

I think that's a place to start. I think most of the time, our organizations are always interested in providing the real information and combating fake news. It doesn't mean that they will always get it right. We are humans. And organizations and associations are a part of humans. So sometimes, we make mistakes. But, thankfully, the organizations often correct their mistakes. So that's a good area to start.

Dr. Tony Tizzano:

So that brings us to the point where I've got a research idea. I've pinned down a hypothesis, and I'm beginning to make plans for a literature search. When should the services of a librarian be considered to avoid what seems to be a plethora of potential pitfalls?

Michelle Kraft:

Well, I think the librarian's search can start as soon as you have the hypothesis. We can help take that hypothesis and turn it into a search strategy to retrieve precise and relevant information while minimizing their irrelevant hits. We also know the best databases to search for that information. As I mentioned earlier, PubMed is just one of many databases, and it isn't always the best database to search. It all depends upon your topic, and we know the topics and the databases and how they match.

If you want to do a systematic review, they absolutely seek a librarian for librarian involvement before you start. It will save you hours and hours of work. And studies have shown that systematic reviews involving librarians have higher quality search strategies and better reporting standards.

Dr. Tony Tizzano:

There's money there. I can tell you-

Michelle Kraft:

(laughs)

Dr. Tony Tizzano:

... right now from some experience. So what do you think lies on the horizon for medical libraries as they continue to evolve?

Michelle Kraft:

On the horizon, I think we are definitely seeing AI coming up, and we need to have a way to keep AI legitimate. AI is definitely the next evolution, but it's going to be a bumpy road while we're getting there. I think we need librarians as well as medical professionals vetting the data and testing the AIs to make sure that it's giving the proper results.

I would say that librarians are very familiar with prompt engineering. I would like to say that librarians are like the OG of prompt engineers. Doctors, nurses would come to us with a question, and we change that question to make it fit the search database to present and provide the best results. So we're very familiar with the concept of prompt engineering.

We need librarians and the support of medical researchers as we try to work with publishers to allow their content, the publisher's content, to be within the AI systems. Right now, there's a lot of published information that's behind firewalls, and it's inaccessible legally to AIs. So as I mentioned earlier, the libraries buy a lot of these resources, and they're very expensive. They aren't free. So if these AIs are on the internet looking for information, they're running into those firewalls. So they're not finding always the best information. They might find good information, and they might find some of the best information that's open access. But other information that's behind paywalls is inaccessible to them.

Dr. Tony Tizzano:

So you're casting a broader net-

Michelle Kraft:

Mm-hmm.

Dr. Tony Tizzano:

... and a more refined net to pick the things up that would be most important. Well said. Are there any final thoughts or questions that I didn't pursue that you feel are important for our listeners to know?

Michelle Kraft:

Well, I think it's important for people to remember that medical librarians can be useful and powerful person on the medical professional team. We go on clinical rounds providing information, impacting patient care. We can discover and deliver difficult-to-find information. And we can help organize that information. So it's no longer like a fire hose drenching you.

Dr. Tony Tizzano:

Thank you very much. Michelle, this has been a wonderful podcast. It's enlightened us all. And to our listeners, thank you very much for joining, and we look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute Podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.