Practical
Experience
In September of 2000, I began working at the Waterbury Hospital Health Center Library in Waterbury, Connecticut. The hospital library serves the medical staff of Waterbury Hospital and the general Waterbury community. I received extensive on the job training and was encouraged to attend workshops and local programs. I was given in-depth training by Carol Youle, the assistant librarian, and will always be indebted to Carol for help. Her quiet, patient manner, her thorough methods, and her willingness to share her knowledge made her the perfect mentor. Much of what I know about medical libraries can be attributed to her commitment to teach me.
In my position as a library assistant, I provided library services to physicians, residents, nurses, hospital staff, and to the general public. I was responsible for the journal collection, updating holdings, and providing reference service. I was also responsible for marketing the continuing medical education programs to clinicians. While I was taught many of the day-to-day functions in a medical library, I also learned about the needs of medical professionals and of the general public when seeking health information. I gained a greater understanding of the needs of the medical residents, physicians, and nursing staff. I also interacted with many vendors, such as Ebsco, Majors, and Rittenhouse. I was included in vendor meetings and encouraged to participate in library meetings and discussions. I was always treated as an important member of the staff, and my comments and contributions were welcomed.
I established a table of contents
service for physicians, nurses, and hospital administrators. This current
awareness service was a major component of library outreach to the medical
community. I was also responsible for activating and maintaining online access
for our print journal subscriptions. During the anthrax scare in the fall of
2001, we worked to make resources quickly available to hospital personnel. The
library distributed articles, created bibliographies, and established
information desks outside the library in areas such as the physician’s lounge.
A separate bulletin board was maintained in the library with resources that
were updated daily. e-mail alerts were distributed from the library with
important information from the Centers for Disease Control and other sources.
During my time in this position, I established contacts with other medical
librarians in the state and participated in local meetings. I attended CAHSL
(Connecticut Association of Health Sciences Libraries) meetings at the
Connecticut Hospital Association in Wallingford, Connecticut. I also subscribed
to the CAHSL mailing list.
I served as the representative for the Waterbury Hospital library when the Connecticut State Medical Society conducted their onsite review for Continuing Medical Education. I attended the meeting, answered questions posed by the reviewers, and provided a tour of the library. I was also asked to compile statistics on the library and respond to a detailed questionnaire. The review went well and the hospital’s continuing medical education program received renewal of its accreditation.
At work, I gained exposure to both important medical journals as well as journals for medical librarians such as the Journal of the Medical Library Association, Medical Reference Services Quarterly, and Journal of Hospital Librarianship. The library also subscribed to Library Journal. I received American Libraries and Information Outlook as part of my membership in the American Library Association and the Special Library Association, and found that keeping current with the professional literature was an enormous aid to learning more about the field.
During my time at the library there was one event that had a very strong impact on me. On June 2, 2001, a 24-year-old volunteer in a Johns Hopkins asthma study died. The study was funded by the National Institutes of Health, and there was an investigation by the Office for Human Research Protections. There were many problems identified with this study and several areas were investigated. The issue I found most significant concerned the medical literature search performed prior to the study. The investigator failed to locate older references to reports that hexamethonium was found to have potential pulmonary toxicity. The research subject inhaled this substance, and this contributed to her death. The study failed to make clear all of the potential risks because the researchers failed to conduct a comprehensive search of the medical literature, and medical librarians were not consulted for the literature search prior to the study.
The issue immediately made its way to MEDLIB-L, the medical librarians’ mailing list, where members conducted their own searches and found the material that the initial researcher had failed to locate. Many librarians questioned why the researchers had not consulted medical librarians for their literature search. The supervising physician of this project did make a good-faith effort to conduct research on the drug’s adverse effects, but his search only focused on a limited number of resources. The search went back to 1966, but failed to capture earlier articles written in the 1950’s that had contained citations warning of lung damage associated with hexamethonium. Articles appeared in the major medical journals and in news publications. With headlines such as Could medical librarians have helped avoid the tragedy at Johns Hopkins? and Johns Hopkins’ Tragedy: Could Librarians Have Prevented a Death?, many librarians voiced their opinion that they could indeed have found and provided medical information that would have been vital to the study. Some librarians did voice concern that they, too, may have missed this essential older research, and discussed the burden they would have shouldered had they directly contributed to a death.
Good reference work involves more than simply knowing where to look. It requires many talents, the least of which is knowing when to continue a search and when to stop searching. In areas of medicine or law in which there is a great potential for harm, the need to conduct exhaustive searches should be apparent. One outcome of this tragedy is that Johns Hopkins revised its internal protocols to require investigators to collaborate with a librarian in literature searches.
This incident made me acutely aware of the importance of comprehensive searching in the medical literature, and as a result, I decided to avail myself of every opportunity to improve my search skills. I still have much to learn, but have a greater idea of the pitfalls and problem areas. I also have a strong network of colleagues on whom I will rely when I need assistance.