The introduction of librarian tutors into the Teaching Evidence‐Based Medicine week in Oxford, UK

The involvement of librarian tutors in supporting workshops for teaching the skills of evidence-based medicine (EBM) has been tried in Canada.1,2 Participating librarians required knowledge of critical appraisal, literature searching, and teaching skills. The author was a librarian tutor at these workshops in 2001 and 2002,3 and was encouraged by the experience to pilot a similar scheme in the UK. The Centre for Evidence-Based Medicine (CEBM) in Oxford has run an annual workshop on teaching EBM for 9 years.4 In September 2004, the Teaching EBM workshop was held at St Hilda's College. As the result of co-operation between the authors and the CEBM, a pilot scheme of librarian tutors was introduced. In order that these librarian tutors were well grounded in the fundamentals of EBM and critical appraisal, the authors attended an earlier 3-day workshop in Oxford called ‘How to Practise EBM’. This workshop proved a valuable experience for those librarians intending to be a tutor on the Teaching EBM week. The National electronic Library for Health (NeLH) (http://www.nelh.nhs.uk) provided the funding for five librarians to attend, and they were selected on the basis of an application detailing their skills, experience and reasons for participation. This paper summarises the experience of the librarians who attended the Teaching EBM workshop. There were about eighty participants from countries all over the world, including Dubai, USA, Australia, New Zealand, Canada, Spain and China. Every participant was assigned to a small group, along with seven other participants, two facilitators and a librarian tutor. Two groups were unable to have their own librarian tutor, as the workshop clashed with the UK's annual Health Libraries Group conference. However, both groups ‘borrowed’ a librarian tutor towards the end of the week. Most of the timetabled hours were spent within the small group, which allowed each group member to practise teaching in a supportive environment. Each participant prepared a teaching session for their group, and received feedback from tutors and other group members. The teaching took place primarily in the small-group context. Each morning all participants assembled for a plenary session, covering topics such as ‘EBM in homeopathic doses’ and the dynamics of small-group teaching. Participants could also sign up for Tutor Ad-hoc Discussions (TADs), and Participant Ad-hoc Discussions (PADs), where tutors or participants could lead a session on a specific topic such as running a journal club or focusing a search for evidence. The librarian tutor at the EBM workshop took on both tutor and participant roles which enabled them to both provide and gain knowledge as well as participating fully in all aspects of the small group work. A networked computer room with eight computers was available for the searching skills sessions, and each group had at least 1 h timetabled to use this room. It was also possible to book further searching sessions in the computer room. Based on previous experience, and in consultation with the CEBM, the role of a librarian tutor was outlined. The librarian should: Ensure that question formulation and finding quality evidence discussions are included in any teaching sessions the participants give. Assist participants in finding research papers for their teaching sessions. Teach one searching session to their small group. Volunteer to lead a TAD on aspects of searching for evidence, specific sources or formulating questions. Be available during ‘free-time’ sessions to work one-to-one with participants if they wish to have extra searching help. Be flexible! The librarian tutor's input to teaching sessions will usually be determined by the dynamics of the group, or by the participants’ own searching experience. The librarian tutors met at the end of the week to identify various issues about their participation. These are reported here along with comments taken from the CEBM evaluation form. It was agreed that: the week had been enjoyable and useful and the librarian tutors felt integrated within their small groups; the critical appraisal sessions had increased confidence in that area, enabling us to feel better able to implement the skills gained on return to work; question formulation and searching skills were covered well within the small groups; sharing search tips and tools with participants was useful, giving an opportunity to improve the participants’ search skills and knowledge. One librarian tutor commented that. ‘I thoroughly enjoyed my involvement as a librarian and felt useful—I hope you will consider involving librarians in future workshops’. Three issues were identified by the librarian tutors: the 1 h allocated for teaching searching skills was not enough—some groups managed to get another session in the computer room, but this was not always easy. Having two computer rooms, or access to a networked personal computer (PC) in the small group rooms, would have improved the learning and teaching experience; specific pre-course material had not been available nor was it clear what would be happening in advance of the workshop week. Information about the workshop, the searching sessions and the access to facilities would have been useful before the workshop; the lack of access to a PC during small-group sessions restricted the amount of ‘reality’ searching that could be done. At the end of the week, workshop participants completed an evaluation form, which included questions on the searching sessions and the librarian tutors’ involvement. This was used to assess the effectiveness of introducing such a scheme for future workshops (60 forms completed). Selected comments are discussed below. The balance of time devoted to searching was listed as about right by 27/60 (45%) participants, too little by 31/60 (52%), and far too little by 2/60 (3%). Several participants commented that they wanted more time for searching sessions. One evaluation question asked participants to suggest improvements to the course. The main issues relating to the searching sessions and librarians were lack of access to computer facilities, and not having networked access in small-group sessions. One participant remarked that ‘Internet access in group rooms would increase impact of librarians’. Another evaluation question asked participants what they liked best about the searching sessions. Most comments related to gaining hands-on database experience, demonstrations of searching from the librarian, and search tips and sources. Participants were also asked about how the searching sessions could be improved in the future. The collective view was that more time should be dedicated to searching, and the sessions should be better integrated into the workshop. The two groups who did not have a librarian tutor seemed to feel that they had missed out on extra help. One participant also commented that there should be a ‘mix of search-skills teaching and consideration of tools and student issues (i.e. issues relevant to what the students currently do and how they can teach their own students)’. The last comment is interesting as the participant was asking for more information about teaching searching to others. The librarians did not necessarily cover this aspect during the workshop, because participants demonstrated only basic search skills, and because the time allocated to search sessions was limited. The evaluation form contained many general comments about librarian tutors’ involvement, which were mainly positive about skills, experience and input to the groups. Many of the issues regarding librarian involvement in this Oxford workshop are similar to those raised after the McMaster University How to Teach EBCP workshop.2,3 The feedback and evaluation show that librarian tutors were integrated well into the small groups, and participants appreciated their skills and knowledge. It was felt that more time should have been available for searching-skills sessions, and to have a PC in the small-group rooms for more integrated ‘real-time searching’ demonstrations—both of which were echoed by participants. A recent systematic review that compared the effects of standalone and clinically integrated postgraduate teaching in EBM, found that knowledge improved with both teaching methods, but good evidence shows that only the integrated teaching improved critical appraisal skills and changed attitudes.5 This supports the observed findings that participants required more integration of searching into their teaching sessions, as knowledge and skills can be learned through tackling real-life problems. The groups with a librarian tutor generally made positive comments about librarian involvement and the searching sessions available; the two groups without a librarian tutor seemed keen to have one. A need was expressed for more pre-workshop information, including the availability of IT facilities and precisely what participants would be expected to do during the workshop. As this was a pilot scheme, a certain lack of clarity was inevitable. The experiences and comments received from this workshop can be used to produce clearer pre-course information for librarian tutors at future EBM workshops. It was agreed that this was an invaluable experience for gaining critical appraisal skills, knowledge of evidence-based practice, and insight into how health professionals search. These skills and knowledge can be incorporated into the workplace evidence-based teaching, and will therefore benefit health professionals in the long term. These workshops provide a rare opportunity for librarians to gain practical experience of EBM. The qualitative information from the CEBM evaluation shows that allocating a librarian tutor to small groups appears to benefit participants and librarians, but improvements to the format, length and availability of searching sessions are needed, along with a clear definition of the role of librarian tutors. Implications for Policy Allocating a librarian tutor to each small group in an EBM workshop appears to benefit both health professionals and librarians. Participating in small group sessions at an EBM workshop provides a valuable opportunity for librarians to gain critical appraisal and teaching skills, which can be implemented on their return to the workplace. Implications for Practice Improvements to the format and length of searching sessions within EBM workshops are needed. Integration of search skills teaching into real-life problems is seen as important by both health professionals and librarians. A clearer definition of the role of a librarian tutor is required.

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