Evidence‐based librarianship: one small step

We have previously reported (HILJ, March 2002) on the First Ever Evidence-based Librarianship (EBL) Conference, hosted by the School of Health and Related Research (ScHARR) at the University of Sheffield on 3rd and 4th September 2001.1 The Conference featured two particularly noteworthy international contributions. The first was by Jonathan Eldredge, former Chair of the Medical Library Association’s Research Section. Eldredge reported how the concept of EBL has developed over recent years in the United States before attempting to extrapolate its further uptake and evolution over the next two decades. The second was by Ellen Crumley, now Editor of the premier Canadian medical library journal Bibliotheca Medica Canadiana. Crumley described how she and a number of colleagues have attempted to create a forum for EBL at a local level. Both of these papers are featured in this issue of HILJ. It is therefore fitting to review developments in the UK against such an international backdrop. With upward of 130 delegates in attendance at the Conference, it is clear that EBL is a concept whose time has come. Whether this initial enthusiasm translates into sustained action in changing the culture of health librarianship remains to be seen. However, it is interesting to learn that the idea of an EBL journal club has proved sufficiently stimulating to lead to at least one such initiative in Trent Region set up by enterprising librarians in Nottingham. Similarly, it was suggested at the Conference that, in advance of the appearance of systematic reviews, librarians should seize opportunities to share contemporaneous experiences from related projects, thereby creating a de facto knowledge base. Such an approach is currently embodied in a Clinical Librarian conference, hosted in Leicester on Friday 15th March 2002, and by a proposed primary care knowledge management event possibly to be held later in the year. Above all, we can witness a perceptible shift in librarians’ attitudes to projects in which they are involved at a local level. The first stage seems to be an awareness, fuelled by exposure to critical appraisal, that the emperor has few, if any, clothes. This is soon followed by a purposeful attempt by individual librarians to improve the rigour of their projects and of the subsequent evaluations. We wait with interest to see if this primarily defensive impulse for self-preservation stimulates an improved quality of papers submitted to journals or whether it has a counter-effect—namely, to make potential contributors more bashful and peer reviewers more discriminating. What is clear, however, is that there is a place in our professional literature for both the ‘raw’ exciting innovation and the more considered, rigorously evaluated, project. The issue is not whether one or the other should exist, but rather that a research project should be judged by the appropriate criteria for such a project. Similarly, an innovation, ideally accompanied by at least some form of audit, should be subject to more pragmatic appraisal. It is fitting that the papers by Eldredge and Crumley take contrasting and yet complementary approaches. Eldredge focuses on the production end of the EBL process; his association with the Research Section is seen in his valuable attempts to document the quantity and quality of the existing evidence base.2 He has also encouraged improvements to the exploitability of this evidence base through strategems such as the adoption of structured abstracts.3 In contrast, Crumley places herself at the consumer end of EBL. Journal clubs and classification of question types help practitioners to exploit the evidence for themselves. Of course we should not overplay such an apparent polarization. After all, Eldredge has run a number of successful EBL workshops to assist practitioners to interpret particular study types, especially cohort studies. This consumer focus is apparent from one of the many descriptions of his continuing education workshops as found on the World Wide Web: “Take the next logical step toward applying evidence-based health care (EBHC) approaches to health sciences librarianship. Learn to recognize the possible adaptations of EBHC approaches to the conditions found in librarianship through problem-based learning exercises, cases, dialogue, and more. Outline the obstacles and clarify the opportunities to form a vision for creating evidence-based librarianship.”http://www.mlanet.org/am/am1999/ce Notwithstanding the above, it will be helpful to view possible future developments for the UK as being placed at diverse points on such a producer–consumer continuum. Of course, diversity is not in itself a weakness— in fact, quite the reverse is true. Evidence-based practice should be a ‘broad church’ that accommodates a plethora of approaches and perspectives. Remember how, in the early history of evidence-based healthcare in the UK there was a place for the consumer-focused Critical Appraisal Skills Programme within sight of the ivory tower of the Centre for Evidence-based Medicine. At the production end, a short drive away in the city of Oxford, lay the UK Cochrane Centre. Furthermore, within an international context it is appropriate that different countries lead on different tasks identified for what is, after all, a still-emerging paradigm. It is also fitting that efforts at a national level are targeted within a context that is sensitive to the priorities of that particular country. What are the existing strengths of evidence-based practice within the UK? What might be the national priorities, potentially to inform our contribution to the international landscape? Undoubtedly a considerable asset is a critical mass of information specialists who are familiar with the methods and skills required to sustain systematic review activities. A recent meeting of information professionals associated with the production of assessment reports for the National Institute for Clinical Excellence (NICE), convened by Ruth Frankish of NICE, revealed considerable expertise and activity in the field of information retrieval research and development. Outside of this function-specific grouping can be found other information specialists associated with the various Cochrane groups, the Health Evidence Bulletins from Wales and numerous systematic reviews for the NHS Health Technology Assessment Programme and the research councils. Participation in such activities places a specific imperative to keep up with new thinking around information retrieval methods and their comparative merits—in short, to be evidence based. At the consumer end of the paradigm, considerable numbers of UK health librarians have undergone basic critical appraisal training. The majority are familiar with the basic design of randomised controlled trials and of systematic reviews. However it is likely that few will have encountered the cohort study, claimed by Eldredge to be one of the richest veins of evidence for practising librarians.4 Many will have used questionnaires at some stage of their professional careers, even if comparatively few would be able to identify the three most important characteristics of questionnaire surveys, namely: selection of the sample; response rate; characteristics of non-responders. Nevertheless, problem-based learning scenarios, the checklists used to assess the quality of studies and other tools such as Critically Appraised Tools (CATS) are probably more familiar to UK librarians than our North American counterparts. Then there are the political and geographical characteristics of the UK. For example, the UK scene is more compact than that in the USA and yet more intensive than that in Canada. If one is to attempt to promote the uptake of a paradigm, it should be more achievable in a national setting where there are less than a dozen regional constituencies, a similar number of academic departments and no more than a handful of professional groups. Of course this makes it even more critical that, from an early stage, we as the health library profession in the UK, make the right decision on what exactly we wish to promote. The UK can undoubtedly make an important contribution to the development of technical skills in systematic reviews and critical appraisal of the health information literature. Ironically, however, there is probably an even more important role for the UK to make. Librarians’ experience of systematic reviews and critical appraisal teaching and development has provided opportunities to work in multidisciplinary teams dedicated to evidence-based practice. For the first time in living memory we find researchers discussing the sensitivity and specificity of different search strategies or criticising systematic reviews because of the limited number of included databases. In such a multidisciplinary environment, is it appropriate to be emphasizing our separateness by using labels such as ‘evidence-based librarianship’? Even a more inclusive term, such as ‘evidence-based healthcare’ is actually more alienating than uniting in the context of imminent moves to integrate the health and social care fields. Certainly the commonality of initiatives such as the National electronic Library for Health with the electronic Library for Social Care or of NICE with its social care equivalent, SCIE, suggest that many features of evidence-based practice will soon have broader application than is currently the case. Arguably then, the unique contribution of the UK health information sector might well be in the development of ‘evidence-based practitioners’ who are equally comfortable with turning a critical eye on their own domain of professional practice, or on other activities taking place within their organization. In this connection, the confusion, reported by Crumley, between evidence-based librarianship and librarians supporting evidence-based health care becomes something of an irrelevancy. Would librarianship stand to lose something by suppressing its ‘evidence based’ prefix and highlighting, instead, the generic nature of evidence-based practice activities? Quite the reverse is true, in fact. There are several areas that are common to a number of professions where methods or tools developed by information professionals might receive greater acceptance if not constrained by the label ‘evidence-based librarianship’. Consider, for example, how the current preoccupation with quality of health information from the Internet calls out for involvement from a profession that has many decades of experience in evaluating the written record. Consider too, how the growth of end-user searching of the Internet demands the same evaluative techniques with regard to coverage and search engine performance that have commanded the attention of our profession since the dawn of online searching. While it is true that many enduring questions from the specific field of librarianship are yet to be answered,5 they are still outnumbered by a factor of at least ten to one by questions that cut across many disciplinary fields. What is the most effective way of conducting staff performance appraisal? In what contexts is zero-based budgeting most useful? What is the most appropriate setting for teaching health practitioners how to acquire information literacy skills? In her paper Crumley suggests six domains for EBL question types. I repeat my assertion, made elsewhere6 that three of these are more likely to identify a significant body of research from outside the professional literature than they are from within, namely the literatures of Education, Management and Marketing. A further two are likely to comprise an evidence base primarily from within the professional literature but with important contributions from associated disciplines; Information Access and Retrieval from computer science and Reference/Enquiries from both computer science and business. This leaves one, arguably the least pressing of the six, Collections, that is located exclusively within information science. By all means let us cling to the label of ‘evidence-based librarianship’ if indeed we wish to place greatest emphasis on this sixth and last domain! ‘Evidence-based librarianship’ has already proved a useful rallying call for like-minded librarians who wish to see the techniques of evidence-based practice applied to their own profession. As such, it is only of value when emphasizing a contrast with non-evidence-based librarianship. Clearly, it is not in the interests of our profession to invite close scrutiny of our own inadequacies in professional performance in this way. Having done much to promote ‘evidence-based librarianship’ over the last year, I hereby propose that we phase the term out of existence as soon as possible. Instead, let us herald the birth of a far more enduring concept ‘the unique contribution of information professionals to evidence-based practice’.

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