Creating a Digital-Only Medical Library from Scratch
Director of a digital-only library in a new medical school shares what she’s learned
October 19, 2017
When Elizabeth R. Lorbeer arrived in Kalamazoo in May 2013, she faced a blank slate and a deadline: As the first library director of the yet-to-open Western Michigan University Homer Stryker MD School of Medicine (WMed), her task was to create a library from scratch. Her deadline was to have the library up and running in one year, before the arrival of the first students.
In just nine months, the new medical library was fully functional, with more than 100,000 electronic resources.
Lorbeer jokes that the library actually opened the day she arrived, when she began convincing her colleagues that the terms “librarian” and “library” were synonymous: “If you have a librarian, it’s possible to get access to content even when no library exists,” she says. This was the beginning of educating a community about a “digital-only” library. Starting from scratch meant drawing on her experience building and culling collections, while mindful of the needs of a new (and small) medical school.
“In a new medical school, you want a lot of content for the money. Liz has found very creative ways to get relevant content that supports education and research,” says Nadine Dexter, who pioneered “born-digital” medical libraries at Florida State University in 2000 and at the University of Central Florida since 2008. She praises Lorbeer’s innovations with subscription models and partnering with faculty to try new things. “She’s taken what I and others have done and run with it.”
The resulting WMed library is “one of the strongest points of interest for faculty coming on board, for both teaching physicians and clinical positions,” says Lisa Graves, MD, associate dean for faculty affairs and chair of the Department of Family and Community Medicine. “What appeals to people is the access, 24/7, in digital form.”
“Even in the library itself, having librarians sitting out in open space, instead of behind desks, sends the message that they are accessible and available — that information is no longer hard to reach and access,” Graves adds. “Instead of being ‘keepers’ of information, librarians are extensions of it. When your library is no longer constricted by location, the people who work in the library go out. To have a librarian pop into your journal club, participating and guiding others to more information, changes the sense of what a library is and does.”
With a fourth class now enrolled at WMed, the 268-member student body is approaching the school’s 336-student goal. Yet even a small school needs full resources. Lorbeer explains that her experience at WMed applies to established libraries as well as new medical schools.
Q. What experience and mindset did you bring to the task?
Due to budgetary constraints at prestigious university libraries that I have worked for, I have had to toss out print collections and significantly reduce their serials holdings. For several consecutive years, I had to eliminate between $100,000 to $300,000 worth of content in a reduced state-budget year. Deciding what to keep or throw away were often agonizing decisions that caused me great sadness. Those stressful experiences shaped me.
So when I built the new digital library for WMed, I wanted to avoid at all costs ever being in a position to have to remove content from my community of learners. I am very focused on sustainability and preservation, and finding alternative methods to content so that learners have what they need when they need it
Q. What is your advice to library directors at other new medical schools — or for any librarian making purchase choices?
Focus on sustainability in building and developing your library’s collection and services. Do not acquire or introduce content or systems that will be unattainable to renew after full accreditation. Plan how much the collection will cost the institution at least seven to ten years into the future.
When you’re building a new collection to support a new educational program, content needs to be purchased to support assembly of the curriculum a year or two before students arrive. Discuss your long-term goals with your content providers. This means considering what it may cost over several years and negotiating for lengthier contracts than the industry standard of three to five years. What is normalized pricing for a medical school with four full classes of students and full accreditation is not the case for a startup school with preliminary or provisional accreditation status. You have to ask, “What is the list price of your product?” as you have no primary users yet.
Also, your first few classes of students are often smaller than a typical admitted class. You do not want to purchase materials for students who do not need access to the content yet, especially in a competency-based education program. It’s important to gauge when you need to buy certain content as students progress in their learning. This means appropriately budgeting for these resources in the correct fiscal year.
We work closely with instructors to acquire the content they need to assemble their curriculum. Faculty are eager to partner with us. They take our resources and annotate them, sometimes making small interactive features out of existing content. Instructors boutique the content to meet learning objectives.
We don’t have a legacy print collection and we won’t. But we have online access to a lot of content. We have a cooperative relationship with our university and hospitals to share collections so that our shared community of learners benefit from this arrangement.
Q. How big a component of your job is training staff and constituents? Has that changed since you first opened?
It’s the primary focus of what we do. Our guiding principle is to disseminate and share our expertise in searching and appraising the biomedical literature and to empower our community of learners to proficiently find and evaluate content to support and be successful in the teaching, research, scholarship, clinical, and community service missions of WMed.
We’re learner focused. We’ll meet with users anywhere in the educational setting, including affiliated hospitals and clinic sites. The library staff supports medical education in information literacy, evidence-based medicine instruction, health literacy, research methodology, systematic review service, citation management software support, scholarly publishing, and assembling content for team-based assignments.
Through outreach, we assist students in translating evidence-based medicine into practice through literature search assistance, resource retrieval, research question formation, evaluation of biomedical information, and advanced use of research databases and point-of-care tools. We co-teach evidence-based medicine in the Principles of Medicine course, which runs over four years. We’re among the very few faculty instructors to interact with learners in all four years of their study!
Q. How do you promote library use?
We rely on really good word-of-mouth. When a medical instructor or student points someone our way it means more than when we say it ourselves. We don’t maintain our own social media accounts. We post on the medical school’s social media to reach the larger audience.
I’m mindful that we always need to recruit new internal champions. As part of the hiring process for community and faculty physicians, I talk with each of them for 30 minutes to make them aware of our resources.
Q. Your title of associate professor (as well as chair of the Department of the Medical Library) is unusual. How did that come to be?
The medical school’s founding dean established the library as a separate non-clinical department and reassigned my faculty appointment and future staff appointments to the library. The title I carry is aligned with my administrative peers on the organizational chart.
The library’s mission is to provide the best biomedical information resources and services to support the WMed community. We build equitable collections and services by being independent of any one department assignment where mission, responsibilities, and scholarship may differ. This allows us to focus on serving the information needs across WMed in a consistent approach. We engage in research and scholarly support without preference or alliance to specific departments.
We actively publish and present papers and posters and co-author with other faculty on the literature review and methodology sections of papers. We’re actively involved in scholarship and service work and disseminate our knowledge in both the biomedical and library science literature disciplines. We also host student interns who are exploring a career in information and library studies.
Q. Describe your department.
Our department consists of the WMed librarians and affiliated hospital librarians for a total of seven faculty librarians. We have our own journal club to explore topics in medical librarianship, we attend medical education grand rounds, and we participate in joint scholarship opportunities.
I did revise the library’s staff titles to “Informationist.” It reflects more accurately our daily work, as we spend significant time in the clinical setting as information scientists. We answer questions that clinicians do not have time to look up, support their training in journal club and morning report, and identify literature to improve clinical outcomes. The informationists also co-teach in the evidence-based medicine thread alongside epidemiologists, biostatisticians, and clinical teachers.
This is the simple truth: Our library’s collection does not define who we are on campus. The secret of any great library is its exceptional librarians. It doesn’t matter how many books or journals your library holds, or how large or small your library might be, it’s the connection to and the services you provide to support your learners and practitioners.
Q. What makes you especially proud?
I am especially proud of the library staff’s contribution to the arts and humanities thread in the medical education program. The Arts in Medicine (AiM) is a student group whose two faculty advisors include a librarian. AiM events for students (and sometimes faculty) use a variety of art techniques to teach coping skills and new ways to express emotions faced during medical school and in clinical environments.
This summer, our librarians partnered with the Kalamazoo Public Library to sponsor a summer reading program to support students, faculty, and their families as part of wellness at WMed. I am excited that the library staff is exploring programming with instructors and students at the intersection of medical research and medical writing, narrative medicine, and in using children’s literature to teach health literacy and communication.
Photo credits: Western Michigan University Homer Stryker MD School of Medicine