Author: Paul Frangakis

How We Transformed our Library into a Lively Space for Learning

Taubman Library evening wide By UMHealth System

Jaws drop when people familiar with the original 1980 Taubman Health Sciences Library (THSL) walk into the University of Michigan’s light-filled renovated space — humming with teaching, learning, and collaboration and no stacks in sight.

Students by anatomy table
Taubman_Library_144 By UMHealth System

The repurposed library is a testament to how technology has changed medical education and the libraries that support it. THSL’s transformation added 67 miles of data cables and 18,000 square feet of glass wall. All print books and print journals are now off-site, but available. An entrance-level café greets visitors. Students tap a table-top screen — a virtual cadaver — to explore 3-D anatomy of a life-size patient. Throughout the medical student lounge and study areas, working groups scribble on whiteboard-covered tables and walls.

Less visible is the partnership between the library and U-M’s medical school, the primary funder of the $55 million transformation.

“The library already was a good partner on medical education. It was a natural next step to think about space,” explains Rajesh S. Mangrulkar, MD, U-M Associate Dean for Medical Student Education.

This ongoing collaboration seeks to leverage the digital revolution while optimizing university space for education, research, and patient care. The Taubman’s re-opening in August 2015, after the 18-month renovation, coincided with a new medical school curriculum that embraces new types of learning. And it ushered in a shift in how librarians, redefined as informationists, interact with faculty, students, and trainees throughout U-M’s six health science schools.

The new space itself “has been incredibly positively received,” says Mangrulkar. “For students, it’s the best study space on campus. And faculty love using the great collaborative meeting areas.”

Jane Blumenthal, Associate University Librarian and THSL Library Director, shares lessons learned about transforming a library — and how the experience may apply to others, regardless of size and budget.

Q. Let’s talk about space. How did it come about for you to use library space in new ways?
We began talking about space internally about nine years ago, initially with the University Library. That provided an opportunity to think about what we really needed. We concluded it wasn’t so much access to the print collection on site that was needed, but rather space to work together and to collaborate in a quiet place. We had lots of cubicles, but no good conference rooms or places for small group discussion.

We had worked to get electronic subscriptions, with the goal of dropping the print, so we knew we could give up space being used for printed materials. When the medical school came to us because they needed space for additional study rooms and other collaborative work and teaching areas, we already had some of these ideas in mind. It helped that we had a long history of working well together. We’d been partnering on medical education for many years.

Q. How do you define your health sciences library now?
For years, we’ve been redefining the collection and the library to align with institutional mission and priorities, reflected in our mission statement: “…to be a valued partner, fully integrated into the work of the university and providing leadership in knowledge management for education, research, patient care, and community outreach.”

I don’t know how many times I have explained that we are not “a library without books.” At most, we are a library without print in the library building. We have lots of books — some located remotely and some online. We have more than 500,000 volumes of print materials available, not all of which are books.

Q. Among the biggest changes is that you closed the reference desk and shifted to a liaison model for librarians, now called informationists. How does this work?
We work beyond the traditional library reference model to be an active partner in education and research, with both faculty and students. Our informationists work primarily outside of the library building in departments, clinical sites, and laboratories.

They are strongly affiliated with these departments. We contribute to departmental committees and projects. We try to be very alert to what’s going on – and when we see or hear an opportunity, we ask if we can participate. Our informationists develop deep knowledge of the content, context, and culture of the subject area, and share their knowledge of information resources beyond the library’s collections.

In our team model, multiple informationists are aware of each department’s work, so that the department doesn’t become too wed to any one of us. For example, a five-person team works with the school of medicine; other teams work with nursing, public health, pharmacy, kinesiology, and dentistry. We also have a tech team that works across all schools to help informationists with the details of using emerging technologies in instruction and research.

Informationists spend a lot of time within health sciences departments, but their home department is still the library, where their offices are. It’s important to have a place where library professionals can come together to interact.

Students at whiteboard
Taubman_Library_027 By UMHealth System
Q. Did you face resistance within the library staff for the changing roles?
We made this change to show our commitment to meet changing expectations and needs of our faculty partners. And, yes, in the beginning there was opposition. Over time, people made peace with it. We reallocated some positions and created some new ones. We expected and accepted some attrition. In new hires, we looked for people who are flexible, interested in partnerships, and have varied expertise. We continue to invest in professional development.

Q. How do you work with clinical care sites?
We have a big connection with clinical care enterprises, primarily in two areas:  We collaborate with individual departments to help them create clinical guidelines. And we partner with people who are producing systematic reviews.

Sometimes people come up to us with questions about clinical care. But generally people can find answers to their point-of-care questions themselves and not deal with a mediator. That’s ideal. That leaves the library resources available for the more complex presentation of information.

Q. Short of a $55 million renovation, what steps can a library take to ensure it keeps the space it needs? How can librarians make their voices relevant and heard?
Some schools come in and with no notice say “We’re taking over this space.” But if you are open to proposing change before it is foisted on you, then you can have more control. You will not have complete control. But at least you can have some say.

First, make sure you are getting as many resources as possible electronically, so you don’t have such pressure on space. Then, think about how you use space and how you might repurpose it. Move furniture before remodeling. For example, early on, we took out a section of stacks and put in tables and chairs in spaces surrounded by books. The books absorb sound. We didn’t have funding to build, but we could offer an intermediate step to show we were working toward solutions.

Most of all, it helps to have good working relationships with other departments. You have to build your relationships before you can call on them. You can do this by presenting yourself as collaborators and partners, and by going to faculty meetings and presentations where potential partners are. Ask them about their work and learn their needs.

Revamped library
Taubman_Library_123 By UMHealth System

Q. With the revamped library now in full swing, can you share any surprises? Lessons learned?
The building renovation was designed for all the space to be used — and that is happening. We have quiet single studiers as well as groups of four or five students working together, writing on the whiteboard walls. Some courses now have classroom time in the library. On a recent morning, the small group learning rooms (for 30 students) were all in use.  And the coffee shop is doing a gangbuster business. The building is vibrant and used more fully than before.

We have seen that natural light, art, and food and coffee bring life and energy. That’s one lesson. Another is the need to reinvent and reiterate. It’s OK to change the library!

Q. What feedback have you received?
Everyone is very proud of this building. It’s been shown off to U-M alumni and donors and conferences visiting the area. People walk in, and their jaws drop. Visually, it’s beautiful. People who had been in the old building are flabbergasted by how much the building has changed. And it’s a very functional space for medical education — designed for education by educators. I and the THL informationists are proud to be educators in a community that is able to work together so well for the common good.

For further information, contact Jane Blumenthal at

Photo credits: UMHealth System, (CC BY-NC-SA 2.0)

NEJM: Bringing Together Ideas for Sharing Clinical Trial Data

Can data from clinical trials be shared responsibly, fairly, and effectively? That was the question addressed by clinical trialists, data analysts, and others at the recent NEJM Data Summit — a candid, two-day event that initiated dialogue among those with differing points of view on this hot topic.

Key constituents listened and learned from each other, as attendees at the New England Journal of Medicine gathering focused on the promise and pitfalls of sharing data from clinical trials. NEJM and Editor-in-Chief Jeffrey Drazen, M.D., have been at the forefront of public discussion on the topic.

To explore the potential of data sharing leading up to the April summit, NEJM hosted the SPRINT Data Analysis Challenge. Individuals and groups were invited to analyze the dataset underlying the SPRINT article published in NEJM, A Randomized Trial of Intensive versus Standard Blood-Pressure Control. Data analysts were challenged to identify a novel scientific or clinical finding that advances medical science. Of 200 teams or individuals from around the world who passed the initial qualifying round, 143 submitted full entries. An expert panel combined with online crowd voting chose three winners: first place from Tel Aviv’s Clalit Research Institute, second place from Boston University, and third place from Stanford University.

The two-day summit in April, Aligning Incentives for Sharing Clinical Trial Data, brought SPRINT Challenge winners together with trialists, patients, data scientists, and representatives of data repositories and funding agencies. With 140 participants in the room and nearly 5,900 people registered to view the live webcast, speakers addressed the question, “How can we create an effective, sustainable data research eco-system?” Amidst the many views, one point of agreement emerged: small experiments such as the SPRINT Challenge can help generate experience and confidence for moving forward.

Dr. Drazen reflects here on what was learned from the SPRINT Challenge and the Data Sharing Summit, and what to expect next for data sharing.

What are the biggest takeaways from the Data Sharing Summit?
This is a controversial area in transition. You have three major constituencies: Patients who put themselves at risk by participating in trials; trialists who design the trials and gather the data; and data analysts who look for signals in data that someone else has collected. Bringing these three groups together in one place helped us to define key issues in unique and illuminating ways.

We made real progress. We learned that patients want data to be used widely and respectfully. Trialists heard others’ views on why they shouldn’t be allowed to hold onto a dataset solely for their own use for an extended period of time. Data analysts heard that while some datasets can be shared easily and quickly, there may be good reasons for other data not to be shared or used right away.

But the key thing was having patients there. Patients who had been in clinical trials were truly surprised at the degree of conflict between trialists and analysts. Trialists and analysts need to remember that disease is the real enemy. One of the patients who had been in the SPRINT trial essentially said, “You are the experts, you understand the issues, you know your fields. Work together — figure this out.” This was a reminder to everyone that the real goal is to improve human health.

Participation in the SPRINT Data Analysis Challenge was impressive – 143 completed entries. Did anything surprise you about the response or about the entries themselves?
On the downside, I lost a bet with [Summit Co-chair] Isaac Kohane. I predicted the SPRINT Challenge would draw fewer than 30 entries; he predicted more than 100.

The response was heartwarming. There was a big range in participants. Not all were data analysts. We had ordinary citizens, pharma, and medical students. Entries came from around the world. Some teams had representation from both the clinical and the data camps. Good surprises came in the sophistication of some of the analyses and seeing the novel techniques used to advance questions.

I did hope for more entries that combined multiple datasets, in creative ways. Maybe the timeframe hindered that. I also was surprised that no one tried to predict the final rate of events from the SPRINT Trial’s close-out data. The trial was stopped early and published in November 2015. But the trial’s closeout visits were not until July 2016. It would have been fun to predict what the closeout numbers actually were compared to the data available in the fall of 2015.

Interestingly, a number of entries were decision-support tools. The tool from the Clalit Research Institute was very easy for physicians and patients to use and understand as they decide whether to aim for intensive treatment of hypertension. This may reflect a key message: It’s really about caring for the patient.

At the Data Sharing Summit, did the level of disagreement surprise you?
No, we expected the conflicting views. And we encouraged people to express their real opinions. Progress is made when we listen respectfully to the views of others. We wanted people with varied viewpoints to speak with each other and with the wider world. One speaker said afterward that this was the beginning of a dialogue — people talking with each other instead of at each other.

Bernard Lo summarized the feeling in the room. He said that each group — trialists, data analysts, repositories — may need to give up something for the common good. There also was realization that opposing sides may need to be incentivized if we are to get together and find a way to make data sharing work. For example, there was a strong call for academic and promotion committees to recognize data analysis, and not only published research, as a measurable professional achievement.

What comes next in discussion of Data Sharing?
At the Summit, there was a call for small, short-term experiments, to “get granular” as one speaker said, and to create some evidence base as to what happens when data is shared. Some of these are already underway, with some data sets being widely used. The NIAID TrialShare, with clear guidelines, has been up for more than two years. The effect has been only positive. I think we’ll see more experimentation.

Our SPRINT Challenge was one such experiment, showing how contests can make people aware of the possibilities and confident about moving forward.

This month, the International Committee of Medical Journal Editors announced that as of July 1, 2018, manuscripts will be considered for publication only if they include a data sharing statement. And, trials that begin enrolling patients on or after January 1, 2019, must include a data sharing plan. These steps will move data sharing forward, which is explained more in this interview [starting at 6:40].

You’ve said unequivocally that NEJM supports data sharing. What future do you see?
We have a generation of young people who are used to sharing tools and information. When I pose a problem to a class of graduate students, they automatically break into groups to solve it. There is a desire to take, use, and share information. It’s the openness of the next generation that I think will make a difference.

We have a new science of bioinformatics. How do we use it to maximum benefit? Instead of trying to figure out who is right and who is wrong on the ground, trialists and data scientists need to work together and ask, How do we get true information that makes people’s lives better? What is the best way to help people through the best science?

Putting data out there — available and open — will increase public trust. Doing so is more believable than if you say, “Trust me, I’m a doctor or I’m a trialist.”

Sharing data has the potential to teach us things we did not know, to maximize the value of clinical trials, and to improve health outcomes. When I am at the bedside, I want to tell patients not what I think, but what I know.

NEJM LibraryHub would like to hear from you: What role do you expect to play in data sharing? Are you currently storing or managing clinical trial data? How might medical librarians prepare now for any changes ahead?

Email your thoughts to to inform the next LibraryHub update on data sharing.

NEJM Catalyst: Free Web Event on Leading Physicians and More

NEJM Catalyst invites health care leaders — and those who aspire to be — to join its Physicians Leading|Leading Physicians online event on July 12. Nine trailblazers in a lively forum offer their experience and practical tips to address: How can you lead physicians and identify those who want to become leaders? How should leaders address physician burnout? How can you set the right priorities in a changing health care landscape?

NEJM Catalyst helps physicians and executives drive value and improve patient care via daily articles, videos, and case studies. You can also view seven prior broadcast events that focus on care redesign, patient engagement, leadership, and the new health care marketplace.

Register here to view the free July 12 event, which will be held 9:00 a.m.–1:00 p.m. US MT, hosted by Intermountain Healthcare.