Bringing evidence to practice: a team approach to teaching skills required for an informationist role in evidence-based clinical and public health practice*† Kathleen Burr Oliver, MSLS, MPH; Prudence Dalrymple, PhD, AHIP; Harold P. Lehmann, MD, PhD, FACMI; Deborah Ann McClellan, PhD; Karen A. Robinson, MSc; Claire Twose, MLIS See end of article for authors’ affiliations. DOI: 10.3163/1536-5050.96.1.50 Objective: The objectives were (1) to develop an Intervention: A 1.5-credit, graduate-level course, academic, graduate-level course designed for ‘‘Informationist Seminar: Bringing the Evidence to information professionals seeking to bring evidence Practice,’’ was offered in October to December 2006. to clinical medicine and public health practice and to In this team-taught course, a series of lectures by address, in the course approach, the ‘‘real-world’’ course faculty and panel discussions involving time constraints of these domains and (2) to further outside experts were combined with in-class specify and realize identified elements of the discussion, homework exercises, and a major project ‘‘informationist’’ concept. that involved choosing and answering, in both oral and written form, a real-world question based on a Setting: The course took place at the Division of case scenario in clinical or public health practice. Health Sciences Informatics, School of Medicine, Johns Hopkins University. Conclusion: This course represents an approach that could be replicated in other academic health centers Participants: A multidisciplinary faculty, selected for with similar pools of expertise. Ongoing journal their expertise in the course core competencies, and clubs that reiterate the question-and-answer process three students, two post-graduate National Library of with new questions derived from clinical and public Medicine (NLM) informationist fellows and one health practice and incorporate peer review and NLM second-year associate, participated in the faculty mentoring would reinforce the skills acquired research. in the seminar. INTRODUCTION Highlights ● Interdisciplinary faculty designed and offered a grad- Current and accurate information is a critical compo- uate-level course to teach the skills required by an nent of good health care practice, and the role that information professionals can play in facilitating the informationist in clinical and public health practice, transfer of evidence into practice is continuing to ex- further elaborating a model for preparing information- pand. Over thirty years ago, Lamb drew attention to ists. the gap that can exist between the published clinical literature and the knowledge that individual physi- Implications cians bring to bear on a patient’s care [1, 2]. As part ● This scalable approach to teaching skills for the trans- of her work in this area, she established the first clin- fer of evidence into practice could be replicated in ical librarian program at the University of Missouri– academic health centers with similar pools of exper- Kansas City School of Medicine in 1971. In the 1990s, tise; such replication could contribute data toward val- Giuse and her colleagues at Vanderbilt University Medical Center expanded this concept by redefining idating this training approach. the clinical librarian’s role, implementing and evaluat- ● Greater clarity on an appropriate, or ‘‘good enough,’’ standard of evidence for supporting point-of-action decision making is needed. * The authors acknowledge with appreciation the contributions that ● Based on the assumption that practicing skills in- funding from the National Library of Medicine (NLM) made to the training programs described (1F37LM008608-01, 1F38LM008610-01, creases confidence and the likelihood that skills will and the second-year associate fellowship). Kathleen Burr Oliver ac- be applied, this course included mentored practice of knowledges the Centers for Disease Control and Prevention Information oral and written evidence presentation skills. Further Center and its director, Jocelyn Rankin, AHIP, FMLA, for funding an research could determine whether a course that in- Oak Ridge Institute for Science and Education (ORISE) fellowship that cludes such mentored practice increases the likeli- led to the one of the NLM informationist fellowships described above and enabled some development and testing of the public health infor- hood that students will apply their newly acquired mationist concept. skills. † Based on a presentation at the ‘‘Evidence Based Library and In- formation Practice Conference (EBLIP4)’’; Chapel Hill, NC; May 6– 9, 2007. 50 J Med Libr Assoc 96(1) January 2008 Bringing evidence to practice ing innovative practice with intensive care and other contributed positively to the team’s ability to respond teams that emphasized acceptability by clinicians and effectively to those needs. demonstrated competencies of medical librarians [3– From this literature emerges an implicit mandate to 6]. train informationists. In 2005, the Welch Medical Li- In 2000, Davidoff and Florance [7, 8] expressed con- brary at Johns Hopkins University responded to this cern about inadequate inclusion of new knowledge need by sponsoring two National Library of Medicine from the published literature in clinical decision mak- (NLM) informationist fellows, designing individual- ing and called for development of a new professional ized curricula to provide training in the skills required to address this gap. To respond to clinical realities, for their new roles as informationists. This paper de- they proposed developing a ‘‘national program, mod- scribes the design and content of this approach to in- eled on the experience of clinical librarianship, to train, formationist training and discusses the results and les- credential, and pay for the services of information spe- sons learned from the first offering of this seminar in cialists’’ [9]. These ‘‘informationists’’ would be cross- the fall of 2006. trained specialists who have specific content knowl- edge, could provide in-depth information services, and COURSE DESIGN AND OVERVIEW would be uniquely qualified to apply their expertise to information problem solving in a specific domain The ‘‘Informationist Seminar: Bringing the Evidence to [9]. Practice’’ course was a 1.5-credit, graduate-level course The name, the role, and even the need for such in- offered through the School of Medicine at Johns Hop- formation specialists are topics under debate in the lit- kins. Taught for the first time in October to December erature. Whether the informationist is really a new 2006, this seminar was designed for information pro- professional category or just a new word for a clinical fessionals seeking to develop the core competencies re- librarian, whether the informationist can be seen as quired of an informationist in the fields of clinical naturally evolving from the clinical librarian’s histori- medicine and public health: how to identify a ques- cal role, and what might be the distinguishing char- tion; how to search for and critically appraise the avail- acteristics of the informationist are just some of the able, relevant evidence; and how to effectively present questions being asked [7, 8, 10–19]. that evidence in response [18]. In particular, the goal Models in which information specialists facilitate the of this first course presentation was to address the spe- application of evidenced-based answers to questions cific curriculum needs of two NLM informationist fel- arising in clinical practice have been tested interna- lows: a senior fellow whose focus was clinical and a tionally as well. In 2002, Greenhalgh and colleagues junior fellow whose focus was public health. Both of [20] at the University College London Medical School these NLM informationist fellows were medical librar- described and compared two models of ‘‘informati- ians. A third student, a second-year NLM associate cist’’ service: one, ‘‘more academically rigorous with a fellow and medical librarian, audited the course. All research component and little personal contact with three either had completed or were currently taking practitioners,’’ and the other, ‘‘based in a general prac- basic classes or coursework in statistics. tice and one that took a more flexible, facilitative ap- The course faculty, chosen on the basis of their ex- proach.’’ pertise in the required competencies, consisted of a Considerable attention has been paid to the appli- librarian with public health training, who served as cation of the informationist concept to the clinical set- course director and recruited the other participating ting, and the importance of such a role in basic re- faculty; an NLM post-doctoral informatics fellow, who has been a faculty member and administrator in a search has been considered [21, 22]. However, less at- graduate school of library and information science; a tention has been paid to the role of the informationist clinician educator, who practices medicine and teaches in the public health setting, although there is a grow- evidence-based medical care; a systematic review ex- ing need for research into roles that combine the pert, who serves as co-director of the Johns Hopkins unique attributes of public health expertise (i.e., the Evidence-based Practice Center; an expert searcher, focus on a population versus an individual, the drive who has post-graduate training and several years of to advance prevention, and the need to evaluate pro- experience conducting searches and teaching search grams and activities) with expertise in library and