Education for Medical Librarians Around the World by ESTELLE BRODMAN, PH.D

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Education for Medical Librarians Around the World BY ESTELLE BRODMAN, PH.D. Librarian and Associate Professor of Medical History Washington University School of Medicine St. Louis, Missouri

ABSTRACT This paper describes the training of medical librarians in England, the European con- tinent, the United States, Latin America, Israel, and Asia, with special reference to the level of such training (i.e., primarily for practitioners or for those who will make ad- vances in the field). At the end of the paper, there is a short discussion of the need for advancing education for medical librarians, and the personal belief is stated that medical librarians should be trained at the highest level possible to avoid intellectual serfdom, to see that society receives the best return on its investment in medical libraries, and to insure that the help which medical libraries can give to society is actually available where needed.

EDUCATION for a quasi-profession, such as librarianship, must have several goals. It must teach the techniques, the body of accepted knowledge, the philosophy behind the practice, and the tools with which the few who are capable of adding to the accepted body of knowledge (or of chang- ing it) can go about their researches. It is easiest to teach the practice, less easy to give the student the philosophy (which in itself may be obscure), and very difficult to provide the milieu which will produce the question- ing mind needing the tools of research. In some cultures the education of librarians has been possible only at the practitioner's level; in others it has been possible to go beyond this to the theory or the research. In this paper an attempt will be made to describe the education given to medical librarians in a number of countries around the world from the point of view of what level that education has attained. It must be pointed out in advance that societies do not all move as a unified group. In the United States, Great Britain, and in many other countries which have attained professional maturity in this field, there are still some schools educating librarians who never practice their profession beyond an elemen- tary level. Moreover, societies which attempt to by-pass the practitioner's level and go directly into the philosophic level without adequate ground- ing in techniques generally are unable to take care of the needs of their users in a workmanlike manner. In this case their philosophy comes to 99 100 ESTELLE BRODMAN nothing and the libraries are rarely given a chance to advance knowledge in their field.

HISTORY OF EDUCATION FOR MEDICAL LIBRARIANSHIP Education for medical librarianship followed closely the development of education in other fields of librarianship. The first method evolved was apprenticeship. Prospective medical librarians were hired and learned on the job whatever their supervisors could teach them and whatever they could gain from the tools at hand. In addition, in some parts of the West- ern world, the voluntary organization of medical librarians became ex- tremely important, particularly when the specialty of medical librarianship was just beginning to split off from the larger field of librarianship as a whole. Not only were training classes frequently discussed and early recom- mended by such groups as the Medical Library Association in the United States (1), but the meetings of these organizations became in themselves informal training courses. For example, some of the topics discussed at the turn of the century meetings in the United States concerned the classification system used by the College of Physicians of Philadelphia, the rela- tion of the medical library to the county medical society, methods of interesting non-reading doctors in the new works in the medical library, a system for bringing the library's wares to rural physicians, how to bind books, and changes in periodicals in the past few years (2). Nor was it necessary to be present at the meetings in order to benefit by these discussions, for most such organizations published a bulletin of more-or-less completeness, accuracy, and regularity, which reported the text or the gist of most of the papers read at the meetings, and which could then be studied at leisure. And although some of the titles of the articles may amuse us today (3), they provide a good picture of the problems besetting our predecessors, and allow us to determine how many of them still are unsolved today (4). Apprenticeship combined with informal study, such as we have just described, is often the only way in which specialty librarians far from centers of literary teaching, placed in library positions without education or previous experience, can get the training they need. While it is natural that we think that formal education is better than this, it must be pointed out that many fine librarians have been produced by the older method, both in the past and today, who bring to their profession a clear outlook and an untrammeled view of what needs to be done and how to do it. But one need only go into a library where untrained librarians are spending their energies trying to solve problems which have already been solved elsewhere to be impressed by the human wastage found there. It is as if no one had ever invented writing or that human educability did not exist! EDUCATION FOR MEDICAL LIBRARIANS 101 With the advent of formal education different kinds of training emerged: one based upon the old medieval guild system, one on the con- tinental university system, and one on the school of technology approach to professional education seen in the United States. The guild system is characteristic of British and Commonwealth countries, the European university system is mirrored in German practice, and the Americans tend to use the technological school approach. As might be expected, also, new countries followed the example of the country with most influence on them in other respects. Commonwealth countries generally followed the British lead; Italian and Czechoslovakian schools have many similarities to German ones; and South American, Japanese, Indonesian, and Thai schools are modeled after the American. BRITISH SYSTEM In Great Britain the traditional method for becoming a librarian was to study at a good secondary school and perhaps at a university, then go to work in a library. While engaged there the assistant read up on librarianship, as well as learned the methods and philosophy of the particular library from the chief librarian under whom he worked. After a certain period of individual study, with or without some formal classes, if he happened to live in an area where there were enough young librarians to make such courses feasible, the young librarian then took a series of examinations given by the Library Association, based upon the latter's syllabus. Depending upon the level and kind of examinations taken and the amount of experience the assistant had before sitting for the examinations, he was given Association recognition as an Associate of the Library Association (ALA) or as a Fellow of the Library Association (FLA). For the latter he would need to designate some area of special study, of which medical librarianship was one; in that case he took separate examinations in his specialty. A course to prepare young assistants for the examination in medical librarianship was given in London, but many people who took and passed the Library Association examinations in this subject had never been students in this course (5). As might be expected, this pattern, following closely the old British guild system, was also used in other parts of the British domain: its colo- nies, the Commonwealth countries, and former possessions. Many librarians in Australia, India, New Zealand, and elsewhere actually took the British home examinations; in some countries, such as Australia, the local library association acted out the same role as the Library Association in Great Britain. In still other countries, separate schemes developed. For example, Canada, greatly influenced by the American system of libraries and general education, accepted both the British certificates and the di- plomas of Canadian library schools, which followed American schemes. 102 ESTELLE BRODMAN

Recently changes have been announced for the British system, to go into effect in 1964, which seem to bring it closer to the American plan, though the two will still not be the same. For many years the London University School of Librarianship was the only library school of a graduate nature in Great Britain; but since World War II a number of pro- vincial colleges and universities have opened similar schools (6), in which students are exposed to much the same curriculum as in American schools. Unlike American students, however, the British ones must still take the Library Association examinations for "certification" (not to be confused with the legal certification by the government in some societies). The newer British library schools offer specialty courses, and the old Library Association-sponsored specialized course in medical librarianship is now being given at the London School also. Changes envisioned in the entire syllabus of examinations of the British Library Association, whose practical results have not yet emerged, include more formal training at a younger professional level, which implies in its train that librarians must decide earlier in their careers what direction they wish to take professionally. British libraries are among the oldest of which we have record. The medical collections of Marischal College, Aberdeen, were started in 1593 and before the end of the seventeenth century libraries of the Society of Apothecaries of London, St. Bartholomew's Hospital, and the Royal Fac- ulty of Physicians and Surgeons of Glasgow were all of respectable size. Similarly, British librarianship is of ancient lineage, and the time when it educated for practitioners only is lost in antiquity. This is as true of medical librarianship as of other specialties. GERMAN SYSTEM In the German system of educating medical librarians, a differentiation is made between the work done by lower grade employees and by administrators of large libraries. (A third grade, that of nonprofessional and cus- todial workers, will not be discussed here.) Administrators of large German libraries (the so-called "Gehobener Dienst") are expected first and fore- most to be scholars, onto whom is added some knowledge of library techniques. Those who are destined to be the rank and file of the library staff (the "Mittler Dienst"), on the other hand, are trained primarily as technicians along German lines, with all that implies in superb technical training. After the "Abenthur" examination, they study for two years in specialized schools of librarianship, emerging as specialists in cataloging, classification, bibliography, languages, or paleography, without regard to any particular subject field. State examinations must be passed by candi- dates for either grade, and while the path from one category to another is not absolutely closed, it is not easy, and it is an unusual "Mittler Dienst" EDUCATION FOR MEDICAL LIBRARIANS 103 person who makes the transition to the "Gehobener Dienst," which (as noted above) requires a scholarly university degree. Medical librarians, since they work in fairly small libraries, tend to be of the "Mittler Dienst" category. This is so partly because German medical libraries tend to be broken up into small units, by American standards, with individual libraries in each institute of the medical school still more common than in Scandinavian countries, Great Britain, or the United States. Moreover, because of their training in the methods of bibliography, cataloging, and technical library work, German medical librarians usually find it easy to learn the specialized needs, tools, and methods of medical libraries on the job. Since there are no particular courses in medical librarianship per se in Germany, individual study and apprenticeship comprise the only means for obtaining the specialized knowledge needed. As might be expected from the kind of training available to German medical librarians, the scholarly researches which have come from this group have generally been either in the subject field (e.g., history of medicine) or in the technical aspects of medical library work (e.g., bibliogra- phies, printing, mechanical devices such as compact storage shelves, and the like). With slight variations, this system of educating for medical librarianship has been taken over by most of the countries in Eastern and Southern Europe. So far as can be easily determined, the only countries in this area which provide specialized courses for medical librarians are Bulgaria (7) and Russia (8). In each of these places there are classes and state examinations on the literature and specialized technical work of medical libraries; the Russians even append to their syllabus suggestions for the political in- doctrination of medical library patrons through specialized technical methods in the libraries, such as divided catalogs or special kinds of classification (9). AMERICAN EDUCATION The development of education for medical librarians in the United States has been described in a series of papers presented at the First Inter- national Congress on Medical Librarianship, held in London in 1953 (10). Following the American pattern of technical training, schools of library service were almost at once after their founding (1890's) attached to universities, where for many years they presented the puzzling exception to usual American practice by being so-called graduate (i.e., post-bacca- laureate degree) schools bestowing a second bachelor's degree on their students for a fifth year of college study. Moreover, in spite of claiming to be graduate schools, colleges of librarianship tended to teach at a level generally conceded to be more like that of undergraduate schools than 104 ESTELLE BRODMAN postgraduate ones. When in the 1940's it was decided to develop these schools into truly graduate ones, a complete overhauling and revision of the curriculum and methods of teaching had to be undertaken. In this reorganization, however, education for medical librarianship underwent hardly any changes. At present students training to be medical librarians in American institutions attend a college or university for four years; then, after receiving a bachelor's degree in some subject field, the students are admitted to study at a graduate school of librarianship. Here they are given a com- posite curriculum: i.e., certain courses are "required" of all students, no matter what sub-specialty of librarianship they elect, while other classes are chosen by the student in relationship to the field of librarianship he wishes to enter. The "required courses" are a kind of insurance that a student will be able to take any of a number of kinds of library jobs. This is especially important in a situation such as prevails in the United States, where students in library schools may have no previous library training and no idea into what kind of job or in what type of library they will work after completion of their formal education. The "elective" courses, on the other hand, give the students insight into the problems of specific library situations, and are thought to be particularly valuable for individuals with specially oriented backgrounds or for practicing librarians returning to specific posts in certain types of libraries. American library schools feel that they have a twofold purpose: to prepare their students to take on the complicated technical tasks which make up the day-to-day work of a great many practitioners, and to present to the students the theory and philosophy of librarianship, which puts the practice into its larger perspective, and without which the daily practice becomes only the blind following of badly understood rules and regulations. This double goal is as true for the specialized course in medical librarianship as it is for cataloging, reference work, or the newly introduced documentation and machine methods. How well the individual library schools carry out their tasks and how closely they achieve their goals varies enormously in the country, with some library schools universally regarded as excellent for presenting to their students the exciting aspects of their prefession in such a fashion that they cannot help but catch fire, while others seem unable to rise above a purely pedestrian level. Naturally, also, most schools belong somewhere in between these extremes, with here and there one faculty member combining the two approaches with ability and enthusiasm above the average. Since the system of educating for librarianship in the United States is so flexible that graduates may be appointed to library positions in a variety of kinds of libraries, many people work in medical libraries for a number EDUCATION FOR MEDICAL LIBRARIANS 105 of years without specialized training in this field. An increasing number of these people are returning to library schools for short courses (generally of six to eight weeks' duration) in medical librarianship, and this trend has been intensified by the efforts of the Medical Library Association. As early as the late 1940's the Association was aiding in the formal education of its members by approving certain courses in medical librarianship for its certification, and reinforcing this approval by providing scholarships for some students taking these courses. These practical measures have resulted in giving outside "respectability" to academic work and, by providing a bridge between the practitioner and the teacher in the subject, have interacted to the benefit of both groups. One difficulty, so far theoretical, but to be guarded against: since the Association approves certain courses for its certification, it could, by withholding approval, cause some students not to take the courses at certain schools. In turn, this might mean that schools may be reluctant to make changes in the courses in medical librarianship in advance of the acceptance of certain doctrines by the mass of practitioners or by the approval committee of the Association. An example of this might be the extent to which non-standard methods (such as newer systems of classification or documentation activities) or differing concepts of eligibility for recruitment to medical library positions would be introduced into courses already approved by the Association. It must be stressed that no such case has ever arisen; nevertheless, the principle of the separation of the teaching and the certification ("licensing") of practitioners must be carefully guarded. There are as many mansions in the field of medical librarianship as in religion, and many portals of entry, and it is important that no one who is worthy of entrance be barred. If one may define education as the formal learning in courses, study groups, books, and examinations, we may use the term training to indicate the more informal and less rigid methods of obtaining knowledge. In this sense we should now turn our attention to training for medical librarians being carried out in the United States at this time. As was noted at the beginning of this paper, the American association of medical librarians has been interested in this problem from the very first days of which we have any record (1). Attempts to supplement formal training and to provide some of the basic elements of such training to those without it did not stop when the library school courses in medical librarianship were established. It has been an American tradition that individual groups in individual localities have come together for further study from the very beginning, and they are still doing so (11). In addition, the Medical Library Association has continued its strong interest in ele- vating the knowledge of its members, and has had a series of study groups for the past six or seven years. These have been frankly experimental in 106 ESTELLE BRODMAN nature, and have had a number of designations: Seminars, Workshops, Courses, Classes, Refresher Courses, and the like. While each group of such "classes" has been successful in some respects, they have not been universally acclaimed as the answer to the problem of how best to meet the needs of the American medical librarians who attend these meetings. As a result, the Association has recently established a Committee on Con- tinuing Education, whose duty it is to make recommendations for the Association's program in this field. The Committee is too new to have come up with any specific recommendations, and certainly too new for any experience to have accumulated about the likelihood of its methods' being successful, but preliminary discussions of the group seem to bear out the feeling that no single solution can be the entire answer to a problem with as many ramifications as this. Consequently, many approaches to this subject will probably be suggested. If nothing else comes of this Committee, however, its published review of what has been done and what has been suggested should prove valuable as a bench mark for future work in the field. So far we have been discussing education of medical librarians in its traditional format of education in the well-established routines of librarianship: the acquiring, the describing, the storing, the retrieving, and the using or helping others to use medical literature, and the theory and philosophy behind these. But recently a ferment has arisen in the field of librarianship, and necessarily, therefore, into the education for librarianship: a ferment on the wider implications of its work and the proper view- point and training required. Questions on the ecology and sociological implications of medical librarianship have been raised, and surveys of the extent of medical literature and the places in which collections are housed and used have been made, while a whole literature has grown up on the value to medical librarianship of subject orientation or machine orientation. The need for some knowledge of the subject fields being treated in a medical library has caused some people to feel that only those previously trained in one of the sciences basic to medicine should be allowed to run medical libraries, while still others hold that since manual systems for many of the library's functions are becoming too expensive for today's scientific literature, only those who are machine technicians can qualify as heads of scientific libraries. Much heat has been generated by these discussions, in which questions of pay, status, and tenure have been present but not always acknowledged. While the acrimony engendered has not entirely died down, it is en- couraging to see a sense of proportion appearing on both sides of the question, with librarians and so-called documentalists each giving ground (12). Indeed, a recent discussion of the proper education of science infor- EDUCATION FOR MEDICAL LIBRARIANS 107 mation personnel (13) has many similarities to the report on the proper education for special librarians made a number of years ago (14), with both groups claiming that a broad college education, some knowledge of the subjects involved, understanding of several languages, and technical ability are the goals for those needed in technical libraries. Already we are beginning to see changes in the curricula of the American library schools to prepare their students for this new hybrid profession. In thirty library schools, for example, a 1960 survey reveals, eight offer full-fledged "special library programs," two of which are in medicine; fifteen provide general courses in special librarianship; and a number give seminars arranged by type of library, while all of them have required courses in the literature of science and technology (15).

AMERICAN ATTEMPTS TO AID IN EDUCATION OF LIBRARIANS IN OTHER COUNTRIES American peoples have traditionally become missionaries for their be- liefs in foreign countries, and they have apparently carried this tendency over from religion to librarianship. At any rate, American medical librarians individually and in groups have concerned themselves with aiding librarians from other countries to set up libraries and to train personnel for running them. This has been done by sending donations of books and journals to foreign libraries, by bringing individual foreign librarians to the United States for study, by sending American librarians to foreign countries to give advice, to teach, or to set up demonstration libraries, and, finally, by working with the educational authorities in foreign countries to establish schools of librarianship which naturally tend to follow the American pattern. Such groups as the Rockefeller Foundation, the China Medical Board, the Kellogg Foundation, the Eli Lilly Foundation, and a few others, have been particularly generous in their overseas programs concerned with medical librarianship. Using funds provided by these and other groups, individual medical librarians and the Medical Library Association as a body have been able to provide all the types of aid enumerated above. The aid given foreign medical libraries through grants of the Medical Library Association to the United States Book Exchange should be men- tioned, as well as the reports of this Association's Committee on Interna- tional Cooperation. The Committee has brought a number of foreign medical librarians to the United States for formal study, work-study programs, or travelling fellowships, as the needs of the individual dictated. The reports of this Committee furnish interesting data, but do not, perhaps, stress enough the difficulties faced by many of these fellows upon their return to their own countries where conditions and equipment are often 108 ESTELLE BRODMAN very different from the American, and where their estrangement from the political, social, and' professional life of their colleagues may be decisive in their futures. Realization of these facts has resulted in attempts to train the foreign librarians in their native countries. Workshops and short courses, for in- stance, have been given by Americans in South America; among them are Miss Mary Louise Marshall, formerly Librarian of Tulane University Medical School; Miss Mildred Jordan, Librarian of Emory University Medical School; Miss Louise Darling, Librarian, Biomedical Library, University of California at Los Angeles, who have all been engaged in such educational and consultative endeavors in the Western hemisphere. Mrs. Eileen Cunningham spent more than two years in Pakiston setting up a medical school library which could be turned over in running condition to Pakistani authorities when she left. A special situation is demonstrated in American aid to medical librarianship in Japan. At the end of World War II the American Library As- sociation was invited by the Occupation Forces to set up a library school at Keio University, Tokyo, along American lines. Originally staffed entirely by Americans and with an American director, the teaching and administration of the school were gradually turned over to the Japanese, until, by 1960, there were no foreigners attached to the school at all. A discussion of general education for librarians in Japan will be given further on in this paper; here it is only pertinent to note that the Japan Library School has been greatly helped by subventions from the Rockefeller Foundation, which decided in 1960/61 to offer a grant of money to the School for a three-year program to strengthen life sciences libraries in the country. As a result, Dr. Estelle Brodman spent five months in Japan in 1962 visiting the medical and allied sciences libraries and teaching several courses and workshops in Tokyo and Osaka. In 1963 Mr. Thomas P. Fleming of Columbia University will be the Visiting Professor at Keio, and it is hoped that a librarian of an agricultural library will be the visitor for the last year of the grant. A final point should be made about American aid in the education of foreign medical librarians. It is not realized in the United States how much the general libraries run by the United States Information Service abroad have helped in this field. Because in many countries-Mexico, Japan, India, the United Arab Republic-these USIA libraries stock many new American medical works and even sometimes take medical journals, they naturally attract many physicians and medical students. These may get a new concept of what help such libraries can give them and begin to demand the same kind of service in their own institutions. Moreover, local librarians are given demonstrations of the kind of librarianship rep- EDUCATION FOR MEDICAL LIBRARIANS 109 resented by the trained American staffs; many of them may work for a period in such libraries, and both the techniques and the spirit behind these libraries are absorbed informally. While external conditions sometimes make it impossible to imitate USIA libraries on a large scale, almost always some of the things seen in these demonstration libraries are taken up locally. LATIN AMERICA The earlier International Congress on Medical Librarianship received a report on medical library education in the Western world south of the United States (16). Since that time the growth of such training has been as rapid as political and economic conditions in the various countries per- mitted. For example, the library school in Caracas, Venezuela, used to give a course in medical librarianship, but it is now suspended and one reason given is the political leanings of the individual who taught the course. Argentina has also been planning such courses, but so far appears not to have been able to offer them. The medical librarian at the Uni- versity of Havana had been engaged in translating some of the American medical library reference tools into Spanish, but little has been heard from her recently. The problems of inflation and social unrest in Brazil, for example, do not leave it much time for consideration of such things as education for medical librarianship - homes, food, and clothing are much more important. Nevertheless, it must not be thought that nothing is being done in Latin America to raise the standards of medical librarians. Those who have returned from that area speak with admiration of the attempts of local medical librarians to study together in seminars and small classes; here and there a medical school has entered into a contract with one of the American schools for consultation and guidance, including the training of their librarians, and certain library schools (such as that in Mexico City) are apparently firmly established and providing the drive needed to move the mass of librarians in the area. One of the greatest problems of training for librarianship in Latin America and in Asia appears to be the low status of librarians as a social and economic group. Since most librarians are considered mere clerks, they are paid at this rate, which in turn means that individuals with fairly high educational backgrounds do not enter the group. Since the librarians are so poorly trained they can do no more than their native intelligence dictates; consequently, they are not entrusted with any authority, but must consult with their governing boards in even minute decisions. A further result is that able people who do enter the field are discouraged and frustrated and either leave at the first opportunity or sink 110 ESTELLE BRODMAN into a lethargy which deprives society of their talents. This vicious circle can be broken only if some outside force changes some of the conditions. This may be an increase in economic wealth in the country, the payment from some outside source of wages high enough to attract well-educated librarians, changes in teaching and administrative practices in medical schools as a result of visits of the faculty to other countries, or by the gradual raising of standards of medical librarianship through the force of personality of a few outstanding practitioners. Until that is done medical librarians seem to face only a continuation of unsatisfactory and unreward- ing service. ISRAEL AND AFRICA Much of the intellectual life of Israel today stems directly from the European universities, modified somewhat by the conditions found in the Near East and by changes which a forward-looking group will always make when adapting old methods to new situations. The library school at the university in Jerusalem, for example, is a case in point. The university is modeled on the East European university system - say, Berlin or Prague - but the library school was set up by Mr. Carnovsky from the University of Chicago Graduate Library School. It offers courses for both full-time and part-time students, and through its excellent and truly amazing university library, provides a laboratory for its students. While it does not give courses in medical librarianship per se, it does have courses in special librarianship, and even in its other courses it provides the student with an opportunity to choose examples from the field of medical librarianship. Its medical library is now in cramped quarters in the old school building, but it is hoped that new quarters will be provided in the near future. The importance of this library school is that here, as in other fields, Israel, as a not-too-distant neighbor, can serve many African countries as a consultant and as a place to send students without causing political problems due to the cold war. It is, moreover, a country small enough and new enough not to intimidate its non-Arab neighbors and to provide an inspiration to newly emerging countries. Although library schools have been set up or are being set up in various parts of Africa, for example, Ibadan and Cairo, there is some question whether enough librarians specializing in so small a field as medical librarianship can be expected in any of these countries for some time to come. The question, therefore, naturally occurs: would it not be advantageous to use the library school at Jerusalem as the place for the training of African medical librarians? AsIA There are library schools in Bangkok, the Philippines, Calcutta, New Delhi, Tokyo, Taiwan, and Djakarta, but except for Tokyo (as explained EDUCATION FOR MEDICAL LIBRARIANS III above), none of them offers specialized training in medical librarianship. The Crown Colony of Hong Kong recruits many of its librarians from British Library Association examinations, though a few librarians at the university in 1962 were trained in American library schools. The small number of medical librarians in most of these countries makes the setting up of such specialized training economically unsound. Japan is the one exception to the above statement. A recent article (17) points out that medical schools, some hospitals, and many pharmaceutical firms in Japan contain something called a medical library. This may be nothing more than a few shelves of books behind the desk of one of the professors, a small handful of periodicals placed in a department "common room," or a really respectable collection of a hundred thousand items with a staff of twenty or more people. Until the establishment of the Japan Library School in Keio University, no schools of librarianship in the West- ern sense existed, but under the aegis of the government there has been for years in Japan a six-months' course for librarians, leading to an official shisho certificate. This school (still in existence) enrolls middle school (high school) graduates and teaches them mostly the technical aspects of librarianship: cataloging and classification, shelving practices, binding, and the like. In so short a time, obviously no attempt can be made to go beyond this basic methodology, which is taught as rules, not as theory. In addition to this training some courses in librarianship are taught in a few teacher-training schools around the country. The only official li- censure for librarians, however, comes through the shisho courses, and even graduates of the Japan Library School, who are then college graduates and have spent approximately eighteen months studying librarianship, must petition to attain shisho status. Since such status is a factor in the ability of the individual to obtain a job in a government-supported library, this is a serious matter. Although the insistence on shisho training for certification of librarians was meant to be a step toward raising the standards of Japanese librarians and thus providing better library practice, in actual practice its rigidity has tended to keep some good people out of librarianship. Moreover, it has raised an agonizing question in the minds of the Japan Library School students: is it worth investing the time and effort required to go to the university school, only to be lumped together, to all practical purposes, with the students who have had no university training and only a small amount of library training at the most basic level? This is the same problem faced by Japanese librarians who are trained abroad and then return to their own country to work. The whole system of salaries for library workers in Japan is such that no premium can be placed on additional training. Pay is dependent upon the age of the individual and the number of years he has been employed 112 ESTELLE BRODMAN in the institution, not upon the job he is doing or his special qualifica- tions. Moreover, since the number of years an employee has been with the library has such an important bearing on the size of his pay-check, transfers of personnel from one library to another are very rare. The educational process of seeing how similar things are done differently by different groups is, therefore, lacking; the librarian knows only what he learns by doing in his own library, and since (except for graduates of the Keio school) he is not taught the theoretical principles underlying what he does, he is generally unable to make useful changes in the established situation. If he should go to another library, he is, therefore, not much more useful than a neophyte in the field. Thus it is greatly to the credit of the Japanese librarian that he has continued to study in his field and has done so much to raise the level of his knowledge. One of the ways in which Japanese medical librarians have tried to en- large their experience is by week-long workshops organized by the Japan Medical Library Association in conjunction with its annual meetings. Such workshops are real innovations, for the Association is a society of libraries, not librarians, and each library is represented by its official Di- rector, a faculty member who is elected to the post for two to four year terms. Others may attend the meetings and take part in the discussions, but all official voting is done by the Directors. It speaks well for the deter- mination of the librarians and the good will of the faculty members that these workshops (including lectures on medical terminology, simple anatomy and physiology, and some specialties, as well as librarianship) should have been presented for the past seven years and been so well received. In addition to these workshops, the Japanese Ministry of Education has sponsored institutes on such subjects as documentation and abstracting and indexing, and the Japanese Special Library Association has had one- day institutes on these subjects in conjunction with its regional meetings. The impression given everywhere in Japan is that librarians and administrators of libraries feel the need for further education in the fields covered by their libraries, but the direction such efforts should take is not yet clear. Before the changes needed can be brought about in Japanese libraries, many changes must take place in other parts of the whole system. DISCUSSION Education for a profession everywhere pursues several goals simultane- ously. It attempts the training of future practitioners, the creation or discovery of new knowledge in the field, and the development of some logical relationship with the community it serves. All these goals are important and society would suffer if any one of them were slighted. But EDUCATION FOR MEDICAL LIBRARIANS 113 the needs of the particular society in which the education is being offered determine - or should determine - which of the three goals will be most profitably emphasized at any one time. Indeed there appears to be a logic and a chronological hierarchy in their order of presentation. A profession just being introduced into one society, but already known in other societies, must almost inevitably begin by concentrating on educating practitioners and accepting the status, dicta, and theories of the profession as developed elsewhere, before it can begin to examine these things critically, change them to fit its own society, or create and develop new knowledge in the field. For a while it must be a passive instrument, like a child accepting instruction, because it does not have the information or maturity to examine the subject and its shibboleths understandingly. A new profession which attempted to bypass this stage or go through it too rapidly would not have the foundation on which to base careful judgments; on the other hand, a society which accepted these teachings uncritically for a long period of time would be like a retarded child, never able to add to man's store of knowledge. Education, obviously, can never be successful in a vacuum. The fundamental question of "education for what" must first be answered before "education in what" or "how" can be answered. And in answering the question of education for what, the entire scene must be considered: the economic conditions, the social situation, the history of the area, the physical and emotional climate in which the education must be fitted. The librarian in Lagos needs to know less about the Shakespearean sonnets than about how to keep scorpions out of bindings, and the medical librarian of Papua need not worry about machines for storing and retrieving medical information so much as the airmail schedules for Lancet and J.A.M.A. A country with a desperate need for trained personnel must forego the luxury of librarians trained to the postgraduate university standards of Western Europe. And yet - stated this way, is this not an error? Should not some training be smaller in scope than others, perhaps, but no less rigorous in standards? Is sloppy checking of journals in Assam any better than sloppy filing in St. Louis? Should we not strive everywhere for a standard of excellence even in small things? Moreover, are we not creating intellectual serfs, bound to their own institution or stratum, if we do not insist on education which allows the individual to grow and develop? If the librarian does not know why he checks in journals, or that there are other ways of doing so, or the difference between the essentials and the accidentals in the process, how will he react as a thinking person? Will we not lose the best minds and end up with a profession of mediocrity? The question might be raised of whether or not it is important to so- 114 ESTELLE BRODMAN ciety that medical librarians be above 'mediocrity. Does it matter, except to the individual medical librarian who prefers the company of bright, interested, and well-paid people and who wishes a social position of some prestige, that medical librarians may be mere clerks with no authority to plan or carry out library work? After all, in many parts of the world (and not only in so-called backward areas, either) there are many physicians who train and practice without any library, public or private, to which they can turn. Indeed, in some cases research of a fairly high level is caried out by such people, who are not hampered by the dead weight of other peoples' conclusions (18). Why then should a society struggling with so many more weighty and urgent problems concern itself with the education of medical librarians? Each person must answer this doubt for himself, if he continues in this field. A personal answer, which many years of struggling with this problem leads me to propound, is that medical librarianship is a service to society. If this is true, then society should strive to receive the best service it can use and afford. Sanitary conditions are easier to maintain with running hot water than with teakettles of water heated on the back of the stove. Where it is desired that morbidity and mortality from diseases caused by insanitary conditions be kept at a minimum, society must strive to furnish running hot water. In the same way, good medical librarianship is an easy (some believe the best) way for society to assure that it is receiving a fair share of the knowledge which it needs of health and disease and of the underlying knowledge of the universe. Society, not librarians, needs librarianship. A second reason, to my way of thinking, is that poor medical librarianship is a waste of society's money. It is a dribbling away of sums, which, when totaled, represent a large investment offering poor returns. Good business practice requires that the tools fit the needs of the work. Unless society wishes to continue indefinitely the high cost of running medical libraries through the use of expensive faculty members, it must consider how to make the librarians able to do most of the decision-making. Educa- tion of these librarians to the level of the theory and the grasp of possible goals of the library is essential. It has been said that the Irish monks of the seventh to tenth centuries presented to the world the inspiration of fine scholarship, understanding piety, and high-minded cooperation. Can this ideal somehow be brought to all that medical librarians do everywhere in the world so that it becomes the inspiration for all who need and use medical literature? Is there not a reverse-Gresham's law, by which good medical libraries drive out poor ones? I believe so, but to my mind this can only be brought about when the knowledge of the medical librarian approximates his spirit of helpfulness. EDUCATION FOR MEDICAL LIBRARIANS 115 And for that, the education of medical librarians beyond the practitioner level to its fundamental philosophy and theory is a sine qua non.

REFERENCES 1. Class work for library workers. BULLETIN 2: 11, July 1912. 2. Classification used at the Library of the College of Physicians, Philadelphia. BULLE- TIN 1: 3-26, Oct. 1911. Medical library and the county medical society. BULLETIN 2: 19, Oct. 1912. (Comment on article by C. E. BLACK, P. 13-18.) How is medical library brought to the attention of physicians who never use it? Med. Libr. Hist. J. 4: 133-134, 1906. How may the circulation of books be increased, especially in country districts? Med. Libr. Hist. J. 4: 134-135, 1906. KIMBALL, A. R. The care of books with special reference to fine bindings. BULLETIN 1: 49-55, Oct. 1911. FISHER, C. P. Changes in medical periodical literature since January 1909. BULLETIN 2: 21-23, Oct. 1912. 3. See, for example: MYERS, G. W. Dusting the library. Med. Libr. Hist. J. 1: 135-136, 1903. FISHER, C. P. The typewriter in cataloging and shelf-listing. Med. Libr. Hist. J. 1: 201-204, 1903. 4. See, for example: What are the best books in all branches of medical literature published during the past year that a medical library with a limited appropriation should purchase? Med. Libr. Hist. J. 4: 135, 1906. [A committee was appointed to report back their findings the next yearl] 5. Library Association Yearbook, 1962. London, Library Assn., 1962, p. 5 ff., esp. p. 21-22. 6. In July 1962, the number of such schools had risen to ten in Great Britain and three recognized overseas, leading to the foundation of an Association of British Library Schools. Cf. Spec. Libr. 53: 548, Nov. 1962. 7. TRENKOV, KHRISTO. Meditsinskata bibliografiia ... Sofiia, Nauka i izkustvo, 1956. 71 1. 8. GNUCHEVA, V. V. Putevoditel' po inostrannol bibliografii meditsinskol literatury (1945-56 gg.). Leningrad, Biblioteka im. M. E. Saltikova-Shchedrina, 1957. Also: BEYERLY, E. Soviet library literature; a survey of selected manuals of methodology. Libr. Quart. 30: 173-187, July 1960. 9. See, for example: Metodicheskoe pis'mo o rabote s katalogami v meditsinskikh bibliotekakh. Moskva, Gos. Tsent. Nauch. Med. Bibl., 1956. 10. Symposium on education and training for medical librarianship. Libri 3: 205-225, 1954. 11. BRODMAN, ESTELLE. Teaching medical bibliography to medical librarians. BULLETIN 40: 366-368, Oct. 1952, esp. p. 368. Note also the St. Louis Medical Librarians Group, which now meets five times a year to discuss basic problems of medical libraries and ways of solving them. 12. See the program for the 1962 meeting of the American Documentation Institute, which included librarians, machine experts, and subject specialists, now once again able to talk to each other on common ground. 13. COHAN, LEONARD, AND CRAVEN, KENNETH. Science information personnel; the new 116 ESTELLE BRODMAN

profession combining science, librarianship and foreign language. New York, Mod- ern Language Assn., 1961. 74 p. 14. Education for special librarianship. Libr. Quart. 24: 1-20, Jan. 1954. 15. DE TONNANCOUR, P. R. Education, training, and recruiting of technical information personnel. (Mimeo. Presented at Symposium of Technical Information Personnel, New York City, April 28-29, 1960.) 16. SECONDI, JUAN CARLOS. Medical library education and regional seminars in Latin America. Libri 3: 238-249, 1954. 17. BRODMAN, ESTELLE. Japanese medical libraries. BULLETIN 51: 16-25, Jan. 1963. 18. BISHOP, W. J. Medical libraries and librarianship in Great Britain. BULLETIN 38: 296- 311, Oct. 1950.