The aim of this article is to summarise and present experiences with embedded librarianship, particularly in a diagnostic biomedical field, and reflections on how medical librarians can form partnerships in research teams to produce systematic reviews to strengthen the scientific basis in medical research. The article also outlines the different roles of the librarian as from the perspective of stakeholders and in light of the current literature. Additionally, the article describes some of the potentials and pitfalls in the role of an embedded librarian in a clinical research team

Petersen, Lars J

Skrubbeltrang, Conni

Stenholt, Louise

English

Journal of EAHIL

18 Journal of EAHIL 2018; Vol. 14 (2): 18-22 Feature ArticleIntroductionPartnerships between libraries and faculty in healthscience is presently an established part of academiclibraries’ portfolio of services. A brief search of theliterature on inter-professional collaboration betweenlibrarians and faculties in biomedicine showed thatmost of these collaborations were built aroundteaching and developing information literacy (IL) andevidence-based practice skills (1, 2). Collaborationsoutside the library or the curriculum are much lesspresent in the literature. Although there is a solid andgrowing body of literature regarding librarians workingwith systematic reviews (3-6), few studies have focusedon librarians embedded in clinical research teams (7).In parallel to an exponential rise in scientific publishing(8) within biomedical research (9), there is also anexponential increase in the number of publishedsystematic reviews and research syntheses. This is alsothe case at Aalborg University Hospital. Doctors areonly able to read a fraction of these original articles peryear (10, 11). Knowing how to find, select, use andappraise academic papers is essential for doctors whenthey do research as well as part of their clinical work,but research demonstrates, that doctors' level of ILskills upon graduation are low (12). Thus, there is aclear need to support doctors and assist them withliterature searches. Forming teams and collaborationswith researchers is one way to achieve this goal.The objective of this article is to reflect upon the inter-professional experiences drawn from both thepartnership itself and working as an embeddedlibrarian in the Department of Nuclear Medicine atAalborg University Hospital, particularly in terms ofliterature searching and supporting systematic reviewsas well as clinical guidelines.Embedded librarian at the Department ofNuclear Medicine Bone GroupThe Medical Library at Aalborg University Hospital inthe North Denmark Region is a health scientific librarywith six employees, including the head of the library.In 2013, the library launched the “Research Librarian”project to further develop the library’s research supportas one of its core services. Research support is alreadywell incorporated into the library’s regular service, butwe wanted to structure our research service as acomplete package solution and boost the library'sprofile in the hospital.The Research Librarian Project has, side from asignificant rise in the number of search sessions, timespent per search, consultancies, acknowledgementsand co-authorships, led to a formalised partnershipAbstractThe aim of this article is to summarise and present experiences with embedded librarianship, particularly in adiagnostic biomedical field, and reflections on how medical librarians can form partnerships in research teams toproduce systematic reviews to strengthen the scientific basis in medical research. The article also outlines thedifferent roles of the librarian as from the perspective of stakeholders and in light of the current literature.Additionally, the article describes some of the potentials and pitfalls in the role of an embedded librarian in aclinical research team.Key words:medical libraries; library services; information literacy; professional competence; evidence-based medicine.Initial experiences of embedded librarianship at a Danish University HospitalLouise Stenholt (a), Lars J. Petersen (b) and Conni Skrubbeltrang (a)(a) Medical Library, Aalborg University Hospital, Aalborg, Denmark(b) Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospi-tal, Aalborg, DenmarkAddress for correspondence: Louise Stenholt, Medical Library, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Den-mark. E-mail: l.stenholt@rn.dk.19Journal of EAHIL 2018; Vol. 14 (2): 18-22 Embedded librarianship at a Danish University Hospitalwith a clinical research team. Upon request, a librarianjoined a research team, the Department of NuclearMedicine Bone Group, also entitled Nuclear MedicineAalborg Bone Group (NMA Bone Group) on a regularbasis as of February 2016.The NMA Bone Group consists of a clinical professor,a chief physician (registrar), who is also associateresearch professor, a number of PhD students, juniordoctors, and medical students. In addition, the groupinclude an ad-hoc statistician from the Unit for ClinicalEpidemiology and Biostatistics and a librarian from theMedical Library under the Department of Research,Education and Innovation. The statistician andlibrarian are full-fledged members of the group, and,as such, they are not restricted to serving only in anadvisory role. The main research interest of the NMABone Group is diagnostic test accuracy studies,primarily with prostate cancer and bone metastases.The projects range from interventional trials with novelimaging methods, retrospective studies, systematicreviews, and research methodological studies.As part of the project, the embedded librariancompleted a course on diagnostic test accuracy studiesarranged by the York Health Economics Consortiumin June 2016. The course was primarily focused onchallenges and strategies when identifying diagnostictest accuracy studies because the librarian's existingknowledge in this specific area of searching at thatpoint was still limited. Because the course was takenearly in the project, the timing was good, as were thebenefits of the course. Librarian's roleThe librarian participates in regular meetings in theNMA Bone Group. These meeting are held inconference rooms in the Department of NuclearMedicine. The rest of the time allocated to the NMABone Group is spent in the Medical Library whilemaintaining close contact with the NMA Bone Groupthrough telephone and mail correspondence. Ifsomething urgent needs to be discussed, the teammeets in person. Some NMA Bone Group projects arein collaboration with research teams outside AalborgUniversity Hospital, and, in these cases, differentforms of conference calls are also used.Table 1 is a list of the different tasks performed by thelibrarian as co-author in the three publications, ofwhich two are systematic reviews and one is a casereport with a comprehensive overview of the literature(13-15).Embedded librarian’s tasks in reviews1. Plan the process2. Define search question(s) and prospectiveinclusion and exclusion criteriaa. Search models as PICO(S) or PIRO fordiagnostic studies3. Conduct preliminary search to clarify the scope4. Choose relevant data sources5. Reformulate the research question 6. Develop search terms and synonyms usingcontrolled vocabulary and text words7. Execute search8. Adjust searches according to database platform and interface9. Document the search through search protocol10. Document search results11. Manage referencesa. Import the search results to referencesoftwareb. Search for duplicate referencesc. Removal of duplicate references12. Exporting to Covidence (SR-tool)a. Apply review settingsb.Guide researchers in the use of SR-tools13. Provide full texts for review14. Deliver consort diagrams according to PRISMA15. Suggest journal for publication based on:a. Indexingb. Topicc. Impact indicators16. Suggest author keywords17. Co-authorshipa. Write the relevant method section at aminimumb. Revise manuscript, tables and figuresc. Check and update referencesd. Apply and adjust output style for targetjournalTable 1. Embedded librarian's tasks as co-author inreviews.20 Journal of EAHIL 2018; Vol. 14 (2): 18-22 Louise Stenholt, Lars J. Petersen and Conni Skrubbeltrang Other tasks for the embedded librarian have evolved inthe process and now involves training sessions on basicand advanced PubMed searching, including post-training examination and certification, for clinical staffin the Department of Nuclear Medicine. Thesetraining sessions are driven by a combination ofincreased awareness of the librarian's expertise insearching and a realisation of the need to develop thedoctor's information literacy in clinical practise. Thereis also an increase in individual requests from theclinical staff directed to the embedded librarian. In thatway, word has spread and the portfolio of servicesdelivered by the embedded librarian continues toexpand. ResultsThe Embedded Librarian Project was initiated inFebruary 2016; as of December 2016, theDepartment of Nuclear Medicine has hired a librarianto work the equivalent of one full day per week on acontractual basis. The fact that the Department ofNuclear Medicine took the initiative to offer to payfor embedded librarian services on a contractual basisis an objective measure supporting the assumed valueof the librarian embedded in the research team.At this point, two systematic reviews and a case reporthave been published with the librarian as a co-author;and currently more manuscripts are in progress orunder review (13-15).In our experience, medical librarians’ expertise can beuseful in evidence-based medicine due to thesearching and filtering methods, which result in high-level evidence when involved in the literature reviews,clinical guidelines and so forth. When librariansprovide structured and more exhaustive searches, thescientific basis is strengthened. It is also beneficial tobe part of the entire process, starting in the earlyphases.This project has given the library staff experience,particularly in searching for diagnostic test accuracystudies and experiences with systematic reviews.Earlier, librarians in the library would have primarilybeen involved only in the search process.Researcher's perspectivesThe Department of Nuclear Medicine was previouslysatisfied with the Medical Library’s services and areeven more so now. Having all communication, worktasks and sessions handled by the same librarian alsoadds value for the team in terms of continuity andresults in time savings for the researchers because ofthe expert knowledge in this specific medical field ofdiagnostic accuracy within nuclear medicine.The librarian delivers systematic, well documented,and exhaustive searches in more databases, whereasdoctors perform more simple searches in fewerdatabases on a daily or weekly basis, primarily inPubMed. Despite the larger result sets, the embeddedlibrarian is perceived as offering relief in terms ofworkload, even though the researchers need to reviewa significantly larger number of references due to thehigher quality of the searches. This is supported byRethlefsen et al., who argues that involving librariansin the search process correlates with higher qualityreviews (16).Our collaborators state that they experience fasterliterature searches and, most importantly, a sense ofconfidence in terms of relying on the librarian’s searchresults compared to when they perform the literaturesearches themselves.The reasons to engage with a medical librarian in thisproject is an expression of the fact that searchstrategies developed by the researchers themselves arelacking in terms of quality and therefore are biased.This is line with Janke and Rush, who state thatconducting comprehensive literature searches isdifficult unless you have sufficient expertise andexperience within information retrieval (17).The way in which our collaboration is now formalizedhas made the library’s offerings even more clear to ourpartners. Medical researchers recognise that thelibrary offers a more complete package to supportresearch and clinical work. Based on the trainingsessions and presence in the department, there is nowgeneral awareness of the complexity of informationsearching amongst health professionals in terms ofclinical questions or research questions.DiscussionIn the following section, we briefly discuss ourexperiences from the stakeholders' perspectives.This project has required a large amount of flexibilityon the part of the head of the Medical Library andcolleagues because of the significant differences in theworkload over time, which sometimes influences theability to plan accordingly. Therefore, organisational21Journal of EAHIL 2018; Vol. 14 (2): 18-22 Embedded librarianship at a Danish University Hospitalsupport has great significance for the success of suchcollaborations (18). Because the embedded librarian is primarily physicallysituated in the Medical Library, a 10-minutes’ walkfrom the Department of Nuclear Medicine, it is easyto meet with the team when needed. On the otherhand, when spending this much time outside thelibrary, it is not possible to provide the same amountof service to all our users without requiring largeramounts of financial resources and in terms ofallocating time to participate in other research teams.Our collaboration also provides flexibility for thelibrarian to work from home on the days allocated tothe Department of Nuclear Medicine.From the researcher’s point of view, there have onlybeen a few minor misunderstandings, e.g. problemsin communication in the early phases of the project,which meant that a search had to be changed. This,of course, meant extra work for both the researchersand the librarian. This is in line with Seeley et al. andunderlines the importance of an ongoing dialogue tomake sure that the searches are moving forward in theright direction (19). Maintaining this ongoingdialogue is facilitated by having the librarianembedded into the project, instead of using the libraryas an external service.Adding to the amount of work that the librarycontributes automatically increases the overall timespent per research project, but at the same time, itresults in better quality searches and co-authorships.Thus, time is well spent on both parts.ConclusionLibrarians embedded in research teams carry outdifferent roles, such as expert searcher, co-author andteacher (20), which is supported by Kirtley, whoforesees librarians in a future role outside the libraryembedded in research teams and departments whilesupporting literature searches for systematic reviews.Kirtley strongly advocates that all relevantstakeholders acknowledge and leverage the librarians’professional competencies to increase value (21).We expect this collaboration to result in co-authorshipin several systematic reviews and other scientificmaterial, which depend on thorough review of themedical literature. At this point, a number ofmanuscripts are either ready for submission or arebeing written. Prospectively, we also hope to be ableto form new partnerships in other medical specialtieswithin our institution.Embedded librarianship has the potential to expandthe librarians’ role in health science and enhance thelibrarians’ qualifications in information science and asresearch professionals, who submit research in theirown domain, not merely as facilitators of the researchof others.Submitted on invitation.Accepted on 14 May 2018.REFERENCES1. Butera G, Gomes AW, Kakar S. Expanding ourroles: embedded in curriculum design. Med RefServ Q. 2014;33(3):292-301.2.  Hackman DE, Francis MJ, Johnson E, Nickum A,Thormodson K. Creating a role for embeddedlibrarians within an active learning environment.Med Ref Serv Q. 2017;36(4):334-47.3. Harris MR. The librarian's roles in the systematicreview process: a case study. J Med Libr Assoc.2005 Jan;93(1):81-7.4. McGowan J, Sampson M. Systematic reviews needsystematic searchers. J Med Libr Assoc. 2005Jan;93(1):74-80.5. Foster MJ. An overview of the roles of librarians insystematic reviews: from expert search to projectmanager. J Eur Assoc Health Inf Libr.2015;11(3):3-7.6. Dudden RF, Protzko SL. The systematic reviewteam: contributions of the health scienceslibrarian. Med Ref Serv Q .2011;30(3):301-15.7. Janke R, Rush KL. The academic librarian as co-investigator on an interprofessional primaryresearch team: a case study. Health Info Libr J.2014 Jun;31(2):116-12.8. Michels C, Schmoch U. The growth of science anddatabase coverage. Scientometrics.2012;93(3):831-46.9. Bornmann L, Mutz R. Growth rates of modernscience: A bibliometric analysis based on thenumber of publications and cited references.Journal of the Association for Information Scienceand Technology. 2015;66(11):2215-22.22 Journal of EAHIL 2018; Vol. 14 (2): 18-22 Louise Stenholt, Lars J. Petersen and Conni Skrubbeltrang 10. Bastian H, Glasziou P, Chalmers I. Seventy- fivetrials and eleven systematic reviews a day: how willwe ever keep up? PLoS Medicine.2010;7(9):e1000326.11.Fraser AG, Dunstan FD. On the impossibility ofbeing expert. Br Med J 2010;341(7786):c6815.12 Cullen R, Clark M, Esson R. Evidence- basedinformation- seeking skills of junior doctorsentering the workforce: an evaluation of the impactof information literacy training during pre- clinicalyears. Health Info Libr J. 2011;28(2):119-29.13.Petersen LJ, Nielsen JB, Dettmann K, Fisker RV,Haberkorn U, Stenholt L, et al. (68)Ga-PSMAPET/CT for the detection of bone metastasis inrecurrent prostate cancer and a PSA level <2ng/ml: Two case reports and a literature review.Mol Clin Oncol. 2017 Jul;7(1):67-72.14.Petersen LJ, Strandberg J, Stenholt L, JohansenMB, Zacho HD. Reporting and handling ofindeterminate bone scan results in the staging ofprostate cancer: a systematic review. 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Health Info Libr J. 2012Dec;29(4):274-84.19.Seeley H, Urquhart C, Hutchinson P, Pickard J.Developing the role of a health informationprofessional in a clinical research setting. EvidenceBased Library and Information Practice.2010;5(2):47-62.20.Spencer AJ, Eldredge JD. Roles for librarians insystematic reviews: a scoping review. J Med LibrAssoc. 2018 Jan;106(1):46-56.21.Kirtley S. Increasing value and reducing waste inbiomedical research: librarians are listening andare part of the answer. Lancet. 2016 Apr16;387(10028):1601-6736(16)30241-0. Epub2016 Apr 14.This paper is published under a CC BY license

Initial experiences of embedded librarianship at a Danish University Hospital

Petersen, Lars Jelstrup

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Initial experiences of embedded librarianship at a Danish University Hospital

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