The Doctor is Out

10 Jul

Psychiatric BoothAdmit it. We all know a lot better, a lot of the time. People know that sitting around all day isn’t the best thing for one’s health, but here we sit. We know that the label says there are 6 servings of macaroni and cheese in the box, but it really divides better by 2 or 3. We know that being distracted while driving isn’t the safest thing, but we text and we do our makeup and we fiddle with the radio and we play our ukuleles while we drive, anyway. And when it comes to information and data, of course we know that it’s best to back-up our files in multiple places and formats, to name our files a certain way so that we can find things easily, and to write down instructions and practices so that we, or others, can repeat what we did the first time. Of course we know these things because let’s be honest, it’s common sense. But… we don’t.

Personally, I get incredibly frustrated at librarians who think we’re adding something important to the world of data management, just by teaching people these notions that really are common sense. I think that there’s something more that we need to do and it involves understanding a thing or two about the way people learn and the way they behave. In other words, lacking a behavioral psychologist on your research team, librarians would do well to study some things from their camp and put them to use in our efforts at teaching, providing information, helping with communication issues, and streamlining the information and/or data processes in a team environment.

I’m preparing to teach a course in the fall and thus I’ve been reading some things about instructional design. In her book, Design for How People Learn, Julie Dirksen explains that when you’re trying to teach someone anything, it’s good practice to start by identifying the gaps that exist “between a learner’s current situation and where they need to be in order to be successful.” (p. 2) Dirksen describes several of these gaps:

  • Knowledge and Information Gaps
  • Skills Gaps
  • Motivation Gaps
  • Environment Gaps

More, I believe she hits the nail on the head when she writes, “In most learning situations, it’s assumed that the gap is information – if the learner just had the information, then they could perform.” I know that I fall into this trap often (and I bet that I’m not alone). I believe if I teach a student how to conduct a solid search in PubMed, that’s how they’ll search. I show them a trick or two and they say, “Wow!” I watch them take notes. I help them set up their “My NCBI”  account. We save a search. They’ve got it! I feel like Daniel Day Lewis in the movie, There Will Be Blood, “I have a milkshake and you have a milkshake.” I have knowledge and now you have the knowledge. Success!

Now if you do any work that involves teaching students or clinicians or researchers or anyone, you know not to pat yourself on the back too much here. I teach people, my colleagues teach people, all of our many colleagues before us (teachers, librarians at undergraduate institutions, librarians at other places where our folks previously worked) teach people. We all teach the same people, yet we keep seeing them doing things in their work involving information that make us throw up our hands. How many times do we have to tell them this?! 

Well, maybe it’s not in the telling that we’re failing. This is where I think understanding and appreciating the other gaps that may exist in the situations, addressing them instead of simply passing along information, could lead us to much more success. And this is where we could use that psychologist.

Earlier this week, I tweeted that I was taking suggestions for what to rename the systematic review that I’ve been working on with my team, for it is anything but systematic. A’lynn Ettien, a local colleague, tweeted back the great new name, “Freeform Review.” I loved that. Another colleague, Stephanie Schulte, at the Ohio State University, offered up a really helpful link to a paper on the typology of reviews. But it was what my colleague, Eric Schnell, also at OSU, tweeted that led me to this blog post:


BINGO! Every person on my team knows what the “rules” are, but they keep changing them as we go along. I spend time developing tools to help this process go more smoothly, but still get a bunch of notes emailed to me instead of a completed form. I give weeks to developing a detailed table of all of the elements we’ve agreed to look at. Except this one. Oh, and this. Oh, and should we also talk about this? I put my head down on the table.

But Eric is exactly right. This is how most people deal with information. This is how we work. And it’s not a matter at all of people not knowing something, but rather it’s a problem of people not doing something. Or better put, not doing something differently. Sometimes people do lack knowledge. Many times, people lack skills – something that a lot of practice can fix. But an awful lot of time, what we really need to address are the gaps that have nothing to do with knowing what or how to do something.

Why won’t my people use the forms I’ve created and the tables that I’ve prepared? They said that they liked them. They said they were what they wanted. So… what’s the problem? I think it’s something that each of us who works in this field of information wrangling needs to become proficient at, i.e. learning to see and address all of the gaps that exist. At least the ones we can.

And I, for one, am still learning. 


12 Responses to “The Doctor is Out”

  1. Julia Esparza July 10, 2014 at 5:33 pm #

    Sally this is exactly the reason that I dislike the idea of “teaching” PubMed skills. While I know that they are intelligent enough to learn it, from my real world clinical experience most of them won’t use it. It isn’t because they don’t want to, they just don’t have the time to stop and think how to do it. I’ve said this many times that while the EBM opened many doors for librarianship, I think that it also gave clinicians (physicians, nurses, and others) a false sense they can search well. Just because you can use a cell phone, do delicate heart surgery, or be as good a diagnostician as House, it doesn’t mean that you can search. By thinking we can just “teach them” we have endangered patients. I know that I have an extreme view but seeing what I see I really truly believe this with my whole heart. Evidence shows that they don’t bother to look up answers to their questions, if they do they can’t find what they need and then if they find information they are only going to look at the top 5 citations OWNED by their organization.

    • salgore July 10, 2014 at 6:32 pm #

      GREAT comment, Julie. Thank you so much for sharing it.

  2. Olendzki, Barbara July 10, 2014 at 8:18 pm #

    I love this!!! It’s so true in my field, that knowledge alone is RARELY enough, so why is that what they teach us in school?
    Keep writing the blogs, I’m listening.
    And it’s best to leave the ukulele tunes for when you get home.

    • salgore July 10, 2014 at 8:29 pm #

      Thanks, Barbara, and don’t worry, I only play while sitting at traffic lights. 🙂

  3. Donna Beales July 11, 2014 at 7:44 am #

    Isn’t this a case for retaining medical librarians in the workforce? Medical librarianship is a risk management issue, for all the reasons you delightfully cover here. 🙂

  4. Fred July 11, 2014 at 8:17 am #

    One problem is that doing a good search is a lot harder than we think it is. I’ve been a medical librarian for nine years, and a librarian for almost 25 years. (A depressing thought, but see today’s XKCD: Sure, we can teach people the basics, but not the experience of hundreds of hours of searching. When I do library orientations to residents/nurses, I tell people “if I cut my hand, I can bandage it up myself. If I cut my hand OFF, I’m going to come to one of you. The same goes for searching. Don’t spend more than five or ten minutes looking for something, getting frustrated, and end up putting your fist through the screen. Come to one of us librarians. That’s our job.” Besides, we have the time. Right now I’m working on one Search from Hell (TM) that’s taken me four hours, and will probably take me another hour before I come up with anything I feel I can send to the person requesting the search. What resident has that kind of time for a literature search? Wouldn’t their time be better spent doing doctor stuff– saving lives and that kind of thing?

    A slight tangent: learning something new can be hard, no matter what it is or how easy it looks to other people. I just got an iPad Air. I’ve been using PCs since 1988, I build my own Windows systems to connect to my gigabit home network with three NAS drives. Last year I built an Xubuntu server and migrated our ILS to Koha. But can I use the iPad? Just barely. Every time I try to do something, my blood pressure goes through the roof and I grind my teeth down another millimeter. Sure, I’ll catch on eventually, but right now I’m having an amazing amount of trouble with their ultra-intuitive, easy-to-use interface.

    Or, to put it another way (copyrighted, but used under the terms of US Code Title 17, Sec. 107, Fair Use, and in no way meaning to compare proficient iPad users to children)
    It’s so simple
    So very simple
    That only a child can do it!

    • Carolyn Biglow July 11, 2014 at 4:43 pm #

      I also tell our staff to contact me if their search is taking more than 15 minutes. They are usually surprised when I send them a list of articles that they couldn’t find! But I just tell them that literature searching is my job, and I’ve been doing it every day for 6 years.

  5. Ed Donnald July 11, 2014 at 10:35 am #

    Continued insight and wisdom from my favorite ukulele player!

    Just this morning, the audio book I’m listening to on my long commute, relayed the story about Sun Tzu and the Kings’ Concubines [] where success also required more than just “Information”.

    • salgore July 11, 2014 at 10:59 am #

      Hi Ed! I love it when different things going on in our lives collide. 🙂

  6. Barb Folb July 11, 2014 at 1:29 pm #

    Librarians can benefit from having a general idea of theories and models of how people address information needs. I’ve found it very dense going, but useful to read the literature on sense making, and books like “Theories of Information Behavior” edited by Karen Fisher. These are rather dense going, but putting the seeking of health and medical information into a more general information seeking context makes the students, faculty and clinicians we work in seem less willful or foolish in ignoring our wise advice on searching.

    About five years ago I taught a session in a theories of health behavior class where I showed students how to use PubMed and citation databases like
    Scopus to find articles that used a health behavior theory to address a problem. I was very sad when the main instructor told me they all used Google Scholar anyway. Happily, I have been continually involved with the class and able to modify my teaching over time.

    Now there are two searches we do in class, one a keyword search to find articles with “theory” words in them. First, one to find articles using “theory” words in the citation and abstract. I split the class in half, one side uses PubMed, one uses Google Scholar. They work in pairs to do the search. Then the whole class discusses how they worked, and I ask what they preferred. Second we do a cited article search for papers citing an important article describing a health theory. People who used PubMed for the first search now use Google Scholar, and people who used Google Scholar now use Scopus. Then there is more discussion.

    I leave them with the idea that I don’t have a personal stake in which database they use, but that all of them have their strengths and weaknesses. For their assignment, they can use whatever they want. I tell them pick what seems best to you, try the other if the first one disappoints you. Reports back tell me that some use PubMed, some use Scopus, some use Google Scholar, and they are doing a pretty good job of finding stuff they can use that fits the scope of the class assignment.

    Everyone is happier.

  7. salgore July 11, 2014 at 1:50 pm #

    Thanks to everyone for sharing your experiences, thoughts, and ideas. It’s terrific!

  8. Catherine Arnott Smith July 12, 2014 at 11:21 am #

    Nice piece, Sally! @ Barb Folb: Total agreement. I’m a former medical librarian who turned into an information school professor and I fought hard to have a required online searching class made part of our curriculum when I got to Wisconsin-Madison in 2006. I use a “bake-off” strategy in class just as you describe, and I’ve found time and time again that the most effective learning happens when students discover the results themselves — my bake-offs compare full-text farms (JSTOR, Academic Search Elite, etc.) to subject-specific databases, databases to Google and other search engines, Primo discovery tools to everything … I could lecture about this at the front of the room until I was blue in the face and it wouldn’t matter. When students see for themselves what a difference it makes to use the right tool for the right question, they honestly do take that message home.

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