curriculum integration
ByElizabeth H. Wood, M.S.L.S.Computer
Services Librarian University of Southern California NorrisMedical LibraryLosAngeles, California 90033 Janet L. Morrison, M.L.S.*
InformationServices LaneMedical Library
Stanford University Medical Center Stanford, California 94305
PhillipR. Oppenheimer, Pharm.D. Associate Dean forProfessional and StudentAffairs
University ofSouthern California School of Pharmacy
LosAngeles, California 90033
Forpharmacy studentsto provide optimal and complete
pharmaceutical care, it isvital that theydevelop drug information skills. Atthe University ofSouthern California, the School of Pharmacy and the Norris Medical Library have establishedan
interactiveeducational program. Library programs support an
increasingly complex progression of information retrieval, evaluation, organization, application, and communication. Librariansare
systematicallyinvolved inall four years of coursework for the doctor ofpharmacy degree. Training and experience in computer literacy
and online database searching are included inthe library components. Description of the educational program covers its
beginningadecade ago,current status,and futurein an environment
ofrapidly advancing technology.
The complexity of the drug information field and the expanding roles of pharmacists as information
resourcesdemand that students be trained
thorough-ly in the skills necessary for handling information.
Prior to entering pharmacy school, many students
lack basiclibraryandinformation researchskills,and
all need instruction toreach necessary levels of bib-liographic and drug information expertise. Students who do notunderstand how to use a librarycatalog
or a printed or online index are at a disadvantage; theycannotbeexpectedtoresearch the
pharmaceuti-caljournal literatureorfindforeign drug information
in anonline database. Health sciences librarianscan
and should train pharmacy students in this entire
spectrumof activities.
Teaching library and literature research skills in
thecurricula ofpharmacyschoolshas been discussed for at least two decades [1-7]. Rather than develop
separate library courses, Sewell et al. describe
inte-gration ofbibliographic skillsinto aseriesof existing pharmacy school courses [8]. At the Norris Medical Library, University of Southern California (USC) Health SciencesLibrary System,aprogramof biblio-graphic and drug information instruction is inte-gratedintothe School of Pharmacy curriculum at all four years of the doctor of pharmacy coursework. There is an additional seminar for pharmacy resi-dents.
Thispaperdescribes the development of the USC *Formerly pharmacy liaison and reference librarian at the
library's educational program on drug information for doctor of pharmacy students. The discussion cov-ers the beginnings of the program a decade ago, its current status, and itsfuture in a technologically ad-vanced environment.
PROGRAM BACKGROUND
The Norris Medical Library's discussions with the USC School of Pharmacy faculty adecade ago were the beginning of the integrated instructional design process.Faculty explained the need for increased stu-dent learning experiences to build drug information skills. Observationsfrom the librarians and pharmacy
faculty confirmed that students were not skilled in
finding druginformation; neither were students aware of the wide range of medical and pharmaceutical lit-erature.Thefaculty observed deficiencies in students' communication skills and in their ability to relate pharmaceutical and medical knowledge to practical
situations. Previously there had been a brief
orien-tationtothelibrary anditsinformation sources, along with the assignment of simple drug information questions;however, thiswasclearly not enough.
Prior to
entering
pharmacy
school,
many
students
lack basic
library
and
information
research
skills,
and
all need instruction to reach necessary levels
of bibliographic
and
drug
information
expertise.
The literature confirms the need for enhanced training.Astrongstatementaboutdeficiencyin
phar-macy education was found in the 1975 report of the
StudyCommissiononPharmacy [9],which criticized the pharmacy profession's organization and trans-mission of drug information. The reportemphasized
the increasing significanceof druginformation, and the need for changes in pharmacy education and training as pharmacists are called upon to be more sophisticated and knowledgeable. Subsequent
writ-ings have reaffirmed this conclusion [10-11]. Phar-macy students need education and experience in us-ingliterature sourcesanddruginformation systems; thustheybecomemoreeffective andefficientin deal-ing with the analysis and dissemination of drug
in-formation [12]. Today studentsmustalso have
train-ingandexperienceinusingcomputerizedinformation
systems. AsBrodie and Smith state, "Adaptingto the age ofknowledge and technology is not an option; rather, it is an imperative" [13].
The pharmacy education literature contains an abundanceof material about the need for educational programs withinpharmacy curricula that emphasize
drug information skills. Students should be able to apply theoretical knowledge and research methods toproblem-oriented case studies and real-life clinical situations [14]. Pharmacists need to be capable and effective drug information consultants to peers, col-leaguesinother healthprofessions, and patients [15-16]. Of particular importance is the need for experi-enceincommunicating druginformation throughout students' education, not in just one course. Pharma-cists need knowledge about the identification and evaluation of resources, including online information systems. Results of a 1984 survey of pharmacy edu-cational programs suggested that "many of today's pharmacy students may not be receiving sufficient druginformation training .. ." [17].
Toinitiatedevelopment of the USC program a de-cade ago, a core working group was established to interact with the school's Pharmacy Curriculum Council and to devise a model program that would address the recognized needs. The working group consistedofaninstructionaldesignspecialist,a phar-macy faculty member, and the pharmacy liaison
li-brarian. The librarian participated in the develop-ment and implementation of the program by organizing support from the library, later preparing andteaching classsessions. Thegoal of this original program was to develop the drug information and
communication skills of the pharmacy students so
they could fulfill asignificant,uniquerole in health
care through their knowledge and experience. The original intent of the program has changed little during the past ten years. The core working group that initially developed the library program believedintheimportanceof libraries and librarians
asinformationresourcesfor thepharmacyprofession.
They wantedto instill thisoutlook in pharmacy
stu-dents.In a 1985 reportthat includedastudyof
phar-macists' needs for the informationservicesofa med-ical library, the researchers found that younger pharmacists and those working in a hospital setting
weremore likely to usethe library [18]. The authors commented that this trend may bearesultof training and education and that health professionals are be-comingmoredependentonlibraryinformation. The
current program, like the original one at USC, con-tinues to emphasize that pharmacy students need to
gain experience usinglibrary resources;theyneedto
beawareof the valueof using theresourcesavailable and theservicesof librariansaspartnersinthe health
care team.
The originalprogramservedas abasis for the cur-rentprogram. Learningactivitiesatthelibraryduring the firsttwoyearsincludedalecture component but
were largelyexperiential. The identificationanduse ofdrug informationresources weretaught bylecture and demonstration. Students then had direct
mate-rials. Library assignments for research with written and oral presentations were related directly to par-ticular pharmacy classes. Progressive levels of learn-ing activities with library support durlearn-ing the third and fourth years were designed to build skills for identifying and evaluating druginformation, solving specific patient problems, and communicating this information to immediate colleagues, other health professionals, and patients.
The current program continues to
emphasize
the
retrieval,
evaluation,
organization,
application,
and
communication
of drug
information.
THE CURRENT PROGRAM
During the past decade, the library and pharmacy
school program has evolved in content and method
to include the developments in technology that en-able endusers to do theirownbibliographic search-ing; microcomputers now exist in many offices and clinics. However, the goals of the original program model have remained largely unchanged. The cur-rent program continues to emphasize the retrieval,
evaluation, organization, application, and commu-nication of drug information. The program also
stressesthepharmacyprofession'suseoflibraries and librariansasinformation resources, and waysinwhich librarianscan assist indeveloping studentawareness
of the need for lifelong professional development
andlearning.
Overview
Bibliographic and drug information instruction has been integrated into the classes atall four levels of the existing curriculum. The content provides
step-wiselearningwithincreasingcomplexity throughout
the coursework for the doctor of pharmacy degree.
Each year's work reinforces and builds upon what
wastaught in the previous year.
The progression begins with basic library orien-tation and retrieval of drug information in the first year, then continues with evaluation ofprinted and
computerized tools in the second year. Also in the
secondyear,studentspresent whatthey have learned
to one another insmallgroups. The thirdyear intro-ducesthe application ofdrug information to patient
cases and further builds communication skills. The online database searching taught in the fourth year enables students to become more independent and enhancestheirdrug informationresearch.Computer literacy andcomputerized literature-searching skills are emphasized throughout the program.
Technological advances in both the information retrieval and pharmaceutical fields have altered teaching content and technique. It is now realized that studentsneed computer skillstomaintain
aware-ness of the exploding drug information literature. Whenthey leavepharmacyschool, studentsmustbe able to use electronic forms of communication and computerized databases.
Evaluation
Regularcontactbetween theliaison librarian and the faculty members whose courses have alibrary
com-ponentensures thequality and relevance of the pro-gram. The librarian ensures that these contacts are
made prior to the beginning of each semester and that any changesin personnel or course contentare
reflected in the library program. Topics for student research are revised each year to include recent de-velopments.Examples of topics addedinrecent years include AIDS and genecloning. Duringthese meet-ings, the librarian shares with the faculty the eval-uationsfrom the first- and second-year program
seg-ments and observations made by students at the library. The observations include the numbers and types of questions asked of librarians, the students' apparent familiarity with the printedliterature, and the amount of handbook and index use. Librarians
are currently able to evaluate formally only those partsof the program where librariansadminister the
testsand assignments.Informal evaluation of the
stu-dents' progress occurs as reference librarians help students with assignments. The type and frequency of students' questions indicate where the program needsenhancement orchange.
While both faculty and librarians have indepen-dently observed the students' improved skills, there has beenno thorough, formal evaluation of the pro-gram.The librarians have written their own pre- and posttestsanddiscuss each year how best to organize the work load of teaching and supervision. Faculty and librarians have not shared evaluations in any formal manner. Efforts would be enhanced by the coordination ofevaluationinstrumentsanda follow-upstudy ofpharmacygraduates.
Practical matters
One-on-one and classroominstructiontakeplace both
within the library and atthe pharmacy school close by.Direct NLMMEDLINEsearchingisdonefor a fee by librarians or by users with their own passwords
atdesignated microcomputers. MEDLINE on CD-ROM
is available free for any library user.
Each year's class has approximately 160 students. One pharmacyliaison librarian coordinates the pro-gram butreceives help in teaching and demonstrat-ing from a total of six information specialists. Each
of these six librarians spends several hours with the first- and second-year students. The librarian who is also the online search coordinator supervises the trainingof the preceptorsinthefourth-year program andspendsseveral hoursinthe spring helping fourth-yearstudents with theirsearches.
First year
The library invites first-year students to a general class on computer literacy. In 1988 about half the students arrived atpharmacy school with some com-puter background. A two-hour session, which in-cludespractical experienceinthe basicsof microcom-puting and word processing, is given to provide minimumlevelsof competence. A further lecture dis-cussesthe library's extensive microcomputer facilities and the availability of drug information via online databases. The popularity of the library's microcom-puter facilities among pharmacy students increases annually.
By the end of the first semester, students should be able to:
* identify and locate library materials by author, title,
orsubject;
* understand howto use printed Index Medicus; * identify bibliographiccitation elements;
* locatejournal holdings at Norris and affiliated li-braries;
* understand the usefulness of onlinebibliographic databases; and
* acquire basicproficiency withanend-user database searching system (CD-ROM).
First-yearstudents havewidelyvaried understand-ingand competence in using libraries and
informa-tion resources. The thrust of the first-year program,
therefore, is to introduce students to the pharmacy
literature and its organization, publication, and
re-trieval, with emphasis on library and information-seeking skills.
Afirst-semestercourseintroducingpharmacy
prac-tice begins witha two-hourlibrary orientation. The pharmacy liaison librarian givesa forty-minute
lec-turedescribing thelibrary'scollections andservices;
thelectureincludesanintroductiontoIndex Medicus andanexplanationof howtofindinformationinthe library by author, title, or subject. A thirty-minute
slide-tape program is then used to describe the
li-brary's layoutand howtolocatelibrary holdings.The
final segment is a demonstration of MEDLINE, the
majorindexto thebiomedical literature,available in
thelibrary online directlyto NLMandonCD-ROM.
Forevaluation, studentsare given pre- and posttests
and an assignment that iscorrected by the librarian
and returned to the students. Results indicate that students doaccomplish the objectives.
Bythe endof the second semester, students should also be able to:
* differentiate types and functions of information re-sources, e.g.,handbooks, indexes, journals;
* understand the process by which pharmaceutical literature is published;
* understand the concept of peer review; and * begin to evaluate drug information by authority, timeliness, and relevance.
Atthe beginning of the second semester, the
phar-macyliaison librarian givesa moredetailed two-hour lecture in the first session of a course on literature evaluation and biostatistics.
This classalso has an assignment. Studentsare
re-quiredto locatejournal articles that demonstrate
re-search methods and prepare a short description for presentationinaclasssession atthepharmacyschool. Themost commoncomplaintamongfirst-year
stu-dents is a request for more supervised CD-ROM searching or more free time
searching
MEDLINE directly rather than the hands-on practice providedin class. (In 1989, this problem was resolved by the provision of locally-mounted MEDLINE at the
uni-versity,free to all library-card holders and available
atterminals in the library.)
Second year
Library involvementinthe first month of the micro-biologycourse at the beginning of the second year is
more intensivethan thefirst-year program. The pur-poseof the programatthis levelis toprovide practical experience in finding drug or related health
infor-mation on specific, individual topics. The students
mustanalyze their information needs, then select the appropriatesources to meetthem.Librarians discuss appropriate search strategies for handbooks and
in-dexes with small groups of students to help in the choice and evaluation of sources. In addition,
stu-dentscommunicatetheirfindingsinbothsmall-group andlarge class settings.
The class of 160 students is divided into groups of
ten. Each group makes an appointment to come to the library for a two-hour class session. Six Norris librarians share the teaching. Each student is given volumesofIndexMedicus, International Pharmaceutical Abstracts, Science Citation Index, Current Contents, and DrugLiteratureIndex.The librarian assignsadrug top-ic, and the classmembers locate articlesinthe various
indexes.Classdiscussionensues,comparingwhat stu-dentshave found. The librarian then handsout thir-teen different pharmaceutical handbooks. Students
are given a few minutes to find information on the assigned drug topic. The librarian takes two of the
handbooks, demonstrating what each student is ex-pected to present regarding the content, authority,
timeliness, organization, and scope of the work. In classdiscussion,students compare thehandbooks and contrast the information found in the indexes and handbooks. At the end of the session, each student receives a research topic that requires theuse of
in-dexes and handbooks. A brief presentation is given
in alater antimicrobial therapy class, reiterating the methods and sources usedtolocate the information. Thus, students are gaining experienceinfinding,
or-ganizing, and evaluating drug information, then in
presenting it to others.
At the end of the semester, students are asked to complete an evaluation form regarding the
library
component of the course. They areasked to rate the usefulness of the program as a whole and its effec-tiveness in meetingspecific learning objectives. The mosthighlyratedcomponentsareusuallyinstruction
in the use of Index Medicus and the hands-on expe-rience with the handbooks. Most students rate the program as "very effective" in improving their use
oflibrary information sources and comment on the practicality of the small-groupsegments.
Third year
Activities at this level introduce the application of drug information to patient cases. Two semesters of clinical therapeutics courses concentrate on the
pathophysiology of disease and relatedtherapeutics.
Librarians are not directly involved in teaching in
this year and therefore have no stated goals or ob-jectives for the students. Students participate in clin-ical workshops and work with othersin the evalua-tion ofdrug therapy in preparedcases. In addition,
they are assigned patient-related topics to be pre-sented in class after library research. Related back-ground reading materials, such as copies ofjournal articles, book chapters, and notes provided by
pro-fessors,areplacedonreserve inthelibrary. Students
are expected to do further independent research on theirassigned topics.Althoughlibrarians donottake partintheteaching inthis year,theyarenotifiedby
thefacultyof the topics that have beenassignedand discuss withfacultytheamountofhelpthat students
canexpect whentheycome to thelibrary. Many
stu-dents request computerized literature searches from reference librarians orperform searches themselves usingMEDLINE on CD-ROM.
Through these experiences with individual topics forlibrary research, students become more
indepen-dent learners. Their personal research into practical topics that relate directly to patient care stimulates self-motivation. Presentingfindings builds verbal and
written communication skills. Fourth year
By the end of their fourth year, studentsare
expected
to:
* understand the structure and content ofMEDLINE;
* know howtologontotheMEDLARS systemusing
standard telecommunications software;
* formulate search strategies that include
multiple
concepts such asdisease, drug, and
dosage;
* interact online with the database, limiting searches
by subheadings andcheck tags; and * printorcapture retrieval to disk.
Pharmacists today depend increasingly on
micro-computers. One goal of the library's pharmacy pro-gramistofamiliarize students withmicrocomputers, especially their use for online literature searching.
MEDLINE isdemonstratedinthefirst-year class,and students areencouraged to request online literature searches from librarians throughout their years in pharmacy school. A small fee is charged for these
searches, and no free passwords are available.
In-creasing numbers of students use MEDLINE on
CD-ROM,whichprovides quickandeasy access to a lim-itedpartof the database. Direct online searching with NLM command language, however, provides access to databases other than MEDLINE and enables the user tosearch moreefficientlyandcomprehensively.
To
provide
students with
comprehensive online
searching skills,
preceptors
from
the
clinical
phar-macy
faculty
in
the acute care
therapy
clerkship
teach
fourth-year
students to search MEDLINE
using
NLM command
language.
To provide students with comprehensive online
searching skills, preceptors from the clinical phar-macyfacultyintheacute caretherapy clerkshipteach
fourth-year studentstosearchMEDLINE using NLM command language. The preceptors themselves are trained originally by librarians. Funds for online
chargesare provided by the pharmacyschool. After an initial lecture,students attend a three-hour prac-ticum. The lecture covers the principles of online searching-the use of a controlled vocabulary, Boo-lean operators, and field-specific searching. MED-LINE commands are taught, together witha
descrip-tionofthe database and instructions for logging onto the system. The practicum takes placeinthelibrary's microcomputer classroom. A librarian illustrates
re-trieval ofreferences on a given topic; each student thenduplicates the exercise online. The librarian dis-cussessearchstrategy formulation and compares re-trieval using different strategies; once more, students duplicate the searches. Students are then assigned topics and encouraged to experiment with various formulations. Over the next six weeks, they are en-couraged to make arrangements with their preceptors
executing searches. Students perform an average of four to six searches each. Further consultation with librarians isavailable as needed.
A further activity for fourth-year students is an elective clerkship at the Drug Information Center (DIC) at the affiliated Los Angeles County General Hospital andatother DICsinthe SouthernCalifornia basin. The DIC and the Norris Medical Library are aware of each other's collections and activities and cooperate in providing information service. As in similar programsdescribed in the literature [19-22], the USC fourth-year students receive practical ex-perience atthe DIC, participating in all ofits
activi-ties.Theyuse variousreference and indexing sources for answeringspecificquestions.Thisclerkship
com-plementsthe drug information component of the li-brary program.
Sixclerkships,each ofsixweeksduration,make up the final year of the curriculum. In all the required
andelectiveclerkships,studentsarerequiredtogive presentations on patient cases in a professional
set-ting. The libraryplaysavital supportive roleduring thistime: librarians guide students in finding
infor-mation for their case conferences, perform comput-erized literaturesearches,andhelpstudentstosearch for themselves on CD-ROM or by direct MEDLINE
access.
Pharmacy residents
The USC Schoolof Pharmacyoffersaone-year post-graduate training program (residency) in specified
clinicalpharmacyareas. Aboutonethirdof the USC residency participants are from other schools. They
havenot necessarily experienced the type of biblio-graphic and drug information program that is pro-vided at USC. A single-session, three-hour library seminar is therefore heldin the fallof each yearfor orientationandreview.Theseminarformat and
con-tent depend largely on the needs of the
particular
group.Orientationtothelibrary'scollections and ser-vices,plusreviewof relevantreference andindexing
sources, are usually included. Discussion and
ques-tions are encouraged. Theseminartypicallyincludes
a demonstration of online bibliographic searching
and comparison of pharmaceutical handbooks.
Li-brarians are available for consultation upon request
atany timeduring the pharmacy residency; further trainingin both computerliteracyand thesearching
of online databases is available through existing li-brary programs.
THE FUTURE
TheTaskForceReport ofCompetencyStatementsfor Pharmacy Practice [23], presented to the American
Association of Colleges of Pharmacy at their annual meetingin 1987, confirms that many responsibilities of pharmacists require skills in the performance of drug information research, application, and com-munication. Researching the medical and pharma-ceutical literature and maintaining access to current drug information, for example, are specifically de-fined as necessary skills for patient care and for pro-vision of drug information to other health care professionals. Library participation in pharmacy ed-ucation can help to develop these skills. It is the re-sponsibility of pharmacy education to build these skills, using the latest technological advances.
Technological developments in computerized drug information systems and advances in pharmaceutical research will demand changes in drug information training programs. Thefollowing developments will affect such programs:
* The drug information literature will continue to expand rapidly with biotechnological research ad-vances; current awarenesswill be critical.
* The pharmacist of the future will increasingly be using computerized drug information systems with direct access to online databases to identify needed drug data and literature.
* Libraries will expand their microcomputer
facili-ties and training programs in basic computer and drug information skills.
* More librarians willact asconsultantstohealthcare professionals for electronic access to the biomedical literature.
Healthscienceseducation isbecomingmore prob-lem-oriented and employing new techniques, such
ascomputer-assisted instruction andinteractive
vid-eo programs, thus changing the traditional roles of
teaching faculty and librarians. Technological
ad-vances areenhancingstudents' learningexperiences and preparing them for professional practice. The NorrisMedicalLibraryprovidesextensive
microcom-puter facilities for both students and
faculty.
Librar-ians usethese facilitiestoteach computerliteracyand demonstrate software for online database
searching
and information management. Thelibrary routinely acquiresself-directedlearningprogramsondiskettes,
laser disks,and videotapes. These programs are
fre-quently patient-oriented. USC pharmacy faculty members have written their own problem-oriented pharmacokinetic modeling programs for student
learning within the library.
Neweducational needsarising fromtechnological advancesshouldcontinuetobeassessed. The library canandwillworkintandemwith thepharmacyschool
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ReceivedNovember 1988; accepted March 1989
FROM THE BULLETIN-25YEARS AGO
Random thoughts about medical libraryplanning
By Alderson Fry, Librarian, Medical CenterLibrary, West Virginia University, Morgantown, West Virginia Mostof therestof thistalkisdevoted(andyou mayconsider that word eitherinthesenseof theminister orthe agentprovocateur) to anattack onthe idea thatmostofus mustkeep building bigger and bigger
libraries,or atleast puttingmoreandmorebooksin them.We mustbe concerned(1)withaddingtothat
hugemass of books we haveback in the bowels,or megacolon, of the library or (2)with getting rid of this matter altogether. This latter action will result in saving money, running more efficient libraries,
and,unfortunately forsome ofyou,building fewer libraries.NaturallyIthink it will befortunatefor the restofsociety.
Some of my attitude is easy to illustrate. Thank God for that accretive hi-fi set, the engaging TV, the amiability of the car, and the blessings of medicine in eliminating agreatdealofonly marginal health, thusmaking available energy for something besides reading. They arebreaking the stranglehold of the writer-publisher-critic guild, which would have us believe reading is man's highest pursuit. As Peter Dooley said, "Readin' ain't thinking." And Oscar Wilde said, "Work is the curse of the drinking class." Well, print isthe curse of thethinking class.