A greater voice for academic health sciences libraries: the Association of Academic Health Sciences Libraries' vision

Abstract

The founders of the Association of Academic Health Sciences Libraries (AAHSL) envisioned the development of a professional organization that would provide a greater voice for academic health sciences libraries, facilitate cooperation and communication with the Association of American Medical Colleges, and create a forum for identifying problems and solutions that are common to academic health sciences libraries. This article focuses on the fulfillment of the “greater voice” vision by describing action and leadership by AAHSL and its members on issues that directly influenced the role of academic health sciences libraries. These include AAHSL's participation in the work that led to the publication of the landmark report, Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management; its contributions to the recommendations of the Physicians for the Twenty-first Century: The GPEP Report; and the joint publication with the Medical Library Association of Challenge to Action: Planning and Evaluation Guidelines for Academic Health Sciences Libraries.

The founders of the Association of Academic Health Sciences Libraries (AAHSL) envisioned the development of a professional organization that would provide a greater voice for academic health sciences libraries, facilitate cooperation and communication with the Association of American Medical Colleges (AAMC), and create a forum for identifying problems and solutions that are common to academic health sciences libraries [1]. Early association efforts focused on establishing a formal role for medical school library directors in the AAMC through membership in the AAMC's Council of Academic Societies (CAS). Membership in CAS was pursued unsuccessfully until 1982, when the AAHSL Board of Directors “argued … that official affiliation was unnecessary. In fact it could be detrimental to the present relationship” [2]. Member reaction to the board's decision brought into question the overall purpose and vision of AAHSL. In response to these concerns, the board held a two-day retreat that resulted in development of a Planning Document for the Association of Academic Health Sciences Library Directors that defined three basic purposes of the organization:

1. promotes and fosters excellence in management and information management in medical school libraries;

2. evaluates and takes action on issues that directly affect medical school libraries; and

3. represents members' interests and concerns to agencies and other organizations [3].

It is useful at this key juncture in the association's history to consider to what extent the visions of the founders and those who followed them have been achieved. Other articles in this symposium document AAHSL's accomplishments in promoting and fostering excellence in management and information management and representing members' interests and concerns. This article focuses on the fulfillment of the “greater voice” vision by describing action and leadership of AAHSL and its members on issues that directly influenced the role of academic health sciences libraries.

THE MATHESON/COOPER REPORT

In 1979, AAHSL met with Marjorie Wilson, M.D., director of AAMC's Department of Institutional Development, to offer assistance in carrying out the AAMC's contract with the National Library of Medicine (NLM). NLM was interested in updating three significant AAMC reports relating to libraries and the role of libraries and educational technology in medical education [4–6]. Two AAHSL committees provided Dr. Wilson with evaluative comments on the reports. AAHSL was included in the first formal planning meeting for the contract, where the direction to focus on information management in academic health sciences centers was set. Of greatest significance, however, was the appointment of AAHSL Board Member Nina Matheson as project coordinator effective July 1, 1980.

AAHSL was actively involved in the work that led to the publication of the landmark report, Academic Information in the Academic Health Sciences Center: Roles for the Library in Information Management [7]. Two AAHSL members served on the project advisory committee. The membership at large participated in the project delphi study, responded to an AAHSL questionnaire, and reviewed early drafts of the report. The final report provided a bold and exciting vision of the role of academic health sciences libraries, thus laying the groundwork for a number of opportunities for AAHSL action. As noted by AAHSL President Virginia Holtz, “As members of this association and as librarians, these recommendations are of major importance to us and deserve our careful study. Reviewing this report and integrating appropriate recommendations … will be one of the major goals of the association in the months to come” [8].

The Planning Document for the Association of Academic Health Sciences Library Directors included objectives for AAHSL developed from the recommendations in the Matheson/Cooper report. These included “joining in a health information coalition to help [academic health sciences centers] (AHSCs) adopt and use state-of-the-art information technologies,” working with other organizations to “improve AHSCs' ability to adopt new technologies,” and joining with the Medical Library Association “to ensure the development of appropriate professional skills in … academic health sciences libraries” [9].

The Matheson/Cooper report led directly to the creation of NLM's Integrated Advanced Information Management Systems (IAIMS) grant program. Health sciences libraries have played strong roles in many of the more than forty IAIMS funded projects to date. A recent review of the IAIMS program noted the changes in the information management landscape of AHSCs and evaluated the success of the IAIMS program. Notably, one of the two values of IAIMS planning mentioned most frequently was the “increased visibility and/or higher-level involvement in the institution's management processes” achieved by health sciences libraries [10]. Other recorded benefits that participation in IAIMS has had for libraries include:

• sustained participation of the library director in institutional leadership teams;

• high expectations from the library's users for more and better technology-based services;

• view by staff, faculty, and students of the library as a source of technical expertise;

• increased demand for library staff participation in activities “outside the walls”; and

• role for the library as an “incubator” for informatics training, technology development, and information technology (IT) pilots. [11]

The report further recommended to NLM that health sciences libraries must play a key role in the next generation IAIMS projects:

The task of working on research problems and information management problems in tandem will require new alliances between research faculty, librarians, and other information professionals. The health sciences libraries at AHSCs were expected to have a role in first-generation IAIMS projects, but their involvement in phase 2 grants was often marginal. It is unlikely that a well-formed next-generation IAIMS pilot project or testing and evaluation project or implementation project could be specified that does not involve the organization's central information management center (i.e., the library) in a substantive way. [12]

THE GENERAL PROFESSIONAL EDUCATION OF THE PHYSICIAN (GPEP) REPORT AND MEDICAL SCHOOLS OBJECTIVES PROJECT (MSOP)

In 1981, the AAMC established a Panel on the General Professional Education of the Physician (GPEP) and College Preparation for Medicine. The panel assessed current practice for educating physicians including undergraduate preparation for medical school. Its efforts culminated in 1984 with the publication of a landmark report (the GPEP report) that proposed major changes to medical school curricula based on strategies intended to promote learning by and individual development of physicians [13]. One of the panel's charges was “to stimulate broad discussions among the medical school and college faculties and their disciplinary societies about their philosophies and approaches to medical education and college preparation of medicine” [14]. The AAHSL Committee on Medical Education submitted a position paper [15] that proposed a strong role for academic health sciences libraries “to improve the general professional education of the physician” [16]. Gerald Oppenheimer subsequently represented the association at the San Francisco AAMC GPEP hearings and later noted, on the occasion of AAHSL's tenth anniversary, that the “final report reflects some of the AAHSLD recommendations” [17].

One of the position paper's recommendations was “that the academic health science library/information center be recognized as an institutional unit which is uniquely qualified to assist in the development of life long learning skills” [18]. Though the final GPEP report did not specifically designate a role for libraries, the sixth recommendation in the “Acquiring Learning Skills” section of the report provided an opportunity for proactive library involvement: “Medical schools should designate an academic unit for institutional leadership in the application of information sciences and computer technology to the general professional education of physicians and promote their effective use” [19].

As a follow-on activity prompted by the GPEP report, the Medical School Objectives Project (MSOP) developed thirty broad learning objectives on the knowledge, skills, and attitudes that physicians should possess as they enter their professional careers [20]. The medical informatics objective: “The ability to retrieve (from electronic databases and other resources), manage, and utilize biomedical information for solving problems and making decisions that are relevant to the care of individuals and populations” [21] was of particular relevance to AAHSL. AAHSL members were actively involved in the development of the second MSOP report that proposed more detailed learning objectives for medical informatics [22]. Of particular note was the strategic advice recommendation that the health sciences library be a major resource for dealing with instructional issues [23].

Many U.S. medical schools addressed the GPEP recommendations for promoting learning and individual development by instituting problem-based learning (PBL) in their curricula. Because, as noted by Rankin, “information-seeking skills are central to the PBL curriculum” [24], these changes provided new opportunities for many health sciences libraries to become more actively involved in the education of medical students. The Annual Statistics for Medical School Libraries did not begin to include statistics on education and orientation sessions until 1985/86, shortly after the publication of the GPEP report. Though definitively linking the steady increase in number of educational sessions and session attendees illustrated in Figure 1 to the GPEP recommendations is impossible, the statistics do provide documentation of a new service emphasis in academic health sciences libraries.

Figure 1.

Mean number of educational sessions and attendees in library members of the Association of Academic Health Sciences Libraries

CHALLENGE TO ACTION

Updating the 1965 Guidelines for Medical School Libraries [25] was an early AAHSL goal. Initially, it appeared that the 1979 NLM contract with AAMC mentioned earlier would accomplish this work, and the AAHSL Committee on the Development of Standards and Guidelines provided an evaluation of the “current validity” of the Guidelines [26]. The decision by the AAMC and NLM to shift focus from updating previous publications to the effort that led to the Matheson/Cooper report left the question of the need for updated guidelines open. In 1983, the AAHSL Committee on the Development of Standards and Guidelines recommended that the 1965 Guidelines “should be replaced by a completely new set of guidelines” [27]. They further recommended that this work would be more effectively accomplished by an ad hoc rather than a standing committee and with the formal participation of the Medical Library Association (MLA). The MLA and AAHSL presidents agreed and appointed the AAHSLD/MLA Task Force for Academic Health Sciences Library Guidelines [28]. The task force soon determined that updating the 1965 Guidelines was no longer appropriate. Instead the final publication, Challenge to Action: Planning and Evaluation Guidelines for Academic Health Sciences Libraries [29], provided a “framework for strategic planning and self-evaluation” that served to inform institutional administrators of the key role that the library can and should play in the AHSC and the “importance of coordinating institutional planning and development efforts in information management for effective and economical operation” [30].

Key to the development of Challenge to Action was a visioning effort conducted in three areas of the country that brought together administrators from AHSCs, university library administrators, and directors and staff from academic health sciences libraries. The participants were asked to create a future scenario that described the library and its environment in the year 2004. This effort led to the refinement of the initial guidelines developed by the task force, because the participants critiqued the guidelines in light of the scenario they had just created.

Challenge to Action laid out the challenges facing the AHSC and the health sciences library and provided guidelines for actions that libraries and their institutions must take to meet the challenges. The primary focus was on the provision of “a set of guiding principles flexible enough to adapt to periods of rapid change and, at the same time [allowing] for diverse missions and priorities” [31]. A section on “using the guidelines” provided advice on methods for measuring performance, including reliance on the Annual Statistics for Medical School Libraries [32] for statistical indicators, and realigned the guidelines according to Matheson/Cooper concepts. A “summary of needed actions” provided guidance to agencies and organizations (e.g., NLM, AAHSL) and academic health sciences centers on the resources or actions required to “fulfill the vision inherent in these guidelines” [33].

To ensure that Challenge to Action included an outside perspective, Erika Love, the task force chair, was instrumental in organizing an external advisory committee chaired by Richard Janeway, M.D., then vice president for health affairs and dean of the Bowman Gray School of Medicine. The advisory committee vice chair was M. Roy Schwarz, M.D., AAMC vice president for medical education and sciences policy. In his introduction to Challenge to Action, Dr. Janeway noted:

If the significance of any structure lies, not in its specific form but in its responsiveness to changing circumstances, I am optimistic for the future of the academic health sciences library that perceives this document as a framework for planning, evaluation, and action. [34]

Dr. Janeway also wrote the cover letter that accompanied the copies of the report sent to members of the Association of Academic Health Centers, the AAMC's Council of Deans, and the AAMC Group on Medical Education [35]. AAHSL took an active role in ensuring that its members became aware of and discussed the Challenge to Action recommendations. A plenary session of the 1987 AAHSL annual meeting included a discussion by four directors of the impact of Challenge to Action on their institutions. Robert Braude, Ph.D., Cornell University Medical Center, and Love, University of New Mexico, described their use of the Challenge to Action document in strategic planning at their respective institutions. Roger Verny, University of Cincinnati Medical Center, interviewed senior administrators, who noted that they expected the library to provide leadership in the use of educational technology and information management instruction. During the general discussion, many directors indicated that their administrators had received and forwarded the publication [36].

Holtz and Love conducted a follow-up survey to gauge member acceptance of the guidelines in Challenge to Action. Seventy percent of AAHSL members responded to the survey and expressed general support for the goals [37].

Challenge to Action proved to be a useful document for self-evaluation by health sciences library directors. In 2001, AAHSL appointed the Task Force for Charting the Future with the charge “to create a vision for the future and develop guidelines for planning and evaluation to assist academic health sciences libraries in achieving leadership in the future environment using the framework in Challenge to Action” [38].

LIAISON COMMITTEE ON MEDICAL EDUCATION (LCME) LIBRARY SELF-STUDY QUESTIONNAIRE

Shortly after Challenge to Action was promulgated, AAHSL appointed the Task Force to Review the LCME Accreditation Program for Medical School Libraries. The Liaison Committee on Medical Education (LCME), with membership from the AAMC and the American Medical Association, is the U.S. accrediting authority for the medical doctor degree. The questionnaire used by the LCME to gather evaluative data on the health sciences library focused almost exclusively on statistical indicators such as size of the collection, staffing, and budgets. It did not provide an opportunity for the library director and institution to comment on the qualitative aspects of the library's programs and activities. The task force was charged to suggest revised questions for the self-study questionnaire, examine the usefulness of creating a site visitor's manual, and examine the usefulness of an AAHSL accreditation or evaluation program [39].

The questionnaire developed by the task force was incorporated into the 1990 LCME survey [40]. It preserved the essential statistical indicators and added evaluative questions designed to provide an opportunity to comment on the strengths and weaknesses of the library and provide an indication of the level of involvement of the library in medical school activities.

Once the revised questionnaire was adopted, Rachael K. Anderson, task force chair, met with Donald Kassebaum, M.D., the AAMC LCME co-chair, to explore the development of a site visitor's manual and participation by AAHSL members on survey teams. It was agreed that keeping the LCME advised of current issues of concern to health sciences libraries via periodic concept papers would be preferable to a manual. Dr. Kassebaum also advised that adding librarians to the survey teams was not feasible at that time.

ASSOCIATION OF ACADEMIC HEALTH SCIENCES LIBRARIES' (AAHSL'S) SECOND DECADE AND BEYOND

As AAHSL entered its second decade, it realized one of its earliest visions: the establishment of a formal relationship with the AAMC when on October 31, 1989, AAHSL was granted full membership in the Council of Academic Societies. The early efforts of AAHSL leaders and members to increase the visibility of health sciences libraries and librarians were producing significant results, and AAHSL's participation in a number of key activities of interest to health science libraries was being sought.

In 1992, in collaboration with MLA, AAHSL undertook responsibility for a journal review column in the Journal of the American Medical Association (JAMA). AAHSL members participated actively in NLM planning efforts. Most significant to the profession was the appointment of an NLM planning panel on the education and training of health sciences librarians [41]. AAHSL, along with MLA, persuaded NLM of the importance of undertaking planning in this arena as a key component in implementing the recommendations in MLA's publication, Platform for Change [42]. The panel report laid out a number of recommendations for professional associations including strengthening professional education programs and broadening recruitment programs. AAHSL's Task Force on Future Leadership is proactively addressing these recommendations today.

In 1998, the Group on Information Resources (GIR) was formally established in the AAMC. Though not the organization of medical school libraries that the AAHSL founders envisioned, GIR's purpose is of particular relevance to academic health sciences libraries:

to provide a forum for individuals in relevant roles of leadership and responsibility to promote excellence in the application and integration of information resources in academic medicine, including medical education, clinical care, medical and health sciences research, health science libraries, public health, and institutional planning. [43]

AAHSL members have provided strong leadership in the GIR through service on the Steering Committee and participation in various GIR activities.

The vision of a “greater voice” appears, indeed, to have been realized. Today, AAHSL and many of its members are viewed as leaders in providing and managing information resources in the academic health sciences arena. The challenge remains to continually strengthen the voice through active collaboration with academic health sciences centers, professional organizations, and the National Library of Medicine.

Note on naming: In 1978, the Association of Academic Health Sciences Library Directors (AAHSLD) was incorporated. In 1996, in response to IRS requirements, AAHSLD formed a new organization to carry on its work, under the name Association of Academic Health Sciences Libraries (AAHSL). In this article, unless otherwise stated, the newer name is intended to refer to the organization throughout its history.