The Use of the Library in Dental Education, 1968
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the use of the library in dental education i'd like to share with you today some of my thoughts about a minor revolution which is occurring in the field of health information services the revolution is concerned with the application of new technologies to the traditional methods of diffusion and use of knowledge in the educational process in this revolution the health science libraries which have long been the conventional repositories of knowledge are developing new modes of active support for educators members of the dental profession have the opportunity to take advantage of the many new programs and services directed to their interests health-science libraries have been sensitive to the needs of the dental profession and are paying particular attention to those needs as i will illustrate a little later nevertheless i'm convinced that the nation's dentists have not yet learned to take advantage of what we have to offer and i would like to cite as evidence for this a recent survey presented by martin m cummings, m.d, director national library of medicine at the american association of dental schools san francisco california march 26 1968

Page  2 2 dean emeritus dr russell a dixon howard university college of dentistry a former member of nlm's board of regents and currently a consultant to the library on dentistry analyzed the use of nlm for the month of may 1967 of the 3,700 readers registered 66% were students and the remainder were researchers and practitioners although most of the non-students registering did not list their professional specialty i believe it is valid to draw a comparison among those who did 336 were physicians and only 25 were dentists dr dixon's analysis of those requesting computer-produced demand bibliographies during the same month reveals that of the 570 searches provided only 3.1% of the requests were from dental schools none from dental practitioners i believe it is fair to conclude even on the basis of this small sample that dentistry is not taking full advantage of the national library of medicine it is not my intention to dwell on comparisons between the medical and the dental users of libraries but rather to inform you about opportunities and resources which are available to you as you design the ways and means of meeting the communication problems in which

Page  3 3 you in common with medicine and all the other learned-professions are involved i plan to talk therefore about the modernization of library and information systems which are fundamental to the satisfaction of your information needs last fall to coincide with the meeting of the american dental association in washington d c, we featured at the library an exhibit of historical prints relating to dentistry from that exhibit here is a 19th century lithograph by honore daumier titled ok let's open up slide i and this one slide 2 a colored etching and aquatint by thomas rowlandson reveals that in the 18th century dentists were already interested in tooth transplantation these prints and many others from the collection are included in this catalog which we published mmc to show catalog although we are very much concerned with tradition and in fact very proud of our historical collection i hasten to point out that the library today is much more than a passive repository of information even the term library is perhaps not really appropriate for we have evolved

Page  4 4 into what might better be termed an active information center it is this evolution and how it relates to dentistry that i will now describe the national library of medicine slide 3 - nlm is located in bethesda maryland including the national medical audiovisual center in atlanta georgia the library currently employs about 500 persons the library now holds nearly 1.5 million pieces of biomedical literature in more than 70 languages slide 4 - stacks acquiring more than 100,000 new items each year our task is to acquire all new literature of direct concern to biomedicine including all applicable literature from the allied sciences the library's new acquisitions are listed bi-weekly in a computer-prepared nlm current catalog slide 5 a book published in a country like great britain will appear in the catalog within less than a month of the publication date a major problem in deciding what to acquire involves the allied sciences and certain fringe areas a book on pipes and seemingly strictly civil engineering interests at first glance may appear to have no place in a biomedical library until you consider that there are engineering aspects of water fluoridation of concern to public health dentists

Page  5 5 biomedical engineering is another field where seemingly nonmedical literature suddenly becomes useful to developers of new dental equipment and designers of dental offices most clinicians and researchers are concerned with getting the most current information available on particular subjects and look to the biomedical journals as their best source nlm receives about 20,000 such journal titles each year a good portion of which relate directly or indirectly to dentistry some 35 employees regularly index the articles in approximately 2,300 of these titles in 40 languages in cooperation with the american dental association 100 of the most substantive dental journals selected by an advisory panel of experts are indexed at nlm dentists also review all articles considered of relevance to dentistry that appear in non-dental journals the ada assumes the responsibility of indexing all other dental journals including state and local society publications bibliographic citations to the articles are stored in the nlm computers which prepare for printing the monthly index medicus slide 6 and the annual cumulated index medicus in the washington area access to the collection can be as simple as visiting the public reading room making a selection from the card catalog and requesting the selection

Page  6 6 from the main desk the reader knows his material is ready when his reader's identification number is flashed on an electric board in the reading room he may then consult his material at one of the many specially-designed desks set aside for visitors slide 7 for the reader who can't get to the building whether he is downtown washington d c or in walla walla washington the procedure is a little more elaborate the reader first must request the desired book or journal from his local library if the item isn't available there his library requests it by mail or teletype from nlm which sends the document to the library for a four-week loan if only certain chapters of a book or if a journal article is requested a mobile camera slide 8 moves along the stacks at nlm and photographs the appropriate pages another machine processes and enlarges the microfilm and turns out printed copies of the material photographed ready for mailing to the local library computers are the hub of nlm's medical literature analysis and retrieval system medlars slide 9 they consist of a honeywell 800 series computer one 200 series computer and the computer-driven phototypesetter called

Page  7 7 grace an acronym for graphic arts composing equipment a bank of 24 reels of tape holds the library's index of journal articles for the past four years with an average of about 31,000 citations on each reel or tape medlars produces the monthly index medicus as well as a number of discipline-oriented recurring biblio graphies these bibliographies are published and distributed by cooperating organizations slide 10 a good example is the index to dental literature which comprises citations to articles from more than 350 additional dental journals and relevant articles from a significant number of non-dental journals approximately 800 journal titles are included in the index to dental literature annually in addition any member of the biomedical profession can request a bibliography on any health-related topic from tetracycline toxicology to oral cancer and will receive it within a few weeks nlm receives about 35 to 40 requests from individuals for computer-produced bibliographies each day these demand searches are printed out by the computer and then mailed to the requester to make the demand search service even more accessible to health professionals

Page  8 8 university-based decentralized medlars stations will accept search requests from health professionals in their area medlars is just one example of how the introduction of modern technology can extend the traditional role of the health-science library much remains to be done in furthering the application of new technology in such areas as graphic image storage and retrieval facsimile transmission of documents and the use of audiovisuals a great deal of new technology is already being applied at the library's national medical audiovisual center in atlanta nmac operates the largest medical motion picture studio in the world and a completely equipped television production facility a staff of artists photographers and technicians turn out thousands of visual materials each year for use in films and publications nmac runs an audiovisual library and is on the ground floor in new teaching techniques and equipment from special television hook-ups to filmed lectures and demonstrations which a student can watch in his spare time on a special self-teaching projector in a recent cooperative effort between nmac and the university of kentucky school of dentistry a prototype oral cancer programmed instruction package slide ii was developed and distributed to all dentists in the state of kentucky in

Page  9 9 this compact kit slides 12 13 14 the first slide shows normal buccal mucosa with the opening of the parotid duct in the second the reddish white area is beginning cancer of the buccal mucosa the third shows how a biopsy is performed we are hopeful that if this project is as successful as the preliminary findings indicate we shall be able to develop other tools for continuing education in the dental field as well as in other biomedical disciplines i believe that the biggest challenge the library and the biomedical library community face is the development of an efficient information transfer system for the past two years we have been building the framework for a national biomedical communications network to improve and accelerate the flow of information in all forms audiovisual as well as print to clinicians researchers educators and students the network would be stratified according to the resources of the libraries and the services they would be able to provide nlm's present services would provide the central element because of the great difference in the resources of medical libraries ranging from those of a small hospital collection with perhaps only a few hundred

Page  10 10 volumes to the more than 1.5 million items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all other medical libraries in the united states a central resource to which they could turn for material not in their collections and for assistance in improving services to their users helping to make the network a reality is the medical library assistance act regional medical libraries which the act authorizes and academic medical or dental libraries would play a large role in the network we are now in the process of reviewing regional medical library grant appillion items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all other medical libraries in the united states a central resource to which they could turn for material not in their collections and for assistance in improving services to their users helping to make the network a reality is the medical library assistance act regional medical libraries which the act authorizes and academic medical or dental libraries would play a large role in the network we are now in the process of reviewing regional medical library grant applications from existing institutions in defined geographic areas of the country to enable these libraries to expand their collections and provide increaseillion items at nlm we came naturally to the conclusion that the national library of medicine should continue to serve as the backstop for all other medical libraries in the united states a central resource to which they could turn for material not in their collections and for assistance in improving services to their users helping to make the network a reality is the medical library assistance act regional medical libraries which the act authorizes and academic medical or dental libraries would play a large role in the network we are now in the process of reviewing regional medical library grant applications from existing institutions in defined geographic areas of the country to enable these libraries to expand their collections and provide increased and more efficient services to local biomedical libraries in june 1967 nlm's board of regents approved a grant for the first regional medical library at harvard university there will be six or seven such libraries operating by 1970 and ultimately if these are successful some 25 to 30 regional institutions serving their respective

Page  11 11 geographic areas may be supported these libraries will be linked electronically to the central medlars facility at nlm the local medical library is the base of the entire biomedical library network it is to the local library that most health professionals will turn for information consequently it is the type of library that most needs strengthening to enable it to adequately meet its users' needs it is desirable to have the gaps at the local level as small as possible to preclude a torrent of requests to the academic and regional libraries again the medical library assistance act is providing the means for shoring up the local facilities grants are authorized for library construction expansion and renovation for enlarging and improving collections for research projects on health communications problems and projects on documentation and analysis of advances in the health sciences and for preparing and producing special publications the act also provides for graduate training programs in health information specialties individual traineeships and postdoctoral fellowships in communications research

Page  12 12 some 8 million in grants have been awarded since the act was signed by president johnson in october 1965 the volume of published research in the fields of medicine doubles every ten years said the president in signing the measure such a tremendous expansion of knowledge is cumulative it feeds upon itself no one can predict when a key discovery will be made which will unlock a whole new chain of knowledge this creative process cannot go on unless the results of scientific work are available to practicing physicians and to health workers across the country to explore ways to capatalize on the creative process by making the results of research available to practicing dentists the library convened two conferences on continuing dental education a group of leading representatives of dental education research librarianship dental practice and organized dentistry met at nlm twice in 1967 the recommendations of the participants included such ideas as (1) that the national library of medicine continue to develop programs to familiarize the numerous specialty groups of dentistry with the library's various services and products

Page  13 13 2 that the present close cooperation of the library with the american dental association and the american association of dental schools be fostered and expanded as far as possible 3 that the library encourage and promote the participation of dental librarians in medlars training and other library programs and 4 that nlm continue to work closely with the american dental association and other professional groups to develop and promulgate new indexing and abstracting tools and services for the dental community some examples of the specific projects suggested by the conferees follow a training programs to prepare greater numbers of personnel for the field of library science and communications related to the health professions b material for a course in library and information retrieval techniques for use in dental schools and programs of continuing education c courses utilizing programmed learning films or packaged instruction in library science in the health fields for use by dental faculty students and the dental community

Page  14 14 d conferences to clarify the definition of dental literature e new and experimental forms of abstracts to meet the two separate needs of the profession the academician and the practitioner f core instructional material which will be readily available in the various forms of informational media g comprehensive critical review articles on various phases of dentistry on a continuing basis both foreign and domestic h a scholars-in-residence health science scholars program for the dental profession i fellowships or institutes in communication science for selected dental faculty members j studies related to the better utilization of all health-related libraries in continuing education k new and unique newsletters or news magazines to bring the latest developments in dental science to the attention of the dental profession the medical library assistance act provides financial support for those projects related to library facilities and personnel we encourage the submission of proposals for assistance under the act

Page  15 15 i can assure you that nlaa is taking steps toward carrying out these recommendations from your distinguished colleagues and we welcome others among the steps we have already taken are our exhibition of dental prints and the catalog i mentioned earlier the oral cancer continuing education project we have expanded our traveling exhibits program to assure representation at the major dental meetings where we describe and depict our programs and services i am sure that you will be interested to learn that a dentist has recently been appointed as the library senior scientific editor in conclusion i should like to emphasize that if the library is to be successful in its efforts to create a viable biomedical information network and to assist the dental and all other biomedical disciplines in such areas as continuing education we need your active support and cooperation i thank you for inviting me today and i look forward to meeting you again

Page  16 list of slides slide 1 daumler page 3 slide 2 rowlandson page 3 slide 3 nlm page 4 slide 4 stacks page 4 slide 5 current catalog page 4 slide 6 index medicus page 5 slide 7 reading room page 6 slide8 mobile camera page 6 slide 9 medlars console slide 10 index to dental literature page 7 slide 11 oral cancer kit page 8 slide 12 normal buccal mucosa page 9 slide 13 beginning cancer page 9 slide 14 biopsy page 9