The Changing Role of the Library in Support of Medical Education, 1981
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the changing role of the library in support of medical education i appreciate this opportunity to share with you some insights about the role of the library in medical education nothing could better illustrate the involvement of medical libraries and specifically the mational library of medicine than to note that we have been closely associated with the areas that are being addressed by my fellow panelists medical libraries have been innovators in the application of information technology the subject of don lindberg's fascinating observations this morning the most obvious example of this of course is medline the nationwide online bibliographic retrieval network sponsored by nlm and used heavily by faculty and students of all u s medical schools over five million references to medical books journal articles and audiovisual materials are now available for rapid search and retrieval there are more than 1500 network institutions in the u s giving american health professionals access to their literature unparalleled by any other scientific discipline another innovative application of information technology was nlm's development of a nationwide network for creating and sharing computer assisted instruction programs among presented by martin m cumrnings m d director of the national library of medicine to the joint meeting of the council of deans and the society of medical coll eye directors of continuing education aamc november 1 1981

Page  2 2 medical education facilities cai allows self paced learning in an interactive mode and it can be an extremely effective method of teaching the system we helped to establish in the mid seventies is now a vigorous self supporting network of some 80 health science education institutions phil manning who follows me on the program this morning will talk about continuing medical education this also is a subject in which nlm has a great interest i might cite our work in developing avline an online database for retrieving references to evaluated audi ovi sual materials and then backing this up with programs to lend these materials nationwide videotapes films and other av media have an important role in cme and we will be expanding our efforts in this area under the auspices of the national medical audiovisual center a major component of the nlm among its programs is one that will have a multiplier effect in the health education community this is the center's field training operation under which hundreds of faculty are trained each year at nine u s academic institutions the faculty are introduced to modern audiovisual methods in health science teaching and we hope will influence their colleagues to apply audiovisual techniques in their own classes

Page  3 another training activity of the library and one that we hope will have a long range payoff is our grant support for a computers in medicine program we are supporting the training of about 60 health professionals in how to use rapidly evolving computer technologies to organize and transmit biomedical knowledge pertinent to research education and practice this training is being conducted in ten u s academic institutions and the graduates of the program are eagerly employed by academia and industry to serve on faculties and as researchers the growth potential of this new field may be inferred from the fact that at present only seven medical schools have a senior position for scientists and physicians with extensive computer training and only one college of medicine has a program with divisional status the library's knowledge base research program is another activity with implications for continuing iledi cal education the knowledge base research program is an interdisciplinary project to develop a medical information system that synthesizes and computerizes current knowledge in specialized areas and makes this knowledge available rapidly and conveniently to health practitioners hepatitis

Page  4 4 peptic ulcer and genetic diseases are the three topics we have chosen to build as our first experimental knowledge bases the ability to address specific queries about patient problems to a computerized database and to receive authoritative information that is the consensus of experts would be a valuable addition to the physician s array of information resources it is also a radical departure from nlm's traditional and almost exclusive concern with the bibliographical nature of the literature since i am linking specific nlm activities with the topics of our panelists this morning let me say that we have also had a role in one of roy schwarz's wami programs this was the telemedicine by satellite program in alaska and the pacific northwest earlier in the seventies the experiment demonstrated and documented the feasibility of using nasa communications satellites for medical education and health care delivery to remote areas not served directly by educational institutions or hospitals

Page  5 i have used my fellow panelists as squares in a hopscotch game tossing my stone onto each in turn and jumping quickly from topic to topic by now you may be wondering whether the national library of medicine is in fact a library at all i have scarcely mentioned books and journals and haven't alluded to cataloging or indexing or lending or any of those other functions usually associated with libraries the reason is quite simply that we are now at the beginning of a revolution in the way we process information the potential impact of this revolution on medical education research and practice is still unknown but i hazard a guess that it will be great before i discuss our role in this revolution let me note several disturbing trends neither is exactly new and neither shows signs of abating the first is the growth of scientific knowledge this is hardly a disturbing trend you say and we certainly don't want it to abate the problem however is the recorded form of this knowledge namely books and journals their proliferation is increasingly burdensome to libraries to say nothing of the problems of readers trying to stay abreast of their field

Page  6 it has been estimated that by the year 2040 there will be 200 million different books requiring 5000 miles of shelves and a card catalog of 750000 drawers even more intimidating is the growth in scientific journals beginning in 1750 the number of extant journals has increased by tenfold every 50 years by 1900 there were 10000 by 1950 100000 and the projected one million by the year 2000 only makes me glad that i won't be director of the national library of medicine at that time the number of scientific papers is increasing at an even greater rate than the number of journals according to james martin in his book the wired society more articles have been published since world war ii than in all prior human history the other trend keeping pace with the proliferation of biomedical literature is the inflation associated with medical publishing recently the new england journal of medicine estimated that the standard textbook now sells for 35 to 60 the cost of heavily illustrated books such as those on computed tomography ultrasound isotope imaging dissection atlases and surgical technique regularly exceeds 100

Page  7 7 these twin forces working in concert are forcing libraries and specifically the national library of medicine to look to new methods of information handling this slide will give you some indication of where our salvation lies it is a rank order of the storage capacity of various memory devices one interesting thing to note is that the entire collection of the national library of medicine might be stored on just 2000 optical discs a collection that would fit in my den at home anderson and graham have estimated that medical students are expected to learn approximately 77800 bits of information during the basic sciences and 52500 facts and concepts in their undergraduate clinical training dykes points out that this combination of 130300 bits of information compares with the approximately 50000 chess board patterns that a grandmaster chess player can recognize and is believed to constitute an information overload slide

Page  8 the ability to store and retrieve such a mass of information requiries a prodigious effort on the part of even the best brains of our students here is where i believe teaching students how to find information quickly and effectively is important note that the storage capacity of the optical disc is more than adequate to handle such a requirement i believe also that the future of continuing medical education will be closely tied to this technology although the engineers and scientists in the library's lister hill center are investigating a number of the new technologies for application to medical information handling we have particularly high hopes for the optical disc one disc which looks much like an lp record can contain the entire contents of up to 108000 pages we are now exploring the possibility of a system capable of storing a thousand such discs with online access time of a few seconds the ability to store tens of millions of pages of text and graphics combined with a system to access and display this information at terminals in medical libraries around the country would be a true revolution in handling printed information thank you

Page  9 references 1 martin j the wired society englewood cliffs nj prentice hall inc 1978 p 116 2 ibid 3 moore f d books the medical book business nejm 1981 july 9 305 2 114 4 anderson j & graham a a problem in medical education is there an information overload med educ 1980 14 4 7 5 dykes m beating the knowledge and technology explosion jam 1981 246 1924 24