NOV. 22, 2010

Librarian’s trip to Bhutan, Nepal enhances access to data sources

BY SASCHA ZUBRYD

Stanford clinical librarian Lauren Maggio was on the ward of a hospital in Nepal to role model information literacy skills when the doctors faced a critical decision: They were unsure whether a baby, less than a month old, was suffering from neonatal meningitis. The physicians explained to Maggio that they needed to do a lumbar puncture to confirm the diagnosis, but the tiny infant was clearly distressed at that moment. The question was how long they could wait before performing the procedure, and they were not sure where to turn to for the answer.

This was why Maggio, Lane Medical Library’s medical education librarian, was in Nepal and Bhutan in September, as part of an effort to extend Stanford’s expertise in 21st-century library science and medical education to medically underserved areas. She first spent three weeks in Bhutan with a group from the Global Health Research Foundation, which was advising Bhutanese Ministry of Health officials about creating a national electronic health record, forming the country’s first medical school and introducing information sources for physicians. Directed by Stanford alumna Erica Weirich, MD, the nonprofit foundation provides medical IT resources to countries around the world. Maggio’s role was to help embed information technology use into physicians’ daily routines.

In the capital city, Thimphu, Maggio gave a lecture series about information literacy, which she described as “a person’s ability to recognize gaps in their knowledge and to locate, evaluate and effectively use information to satisfy those gaps.” Approximately 400 physicians, allied health-care professionals and students attended.

Maggio travelled throughout the Bhutanese countryside where she saw intricate stone buildings, towns perched atop mist-covered mountains and trees draped with fluttering prayer flags. More important, she visited regional hospitals and rural clinics. “Some places didn’t have electricity. In many hospitals there was only a single computer,” said Maggio. “That was very eye-opening for me, thinking about how to maximize information resources and training in that environment.”

After three weeks in Bhutan, Maggio went to neighboring Nepal for a week on behalf of Stanford’s Office of Global Health. In Kathmandu, she visited Patan Hospital and Nepal’s only medical school, Patan Academy of Health Sciences. The year-old medical school uses a problem-based learning curriculum similar to Stanford’s two-year Practice of Medicine class, which teaches clinical skills such as how to interview a patient, how to do a physical exam and how to formulate and research clinical questions. Maggio and her colleague Keith Posley, MD, clinical assistant professor of medicine, co-teach the information literacy portion of the course at Stanford.

Stanford is among the first schools of medicine to integrate learning about information literacy into medical education. Maggio and Posley presented the first clear definition of an information-literate physician to the Western Group of Educational Affairs (part of the Association of American Medical Colleges) in April 2009. They defined five Stanford Information Literacy Clinical Competencies. Put simply, these are: acknowledging and articulating what you don’t know, finding evidence-based information on the fly, critically evaluating that information, applying it in a clinical setting and continually improving your information literacy skills.

At the hospital in Nepal, Maggio had joined pediatric and medical teams on patient-care rounds, observing how they formed clinical questions and searched for answers. To help clinicians quickly access clinical research and medical information relevant to their patient’s unique situation, Maggio showed them a new online resource designed at Stanford: Lane Medical Library’s open-access clinical search tool.

And it was during these rounds that the problem arose with the baby who potentially had meningitis. While the clinicians pondered whether to go ahead with the diagnostic lumbar puncture, Maggio tapped on her iPad and began to show the clinicians how information literacy could make a difference to physicians faced with a real-time clinical decision. They watched as she accessed the Lane Library clinical search tool, which provided them with an answer.

“The best part was,” Maggio said, “I was able to demonstrate a skill and resource that they will be able to use long after I’ve left Kathmandu.”

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Sascha Zubryd is a science-writing intern in the medical school’s Office of Communication & Public Affairs.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu/.