Category Archives: First Year Academic Librarian Experience

Narrative as Evidence

This past week I attended the MLGSCA & NCNMLG Joint Meeting in Scottsdale, AZ. What do all these letters mean, you ask? They stand for the Medical Library Group of Southern California and Arizona and Northern California and Nevada Medical Library Group. So basically it was a western regional meeting of medical librarians. I attended sessions covering topics including survey design, information literacy assessment, National Library of Medicine updates, using Python to navigate e-mail reference, systematic reviews, and so many engaging posters! Of course, it was also an excellent opportunity to network with others and learn what different institutions are doing.

The survey design course was especially informative. As we know, surveys are a critical tool used by librarians. I learned how certain question types (ranking, for example) can be misleading, how to avoid asking double-barreled questions, and how to not ask a leading question (i.e. Do you really really love the library?!?) Of course, these survey design practices reduce bias and attempt to represent the most accurate results. The instructor, Deborah Charbonneau, reiterated that you can only do the best you can with surveys. And while this seems obvious, I feel that librarians can be a little perfectionistic. But let’s be real. It’s hard to know exactly what everyone thinks and wants through a survey. So yes, you can only do the best you can.

The posters and presentations about systematic reviews covered evidence-based medicine. As I discussed in my previous post, the evidence-based pyramid prioritizes research that reduces bias. Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) helped to conceptualize the three-legged stool of evidence based practice. Essentially, evidence-based clinical decisions should consider the best of (1) the best research evidence, (2) clinical expertise, and (3) patient values and preferences. As medical librarians we generally focus on delivering strategies for the best research evidence. Simple enough, right? Overall, the conference was informative, social, and not overwhelming – three things I enjoy.

On my flight home, my center shifted from medical librarianship to Joan Didion’s Slouching Towards Bethlehem. The only essay I had previously read in this collection of essays was “On Keeping a Notebook”. I had been assigned this essay for a memoir writing class I took a few years ago. (I promise this is going somewhere.)  In this essay, Didion discusses how she has kept a form of a notebook, not a diary, since she was a child. Within these notebooks were random notes about people or things she saw, heard, and perhaps they included a time/location. These tidbits couldn’t possibly mean anything to anyone else except her. And that was the point. The pieces of information she jotted down over the years gave her reminders of who she was at that time. How she felt.

I took this memoir class in 2015 at Story Studio Chicago, a lofty spot in the Ravenswood neighborhood of Chicago. It was trendy and up and coming. At the time, I had just gotten divorced, my dad had died two years prior, and I discovered my passion for writing at the age of 33. So, I was certainly feeling quite up and coming (and hopefully I was also trendy). Her essay was powerful and resonated with me (as it has for so many others). After I started library school, I slowed down with my personal writing and focused on working and getting my degree, allowing me to land a fantastic job at UCLA! Now that I’m mostly settled in to all the newness, I have renewed my commitment to writing and reading memoir/creative non-fiction. I feel up and coming once again after all these new changes in my life.

As my plane ascended, I opened the book and saw that I had left off right at this essay. I found myself quietly verbalizing “Wow” and “Yeah” multiples times during my flight. I was grateful that the hum of the plane drowned out my voice, but I also didn’t care if anyone heard me. Because if they did, I would tell them why. I would say that the memories we have are really defined by who we were at that time. I would add that memory recall is actually not that reliable. Ultimately, our personal narrative is based upon the scatterplot of our lives: our actual past, present, future; our imagined past, present, future; our fantasized past, present, and future. As Didion (2000) states:

I think we are well advised to keep on nodding terms with the people we used to be, whether we find them attractive company or not. Otherwise they turn up unannounced and surprise us, come hammering on the mind’s door at 4 a.m. of a bad night and demand to know who deserted them, who betrayed them, who is going to make amends. We forget all too soon the things we thought we could never forget. We forget the loves and the betrayals alike, forget what we whispered and what we screamed, forget who we were. (p. 124)

What does this have to do with evidence-based medicine? Well, leaving a medical library conference and floating into this essay felt like polar opposites. But were they? While re-reading this essay, I found myself considering how reducing bias (or increasing perspectives) in research evidence and personal narrative can be connected. They may not seem so, but they are really part of a larger scholarly conversation. While medical librarians focus upon the research aspect of this three-legged stool, we cannot forget that clinical expertise (based upon personal experience) and patient perspective (also based upon personal experience) provide the remaining foundation for this stool.

I also wonder about how our experiences are reflected. Are we remembering who we were when we decided to become librarians? What were our goals? Hopes? Dreams? Look back at that essay you wrote when you applied to school. Look back at a picture of yourself from that time. Who were you? What did you want? Who was annoying you? What were you really yearning to purchase at the time? Did Netflix or Amazon Prime even exist?? Keeping on “nodding terms” with these people allows us to not let these former selves “turn up unannounced”. It allows us to ground ourselves and remember where we came from and how we came to be. And it is a good reminder that our narratives are our personal evidence, and they affect how we perceive and deliver “unbiased” information. I believe that the library is never neutral. So I am always wary to claim a lack of bias with research, no matter what. I prefer to be transparent about the strengths of evidence-based research and its pitfalls.

A couple creative ways I have seen this reflected in medicine is through narrative medicine, JAMA Poetry and Medicine, and Expert Opinions, the bottom of the evidence-based pyramid, in journals. Yes, these are biased. But I think it’s critical that we not forget that medicine ultimately heals the human body which is comprised of the human experience. Greenhalgh and Hurwitz (1999) propose:

At its most arid, modern medicine lacks a metric for existential qualities such as the inner hurt, despair, hope, grief, and moral pain that frequently accompany, and often indeed constitute, the illnesses from which people suffer. The relentless substitution during the course of medical training of skills deemed “scientific”—those that are eminently measurable but unavoidably reductionist—for those that are fundamentally linguistic, empathic, and interpretive should be seen as anything but a successful feature of the modern curriculum. (p. 50)

Medical librarians are not doctors. But librarians are purveyors of stories, so I do think we reside in more legs of this evidence-based stool. I would encourage all types of librarians to seek these outside perspectives to ground themselves in the everyday stories of healthcare professionals, patients, and of ourselves.

 

References

  1. Didion, J. (2000). Slouching towards Bethlehem. New York: Modern Library.
  2. Greenhalgh, T., & Hurwitz, B. (1999). Why study narrative? BMJ: British Medical Journal, 318(7175), 48–50.
  3. Sackett D.L., Rosenberg W.M., Gray J.A., Haynes R.B., & Richardson W.S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ: British Medical Journal, 312(7023), 71–2. doi: 10.1136/bmj.312.7023.71.

 

Vocational Awe and Professional Identity

A few days ago, In the Library with the Lead Pipe published an article by Fobazi Ettarh titled Vocational Awe and Librarianship: The Lies We Tell Ourselves. Ettarh uses the term “vocational awe” to “refer to the set of ideas, values, and assumptions librarians have about themselves and the profession that result in beliefs that libraries as institutions are inherently good and sacred, and therefore beyond critique.” Her article masterfully traces the root of this vocational awe, from the intertwining history of faith and librarianship to our current state, where librarians are expected to literally save lives. Ettarh argues that vocational awe leads to some of the structural problems in our profession, like lack of diversity, undercompensation, and burnout.

I will admit that I initially felt some defensiveness when I started reading this article. One of the reasons I became a librarian is because I wanted to care about and be engaged with the mission of my work, and I do deeply believe in the values that libraries try to uphold. When I got past that initial reaction, I realized how Ettarh’s research allows us to talk about our profession more honestly. As the author clearly states, the article doesn’t ask librarians not to take pride in their work. Nor is it an indictment of our core values (although it does, rightly, point out they are inequitably distributed across society).  Rather, it encourages us to challenge the idea that our profession is beyond critique, and therefore opens up space for us to better it.

Although this is not its primary intent, I wonder whether this research direction will help us resolve some of our own tortured professional identity issues. I am among those who became a librarian partly out of passion and partly out of convenience. I didn’t feel called to the profession. Instead, I made a conscious decision based on my interests and the sort of life I wanted for myself. I knew I wanted to be in a job where I would be helping people, with the opportunity for intellectual growth, and that I wanted to have a stable job with a balance between work and my other personal interests. Librarianship seemed like a very natural fit. But the vocational awe in librarianship means that you’re surrounded by the idea that being a good librarian means being driven solely by passion. Heidi Johnson previously wrote about the isolating feeling of not being a “born librarian” here at ACRLog, and I remember this post resonating deeply with me when I first started to become self-conscious that my professional identity was built less on my sacred calling to it than some of my peers. I think that unpacking the vocational awe that makes us feel this way might help to dispel some of the professional identity issues that so many librarians, and particularly new ones, seem to have.

As I was thinking about this article, I also realized that my own version of vocational awe usually manifests when I’m talking to non-librarians. Telling people I’m a librarian produces surprisingly revealing responses. Some people respond a well-meaning, but misinformed, “how fun! I wish I could read books all day, while others respond with some variation of “but aren’t libraries dying?” I suspect that this is partially a result of the slew of articles that are published every year on the decline of libraries and the death of librarianship. After responses like this, I feel compelled to defend librarianship in the strongest terms. I talk about information literacy, intellectual freedom, public spaces, privacy, access to information, democracy, you name it. I turn into a library evangelist. None of my own hesitations, challenges, or frustrations find their way into these conversations. Several people have already written about the exhaustion of constantly defending and explaining our profession. But this article made me wonder if there is some connection between how often we find ourselves needing to defend what we do — to friends, to faculty, to funding agencies, to the public — and tendency to resist the idea that there is a lot of internal work we need to do to truly uphold the values we claim. Ettarh’s article made me think about how to balance these two ideas: believing in and advocating for my profession, while working to make it better for the people in it.

What does that look like? I’m not entirely sure yet. But I think it entails being more honest. It means advocating for our value, but not pretending that we can do everything. And it means contributing to a culture that doesn’t valorize martyrdom. For me, that means saying no if I don’t have the bandwidth for a project. It means using my all my vacation time, and stopping using busyness as a measure of worth. There is much more to the article than I can unpack here, and I hope that everyone will go read it. I’m looking forward to hearing other people’s thoughts on how vocational awe impacts our profession, and how we might work to stop using it, as Ettarh puts it, as the only way to be a librarian.

Questioning the Evidence-Based Pyramid

As a first year health sciences librarian, I have not yet conducted a systematic review. However, as a speech-language pathologist, I learned about evidence-based medicine and the importance of clinical expertise combined with clinical evidence and patient values. As a librarian, I’m now able to combine these experiences, allowing me to view see evidence-based medicine more holistically.

In the past month, I attended two professional development courses. The first was a Systematic Review Workshop held by the University of Pittsburgh. The second was an Edward Tufte course titled “Presenting Data and Information”. While these are two seemingly unrelated subjects, I left both reconsidering how we literally and figuratively view evidence-based medicine.

One of my biggest takeaways from the Systematic Review workshop was that a purpose of  systematic reviews is to search for evidence on a specific topic in order limit bias. This is done by searching multiple databases, reviewing grey literature, and having multiple team members  to screen papers and resolve disputes. One of my biggest takeaways from the Tufte course was that space should be used well to effectively arrange information and that displayed content should have integrity. In his book Visual Explanations, Tufte poses the following questions to test the integrity of information design (p. 70):

  • Is the display revealing the truth?
  • Is the representation accurate?
  • Are the data carefully documented?
  • Do the methods of display avoid spurious readings of the data?
  • Are appropriate comparisons and contexts shown?

When I think about visualization of evidence-based medicine, the evidence-based pyramid immediately comes to mind. It is an image used in many presentations related to evidence-based medicine:

EBM Pyramid and EBM Page Generator, copyright 2006 Trustees of Dartmouth College and Yale University. All Rights Reserved. Produced by Jan Glover, David Izzo, Karen Odato and Lei Wang.

While there is a lot of information in this image, I don’t think it is very clear. I have spoken to librarians (in the health sciences and not in the health sciences) that agree. I think this is a problem. I don’t think all librarians need to immediately know what cohort studies are, but I do think they should understand its context within the visual.

From what I have gathered and discussed with other professionals, quality of evidence/limited bias increases as you go up the pyramid. The pyramid is often explained in a hierarchical way; systematic reviews are considered highest standard of evidence, which is why it is at the top. There are usually fewer systematic reviews (since they take a long time and gather all the available literature about one topic), so the apex also indicates the least quantity. So let’s take a look each of the integrity questions about information design and investigate this further:

Is the display revealing the truth?

Is it? How do we know if this truthfully represent the quantity of each type of study/information? I believe that systematic reviews are probably the least in quantity and expert opinion are the most in quantity. That makes logical sense given the level of difficulty to produce and disperse this type of information. However, what about the types of research in between? Also, is one type of evidence inherently less biased than the ones below? Several studies suggest that systematic reviews may be systematic, but are not always transparent or completely reported and are outdated. This includes systematic reviews published in Cochrane, the highest standard of systematic reviews. While there are standards, they are very frequently not followed. However, following these standards can be very challenging and paradoxical. It’s very possible that a cohort study can be designed in a way that is much more systematic and informed than even a systematic review.

Is the representation accurate?

When I see the word “representation”, I am thinking about visual representation – the pyramid shape itself. There is an assumed hierarchy not just in terms of evidence, but also superiority here. This is a simplistic and elitist way of thinking about this information rather than being informative and useful. If you think about it, a systematic review cannot be conducted without having supporting RCT’s or case reports, etc. Research had to start somewhere. It this was seen as more of a scholarly conversation, I wonder if there would be a place for hierarchy.

I have learned that the slices of the pyramid represent the quantity of publications of each level of evidence. However, this is not something that can be easily understood by looking at this visual alone. Also, if the sizes of the slices represent quantity, why so? Quality is indicated in this version with the arrow going up the pyramid. This helps to represent idea of quality and quantity. However, if evidence-based medicine wants to prioritize quality, maybe the sizes of the slices should represent the quality, not quantity, of evidence. If it is viewed from that perspective, the systematic review slice should be the biggest because it is ideally the highest quality. Or, should the slices represent the amount of bias? This is all quite unclear.

Are the data carefully documented? Do the methods of display avoid spurious readings of the data?

I don’t believe that any data is actually represented here. Moreso, it feels like it’s being told to us so we believe it. I understand this is a visual model, but this image has been floating around so much that it is taken as the truth. I don’t think one can avoid spurious readings of the data because data aren’t represented here.

Are appropriate comparisons and contexts shown?

I do think that this pyramid provides visual way to compare information, however, I don’t think contexts are shown. Again, should the amount of each level of evidence referring quantity or quality? Is the context meant to indicate research superiority? If not, perhaps a pyramid isn’t the best shape. By virtue of its definition, a pyramid has an apex at the top, indicating superiority. Maybe a different shape or representation can provide alternate contexts.

So, how should evidence-based medicine be represented?

I have presented my own perceptions sprinkled with perceptions from others. I’m a new librarian, and my opinion has value. However, I also think this concept needs to be re-envisioned collectively with healthcare practitioners, researchers, librarians, and patients.

Another visualization that has been proposed is the Health Care Literature Wedge. It would look like  a triangle with the apex facing right indicating progressive research stages. I do think there are other shapes or concepts to consider. Perhaps concentric circles? Perhaps this can be a sort of spectrum? 3D maybe? I really don’t know. Another concept to consider is that systematic reviews are intended to reduce bias pertaining to a research question. Instead of reducing bias, maybe we can look at systematic reviews as having increased perspectives? How could this change the way evidence-based medicine is visualized?

I think the questions posed by Tufte can help to guide this. And I’m sure there are other questions and models than can also help. I would love to hear other epistemologies and/or models, so please share!

References

  1. Chang, S. M., Bass, E. B., Berkman, N., Carey, T. S., Kane, R. L., Lau, J., & Ratichek, S. (2013). Challenges in implementing The Institute of Medicine systematic review standards. Systematic Reviews, 2, 69. http://doi.org/10.1186/2046-4053-2-69
  2. Garritty, C., Tsertsvadze, A., Tricco, A. C., Sampson, M., & Moher, D. (2010). Updating Systematic Reviews: An International Survey. PLoS ONE, 5(4), e9914. http://doi.org/10.1371/journal.pone.0009914
  3. IOM (Institute of Medicine). (2011). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press.) Retrieved from http://www.nationalacademies.org/hmd/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx
  4. McKibbon, K. A. (1998). Evidence-based practice. Bulletin of the Medical Library Association, 86(3), 396–401.
  5. The PLoS Medicine Editors. (2007). Many Reviews Are Systematic but Some Are More Transparent and Completely Reported than Others. PLoS Medicine, 4(3), e147. http://doi.org/10.1371/journal.pmed.0040147
  6. Tufte, E. R. (1997). Visual Explanations: Images and Quantities, Evidence and Narrative. Cheshire, CT: Graphics Press.

 

Keeping Track of Your Commitments

I’m not the first FYAL blogger to note this, but there are significant differences between professional and student life. Lindsay O’Neill previously wrote about the culture shock of academic life, as well as her techniques for time management, and how the amount of freedom you have to shape your own days is both liberating and overwhelming. I’ve noticed many similar differences. When you’re a student, the semester feels like a sprint towards the finish line. When I became a librarian, there was suddenly a vast amount of time stretching out before me, and it was up to me to figure out how to fill it. As a student, assignments and deadlines are clearly defined for you by somebody else. Now, a lot of the work I do is self-generated and much less defined in its contours.  In this post, I wanted to discuss some of the strategies and tools I’ve used to adjust to this environment.

Last year, I received the book Getting Things Done: The Art of Stress-Free Productivity by David Allen as a gift (and a subtle hint, perhaps). I’m naturally averse to most things that seem like they’d be found on a CEO’s bookshelf, but this book has actually proved to be helpful as I’ve transitioned into my new job. Although I was able to define some big picture projects and goals for myself when I started, I wasn’t quite sure how to accomplish them. When a goal is as loosely-defined as “figure out how to support graduate students” or “plan successful outreach initiatives”, the next steps are not immediately obvious. More than once, I found myself feeling stressed or anxious about projects I was working on outside of work or while I was falling asleep, without making much progress on them while at work because I wasn’t exactly sure how to move forward.

Allen posits that the stress most people experience comes from “inappropriately managed commitments they make or accept” (Allen 13). Whether these commitments are with yourself or someone else, they generate “open loops” that need to be attended to. His system for managing commitments requires three basic tasks:

  1. Capture anything that is unfinished in a collection tool.
  2. Clarify your commitment and what you have to do to make progress towards it.
  3. Keep reminders of the actions you need to take in a system you review regularly.

I decided to commit to Allen’s system. I downloaded the task management application Wunderlist, where I keep both a list of ongoing projects and a list of immediate to-do items. For any given project, I spend a few moments thinking about what a successful outcome would look like, what the next actionable step I can take to get there is, and capture it in my to-do list. Allen’s book helped me see that this kind of work — planning, clarifying, and prioritizing — is, actually, work. This was a revelation to me, as I had previously felt that unless I was producing something, I wasn’t really working.

This system makes it much more manageable to keep track of long-term or bigger projects by breaking them into smaller, actionable pieces. If the next step on a project requires action from another person, I can transfer that to-do item into my “waiting for” list, so that I know where the project stands, and that I’m not personally responsible for the next action. It’s helped me keep track of ongoing or informal responsibilities, too. For example, I have a recurring weekly reminder to input my reference and teaching stats, so I don’t forget and try to do them all at the end of the semester. If I say “oh, I’ll email that to you!” to someone, I put it on my to-do list so I don’t forget. I also have a space to keep track of the things that need doing in my personal life, like “schedule dentist appointment” or “oil change” (both real life items from my current to-do list — very glamorous).

Another thing I’ve learned about the pacing of academic life, and working life in general, is that you cannot work at your full capacity all of the time. There are natural dips in energy and motivation, and allowing for those is a necessary part of avoiding burnout. I select items to work on from my to-do list based on how I’m feeling and how much time I have before the next meeting or appointment. On a Friday afternoon, when I’m feeling bleary and my brain is turning off, I might choose to update links on a LibGuide. On a Monday afternoon, when I’ve just had my post-lunch coffee, I’ll tackle a writing project or draft a particularly complicated email. Having a list of all the things I’m on the hook for helps me make those decisions more easily.

Breaking bigger projects down into actionable items and writing down what those next steps are has helped me immeasurably. If this is sounding very common sense to you, I imagine you are a more naturally organized person than I am. My personal organizational system prior to reading this book was to keep about five different to-do lists at any time, scattered throughout different notebooks and digital spaces. I generally used to-do lists as a tool to review my commitments in that current moment, but rarely referred back to them. The mental energy I was expending on storing all of the things I had to do in my brain was enormous, and not particularly efficient or effective. Now, I’ve outsourced this memory work, and it’s helped me feel more at ease with long-term or big picture projects. For any given project, I’ve identified a next step, and it’s on my to-do list.

What are your techniques for moving forward with gooey projects? How do you manage your time and stay productive in a less regimented environment?

Works Cited

Allen, David. Getting things done: The art of stress-free productivity. Penguin, 2015.

Digging for Gratitude

A little over a year ago, I took a flight to Los Angeles to interview for my job at UCLA – it was the night before the election. At the time, natives and their allies were fighting to re-route Dakota Access Pipeline. I found out towards the end of my flight to LA, that the gentlemen in the aisle seat of my row was from North Dakota and thought natives were “making a big deal” out of it. I woke up the next morning to learn that my less preferred candidate won the election, and I cried in disbelief. I had no idea how I was going to get through my interview.

A year later, I am in my position at UCLA, and recent news of the Keystone Pipeline 210,000 gallon oil spill has come to light days before Thanksgiving, a holiday based upon the false notion of unity between natives and colonizers. I don’t mean to be a Debbie Downer, but I just wanted to place this article in it’s appropriate historical context of my life as a first-year librarian. While I am beyond grateful for my job, my amazing colleagues, and the sunny skies around me, I started in this profession during, what I believe is, a grave time in global history.

I approached librarianship as a career because I loved being able to provide individuals information. However, as I mentioned in my first post, I also embraced the critical possibilities within the profession. I would be lying if I said I have been able to sustain the enthusiasm for deneutralizing the library because between moving across the country, starting a new job, and the current political climate, I am emotionally exhausted.

The good news is I have still found outlets that affirm my place in this field. So here is a list of what has kept me going. I want to share this for anyone else feeling a lack of hope and/or motivation to keep sticking with the fight:

  • Multiple students have approached me with a research question that focuses upon a marginalized population.
  • The UCLA Medical Education Committee held a retreat to discuss diversity, inclusion and equity in medical education. This included speakers that used words such as “racism”, “oppression”, and “microaggressions”.
  • I have been able to collaborate with amazing South Asian women librarians for an upcoming chapter in Pushing the Margins: Women of Color and Intersectionality in LIS. On top of it, my co-authors and I were able to share our experiences about being South Asian women in librarianship in a panel at a symposium at UCLA. And even better, I was able to meet and listen to the other incredible authors that will be included in this book!
  • My colleagues and I were able to create an in-person and virtual exhibit to highlight Immigrants in the Sciences in response to the DACA reversal and the White nationalist march in Charlottesville.
  • UCLA’s Powell Library held a successful Conversation Cafe for International Education Week.
  • I attended a fulfilling professional development opportunity about systematic reviews.
  • I have shared tears and memories with several other LIS students through the ARL IRDW and Spectrum Scholar program.
  • I was able to visit Seattle for the first time and attend my first (of many) Medical Library Association conference.
  • I gained a mentor and friend.
  • Every time I teach, I learn something new about active learning, teaching methodology, and how to teach to specific audiences. Most importantly, I feel like I am truly in my element.
  • I met the Librarian of Congress! #swoon
  • I inherited two precious cats (librarian status achieved).
  • I’m way less clueless about being a librarian than I was when I started in April!
  • And now I am able to share my first-year experiences through ACRLog!

This is not an exhaustive list, however, it proves that in less than 8 months of working in my position, I have been blessed to create, pursue, attend, and feel a part of unique opportunities within my profession, especially at my institution. So while I might feel disillusioned and hopeless because of the world and its inequities, I have to admit that there have been several upsides.

Thank you for reading, and I hope you too can discover these golden nuggets amongst the rubble around us.