library neutrality

Amping up Diversity & Inclusivity in Medical Librarianship

This past week, I attended the 118^th Medical Library Association (MLA) Annual Meeting in Atlanta, GA. While it was a standard conference in many respects, it was also a historic one. Beverly Murphy was named the first African American president of MLA since it was incepted in 1898.

When I first considered becoming a librarian, I quickly learned about #critlib, which centers the impact of oppression and marginalization of the many –isms in librarianship. I wanted to be in a profession where I could provide information in a critical way, dismantling library neutrality. I found this through a hashtag which allowed me to meet diverse, inspiring, kind, and intelligent librarians. However, I find it slightly more difficult to apply a social justice framework as an academic medical librarian focusing upon the School of Medicine. I have tried my best through critical search strategies and educating others about bias within publishing. And of course, subject areas specific to public and/or global health easily lend themselves to health disparities. Overall though, I have noticed that medical librarianship has been slower to the game, especially in terms of coming together as a community. During this meeting, however, it felt different.

The annual Janet Doe lecture was given by Elaine Martin, focused upon social justice. I have listened to some talks concerning social justice that just scratch the surface. They seem to give a nod to diversity as more of a check box rather than a critical interpretation and call for action. However, Elaine stressed mass incarceration as a public health issue; she emphasized dismantling library neutrality; she quoted Paulo Freire, the author of the seminal Pedagogy of the Oppressed. She received a standing ovation. It was inspiring, and while it may have just been pure emotion, it gave me hope.

I also attended a Diversity & Inclusivity Fishbowl session by MLA’s Diversity and Inclusivity Task Force. During a fishbowl, a moderator poses a question to a group of individuals seated in a few concentric circles. In our case, there were around 30 of us. There were four seats in the innermost circle, and the individuals in that circle answered the question and can be “tapped out” by others in the outside circles who wish to speak. Unless we were in the inner circle, we were solely active listeners. I’m not going to lie, when I saw the format of this meeting, which was three days into the conference and from 5:00 p.m.-6:30 p.m., I dreaded it. But I also knew this was an important issue. Not only did I feel welcome, but I enjoyed the structured yet conversational format. It can be difficult to talk about diversity and inclusion because everyone’s positions are well-intentioned, however, because this is an issue that historically induces trauma upon the marginalized, it can become very passionate. This passion is essential for affecting change, and this format provided a way to combine this passion with respect and compassion. While this is just the beginning of these discussions, it is important to understand perspectives, especially for those greatly affected by oppressions. It was assuring to see so many people coming together while sharing their individual experiences and beliefs for a topic I thought was somewhat dormant within medical librarianship. And, because of the incoming presidency of Beverly Murphy, I am full of hope and faith that events like these will result in an action plan.

I can’t say that I remember everything that Beverly said during the talk she gave after being named the new MLA president. But I can tell you how I felt in response. First, Beverly did not stand at the podium when delivering her words. She sat at a table on the stage to be in conversation with the MLA members. She included song, humor, and love in her words. It was warm. It was inviting. And given the previous events I witnessed, it felt promising. She incorporated the importance of diversity and inclusivity, so it wasn’t a mere check box. Rather, it was always part of the conversation. Just two days before, I met Beverly at the New Members Breakfast. As a co-convener of the MLA New Members Special Interest Group (SIG), I was interested in how we can further engage new members. Shannon Jones, the founder of the New Members SIG, was eager to share ideas with me and introduced me to Beverly, who immediately stated her commitment to advocating for new members. She also told me that she was asking first-time attendees she met to share their experiences, positive and negative, and to contact her directly. Real change comes from strong leaders and action. And diversity is more than an initiative – it is a way of being. Regardless of topic, subject area, or library role, it needs to be part of all we do. Beverly is firm in this commitment:

“No matter what race we are, what color we are, what ethnicity we are, what gender we have, or whether we have physical issues – we are all information professionals, with a common goal, and that is ‘to be an association of the most visible, valued, and trusted health information experts.’ Diversity drives excellence and makes us smarter, especially when we welcome it into our lives, our libraries, and our profession.” – Beverly Murphy

The solidarity and volume is increasing for diverse voices in medical librarianship, becoming a stronger driver for diverse and inclusive representation, pedagogy, scholarship, community, and more and vice versa. I know that equity of race, sexual orientation, gender, and ability is a long road. And I am appreciative we are on it.

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

Didion, J. (2000). Slouching towards Bethlehem. New York: Modern Library.
Greenhalgh, T., & Hurwitz, B. (1999). Why study narrative? BMJ: British Medical Journal, 318(7175), 48–50.
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.

Librarianship Doesn’t Need Professionals

Check out our post on HLS today too! Heidi Johnson, ACRLog FYAL blogger, reflects on the greatest differences between grad school and professional life in “Structuring My Time.” See more information about the HLS/ ACRLog collaboration here.

Madison Sullivan is a NCSU Libraries Fellow at North Carolina State University, where she is a librarian for Research and Information Services, and External Relations. Madison received her MSLIS in from the University of Illinois at Urbana-Champaign in 2015 and is a 2016 American Library Association Emerging Leader. Her views are her own, not her employer’s.

I’m supposed to write about professionalism from the perspective of a new librarian. How to be taken seriously as a “new professional,” and how to “be yourself” at the same time. Here’s the deal – it’s a total mystery to me how people manage it.

A derivative of Jenny Holzer stickers by nadja robot, licensed under a CC BY-NC 2.0

I question what is it to be a professional every single day. I’m not sure I know what professionalism means or what it looks like. Perhaps I do, but the idea of it makes me nauseous.

It makes me nauseous because what if who I am, and who I’d like to be in the workplace, doesn’t align with other people’s definition of what a professional is? It makes me nauseous when I think about the advice, or implied advice, other people have given me about how I should go about being a professional. “Keep your head down. Don’t make waves. Don’t question anyone or anything, especially not your superiors. Keep your mouth shut. Emotions don’t have a place at work. Don’t tell anyone anything personal. Remember to smile.”

In the past, this advice limited my capacity to share my humanness and individuality with my coworkers, and impaired my ability to connect with others. Fear of being perceived as “unprofessional” or naïve has led me to being silent during meetings, and timid to my coworkers and supervisors. Performing professionalism left me feeling robotic and so not myself. Whose rules were these, really?

I know the kind of work environment I want to be a part of. I know the kinds of people I want to work and collaborate with. Much of the commentary surrounding professionalism wasn’t matching up with what I had envisioned and hoped for. If this was advice for being a professional, then perhaps I didn’t want to be one.

People say, “you need to be more professional” when what they really mean to say is “you need to fall in line” or “I don’t like that tattoo” or “hey, tuck in that shirt!” Professionalism is a word people use to maintain and enforce the status quo. Professionalism doesn’t take risks; it encourages conformity. Can you simultaneously call yourself a professional and advocate for radical change? Professionalism is safe and it is boring. I’d also argue that professionalism plays a part in reinforcing the illusion of library neutrality.

I don’t want professionalism to mean putting a façade or a veneer around ourselves before we walk into work everyday. But it does. And I don’t know what we can do about that. The illusion that our lives outside of work stops the second we enter the workplace has never made sense to me. I don’t know what we can do about that, either. It’s an exhausting charade.

Maybe, I think we can love one another. I think we can comfort each other and let our coworkers know it’s safe to share and express themselves. As a new employee, I have to see vulnerability first before I’m comfortable doing the same. I think we’re capable of that. Less judgment. Fewer assumptions. Is this professionalism in practice? I’d like it to be.

For me, the most difficult thing with any new job is that almost everything is unknown at the start. It can be a solitary, unsettling time in a person’s life, even if you haven’t relocated. You have to figure out the boundaries, the culture, your users, and the people you work with. You have to figure out what is acceptable, when it’s acceptable, and around whom. You have to discern how much of yourself is appropriate to bring into this new territory. Which parts of yourself do you hide, which parts do you let people in on? Who can you trust with your worries and your anxieties as you work through starting somewhere new?

I’ll be honest with you. I finished library school in May and have been in my first position as a new librarian for six months. It’s the most exciting thing in the world, and also the most terrifying. I still don’t feel like I’ve figured everything out, and I’m not incredibly comfortable being vulnerable yet. Even though I have been given so much love and support, I’m still trying to “fit in” in some respects. As a new librarian, it can be difficult to express yourself and let your guard down when you want to be respected, valued, and have your ideas taken seriously. You want to show everyone that you can do a good job and that they made the right choice when they hired you.

Learning how to “put a face on” was not something that ever came naturally to me – even after working almost a decade in customer service. As a woman, I’ve been told to think, behave, and act a certain way from a variety of sources and institutions. As a professional, we’ve been given a whole other set of rules to live by (gendered expectations abound!). I’d like for librarians, especially those in leadership roles, to question what professionalism means and what it looks like. Are we taking a humanistic approach in helping to shape new professionals, in assisting our users, and impacting our profession for the better? Some libraries have done this well, and I feel so fortunate to work where I do.

It’s clear to me that professionalism is a performance. It is, among other things, a gendered term, attributed more often to those with a good deal of privilege. It’s a complex word. Those who successfully perform the role of The Professional are afforded more respect and responsibility in the workplace. Yet the traits I value in other human beings (vulnerability, emotional intelligence, authenticity, empathy) don’t often seem to fit into a typical professional construct.

I want library professionals to have real, open relationships with the people they work with. Is this an unprofessional idea? I want library workers and managers to recognize the humanity of their users, their coworkers, and their staff. We need library professionals who question the ethics of our institutions, and our commitment, or lack of commitment, to diversity. We need librarians who stand up for access to information, patron privacy, and intellectual freedom, even when it is hard to do. I want librarians to feel comfortable challenging “the way we’ve always done things.” Does your organization encourage performing professionalism more than it encourages questioning the status quo?

Librarianship doesn’t need more professionals. Librarianship needs people who can look critically at our field and feel compelled to bring about change. We need leadership that actively encourages this. How can we create work cultures conducive to this?

I’m a passionate and idealistic individual. Sometimes I’m overly enthusiastic when it comes to my work. To some, I may come off as completely unprofessional. I love being a librarian and I love this profession, and I’m usually not too shy about expressing it. It’s been difficult to write this blog despite my own insecurities (what if I sound GASP – unprofessional?!). I’m genuinely interested in knowing how others have approached professionalism within librarianship – feel free to share your thoughts below.