Isla Kuhn – Series 2 – Libraries

[00:00:00] Cheryl: Welcome to the podcast from Cambridge University Medical Education Group, or CUMEG for short. This is a podcast from the University of Cambridge Clinical School, focusing on medical education. We discuss a range of topics that medical educators are dealing with. I'm your host, Cheryl France, head of CUMEG.

Today I would like to introduce Isla Kuhn. Welcome Isla. It's wonderful to have you with us today.

[00:00:30] Isla: It's a pleasure to be here. Thank you.

[00:00:32] Cheryl: Would you be kind enough to tell us a little bit more about your background and your current role?

[00:00:38] Isla: So, I'm a geography graduate, which is not the most obvious route into medical librarianship, but nevertheless, I graduated with a geography degree, but then did a master's in information in library studies and have worked in university libraries supporting medical and NHS staff and students ever since. So that's been 20 plus plus years of a library experience and the last 18 of them have been here in Cambridge. And I've worked through a variety of roles in the medical library, as I say, always in a medical, health and medical role.

The role that I have at the moment is as Head of the Medical Library Services and that's about developing the space and about developing the service and developing the team to best support undergraduate medical education, postgraduate research and clinical practice as well because we support the hospital Cambridge University Hospital's trust, as well as the students in the clinical school.

[00:01:34] Cheryl: Oh, so that's quite a large population, if you're thinking the hospital as well as the clinical school.

[00:01:38] Isla: Wide and diverse, and there's students who go on placement in the hospital. So, there's lots of parallels with the students that we support in the university, but there's also clinical practice and that works at a very different pace and has got a very different urgency behind it to research, which has urgency but is, has a slightly different pace sometimes.

[00:01:57] Cheryl: Oh, that's interesting. Okay. Sorry, I would like to pick up on that. So, the clinical practice side of things. So, is that in terms of potentially a consultant, a doctor saying, I need information on X, or what exactly do you mean by the clinical practice side?

[00:02:13] Isla: So, absolutely, there's been cases where somebody has arrived into the library saying, ‘I'm doing an operation tomorrow and I just need to refresh on this technique’, or ‘I need to update on this particular technique’, which is brilliant that they're doing that, they recognize that that's something they need to brush up on or they haven't done for a while. So, they're just checking their clinical knowledge.

There's ongoing clinical practice, so making sure that their evidence-based practice is up to date. It's also making sure that services are developed and delivered in an evidence-based way as well. So, it's clinical care for individual patients. It's clinical practice for delivery of a service as a whole, but it's also developing the services that the hospital delivers. So, it's a management sort of non-clinical level as well as very direct individual patient care as well. So, it's, everything. It's from the point of I think I might want to be a doctor through to every aspect of the hospital that they want to us to use us for.

[00:03:13] Cheryl: That is fascinating. That's really interesting. So, thank you for that. I mean, it's quite a diverse role.

[00:03:18] Isla: There's not many university medical libraries that serve both the NHS and the university, so it is, I'm one of a few that have that sort of double agenda, but there are NHS libraries that support NHS trusts and so there is a service for other trusts as well.

Clearly, there's medical libraries in universities and there's no hospital connection, but yeah, I get the best of both worlds and seeing the transition through the whole thing is really nice as well. So, seeing the, makes me feel old, but seeing the students come back in their first positions and through even I'm getting to the age where I can see them coming back as consultants is a real privilege to see their career progress and develop.

[00:03:58] Cheryl: I bet. I mean, it sounds like quite an interesting role and so diverse to span both, the hospital and the clinical school, that's really interesting.

[00:04:07] Isla: There's massive challenges in terms of the diversity of requirements, but there's also a huge benefit because we see it all the way through every single step.

[00:04:17] Cheryl: I imagine that's the case. Yes. That's very interesting. Oh, thank you for that.

So, you've just described some very interesting scenarios of the differences that you're supporting. And here I was thinking, I'm going to be controversial. Do you even need a library? You know, everything's going online. Why do we need a physical library? And, you know, what role does that have in a student's education. You've already started that, but I think it'll be interesting to take it from the student's perspective and why it's important, if you would, please.

[00:04:50] Isla: Yeah. I think from a student's perspective, having an actual space that is not their home, their room, their shared flat or whatever is really, really important. Physically just providing them with the space which is convenient to the place where they're learning, the lecture theatres that we have here in the clinical school, the wards where they're on placement in the hospital, it's physically convenient for them to pop in to take advantage of that spare 20 minutes, half an hour, whatever it is, in between scheduled events in their day just to take stock, just to have a little break and a breather in a quiet space. And to study as well. So having somewhere where it's physically convenient counts for an awful lot.

Having something somewhere with the right sort of atmosphere, the quiet space somewhere where they can come and just decompress a little bit because going in, there's lots of noise and bustle and rush in the hospital. And so, it's just having a quiet space where they can just take a moment and reflect on what they've learned and prepare for what they're about to encounter is a really important. So just the atmosphere of the place helps.

The physical stuff in that place is really important as well. The books, the reading lists that they need, that they're recommended text from the tutors. Clearly, that needs to be brought together in a place. And despite the massive push towards eBooks, which has accelerated enormously over the pandemic, yes, we provide eBooks, but the physical copy is still very much a favourite among students.

Having six physical books in front of you is a very different experience in the learning perspective than one screen, perhaps even just your phone. You can't have six books open at the same time on your phone. It's just a, you can't. I would find it challenging and I would be surprised if students didn't find that a challenging prospect. So having the physical books is just as important as the, as the e-books, and we need to get the books on the shelves, and we need to get them bought. And that doesn't happen by magic. So, the liaison with the teaching staff to make sure that the right books are there, recognizing that we need more than just the reading list. So, we need to give materials around the topics as well, because as I mentioned, we're supporting the trust as well as the university, thinking about the clinical practice books as well as the medical undergraduate education.

So, there's, they can see all the way through and also from different profession's point of view as well. We've got nursing books, we've got OTs and physios. They could be entering a topic from a different angle as well or looking at it from a different angle. So having the texts is important.

Going beyond the reading list is, I think, really important and all of that has to be achieved, and that's the library staff. So having the space, having the right books and materials in this space is important. Having the right stuff online is important as well. And again, that’s not the magical, magical Google, it is stuff that is purchased, that is selected, that is collated and brought together by people, by my colleagues. That doesn't, as I say, that doesn't happen by magic. So, it's all of that learning material in the right place as well as wherever they are is what a library does for the students.

[00:08:02] Cheryl: Fantastic. And I think it's lovely to hear that yes, you're right. It's that physical book is still important and often you hear of younger people, younger generations coming through, just not picking up that physical copy of a book. So, it's lovely to hear that still happening and how important it is, because I think it's really important. But, I'm older, so I'd love a book.

[00:08:28] Isla: I think people mix and match a little bit. They may, if they're going on placement, clearly having an eBook so that they don't have to carry five enormous copies. Have you seen Kumar and Clark lately? It's enormous. They don't have to carry that to the placement if on public transport. I mean, that's just too much. Yes, there are placement libraries wherever they go so that the NHS library could provide them with access to the physical books as well.

But having the opportunity to combine formats in a way that suits them best and to be able to dip in, if they only have a limited number of items that they can borrow, being able to say, well, I'll take these five because I can get that one online. And to compliment. It's about having the best combination that will suit each individual's perception of what the best combination is.

[00:09:11] Cheryl: Yes. And that's really important. And it sounds like you've worked hard to try to get that right.

[00:09:16] Isla: Yeah, it's a constant balancing act and one that evolves because some eBooks don't exist. People haven't, publishers, whether it's publishers, the authors, or whoever, the transition to an eBook format doesn't exist. So, we would, but we can't.

[00:09:31] Cheryl: Yes.

[00:09:31] Isla: In some ways, and that applies to some material in different topic areas as well. Decolonization as an issue for libraries is enormous. Making sure that there's enough representation and enough diversity in the materials, which are made available as teaching resource. In arts and humanities, that is a move away from the old white dead male authors into a more diverse set of readings. In medicine, it's about making sure that enough skin tones are represented, or enough examples are used across the diversity of cultural or minoritized ethnicities that might exist.

And, so it's just, but this stuff has to exist, and so we try our best to make sure that we buy the materials that has best representation, has best diversity, and so on. But the authors have to write it first. So, a plea to anybody writing a clinical medical book make sure that you get representation, diversity, different skin tones. It doesn't need to change the stuff that you're teaching. It's just make sure that it's visible across the spectrum of people who all clinicians will encounter every single day.

[00:10:38] Cheryl: I think that's really important. I'm glad you've brought that up because we have touched on that. You know, and I think it's really important that we are representative or the teaching is representative of what clinicians are going to be,

[00:10:50] Isla: who the clinicians are, as well as who the patients are.

[00:10:53] Cheryl: Exactly.

[00:10:54] Isla: Yeah. It's about who do I see myself, as the doctor delivering the care in a limited example, using doctors, but also do I see the patients that I'm likely to be to be meeting and can I recognize a bruise on a different skin tone rather than just white skin.

[00:11:09] Cheryl: Exactly, exactly.

That's really important, so thank you. Yeah, I'm glad you've brought that up because I think it was such an important topic and something that, as you say, the books aren't out there as much as you'd like, so please, let's get the information.

[00:11:23] Isla: Yeah.

[00:11:23] Cheryl: In the eBooks or physical books so that we have it

[00:11:28] Isla: Yeah.

[00:11:28] Cheryl: For the next generation to learn from. So yes, thank you for that.

I'm now going to kind of change a little bit and ask a different question still on the same tone, obviously. But I understand that there's a range of courses that medical students can take. So, for example, the risk of bias assessment or an introduction to literature searching and systematic reviews and those things are, you hear about them, they're really important, but can you tell us some more about what sort of training you provide for medical students and why that's important?

[00:12:05] Isla: So, the sorts of training that we provide is across the whole course. Cambridge has a six-year standard course, three years preclinical, three years clinical and we introduce skills, in timetabled sessions throughout those six years, and we improve and increase and develop on the skills from the previous year each time. So, it's about developing. We don't, so entry point, systematic review isn't, that's not where we go. Can you find the items on your reading list? And we develop and build up on, on the skills.

The preclinical students, for example, have sessions in supporting them, in preparing for patients to help them make that transition from the lab into a clinical setting, into a place where they're engaging with patients. And we support them with finding the information that might help inform their engagement with a voluntary community group or whatever it, an alternative therapy practice or whatever it is. So that's part of the preparing for patient's course.

In the third year, part two, as we call it in Cambridge, there's a dissertation or project and we introduced literature searching skills at that point cause that's the first time they've been sent off to find information to support an independent piece of work as opposed to use these reading list texts to write an essay on. And we support them in developing that sort of entry level light, relatively light touch, but revolutionary skillset because there's life beyond Google. What! PubMed has an advanced search and oh, you can see light bulbs going off because it creates opportunities for complexity of searching that they hadn't realized existed because it's not just a one topic, type in diabetes and it doesn't work like that. You're going to be either inundated or still searching for the piece of information that you need. So, you'd be able to need to be able to translate the question that's in your head, into a strategy that will find you the right stuff sufficiently close to the top of your search.

So, we have that in preclinical. And then in the clinical years, we develop that because there's an SSC section, a student selected component section where again, there's independent study. They can go off and explore and develop a presentation, perhaps a something for conference that reflects the learning that they've done in relation to a topic area, reflects the contribution that they've made to a piece of work.

That's what the SSC does. And again, we introduce a development on their preclinical experience and developed that further in the SSE. And so those are the sorts of skills that we offer. There's lots of supplementary courses that we offer as well. Diana, in the first episode of the course mentioned the amount of research emphasis that Cambridge has and the option for inculcated or MB PhDs, and the optional additional sessions that we have, have a more research orientation. So, there's research, data management, there's critical appraisal, there's risk of bias. There's how you read papers to make sure that they're going to be incorporated into your final analysis in a way that reflects the quality of the work that those papers contain.

We support them if they want to explore systematic views a little bit more. Those sorts of things. We also offer an extracurricular course that really focuses in on systematic reviews, if that's something that the students want to do, but it's about making sure that the way the course connects them with experienced researchers that can take them into a systematic review at the right point and not expect them to do a systematic review independently, by themselves. So, it's about introducing them to an ongoing research project, so that they can make a contribution and really gain a solid understanding of what a systematic review is. And that course is, it's led by Dr. Juliet Asher Smith. It's incorporating experienced researchers at every stage of the systematic review process, and it's something that interested students can really get a lot more depth in. Not all students want systematic reviews, but they all need to do literature searching they all need to gain those skills.

[00:16:19] Cheryl: Yeah, and that's really interesting. So, it sounds to me that like there's a mix of, not quite mandatory, but courses that they will be taking as part of the course.

[00:16:26] Isla: Yes.

[00:16:27] Cheryl: As well as the opportunity to go and learn more or gather additional skills in research, which is fantastic

[00:16:35] Isla: Yeah.

[00:16:35] Cheryl: For them to be able to do that. And I think it's helpful because you've touched on now talking about systematic reviews in that sense, in that we're talking not just physical books, but journals and how important medical journals are in terms of learning.

[00:16:51] Isla: Yeah. The clinicians in the hospital, it's all about the journals. Undergraduate education is much more about the books. There's a switch in terms of what is the right material because it reflects the skillset and the expertise and the stage in the career that they are.

What we also have is the option for one-to-one sessions, so that those students that are struggling with a particular aspect of their personal work, whether it's at dissertation stage or whether it's at SSE stage or at any other point in their course, if they're doing a piece of work, if they're struggling to find the information that they need, yes, we've got scheduled sessions that they can attend. We've got training, which is timetabled as part of their course, but in that moment, they just need to sit down in a chat and how, why is my search not working? And we can do that. And we are always delighted to do that. So, whether that's with undergraduate medical education, whether that's post-grad or whatever, it's case of, I'm trying to do this by myself and I can't get it to work. Let's have a chat. Let's see what you're doing. Let's see if we can fix that and let's build on it and make it better. This point was really good, and this is where it went skewwhiff.

[00:17:58] Cheryl: That's really helpful. And I can imagine when you're at that. Oh, I can't get it right. That really frustrating stage. Where, why can't I get to the next level? It must be so wonderful to have somebody come in and be able to say, yep, let's help you sort that out.

[00:18:14] Isla: Nobody's got time to bang their head against a brick wall. They have to move on. And they either flounder or they ask for some help, and that's the point of education. You can not know, and it's okay. but ask and you can get help and develop the skills so that you might ask a different question next time, but you've gained something to get you smoother. Along the road smoother next time.

[00:18:40] Cheryl: Absolutely. And that's really important, and I think that's another important highlight is ask the question. It's always okay to ask.

[00:18:47] Isla: Yeah, definitely. Please do.

[00:18:49] Cheryl: Yes. And I think sometimes people get afraid to step back and go, actually, I don't know that, and it's okay not to know it, so let me just ask.

[00:18:56] Isla: Yeah. How can you be expected to know it? Because you're just so early in your career, the point is to learn everything. You didn't come in knowing everything about a particular lab experiment. You learned it. It was either through demonstration and then copying or it was a book and then you, you applied your skills.

It applies to literature searching as well, just because you can use Google. Well done. That's not literature searching.

[00:19:19] Cheryl: Exactly. Well, and I think, you know, even, as you said, hospital staff as well as experienced doctors come at times thinking, okay, this is not going the way I want. I'm sure there's more information out there. Let's look at that.

[00:19:34] Isla: The collaborative aspect of healthcare and the teamwork that helps anyone do their job better is a fundamental part of clinical practice, isn't it? No one is working in isolation, so the ability to call on the people with the expertise that you need at that point, is a life skill that will help them through, help everybody work better together. Because why struggle when somebody else has the information and the skills. Just ask them for help and they'll contribute and then it'll work better.

It seems extraordinary to think that everything needs to be done in isolation and, yes, exams need to be passed and that needs to be a personal skillset. But the work is collaborative so much of the way, that work with people don't think you can't ask for help.

[00:20:26] Cheryl: I totally agree and I think that's the thing we've tried to touch on within the podcast series that we've been doing is that everybody has a role to play and it's important to work together and I think that's really important and the library is an essential mode of being able to get additional information to help solve problems, whatever they may be within the medical community.

[00:20:52] Isla: Clinical reasoning is a skill which is developed and learned, and you get to the point of expertise through pattern recognition, and you get to the point of pattern recognition and that's fine, but the process to get you there, going to use fancy word that I learned the other day, hypothetical deductive reasoning. You have to, you're nodding you are a clinical educator, you know what this is. But you have to work through that process to get to the point of expertise and pattern recognition, and the library can help you develop the skills to get to that point.

So, the whole point of library skills and information skills., I mean, that's what we're talking about. It's not the ability to use a library, its ability to use information. That's a whole set of skills and you need to be looking, finding the answer before you can get sufficiently expert to be able to recognize what it is further in your career.

If I was speaking to librarians, if that is who the audience is, it's all about information literacy. It's about being able to define a question, work out where your knowledge gap is, define what is the question that I really need to answer here, that's going to help me, know where it is that you're going to be able to find the answer.

It's going to be about being able to use that resource to get the answer out. It's over well, knowing that PubMed might have the answer. It's like, I don't know how to search PubMed. You have to be able to have the skills to search the resource, analyse the material that you find, ditch half of it and focus in on the right papers to read that will answer the question so the analytical critical appraisal skills, and then turn that into something that either you talk to the patient about or you apply and see if it has the effect that you want.

Librarians call that information literacy. Clinicians call that evidence-based practice, and the GMC require that students have that skill, and it's called evidence-based practice. You have your clinical question, you turn it into PECO (Population, Exposure, Comparison, Outcome), you find the evidence, you appraise it, you apply it to practice, you review and then improve again next time. It's exactly the same thing, but just different names for the different thing. And we contribute to the development of those skills that the GMC requires that the students have.

I'm very, very pleased that we contribute to the marking and the assessment of those skills as well. Because who better to assess than the people who have taught? A, we can improve our teaching because nobody got that element of it. They just have got it. Everybody in the year group has just got that wrong. Clearly that's something wrong in our teaching or it's a case of Oh yeah, the majority are getting it, that's all fine. Clearly our teaching is okay, but there's just one or two who didn't get it. Was that because they didn't turn up, just assumed they knew it? Was it because they turned up but just didn't get? We need to do better. And so being part of the assessment process is something that I'm really, really pleased that the library team is doing.

[00:23:51] Cheryl: That is good because it does mean you get to close the gap. You close that circle, and I think your examples were really useful to help understand how it's important to close the gap.

And thank you. I think you're really clear in defining the differences in library speak as it were, versus clinical speak, but the skills that are needed are still there and we have to make sure that the students get the skills that they need to graduate.

But it's not just about graduating, it's about treating that patient at the end of the day and as they develop, if there's complex cases or other issues, they know where to go, how to get that information.

[00:24:33] Isla: Absolutely. It's a purely selfish choice, me becoming a medical librarian because I want the best doctors to treat me as a patient.

[00:24:39] Cheryl: Absolutely.

[00:24:40] Isla: If I can contribute to that by helping them become better at finding the information to help answer the questions that they have, to fill the gaps in their knowledge, I'm going to be healthier, or I'll be better treated as a consequence of it. So purely selfish.

[00:24:52] Cheryl: Absolutely. I love it. I love it. And why not, right? I think we all want that at the end of the day. Right?

[00:24:58] Isla: Definitely.

[00:24:59] Cheryl: You and your loved ones cared for in the way you want.

I'll go back now. Thinking about, you know, the last few years we've had Covid, we've had a real shift that was unusual at the time, you know, going from being in person, particularly for medical students needing to be in person and having that human touch as it were. With all of our lessons going on online, that obviously meant that students weren't coming into the library. It was a shift for you as well. Have students now shifted back to coming back into the library again and seeing that wonderful space in which to study and to get the information in which they need?

[00:25:44] Isla: Yes, it's, it's on a trajectory.

In the first part of this year, where coming back was more common and being in person was more common after the massive period over the pandemic. It's starting to increase. It's in a gradual way, but with the final years returned already, the year four is just about to arrive. As we record, it's going to be next week that they arrive. So, it's going to be lovely to see a whole new quarter of students being introduced in person again and start that cycle because we had two years of new intakes who were taught to live online and to learn online and everything else.

So having them back is going to be lovely. We have seen an increase, we've seen that those numbers increase and at different points in the year. It is a very seasonal thing as different pieces of work or different bits of assessment and so on vary. But yeah, we are seeing people coming back in, which is really great as they are spending more time on campus in placement in the hospital being taught, we're going to be seeing them more and more, which will be lovely.

[00:26:54] Cheryl: Yes, it is lovely.

[00:26:55] Isla: Makes it alive.

[00:26:56] Cheryl: Yes. It's lovely to have the students back in the building and the vibrancy going on, and I'm sure in the library it's exactly the same, so yeah.

[00:27:05] Isla: Yes, we've gone through quite a few periods of refurbishment over the past few years, and to see the spaces used in the way that we'd hoped is really satisfying. We've got such a variety of spaces, and this will be the same for every library across the country, whether it's comfortable seats or whether it's individual study areas, or whether it's places where they can share and collaborate. We've worked hard to try and make it as many different versions of what is the right space for the different approaches to studying and learning.

[00:27:34] Cheryl: Fantastic.

This has been really interesting. Thank you so much for giving us the time today because I've learned a lot more about your particular role, but your team and how much you're able to provide to not just our students, but to the wider community.

What would be your top takeaway points from today?

[00:27:57] Isla: The fact that librarians are professionally evolving all the time is a really important thing to be aware of. We get books on the shelf and that's an important aspect of the service that we offer. But we help with the ability to read the books that go on our shelf. So, the critical appraisal skills. We help with the skills to find information beyond the books on the shelves. We make sure that the journal articles are available for reading. It's all very well finding that a paper exists, but you need to be able to read it as well. We help with the incorporation of that into research. So, the research skills in terms of doing a systematic review, we work on that research data management, whether it's getting to the point of publishing and open access publishing, we help with all of those different stages.

And so, as a professional body, we have changed almost beyond all recognition from when I first qualified. The fact that we've got so many more skills, is really helps to diversify. The teaching roles that we have is great. I'm so pleased that the Medical Library team has teaching qualifications as well as library qualifications I think that's really, really important.

The fact that we're evolving, developing new skill sets to support our users in the wide variety of ways that they require is the biggest take home message. We have skills.

The fact that library spaces are evolving to become more than what they might have been when you were studying, when I was studying, into places that are suitable for different ways and approaches to learning and different ways that people like to work together. The spaces are evolving as well.

So, the final, yeah, I think that was two. The staff are evolving, the spaces are evolving. The final take home message is if you haven't spoken to a librarian recently, I would recommend it because we can support your work and your learning, and your teaching, and your research and your practice in ways that perhaps you hadn't imagined, and we can work with you. Please help us work with you.

[00:30:04] Cheryl: I think that's really important, and I think you've really highlighted that throughout the conversation today. It's been really interesting to hear the different aspects of what you can offer and the fact that you are readily available to help. I think most people would really value that, to know that there's space that's safe to go to and to ask those questions and to get help, get that detailed knowledge.

So, thank you. It's been really interesting discussion today, so I really appreciate your time today and coming and speaking to us. Thank you, Isla.

[00:30:37] Isla: It's been a pleasure to blow my own trumpet, so thank you very much indeed.

[00:30:43] Cheryl: Well, we've really enjoyed it. Thank you.

If listeners are interested in learning more about the effective use of libraries or some of the courses on offer, please contact us via the CUMEG website. You will also find other podcasts on the website at. www.cumeg.cam.ac.uk or look out for us wherever you get your podcasts.

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Until next time, I'm your host, Cheryl France, and thank you once again for listening.