Development Of A Syllabus For Healthcare Database Training. The Experience Of Libraries Serving National Health Service Staff In Leeds, Uk

The Leeds National Health Service (NHS) Library Healthcare Database Training Syllabus (detailed in Appendix) was developed in 2005 by the User Training Workstream of the Leeds Library and Information Service Project Team (LLISPT). Delegates on the LLISPT represent each of the library and information services serving the NHS community in Leeds, UK. As such, there are representatives from the two local universities, as well as professional staff from the libraries of the NHS Trusts in the city. The LLISPT forms part of a range of measures which aim to increase co-operation and collaboration between the libraries serving the distinct NHS organizations within Leeds with the aim of enhancing the library and information service offered to local NHS staff and thereby, ultimately, of improving patient care. The city-wide library collaboration programme, formerly under the auspices of the Leeds Library Development Group, and whose progress has been reported previously by Thompson1 and Walker and Thompson,2 now works to an approved Leeds Library Development Strategy.3 This strategy identifies that ‘an extensive and systematically planned programme of library/information-skills training for users’ is an essential aspect of the ideal library service. The aim of the User Training Workstream is to realise this vision by overcoming the challenges posed by inter-organizational working and by building on the existing strengths within the library services in Leeds. The librarians within the Leeds NHS community all offer information-skills training. For most, this includes delivery of training in the use of those health-care databases currently provided by the NHS Core Content collection. The style and content of this training, however, varies considerably between libraries. The length of training, for example, can range from the short one-to-one session to the full day option offered as part of a wider Evidence-based Practice course. In terms of content, it is left to the professional judgement of the librarian to decide what to include in a session, and this flexibility is essential in targeting training at individual service users and their needs. The situation is exacerbated by the tendency to use titles such as ‘Advanced Database Searching’ when advertising and describing courses. As there had been no agreement between local library professionals as to what constituted ‘advanced’ or ‘basic’ training, these titles were essentially meaningless in trying to compare one course with another. Although a detailed examination of the aims and learning outcomes of the course would illustrate the true content of the session, this situation was not consistent with the need to make the service more transparent and user friendly. The User Training Workstream (referred to hereafter as ‘the group’) aimed to develop a syllabus for database training which would incorporate a number of agreed levels of competence in searching. These levels would consist of a logical progression, with knowledge and skills gained at the lower levels being assumed and built upon in more advanced levels. The levels would then be used to identify the complexity of a particular training course, and act as a guide for users when deciding which course was most suited to their needs based on their own previous learning and existing skills. A brief review of the literature suggested that extensive work had taken place on developing general information-skills curricula, particularly for students in higher education. However, there was no evidence of any curriculum specifically for health-care database searching. Informal contact with local information-skills trainers within the West Yorkshire NHS community confirmed this deficiency. The group therefore decided to concentrate on elements which were either already included in existing healthcare database training courses within Leeds, or which trainers believed should be included. Negotiation then took place over the levels at which the individual competencies should be placed. Debate took place over the inclusion of the content of Level 1 in the Healthcare Database Syllabus. The main issue was that this level does not actually deal with searching the databases themselves, and it could be argued that it should not therefore constitute part of the syllabus. However, it was recognised that a certain level of information literacy and familiarity with the Internet is advantageous, if not essential, prior to tackling material covered in Level 2 of the syllabus. The group believes that Level 1 provides the grounding and preparation necessary to proceed to the subsequent levels of the syllabus. It is both anticipated and recognised that service users may have gained many of the competencies in this level by a number of different means, including being self-taught or by attending courses offered elsewhere. Attendance at a Leeds NHS Libraries Level 1 course, therefore, may not be deemed a prerequisite for signing up to courses pitched at the subsequent levels. Nevertheless, the syllabus offers an indication of the kind of competencies which candidates are expected to possess in order to succeed on a Level 2 course. There was considerable negotiation over the content of Level 2. The main issue here was the sheer number of competencies which were proposed for inclusion at this level. Many of the local information-skills courses are 2 h in length, and concern was expressed that it would be impossible to cover all elements of the level effectively in this time span. There was also resistance to making some competencies included in Level 2 either more or less important than others. As a result, a compromise was reached which separated Level 2 into two subsections, Level 2a and 2b. This permitted trainers to deliver material covered by Level 2 in two sessions where necessary, thereby avoiding making value judgements over the importance of competencies assigned to this level. The elements which make up this section of the syllabus are those which were considered to be relevant to more advanced searchers who had already successfully mastered elements defined at Level 2. The Evidence-Based Quality Filters, for example, assume knowledge of Thesaurus searching and combining using Boolean operators. Although very useful in performing literature searches, it was felt that elements within Level 3 could prove too challenging for relatively new trainees tackling databases at Level 2. While local trainers are free to offer a combined Level 2 and 3 course, the separation of these elements in the syllabus increases flexibility by allowing shorter courses to be provided. Initial drafting of the syllabus was limited to the User Training Workstream. Once agreement was reached within this group, the proposal was circulated to the wider health library community via LLISPT with a view to obtaining the support of both NHS and higher education. Several further drafts took place before the syllabus was approved. Approval took place in summer 2005, and all health-care database training courses offered by Leeds NHS Libraries from January 2006 will be mapped to the levels of the new syllabus to allow library patrons to more easily identify those courses suited to their needs. These training courses are also advertised on the Leeds Libraries website (http://www.leedslibraries.nhs.uk), with a link provided to the relevant syllabus level to facilitate access for service users. Any review of the current course provision can now incorporate the syllabus into the planning phase, which will ensure that all areas of the syllabus are covered. The presence of local higher education library and information service representatives on the LLISPT means that they are aware of the development of the syllabus and able to access it. This is beneficial as it provides the opportunity, should it be seen as appropriate and feasible, for the syllabus to influence future development of the healthcare database training courses offered by these institutions. The group has a number of other tasks in progress, all aimed at improving user-friendliness of NHS Information Skills Training. The group has already facilitated agreement in Leeds over the use of the term ‘Healthcare’ to describe those databases available via the NHS Core Content collection. The advantages of this are twofold. First, it helps to avoid the confusion which can arise around the use of so many disparate terms (Clinical Knowledge Databases, Knowledge Databases, Medical Databases, and so on). Secondly, the choice of the inclusive term ‘Healthcare’ over ‘Medical’ or ‘Clinical’ helps to promote the library and its resources as being useful for all NHS staff rather than simply a service for clinicians. Future work will seek to develop a glossary of ‘preferred terminology’ which will be used in local NHS information-skills training. This will, for example, identify agreed terms to refer to controlled vocabulary searches, free text searches, and so on. Once available, these terms will be incorporated into both the syllabus itself and any course booklets and documentation. Finally, the syllabus itself will be subject to a continued review within the Leeds NHS Library community. Continuing discussions within the group have led to minor changes and it is expected that it will continue to evolve as trainers apply it in practice and offer feedback. It is envisaged that a more formal evaluation of the syllabus will take place within 6 to 8 months. Implications for Policy A nationally produced NHS health-care databases training syllabus would provide guidance and allow comparison of courses across the UK. Ideally, this syllabus would be agreed with, and adopted by higher education institutions and other non-NHS organizations which provide information-skills training to NHS staff. Implications for Practice The syllabus is a tool which can allow library service users to make better informed choices about the healthcare database training courses best suited to their needs. The syllabus has a valuable role to play in the planning, promotion and delivery of healthcare database training. Syllabus for Healthcare Database Training Leeds NHS Library Healthcare Database training courses are available covering the full range of features listed below. Level 1 – Use of the Internet 1.1.1 Access the Internet without direction/assistance. 1.1.2 Use the following functions on a web browser: Home, Back, Forward, Refresh, History, Favorites, and Print. 1.1.3 Type a URL directly into the address bar. 1.1.4 Understand the difference between nww and www sites. 1.1.5 Comprehend the basic component of an internet address and how it can assist with quality assessment e.g. .ac, .org, .net, .nhs, .gov, .uk. 1.1.6 Recognise quality issues relating to internet-based information e.g. provenance of a site, currency of the information, verifiability of the information etc. 1.2.1 Locate and search using a standard search engine e.g. Google, Google Scholar, NLH Single Search Engine etc. 1.2.2 Execute a Google search using “”, + and – . 1.2.3 Identify recognised information gateways and/or sources of quality health/medical information e.g. NMAP, OMNI, NeLH, etc. 1.3.1 Obtain an NHS Athens username and password. 1.3.2 Understand when and how to use an NHS Athens username and password. 1.3.3 Comprehend a general overview of NeLH, NLH and specialist libraries. 1.3.4 Make basic use of key NLH resources e.g. Search. 1.4.1 Locate and use the full-text journals via the A-Z journal service. 1.4.2 Navigate the full-text journal collection. 1.4.3 Understand the differences between Text, HTML, PDF and Abstract files when viewing full-text journals. 1.4.4 Use PDF files. Level 2a – Basic Healthcare Databases 2.1.1 Differentiate between the various healthcare databases available and select the appropriate database. 2.1.2 Access the healthcare databases via a personal NHS Athens password. 2.1.3 Understand the differences between Easy and Advanced search in the healthcare databases. 2.2.1 Understand the need for a precise question and why it will improve the search. 2.2.2 Plan a search using an appropriate method e.g. PICO. 2.3.1 Understand the difference between a free-text/word/phrase search and a subject/ thesaurus mapped search. 2.3.2 Perform a subject search in a healthcare database using the controlled vocabulary/thesaurus. 2.3.3 View a Scope Note relating to a chosen subject heading. 2.3.4 Understand why and how to explode a search. 2.3.5 Combine searches using the Boolean operators. 2.3.6 Use basic limits e.g. Humans, Male, Female, Documents in English. 2.3.7 View abstracts/complete references. 2.3.8 Save/e-mail/print results. Level 2b – Intermediate Healthcare Databases 2.4.1 Navigate the Thesaurus Tree relating to their subject headings. 2.4.2 Understand why and how to use major. 2.4.3 Appreciate the difference between subject headings and subheadings e.g. surgery, radiotherapy etc. 2.4.4 Use subheadings. 2.4.5 Search for single citations using author, title or journal reference. 2.4.6 Create an Alert. 2.4.7 Save and retrieve their search strategy. Level 3 – Advanced Healthcare Databases 3.1.1 Understand the need for high quality evidence in the results. 3.1.2 Differentiate between therapy/diagnosis/prognosis questions. 3.1.3 Apply an Evidence Based Quality Filter to retrieve high quality results. 3.1.4 Use the limits and “Advanced limiters” e.g. journal subsets, publication types etc. 3.1.5 Use a range of proximity commands e.g. ADJ, NEXT, NEAR, WITH, SAME. 3.1.6 Use shortcuts e.g. .ti.,.au. etc. 3.1.7 Use truncation and wildcards e.g. $, $x, () and ? 3.1.8 Run the same search in two databases. 3.1.9 Save a search strategy from two or more databases.