Welcome to the what is clinical librarianship section of the EBM Express course. EBM Express is designed to build your understanding of evidence-based practice in short manageable blocks of content. 

In this section we'll be defining clinical librarianship and some terms that are helpful for the clinical librarian. Clinical Librarianship brings EBM to the practicing physician when and frequently where they need it at the point of care. In other words the library
comes to the patron rather than vice versa. 

One formal definition of clinical librarianship is the provision of information quickly to physicians and other members of the healthcare team to influence the information seeking behavior clinicians and to improve their library skills and to establish the 
medical librarian's role as a valid member of the healthcare team.

Some librarians make themselves available to a clinical unit familiarizing themselves with the vocabulary and most frequent clinical questions. Others actually visit patient rooms. Clinical librarianship is also sometimes referred to as EBM at the bedside or point-of-care librarianship. However they choose to practice clinical librarianship, the librarian must first be approved to offer services whether invited by a health professional or seeking approval themselves.The librarian will need to approach the head of the hospital, the head of a department such as pediatrics or surgery or possibly an individual physician. 

If a librarian is invited into the clinical setting it is frequently by a physician who wishes to incorporate EBM into the teaching experience of students and residents. 

Once a librarian has been invited into the clinical setting they'll need to learn a new set of vocabulary. 

A resident is a doctor who has graduated medical school but is not yet practicing and has not yet completed their board certification. A fellow is a doctor who has graduated medical school, finished residency, passed their board certification and has chosen to spend additional training time in the specialty of their choice. 
For example, a pediatrician fellow may enroll in a neonatology fellowship.

The attending is the supervising physician for the residents and fellows. An attending physician is also sometimes called a preceptor.

A librarian familiar with EBM principals may be asked to attend morning report or rounds.Morning report is a meeting of departmental residents or fellows with their attending to discuss a topic. 
A case presented during morning report may be theoretical or an actual patient case that one of the doctors is treating.

A list of symptoms is described and then every possible diagnosis is listed by process of elimination. Several possible diagnoses are determined and the test needed to confirm them.

The librarian's role may be to search the medical literature for a possible additional diagnosis, search the tests suggested to see if they are feasible in the setting or appraised literature that offers diagnoses.

Rounds are when the attending residents, fellows and medical students walk around the hospital and visit their patients. 
During rounds the clinical librarian might accompany the group to the bedside of the patients in their care.

A resident presents the case symptoms and treatment and afterwards the attending and other residents comment discuss and ask questions.
The clinical librarian must listen very carefully, and search the symptoms diagnosis and answers for any questions presented.

If the attending asks a question of a resident it helps for the librarian to have the answer at hand either to help the resident or to confirm the resident's answer.
A resident might also ask the librarian a question privately during rounds.

Journal club is a departmental meeting of health care providers that is commonly held during lunch hour to discuss a recent article in the medical literature. One person or a small group of people is asked to present the findings of an article and to appraise it. 
They may be asked to include a bottom line or a succinct statement of the most important thing to take away from the article.

Librarians may be asked to attend journal club to help residents find an article of interest or to help answer questions that may come up during the presentation. They may also be asked to look for more up-to-date research or other critical appraisals of the article.
The clinical librarian may even be asked to attend the hospital or clinic's ethics committee meetings. An ethics committee is led by a health care worker who specializes in bioethics. 
A lawyer may also be in attendance. 
Topics may include conflict between family members regarding the discontinuation of life support or conflicts of interest in a clinical trial. It is important to know if ethics committee conclusions are advisory or binding. 
Familiarity with the ethics committee fundamentals is valuable to the clinical librarian so that they can recommend that a resident bring a question to the committee or remind a physician who is meeting conflict with a patient or the patient's caregiver. 
Then an ethics committee consult may resolve the dispute. 
The clinical librarian must also always maintain the highest ethical standards and always be HIPAA compliant.

It is vitally important that you never share any personal information about any patient or case.

Clinical librarianship brings library services to the point of care.
It helps health care professionals find evidence for patient care and can be an effective teaching tool. 
It saves physicians time while familiarizing them with library services and can be a marketing tool for the library.