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    California Pacific Currents 2005

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    The Modern Medical Library: Migration from Print to the Internet

    When Anne Shew began her career as a medical librarian in the early 1970s, searching for a half-remembered journal article was a day-long undertaking. First, she would conduct an in-depth interview with her client, trying to coax out an author's name, a hint of a title, or a guess at a publication date. Next, she would station herself over a hefty printed index and patiently page through its gray columns.

    "A search like that is very, very simple with today's technology," says Shew, Director California Pacific Medical Center Health Sciences Library, which serves both the medical center and the University of the Pacific, Arthur A. Dugoni School of Dentistry. "Having electronic access to databases and having those databases be searchable is one of the big leaps ahead in medical information." Shew, who is also webmaster for California Pacific's Internet and Intranet sites, pauses to remember her first years after graduation with a master's degree in library sciences from UCLA. "I can't imagine being able to function now without the National Library of Medicine and PubMed," she says, referring to the online searchable database that contains citations and abstracts for more than 15 million biomedical articles, with more being added every day. With the advent of information technology, the Health Sciences Library's users are now more likely to enter its stacks via the library's website as its front door. In fact, the library's website attracts more than 29,000 visits each year, with users viewing about 170,000 pages of information.

    Through the website (, California Pacific Medical Center staff has free and seamless access to the library's catalog and the PubMed databases from the National Library of Medicine. They have free use of the compendiums of clinical information in UpToDate and MD Consult, as well as the research databases of Ovid and EBSCO Fulltext. In addition, the library has electronic subscriptions to hundreds of medical journals and electronic versions of about 100 core medical texts. Once users have established an account and password, most are available through the Internet. And if users have trouble sifting through the information, Shew says, the research professionals on her staff are happy to e-mail, fax, or send hard copies of documents and citations.

    A Treasure, with Walls and Without
    Shew, Medical Librarian at the Davies Medical Center for 25 years before joining California Pacific when the institutions merged in 1998, says medical libraries truly have become institutions without walls. But she believes her library's physical space still is important, especially to staff who use its newly renovated conference rooms and the dentistry students who occupy it as a particularly beautiful study hall.

    The library, located at 2395 Sacramento Street, across from the Pacific campus and the School of Dentistry, is one of San Francisco's architectural treasures. A designated historic landmark, the four-story classic revival building was completed in 1912 as the library for Stanford University's medical school. It was the seventh medical library built in the United States, and nearly a century later it remains dedicated to its original purpose.

    As the library's building approaches its hundredth birthday, however, the amount of medical information available electronically continues to grow. Shew spends a significant amount of time reviewing and choosing the materials and services her clients are likely to need in the near future. But while the migration of materials from print to the Internet and the rise of e-mail have revolutionized the way clinicians, administrators, and researchers get the information they seek, in some ways the skills of Shew's profession remain the same.

    "As librarians, we still hold on to the fundamentals," says Shew, who received the 2005 Award for Professional Excellence from the Northern California and Nevada Medical Library Group. "You need someone who knows how to collect the right information, how to retrieve it, and how to organize it so that it's useful."

    Not Just Any Data, the Best Data
    So while Shew and the library's staff teach courses in how to use electronic information effectively and efficiently, they also provide support for California Pacific's clinicians, researchers, and staff, especially when these clients seek information that requires more than typing a few words into a general search engine.

    "We think of the Web as the ultimate source of information," Shew explains, "but that isn't always the case. The public search engines don't return information from proprietary databases." While a general search may return plenty of sources, she explains, those sources may not be the most accurate, up-to-date, or useful. For example, a Google search on oncogene expressions in breast cancer may return consumer health information, older scholastic articles, advertisements from pharmaceutical companies, and news items, but not the latest professional articles and research.

    Despite the rapid pace of changes in her field, what motivates Shew now is very close to what motivated her 30 years ago. "Medicine makes a difference in people's lives," she explains. "It's always exciting, always evolving as an art and as a science. It's alive, and it affects people greatly. I think librarians can make a contribution to medicine, and I find that very satisfying."

    Online References
    Through its website (, the Health Sciences Library offers free access for its staff to a variety of subscription services that provide reference materials online. Subscriptions include:
    EBSCO Fulltext: Online access to more than 10 databases and the full text for over a thousand medical and health business journals.
    MD Consult: Information aimed at helping physicians answer clinical questions quickly, with special editions for primary care physicians as well as specialists.
    Ovid: Offers online access to numerous medical journals, books, and databases.
    PubMed: A service of the National Library of Medicine that includes more than 15 million citations and abstracts for biomedical articles dating from the 1950s to the present. PubMed includes links to the full text of articles and other related resources.
    UpToDate: A compendium of current clinical information written for physicians by physicians and subject to peer review.