Medical libraries and their users in the electronic age

Abstract

An inquiry in twelve German-speaking academic libraries was undertaken to determine the changes associated with the unlimited enduser access to MEDLINE on CD-ROM. Eleven libraries and 287 users responded.
The inquiry shows that almost all of the users not only accepted MEDLINE on a CD-ROM LAN but liked it very much. 54% of the inquired CD-ROM users never before performed a search in the MEDLINE database, either in printed, online or CD-ROM form, thus demonstrating the powerful attraction by this new medium. MEDLINE on a CD-ROM LAN offered an unlimited and easy access to this important bibliographic database and thereby fitted very well to the information needs of both physicians and students of medicine.
The introduction of MEDLINE on a CD-ROM LAN enhanced not only the work load of the librarians but also the work quality. The staff has to be well prepared to keep pace with the changes, and new skills have to be developed. The library management has to make that change palatable to the staff, because work load seems to grow in every department, and because some librarians became frustrated in front of a changing environment.

Introduction
In 1992 twelve academic libraries in German-speaking countries offered for the first time unlimited access to the database MEDLINE via a CD-ROM LAN. It was to be expected that this did not only lead to the widespread use of this database but also to a changing relationship between the user and the library. This led me to start an inquiry, to which eleven of the twelve libraries and 287 of 600 users responded. Ten of the eleven responding libraries are located in Germany, one in Austria. In Switzerland no academic library at that time offered MEDLINE via a CD-ROM LAN. Six of the ten German libraries are located in one German federal state, in Northrhine-Westfalia because of a special fund of the state ministry. Three of the remaining four libraries are located in the former German Democratic Republic. They received grants to build up CD-ROM LANs too. This strongly confirmed that at least in Germany the financial background is most important for the development of this new library service.

Results
The inquired libraries subscribed to 150 to 7000 journals, the number of staff ranged from 3 to 80, and of students of medicine from 50 to 5000. The size of the CD-ROM LANs varied too. Two libraries (not the biggest ones) offered 200 and 300 terminals for MEDLINE access, the LANs of the remaining nine has only 2 to 10 terminals. 57% of the responding users were physicians, 38% were students, and the remaining 5% of different professions or faculties.

User
Only 2% of the students were in the first two years of their studies, but over 2/3 were performing their MEDLINE search close to the end of their studies, i.e. beyond the 9th semester. This is obvious due to the fact that they used MEDLINE first of all for their dissertations (Fig.1), which usually fall in line with the end of their studies.

Every other reason was not true for more then 10%. The physicians were using the MEDLINE system primary for research (36%), dissertations (27%), and publications (20%). The high level of 'dissertations' was obvious due to the fact that many students were finishing their dissertations only after having become a physician. Only 2.5% of them used MEDLINE for the purpose of therapy or diagnosis, which looks quite astonishing.
The acceptance of the database was enormous. Only one fifth of the users declared themselves as beginners. The average of searches amounted to 13 per year, and so it seemed that for the majority of the users a MEDLINE search has become a routine. Every twelfth user accessed the MEDLINE system for 40 times a year and even more! So it is save to suggest that the users fall in two categories: Two thirds of the users seemed to perform a MEDLINE search on occasion, whereas one third seemed to be periodical searchers.
Most users were searching only the latest years of MEDLINE, only one third of the physicians and one fifth of the students was looking for articles older than seven years.

Search results
More than one half of the users retrieved 1 to 20 documents per search, and further 30% 21 to 50 ones. Interestingly their existed a second peak of the distribution curve at 100 and more documents, which was retrieved by about 15% of the users. The overall mean amounts to 50.1 . This two-peaked distribution curve reminds us of the two major problems connected with enduser database searching well known in literature: First, that the search result is zero, because the users do not know how to perform a complete search, and second, that the users get too many documents and do not know how to select the relevant ones. The last statement matches closely with another result of the inquiry, i.e. more than one half of the users (57%) considered 40% or less of the retrieved documents as relevant. Nevertheless, they were very pleased with their search results, indicating that they did not put the blame on the system.
The inquired users retrieved a total of 12.210 documents, of which they regarded 29% as relevant, 25% as read, and 5.2%, i.e. 633, as requested per interlibrary loan. 79% of the read ones could easily be accessed in the local library, indicating a quite satisfying coverage ratio of the local library holdings.

Satisfaction rate
One of the most important questions for librarians is, if their users were content with the services they offer. Fig.2 shows to which extent the users were pleased with the MEDLINE system.

The users could specify their satisfaction with five characteristics of the system on a one-to-six scale, on which one means very satisfied and six very unsatisfied. The Physicians (black columns) were almost more critical than the students with the exception of the manual, which they jugded a little bit better. The users, if physicians or students, were most of all pleased with the handling of the system, and the physicians with the search result, too. The option to print or download the search result was welcomed.
Speed of search and the manual got higher rates, indicating lower satisfaction rates. The mean satisfaction rate amounted to 2.2, which indicates that by far most users enjoyed to perform a MEDLINE search.
How did the users searched their literature before they knew about MEDLINE on CD-ROM? 31% used to search in the Index Medicus, whereas 15% used to call on a mediated online search in MEDLARS. Further 8% used other databases like Current Contents, CAS, and the local OPAC. However, what seems most important to me, the largest group of 46% did not use any database before. This group was attracted by the MEDLINE system to perform for the first time a database research. Even more than one half of the inquired users, i.e. 54%, was attracted to use the MEDLINE database for the first time. This means that this single CD-ROM database was capable of attracting a lot of fairly new users not only to the MEDLINE database but apparently also to the library.

Library
Every library reported about additional work load due to the CD-ROM LAN. They complained about user education (8), writing manuals (7), installation and trouble shooting of the CD-ROM LAN (6), as well as reference service (5), and staff education (4). Although not inquired, the ILL was increasing, too, as well known from literature.
One important consequence of unlimited enduser access is the decrease of a traditional library service like mediated online searches. In all libraries responding to that question (7) the number of mediated online searches decreased to at least one half or even to one fifth of the level before CD-ROM LAN installation, showing an immediate and strong impact of CD-ROM on online. Only one library declared that they benefited from this decrease, but in the remaining libraries the additional work load caused by the LAN was not outweighed by the gain due to the decrease of the mediated online searches. Because in the meantime every single of the inquired libraries offers more terminals and databases, the tendency of increase of the overall work load is becoming even stronger.

Who has to cope with the additional work load ?
In five of the eleven libraries the library manager itself took care of the LAN, in further three libraries another librarian. In five libraries the library computer department was responsible for the LAN or supported the responsible librarian. In three libraries the task of maintaining the LAN was not within the library itself, but was transfered to a commercial company or the university computer center. This very heterogenous method of handling the CD-ROM LAN strongly suggests that at once there did not exist a common mode to integrate this new and surprisingly successful medium into the libraries organization structure. The future will show if a special way of administration will take shape as the common way or if libraries will go on to implement the LAN in their organization structure where it fits best.

Conclusion
MEDLINE on a CD-ROM LAN attracted both students and physicians very well. They were delighted about that new medium. Obviously this was because it combines most of the advantages of the online- as well as the print-version. Like the print- version it can be used from many users at the same time; it has a fixed price, no matter how often it will be used; it is free of charge for the user, if the library does not charge him; and perhaps most important for the great success of MEDLINE on CD-ROM: the user is independent of any intermediary. He can search by his own. He can do or leave as he likes.
MEDLINE on a CD-ROM LAN offeres multiple search options like the online-version; the user can perform a comprehensive search in a fraction of the time he would need to do the same search in the Index Medicus; he can get abstracts with a lot of additional information he does not find in the print- version; he can print his search results, walk away with them, and study them wherever and whenever he liked. In summary: MEDLINE on a CD-ROM LAN fits very well for the information needs of physicians as well as of students of medicine. But the library has to take care, because the expectations of their users will grow after the first enthusiasm fades away. But there are also some disadvantages. If the user performs his own search, the librarians have to teach him the right way to use the system. The library has to make space available either for the printed books or for many terminals. Until now the user cannot perform a search in more than one database at a time. Like online the user has no browsing facility, he cannot find something in the way of serendipity. An further important drawback of the CD-ROM is that in most cases it cannot be owned by the library. Even if a producer sells it, nobody knows anything about the stability of the CD-ROM, apart from technical problems to run it in the future, when hardware has changed to incompability. In most cases databases on CD- ROM are more expensive than the printed analogues, and the library cannot buy everything which might be useful. On the opposite the economic analyses in the literature suggested that some databases have to keep in printed form, some as online version and only a minor part could migrate to CD-ROM. However, as the inquiry shows clearly, each CD-ROM the library buys, means more work, and in special more sophisticated work, for which the library staff has to be well prepared to keep pace. But after all, almost all of the librarians welcomed the CD-ROM, because they knew that there was not any such extraordinary publicity for the library before.