impact of a graduate entry programme on a medical school library service

42

© Health Libraries Group 2003

Health Information and Libraries Journal

,

20

, pp.42–49

Blackwell Science, Ltd

Impact of a Graduate Entry Programme on a Medical School Library service

Sam

Martin,

St George’s Medical Library, Tooting, London, UK

Abstract

The aim of this study was to compare the use of library facilities by first yearundergraduate medical students and Graduate Entry Programme students(GEP). More specifically it tried to determine which library services (if any)were more frequently used by GEP so that this could be taken into account infuture Information Services planning. A questionnaire on the use of Libraryand Information Services was posted to all first year GEP students and under-graduates on the 5-year course. In addition, user statistics of library entry andborrowing were collated from gate readings and the library Unicorn manage-ment system. Overall, GEP students were found to make a greater daily/weeklyuse of library facilities than undergraduates on the 5-year course. The facilitiesmost used by both sets of students were essential texts, e-mail, PCs and studyfacilities. Computer Aided Learning packages, journals and video facilitieswere least used. However, on a daily/weekly basis GEP students made 74% moreuse of journals (

P

< 0.01), 59% more use of e-journals (

P

< 0.05), 36% moreuse photocopiers (

P

< 0.05), 42% more use of printers (

P

< 0.05), 56%more use of the library catalogue (

P

< 0.05) and 50% more use of databases(

P

< 0.05). This difference in use should be taken into account by LIS providersas there is expected to be an increase in fast-track graduate courses offered bymedical schools throughout the UK.

Introduction

The Graduate Entry Programme at St George’sis a 4-year fast-track medical course aimed atgraduate students.

1

The students on the courseare well suited to the ‘Tomorrows Doctors’ visionof medicine that recommends a problem-basedapproach to learning that is student centred.

2

The course is based on the 4-year graduate-entryprogramme running at Flinders University,Australia.

3

The first year started in September2000 and consists of 35 students (average age28 years) who all have first degrees in a wide range

of disciplines including biochemistry, psychologyand law.

GEP students are taught separately from under-graduate MBBS students. They are divided intofive groups of seven students, each group havingtheir own ‘base-room’, that acts as a teachingand discussion room. The base-rooms each haveone networked PC and a small library of standardmedical textbooks. The walls of the base roomsare covered with white boards on which learningobjectives can be written. Each week a clinicalproblem is presented via a series of web pagesusing WebCT. A tutor facilitates the learningprocess for each group and much of the learningis student-led, problem-based and self-directed.Students generate issues which become learning

Correspondence: Sam Martin, Medical Liaison Librarian, St George’sMedical Library, Cranmer Terrace, Tooting, London SW17 0RE, UK.E-mail: [email protected]

Graduate entry programme at St George’s,

Sam Martin



,

20

, pp.42–49

43

goals for the next session. Textbooks, monographs,journals and web resources are employed toprovide answers to the issues. GEP students, unlikeMBBS undergraduates, gain clinical experienceearly on in their course.

The MBBS course is a 5-year course. TheOctober 2000 entry consisted of 194 students(average age 19 years) most of whom completedA-levels in the summer of 1999 or 2000. The newcurriculum started in 1996 and has elements ofProblem Based Learning (PBL) which is integratedinto more traditional approaches such as lectures,practicals, large/small group teaching and directedreadings. Student profiles for the two groups aregiven in Table 1.

Problem-based learning is an established edu-cational method in medical courses, especially inAmerica and Canada where medical students tendto be graduates. Most of the research by librarieshas focused on the impact of PBL on library ser-vices in these countries. As far back as the early1970s, a McMaster University study indicated thatone of the main differences between medicalstudents on PBL curricula and traditional curriculawas in the use of library resources.

4

Students ona PBL curriculum have also been shown to uselibrary services at an earlier stage in their medicaleducation, conduct literature searches moreroutinely, use journals in pre-clinical years anddemonstrate a more independent approach toproblem solving.

5,6

Other research has shown thatPBL students use library services more frequentlyand for longer periods of time than students ontraditional curricula.

7

Studies have also looked atthe challenges of PBL curricula to professionallibrarians, in particular, staffing, budgets, physicalfacilities and collection development in order tosupport such courses.

8

Many librarians supporting

PBL curricula have developed a more integratedrole in the PBL curriculum and have adaptedinformation-skills teaching patterns to fit in withPBL, for example by using case studies.

9,10

Thiscloser relationship with curriculum developershas, in some cases, led to librarians being offeredjoint or honorary faculty appointments.

11

This study differs from previous studies in thatit focuses on a new and potentially increasingnumber of graduate students on a fast-trackmedical course in the UK. We wanted to find outif GEP students used library resources moreheavily than students on the 5-year course. Asshown in Table 2, the students are on very differentcourses, which have a number of differences indelivery, content and the students themselves. Wewere simply comparing library use and were notspecifically attempting to compare PBL/non PBLor graduate/undergraduate use.

Methods

At the start of the Summer term (25 April 2001), aquestionnaire on library services use was sentthrough the post to all students on both courses;194 undergraduate medical students on the 5-yearcourse and 35 GEP students. The questionnairecontained questions about 12 different libraryservices and the respondents were asked to indicatefrequency of use (daily, weekly, occasionally, never)and importance (very important, important,unimportant, very unimportant). The deadline forreturns was 18 May 2001. A reminder to completethe questionnaire was sent one week before thedeadline and returns were entered into a prizedraw. Completed forms were returned by 69%GEP (

n

= 24) and 30% undergraduates on the5-year course (

n

= 59) and analysed by a Chisquare test. Statistics for library entry werecollated from gate readings taken throughout theyear. Item loan statistics were obtained fromreports run on the library Unicorn managementsystem.

Results

The results for extent of use of facilities is shown inTable 3. In addition, daily/weekly use of facilitiesby both student groups was summated and is

Table 1 Student profiles.

GEP 5-year course

Male : female ratio 50 : 50 50 : 50% first degrees 100% 7%% postgraduate degrees (MSc/PhD)

26% 0.5%

Average age 28 years 19 yearsAge range 24–37 18–30

Graduate entry program

me at St G

eorge’s,

Sam M

artin

© H

ealth Libraries Group 2003

Health Inform

ation and Libraries Journal

,

20

, pp.42–49

44

Table 2

Course comparisons.

GEP 5-year MBBS

Year 1–2 Year 3–4 Cycle 1 (year 1, 2, 3) Cycle 2 (3, 4, 5)

Duration 4 years 5 years

Themes Basic and Clinical Sciences, Patient and Doctor, Community and Population Medicine, Personal and Professional Medicine covered in dedicated sessions throughout the learning week

Basic and Clinical Sciences, Patient and Doctor, Community and Population Health, Personal and Professional Development. There are no specific sessions dedicated to the themes. Instead the themes underlie general teaching

Modules The course is divided into 6 modules. Each module covers all 4 curricular themes. Cases are presented each week during PBL to cover module sub-themes, e.g. Life Cycle would include a PBL on reproduction

(Years 1–4) The course is divided into modules including content from all 4 curricular themes. Some modules are based on body systems, there are also specialized modules, e.g. mechanisms of disease. Modules run concurrently 3–4 modules per term

Curriculum Delivery

Learning week Week is separated into distinct activities, e.g. PBL, independent learning, community placements, expert forum

Mainly clinical attachments and firm rotations. PBLs based on real patients

Activities vary from week to week

Group sizes Mostly groups of 7 Groups of 5 Group sizes vary from 190 to 10 students 20–30 per firm in the 5th yearrotations

Foundation module No Yes. A foundation module in the first term which is multidisciplinary

Educational approach Mainly PBL, some lectures Mainly lectures plus some smaller group tutorials, some CBL/PBL

Lectures A maximum of 3 per week including a masterclass

Yes (the main means of curriculum delivery)

Masterclass Yes in years 1–2. A weekly expert forum

No

Electives 10-week elective in year 4 10-week elective in year 5

Clinical experience Community placements in year 1 Clinical attachments in 3rd year and firms Some GP/Community visits Clinical attachments and firms

Resources

Staff : student ratio 1 : 7 1 : 20

Study facilities Library study areas, 24-h access computer room, GEP base rooms Library study areas, 24-h access computer room

Teaching facilities GEP base rooms, lecture theatres, clinical teaching labs, Anatomy Resource Centre, Pathology Museum

Lecture theatres, clinical teaching labs, Anatomy Resource Centre, Pathology Museum

Web delivery Yes: WebCT for each clinical problem No dedicated website for course materials. Students rely on paper module booklets and lecture handouts


Sam Martin



,

20

, pp.42–49

45

shown in Fig. 1. On a daily/weekly basis GEPstudents made 74% more use of journals(

P

< 0.01), 59% more use of e-journals (

P

< 0.05),36% more use photocopiers (

P

< 0.05), 42% moreuse of printers (

P

< 0.05), 56% more use of thelibrary catalogue (

P

< 0.05) and 50% more use ofdatabases (

P

< 0.05). The facilities most used byboth sets of students were essential texts, e-mail,PCs and study facilities. Least used facilities werevideos, CAL and journals. The importance of

different library facilities is shown in Fig. 2 whichshows most facilities being rated as important/very important by both groups of students.

Access

Library gate entry statistics for the period(October 2000–June 2001) showed 6410 GEPentries and 25 386 medical student entries. Thisis an average of 183 entries per GEP student and

Table 3 Resource use.

Resource % use

Significant difference in daily/weekly use between the two groups

Library catalogue Daily Weekly Occasional NeverGEP 38 33 33 0 Yes P < 0.055-year course 7 24 44 8TextbooksGEP 62 33 4 0 No5-year course 31 58 14 0JournalsGEP 0 38 54 8 Yes P < 0.015-year course 0 10 46 44E-journalsGEP 8 38 42 13 Yes P < 0.055-year course 5 14 41 41ComputersGEP 79 4 13 4 No5-year course 56 34 10 0e-mailGEP 92 4 4 0 No5-year course 73 24 3 0Medical databasesGEP 4 50 33 13 Yes P < 0.055-year course 3 24 42 31Video facilitiesGEP 0 8 62 29 No5-year course 0 2 25 73CALGEP 8 8 58 17 No5-year course 0 2 47 51PhotocopiersGEP 21 54 25 0 Yes P < 0.055-year course 2 46 47 5PrintingGEP 13 54 29 14 Yes P < 0.055-year course 2 37 39 22Study facilitiesGEP 42 38 17 4 No5-year course 34 37 25 2


Sam Martin



,

20

, pp.42–49

46

131 entries for each student on the 5-year courseindicating 40% more entries by GEP.

Textbooks

The Library holds over 30 000 books. Most booksare available for one-week or three-week loanperiods. Reading lists are passed to the Libraryfrom lecturers, module co-ordinators and PBLwriters to ensure that an adequate number of coretextbooks are available for students.

Course books and essential texts were used toa similar extent by both groups which underlinesthe importance of standard medical textbooks inboth courses.

However, there was a difference in daily use oftextbooks (62% GEP and 31% undergraduates onthe 5-year course). GEP students have their ownsmall collection of essential course books in their

PBL rooms (supplied by library services) andconsult these books throughout their weeklyclinical problems.

From library loan statistics for the period(October 2000–June 2001) GEP students bor-rowed 2932 items (including renewals) and under-graduates on the 5-year course borrowed 5738items (including renewals). This averages 84 loansper GEP student and 30 loans per undergraduatemedical student. So GEP students borrow almostthree times as many items as undergraduates onthe 5-year course.

Library catalogue

The Library uses the Unicorn managementsystem. A web version of the catalogue (WebCat)is available to students via the Internet, there arealso dedicated WebCat terminals in the Library

Figure 1 Daily/weekly use of Library services by GEP and undergraduates on the 5-year course

Figure 2 Library facilities considered important/very important by GEP and undergraduates on the 5-year course


Sam Martin



,

20

, pp.42–49

47

that students can use to find the location of books,reports and journals. A larger proportion of GEPstudents used the catalogue on a daily basis(

P

< 0.05) compared to undergraduates on the 5-year course. It would be interesting to ask bothsets of students how many books they used werefrom recommended reading lists, and about theamount of extra reading done in addition to therecommended texts.

Journals/e-journals

The Library houses over 800 journal titles, morethan 300 of which are in electronic format. Thepaper journals are for reference only. Neithergroup used paper journals on a daily basis.However, there was a significant difference inweekly use of journals between the two groups(

P

< 0.01). There was also a significant differencein use of e-journals on a daily/weekly basisbetween the two groups (

P

< 0.05). Furtherinvestigation on journal /e-journal reading habitsfor both groups would be useful.

Computing facilities

The Library has three computer rooms with over100 PCs. Students can access the Internet, MicrosoftOffice packages, various networked CD ROMsand e-mail. All medical students are provided witha personal e-mail account and personal space ona networked drive which is backed up regularly.Many tutors now communicate with studentsvia web-based e-mail (I-mail). In addition, GEPstudents can access group e-mail via their WebCTlearning environment. One computer room is 24-h access and operated by swipe-card. The maincomputer room has a helpdesk staffed by librarystaff (09.00–21.00 hours).

GEP and medical students used computers toa similar extent on a daily/weekly basis althoughGEP students seemed to use PCs more on a dailybasis than undergraduates on the 5-year course.As expected, the use of the library facilities toaccess e-mail was very high on the list of activitiesfor both GEP and undergraduates on the 5-yearcourse and considered very important by bothgroups. There was a slightly greater daily use of e-mail by GEP students compared to undergraduates

on the 5-year course but this difference was notsignificant. It was reassuring to note that no onereported never accessing their e-mail.

Medical databases

Staff and students are provided with access toa wide range of medical and health databasesincluding

,

, PsychInfo, Embase,Web of Science. Training sessions in the use ofthese databases are timetabled at the start of thefirst term for GEP and undergraduates on the5-year course. Further training is available through-out subsequent terms, either as drop-in sessionsregularly held in the library, or as specific sessionsarranged between tutors and library staff.

There was a significant difference in weeklydatabase use between the two groups (

P

< 0.05)with greater use of databases by GEP, althoughdaily database for both groups was low. Someundergraduates on the 5-year course (31%)reported never using medical databases.

Video facilities

The Library has a license to tape televisionprogrammes of interest to the medical and healthsciences. These videos are stored for one monthand are then added to stock (at the request ofusers) or wiped and reused. There are alsocommercially published and in-house videosavailable for loan. Carrels in the Library are fittedwith video and headphone equipment. The resultsshow a low use of video facilities by both groups.Unfortunately, video loan statistics for the twogroups could not be obtained.

Computer Aided Learning packages

A variety of web-enabled CD ROMs forComputer Aided Learning (CAL) are deliveredto St George’s students via the Intranet. The‘Anatomy Project’ CDs have been especially usefulin the Anatomy labs as an aid in dissection classes.Individual copies of CDs are also available for useon PCs in the Library computer rooms. Some arerecommended by lecturers to serve as an extradimension to their teaching. The results showed avery low use of CAL in both groups.


Sam Martin



,

20

, pp.42–49

48

Photocopier, printer and study facilities

The Library has seven photocopiers that areheavily used by students and staff, especiallyfor photocopying journal articles. There was asignificant difference in daily/weekly photocopieruse between the two groups (

P

< 0.05). There wasalso a significant difference in the daily/weeklyuse of printing facilities between the two groups(

P

< 0.05) with GEP using printers more than thestudents on the 5-year course.

There are two networked printers, one in eachmain computing room within the library. The 24-h access computing room and GEP base rooms donot have printers.

Study areas within the Library are used bystudents to complete research and course work.The increasing yearly intake is adding pressureto these study areas and there has been a markedincrease in noise and disruption during the currentyear, noticeably by undergraduate medical students.Study facilities (specified in the survey as studydesks and not PC workstations) were used to asimilar extent in both groups.

Discussion

The results show significant differences betweenthe two groups in the use of journals e-journals,photocopiers, printers, library catalogue anddatabases, with GEP students using these moreheavily than students on the 5-year course. Theseresults were based on a 69% response rate fromGEP and a 30% response rate from students on the5-year course. The poor return for the first-yearmedical students could have introduced bias intothe results and this has made comparison with theGEP course difficult. A better response rate mighthave been achieved by handing the questionnaireout at the end of a large group lecture and ensuringthat the questionnaire was completed beforestudents were allowed to leave. In this study,students responding to the questionnaire mayhave been keen library-service users with aninterest in library services and this would not be atrue representative sample of the population.Where possible other statistical data was obtainedto support the survey results, for example, gateentry readings which show GEP students entering

the library 40% more than 5-year course students.However, in some cases, statistical data proveddifficult to obtain because user groups forstatistical reports were sometimes only availableas broad categories and not differentiated intocourses.

The difference in use of facilities by GEP incomparison with undergraduates on the 5-yearcourse may have been due to a combination offactors. There is a greater element of web deliveryof materials in GEP compared with the 5-yearcourse, which may encourage students to use elec-tronic services to find information early on in theircourse. The greater PBL element in the GEPcourse could also have encouraged students touse a variety of information sources to answer theissues arising from discussions of clinical problemspresented each week. In addition, the GEP stud-ents already have first degrees and therefore onewould expect them to be more familiar with usingHigher Education Information Services and moreconfident in using a variety of information servicesearlier on in their course. From general observa-tion during information skills training sessions atthe start of term, the GEP students seemed to needless help than the first-year medical students andwere more interested in learning about remoteaccess from home, e-journal access, and advanceddatabase functions such as command language.The present study indicates significant differencesin the use of databases, journals and e-journalsbetween the two groups. This idea of a differencein awareness and confidence in using informationservices needs to be confirmed by questioningfocus groups and perhaps observing problem-solving activities in both groups.

The study shows that computers were usedheavily by both groups, highlighting the import-ance of IT facilities to students and the increasedreliance on electronic information as a way ofinformation organization, retrieval and commun-ication. Many students used PCs to access e-mail.Students now rely heavily on PCs for essay writing,presentations, data analysis, information search-ing and to communicate via e-mail. The low use ofCAL packages, however, could be because of lackof inclusion as a teaching material by lecturers,lack of publicity by the Library and the fact thatmany CAL packages are not very user-friendly.


Sam Martin



,

20

, pp.42–49

49

The greater use of photocopiers and printers byGEP compared to undergraduates on the 5-yearcourse may have been due to the PBL nature of theGEP course and its web delivery. Students on the5-year course used printed module booklets of col-lated lecture handouts, reference lists and exercisesinstead of having a website to refer to and so maynot have needed to print or photocopy as muchinformation as GEP students. This can only beanswered by questioning focus groups.

One would have expected GEP students to usestudy facilities less as they did have their ownrooms but as the Library is physically near theGEP base rooms this may account for the greaterthan expected use. The base-rooms were alsophysically small for seven people, which may beanother reason why library study areas werepreferred.

This preliminary research can only be seen as anindication that there are some differences in useof facilities by the GEP students, but cannot shedmuch light on why the differences exist. A furtherstudy in the way students from both groups findinformation to solve problems is currently beingcarried out.

Graduate Entry Programmes offer graduates invarious disciplines the opportunity to study medi-cine. Currently St George’s Medical School, theUniversities of Oxford and Cambridge, and thejoint Medical School of Leicester and Warwickoffer GEP courses. Recently 1033 new medicalplaces were announced by HEFCE,

12

40% ofwhich will be dedicated to graduate places on fasttrack courses. The St George’s GEP course is set toincrease to 70 places for the 2002 entry. Theincreased number of GEP students at St George’sin 2002 will increase pressure on library serviceswith many students searching for information onone specific clinical problem at the same time. TheLibrary will need to plan for increases in shortloan collections, textbooks and monographs, aswell as CAL and provision of web resources tosupport clinical problems. This can only be donewith the continued communication betweenlibrary staff, GEP problem writers and tutors that

has been established in the past 12 months. Thedevelopment of services available to studentsremotely such as e-journals, e-books, databaseaccess and PCs in student halls of residence maylessen the physical presence of students in theLibrary in the long term but not the short-term.However, none of this will lessen the commitmentof time and resources needed to support such newinnovative courses by Library and InformationServices staff.

References

1 <http://www.sghundergraduatesonthe5yearcourse.ac.uk/courses/agep.htm>

2 General Medical Council.

Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education

. London: General. Medical Council, 1993.

3 <http://www.flinders.edu.au/courses/ugrad/bachelor/bm.htm>

4 Neufield, V. & Spaulding, W. B. Use of resources at McMaster University.

British Medical Journal

1973,

3

, 99–101.

5 Rankin, J. A. Problem-based medical education: effect on library use.

Bulletin of the Medical Library Association

1992,

80

, 36–43.6 Rankin, J. A. Preparing medical libraries for use by

students in PBL curricula.

Academic Medicine

1993,

68

, 205–6.

7 Marshall, J. G., Fitzgerald, D., Busby, L. & Heaton, G. A study of library use in problem-based and traditional medical curricula.


1993,

81

, 299–304.8 Watkins, M. C. Characteristics of services and educational

programs in libraries serving problem-based curricula: a group self-study.


1993,

81

, 306–9.9 Burrows, S., Ginn, D. S., Love, N. & Williams, T. L.

A strategy for curriculum integration of information skills instruction.


1989,

77

, 245–51.10 Schilling, K., Ginn, D. S., Mickelson, P. & Roth, L. H.

Integration of information-seeking skills and activities into a problem-based curriculum.


1995,

83

, 176–83.11 Eldredge, J. D. A problem-based learning curriculum in

transition: the emerging role of the library.


1993,

81

, 310–4.12 HEFCE Press release. A thousand more doctors to be

trained each year. 2001. <http://www.hefce.ac.uk/news/hefce/2001/medical.htm>

http://www.sghundergraduatesonthe5yearcourse.ac.uk/

http://www.flinders.edu.au/courses/ugrad/bachelor/

http://www.hefce.ac.uk/news/

impact of a graduate entry programme on a medical school library service

Documents