1 Is electronic always the right choice? Dr. Octavia-Luciana Porumbeanu Lecturer Library and Information Science Department, Faculty of Letters, University of Bucharest, Bucharest Romania Abstract Many assumptions are made by health librarians that electronic resources are preferred by medical students and this has led to the development of major electronic collections both in the United Kingdom and the USA. But, is this an erroneous assumption made without asking the users themselves how they consult materials? This paper investigates the situation in Romania where, it appears, medical students using medical library resources prefer paper resources to the available electronic resources. This anomaly was thrown up by a previous study from the author (Porumbeanu et al, 2008) who was investigating the implications of access to electronic information resources for the users of large academic medical libraries in Romania. The results of the study prompted further research and questionnaires were distributed to medical students to obtain more detail on their usage of particular materials. Contributing factors such as culture, content and access were investigated and whether these had any effect on the previous results. From the research it appears that there are various factors underlying the preference for paper resources. The results underline the need for a marketing approach to users when introducing electronic resources to medical libraries. Introduction Most academic libraries have focused in the last few years on developing large electronic collections in order to better satisfy the information needs and preferences of users. Some of them succeeded in making available for their users access to a large number of databases, others to just a few such resources. The advantages of electronic information resources are obvious, but in any discussion about information resources provided for users, especially when decisions are to be made on which information resources will be bought and a greater movement toward acquisition of electronic resources to the detriment of paper resources, things are not so easy or at least should not be considered simple. Firstly libraries must consider meeting the information needs of their users and offer, if possible, a variety of ways to access these resources depending on user preference, but also offering more alternatives. Without a doubt, all libraries currently should provide
2 access to electronic resources for their users, but before taking the decision of switching massively to electronic resources they should also discover the users opinion about the resources they consult and prefer. Romanian medical libraries The last decades have meant major transformations of all aspects of Romanian libraries, considering also how far behind Romanian libraries were to those of developed countries. The transformation from traditional to modern libraries based on the new information and communication technologies wasn t fast or easy, but at present the large Romanian libraries, in a similar way to libraries abroad, have made the transition to a mixed collection, providing access to both paper and electronic information resources for their users. And year on year the number of electronic resources has increased, developed and diversified. For Romanian libraries the financial considerations are important as there are problems with efficiency and with cost-benefit analysis, because it could be noted, even without formal research, that the electronic resources available have a limited use. In the area of medical libraries the same changes can be noted. At individual level or together, the ten academic medical libraries in Romania try to meet the information needs of users and adapt to the requirements of the information society aligning themselves with international standards. In this context we considered it necessary to investigate the way in which the changes implemented in medical libraries are efficient, support the information and research needs of users, identify the measures that need to be taken in the future and analyze the patterns of usage of document collections in Romanian medical libraries. Medical librarians in many countries assert that electronic resources are preferred by medical students. Can we say the same things about Romanian medical students? There are obvious variations depending on the specifics of the community of users served by the library and this paper is in no way a plea for paper resources against electronic resources. What it wants to achieve is to draw attention to the fact that here in Romania some categories of user may still prefer paper resources whilst those overseas may prefer electronic resources. Context of the research In the context of the changes that took place in Romanian library activity, especially due to the introduction of the new information and communication technologies and the ensuing diversification of services and resources made available to users we have undertaken more research at the level of the Romanian academic libraries (Porumbeanu 2003, Buluţă, Mihăilescu, Porumbeanu 2008, Porumbeanu 2008). This was undertaken in
3 order to investigate the way in which Romanian medical libraries succeeded in meeting the information needs of users and the satisfaction level of users with the conditions of the current information explosion and the multiple ways of accessing that information. We had as a starting point the results of a previous study from In order to get as complete and exact an image as possible concerning the implications of the use of electronic resources and new technologies in Romanian academic medical libraries, a survey was undertaken in three medical academic libraries - the Central Library of the Carol Davila University of Medicine and Pharmacy in Bucharest, the Central Library Valeriu Bologa of the Iuliu Haţieganu University of Medicine and Pharmacy in Cluj- Napoca and the Central Library of the University of Medicine and Pharmacy Gr. T. Popa in Iaşi. These are the largest and the most representative in Romania, they are situated in three different areas of the country and serve an extended community of users. The study showed that a rather small number of users of the three libraries surveyed use and prefer electronic information resources. Despite the fact that access to electronic information resources has been available since the 1990s and that the number of resources has increased, there are no significant changes in user behaviour and practice. Only 28% of the respondents came to the library to consult databases and 16% to consult electronic journals. The majority (92%) still came to consult paper documents, especially books (41%). Their preference for printed information sources was clear (77%), with only 10% preferring electronic information sources. Another finding of our study was that 43% considered they needed assistance to access electronic materials. (Porumbeanu, 2008) We considered necessary to continue our research in order to investigate in greater detail the main reasons for this low usage of electronic resources, the lack of user education, if something had changed during the last year, however minor, and to find out which might be the best way for libraries to promote the use of electronic resources. We decided to focus our research only on one of the three libraries surveyed in the previous study, having in view that the results were similar in the three libraries and also considering that in the case of a smaller scale study we would be able to come with some concrete solutions, suitable for the library and the users analyzed. We chose the Central Library of the Carol Davila University of Medicine and Pharmacy in Bucharest. This is the largest and the oldest medical library in Romania. It was established in 1857 and it serves the users from the whole University that is: the Faculty of General Medicine, the Faculty of Dental Medicine, the Faculty of Pharmacy and the Faculty of Medical Assistance and Midwives, having also 97 branch libraries that exist at the level of university departments, chairs and clinics which are spread all over Bucharest. These libraries vary in size of collection: from 40,000 50,000 volumes down to volumes. The main library currently has 366,546 book titles, 5,531 periodical titles and approximately 27,000 documents in open access. There are more than 10,000 active users of the library (7,567 students, 1496 teaching staff and 957 physicians). The Library
4 has provided access to electronic information resources since Since 2007 the software used by the library is LIBERTY 3-Softlink. There are 10 computers with access to the Internet and to databases for the users. At present the library offers access to the following electronic resources: HINARI (since 2004) ProQuest (since 2006), EMBASE (since 2007), Ovid and ScienceDirect (since 2008). Every trimester the Library offers training sessions for users on the general use of the library and on the use of electronic information resources. The staff of the library consists of 47 people, 41 of whom are specialists. Our study focuses on user preference for printed or electronic resources and on the reasons for their preference and is based on the analysis of the answers received through a questionnaire completed by the users of the library mentioned above. Objectives of the research The research had 5 main aspects: - identification of user preference for traditional information resources and/or for electronic information resources - identification of the information resources which they use most frequently - identification of the basis for the users preference for traditional or printed information resources - evaluation of the need for user training about use of electronic information resources - identification of the best way to promote the use of electronic information resources among users Methods of data collection The study was undertaken in September-October A questionnaire was developed based on previous questionnaires that had been used by the author and others to carry out user studies. It consisted of 18 questions and was not piloted before the study. 100 questionnaires were distributed at random via the library staff to users that had come to use the library resources in the reading room where the computers with access to electronic information resources are also housed. There was a satisfactory reply rate of 77%. Analysis of the results The questions were aimed at the objectives mentioned earlier. Most of those who answered to the questionnaire are students (86%). We had answers from physicians (6%), from teaching staff (5%) and from other users (3%).
5 With reference to the frequency of usage of those information and documentation services provided by the library, most of those who answered come weekly (54%), then monthly (18%), daily (16%) and 1-3 times per year (12%). 12% 16% 54% Weekly Monthly Daily 1-3 per year 18% These results show, as with the previous research, that despite the fact that they have access to all the medical electronic information resources mentioned, there are no significant changes in user behaviour and practice. Only 30% of the respondents came to the library to consult electronic resources, the majority (91%) still came to consult paper documents. Asked what medical information resources they consult at the medical library most frequently, the majority of participants in the research indicated paper documents (84%), with only 16% indicating electronic resources. There is a clear preference for paper information sources (62%), with 29% preferring electronic information sources and approximately 9% preferring both types. 9% 29% Paper information sources Electronic information sources Both 62% Asked to specify the reasons for which they prefer paper or electronic information resources, the participants in this study offered the following answers: - those that prefer the paper information resources indicated:
6 It is easier to access and use them, and to 40% learn using them Better information 19% You don t get so tired using them as it 18% happens with the electronic ones The routine 9% Quick access to current information 6% No reply 8% - those that prefer the electronic information resources indicated: Quick access to information 25% Quantity of information 9% Current information 8% They are practical 4% Better information 3% No reply 12% Asked to specify the reasons for which they don t prefer paper or electronic information resources, the participants in this study offered the following answers: - those that don t prefer the paper information resources indicated: Difficult access to the necessary 12% information The information is not current 8% I get tired after using them 4% I don t find them 1% No reply 31% - those that don t prefer the electronic information resources indicated: I get tired after using them 27% Difficult access and utilization, more 18% difficult to learn using them They can offer erroneous data 5% I can get the same information from the 5% paper resources Few articles in Romanian 4%
7 I don t have access to them 3% They are not up to date 1% I am not familiar with them 1% No reply 31% We also wanted to find out if the participants in the study had access to medical electronic information resources at home or in some other place. The majority (84%) declared they had access, with only 16% giving a negative answer. Regarding the place where they have access to medical electronic information resources, the participants answered as follows: At home 73% At work 9% In the dorm 8% Concerning those medical electronic information resources they utilised other than those offered by the library, they indicated: Internet 39% Databases 16% Electronic journals 9% Electronic books 8% Free resources 8% Courses from the teaching staff 3% Asked if they would be interested in having access to medical electronic information resources at home or from some other place, 66% of the participants answered positively. 30% Yes No No reply 4% 66%
8 The accessibility of the medical electronic information resources offered by the Carol Davila University of Medicine and Pharmacy Library was acknowledged by the great majority of the participants (96%). 1% 3% Yes No No reply 96% 70% declare they don t have difficulty with using the electronic information resources, and only 23% said that they had a difficulty with use. 7% 23% Yes No No reply 70% Among the difficulties mentioned there were: - problems with the computers 8% - difficulties with access to information 8% - the publications are not freely available 3% The difficulties they confronted when using electronic information resources included:
9 Lack of experience 7% Limited access 5% Problems with computers 4% Too much information 1% Asked to specify the electronic information resources they consult most frequently, the participants in this study answered as follows: Medical articles 13% Internet 10% Databases 8% Electronic books 6% Medline 6% ProQuest 6% PubMed 5% ScienceDirect 5% Wikipedia 3% Thompson ISI 3% Medical Dictionaries 3% Emedicine 3% Ovid 3% Due to the low percentage of users that consult the electronic resources offered by the library and in order to find ways of increasing their use, we considered it very important to know how and from where the participants in the study found out about medical electronic information resources. The answers are as follows: - Colleagues 23% - Internet (by searching) 21% - Teaching staff 19% - The Library 12% - Announcements (conferences) 5% - No reply 20%
10 5% 12% 20% 19% 23% 21% Colleagues Internet (by searching) Teaching staff The Library Announcements (conferences) No reply 34% of the participants consider that the range of electronic information resources offered by the library should be enriched. And among the suggestions made, the most important was for more databases (5%) and for full-text resources (4%). Concerning the way the users learned to consult electronic information resources, 62%, declared they taught themselves and the rest answered as follows: They were trained at the first visit to the library 8% They read the instructions 8% They were helped 6% The librarian helped them 16% 16% 6% 8% 62% Alone At the first visit to the Library They read the instructions They were helped The Librarian helped them 8% We considered the results of the question about the difficulties the users were confronted with as a consequence of the fact that the majority (83%) didn t participate in any training session organized by the library about the use of these resources.
11 3% 14% Yes No No reply 83% Asked to choose the situation/situations that suits/suit them: - you prefer the electronic information resources - you prefer the paper information resources - you would be interested in using electronic information resources but you don t really know them - you would be interested in using electronic information resources but you don t know how to use them The participants in this study, clearly pointed out once again their preference for paper information sources (70%), only 38% choosing electronic resources, 20% saying they would be interested in using them but they don t really know them and 8% being interested in using electronic information resources but they don t know how to use them. Their suggestions regarding increasing the use of electronic information resources in the library included better information (5%), better computers (3%), an electronic network (1%), databases/sites (1%). The large majority of the participants need the information they get at the library for studying and preparing different exams (54%). The other answers were as follows: o for writing different papers, graduation papers, PhD theses etc. 18% o for professional development 16% o for keeping up to date with the latest news in the field 12%
12 16% 12% For studying and preparing different exams For writing different papers 54% For professional development 18% For keeping up to date with the latest news in the field Regarding the level of satisfaction with access to medical information offered by the Carol Davila University of Medicine and Pharmacy Library, 80% of the participants declared they are satisfied and 18% gave a negative answer. 18% 2% Yes No No reply 80% Users mentioned the library opening hours (36%), noise (21%), few resources (21%), computers with problems (14%), no borrowing possibility (7%) as reason that they were dissatisfied with the service. Finally we wanted to know how many participants clearly chose throughout the questionnaire only paper or only electronic resources or both types. Our statistics showed the following results:
13 38% Only printed resources Only electronic resources Both types of resources 54% 8% Interpretation of the results We take as a starting point in the interpretation of the results the fact that a great number of the participants in this study who declared they did not prefer electronic information resources did not indicate any reason for the rejection of these resources. This makes us believe that there are no real reasons for this indifference and in fact they don t really know these resources, what they are, their content and the advantages they offer, 20% even admitting to the fact that they did not know these resources. Also 83% of them didn t participate in any of the training sessions that might have informed them about these resources, their content and the way in which they can be accessed. This lack of user education is another element at the heart of the limited usage of electronic information resources. 8% would be interested in using these resources but recognize they don t know how to use them. Even if the library were to organize a training session every trimester this would be inadequate. Therefore, training should be intensified and maybe the library should arrange with the teaching staff, possibly the Medical Informatics chair, to instigate one or two compulsory classes in the library taught by the librarians. In this way, even if they continue to prefer paper resources, at least the students would know about the electronic resources available to them through the library and this problem could be eliminated. The resulting collaboration between librarians and teaching staff could also be very beneficial. The author s view is that the medical education system in Romania or more accurately, the way in which the teaching-learning-examination process takes place is another reason for this limited use. Most of the time students limit the learning process or are forced to limit the process, due to the immense volume of information they must assimilate, learning only what their professor taught or using the main handbook recommended for that subject. Only in the case where they have to prepare a paper of any kind, for a practical class or for a conference or their graduation paper, will they base their learning and research on a larger bibliography, with both paper and electronic resources. So, Romanian medical students, especially those in the first study years, are not exhibiting any new practices in the information and documentation process from that which happened some years ago. A supporting element to help increase the level of use of
14 electronic resources would be if the teaching staff guide, underlines for students the wisdom of consulting these sources. The situation might be quite different and the results might possibly change substantially if we included some of the branches of the library in our study. Our suppositions are that there is a category of user that consults and is interested in electronic resources. These are the residents who work in the clinics where they have access to these resources through the branch library. Usefully the library provides access to electronic resources in many of its branches that are run at the different clinics and departments. The residents and the specialist physicians use them because they are involved in various research projects and in the preparation of PhD theses all calling for the use of diverse and complex information resources. Unfortunately, at this time, we couldn t include some of these branches in our study, but future research should certainly investigate this segment of users and their information needs, preferences and behaviours. It is also relevant to note that students can have access to the electronic resources the library makes available for them only in one of the library s reading rooms or in the library branches. They only have access from home by special request. If the library could arrange that all users have access from home or any other computer to these resources, then the situation would greatly improve. It would seem the major reason, in our opinion, for Romanian medical students preferring paper resources is the lack of promotional activities for electronic resources. The results of our research underline the need for a marketing approach to users when introducing electronic resources. Considering the limited use of electronic information resources it is reasonable to question making them available for users at such great cost if most of the library users don t consult them? The library must provide access to all types of information resources, but in this case a way should be found to make them more efficient. And this is only possible, in our opinion, through better promotion of these resources and through better communication with users. It would be useful to consider some solutions that could support better promotion of these resources. So, given the specific conditions of Romanian medical higher education, we suggest that a higher visibility of electronic resources is necessary. Much better promotion by the library of their electronic resources could be made on the main web page of the university where students can t miss it. Usage would also increase if the library would instigate more training sessions dedicated to electronic resources. These could be on specific themes and should be adapted to the different categories of users and their specific information needs. Better collaboration with the teaching staff who could provide valuable information to the librarians about the main interests of students and also to students about these information resources could overcome the failure of the library to publicize these resources. Through , for example, the library could also start an information campaign and send a regular bulletin to all library users about the resources which their library provides.
15 Conclusions At present the Central Library of the Carol Davila University of Medicine and Pharmacy in Bucharest provides access to many electronic resources, but our study indicated that a rather small number of users prefer and consult electronic information resources. The main reason for this limited use is the lack of promotion of these resources. To overcome this situation, the author has pointed out some possible solutions such as an intensification of user education with more frequent training sessions designed for different categories of users (students and teaching staff), the introduction of some compulsory classes for the students taught by the librarians, better collaboration with teaching staff and an information campaign on electronic resources. What is certain is that the library must continue to provide important paper collections alongside access to electronic resources. More training sessions are needed that could publicize the advantages of those resources for users throughout the information, learning and research process. Future investigations of the users information behaviour should also include the library branches which could bring more interesting findings to light. References Buluţă, Gheorghe; Mihăilescu, Crina; Porumbeanu, Octavia-Luciana. Current Trends in the Process of Rationalization, Modernization and Diversification of the Information Services organized and developed by the Medical Libraries. In: Proceedings of the 11th EAHIL Conference Towards a new information space - innovations and renovations, Helsinki (Finland), 23rd-28th June 2008, Programme/Home.html Porumbeanu, Octavia-Luciana. Utilizatorii şi intermediarii de informaţii şi documente în epoca contemporană. Bucureşti: Editura Universităţii din Bucureşti, Porumbeanu, Octavia-Luciana. Identifying the implications of the use of electronic resources and new technologies in academic medical libraries. In: MLA 08 Conference Connections: Bridging the Gaps, Chicago (USA), May , Section Forging Connections to Emerging Research: New Horizons,