BRIEF COMMUNICATIONS
3. instituting equitable distribution policy for interlibrary loans, based on the size of collections, and avoiding undue burdens on any one member, 4. maintaining statistics of interlibrary loans within the consortium as a feedback mechanism for evaluating the level of activity, and 5. facilitating health science research by expanding the base of information readily accessible to users. Currently, the bimonthly MEDCORE meetings rotate among member libraries, and include an informal information exchange period as well as a business meeting. Some MEDCORE librarians are new to medical librarianship, so the programs often deal with the fundamentals of maintaining a small health science library. Other programs have dealt with on-line cataloging, MEDLINE searching, computer-aided instruction, administrative viewpoints on consortia, and space-saving ideas for small and medium-size libraries. A brief tour of the library facility at each institution resulted in new ideas for utilization of both space and resources as well as new techniques in processing and maintaining materials. MEDCORE members have also found that by informally sharing individual exchange lists they can redistribute duplicate journals and fill in gaps in their own collections. Two union lists have been produced to facilitate the borrowing of materials. The MEDCORE Union List of Audiovisuals is a computergenerated catalog arranged by title with a subject index. Each member of the consortium holds a copy of the catalog. The loan of audiovisual materials is handled in a manner similar to the standard interlibrary loan routine. The only variations are that borrowing libraries sign formal agreements to assume responsibility for any damage to the materials while they are on loan, and all materials are exchanged via insured mail. The first edition of the MEDCORE Union Listing of Periodicals contains approximately 1,500 titles. Holdings information on a journal and a code for each library appear after the title. Following the format of the 1975 Union List of Periodicals at the New Jersey State College Libraries and the Rutgers University Libraries, the special procedure for requesting articles involved assigning each member library a ranking number based on the total number of title holdings. The term "subscriptions" was defined to include any item for which a library keeps holdings informa58
tion. The borrowing library requests the article needed from the lowest ranked library which holds that title (that is, the smallest collection). MEDCORE members have found that this system distributes requests equitably, allows smaller libraries to contribute services, and prevents larger libraries from receiving all of the requests. The second edition of the MEDCORE Union List of Periodicals is now in preparation. Title holdings for all consortium members are presently being entered into the Union Catalog of Medical Periodicals (UCMP) data base, developed at the Medical Library Center of New York. The new catalog, expected to be ready by the end of this year, will be a computer-generated printout of the joint holdings information of all twenty-four MEDCORE libraries. MEDCORE serves as a model for small specialized libraries interested in low-cost resource sharing. The combination of the traditional health science collection of a hospital library, in conjunction with the more specialized collections of pharmaceutical and special interest libraries, provides a diversified base of information from which the user can draw. The MEDCORE experience illustrates that twenty-four regionally contiguous health science libraries can join together for their individual and mutual benefit. Ac KNOWLEDGMENT
The late Paula Held, a librarian who was much involved with MEDCORE, provided the impetus for this article.
Effect of Fees on an Information Service for Physicians BY Lois J. LEHMAN, Librarian M. SANDRA WOOD, Head, Reference The George T. Harrell Library The Milton S. Hershey Medical Center The Pennsylvania State University
Hershey, Pennsylvania
AN Information Service for physicians in Pennsylvania has been provided by the George T. Harrell Library of the Milton S. Hershey Medical Center since 1966. It is a wholly external program, only for physicians who are not a part of the Medical Center. In 1974, service fees were instituted. The changes occurring in the physicianBull. Med. Libr. Assoc. 66(1 )Januarv 1978
BRIEF COMMUNICATIONS
TABLE I INFORMATION SERVICE FEE SCHEDULES Jan. 1974 to Jan. 1975
Feb. 1975 to June 1976
July 1976 to present
Document delivery
20e/pg. $2.00 minimum
$3.00/article
Brief literature search
$5.00
$5.00
$3.50/article up to 25 pages, 25¢/pg. thereafter $5.00
user group because of the impact of fees are analyzed in this paper. The service consists of document delivery and brief literature searches for which three to five recent citations are retrieved per subject. Either MEDLINE or manual searching is used, depending upon the nature of the subject. A preliminary study was made in 1970-71 to determine the reasons for requesting literature searches. Responses to questionnaires, which were collected for 385 searches, revealed that patient care was the primary reason for requesting a search. During the early years, grants from the Pennsylvania Medical Society, the National Library of Medicine, and the Susquehanna Valley Regional Medical Program supported the service [1].* By 1974, the society provided the sole funding and quotas had to be established. Individual members could request one literature search and five articles per year and were charged if they exceeded this quota. Because of rising costs, the society discontinued its financial support in 1975, and the service has operated since that time on a fee basis. Fee schedules used during various periods of the program are listed in Table 1. There have been several services similar to the one offered by Hershey. The Washington State Medical Association, in cooperation with the University of Washington, began offering library services to its members in 1975. The service, which was initiated on a trial basis, is provided without charge but future funding alternatives are under study [2]. In the late 1960s and early 1970s with grants from the Regional Medical Programs, a number of medical libraries provided free library services to physicians and other health care professionals [3-5]. However, by 1973 most of the projects of the Regional Medical Programs had
been terminated [6]. Except for the drug information programs, we have found no published accounts of a continuation of these information service programs by charging fees. Both document delivery and bibliographic searching have been available for several years through the regional libraries and their resource libraries, which make up the National Library of Medicine's National Biomedical Communications Network. In NLM Region III, document delivery has been provided through a free quota system to medical and health-related libraries. As a result, there has been little need for physicians to pay for documents from the Information Service when they can obtain them without charge through their own libraries. Document delivery has dropped from a high of 2,621 requests in 1972-73, when the service was still completely free, to a low of 218 requests in 1975-76, the first full year of fee-forservice. Bibliographic searching has been available primarily on a fee basis throughout the region since 1973, when line charges were first instituted for MEDLINE [7]. Consequently, the number of literature searches requested from the Information Service once fees were charged has not decreased to as great a degree as have document delivery requests. In 1972-73, 645 searches were provided without charge, whereas in 1975-76, 147 searches were provided for a fee.
STUDY OF PHYSICIANS Our study of physicians using the Information Service is confined to the last six fiscal years, ending with June 1977. During this time period, free service and fee service were each available for two and one-half years; 1974 was a transition year in which both a free quota and fee service were offered. Only physicians who had used the free service more than once were included because we *The service was supported by U.S. Public Health felt that a more valid comparison could be made Service Grant No. 5 G01 LM00291 from the National Library of Medicine; and by U.S. Public Health Service between those demonstrating a repeated need for Grant No. 5 G03 RM 00059 from the Susquehanna service when it was free and those willing to pay Valley Regional Medical Program. for service. Bull. Med. Libr. Assoc. 66(1 )January 1978
59
BRIEF COMMUNICATIONS TABLE 2 METROPOLITAN AND RURAL ANALYSIS BY GEOGRAPHIC AREA FOR PHYSICIANS USING INFORMATION SERVICE
Area
Central metropolitan Central rural Eastern metropolitan Eastern rural Western metropolitan Western rural
Totals
Physicians using
Physicians paying
free service
for service
No.
%
No.
%
78 70 81
28 25 29
65 54 39
35 29
0
0
1
39
14
19
0 10
10
4
9
5
278
100
187
100
A total of 278 physicians used the free service while 187 physicians paid for the service. Table 2 shows the geographic composition and metropolitan-rural data for these two groups. Geographic composition has been defined according to the three Regional Medical Program areas of the state. Metropolitan and rural locations have been determined from the Pennsylvania Statistical Abstract [8]. The impact of fees has made the service more local in character. The central area, in which Hershey is located, accounts for 64% of the total use of the fee service, an increase of 11 % from its proportion in the free service. Both the eastern and western parts of the state contain several large biomedical libraries with resources comparable to Hershey's, and physicians in those areas find it more convenient to use their own area resources. The introduction of fees has also increased the percentage of rural physicians using the service (29% in the free service; 34% when fees are charged). The proportional use by rural physicians has always been higher than their distribution in the practicing physician population of the state, where they make up 11 % of the total [9]. Most of the rural physicians using the service are from the central area. In this area, where 38% of all practicing physicians are located in rural counties, rural physicians account for 47% of those using the free service and 45% of those paying for service. Thus, rural physicians, both statewide and in central Pennsylvania, use the service by a greater percentage than they represent in the practicing physician population. Literature searches remain the prime factor in attracting physicians to the service when charges are instituted, with 75% of the users requesting
60
21
searches. During the free service, 74% of the users requested searches. Althougb no recent study has been made to determine the reasons for requesting searches, most requests appear to be related to patient care. CONCLUSIONS
While the fee-for-service charge reduced the number of users by approximately one-third, those who have need of the service still continue to use it. By charging fees in order to recover costs, we have been able to continue to offer ouF resources to physicians, especially to those in rural areas, who otherwise may not have access to medical library service. Except for an initial announcement regarding the change to fees which appeared in the February 1975 issue of Pennsylvania Medicine, there has been no publicity given to the service. It is now apparent that physicians from rural areas and from the central part of the state will be our primary users, and publicity efforts directed towards physicians in these areas should increase the number of users. A more direct link with continuing education activities, such as the course offered by the library at the University of South Florida in conjunction with the Continuing Medical Education Office [10], seems to be a particularly promising way to reach a larger audience. REFERENC ES 1. BRYANT, FRED D. New medical library buildings. I. The Milton S. Hershey Medical Center Library of the Pennsylvania State University. Bull. Med. Libr. A,ssoc. 57: 374-378, Oct. 1969. 2. DENFELD, KAY F. Library service to physicians in Washington State. Bull. Med. Libr. Assoc. 65: 381-382, July 1977. 3. SCHAFFER, DESI B. Kansas Regional Medical
Bull. Med. Libr. Assoc. 66(l)January 1978
BRIEF COMMUNICATIONS
4. 5. 6. 7. 8.
9.
10.
Program library services. Bull. Med. Libr. Assoc. 58:311-315, July 1970. SCHNEIDER, ALEENE K. An overview of RMP library activities: present and future. Bull. Med. Libr. Assoc. 58: 316-319, July 1970. LORRING, JUDITH. Northlands RMP library services. Bull. Med. Libr. Assoc. 63:344, July 1975. GROTH, PAUL E. Regional drug information service benefits: free versus fee-for-service. Am. J. Hosp. Pharm. 32: 26-30, Jan. 1975. Members of the MEDLINE Advisory Committee, Region 111, 1973. Personal communication. Pennsylvania Statistical Abstract. 18th ed. Harrisburg, The Commonwealth of Pennsylvania, 1976. p. 23. AMERICAN MEDICAL ASSOCIATION. CENTER FOR HEALTH SERVICES RESEARCH AND DEVELOPMENT. Physician Distribution and Medical Licensure in the U. S., 1974. Chicago, American Medical Association, 1975. p. 280-282. BOWEN, ADA M. On-line literature retrieval as a continuing medical education course. Bull. Med. Libr. Assoc. 65: 384-386, July 1977.
Medical Record Administrators and Management of the Rural Hospital Library BY LAUREL A. HAYCOCK, Reader Services L ibrarian DIANE J. CARROLL, Technical Services Librarian Health Science Library School of Medicine University of Minnesota, Duluth Duluth, Minnesota FAYE M. KRASNER, Director
Medical Library Miller-Dwan Hospital and Medical Center Duluth, Minnesota
IN small rural communities, the primary source for biomedical literature should be the hospital library. A role of the hospital library must be to provide a well-managed collection of research materials on the local level, and to interface with the state and regional library networks. Yet "fewer than 10% of all hospitals with less than 100 beds provide information services that meet even the very minimal standards promulgated by the American Library Association, the Joint Commission on the Accreditation of Hospitals, or the Department of Health, Education and Welfare" [1]. Even among hospitals that have a library, fewer than one in six is staffed by a professional librarian [2]. Bull. Med. Libr. Assoc. 66(1 )January 1978
There are many aspects to the problem of information availability, one of which is the lack of trained library personnel. Within Minnesota, there are only thirty-seven trained librarians employed in 137 hospitals [3]. The remaining libraries are staffed by medical record administrators, medical secretaries, or other allied health personnel. In hospitals in nonmetropolitan Minnesota, 70% of the identified contact persons responsible for information services are medical record administrators [3]. Graduates from Minnesota's only medical record administration program, located at the College of St. Scholastica, Duluth, often serve in rural hospitals and are responsible for providing information services for health professionals in these rural areas. Therefore, we designed a course to prepare the medical record students for possible management of the hospital library. In the spring of 1976, an introductory ten-hour noncredit course entitled "Hospital library management" was offered to these students at St. Scholastica by the Arrowhead Professional Libraries Association, an interlibrary loan consortium, in cooperation with the Health Science Library, University of Minnesota, Duluth. The members of the Arrowhead Professional Libraries Association participating in the program were Miller-Dwan Hospital and Medical Center, St. Mary's Hospital, St. Luke's Hospital, and the Environmental Research Laboratory. THE COURSE The course helped students to understand and apply the fundamental principles of hospital library management. Our emphasis was on teaching the practical knowledge necessary for the operation of a small hospital library. We omitted the theoretical orientation which is usually included in the library school curriculum. To accomplish our objectives, four major subject areas were incorporated in the five two-hour sessions:
administration, acquisitions, cataloging, and reference. The administration section included discussion of policies and procedures, interlibrary cooperation, the role of the library committee, budgeting, and public relations. The second section was composed of procedures for acquisitions, binding, circulation, interlibrary loan, and compilation of statistics. Descriptive cataloging, classification systems, and reference tools were examined during the third class session. The reference section considered the mechanics of the reference interview and the methods for using 61
3. instituting equitable distribution policy for interlibrary loans, based on the size of collections, and avoiding undue burdens on any one member, 4. maintaining statistics of interlibrary loans within the consortium as a feedback mechanism for evaluating the level of activity, and 5. facilitating health science research by expanding the base of information readily accessible to users. Currently, the bimonthly MEDCORE meetings rotate among member libraries, and include an informal information exchange period as well as a business meeting. Some MEDCORE librarians are new to medical librarianship, so the programs often deal with the fundamentals of maintaining a small health science library. Other programs have dealt with on-line cataloging, MEDLINE searching, computer-aided instruction, administrative viewpoints on consortia, and space-saving ideas for small and medium-size libraries. A brief tour of the library facility at each institution resulted in new ideas for utilization of both space and resources as well as new techniques in processing and maintaining materials. MEDCORE members have also found that by informally sharing individual exchange lists they can redistribute duplicate journals and fill in gaps in their own collections. Two union lists have been produced to facilitate the borrowing of materials. The MEDCORE Union List of Audiovisuals is a computergenerated catalog arranged by title with a subject index. Each member of the consortium holds a copy of the catalog. The loan of audiovisual materials is handled in a manner similar to the standard interlibrary loan routine. The only variations are that borrowing libraries sign formal agreements to assume responsibility for any damage to the materials while they are on loan, and all materials are exchanged via insured mail. The first edition of the MEDCORE Union Listing of Periodicals contains approximately 1,500 titles. Holdings information on a journal and a code for each library appear after the title. Following the format of the 1975 Union List of Periodicals at the New Jersey State College Libraries and the Rutgers University Libraries, the special procedure for requesting articles involved assigning each member library a ranking number based on the total number of title holdings. The term "subscriptions" was defined to include any item for which a library keeps holdings informa58
tion. The borrowing library requests the article needed from the lowest ranked library which holds that title (that is, the smallest collection). MEDCORE members have found that this system distributes requests equitably, allows smaller libraries to contribute services, and prevents larger libraries from receiving all of the requests. The second edition of the MEDCORE Union List of Periodicals is now in preparation. Title holdings for all consortium members are presently being entered into the Union Catalog of Medical Periodicals (UCMP) data base, developed at the Medical Library Center of New York. The new catalog, expected to be ready by the end of this year, will be a computer-generated printout of the joint holdings information of all twenty-four MEDCORE libraries. MEDCORE serves as a model for small specialized libraries interested in low-cost resource sharing. The combination of the traditional health science collection of a hospital library, in conjunction with the more specialized collections of pharmaceutical and special interest libraries, provides a diversified base of information from which the user can draw. The MEDCORE experience illustrates that twenty-four regionally contiguous health science libraries can join together for their individual and mutual benefit. Ac KNOWLEDGMENT
The late Paula Held, a librarian who was much involved with MEDCORE, provided the impetus for this article.
Effect of Fees on an Information Service for Physicians BY Lois J. LEHMAN, Librarian M. SANDRA WOOD, Head, Reference The George T. Harrell Library The Milton S. Hershey Medical Center The Pennsylvania State University
Hershey, Pennsylvania
AN Information Service for physicians in Pennsylvania has been provided by the George T. Harrell Library of the Milton S. Hershey Medical Center since 1966. It is a wholly external program, only for physicians who are not a part of the Medical Center. In 1974, service fees were instituted. The changes occurring in the physicianBull. Med. Libr. Assoc. 66(1 )Januarv 1978
BRIEF COMMUNICATIONS
TABLE I INFORMATION SERVICE FEE SCHEDULES Jan. 1974 to Jan. 1975
Feb. 1975 to June 1976
July 1976 to present
Document delivery
20e/pg. $2.00 minimum
$3.00/article
Brief literature search
$5.00
$5.00
$3.50/article up to 25 pages, 25¢/pg. thereafter $5.00
user group because of the impact of fees are analyzed in this paper. The service consists of document delivery and brief literature searches for which three to five recent citations are retrieved per subject. Either MEDLINE or manual searching is used, depending upon the nature of the subject. A preliminary study was made in 1970-71 to determine the reasons for requesting literature searches. Responses to questionnaires, which were collected for 385 searches, revealed that patient care was the primary reason for requesting a search. During the early years, grants from the Pennsylvania Medical Society, the National Library of Medicine, and the Susquehanna Valley Regional Medical Program supported the service [1].* By 1974, the society provided the sole funding and quotas had to be established. Individual members could request one literature search and five articles per year and were charged if they exceeded this quota. Because of rising costs, the society discontinued its financial support in 1975, and the service has operated since that time on a fee basis. Fee schedules used during various periods of the program are listed in Table 1. There have been several services similar to the one offered by Hershey. The Washington State Medical Association, in cooperation with the University of Washington, began offering library services to its members in 1975. The service, which was initiated on a trial basis, is provided without charge but future funding alternatives are under study [2]. In the late 1960s and early 1970s with grants from the Regional Medical Programs, a number of medical libraries provided free library services to physicians and other health care professionals [3-5]. However, by 1973 most of the projects of the Regional Medical Programs had
been terminated [6]. Except for the drug information programs, we have found no published accounts of a continuation of these information service programs by charging fees. Both document delivery and bibliographic searching have been available for several years through the regional libraries and their resource libraries, which make up the National Library of Medicine's National Biomedical Communications Network. In NLM Region III, document delivery has been provided through a free quota system to medical and health-related libraries. As a result, there has been little need for physicians to pay for documents from the Information Service when they can obtain them without charge through their own libraries. Document delivery has dropped from a high of 2,621 requests in 1972-73, when the service was still completely free, to a low of 218 requests in 1975-76, the first full year of fee-forservice. Bibliographic searching has been available primarily on a fee basis throughout the region since 1973, when line charges were first instituted for MEDLINE [7]. Consequently, the number of literature searches requested from the Information Service once fees were charged has not decreased to as great a degree as have document delivery requests. In 1972-73, 645 searches were provided without charge, whereas in 1975-76, 147 searches were provided for a fee.
STUDY OF PHYSICIANS Our study of physicians using the Information Service is confined to the last six fiscal years, ending with June 1977. During this time period, free service and fee service were each available for two and one-half years; 1974 was a transition year in which both a free quota and fee service were offered. Only physicians who had used the free service more than once were included because we *The service was supported by U.S. Public Health felt that a more valid comparison could be made Service Grant No. 5 G01 LM00291 from the National Library of Medicine; and by U.S. Public Health Service between those demonstrating a repeated need for Grant No. 5 G03 RM 00059 from the Susquehanna service when it was free and those willing to pay Valley Regional Medical Program. for service. Bull. Med. Libr. Assoc. 66(1 )January 1978
59
BRIEF COMMUNICATIONS TABLE 2 METROPOLITAN AND RURAL ANALYSIS BY GEOGRAPHIC AREA FOR PHYSICIANS USING INFORMATION SERVICE
Area
Central metropolitan Central rural Eastern metropolitan Eastern rural Western metropolitan Western rural
Totals
Physicians using
Physicians paying
free service
for service
No.
%
No.
%
78 70 81
28 25 29
65 54 39
35 29
0
0
1
39
14
19
0 10
10
4
9
5
278
100
187
100
A total of 278 physicians used the free service while 187 physicians paid for the service. Table 2 shows the geographic composition and metropolitan-rural data for these two groups. Geographic composition has been defined according to the three Regional Medical Program areas of the state. Metropolitan and rural locations have been determined from the Pennsylvania Statistical Abstract [8]. The impact of fees has made the service more local in character. The central area, in which Hershey is located, accounts for 64% of the total use of the fee service, an increase of 11 % from its proportion in the free service. Both the eastern and western parts of the state contain several large biomedical libraries with resources comparable to Hershey's, and physicians in those areas find it more convenient to use their own area resources. The introduction of fees has also increased the percentage of rural physicians using the service (29% in the free service; 34% when fees are charged). The proportional use by rural physicians has always been higher than their distribution in the practicing physician population of the state, where they make up 11 % of the total [9]. Most of the rural physicians using the service are from the central area. In this area, where 38% of all practicing physicians are located in rural counties, rural physicians account for 47% of those using the free service and 45% of those paying for service. Thus, rural physicians, both statewide and in central Pennsylvania, use the service by a greater percentage than they represent in the practicing physician population. Literature searches remain the prime factor in attracting physicians to the service when charges are instituted, with 75% of the users requesting
60
21
searches. During the free service, 74% of the users requested searches. Althougb no recent study has been made to determine the reasons for requesting searches, most requests appear to be related to patient care. CONCLUSIONS
While the fee-for-service charge reduced the number of users by approximately one-third, those who have need of the service still continue to use it. By charging fees in order to recover costs, we have been able to continue to offer ouF resources to physicians, especially to those in rural areas, who otherwise may not have access to medical library service. Except for an initial announcement regarding the change to fees which appeared in the February 1975 issue of Pennsylvania Medicine, there has been no publicity given to the service. It is now apparent that physicians from rural areas and from the central part of the state will be our primary users, and publicity efforts directed towards physicians in these areas should increase the number of users. A more direct link with continuing education activities, such as the course offered by the library at the University of South Florida in conjunction with the Continuing Medical Education Office [10], seems to be a particularly promising way to reach a larger audience. REFERENC ES 1. BRYANT, FRED D. New medical library buildings. I. The Milton S. Hershey Medical Center Library of the Pennsylvania State University. Bull. Med. Libr. A,ssoc. 57: 374-378, Oct. 1969. 2. DENFELD, KAY F. Library service to physicians in Washington State. Bull. Med. Libr. Assoc. 65: 381-382, July 1977. 3. SCHAFFER, DESI B. Kansas Regional Medical
Bull. Med. Libr. Assoc. 66(l)January 1978
BRIEF COMMUNICATIONS
4. 5. 6. 7. 8.
9.
10.
Program library services. Bull. Med. Libr. Assoc. 58:311-315, July 1970. SCHNEIDER, ALEENE K. An overview of RMP library activities: present and future. Bull. Med. Libr. Assoc. 58: 316-319, July 1970. LORRING, JUDITH. Northlands RMP library services. Bull. Med. Libr. Assoc. 63:344, July 1975. GROTH, PAUL E. Regional drug information service benefits: free versus fee-for-service. Am. J. Hosp. Pharm. 32: 26-30, Jan. 1975. Members of the MEDLINE Advisory Committee, Region 111, 1973. Personal communication. Pennsylvania Statistical Abstract. 18th ed. Harrisburg, The Commonwealth of Pennsylvania, 1976. p. 23. AMERICAN MEDICAL ASSOCIATION. CENTER FOR HEALTH SERVICES RESEARCH AND DEVELOPMENT. Physician Distribution and Medical Licensure in the U. S., 1974. Chicago, American Medical Association, 1975. p. 280-282. BOWEN, ADA M. On-line literature retrieval as a continuing medical education course. Bull. Med. Libr. Assoc. 65: 384-386, July 1977.
Medical Record Administrators and Management of the Rural Hospital Library BY LAUREL A. HAYCOCK, Reader Services L ibrarian DIANE J. CARROLL, Technical Services Librarian Health Science Library School of Medicine University of Minnesota, Duluth Duluth, Minnesota FAYE M. KRASNER, Director
Medical Library Miller-Dwan Hospital and Medical Center Duluth, Minnesota
IN small rural communities, the primary source for biomedical literature should be the hospital library. A role of the hospital library must be to provide a well-managed collection of research materials on the local level, and to interface with the state and regional library networks. Yet "fewer than 10% of all hospitals with less than 100 beds provide information services that meet even the very minimal standards promulgated by the American Library Association, the Joint Commission on the Accreditation of Hospitals, or the Department of Health, Education and Welfare" [1]. Even among hospitals that have a library, fewer than one in six is staffed by a professional librarian [2]. Bull. Med. Libr. Assoc. 66(1 )January 1978
There are many aspects to the problem of information availability, one of which is the lack of trained library personnel. Within Minnesota, there are only thirty-seven trained librarians employed in 137 hospitals [3]. The remaining libraries are staffed by medical record administrators, medical secretaries, or other allied health personnel. In hospitals in nonmetropolitan Minnesota, 70% of the identified contact persons responsible for information services are medical record administrators [3]. Graduates from Minnesota's only medical record administration program, located at the College of St. Scholastica, Duluth, often serve in rural hospitals and are responsible for providing information services for health professionals in these rural areas. Therefore, we designed a course to prepare the medical record students for possible management of the hospital library. In the spring of 1976, an introductory ten-hour noncredit course entitled "Hospital library management" was offered to these students at St. Scholastica by the Arrowhead Professional Libraries Association, an interlibrary loan consortium, in cooperation with the Health Science Library, University of Minnesota, Duluth. The members of the Arrowhead Professional Libraries Association participating in the program were Miller-Dwan Hospital and Medical Center, St. Mary's Hospital, St. Luke's Hospital, and the Environmental Research Laboratory. THE COURSE The course helped students to understand and apply the fundamental principles of hospital library management. Our emphasis was on teaching the practical knowledge necessary for the operation of a small hospital library. We omitted the theoretical orientation which is usually included in the library school curriculum. To accomplish our objectives, four major subject areas were incorporated in the five two-hour sessions:
administration, acquisitions, cataloging, and reference. The administration section included discussion of policies and procedures, interlibrary cooperation, the role of the library committee, budgeting, and public relations. The second section was composed of procedures for acquisitions, binding, circulation, interlibrary loan, and compilation of statistics. Descriptive cataloging, classification systems, and reference tools were examined during the third class session. The reference section considered the mechanics of the reference interview and the methods for using 61
