Interview with the Authors: Kronenfeld and Kronenfeld, A History of Medical Libraries

Recently, I had the privilege of speaking with Michael and Jennie Kronenfeld, the authors of A History of Medical Libraries and Medical Librarianship from Rowman & Littlefield Press now available in paperback. My interview with them is below. 

Please introduce yourselves to our readers.

Michael (MLS, MBA, AHIP, FMLA) and Jennie Kronenfeld (PhD) across the 45 years of their careers have observed and been part of the evolution of medical libraries and librarianship, academia, and health related research and education.  As the authors were married in the last year of their undergraduate experience, they have made their professional journeys together supporting and learning from each other’s experiences.   They have observed and participated in much of the history presented in this book, from the 1970s forward.  M. Kronenfeld earned his MLS in 1975 and in his forty-five year career as a medical librarian/health information professional has worked in academic, public health, and hospital libraries, and has experienced and profited from the rapid development of health science libraries and our profession over this exciting period of its history.  J. Kronenfeld received her PhD in Sociology with a specialization in medical sociology in 1976.  Her areas of focus have been health policy, the social impact of disease, and the development and evolution of the nation’s health care system.  In her over forty-five year academic career, she has written or edited over thirty books and over two hundred and fifty peer reviewed articles in her areas of specialization.  This is the third book they have coauthored.  

Briefly summarize A History of Medical Libraries and Medical Librarianship.

The book presents a history of the profession as the Medical Library Association has recently celebrated its 125^th anniversary and medical libraries have entered the era of the digital information environment.  The profession has a rich history reaching back to the mid-nineteenth century.  Most medical librarians today are not fully aware of the one hundred and eighty year history of the National Library of Medicine (NLM), the over one hundred and twenty year history of the Medical Library Association (MLA), nor of the dramatic changes that occurred in MLA with the emergence of medical librarianship as a profession seventy-five years ago at the end of World War II.  The purpose of this book is not only to make this history available to the profession’s practitioners, but also to provide context as medical librarians and libraries enter a new age in their history. The digital information environment has undercut the medical library’s previous role as the local, institutional depository of the print KBI/information base.  The final chapter describes how the digital era provides both health science libraries and librarians/health information professionals the opportunity to more effectively achieve their underlying mission: developing more effective and efficient access to and use of evidence/information/data in improving the health of the nation’s and world’s population.

As a framework, we organized the history of medical librarianship into seven eras.  The transitions between each of these eras were driven by challenges to the profession that presented significant threats but also significant opportunities.  The times of transition between eras were, therefore, times of significant challenges and opportunities for medical libraries and librarians.

Chapter 1 – The Era of the Library of the Office of the Army Surgeon General and John Shaw Billings – 1836 – 1898

Chapter 2 – The Era of the Gentleman Physician Librarian – 1898 to 1945 

Chapter 3 – The Era of the Development of the Clinical Research Infrastructure (NIH), the Rapid Expansion in Funded and Published Clinical Research and the Emergence of Medical Librarianship as a Profession – 1945 – 1962

Chapter 4 – The Era of the Development of the National Library of Medicine, Online digital Subject Searching (Medline) and the Creation of the National Health Science Library Infrastructure– 1962 – 1975 

Chapter 5 – The Medline Era – A Golden Age for Medical Libraries – 1975 – 1995

Chapter 6 – The Era of Universal Access to Information and the Transition from Paper to Digitally Based Medical Libraries – 1995 – 2015 

Chapter 7 – The Era of the Digital Health Sciences Library – 2015 –

The transition into the digital era is again presenting the profession with major challenges that threaten the library’s relevance but also offer a possibility for medical libraries to enter another golden age.

Why did you decide to write this book?

We wrote it as a final contribution to the profession that has provided me (M. Kronenfeld) a career that has been exciting because of the opportunities it offered to explore and contribute to the development of medical libraries and their services. This enabled us to make significant contributions to our institutions’ abilities to have a positive impact on the health care of the communities they serve.  

In writing this book, I enjoyed being able to take my time exploring and presenting our history without the concerns of adding to a CV or furthering my career. I took almost 3 years writing it and another full year preparing my Janet Doe Lecture, which was built on what I learned in the writing of the book.  We received support on this project from NLM who awarded us the Debakey History of Medicine Fellowship that funded our research for the book at NLM.  We were able to explore in depth the people, ideas and history we discovered—spending months on each chapter and the era it covered.  

In her academic career, J Kronenfeld has been both a contributor and user of the health care literature and a heavy user of medical libraries in both her research and in her teaching of future social scientists and health care professionals.  She has also profited having her own personal medical librarian for support of her research!

Why do you believe it is important for current medical librarians to know the history of medical librarianship?

In researching and writing our profession’s history, I discovered that one reason for our success has been our ability to adapt and evolve as the health care and information environments have advanced.  
With the emergence of the digital information environment, we are again faced with challenges and opportunities in our transformation from medical librarians who facilitate access to and use of print based Knowledge-Based Information (KBI) collections, to Health Information Professionals (HIPs) who work collaboratively with the units and staff we support—facilitating effective access to, use, and management of digital, increasingly accessible KBI/Information/data. 

In your research for the book, is there anything that surprised you?

Before working on my history, I did not know that development of medical libraries occurred separately from, and independent of, the concurrent emergence of public and academic libraries over the last 30 years of the 19^th Century.  The development of medical libraries resulted in the United States from the scientific based German model of medical education and practice. These libraries were created and operated by physicians who recognized the importance of disseminating current medical advances brought about by the move to laboratory medicine based on the German scientific model—and who also believed physicians needed a basic knowledge of the history of medicine as a foundation for their practice. 

The Association of Medical Libraries, founded in 1898, continued the development of medical librarianship on a different path from that of librarianship in general as represented by the American Library Association (ALA). Public librarians in the last quarter of the 19^th Century saw part of their mission as supporting the educating and ‘civilizing’ of the working class. The ALA from its founding in 1876 was led by and for librarians and the advancement of librarianship. 

In contrast, elite physicians, primarily from the Northeast, led MLA and medical libraries and saw these libraries as part of the medical profession’s infrastructure. The physician librarians saw themselves as physicians with an interest in medical libraries and, especially after William Osler’s three years as the Association’s second president, in the history of medicine. 

Non-physician staff were hired in the 1890s in the role of assistants to the physician librarians. As described by Gertrude Annan in the first Janet Doe lecture presented at the Medical Library Association’s (MLA) 1967 Annual Conference “ … in 1937 (author’s note – forty years after the founding of MLA), the Association was emerging from its first period, a period in which the bookish, scholarly physician dominated. CD Spivak, one of two physicians who led the establishment of the Association in 1898, saw the ‘ideal medical librarian’ as a representative of the “genteel physician “as in “gentleman”. 

Because of this dominance of elite physicians, lay librarians were viewed as technicians and the professionalization of medical librarianship did not occur until after World War II.

What are two things you hope all your readers take away?

First, medical librarians/health information professionals need to understand that medical libraries are on the very threshold of the digital age as they develop their librarians/health information professionals, (HIPs) and their libraries for their roles in this new era.  T. Scott Plutchak put this in perspective in his 2011 Janet Doe lecture presented at the 2011 MLA Annual meeting: 

“The Great Age of Librarians.” I believe that we are at the threshold. But just at the very threshold—the very beginning. The incunabula period of the digital age.

He also states:

In the digital age, physical libraries are becoming less relevant to the communities that they serve. Librarians, however, are more necessary than ever in helping members of their communities navigate the increasingly complex information space. To meet their social responsibilities requires that librarians seek new roles and recognize that their most important activities will take place outside of the physical library.

He also points out:

It is important to remember that we are just now in the very, very early stages of this transformation from a world of knowledge encoded in print to a world where digital information is the dominant medium, and instantaneous broad communication has radically transformed the ways in which people interact. We do not have established norms and protocols. We are making it up as we go along. Which experiments will bear fruit and which will fall by the wayside remains to be seen. It is unlikely that any of us here will live long enough to see the emergence of a truly mature digital culture that parallels the print culture that we all grew up in … In a world in which intellectual content was encased in physical objects, we built the great library systems of the twentieth century. In the period of the digital world, what should we do instead?   

The emerging digital health information ecosystem presents health science libraries and their medical librarians/health information professionals with significant challenges and opportunities. The ending of medical libraries’ role as local collections of print evidence-based medicine (EBM) is our major challenge.  We can either develop our services and contributions to facilitate and support development, organization, effective access and use of the digitally based KBI to more effectively influence the improvement of health care in this country—or we can let our libraries and librarians slowly fade into the background, as what we have done in the past diminishes in importance.

Second, led by their professional organizations—the Medical Library Association and the Association of Academic Health Sciences Libraries—medical librarians/HIPs need to understand the significance of the transition from the print to the digital health information environment.  As we state in our book:

The shift of medical librarians to HIPs who are becoming more closely embedded in the programs and research teams they work with over the last twenty years has represented the start in the shift from their role of support staff to full collaborators. As the data driven health information ecosystem being guided by NLM continues to emerge, it is crucial that the skills and services of our HIPs continue to upgrade and develop.  Below is a brief review of my thoughts on where we are in this shift to HIPs:  

1. We need to work with health informaticians to integrate published literature, research data, research databases, and clinical patient data in digitally based knowledge sources to support clinical decision-making and research. HIPs can take a role in the creation, maintenance, and development of these integrated information resources. 
2. We need to continue to expand our role as part of research teams in the same way biostatisticians are part of research teams. Among the skills and expertise we can bring to the team are:

1. Executing literature reviews, synthesis including systematic reviews, literature scoping, and mapping;
2. Coordinating and supporting access to and management of data; 
3. Facilitating access and use of Computable Biomedical Knowledge (CBK) data sources and tools, which include:

1. Data generated from  scientific  research,  
2. Curation and standards,
3. Data science tools and other executables,  
4. Clinical data, 
5. Status indicators of the health of people and  communities,   
6. Health information for the  public;

4. Support Survey tool development and use; 
5. Serve as institutional repository developers and managers;
6. Collaborate in the preparation of research grant and other funding proposals;

3. We need to upgrade our support of the educational activities of the units and departments we support as instructional design experts and collaborators including:

1. Provide instruction in use of KBI/information in support of clinical decision-making,
2. Collaborate with clinical care teams 
3. Facilitate access and use of Computable Biomedical Knowledge (CBK) data sources and tools in development of systems and tools directly supporting clinical patient care, which include:

• Data generated from scientific research,
• Curation and standards,
• Data science tools and other executables,
• Clinical data,
• Status indicators of the health of people and communities,
• Health information for the public.

The above shift from medical libraries to HIPs working in close collaboration with the programs, faculty, instructors, and clinicians they support is crucial in achieving the “Great Age of Medical Librarians” envisioned by Plutchak in 2011.

Is there anything else you would like to share?

We have tried to point out above that in this time of transition to the digital age the medical/health sciences library profession is faced with great opportunities; we can continue to play a major role in improving the health of our those we serve, or we can lose relevance as our influence will increasingly depend on our services rather than our physical libraries and print based EBM collections. My challenge to current and future practitioners and leaders in the profession is to understand and respond to the opportunities and challenges this transition is presenting.