Sound Selection: podcasts prove positive

The Toowoomba Clinical Library is part of a publicly funded hospital and health network which employs 4000 staff and which serves a rural and urban population of 280 000 people over 100 000 square kilometres in southern Queensland, a region of Australia. The library has introduced and established a service whereby clinically-oriented digital audio recordings are provided to the health professionals throughout the region it serves. Sir Muir Gray has consistently argued in many forums that in the 21st Century, knowledge is the key element to improving health. He has claimed that the greatest future advances in healthcare will come not from new inventions and discoveries but from the application of what we already know. As well, Jaron Lanier has argued that it is people who are meaningful and not merely abstract networks of information. To that end it is the work of the library and its information professionals to meet the need of putting the right information in the right context and the right container for the right client. This provision of digital audio recordings is one small contribution towards meeting that need. This narrative describes its inception as an occasional project meeting the needs of one client, through to its progression as a fully-fledged library program offering a diverse and detailed collection to all staff.

Where did we start?

For several years the library had loaned, first audio cassette and later audio CD programs as a regular part of the circulation service. With the increasing ubiquity of the MP3 player, either as stand alone or as part of smart-phones and computers, for music and entertainment, we had begun to investigate whether there was a role for that technology in the health information arena. A paper published in November of 2007 by Ashok and Priya Roy seemed to reinforce our still nebulous thoughts. They quoted a Pew Internet study that found more that 22 million American adults owned iPods or MP3 players, and 29% of them have downloaded podcasts from the web. They explored a number of intersections of training and podcasting in adult education, including a program at Duke University where all incoming first year students where supplied with iPods, but much of their discussion surrounded possibilities rather than extant services. It wasn’t until a request from a palliative care doctor, one of Lanier’s “meaningful people”, that our thoughts took a concrete direction. This doctor was travelling frequently and wanted to redeem the time by listening to material relevant to his field. There was next to nothing available in established collections and not wanting to return to the client empty-handed library staff began browsing the web trying to ascertain what was available for health professionals. Amongst some obscure material were enough quality resources to convince this doctor of its worth, so once a week two or three audio CDs were created from MP3 files which had been found on the web and downloaded. From the library’s perspective this experience proved mutually beneficial. Sourcing the material was low-cost, and through evolving search strategies an increasing wealth of sources of freely available MP3 files relevant to our professional community was discovered.

What did we do?

In reflecting upon this work we realised this individual and very particular occasion of service was eminently scaleable. It seemed clear there was enough quality and relevant content available to be worth our investment in time and resources. By the late 2000s shared and shareable information was no longer the sole domain of the printed word and for some time the spoken word had been recorded and published online. We also speculated that many busy practising clinicians would value listening to scholarly communication either instead of or alongside the written word, as such information presented as conversation or lecture can be easier to digest and taps into modes of learning which differ from the printed or screened word. We also suspected most of the content was “grey” and not being listened to by those who could most benefit from it. Not all health professionals are tech savvy, and those who are may still not have the time and intellectual energy to practically acquire and play these recordings.

To this end we set about determining the best way to link our clinicians with this audio information. We realized CDs had many limits so pursued the idea of purchasing iPods and making them borrowable. We bought ten iPods but again it was Lanier’s insight of people who are meaningful which gave our ideas and the technology the direction and focus it needed. We sharpened our attentions onto junior doctors. They rotate through the major clinical areas of the hospital so building a collection of podcasts around their needs would ensure most of the clinical disciplines would be addressed. We imagined residents or interns starting a new rotation coming to borrow an iPod preloaded with audio material relevant to each particular discipline. We knew not all the material would be directly applicable to their circumstances and abilities, but enough would, and sometimes it is good to be stretched and exposed to exotic instruction, and one press of the skip was always available. In adopting this approach we also knew that having subject-specific iPods would mean consultants or nursing staff who specialise in those areas would find the players just as useful. 

With an audience in mind and iPods accessioned and available for circulation, we turned our attention to content. This we built through intensive searching and much browsing, trying a variety of techniques and terms and learning where sites typically post their audio content. The vast majority of material collected has been freely available on the web, but we do maintain a small number of subscriptions to commercial audio medical education providers that deliver regular material in MP3 format. The collection is now beyond 1800 files but is not static, and we are continually adding to the files as new material is posted or as we come across new troves. The type of material we download varies greatly and includes specialist presentations, summaries from key journals, lectures from conferences and specialist societies, continuing medical education sessions, and interviews with leading researchers. By and large the content is rich in diversity, of good quality and well-presented.

What have we achieved?

In mid 2008 we launched the availability of the iPods with a viral marketing campaign, which generated substantial interest. We were worried the idea would flare and die away quickly, but this has not proven to be the case. At least seventy-five staff have borrowed one of the ten iPods the library has populated with subject-specific content and made available for loan. One aspect we were slow to grasp initially but have quickly capitalised on is the number of staff who have their own MP3 players, particularly with the proliferation of smart phones. Consequently it was the content alone they were interested in. With this access mode in mind we have built an Endnote library that not only helps track and describe the collection, but allows staff to browse what is available and generate their own “playlist”. This is increasingly the dominant mode of access, with over two hundred additional clients having received content independent of the borrowable iPods. Feedback received informally and through a structured survey has been uniformly positive, with comments typically highlighting the ease of access and quality and relevance of the material provided. As well, increasingly interactions with this content are not static but iterative, with clients coming back asking for more material after their initial exposure. As this service has matured it has diversified, with targeted sub-sections of the collection placed in specific department areas to allow staff easy browsing and access, while the library has also begun making consumer-oriented audio material available for distribution to patients. This extends the scope for librarian – clinician collaboration which can only improve the nature of the service and enhance the involvement of the library in the clinical community.

Description of this project in industry publications has led to opportunities for collaboration with other hospital libraries throughout Australia. The audio collection and model of service have been shared, while methods for comparative evaluation are being explored. It is also encouraging to note this project was runner-up in the 2010 ALIA/IOG Excellence award and was the recipient of the 2011 HLA/HCN Innovation prize.

Conclusion

Through this project, clinicians in Toowoomba have had the opportunity to listen to digital audio recordings they would never otherwise have heard. This has expanded the knowledge base of the local clinical community, which in turn results in better-informed decisions for patient care. Ultimately patient care is where health library best practice should be measured, and it is where we believe that this project has made a significant contribution.