Do Medical Schools Still Need Books?

 NYU health sciences library

Earlier this year the Association of American Medical Colleges predicted that by 2030, the United States would have a shortage of up to 104,900 physicians. To try to curb this impending crisis, a wave of new medical schools have opened in the last decade. Eleven schools have been accredited by the Liaison Committee on Medical Education in the last five years, and eight more are currently under consideration.

As a condition of accreditation, these new schools must provide access to “well-maintained library resources sufficient in breadth of holdings and technology” to support the school’s educational mission, but it seems many medical schools are deciding that large print collections are no longer a vital component of those resources.

Paperless Libraries

The Frank H. Netter School of Medicine at Quinnipiac University, which accepted its first students in 2013, is one such school. Designed as a paperless institution, the school has a library space where students can read and study, but the vast majority of the library's resources are online. Bruce Koeppen, dean of the school, said that by making most of the library's holdings electronic, it ensured that students and faculty could access information “anywhere and anytime, even when the library is closed.”

Charles Stewart, associate dean and chief librarian of City College of New York, of the City University of New York system, said that his institution chose to go a paperless route for the newly opened CUNY School of Medicine on the City College campus for much the same reason -- 24-7 access. “We chose the all-electronic option since our medical school clearly wanted instant e-access to all their resources,” said Stewart.

Matt Wilcox, director of the Edward and Barbara Netter Library at Quinnipiac University, said that he had observed a “definite trend” in the last few years for medical schools to have very different libraries than the traditional large academic medical libraries of old. “These born-digital libraries, with their focus on electronic collections and relatively tiny print collections, allow institutions to think creatively about how to best distribute their study spaces,” said Wilcox.

A Hybrid Approach

Though some schools are curbing their print collections, others see that print still plays an important role. The Virginia Tech Carilion School of Medicine, which welcomed its first students in 2010, opened with just 50 books on its shelves, but students quickly pushed to expand this collection to 4,000 books, saying that they preferred to use physical materials for studying. The school noted, however, that it did not want to increase its print collection beyond the current level.

Fay Towell, director of libraries at the Greenville Hospital System, said that it was interesting that students at the University of South Carolina School of Medicine Greenville, which opened in 2012, frequently requested access to both print and electronic resources. Given the small size of the library, and the prohibitive cost of providing both print and online versions of texts, Towell said the library had to be selective. She noted that often journals might cost more electronically than in print -- “if a journal cost is $4,000 electronically and $400 in print, then the library makes space for print,” she said.

A Clean Slate

While many new medical schools have the opportunity to design their library spaces from scratch, it is not often that more established institutions have the same opportunity. The New York University Health Sciences Library is an exception. The Frederick L. Ehrman Medical Library was “basically destroyed” by Superstorm Sandy in 2012, said Neil Rambo, the library's director, meaning the institution had the opportunity to completely rethink their space. A new library was opened in the same location in 2016, but it is a “completely different type of facility” from its predecessor, with a focus on tech-enabled study spaces, and no bookshelves -- except for the display of a few rare books and artifacts.

Between the destruction of the old library and the opening of the new one, Rambo and his colleagues operated from offices across the street. They had no physical library for four years but didn't find it too difficult to adjust. “A main problem of not having a library is ensuring that students have somewhere to study and work together in small groups, so the institution did have to scramble to make sure there were spaces identified for that,” said Rambo.

Rambo said there was a period when it was not clear that they would ever have a library again, but the institution was committed to rebuilding and creating an “intellectual center” for students and faculty. “Most of our librarians had no problem adjusting to not having a library. They were already in a different mind-set -- their work was not tied to the library as a facility, more their relationships with the people that they work with, and not having to manage a physical space freed them to completely focus on that.” He noted, however, that some library staff -- for example, those dedicated to staffing the circulation desk -- did feel a loss of identity. “We tried to reposition those staff as much as possible,” said Rambo. Now staff who might previously have manned a desk in the library might respond to online queries instead, he said.

Roger Schonfeld, director of the Library and Scholarly Communication Program for Ithaka S+R, pointed out that when medical libraries thin their print collections, it does not necessarily mean that the campus loses access to those physical materials. “Whether the collections are moved to an off-site facility, or the library participates in a shared print program, it is almost always still possible to provide access to a print version on those occasions when it is necessary to do so.” The trend for thinning print collections is not unique to medical libraries, said Schonfeld -- many science and engineering libraries have done the same. “What science, engineering and medicine have in common is that the most important collections are typically journals, and journals in those fields are almost entirely accessed in digital form,” said Schonfeld.

Rambo agreed, adding that in the sciences, particularly biomedical science, there is a strong focus on current research. “Books and monographs in biomedicine have a pretty short shelf life. Ten years old is pretty old in biomedicine, but in other fields that’s clearly not the case. In the humanities and social sciences, things that are decades old can be just as valuable.”

Despite the lack of bookshelves, Rambo conceded, there is still a place for some books in his library. “While we have a lot of ebooks, we’ve generally found that they’re still a work in progress and the technology is not mature enough for students to really love them. Most of our students still prefer to have a hard copy in front of them,” he said. To cater to these students, Rambo says, the library has bought hard copies of required textbooks and put them on a book truck in the students’ study space. “We don’t control them, we don’t check them in and out. Students are in charge of using them as they wish. If the books disappear then we’ll replace them, but we actually have very little problem with that -- the students are pretty vigilant about making sure they’re available to others when needed. It’s a low-tech way of giving them what they need.”

A Conundrum

Asked whether he expected that other established libraries would eventually ditch their physical collections, Rambo said he thought most schools would like to go in that direction, but that legacy schools might face a “political conundrum” if there is not a perceived need for change. “The storm in a way made things easy for us, because it wasn’t our choice. People realized that things were gone and got used to it. Other places where you have to make a conscious decision to throw anything out, it’s a tougher thing -- but I think it’s going to be seen increasingly as not that difficult a decision.”

Anne Seymour, director of the William H. Welch Medical Library at Johns Hopkins University School of Medicine, said that there had been a definite shift in focus from physical to digital collections at her institution in the last few years -- a shift she said she has “fully embraced.”

“Even if you’re not a new medical school, even if you’re in one of the oldest, all schools are faced with the changing notion of their library space -- from being just a collection of books and rungs of journals to becoming a much more vibrant hub of scholarship, collaboration and technology,” said Seymour. She noted that at her library, where much of the collection had been digitized, “our community just really doesn’t use the print material as much -- it doesn’t make sense to use up valuable space on campus.”

“Any space that is underutilized starts to become questioned,” she said. “There’s a lot of attachment to these collections, but I think if anybody looks at them, they're just not used,” agreed Rambo. Seymour noted that students, researchers and faculty rarely visit the library for the latest research -- instead they go online from their office, lab or even a patient’s bedside.

Though Seymour and Rambo see a shift to digital collections as inevitable, there is still a desire to preserve the “rich history” of many print collections, said Gerald Jurek, user experience librarian and clinical assistant professor at the University of Illinois at Chicago Library of the Health Sciences. Jurek recently oversaw a renovation of his library, which had not been remodeled since the early ’70s. Though Jurek said he did have to dispose of some books to claim back shelf space, he said he still saw books and print as an important aspect of the library’s holdings, particularly as the library is a destination for scholars studying medical history.

Even when books aren’t regularly used, Jurek said he liked to think of books as aesthetic, and noted that they could be useful for zoning spaces and buffering sound. Though Jurek’s library still has a large print collection, he noted that the way people interacted with the books had noticeably changed. “It used to be very much that people would come in and browse. You don’t see that at all now. I’d be interested to find out what activity has replaced that.”