 My name is Peggy Tahir. I am an education and copyright librarian at UCSF. And I do have clinical duties as well. And so I'm going to focus on the part of my job and the part of other people's jobs at UCSF to discuss how we support clinical services and services in the hospital. So for our clinical library services, I'm going to cover the library hospitalist partnership that we have, how we reach out and serve the residency training programs, our work with helping people develop their systematic reviews and do the comprehensive searches for those, and then the affiliate librarian programs that we have and how they also support clinical faculty and staff at UCSF. So first I want to talk a little bit about the background of this program and how it started. In 2013, the library was invited to attend a twice monthly conference in the division of hospital medicine. One of the hospitalists had had an experience in her residency training program where the hospital librarian attended rounds and morning report. And she thought it would be useful if somebody could come to their conference from library services and provide research support services for this conference. So cases and conundrums, what is it? So this is the name of their twice monthly conference. It is the hospitalists in a variety of subspecialties. I liken it to the, you know, just a very broad-based group of people, all nationalities. It's like the United Nations. You have someone in pulmonary, you have someone in PEDE, someone in internal medicine working with all the other subspecialty services. So it is the attending physicians. It is not the fellows or residents or anyone in training. They present their most challenging cases and discuss it using their collective intelligence. And then they also follow up with older cases when they see that something has changed in that case. So the noon conference. It's a noon conference. It's the second and fourth Friday of every month. It's held in Moffitt Hospital on the Parnassus campus. They sign in and they, by signing in and filling out a little form, they can get CME credit for attending the conference. So they start off with the organizer and he or she, they do switch around. So one of them will ask, who has cases, who has conundrums, or do you have an image? And then they first will follow up from past cases and then present new cases, conundrums or visual material. So now they do document CNC. And what they do is we have a secure Wiki page. So you can put PHI, personal health information on it. However, they still de-identify the patient data. So they would write it such as, you know, mail, 47, presenting how they do it. We have an online Wiki form and so that they can just fill in the fields that they need. Usually the person that's organizing it asks somebody else to take notes and be writing notes on the Wiki page. And meanwhile the lead organizer will be pulling up the patient records, the electronic medical records, and they also will be managing the time. So at the beginning they decide how many people have cases and then that allows for a certain amount of time for each case discussion. And then my duties, I add links in the Wiki to articles that are evidence-based that support the clinical questions that they ask me. So also the shared Wiki space. It's only available via authentication and it's only authenticated to specific attendings in the division of hospital medicine myself and another library colleague. So my role. So of course I attend the conference. I take notes on the different cases. I run searches during the conference. I try to find the best evidence articles and then I post those articles in the Wiki right where they're putting the case notes. So I look things up on the fly. The last one I attended it was like a rapidly forming neck mass that formed on somebody supposedly in five days. Extremely rare. And then I typically at the end of the conference they will say, Peggy we have these questions for you. I'll make notes of those. I'll go back immediately to my office, run those searches and then post information on a Wiki and usually I will shoot an email off to the organizer of the conference to let them know that there's new information on the Wiki. Okay. Now there has been a little bit of evolution since this conference started. Initially that conference had a meet and greet and the guy that organized it would get somebody from a specialty service to come and for 15 minutes talk about their service and how best the hospitalist can interact with those specialty services when they have a patient. So it would be somebody like the head of environmental health services or one time the head of the lung transplant unit came and they basically talk about their services. Initially we documented it on a secure chatter feed which is sort of like Facebook. That did not work so well because it's just a feed and you can't go back easily to find the past cases. And also when we moved to the Wiki we were able to have a consistent form for the entering patient information. Another thing that changed was in addition of a second librarian in 2014 when we hired another clinical medical librarian. So one of the main challenges facing the hospitalist is the difficulty and complexity of the cases that they actually see. So the typical case is a person has multiple systemic problems. There can be autoimmune components. The person comes from an outside hospital where that person has been in a hospital and the doctors there are like we can't help you. We must send you to UC because they have the doctors that can help you. So sometimes someone comes from an outside hospital and they don't have all of the documentation they need. Also they frequently are dealing with ethical issues, end of life issues and the fact that there are actual medical mysteries and sometimes there are no answers for some of the cases they see. So challenges for me at the conference are the turnaround time which is kind of immediate and the specificity of questions. So what I mean by specificity of questions is the physicians are looking at laboratory values and trying to relate laboratory values specific very tiny little narrow laboratory values to a physical dysfunction in the body. So sometimes that and getting to that in the literature is really difficult. And also the rare conditions may have little evidence based literature or vigorous research studies. So if you're only finding case reports because something is old or you know something is a rare condition, it's a challenge to find more evidence based articles. However, it's really fun working with the hospitalist and we have had some good other outcomes. They know us now and so they're always willing to reach out to us when they need research consultations for projects they're working on. We also did a project where we did several years documenting division of hospital medicine's research output, finding all the papers that they had published and it's also a really good forum for library public service announcements and for me to highlight a feature in a clinical tool or in a database. So residency training. We have a lot of residents at UCSF over 1600. We also have over a thousand postdoctoral scholars and close to 3000 students enrolled in our specialized degree programs such as School of Medicine, School of Dentistry, School of Pharmacy. So our residency training takes place at UCSF Pernassus. It takes place at Mount Zion and Mission Bay campuses. We also have residents who train at ZSFG which is the Zuckerberg San Francisco General, VA San Francisco, Children's Hospital Oakland and UCSF Fresno where we have two hospitals where people train. So these are all programs that the library potentially should support. We have made some inroads into these programs into health education, health professions education pathway, health and society pathway, resident scholarship project, PRIME which is the primary medical education program and the global health program. So because we have so many programs and they're very dispersed, it's been a challenge to get a foothold. So we've gotten into some of these big pathways but there's just sort of systemic issues at UCSF. Everybody's busy, we're very distributed and we need to integrate teaching sessions into programs at a time when it's going to be useful for the residents. When we do meet with them, we typically teach sessions on PubMed and we teach them how to use citation management software such as EndNote, RefWorks and Zotero. So we also handle systematic reviews and just in case you don't know, what is a systematic review? It is a particular broad based method of searching the literature and what they do is they do multiple searches and multiple database very broadly. They get hundreds of studies, they determine the kinds of studies they want to include in their study, rule out the others, then they read all those articles and do a review of the literature in this very systematic way. So we support clinicians doing this type of literature review. So some of the students in our ticker program, training in clinical research, it's a master's program, we teach them because they need to learn how to do the systematic review. We meet with them and they educate them on search strategies. We help people develop their search strategies. We also do mediated searches and we write up method sections of papers for publications so we sometimes get authorship. Right now we're working on developing a systematic review course that would be hands-on with time to help people with their specific research questions so there would be time to develop search strategies for people and we hope to launch the first systematic review class sometime in June. So a little bit about our affiliate programs. We have several different affiliate libraries, Mount Zion Fishbone Library, ZSFG, San Francisco General, VA, UCSF Fresno Children's Hospital Oakland. So for example, the clinical librarian at Mount Zion is pretty much, her job title is systematic review librarian, that's all she does pretty much, just helps people with systematic reviews. Now because we're a magnet hospital, a magnet hospital is a hospital with status that the nursing programs are conducting evidence-based reviews. So the librarian at Mount Zion who is doing those systematic reviews is doing it for a nursing research group. There is an institute called the Joanna Briggs Institute and it has an evidence-based nursing database and she teaches that. At ZSFG, San Francisco General, they have a new clinical librarian position and that person just started and plans on developing outreach to the residents that are rotating through over at general. And finally next steps. So right now my unit in education is involved in a strategic planning process and one of the areas of our strategic plan is to look at the ways we're supporting clinical services. We're not done with the process but we will be targeting additional ways to identify and reach out to programs we currently don't support. By the end of the process we should have some strategies in place to reach more of the residents. And we are also looking at ways to market ourselves as experts and to market the library's educational services so that people will think of contacting us when they start a research project. Also mentioned before that we are developing the systematic review course and I have a personal goal to go back and look at some of the cases and conundrums data and see if there is a way to develop a paper to publish on that service. Thank you very much.