Chief, Medical Library | Education & Research Division
Madigan Army Medical Center
Madigan Army Medical Center is a network of medical facilities in the Northwest that serves more than 100,000 active and retired service members and their families, 30+ residency and fellowship programs, and two research centers of national prominence.
For Jeffery Ring, Chief of the Medical Library, ensuring the library can support the complex information needs of Madigan clinical and non-clinical staff and students requires focusing on three key areas:
1) Patient care and safety
2) Graduate medical education
Read about each area and how Jeff answers the question: “We have a library here?” in our new BMJ Insider’s interview.
BMJ: How long have you worked at Madigan? What unique interactions or activities do you get to experience as a librarian for a military center?
Jeff: I’ve been at Madigan for six years, first as the technical services/systems librarian and then as the chief.
There’s really nothing exactly like working at a Military Treatment Facility (MTF). On the one hand, you’re a semi-autonomous library serving the needs of the local hospital. But on the other hand, you’re part of a much larger system of medical libraries, and you have this distributed network of other medical librarians to lean on. Each library is unique to its own situation: Some are at Medical Centers supporting many residency and fellowship programs; others are at smaller hospitals and clinics supporting patient care and safety. But regardless of the footprint, we’re all working toward the same goals using the same tools in the same system. I’m lucky to attend our virtual meetings and interact with a bunch of really smart people!
BMJ: The mission of the Medical Library is to “help transform Madigan Army Medical Center into the premier Medical Treatment Facility in the Department of Defense and become the model for other DoD medical libraries”. To support this mission, the library is focused on three areas:
1) Patient care and safety
2) Graduate medical education
How did the library identify these key areas and how do you take them into consideration when planning library initiatives?
Jeff: Doesn’t our mission sound grand? With respect to my colleagues in other Department of Defense MTFs, I wanted to aim for the stars. Madigan is one of the largest medical centers in the DoD, supporting a 250-bed hospital, 30+ residencies and fellowships, and two research centers of national prominence.
When people think of military medicine, the first name that comes to mind is Walter Reed. I want people to mention Madigan in the same breath: to be recognized as one of the leaders in military health care, training, and research.
Organizationally, the Medical Library is one department in the Education and Research Division (ERD). Our sister departments are the Graduate Medical Education office (GME), the Department of Clinical Investigation (DCI), and the Andersen Simulation Center (ASC). This puts the Medical Library right at the center of the Venn diagram describing ERD. That creates some synergy among our departments, truly making us all greater than the sum of our parts. I like to think that the Medical Library is the common denominator in that equation. As our clinicians transfer to other MTFs, I want them to remember the services we provided, so that they become library champions as they move forward in their careers, wherever that takes them.
PATIENT CARE & SAFETY
BMJ: How does the Medical Library’s mission support and influence the quality of patient care at Madigan?
Jeff: On the surface, we react to our clinicians’ needs by providing evidence-based research on demand, assisting with PI initiatives and providing resources for our nurse educators to use with patients. Below the surface, we participate in behind-the-scenes activities, such as sitting on the hospital’s Evidence-Based Practice Board and Graduate Medical Education Committee.
We also proactively reach out to departments to learn what’s on their radar for patient care and safety, work with Patient Safety to research cases and outcomes, and provide orientations and refreshers to teach hospital staff how we can help them work more efficiently and effectively. We are big on putting the information our clinicians need right in their hands through apps on their phones. This is especially important when our clinicians are deployed; many will download an entire database or library onto their phone, so that they have access to all the information they need, even when working offline.
From a larger perspective, we are always watching our environment to spot what’s on the horizon. We have a strategic plan that gives us direction, but it’s flexible enough to allow course corrections as priorities shift. Some things never change: patient care and safety will always be our number one priority. Our residency and fellowships are fairly stable, although we do have the flexibility to react to new programs. For example, DoD had Madigan stand up a Physician Assistant residency program a couple of years ago, so we worked with the incoming program director to make sure we had the resources they needed on Day 1, and we continue to work with them to keep our resources up to date. Our research staff work in various fields, so we help them with deep-dive lit searches, keeping a careful eye on the resources they need so that we can meet their evolving needs.
GRADUATE MEDICAL EDUCATION
BMJ: Regarding graduate medical education, how does the library support the needs of students and continuing education requirements of Madigan clinicians?
Jeff: One of the standards of the Accreditation Council for Graduate Medical Education (ACGME) is that the faculty and residents participate in scholarly activity. We have designed our collection development policy to acknowledge residency and fellowship programs by collecting deeper and more broadly in those subject areas.
There are some areas where we just don’t collect anything unless it’s a really special situation: think HVAC air-handling standards – it’s normally so far outside the scope of what we do here in the Medical Library that it’s practically another planet… except in the context of COVID, for example. What would normally be a facility issue becomes a patient safety issue.
There are some areas that are user-driven: we have a test-prep section for hospital staff pursuing additional certifications, e.g., nurses who are going for their critical care certification.
Next, we have areas that are driven by patient care and safety: think dermatology, a perfectly excellent department that treats a lot of patients, although we don’t have a residency program.
Finally, we have areas where we collect deeper and broader than other areas: those are our residency and fellowship areas where we’re supporting research and scholarly activity in addition to patient care and safety for those departments.
Of course, we always welcome suggestions from anywhere in the hospital! Although this has come back to bite me, I prefer to start from the position of saying yes – “Yes, we can get that for you” – until and unless we run into a hard reason to say no if it’s simply outside the scope of our collection development policy. And even then, we try to come up with alternatives to get us to a yes or to at least point the requestor in the right direction.
Shifting gears, CE and CME are peculiar areas for us. The Army does not pay for CE/CME; that’s expected to be part of an individual’s continued professional development, and therefore a personal expense. That said, there are some sources that provide primarily evidence-based information, but incidentally, they also provide CE/CME; we direct our users to them.
BMJ: The final area of focus for the library is research. This includes providing medical resources, but does the library also assist faculty and staff in conducting research and getting published?
Jeff: Oh, yes, most definitely! We are very closely aligned with Madigan’s Department of Clinical Investigation (DCI), and we’re also partners to Madigan’s Center for Nursing Science and Clinical Inquiry. Not only do we help researchers with literature reviews, but we also sometimes get listed as co-authors. My colleague Jackie has a few articles under her belt!
We participate in DCI’s annual research training sessions for residents, and the Medical Library is built into the research approval workflow. We provide customized consultation, training, and assistance to our users, tailored to their research question.
I’m just starting a pilot to work with one of our programs whose residents are working on doctorates through outside institutions. I believe that I can add value to their research efforts, not just as someone who helps with search strategies and lit searches, but as someone who understands the dissertation research process start-to-finish. They certainly have their committee and resources available through the outside institution, but I think it adds value to have someone onsite where they work who understands what they’re trying to do. I was an academic librarian in a previous life, so getting to do this little bit of teaching really scratches an old itch.
BMJ: What are your top priorities as the Chief of the Medical Library?
Jeff: The first thing to know is that we have a very small staff. I have a great title, but that just means that I get to be an administrator on top of my regular librarian duties. We also have a medical librarian and a library technician, so we share duties pretty broadly. I tend to handle the more tech services-oriented duties, and our medical librarian handles the more public services duties. But that’s not a hard-and-fast rule – we “load balance” our work, so either one of us is capable of handling pretty much anything. Our library technician is the front-line staff member who provides circ and interlibrary loan services, always with a smile. So, obviously, getting our staffing “right-sized” is a big priority for me.
Service-wise, our top priority is meeting our users where they are. I never want to hoard information in the library, like a dragon guarding its gold. I want to push our resources to users’ phones and tablets as much as possible. Regulations require us to keep a core physical collection (“What if the Internet goes down?”), but beyond that, I never want to stand between our users and the info they need. We’re always ready to stand as a guide on the side, but I never want to be a bottleneck that slows the flow of information.
This might sound a little unbelievable, but I really enjoy all aspects of my job. I like keeping my librarian skills sharp, and I like the administrative aspects of my job. It’s kind of the best of both worlds: I get up in the morning and think, “I get to go to work today,” not “I have to go to work today.”
BMJ: How has the COVID-19 pandemic affected the Madigan Medical Library?
Jeff: COVID was a real test of our flexibility and adaptability in an unprecedented situation. What I saw was a lot of brilliant, creative, out-of-the-box thinking from a bunch of smart people! Three library staff members figured out how to take nearly all of our services online with almost no degradation in service!
COVID made us rethink our policies and procedures from the ground up. The one service we couldn’t transfer 100% online was OCLC ILL. Aside from that, we were pretty successful, even if arranging online access through the shared VPN was a bit of a challenge. <shudder>
BMJ: What is the most rewarding aspect of your career?
Jeff: It depends on what time of day you ask me. Sometimes the most rewarding aspect is helping our users dig into patient care and safety issues or process improvement projects. Sometimes it’s helping our researchers dig deep into a topic for a big grant-funded research project. Sometimes it’s that I get to help our residents understand the research process and how library research is an iterative process – you start with a research question, and you refine your question as you did deeper into the topic. Sometimes the most rewarding aspect is that I get to keep learning and growing in my job – the Army is big on continuing education and professional development. Overall, I’d say that these things all have in common the feeling that the Medical Library is part of something bigger, something that has an impact beyond what I can see, something that makes people’s lives better. I’m very proud of what we do here, and I’m grateful to get to contribute.
BMJ: What is the most challenging aspect of your career?
Jeff: HA! That’s easy: Answering the question, “We have a library here? Why do we still need one of those?” Although it can be a little tiresome, it’s a great opening to tell our users (and our potential users) what we can do for them. I have all kinds of elevator speeches ready to go depending on who’s asking.
Nurses? “We can help you find info for process improvement projects. And our test prep section is really nurse-driven – are you looking to study for a new certification? Check with us first. I’d rather spend hospital money buying something that lots of people can use, rather than have you spend a couple hundred dollars on something you’re going to use once.”
Doctors? “Did you know that we subscribe to a number of resources that include free CME? We have one source that a lot of our doctors listen to like a podcast on their daily commute.”
Non-clinical folks? “If you need help with spreadsheets, databases, or whatever, we have books for that on the shelves, and we can hook you up with free training sessions.”
Administrators? “You know that database we trialed a few months ago? The use has been amazing! We’re delivering articles instantly to users, and because the use is so great, those articles average out to 56¢ apiece. Faster service at a much cheaper cost!”
BMJ: Anything else you’ve learned that you’d like to share with your colleagues?
Jeff: It would never have occurred to me that I might work for the Army one day. It was never on my radar as a possible job opportunity. Through a strange series of adventures, I landed here… and I love it! No day is ever the same. You get to work with some truly amazing clinicians and researchers. What you do makes a demonstrable difference in people’s lives. I’d encourage anyone to watch USAjobs.gov for medical librarian positions in the Army or the VA. You might find exactly the place you’re meant to be.
BMJ: What sparked your interest in a library science career?
Jeff: When I went to college, I intended to become a high school biology teacher. I got to student teaching and realized that high schoolers were going to EAT. ME. ALIVE. Going to library school was suddenly a more appealing, viable alternative because I had worked in the local public library since high school: first as a shelver, then as a circulation clerk, then as a circ/reference library assistant, and finally as a system support technician at the library consortium level.
I’d never actually considered it as a career option; it was just something I did around my high school and college schedule. I liked it, and I was good at it, but I never really considered it until I needed to make a course correction. Looking back, I can see how (1) unbelievably lucky and (2) unbelievably privileged I was. Once I started applying to schools, I was asked to apply to their scholarship programs because I’d had so much previous library experience. I was selected for the University Library Associates’ Program at the University of Michigan. I got slotted into the Natural Sciences Library (Biology, Geology, and Natural Resources) with a mentor, a salary, and full tuition. I’m one of the very rare birds who made it through grad school with no student debt and a pretty solid resume upon graduation. My first job? Supervisory systems librarian for a college. Not a bad way to start out!
BMJ: What keeps you busy outside of work?
Jeff: When I’m not at work, I like to apply my librarian detective skills to genealogy. I’ve been putting together a family history for my father. He’s getting up there in years, and I thought it might be nice to show him how he fits into the family story. I’ve been able to trace the Ring line back to colonial North Carolina, where my seventh-great-grandfather, Martin Ring, got a land grant from John Cateret, 2nd Earl Granville, who was the nominal “owner” of much of North Carolina through a grant from the king, even though he never set foot there.
Interviewed by Lauren Jones, Head of Marketing, BMJ Americas