Use of information technology in information acquisition, especially MEDLINE on CD-ROM and online, has been evaluated in several localities and regions, especially in the advanced countries. Use of MEDLINE on CD-ROM is still very poor among the medical students of the University of Lagos, Lagos, Nigeria, due to lack of awareness, insufficient personal computers, nonperiodic training, and the high cost of using the facility. Due to financial constraints, MEDLINE online and sufficiently-networked computer systems are not available.
To report on the situation in Nigeria, a developing country, so as to compare the current awareness of searching MEDLINE on CD-ROM among the medical students at the University of Lagos with the awareness of their overseas' counterparts. This is the first step toward setting up an online PubMed search as well as expanding the computer systems and network.
Essentially based on cross-sectional proportional sampling using structured questionnaires, in-depth interviews, and focus-group discussions among the medical students and library staff. The study involved the medical students in their second year to sixth (final) year of study.
Of the 250 students interviewed, 130 (52%) were aware of MEDLINE on CD-ROM searches as a means of information retrieval. Only 60 (24%) had used MEDLINE on CD-ROM — 2% had used MEDLINE on CD-ROM more than 9 times; 4%, 7 to 9 times; 8%, 4 to 6 times; and 10%, 1 to 3 times. Of the students who used MEDLINE on CD-ROM search, 22% used it in preparing for examinations, 24% in research, 6% in patient care, and 26% in preparation of assignments and clinical cases. Lack of awareness (52%) and cost of undertaking MEDLINE on CD-ROM search (46%) were identified as important factors that discouraged the use of MEDLINE on CD-ROM.
Though the above factors were recognized as important, it was concluded that the reasons for the poor use of MEDLINE on CD-ROM are multifactorial. Poor use of MEDLINE on CD-ROM could be attributed to these critical underlying factors: nonavailability of networked personal computers, which should be connected to a central server; lack of mandatory assignments to the medical students that would specifically require use of MEDLINE on CD-ROM; financial constraints on the university management; and infrequent periodic orientation on use of MEDLINE on CD-ROM. It was therefore suggested that the number of personal computers should be increased and that the library staff should periodically train the preclinical and clinical medical students in searching MEDLINE on CD-ROM. These steps would enable the medical students to benefit from online PubMed searching when it becomes fully operational in the future.
The application of information technology has revolutionized the mode of acquisition, storage, and dissemination of information. Today, computer access to the medical literature has become more convenient than ever before with MEDLINE on CD-ROM and online. Computerized literature searching enables the user to efficiently identify germane articles and research studies. Physicians can also learn to use a computerized literature-searching system and efficiently retrieve materials related to patient care [
Although the Medical Library of the College of Medicine of the University of Lagos, Lagos, Nigeria, subscribes to a considerable number of worldwide medical journals, the unavailability of these journals when they are supposed to be available impedes the supply of information [
Online MEDLINE facilitates the retrieval of information from over 4500 journals published throughout the world. The availability of the full text of publications and articles implies that this process, with its recognizable advantages, will be useful in the training of medical students. Over the years, the Medical Library of the University of Lagos has made efforts toward providing MEDLINE both on CD-ROM and online in addition to other facilities that would enhance information acquisition. However, lack of funds to purchase the required computers and to network the computers with online connections limited these efforts to the provision of MEDLINE on CD-ROMs that do not require online connection. Since the personal computers are few, networking was also not available. The extent to which the medical students utilize the available facilities for MEDLINE on CD-ROM in their training is not known. We therefore investigated the awareness and use of MEDLINE on CD-ROM by the medical students of the University of Lagos, College of Medicine in comparison with what exists overseas. This is the first step toward the introduction of online PubMed search when funds become available.
The Medical Library of the College of Medicine, University of Lagos, was used for this study. This library serves the entire medical community made up of undergraduate (medical, dental, pharmacy, and basic medical sciences) and postgraduate students (MSc, MPhil, and PhD levels), resident doctors, nurses, medical laboratory technologists, health workers, and the academics. Generally, the medical library serves the Lagos University Teaching Hospital (LUTH), the School of Nursing and Midwifery, Post-Basic Nursing, the School of Medical Laboratory Technology, and the School of Medical Records and Statistics.
The College of Medicine of the University of Lagos is made up of: the School of Basic Medical Sciences, the School of Clinical Sciences, the School of Dental Sciences, the School of Pharmaceutical Sciences, and the Institute of Child Health and Primary Health Care. Only the medical students enrolled for the Bachelor of Medicine and Surgery (MBBS) or the MD program were used in this study.
The Medical Library usually conducts a one-week orientation program for newly-enrolled medical students. During this period, the students are trained in effective ways of using the library, including using MEDLINE on CD-ROM.
The study was conducted between June and September 2002 among the medical students of the College of Medicine, University of Lagos. The randomly-selected medical students were in the second year to sixth (final) year. The premed class was not studied, because the students were located in another campus and were yet to be enrolled in medical school.
The sampling size of this study was 230 students. A proportional sampling unit was selected from each class to ensure unbiased representation. For this study, 340 questionnaires were administered. Structured questionnaires were administered to each student. This was followed by focus-group discussions and in-depth interviews with key informants among the studied population. The focus group and key informants were randomly selected from the student population. Information was also obtained from designated class representatives of the students and library staff. Clarification that the study was not intended to punish non-users of MEDLINE on CD-ROM — the names of the students were not required in the questionnaire — enhanced participation. This step removed bias from the responses provided by the medical students.
Of the 340 questionnaires that were administered, 250 were duly completed. This represented a response rate of 73.5%. The sample size of 230, which was used in the study, could be taken as 100% response in principle. The study selected: 40 students in the sixth year class (16%); 65 in the fifth year class (26%), 25 in the fourth year class (10%); 90 in the third year class (36%) and 30 in the second year class (12%).
Of the 250 students interviewed about MEDLINE on CD-ROM: 130 (52%) were aware of it, while 48% did not know what it was about; 120 (48%) were aware it was provided by the medical library; 60 (24%) had used it at one time or another, while 190 (76%) had not used it.
The frequency of use of MEDLINE on CD-ROM was: 1 to 3 occasions, 10%; 4 to 6 occasions, 8%; 7 to 9 occasions, 4%; and more than 9 occasions, 2% (percentages are based on the 250 students interviewed; percentages sum to the 24% that had used MEDLINE on CD-ROM at one time or another).
Of the 60 students who had used MEDLINE on CD-ROM at one time or the other, their purposes were: preparing for examination, 22%; personal interest, 20%; research, 24%; patient care, 6%; and preparation of assignments or clinical cases, 26% (percentages are based on the 60 students who had used MEDLINE on CD-ROM).
Of the 250 medical students interviewed, 40 (16%) stated that MEDLINE on CD-ROM was very useful; 20 (8%) useful, and 15 (6%) fairly useful.
Lack of awareness and the cost of MEDLINE on CD-ROM searching were the major factors responsible for its poor use (
Factors responsible for the poor use of MEDLINE facilities among medical students of the College of Medicine, University of Lagos, Nigeria
|
|
Lack of awareness | 130 (52) |
Cost of using MEDLINE | 115 (46) |
Inconvenient location of the MEDLINE facility | 20 (8) |
Inconvenient hours of undertaking search | 15 (6) |
Service of MEDLINE not needed | 5 (2) |
Waiting period for undertaking the search | 5 (2) |
Focus Group discussions and interview of key informants exposed 3 issues:
Examples of responses:
"We were always told to look up journals in the journal section for new information"
"We have never been told to use MEDLINE; any way, there is so much to read in our text-books"
"We are used to hard copies of texts and journals"
"Though we received some orientation on how best to use the library during our first year of enrolment in the medical school, the trend has always been the use of text-books and journals and attend clinics regularly to read case notes"
"MEDLINE is needed by the postgraduate students and resident doctors because they are doing serious research"
They agreed that "the cost and waiting time, which could take several days if a particular class would have to seek information in a given time, made us to always use the available journals and then pay for photocopies." The waiting time is due to the limited number of personal computers, which are not networked.
Examples of responses:
"Access is somewhat restricted because of the limited number of PCs; thus, we the undergraduate will have to compete for the available computers with the Postgraduate students".
"We will be happy to have periodic orientation on MEDLINE use as well as having more computers to make the training qualitative"
The advent of information technology, including the use of MEDLINE facilities, has, over the years, facilitated the acquisition of information. This is diametrically different from manual searches using Index Medicus and other bibliographies. To a large extent, MEDLINE (CD-ROM and online) is fully integrated into the university system in developed countries but is yet to be fully utilized in developing countries. The reasons for this poor utilization range from structural inadequacies to lack of awareness.
The usefulness of MEDLINE on CD-ROM and online are obvious and have been variously reported, though they differ from one institution to another [
The results of this study showed that use of MEDLINE on CD-ROM is poor among the medical students. The reasons for this poor use are multifactorial. First is the attitude of the students toward MEDLINE CD-ROM use — which has made reorientation difficult. In-depth interviews revealed that the students, in most cases, are contented with printed materials available on the shelf. The students' use of printed materials is strengthened by the use of texts by students in the preclinical class (first and second year) in preparing for examinations (including in-course assessments). Our findings on use of MEDLINE on CD-ROM therefore differed from the 87% use of the computerized literature-searching system for patient write-ups by medical students of the Wright State University School of Medicine (WSUSOM), Ohio, USA [
However, the factors responsible for poor use of MEDLINE CD-ROM (
Our study was also different from the results obtained by Osman and Muir [
It costs about US $0.11 to print a copy of an abstract. However, viewing an abstract does not require any form of payment. Even so, viewing would be difficult because the systems are not sufficient to serve those who would wish to pay for a literature search. The nonavailability of networked personal computers was identified during in-depth discussion with key informants as a critical structural inadequacy that is responsible for the nonuse of MEDLINE in the university. Furthermore, lack of awareness appears to be an important factor in the nonuse of MEDLINE.
In most cases, it is sufficient for the students to use the available materials from textbooks and journals for their assignments, patient care, case studies, etc. This can be explained by the materials being within the immediate reach of the students. Information technology is yet to be fully appreciated, with many students preferring to go the old way. Nevertheless, availability and access to software and personal computers remains a major issue, because even the faculty does not have easy access.
An important method of creating awareness is having the faculty require students do a MEDLINE search for information. It has been reported that connecting assignments and other academic activities to MEDLINE searching brought about an increase in the awareness and use of MEDLINE [
The author and JMIR editor thanks the Open Society Institute Zug Foundation for a grant to cover the article processing fee for this paper (Project-Code I7013).
None declared.