Evidence Summary


First Year Medical Students Use Library Resources Emphasized During Instruction Sessions


A Review of:

Rafferty, Ryan S. (2013). The impact of library instruction: Do first-year medical students use library resources specifically highlighted during instructional sessions? Journal of the Medical Library Association, 101(3), 213-217.


Reviewed by:

Laura Newton Miller
Collections Assessment Librarian
Carleton University Library
Ottawa, Ontario, Canada


Received: 25 Nov. 2013 Accepted: 17 Jan. 2014



cc-ca_logo_xl 2014 Newton Miller. This is an Open Access article distributed under the terms of the Creative CommonsAttributionNoncommercialShare Alike License 2.5 Canada (http://creativecommons.org/licenses/byncsa/2.5/ca/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one.





Objective – To determine if library instruction has an effect on resources cited in student reports.


Design – Citation analysis.


Setting – The study took place in the medical school of a large American university.


Subjects - One hundred eighteen of 120 first-year medical student reports were analyzed. Two reports did not include any works cited and were excluded from the study.


Methods - Over the course of 3 years, 15 20-minute library instruction sessions were conducted. The sessions, based on five clinical cases presented each year were conducted approximately two weeks before each report due date. Eighty-five case-specific resources were demonstrated, with teaching plans being modified from year to year based on the frequency of citation of a particular resource cited the prior year. A LibGuide online course guide also directed students to specific resources shown in the class, with content updated every year based on citation trends from the previous year. Every citation referenced in a report was then categorized into a) those that were discussed during an instruction session, b) those found on a course guide, c) those accessible through the library, d) those available from course material (i.e., PowerPoint presentation, lecture notes), or e) those which did not fall under any of the other categories. A citation could be included in multiple categories.


Main Results – The 118 reports included 2983 citations. Over the 3 year period, an average of 77.51% of all citations were from library resources, 49.55% of the citations from a resource demonstrated in the class, and 21.68% from resources found in the course guide. Although citations from sources discussed in class did not increase significantly from year to year, the percent of citations from resources on the course guide significantly increased from 19.40% to 25.63%.


Conclusion – Medical students cite library resources emphasized during instruction sessions.





Although there is a growing number of citation analysis studies related to the effects of library instruction, there are relatively few papers that report on the effect of instruction on medical students. This paper fills that particular niche.


Using the Evidence Based Library and Information Practice (EBLIP) Critical Appraisal Checklist (Glynn, 2006), it was determined that citation analysis was an appropriate tool for this study. The methodology is explained very clearly and those interested would be able to replicate the study relatively easily.


Percentages of citations linked to various sources were presented in averages. Because there were five different cases throughout a particular year for three years, it would have been beneficial to see more detailed analysis. For example, were there any differences in where sources came from based on a particular case? In other words, were students more likely to use demonstrated resources for some case study reports, but use more online course guide resources for other case studies? It also would have been useful to give closer examination to citations found in “nonlibrary” and “other” categories (approximately 20% each).


The author’s literature review describes how verbal encouragement from professors or librarians does not seem to be as effective as actually having clearly defined guidelines for students (p. 214). It was interesting to see that there were no significant changes in percentages of cited resources discussed in instruction over the three year period, yet percentages of cited items found in course guides steadily increased from year to year. This is partially due to the fact that popular resources cited from previous years were added to subsequent course guides. One can argue that citation analysis can be a valuable teaching assessment tool that helps librarians make modifications to teaching plans and guides based on popular citations from previous years.


Reading this paper makes one think of the bigger philosophical questions of providing instruction: Should we be giving students the fish or teaching them how to fish? Should the students simply be given the titles of books/papers where they can find their answers or should they be shown how to find the information through informed search techniques? It is certainly easier to conduct a citation analysis if there are specific titles for which to look, but it may not help students’ information seeking skills in the long term. In this study, the author finds some balance by providing instruction on general navigation of key databases, but it is important for those devising future impact studies to consider the bigger philosophical question.


This study shows that the library is making an impact on a specialized group of students with very specific resource needs. Conducting a follow-up study with those students by examining use of resources in other assignments could inform any long-term impact of instruction. For other student groups where a broad range of journals and books are needed, it may be interesting (or depressing) to know how many of those library resources are also retrievable through Google Scholar. In other words, future studies which include checking Google Scholar as part of the methodology may help determine if students would have found these resources regardless of whether library instruction was provided. This paper is useful for librarians interested in using citation analysis as an assessment tool for their own teaching to be able to modify teaching plans based on what students cite in their papers. It is also of interest to those needing to show the library’s value and impact for specialized groups of students.





Glynn, L. (2006). A critical appraisal tool for library and information research. Library Hi Tech, 24(3), 387-399.


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