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TL v60n1: A Simple Plan Extended
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Tennessee Libraries 

Volume 60 Number 1



 A Simple Plan Extended


Martha Earl
Assistant Director 

Cynthia Vaughn
Clinical Information Librarian

Preston Medical Library, UT Graduate School of Medicine, Knoxville

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This project was funded by the National Network of Libraries of Medicine/Southeastern Atlantic Region under award N01-LM-6-3502.


The Preston Medical Library at the University of Tennessee (UT) Graduate School of Medicine [] and UT Medical Center serves health professionals, students, staff, and the general public.  Preston librarians have been answering questions for health consumers through their Consumer and Patient Health Information Service (CAPHIS) since 1989.  Surveys of consumers demonstrate a strong satisfaction with materials received and the service.  Participants use the information received to communicate more effectively with their health care providers.  Preston librarians also teach consumers through presentations for community groups on how to find and evaluate health information sources [Earl, 1998].

The Preston CAPHIS began with a grant from the Tennessee State Library and Archives (TSLA) [] to improve access to consumer health information through an alliance between a medical library and local and state public libraries.  Preston partnered with the Knox County Public Library (KCPL) [] for document delivery, staff training, and collection development consultation.  KCPL librarians and staff referred consumers to the Preston Medical Library.  Preston librarians also worked with Blount County Public Library [], Oak Ridge Public Library [], E.G. Fisher Public Library in Athens [], and staff from the Nolichucky, Clinch Powell, and Fort Loudoun regions to train staff.  Some classes were taught by National Network of Libraries of Medicine (NN/LM) [] trainers.  Preston librarians developed customized consumer health on the internet training sessions [Stephenson, 2004].

In northeast Tennessee, East Tennessee State University (ETSU) Quillen College of Medicine [] librarians received an NN/LM award to establish a CAPHIS.  Later ETSU librarians received additional funding to teach four NN/LM developed consumer health classes to staff of Watauga, Nolichucky, and Clinch Powell regional libraries and to assist those who completed all four courses in attaining Medical Library Association (MLA) Consumer Health Information Specialist (CHIS) [] certifications.  Rick Wallace, ETSU project leader, called this project “A Simple Plan” to train rural public library staff to answer the frontline health information requests of rural health consumers [Wallace, 2007]. 

Needs Assessment

Preston Medical Library, with another award from NN/LM, organized and led the Tennessee Outreach State Planning Team. The team’s goal was to determine the health information needs of health professionals, library staff, and consumers across Tennessee and to develop a plan to meet those needs.  Librarians from Preston, UT Health Science Center in Memphis [], ETSU, Saint Thomas Hospital in Nashville[] , Nashville Public Library [], Memphis Public Library [], and TSLA met with representatives from health professional and community support groups and NN/LM.  Various successful projects resulted from this planning.  To meet the needs of both library staff and health consumers, ETSU and Preston librarians and NN/LM decided to extend the Simple Plan [Oelschlegel, 2006].

An additional boost in support came from the statewide Continuing Education Summit organized by TSLA.  At that meeting of representatives from all library types and associations, TSLA shared the results of their CE survey of public librarians for 2007.  CE surveys of public library staff in Tennessee revealed consumer health information to be one of the top five areas of interest, including both reference and collection development areas of expertise.  The State Librarian and Assistant State Librarian expressed strong interest in extending the Simple Plan to all of the regional libraries in Tennessee.

The Project

For a Simple Plan Extended, ETSU and Preston librarians once again applied for and received funding from NN/LM (Tenn-Share, 2008).  They selected seven more of the TSLA regional libraries.  Medical library trainers taught the four classes needed for MLA CHIS certification at least four times in each of the regions.  The four classes included “Beyond an Apple a Day:  Providing Consumer Health Information at Your Library,” “From Snake Oil to Penicillin:  Evaluating Consumer Health Information on the Internet,” “Looking in All the Wrong Places: PubMed for Public Librarians,” and “Prescription for Success: Consumer Health Information on the Web.” 

The core class, required for the CHIS certification, was “Beyond an Apple a Day.”  This covered health literacy, the reference interview, collection development, key websites, (especially MedlinePlus), practice questions, and marketing.  “From Snake Oil to Penicillin” covered how to evaluate health web sites.  “Looking in All the Wrong Places,” the most challenging class, covered the basics of PubMed, the National Library of Medicine, term mapping, limits, finding full-text, and practice PubMed searches.  “Prescription for Success” focused on how to be an active partner in your own health care, best doctors, hospital ratings, and drug and nutritional supplement information.  All courses involved lecture, discussion, group work, and hands-on computer learning. These four classes had been taught in the first Simple Plan outreach project and evaluated favorably by regional library staff [Wallace, 2007].

The TSLA map illustrated the location of the regions [TSLA, 2008]. ETSU planned to teach in Caney Fork, Upper Cumberland, and Reelfoot regions. Preston planned to teach in Fort Loudoun, Highland Rim, and Blue Grass regions. Later ETSU added the Warioto region.  Upon completion of the project, ten of the twelve regional libraries received instruction.  Plans to reach the last two regions and any additional interested library staff throughout the state through distance learning are underway.

Regional Libraries Map

Figure 1. Tennessee Library Regions Map

MTSU and Preston librarians began the Simple Plan Extended project in the fall of 2008.  They developed pre and post test assessment questions for each of the four classes and used the MLA CE/Symposium Evaluation Form.  Each class lasted three hours and attendees could earn 3 hours of MLA CE credit.  Preston librarians also designed and included a Health Reference Questionnaire for Public Librarians in the Beyond an Apple a Day course materials.  Training materials available online on the NN/LM site were reviewed and updated, if necessary.  Regional directors determined class locations for hands-on learning and worked with the TSLA CE Coordinator to advertise the classes to staff in the designated regions.  Hosting facility library staff members were also invited.  Classes were scheduled in 2008 and 2009. 

Both Preston and ETSU librarians participated in Simple Plan project.  The remainder of this paper will focus on the Preston Medical Library’s experience. 

The Regional Libraries

The Blue Grass Regional Library serves a population of more than 350,000 people with 25 libraries and 40 bookmobile stations.  Marion Bryant, the regional director, arranged for classes to be held in two locations within her region due to traveling distances for her staff.  Classes were held at Columbia State Community College [] in Columbia and at the Williamson County Public Library [] in Franklin.  Kathy Breeden and Janice Keck, directors respectively, supported this learning initiative. 

Martha Earl instructed Blue Grass Regional staff at Williamson County Public Library.

Figure 2. Martha Earl instructed Blue Grass Regional staff at Williamson County Public Library.


Figure 3. Cynthia Vaughn taught at Columbia State Community College Library in the Blue Grass Region.

The Highland Rim Regional Library serves nine counties with 18 libraries in 10 systems and 94 individual stations.  Betty Jo Jarvis, the regional director, arranged for classes at Middle Tennessee State University  James E. Walker Library [] in Murfreesboro.  Don Craig, MTSU library director, supported this learning initiative. 


Figure 4. Martha Earl and Cynthia Vaughn prepared to train Highland Rim Regional staff at the MTSU James E. Walker Library.

The Fort Loudoun Regional Library serves a population of more than 425,000 people with 27 libraries and 30 outreach service points.  Lynette Sloan, regional director, hosted classes at the Regional Library in Athens. Lynette used laptops to create a portable lab. 


Figure 5. Cynthia Vaughn reviewed consumer health sites for Fort Loudoun Regional Library staff in Athens during the From Snake Oil to Penicillin class.


Preston librarians taught 32 training sessions with 402 in attendance for an average of 12-13 participants per class.  From the three regions, 52 people completed all four classes and received their MLA CHIS certifications.  Application for the MLA CHIS certification was voluntary but paid for by the NN/LM award. 

For all participants taking the classes resulted in more knowledge of consumer health information issues and resources than they had prior to the sessions.  The goals for the project included providing a benefit to staff in terms of support for their own health questions, since some regional library staff did not have health insurance benefits. 

The Health Questionnaire responses demonstrated the participants’ experience with consumer health information.  More than 85% answered consumer health questions weekly.  More than 67% noted an increase in health questions in the last five years.  They observed that patrons preferred the Internet as a source approximately 60% of the time and books 40% of the time.  87% used the Tennessee Electronic Library to answer health questions and 57% had used MedlinePlus.  They expected that medical libraries could provide training and serve as referral sites. 

Pre and post test results indicated the gain in consumer health resources knowledge.  More than 15% learned more about consumer health collection development. Approximately 17% learned that regional libraries can become affiliate members of NN/LM and join Docline for interlibrary loan services.  46% discovered that not all articles in PubMed are free.  Students also learned how to partner with medical libraries for consultation and referrals.  Most participants learned more about MedlinePlus as a first source for consumer health information and Tennessee GoLocal as a resource for community information.  Vanderbilt University Eskind Biomedical Library [] built the GoLocal database to provide consumers with a directory of health information services in Tennessee [Vanderbilt University Medical Center, 2009].

Lessons Learned

Everywhere that the instructors taught the classes, the participants expressed an eagerness to learn more about consumer health information sources and services.  Participants especially appreciated the opportunity for hands-on practice with their colleagues and medical librarian instructors available for assistance.  Class discussions allowed staff to express their concerns and frustrations related to providing consumer health information for their clients as well as with finding information for themselves or family and friends. 

Participants expressed to the trainers how much they valued learning how to find quality information on the Internet.  One commented, “If only I had known about MedlinePlus earlier, when I was diagnosed.  It would have saved me hours of looking at other web sites with incomplete or misleading information.”  Another said, “I am so happy to be able to send patrons to quality health sites.  Knowing how to find out about doctors and hospitals will be so valuable.”  “Now I realize that I can use PubMed for deeper research.”

The impact of the class was well expressed by Lynette Sloan, “Prior to the training, library staff felt uncomfortable dealing with medical questions because they weren’t trained in the medical field.  We now understand that we can guide people to authoritative, quality consumer medical information.  On a personal level…I, like most of the general public, sometimes have problems understanding the medical terminology that physicians use.  My new skills allow me to seek a…better understanding of my health conditions and prospects.”  [Hodges, 2009]

Regional library staff appreciated instructors coming to them.  By visiting the communities, trainers learned more about the needs of the people whom their students served.  Through this project, the Preston Medical Library, TSLA, and NN/LM provided a way to meet the health information questions of rural Tennesseans at the point of need.  


Earl, M. (1998)  “Caring for Consumers:  Empowering the Individual.”  American Libraries, 29(10), 44-6.

Hodges, K. & Johnson, A. (2009) “Preston Medical Library Impacts Libraries, Families, and Rural Doctors.”  Frontiers, 13-15.

Oelschlegel, S.; Ponnappa, S.; Due, K.  Report:  Tennessee Outreach State Planning and Evaluation Team.  Knoxville, TN:  University of Tennessee, 2006. 

Stephenson, P.F., Green, B.F., Wallace, R.L., Earl, M.F., Orick, J.T., & Taylor, M.V. (2004)  “Community Partnerships for Health Information Training:  Medical Librarians Working with Health Care Professionals and Consumers in Tennessee.”  Health Information and Libraries Journal, 21(s1), 20-26.

Tennessee Special Libraries Share Their Resources. (2008, October 23). Tenn-Share News.  

Tennessee Department of State:  Tennessee State Library and Archives. (2009, April 3)  

Wallace, R. & Carter, N. (2007) “Solving Our Nation’s Health Information Literacy:  A Simple Plan.”  MLA News, 397, 22.

Web Site Brings State’s Health Offerings Together. (2009, January 20).

Contact the Authors

Martha Earl, MSLS, AHIP

Cynthia Vaughn, MLIS, AHIP

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