In 2015, I began having in-depth conversations with directors of service, students, and residents about their educational needs. I asked, “What do you need? How can the library budget help you to solve your problems?”

Everyone was thrilled to have this conversation.

My goal was to purchase resources that the clinicians would use, and so I wanted to answer the following questions: Who would use them? Was there time set aside so the residents and students could study? What was the motivation for students, residents, and directors of service? Was the content created by a trusted entity?

Board reviews checked all these boxes. There were many requests for them, across specialties. Students and residents described that they have to pass exams to advance in their education or careers. Instructors wanted to increase pass rates. The resources were created by professional organizations such as American College of Physicians, or were reviewed well by those who had passed their exams. Perhaps the most important justification is a recent study that found that residents and students purchase these products on their own. Medical students spent, on average, more than $4,000 on board preparation and described board reviews as an “overlooked” addition to student debt.

There is evidence they are used at my institution. Instructors use them to create lectures and monthly quizzes, and residents use them in peer study sessions. The chief resident for internal medicine described the purchases as a “morale boost.” When there is a delay in getting access, many residents and students actively ask when they will be available. I sometimes feel like I am holding meat up to hungry dogs!  (There are delays in getting access because the administration of these products can be complicated. Technically we are purchasing a group of individual subscriptions; most of them do not offer a flat rate.)

This year, I plan to work with departments to improve the program. Is there a way to increase usage?

And what is the bottom line: Can we measure a cause-and-effect relationship between access to these resources and the pass rate on exams?

Sheryl Ramer is director, Health Sciences Library, NYC Health + Hospitals, New York City.

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