First, a Library: Celebrating Duke University Medical Center Library

In 1927, on the very day Wilburt Davison, MD, was appointed as the first dean of Duke University School of Medicine, he set out to start a library. He put this task ahead of hiring faculty. He asked for $100,000 from the Duke Endowment for a hospital library and began acquiring books, making many of the deals himself.  

He hired Duke’s first medical librarian, Judith Farrar, in 1929, and together they had the Duke University Hospital Library up and running when the first medical student class was admitted in 1930.  

Today, the Duke University Medical Center Library and Archives (renamed in 1962), has evolved from a repository of books to a living resource and collaboration space for medical students and faculty. The librarians spend much of their time teaching students to search and critically evaluate the medical literature as well as collaborating with students and faculty on research projects. 

“We’re a collection of services and not just a collection of materials,” said Megan Von Isenburg, associate dean for library services at the School of Medicine. “So many of the things that we offer aren't things that sit on a shelf.” 

A Treasure Trove of Books 

Once Davison had medical librarian Judith Farrar in place, they chose the books they wanted and agreed they would pay no more than $3 for any volume, with rare exception. “We made a mimeographed list of about 60 pages, which we sent all around the world and asked for bids, just as if you were buying bricks,” Davison recalled in 1964.  Despite space challenges, they housed the collection in the basement of the hospital, rather than in a separate building, so that students could easily access the library, a priority for Davison.   

Soon after Farrar was hired, her mother, Mildred Farrar, came to work as an assistant, cataloging books. Davison arranged to put her on the payroll, but she repeatedly returned the checks. In 32 years working for the library, she refused to take payment. In a 1964 speech, Davison said of both the Farrars: “We would never have been able to get through the first 30 years at Duke without their help.”  

The library’s collections steadily grew, with the help of several gifts. One of the most notable was a 1953 donation from Mary Duke Biddle Trent Semans and her husband, Duke’s first Chief of Thoracic Surgery, Josiah Charles, Trent, MD:  4,000 books and 2,500 manuscripts about the history and development of medicine. Davison called it “one of the finest collections of medical history in the country.”  

A Leader in Information Technology 

As the 1950s gave way to the 1960s, library leaders recognized the need to emphasize  reference and photocopying services and access to the growing body of medical and scientific information. Today, finding the latest published research it as easy as opening an internet browser and searching an online database like PubMed. But in the 1960s, finding such information meant visiting the small number of libraries that physically received this data from the National Library of Medicine on computer data tapes. Visitors could search the tapes using a specialized terminal.  

In the early 1970s, the Medical Center Library was one of the first in the nation to offer remote access to this information via MEDLINE (a precursor to PubMed). This was accomplished using a phone line and a modem to access a small network of computers, and searching the database required training in command line syntax. 

As the medical center grew into an increasingly complex organization with several decades of history, the importance of capturing history became clear. In 1971, Elon Clark, a professor of medical art who became known as a “protector” of the Duke University Medical Center’s artifacts and history, was appointed medical archivist. He published a call for personal papers in the library newsletter.  “Personal modesty should not prevent anyone from providing the archives with letters and papers of all descriptions,” he wrote. “Without documentary evidence of individual contributions, the picture will be forever incomplete."  Later, in 2001, the archives and library merged.  

True Partners 

When PubMed launched in 1996, medical and other scientific information became much more readily available to users with an internet connection. Today, the library licenses and curates this information, including more than 12,000 online biomedical journals, more than 5,000 online biomedical books, and more than 120 biomedical databases. And, Duke medical center librarians spend much of their time helping students and faculty at the School of Medicine and the School of Nursing make sense of all this information. (The School of Nursing library merged with the Medical Center library in 1975). 

Librarians teach students in the curriculum and in consultations how to find the best available research evidence and how to evaluate the research methodology of a scientific article, Von Isenburg said. They also partner with both students and faculty in authoring published systematic reviews of the literature. 

Bonnie Hepler, RN, MSW, MSPH, PhD, assistant professor in the Duke University School of Nursing, said that Duke’s medical center librarians are responsive partners. When Hepler was a PhD student at the school, they explained every step of the literature review process, she said. Then students drafted search terms, and the librarians gave feedback on how to set them up more rigorously. “By the end of that iterative process, you had a pretty good search strategy,” she said. “Nobody is as rigorous as them.” 

The librarians are also open to evolving methodologies and services. Earlier this year, School of Nursing PhD student Darchelle Excellent encountered racist terms during a systematic literature review on breastfeeding experiences among Black birthing parents, Hepler said. Systematic reviews require “controlled vocabularies” and standards, which include historical terms that identify useful older research, Von Isenburg said. But some older terms can be hurtful. Duke’s medical center librarians partnered with Excellent, Hepler, and other faculty mentors to write a case report on the experience. Published in the journal Health Equity, with Excellent as first author, the article proposes ways to increase transparency and racial equity in the systematic review process. 

 “Instead of saying ‘This is just the way that it is,’ our librarians said, ‘We should do something about that,’” Hepler said. “Their willingness to debrief from what happened, and to think collaboratively and creatively about how to prevent future harm was thoughtful, insightful, and caring. I just couldn't be more grateful for our librarians. They’re good friends to have.”  

Angela Spivey is a senior science writer and managing editor for the School of Medicine’s Office of Strategic Communications.  

Photos by Eamon Queeney, assistant director, multimedia and creative for the School of Medicine’s Office of Strategic Communications.