The Use Of Auxiliary Documentation Resources In Medical Practice. The Impact Of peaceMed Project Upon The Romanian Medical Community



The study at hand represents an analysis of the effect that the peaceMed Project had upon the Romanian medical community when considering the usage of auxiliary methods for article sourcing. peaceMed represents an initiative that proposes novel ways of article research for the medical professionals and offers, for the first time in the Romanian medical environment, a broad range of solely healthcare-related information. This disquisition is a national novelty, also being the first study of this sort made in an East European country. The main purpose of this inquiry is to reveal what sources Romanian professionals use in their daily activity to find reliant, academically approved medical information. The result of this study shows the major impact that peaceMed had on the Romanian medical community included in this project and emphasizes the significant need for such an initiative at a larger scale.



evidence based medicine, medical platform, peacemed, up to date clinical information, clinical information resources

JEL Classification

I10, I20, I23

  1. Introduction

The study of the behaviour of documentation from auxiliary sources in the current practice of medical staff has received little attention so far. Most papers refer to the implementation of medical data recording systems in hospitals (Bae et al., 2017; Sher et al., 2017; Damotte et al., 2018; Jindal & Raziuddin, 2018) and do not focus on the constant need to inform the medical staff in order to be up to date with the latest research, carried out at international level. The few published articles addressing the importance of information from accredited online sources present case studies covering a limited number of countries (Hider et al., 2009; Lindsey & Olin, 2013), such as: Mongolia (Callen, Buyankhishig & McIntosh, 2008), Saudi Arabia (Khudair & Cooke, 2008), Australia (Rowlands, Coverdale, & Callen, 2016; Shepheard, 2017) or Nigeria (Watts & Ibegbulam, 2006). Therefore, there is a gap in the scholarly literature in dealing with this topic and there is a need to expand such research, especially on the situation of European countries (Alving, Christensen, & Thrysøe, 2018), where there have been numerous changes in healthcare systems in recent decades.

This study represents the descriptive analysis of the internationally validated auxiliary source documentation profile of the physicians in Romania and offers a clear image of the information behaviour in the current practice. This research has an increased relevance, both at national level – by providing a clear picture of the documentation needs of medical staff – and at European level – in view of the high number of Romanian physician practicing in Western European countries (Vasilcu, 2013) and which influence the healthcare system in the developed countries in which medicine is practiced (Bidwell et al., 2013). According to the data from the Romanian College of Physicians, during the period from 2007 to 2015, a number of 18,686 medical staff members went working abroad (Păunică, Pitulice & Ștefănescu, 2017), a situation with a real impact on the Romanian healthcare system and the healthcare systems in the recipient countries.


  1. The Romanian Healthcare System

For healthcare professionals, the documentation process is continuous and time-consuming, varying between a quarter and a half of daily working time (Clyncha & Kellett, 2015). Thus, the provision of alternative information solutions, which offer the possibility to access information in real time, as, for example, the search engines of online platforms do, is a necessity (Bartels, 2009). In developed countries, documentation from validated and current sources is the basis for the training of young physicians (Watts & Ibegbulam, 2006), who are accustomed to alternative sources of information since university studies and are in constant dialogue with librarians (Marshall, 2014; Marshall et al., 2014; Chaputula & Mutula, 2018). Currently, there is the possibility that medical staff can use technological progress for continuous information on different devices (Donohoe et al., 2018) and to keep in touch with patients, in order to increase the success rate of treatment (Foster & Callans, 2017). However, this behaviour depends on financing the access to scholarly literature and the accessibility of the necessary technical infrastructure (Ebrahimi et al., 2017). Documentation from accredited sources, for example, from academic journals indexed in international databases, has given satisfactory results in countries that have implemented programmes to access medical information (Marriott, 2002), strengthening the idea that documentation from auxiliary sources in current medical practice, called evidence-based medicine or EBM in the international literature, is needed (Jiang et al., 2016). Given the international context in which Romania is placed – an EU Member State, which is facing a sharp migration of medical staff (Boncea, 2015) and which has a poorly funded and uncompetitive healthcare system (Popescu, Asandului & Fătulescu, 2014) –, this study is welcome for the academic environment and for decision makers in health and education. The research comes in support of the competent authorities, who are currently at a time when they should redefine the educational package for students in medicine and rethink the workforce for medical staff, by providing conditions for practice and documentation similar to those in other performing countries.

Romania is the Member State of the European Union with the lowest percentage of GDP assigned to the health sector, with an allocation of 4.9% of GDP in 2015, which represents almost half of the EU average of 9.9% of GDP (OECD, 2017). In addition to poor funding, the Romanian healthcare system is also characterized by a migration of highly specialized labour force in the field, which has intensified since 2007, when Romania became a member of the EU (Teodorescu et al., 2013; Suciu et al., 2017), and which caused a shortage of physicians at the national level (EUROSTAT, 2018). Factors such as globalization, the high demand for medical staff in countries facing an aging population, as well as the recognition of diplomas in the Community space have allowed those in the system to practice abroad (Boncea, 2015). The superior working conditions offered in developed countries, the level of pay and the knowledge of international languages ​​by young Romanian physicians were the main motivations that led to a brain drain to Western European countries, including France, Great Britain or Germany (Hinrichs & Colquhoun, 2013; Saghin, Luches, & Marici, 2016; Suciu et al., 2017; Păunică, Pitulice, & Ștefănescu, 2017). Also, at present, the educational curriculum within the local medical faculties is based on the students’ ability to memorize, which does not form the skills necessary for documentation from auxiliary sources (Potcovaru, 2014; Dobrin, Deac, & Dinulescu, 2017), and this aspect is an alarm signal for the level of competitiveness of services in the healthcare system.

Although, since 1990, evidence-based medical practice has become a priority in the field of health, and clinical documentation from validated sources is a major step in improving the medical practice at global level (Mano & Harrison, 2012; Letouze et al., 2017), in Romania, the main sources of documentation remained those on physical support, with outdated information, a problem to which also contributed the lack of cooperation between university libraries (Madge, 2013). It is known that investments in the book fund in Romanian university libraries have been reduced and that the renewal of the medical book fund has not been a priority in recent decades (Anghelescu & Chiaburu, 2015). In this context, there has been no national effort by the authorities to facilitate the access of students and hospital staff to accredited sources of documentation, enabling them in real time to find out the updates ne and progress in their field.


  1. Methodology

This article aims at the impact created by the peaceMed Project on the Romanian medical community, an approach developed as a solution to some of the challenges faced by medical staff in the country. The project impact analysis provides a complex picture of the profile of medical staff in Romania, regarding the behaviour of documentation and their need to constantly have available validated and current sources of information at their disposal, in order to help them perform in current practice. The research is based on the analysis of the primary data obtained following the implementation of the peaceMed Project and on the qualitative analysis of the information gathered by the author about the profile of medical staff in Romania.

The peaceMed Project is the first initiative for free access to academically validated information for medical staff in Romania, following exclusively sources of information in the medical field. It can be defined as a novelty for the Romanian healthcare system. Within the project, an impressive range of dedicated information was made available to local medical staff, present in 16 internationally renowned databases. It should be noted that, until the end of the peaceMed Project, no similar national documentation project was implemented, which would be subsidized by a private or state entity and which would contain exclusively medical literature. The only initiative that can be considered complementary is the one developed, starting with 2011, through the Anelis programme, later transformed into Anelis Plus (Madge, 2013), which included six Universities of Medicine and Pharmacy in the country, namely those in Bucharest, Iaşi, Timișoara, Târgu Mureș, Craiova and Cluj-Napoca. However, the international databases in the Anelis Project did not have content dedicated exclusively to medical specializations and could not be accessed by health units, but only by universities.

The peaceMed Project took place in Romania, between April and December 2017, and was a real documentation solution, implemented in health institutions in all counties of the country, through which physicians and auxiliary staff in hospitals and medical practices in the country had free access to the relevant scholarly literature for nine months. It was designed as a pilot project to assess the need to integrate such a concept in all health units in the country and to be able to multiply it later on a large scale, covering most hospitals and medical practices in Romania. In order to measure the success of the implementation, the main indicator was that at least 30% of the medical staff of the units that joined the project become active members on the peaceMed platform and access the specialized content.

This research aims to achieve the documentation profile of the medical staff in Romania, and for this, the author considered the following four main objectives:

Objective pursued in the research Research methodology used
(i) Analysis of the impact that the peaceMed Project had on the Romanian medical community. To achieve this objective, the author conducted semi-structured interviews with three members of the project team.
(ii) Investigation of the documentation preferences of medical staff that have joined the peaceMed Project. To achieve this objective, the author conducted a quantitative research, based on the questionnaire.
(iii) Investigation of the behaviour of using the documentation resources within the peaceMed Project. To achieve this objective, the author analysed the statistics of use of the peaceMed platform.
(iv) Analysis of the documentation profile of medical staff according to the generation to which they belong. To achieve this objective, the author conducted a semi-structured interview with the representative of one of the main university libraries in the medical field in Romania.



  1. Results

(i) Analysis of the impact of the peaceMed Project on the Romanian medical community

The peaceMed Project is a premiere initiative for the medical field in Romania, being implemented and carried out exclusively by Enformation, a private company with fully Romanian capital, which operates in the field of education. Through this approach, it was desired to create a platform through which the staff in the Romanian healthcare system can have access to accredited documentation resources, essential for daily practice, which would contribute to the formation of a climate conducive to performance at the highest level (Fig. 1). The international resources that could be accessed free of charge, both from the campus of the health unit and remotely, through mobile access, were 16 in number, namely: Ovid, BMJ, Springer Nature, ProQuest, Cochrane, McGraw-Hill Education, Alexander Street, Cabi, UpToDate, Thieme, Taylor & Francis Online, Oxford University Press, Cambridge University Press, Clarivate Analytics, IOP (Institute of Physics) and Wiley.

The peaceMed platform was developed to serve the need for documentation of medical staff in Romania and to provide them with the necessary resources to make the best decisions in current practice. Originally conceived as a facilitator of access to accredited medical literature, it has been transformed along the way into an independent platform, through which medical staff in Romania can be up to date with the latest news, worldwide, in each specialty. The peaceMed platform was created following extensive market research and multiple interviews with medical staff in Romania, at various points in their careers. Depending on the needs identified with their help, the interface, the design and the functionalities of the platform were developed and the mobile access was integrated, for the medical staff who wanted to access the content available from outside the health unit.

The free access for medical staff to the scholarly literature was opened between April and December 2017 and aims at a long-term continuity: 2019-2025. Following the results obtained by implementing the project and the growing interest in information from accredited sources expressed by medical staff in Romania, the peaceMed platform also included Open Access resources, which contain medical information available after the project was completed. At the same time, free access was possible due to the efforts of the Enformation team and the partner publishing houses in the project, which agreed to provide free access to medical staff in Romania during the implementation of the project. In choosing the resources, the discussions with the medical staff were taken into account, which resulted in the option for several internationally renowned databases, depending on the specialty, and the availability of publishers to voluntarily support, for nine months, open access to literature for medical staff in Romania. In this way, the aim was to cover a wide range of documentation sources, corresponding to the requirements and specializations of the medical staff interested in the peaceMed approach.


Fig. 1. Features of the peaceMed medical


(Source: Diagram designed by the author based on information provided by the peaceMed team)


The peaceMed Project had national coverage – health units from all over Romania were able to express their desire to join and be included in the project. They benefited from trainings, carried out by the specialized team, in four hospitals of national importance in Romania, located in the country’s capital, Bucharest – Dr. Victor Babeș Clinical Hospital for Infectious and Tropical Diseases, Marie Sklodowska Curie Emergency Clinical Hospital for Children, Prof. Dr. Matei Balș National Institute of Infectious Diseases, Dr. Victor Gomoiu Clinical Hospital for Children – and free webex, in order to disseminate information related to the use of platforms. Throughout the implementation, the project was considered an initiative of national interest, recognized by representatives in the medical field, and was supported by eight media partners in Romania, which addresses the professionals concerned: medicalmanager.ro, mymed.ro, Radio Gold FM, Romedic, Info Sănătate, health.ro, Televiziunea Medicală, ehealth Romania. In addition, invitations were sent to the hospitals in the country, to join the peaceMed network for free, as well as information notices to the Ministry of Health, in order to expand the project nationwide.

The platform page has been designed in a minimalist manner, with little additional information, so that online browsing is not difficult. The data of the main page are available in Romanian and accessing peaceMed can be done from the enformation.ro website. Also, the information presented refers to the partner databases, the training calendar and the webex calendar, the contact information, the login or creation of the peaceMed account section and a synthesis of statistical data related to resources (Fig. 2). The content of the platform is divided into two essential categories: content available during the project implementation, April 2017 – December 2017, and Open Access content, available even after the completion of the project.


Fig. 2. Screenshot – peaceMed Project home page


(Source: peaceMed Project website: https://www.e-nformation.ro/peacemed)


Users affiliated with the partner institutions in the project were able to create an account on the peaceMed platform through a simplified, two-step authentication process. During the nine months of implementation, the project was joined by a total of 126 hospitals and research institutions in the medical field (including universities) and 1,673 medical staff members registered. Regarding the documentation resources made available during the pilot project, they included the following categories: 992,300 clinical trials, 450,800 images useful in medical practice, 99,748 videos with medical content, 86,103 specialized books, 60,532 protocols medical, 24,329 examples of consultation procedures, 15,500 documents with information on medicines, 14,000 examples of patient diagnostics, 10,000 e-Learning titles, 9,950 titles of documents on patient education and 8,037 titles of internationally recognized journals.

For the implementation of the peaceMed Project, health units from Romania were contacted, out of which 126 units responded positively to the invitation to benefit from free access to the available medical content. Their structure is as follows: hospitals, family medical practices, individual practices and medicine universities. The health units included in the project came from all 42 counties in the country, being part of the network including units located in counties that do not have a developed medical infrastructure, nor the presence of centres of excellence or university centres; for example, the counties of Vrancea, Vaslui and Teleorman. The staff of peaceMed beneficiary health units totalized 1,673 medical staff members, who received access to the content available on the platform. Of these, 706 medical staff members created a specific account and were active, downloading medical content, which represents 42% of the total population to which the project was addressed directly. Between April and December 2017, 17,996 accesses of resources were registered and 248,620 pageviews were made (pageviews means the total number of accesses to an online page in a given time interval).

It should be noted that the impact of peaceMed on the Romanian medical community has certainly exceeded the recorded figures, due to the multiplier effect of medical information accessed by specialists in the field. In this sense, some of the downloaded sources could be discussed during the daily meetings held by physicians, while teachers from Medicine universities could disseminate among students the content found on the platform, for information purposes, in print or electronic format.


(ii) Investigation of the documentation preferences of medical staff who have joined the peaceMed Project

In this part of the research, in order to achieve the profile of medical staff in Romania who use auxiliary sources of documentation in current practice, a quantitative, descriptive study was conducted, based on a questionnaire. The mentioned survey took place in the first two weeks of April 2017. The structured questionnaire was distributed in physical format, among 140 medical staff, who expressed their intention to be part of the project. The main objective was to assess the main features of users of medical platforms in Romania, by: preferred document type, motivation, opinion on the importance of hospitals subscribing to medical databases and time allocated for documentation. In order to obtain a high response rate, the questionnaires were personally handed out by the peaceMed team and were collected by the project manager within one week. Seven questions were included in the questionnaire, of which three single choice questions – sex, position and time allocated to documentation – and four multiple choice questions – the usefulness of information for hospitals, the purpose of using platforms, the type of document chosen and the importance of platforms available through the peaceMed portal. Out of the total of 140 questionnaires distributed, 107 questionnaires were returned, which could be centralized, registering a 76% response rate.

The majority of respondents participating in the survey were female, namely 76%, of which mostly medical staff, namely 93%. The rest of the respondents were nurses (4%) and pharmacists (3%). The largest percentage of respondents who were part of the questionnaire-based survey was represented by resident physicians (37%), followed by primary care physicians (29%) and specialist physicians (26%). The questionnaire on the daily time allotted by each person for documentation showed that almost half of the participants in the survey spend less than an hour a day learning about topics related to current practice, with 18% of respondents allocating less than 30 minutes, and 26% of participants allocating about half an hour to documentation. Also, 24% of respondents study more than one hour the useful resources in current practice, while 32% of participants stated that approximately one hour is for allocated for documentation each day – the majority response (Table 1).


Tabel 1. Description of the profile of the respondents to the questionnaire

1.      Sex of respondents
Female 76%
Male 24%
2.      Position of respondents
Resident Physician 37%
Primary Care Physician 29%
Specialist Physician 26%
Pharmacist 3%
Nurse 4%
3.      Time allocated to daily documentation
1         hour 32%
30 minutes 26%
>1 hour 24%
< 30 minutes 18%

(Source: Table designed by the author following the research based on the questionnaire)


Following the analysis of the opinion of those who joined the survey, regarding the need for large-scale implementation among health units of a documentation system from accredited auxiliary sources, it appears that the evaluated medical staff members consider that hospitals in Romania should be subscribed to international medical data. In this sense, the opinion expressed is in line with the statement of 75% of respondents, according to which it would be possible to carry out a lifelong training of medical staff and update their information with the latest news in the field. In addition, according to the answers, through the unlimited access of medical staff to validated information, the quality of medical services and patient satisfaction can be significantly increased, thus increasing the competitiveness of the Romanian medical sector – 63% of respondents are of this opinion (Table 2). At the same time, 43% of the participants in the questionnaire-based survey stated that they notice a connection between the use of medical platforms by hospital staff and the reduction of the patient’s hospitalization time, and 22% said that the information available on medical platforms leads to a review of medical protocols to meet the same standards at international level.


When asked about the preferences related to the type of document used for information, it was noticed that the first three positions are held by: clinical guidelines – 62%, books – 54% and academic journals – 50%. The ranking of respondents’ options also included medical protocols (46%), diagnostic documents (45%) and videos (37%). On the other hand, the fewest choices were for consultation procedure texts (11%) and for documents dedicated to patient education (6%). The main preferences in terms of medical platforms, among those that could be available through the peaceMed Project, indicated before the respondents started the actual use of the portal, were: Ovid, 41% of respondents placing this database in the top of preferences, then Springer Nature (40%), followed by Cochrane (31%), as shown in Table 2.


Tabel 2. Aspects regarding the use of medical platforms by the medical staff in Romania

2.1. Reasons why a hospital should use medical platforms (multiple choice)

Lifelong training of medical staff 75%
Increase in the quality of medical services and patient satisfaction 63%
Reduction in the patient’s hospitalization time 43%
Review of medical protocols in accordance with international guidelines 22%

2.2. Type of document used in the information

(multiple choice)

Clinical Guidelines 62%
Books 54%
Journals 50%
Protocols 46%
Diagnosis / Treatment 45%
Video Content 37%
E-Learning 29%
Clinical Trials 25%
Medicines 24%
Consultation Procedures 11%
Patients’ Education 6%
2.3. Purpose of the use of documentation platforms by medical staff

Obtaining updated and relevant information 78%
Making better medical decisions 50%
Writing medical scientific articles 46%
Preparing presentations for the conferences they attend 45%
Making the time spent with the patient more efficient 21%
2.4. Importance of the medical platforms available through the peaceMed portal in the opinion of the respondents
Ovid 41%
Springer Nature 40%
Cochrane (Wiley) 31%
UpToDate 25%
BMJ 21%
McGraw-Hill Medical 13%
Taylor & Francis 12%
5min 12%
ProQuest 10%
Thieme 9%
Cabi 3%
Alexander Street 2%

(Source: Table designed by the author following the research based on the questionnaire)


With respect to the purpose of using documentation platforms, most participants in the survey stated that the information found in international databases allows them to obtain current and relevant content for their workplace practice (78%), and 50% of respondents felt that the information gained helped them to make better medical decisions. Close percentages, namely 46% and 45%, reflect that the participants in the survey use the resources on the platforms to document themselves in order to write scientific articles, respectively to prepare for conferences. A percentage of 21% of the respondents appreciated that they use the information found on the academic platforms to make more efficient the time spent with the patient.


(iii) Investigation of the behaviour of using the documentation resources within the peaceMed Project


The analysis of the statistics of access of the peaceMed platform completes the image on the documentation behaviour of the medical staff in Romania. Of the total of 706 medical staff members (42% of the total target population), who logged on to the peaceMed platform and were active during the project, 64% are female and 36% male. Most users of the peaceMed Project came from hospitals located in large cities of Romania, where there are also renowned Medicine universities, such as: Bucharest – 287 users (41%), Cluj – 99 users (14%), Iaşi – 71 users (10%) and Timişoara – 31 users (4%). The participating medical staff from the other cities represented less than 3% of the total for each locality.

In addition, most users were represented by resident physicians, who accounted for 36.4% of the total (257 users), followed by primary care physicians – 25.5% (180 users), specialist physicians – 24.9% (176 users), teaching staff – 3.3% (23 users) and nurses – 2.7% (19 users). Lower percentages were met by Ph.D. candidates – 2.5% (18 users), students – 1.8% (13 users) and pharmacists – 1.6% (11 users).

The top five health units affiliated to the peaceMed Project, by number of users, excluding individual medical practices (13%), consists of: Floreasca Emergency Clinical Hospital in Bucharest – 5.8% of total users (41), Cluj-Napoca County Emergency Clinical Hospital – 5.5% of the total (39), St. Spiridon County Emergency Clinical Hospital in Iași – 3.7% of the total (26), SUUB Bucharest University Emergency Hospital – 3.4% of the total (24) ) and Timișoara County Emergency Clinical Hospital – 3.1% of the total (22). The ranking of sources accessed for documentation consists of: BMJ and Springer Nature, respectively 18.7% of users of each preferentially used the two resources, Ovid (17.8%), Cochrane (12.2%), ProQuest (7.1%), Thieme (5.5%) and McGraw-Hill Medical (4.7%). The other resources available through peaceMed were accessed by less than 3% of users (Table 3).


Tabel 3. Demographic description of peaceMed platform users and their documentation preferences


Users’ sex Percent
Valid Male 36,4
Female 63,6
Total 100,0






Position held in the health unit Frequency Percent
Valid Nurse 19 2,7
Professor 23 3,3
Ph.D. Candidate 18 2,5
Pharmacist 11 1,6
Primary care physician 180 25,5
Specialist physician 176 24,9
Resident physician 257 36,4
Student 13 1,8
Other 9 1,3
Total 706 100,0

Resources / preferences (>3%) Frequency Percent
Valid BMJ 132 18,7
McGraw-Hill Medical 33 4,7
Ovid 126 17,8
ProQuest 50 7,1
Springer Nature 134 19,0
Thieme 39 5,5
Cochrane (Wiley) 86 12,2
Altă resursă 106 15,0
Total 706 100,0


Pageviews Frequency Percent
Valid 0 4 0,6
> 10000 3 0,4
5000 – 10000 4 0,6
1000-5000 50 7,1
500-1000 50 7,1
100-500 147 20,8
50-100 109 15,4
<50 339 48,0
Total 706 100,0

(Source: Table made by the author after researching the statistics of use of the peaceMed platform)


Regarding the download behaviour, it is noticed that most users downloaded less than 50 pageviews (48%), with an average of 19.8 pageviews, followed by those who downloaded between 100 and 500 pageviews (20.8%), with an average of 220.6 pageviews, and those with a range of 50-100 pageviews downloaded (15.4%). Most downloads, ranging from 50 pageviews, 50-100 pageviews, 1,000-5,000 pageviews and 5,000-10,000 pageviews, were performed by resident physicians, who can also be considered the most active users of the medical content.


Tabel 4. Documentation preferences based on the position held by users of the peaceMed platform

Resource, by preference (over 3%) Position held Total
Nurse Professor Ph.D. candidate Pharmacist Primary care physician Specialist physician Resident physician Student Other
BMJ 3 2 1 1 29 40 54 0 2 132
McGraw Hill Med. 1 0 0 2 8 7 14 0 1 33
Ovid 4 1 1 1 43 32 42 0 2 126
ProQuest 3 0 0 0 19 11 17 0 0 50
Springer Nature 2 0 3 4 33 29 61 1 1 134
Thieme 1 11 6 1 2 8 6 3 1 39
Cochrane (Wiley) 1 0 0 0 28 27 29 0 1 86
Alta 4 9 7 2 18 22 34 9 1 106
Total 19 23 18 11 180 176 257 13 9 706

(Source: Table made by the author after researching the statistics of use of the peaceMed platform)


Regarding the preference of documentation sources, taking into account the position held by medical staff who used peaceMed, it was noted that resident physicians prefer BMJ databases (21% of resident physicians), McGraw-Hill Medical (5% of resident physicians), Springer Nature (24% of resident physicians) and Cochrane (11% of resident physicians), while primary care physicians prefer the Ovid and ProQuest databases, namely 24% of them, respectively 11% (Table 4). The Thieme database was requested preferentially by teaching staff members from Medicine Universities, 11 of the 23 medical staff downloading content from this platform.


(iv) Analysis of the documentation profile of medical staff according to the academic generation to which they belong

In order to achieve a complex documentation profile of medical staff in Romania, the results obtained in the previously presented sections were supplemented with information obtained by the author, following the interview with the staff responsible for documentation in one of the reference Medical University Libraries in Romania. The research tool was represented by the semi-structured interview sheet, and this part of the study aimed to complete the documentary portrait of Romanian medical staff, starting from time t0, considered by the author the affiliation of medical staff to a certain generation according to the time they carried out their university studies, a period that definitely left its mark on the documentation behaviour.

After analysing the results, the author concluded that the profile of medical staff in Romania, in terms of the period in which they completed their university studies, is a necessary step in this study, as the documentation behaviour analysed by the peaceMed Project is in accordance with the educational background, such as: proficiency in foreign languages, acquaintance with versions of specialized terms in languages ​​of international circulation and preference for the use of sources on paper format. In addition, the fact that the resources in the international databases available on the peaceMed platform are predominantly in English is an additional argument to consider the importance of describing the fundamental sources of documentation used by Romanian medical staff during the faculty (for example: textbooks, atlases, posters). Thus, it can be stated that there are two predominant features of medical staff, depending on the period in which they completed their studies, while noticing the existence of two academic generations.

A first feature is specific to those who completed their university studies by the year 2000. Physicians who carried out training and education during this period learned from scholarly literature translated from Russian, French and German, having at their disposal dedicated books and atlases with terminology translated from these languages. Also, the book fund of university libraries and hospital libraries was, for the most part, in Russian, on paper support. The medical staff of this academic generation, over the age of 40 at the time of this research, is generally characterized by an average knowledge of ICT, as pre-2000 schools did not have a developed technical infrastructure, allowing students to become acquainted with information technology, implicitly with the use of the computer. In fact, this category is distinguished mainly by a preference for documentation from materials on paper support and by appealing to library staff to compile the bibliography based on a written file, avoiding the use of search engines.

The second feature is specific to medical staff who completed university studies after 2000, up to the age up to 40 at the time of this study, and who benefited from more openness both for the use of English in academic experience and for getting acquainted with information technology. After this year, English language courses were introduced in universities, which made it easier for them to understand the academic language and get used to the terminology currently used internationally. In addition, opportunities for students, such as Erasmus Inter-Academic Exchange Programmes, have boosted English language learning. Thus, currently, young physicians and those who are still enrolled in tertiary education are facing less and less of the language barrier. Moreover, after 2012, online documentation sources, such as UpToDate, began to be popular, and specialized journals gradually became accessible only on the basis of an online subscription, giving up subscriptions for the print version. Thus, a modern way of searching the scholarly literature was encouraged, which was in line with international practice, and healthcare professionals were able to become acquainted with technology in the learning process (e.g., the use of search engines and advanced search mode, specific to online databases). Furthermore, this academic generation also benefited from the opportunity of European SOP HRD funds, having the possibility, during the period from 2013 to 2015, to obtain funding for doctoral and post-doctoral studies. Also, during the mentioned period, there was a peak of interest for online documentation, from accredited journals and general databases, presenting the latest news of medical research, as a result of the obligation to publish research results in nationally and internationally recognized journals.


  1. Conclusions

An analysis of the results of the questionnaire-based survey among users of the peaceMed platform and the statistics on the use of available resources shows that the general profile of medical staff documenting in current practice from internationally validated auxiliary sources is that of a young medical staff, aged below 40, mainly a resident physician, who completed university education and training after the year 2000. They have at least proficiency in English and are familiar with the use of search engines, and their affiliation is with a health unit located in one of the major cities in Romania, which also has a specific university centre, such as Bucharest, Cluj-Napoca, Iaşi or Timişoara. The time allocated daily for documentation is on average one hour and they consider that the access of medical staff to up-to-date and internationally recognized information is necessary, associating the competitiveness of medical services with up-to-date information of practitioners. The medical staff in this profile prefers for information documents represented by clinical guidelines, specialized books and scientific articles published in academic journals. The three most accessed databases are Springer Nature, BMJ and Ovid, with usage differences below 2 percent, and the average level of accesses is below the threshold of 50 pageviews. In this respect, it should also be noted that, as a whole, according to the profile achieved, the documentation behaviour is adaptable according to the results found, so that the three main preferences for accessed databases, specified at the beginning of the research, through the answers to the questionnaire, namely Ovid, Springer Nature and Cochrane, were subsequently changed, according to usage statistics, to Springer Nature, BMJ and Ovid.

The implementation of the peaceMed pilot project, during the period from April 2017 to December 2017, showed that there is an increased interest from medical staff in Romania for documentation from accredited auxiliary medical sources. Usage statistics exceeded the initial expectations, of 30% of the target population, by 12% and reinforce the statement that medical staff in Romania need in current practice uninterrupted access to internationally validated databases with medical content. The high percentage, of 42% of the total population that directly joined the project, also underlines this statement, coming in the context in which, in 2017, no research projects were funded through competition at national level – there were only submission stages – and no doctoral and post-doctoral fellowship projects have been carried out to boost scientific documentation.

Last but not least, the impact of peaceMed is certainly greater than the figures, given the great potential for disseminating information among our fellow physicians, in daily meetings and discussions related to patient case studies, and among students by teaching staff members.



The author of this study was part of the peaceMed team, being responsible for disseminating the results of the project in the academic environment. The author mentions that the independence in research was ensured, the design of the paper and the interpretation of the data belonging entirely to them; no other member of the peaceMed team was involved in the conduct of this research.


About the Author

Alina Cerasela Avram

Researcher, Bucharest University of Economic Studies




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