Medical Student Education
in Biomedical Informatics
Howard Silverman, MD MS
howards@u.arizona.edu
Associate Dean for Information Resources
and Educational Technology
&
Professor, Family and Community Medicine
The University of Arizona College of Medicine – Phoenix
Clinical Professor of Biomedical Informatics
Arizona State University
Topics: Medical Student Education
in Biomedical Informatics
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Biomedical Informatics Defined
Phoenix BMI Educational Program
Course Evaluation & Student Assessment
Lessons Learned
Future Directions
The Goals
• Enable informed automation (clinical decision
support) to decrease the cognitive load on
clinicians so they can better attend to
communication, relationship and information
management
• Respond to national movement toward individual
and collective responsibility and interoperability
(“send data to others as you would have them
send data to you”)
• Increase quality, safety and efficiency
Biomedical Informatics (BMI) Defined
• Biomedical informatics is the scientific field that
deals with the storage, retrieval, sharing, and
optimal use of biomedical information, data, and
knowledge for problem solving and decision
making.
• Biomedical informatics touches on all basic and
applied fields in biomedical science and is closely
tied to modern information technologies, notably
in the areas of computing and communication.
Source: Shortliffe EH and Cimino JJ (eds). Biomedical Informatics Computer
Applications in Health Care and Biomedicine, 3rd edition. 2006, page 24.
Biomedical Informatics Defined
• Biomedical informatics sub disciplines
– Bioinformatics
– Imaging Informatics
– Clinical Informatics
– Public Health Informatics
• BMI is much more than
– Information Literacy
– Using EHRs
Phoenix BMI Educational Program
• Curriculum designed in 2005, implemented in
2007
• Initially based on MSOP BMI educational
objectives1
• Subsequently incorporated core content for the
sub-specialty of clinical informatics2
• Lessons learned were incorporated into revision
implemented in 2009
Sources:
1Association of American Medical Colleges Medical School Objectives Project, ed. Report II Contemporary Issues in
Medicine: Medical Informatics and Population Health. Washington, DC: AAMC. 1998.
2Gardner RM,
Overhage JM, Steen EB, et al. Core content for the sub-specialty of clinical informatics. J Am Med
Inform Assoc. 2009;16(2):page 154.
Phoenix BMI Educational Program
• 45+ hours of required instruction in BMI topics integrated
into all curricular components across all four years
– Basic science lectures in system-based blocks
– Single week BMI blocks
– Case based instruction, Doctoring, Capstones, Intersessions,
Scholarly Projects, Elective
• Carefully sequenced
– MS1 Year – focus on data (acquisition, storage, manipulation,
extraction)
– MS2 Year - builds on this foundation to focus on decision making
and decision support
– MS3 Year - data and decisions are combined to discuss key
issues related to safety and quality
– MS4 Year - elective
Course Evaluation & Student Assessment
• Course evaluations:
– Bimodal responses from students
• I don't think I learned anything in this block that I'll be
able to apply in my career
• exposure to important, yet rarely addressed, aspects of
clinical medicine
– Overall positive responses regarding BMI labs
• data acquisition, storage, manipulation, extraction
• decision analysis
Course Evaluation & Student Assessment
• Student Assessment:
– NBME-style questions on standard block exams
– Group projects (decision tree construction and
analysis during BMI block)
– Structured observations of EHR use during
Doctoring course (to be implemented this spring)
– Student self-assessments
Course Evaluation & Student Assessment
BMI Student Self-Assessment Scores (MS3 year end)
Question*
I am comfortable defining Biomedical Informatics.
I understand the relevance of Biomedical Informatics to clinical practice,
biomedical science, and medical education.
I understand barriers to effective implementation and acceptance of clinical
systems.
I can utilize a variety of mobile (PDA, online) decision support tools and
determine which is best suited to various tasks.
I am enthusiastic about employing Biomedical Informatics techniques and
tools in patient care.
I can explain the role of informatics in the cycle through which we learn from
patient care and feed back the results from those lessons for practice in the
future.
I have a reasonably good understanding of the legal and ethical issues
involved in the use of clinical systems.
I understand how to develop information habits to maintain currency in
emerging technologies and biomedical device
I can access evidence-based resources through search engines and other
means.
I am able to use information technologies to support virtual teamwork.
Total no. (%) responding
*
†
Phoenix
1.76
Tucson
2.50
P value†
.0002
1.50
2.00
.0089
1.72
2.19
.0174
1.44
1.81
.0314
1.60
2.13
.0341
1.76
2.13
.0673
1.76
2.06
.0897
1.76
2.00
.1176
1.36
1.63
.1357
1.76
25 (100)
1.94
16 (50)
.3518
N/A
Responses were given on a four-point Likert-type scale: 1 = strongly agree, 2 = agree, 3 = disagree, 4= strongly disagree.
Calculated using an unpaired t test utilizing the number of responses, standard deviation, and mean.
Lessons Learned
• Finding curricular hours
NBME • Student and faculty perceptions of BMI
training
• Computer use versus informatics
competency
• Longitudinal student assessment of BMI
instruction
• Clinically trained BMI faculty are crucial
for content creation and teaching (Clinical
Subspecialty will help)
Future Directions
• Comprehensive longitudinal evaluation
• Impact of the pending subspecialty of clinical
informatics
• Access to “Educational EHR”
• For more info, see:
The Evolution of a Novel Biomedical Informatics
Curriculum for Medical Students
Howard Silverman, MD, MS, Trevor Cohen, MBChB, PhD, and
Douglas Fridsma, MD, PhD
Academic Medicine (epub end of November, in print January 2012)
The Dawn of a New Day…