Medical Student Education in Biomedical Informatics Howard Silverman, MD MS 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 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 objectives 1 Subsequently incorporated core content for the sub-specialty of clinical informatics 2 Lessons learned were incorporated into revision implemented in 2009 Sources: 1 Association of American Medical Colleges Medical School Objectives Project, ed. Report II Contemporary Issues in Medicine: Medical Informatics and Population Health. Washington, DC: AAMC Gardner 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 * PhoenixTucson P value † 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 25 (100)16 (50)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 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) NBME

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)

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