EUNIS97, Grenoble (France) 9-11 September 1997
Ref: 022807
An Approach to Teaching Medical Informatics to Students of Medicine
1. Introduction
One of the most recent definitions of medical informatics defines it as the
discipline concerned with the systematic processing of data, information and
knowledge in medicine and health care. The domain of medical informatics
covers computational and informational aspects of processes and structures in
medicine and health care.
The ultimate objective of informatics in health care is the achievement of the
highest possible level of health of an individual, a nation and the world at
large. The ultimate goal should always be to improve the quality of health care,
and of research and education in medicine and health sciences.
2. Aims of the education in medical informatics for students of medicine
Medical computing has been around for more than 30 years. Medicine and
medical information has been around since the time of Hippocrates. Until
recently, however, most doctors and other health care professionals knew
virtually nothing of medical computing and very little of medical information
science - and until very recently this did not matter much. However, medical
knowledge was simple to know and simple to handle, there was not need for
knowledge of technology or computing.
Of course this is now all changed. Modern medicine is complex, often driven
by technology, and it is impossible for an individual to learn and retain all the
necessary knowledge. Some sort of help is needed, and this is widely
recognised. It is already clear and generally acknowledged that doctors and
other health care professionals (nurses, midwives, health care managers etc.),
will need a thorough working knowledge of the new technology in order to
practise medicine effectively or to manage a hospital effectively. It is observed
that health care professionals are increasingly confronted with computer
systems. Since the professional will always be responsible for the consequences
of the use of the results of medical information processing it is important that
the students in medicine will be taught both the fundamentals of medical
information processing and the essentials of existing applications. In medical
education the most important skill for medical students to acquire is the ability
to identify gaps in their knowledge and go about finding for themselves the
answers to the problems they face.
So, it is obvious that students of medicine should study medical informatics.
This basic knowledge of information management physicians should have as
early as possible in their career. They should have this from the moment they
decide to study medicine. So, the place of medical informatics in the
undergraduate curriculum of students of medicine is of great importance.
However, teaching medical informatics is not so easy. There is actually no
teaching material available which is specifically tailored to the needs and
understanding of medical students, doctors and other health care professionals.
Of course, there is a great number of available material which claims to teach
information science and technology, but this is usually general and in most
cases not oriented towards medicine. Most of the material available in this area
is completely unintelligible to the average doctor or medical student. For these
reasons, the suggestion arose that a special course should be organised.
In fact, this is more difficult than it seems for several reasons.
First, there is no such thing as the average medical student in computing terms.
Some students have never seen a computer, others can be classified as
computer consultants. Some students appreciate quite easy the role and the
importance of the computer technology and knowledge, others keep on
wondering why should they obtain this knowledge since their aim is to become
doctors or other health care professionals. So, one of the aims of the course in
medical informatics must be to explain the need and the importance of medical
informatics knowledge to the future medical professionals and at the same time
to comply with the knowledge which the students already have or do not have.
There is a second and more important problem - that of providing the students
with up to date material. The world of information technology moves with
bewildering speed (even more so than the medical world). So, there is always
the danger, that teaching material, a book or even a course itself will be out of
date before it is published or presented to the students. So, another aim of the
education in medical informatics must be to present always an up to date
knowledge.
Another problem rises from the nature of the medical education. It is
acknowledged that medical education today requires that students accumulate
i.e. memorise a multitude of facts. Because of the explosive growth of
biomedical knowledge more and more of this knowledge is crammed into the
medical curriculum. Ever since students enrol to a medical university or other
school for health care professionals, they are forced to learn as soon as
possible how to memorise that multitude of facts and this somehow forces them
to forget, or rather give up thinking, reasoning and making decisions. Of
course, this is obvious. It is much easier for a person with a good memory to
memorise the facts than spending some time on considering them. It is
however impossible, and also undesirable for a student to learn everything that
can be learned. On one side the knowledge presented to the medical students
during their formal education will be more or less obsolete at the time they will
practice medicine (the duration of this formal education is at least 6 years). On
the other hand, it is difficult to teach medicine of the future, since most of the
futures technology is probably non-existent today. Having in mind the above
considerations as well as the fact that computer science is the last science that
can be learned by memorising, trying to present it to memorising students is
already a challenge. It is time to de-emphasise the memorisation of facts in
favour of independent learning. So, another aim of the education in medical
informatics must be to prepare the course and the teaching material in such a
form and contents that it should be understandable and acceptable by the
students and at the same time it must awaken their abilities to think. It should
help the students develop skills that will enable them to learn throughout their
professional lives.
The skills associated with information management are essential to facilitate the
acquisition of fundamental knowledge, basic learning techniques, clinical skills
and methods for the critical appraisal and effective use of research literature.
The student has to be taught how to manage information so that he himself
can acquire the necessary information when needed. The student should be
required to seek information, rather than be given information. Since more
and more information can be obtained via information systems the student
should be taught how to manage this information systems. So, another aim of
the education of medical informatics, which according to the author is the most
important, is to facilitate the education process by providing the tools and
methods of computer aided learning both for students and teachers. Of course,
this requires that the educational tools, i.e. information systems, different
computer applications, data bases, knowledge bases etc. should be available to
all teachers and all departments. How this can be organised is not the subject
of this paper.
3. Education in medical informatics for students of medicine
Here is one proposal for a general curriculum for teaching medical informatics
to students of medicine in the Medical University in Varna. It may be divided
in two modules.
Module 1 - general introduction (Introduction to informatics and basic
computer skills)
Module 2 - methods and applications (Introduction to medical informatics)
3.1. Module 1 - Introduction to informatics and basic computer skills
This module covers the basics of informatics, the general knowledge, or basic
computer skills. The aim of this module is to give the students the general
knowledge of computers and computer applications, so that after going
through this module they would freely use them.
The general introduction should cover the following items :
- Classification of the applications:
A classification of the different applications of computers, computer
technology and information systems in medicine and health care is discussed.
In this context the roles of man and computer in information management in
the field of medicine and health care are explained. Also the correspondence
with applications elsewhere in society is discussed.
- Systems and hardware:
The logical and physical design of computer systems is discussed. The
various types of computer systems and peripherals are presented. Also an
overview of the different operating systems and computer languages are
discussed. Attention is paid to basic computer skills covering operating systems,
word-processing, spreadsheets, representative graphics, statistics, databases,
networks, communication skills, bibliography and different commercially
available software packages.
- System theory:
A formal approach to the general system theory is presented including
system design and life-cycle of a system. The role of the user in a software
development process is discussed.
- Information theory:
A formal approach to the general information theory is presented
including aspects of information (syntactic, semantic and pragmatic).
3.2. Module 2 - Introduction to medical informatics
This module covers the basics, or general knowledge of medical informatics. Of
course, as it is aimed to non-computer specialist it should apply with their
capacity and abilities. The aim of this module is to increase the sophistication
of the future health professionals, so that they know, understand and use in
the best possible way the available resources. Students should gain general
knowledge on medical information and medical data, how to organise this data
so that it will be available and helpful when needed, how to assess the quality
of clinical knowledge they are acquiring. This module is divided into two parts
- (1) methods and (2) applications.
3.2.1. Methods
- Data documentation
- Data registration, documentation, transfer and communication
Medical data and medical information are discussed in terms of
types, utilisation, quality and communication. The process of data acquisition,
collection, documentation, transfer and methods of storage of medical data in
databases are described. Various types of data organisation are discussed.
Aspects of structured data entry and natural language processing, recording of
temporal patient data, electronic interchange of patient data, interaction
between users and computers are presented. Various topics such as ownership,
protection, security, confidentiality, accuracy, integrity, reliability and
availability of data are discussed.
- Databases:
Databases in health care are presented. Classification and coding
systems are introduced. Attention is paid to data storage and retrieval, query
languages, dictionaries and thesaurus, knowledge bases. It should be clarified
that in all areas of society data base management systems with industry-
standard query systems are used, including standards for the compact storage
of data, signals and images. Health care is no exception in this respect. The
main difference between applications in health care and other areas in society
is the wide variety of different patient data that are stored, from purely
financial items to radiological pictures, and the large number of potential users
of these data. The complexity of the application of the medical data bases
coming from the semantic interconnection of these data and the wide variety of
different goals that are to be served is explained.
- Computer-based patient records:
The transition from paper based medical record to completely
electronic patient record is discussed. Advantages and disadvantages of CPR
are pointed. The basic principles, structure, and models of computer based
patient records are presented.
- Signal and image processing:
A description of signals and images in medicine is given. The process of
analogue to digital conversion is discussed. The process of signal and image
analysis, pattern recognition, classification and interpretation of bio-signals and
medical images is explained.
- Decision support:
Decision support systems in medicine and health care as computer
programs designed to help health professionals make clinical decisions or
systems for information management, for bibliographic retrieval and for using
patient-specific data are explained. Phases in the diagnostic/therapeutic process
(observation, diagnosis, therapy) are explained. Attention is paid to decision
support methods : deterministic, statistic and heuristic. The role of decision
support systems in relation to patient management, diagnostics, therapy
choices, prognosis etc. and the evaluation of these systems are discussed. The
processing of data, leading to information, with the help of available
knowledge is explained. It is also pointed that in health care many decision
problems deal with real patients and that is why they are unique and
sometimes highly individual. Therefore one can never achieve full automation
of the decision making and should use techniques with built-in man-machine
interaction. The questions of formalization of medical knowledge, using of
reference standards (knowledge of multiple experts), integration of computer-
based patient records with decision support systems, evaluation of decision
support systems are discussed.
- Information systems:
The basic functions, aims and architecture of information systems in
medicine and health care are discussed. Attention is paid to the problem of
defining the requirements and the choice of an appropriate information
system. Some basic problems concerning access and security of medical data
are explained. General legal issues are explained.
3.2.2. Applications
The applications are closely related to the methods and cover the topics
described above. They provide for the visualisation (demo versions) or
practical experience (whenever possible) with the available software. They can
be divided into three main branches :
- Data. The students get acquainted with various types of medical data,
systems for standardisation and classification of medical data (e.g. UMLS
diagnostic codes, SNOMED, ICD-10, ICPC etc.), different types and structure
of computer-based patient record, and databases in medicine and health care.
- Information systems. Information systems in use in hospitals, in
departments or clinics etc. or systems in use by personal physicians (general
practitioners). The students get acquainted with hospital information systems,
computer systems in different clinics, clinical laboratory, pharmacy, nursing
applications, clinical/epidemiology research systems as well as computer systems
for biosignals -EEG, ECG and medical images - computer tomography,
magnetic resonance imaging, digital subtraction angiography, picture archiving
and communication systems etc.
- Decision support. The students get acquainted with the main parts of a
decision support systems - knowledge base, where the medical knowledge for a
domain is stored, a patient database, where clinical data are stored and an
interface engine, which is a computer program that uses medical knowledge
and patient data in the problem solving process. They get acquainted also with
some tools and techniques used in building medical decision support such as
(a) clinical protocols, (b) statistical database analysis, (c) mathematical models,
(d) pattern recognition, (e) probability calculations, (f) decision theory, (g)
symbolic reasoning.
Medical University Varna,
Dept.Public Health and Biostatistics,
55 Marin Drinov str., 9002 Varna, Bulgaria
E-mail: somed@mbox.digsys.bg
Copyright EUNIS 1997 Y.E.