and postgraduate teaching has become increasingly apparent with the widespread development and use of information technology. There is an urgent need for.
International Symposium of Medical Infomiatics and Education R. Salamon, D.'Protti, J. Moehr (eds.), May 1989 University of Victoria, B.C., Canada ISBf^-55058-001-9
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Medical Informatics Education In Medical Schools In The U.K.
Jones R£.,Hedley AJ„NavinLM., Murray KJ., KnOl-Jones R J', Department of Community Medicine University of Glasgow Glasgow G12 8QQ Tofindout more about education in medical informatics in British Universities, we surveyed the 29 medical schoolsintheU-Klinthe autumn of 1986. As a result of this, an interest group has been set up and a workshop held. Medical Informatics in the British medical undergraduate curriculum is still at an early stage. Only thirteen out of 29 schools had one or more persons designated as a lecturer in medical informatics or something similar; six apparently had no teaching of this type at all in the undergraduate curriculum. Most teaching of medical informatics is done in departments of community medicine. Questionnaire design and the use of statistical packages are the most frequently taught (21 and 20 medical schools). Other topics receive little attention; only 11 schools provide teaching on computer-aided decisions; 9 on the practical use of wordprocessors; 7 on problem-oriented records. Specialist postgraduate education in thisfieldis also in its infancy with two Univsrsities (Manchester and the National University of Wales) offering a Master of Science. The Manchester course started in 1986 and the University of Wales course in 1987. We intend to complete a further survey of medical schools and present these results at the conference in 1989. THE UNDERGRADUATE CURRICULUM lOTRODUCTION How Many Designated Lecturers While workers involved in clinical research, Thirteen out of 29 medical schools had one or more epidemiology and some other fields have approached people designated lecturer in medical information the collection and use of medical information in a science or something similar. The range of titles scientific manner, this has not always been the case in routine patient care or the management of health included lecturer in: services. The need for changes in both undergraduate • Medical Information Science and postgraduate teaching has become increasingly • Medical Computing apparent with the widespread development and use of information technology. There is an urgent need for • Medical Data Processing both operational studies and experiments in changing • Computational Methods in Medicine methods of working, clinical data collection and recording procedures and in the use of clinical • Biocomputation information for evaluation of medical care. This kind In 1986, no one had the title Lecturer in Medical of health services research should, in turn, form the basis of teaching programmes. By the autumn of 1986, Informatics it was know that at least three British Universities had "Which Departments designated lecturers with titles similar to medical informatics. However, it was not known what or how It appears that teaching of medical informatics is much was being taught, either in these medical schools divided between departments of community medicine, or in those where teaching may form part of other epidemiology, or general practice (14 out of 29) and courses such as epidemiology, statistics and medical of medical statistics, demography or physics. To find out more, we surveyed all 29 medical departments units (12). In two medical schools, it was schools by sending questionnaires to both medical computer by departments of medical physics and for faculties and to other personnel known to have an undertaken one school the replied stating that there was no interest As a result of the survey, an interest group was teaching of thisfaculty kind at alL set up and a workshop held by the British Medical Informatics Society in November, 1987. This was "What y^s Tkught Tb Undergraduate Medical attended by 16 people representing 10 medical schools and 2 other institutions. This paper summarizes results Students? from the survey and findings from the workshop. We The table below shows the number of medical schools aim to repeat the survey during the autumn of 1988 and (out of 28, one school only teaches postgraduates) present updated results at the conference. which included at least some teaching for each topic in the undergraduate curriculum in 1986, even though in many cases this was only for a handful of smdents on optional courses. It is interesting that 11 medical schools included some simple programming in the undergraduate curriculum, and only seven included the use of problem orientated records. 7
^National Reviews of Medical Informatics and Education
Use of medical records Problem orientated recs Quality of data Questionnaire design Clinical inf. systems Computer-aided decisions
13 7 15 21 10 11
Examples Of m a t Is Taught At the November workshop, Dr. Mark Leaning described teaching at the Royal Free Hospital in London. First year undergraduates receive ten lectures and one practical in medical informatics. The content of this course includes an introduction to the technology, programming for arithmetic calculation, concepts of procedural and declarative languages, files, communications, medical databases, advisory systems, other devices in information technology, and human computer interaction. At Glasgow University, undergraduates receive two seminars as part of the fourth year programme of 22 seminars in community medicine. The course, as a whole, emphasises the need for appraisal of the quality and value of information and these two seminars consider the use of routine records, ways of improving the collection and use of First year 0 -27 Second year 0 -17 Third year 0--5 Fourth year 0 -6 Fifth year 0 -3 Intercalated honours/ 0--31 optional courses information, problem orientated records, questionnaires, computer prompting, and access to information. Practical work is included using an on-line statistical package. How Much ms Ikught In Each Of The Undergraduate Years? The table below shows the range of the estimated scheduled teaching time (in hours) in each undergraduate year amongst 29 medical schools, where this was known. THE POSTGRADUATE CURRICULUM By November 1987, there were only two specialist courses, one at Manchester University and the other at University of Wales, College of Medicine, Cardiff. The Manchester course is a two year pan-time Master of Science in Computational Methods in Medical Science, aiming to train students from medical and' allied health backgrounds in medical data handling, research methods, medical statistics and computing. The first intake was in 1986 and eight students completed the first year. The Cardiff course is a Master of Science in Medical Computing and is usually taken for three years part-time or one year full-time. The first
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Hands-on statistical package Hands-on wordprocessing Hands-on database Hands-on spreadsheet Access to external data bases Simple programming
20 9 5 3 4 11
intake was in 1987 when two students started the course. Twelve other medical, schools included some medical informatics (range 2-75 hours) in courses in public health, community medicine and medical statistics. For example, the Glasgow university (one year fuU time) Master of Public Health course includes one (out of a total of five) module in health informatics. The topics covered include types and sources of information in health care, stirvey and questionnaire design, analysis, audit, evaluation of systems, information systems, expert systems, patient access to information and the .practical use of wordprocessors, database systems, computer-assisted learning, mapping and other packages. DISCUSSION Some common themes became apparent from the workshop. Despite the fact that none of the participants were lecturers in medical informatics there was general agreement that MI was becoming accepted both in Europe and increasingly in the USA as a term which describes the area of interest. There was also agreement that MI should be taught throughout the undergraduate curriculum and that as far as possible it should be integrated with other subjects, particularly the clinical sciences. In particular, we need to be clear about om^ education objectives, and relate the information, techniques, methodologies, and knowledge that we wish to impart to students, to the time scale in which they wiU use it The importance of 'hands-on' experience was stressed time and time again. The idea of workstations which students would routinely use for handling information and learning new ideas, was generally approved. There was discussion about the difficulty of teaching medical undergraduates new methods for collecting, storing, retrieving or manipulating information which are perhaps not tmderstood or supported by their clinical tutors. Ways of tackling this include more in-service training, short courses, and using student projects to help 'transmit' ideas to current practitioners. Many of the ideas of medical informatics, in particular in relation to epidemiology, analysis of data, clinical decision-making and so on have been taught in the UK in departments of epidemiology or community medicine and it is perhaps for this reason that medical informatics has not developed strongly as a separate discipline. However, with the increasing volume of medical information and use of information technology, it would now be beneficial if medical informatics did have a more visible aspect The lack of resources, time and expertise for educating both
International Symposium of Medical Informatics and Education
undergraduates and postgraduates in medical informatics means that it is essential that there is cooperation and collaboration between centres. We aim to set up a special interest group on education in medical informatics with the aim of promoting such collaboration by establishing a directory of workers in the field, publishing and distributing a newsletter, maintaining a bulletin board, and establishing a 'swap-shop^ for software and educational material. By collaboration between centres and by demonstrating the success of educational programmes in other countries, we hope to improve medical informatics education in undergraduate, postgraduate and continuing education.
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