EDITORIAL

Informatics in medical education

In times of rapid change, experience is your worst enemy.

(Getty, 1999)

How should medical students and graduates learn to

`acquire, process and use information’ in the information

age (Greenes & Shortliffe, 1990; camis.stanford, 1999)?

In the UK the council of medical deans etc. has just

produced a report (CHMS Joint Working Group, 1998)

and the NHS executive has produced recommendations

about the integration of clinical information and educa-

tion (NHS Executive Bristol, 1999). The International

Medical Informatics Association (IMIA) is about to

produce a repor t (Scheduled for N ovember 1999 ,

contr ibutions via www.rzuser, 1999) and the spr ing

meeting of the American Informatics Association (AMIA)

dealt with this topic (www.imia, 1999).There is widespread

consensus that knowledge and skill levels need to rise in

the medical profession because of changes in society and

the improved decision making the new technologies offer

(Friedman, 1996; www.aamc, 1999). Recommendations

based on evaluated courses and programs vary across

different types of professional specialization and stage of

career progression but some broad principles apply, taken

from informatics and educational theory. These may be

summarized in the following sequence: de ® ne, select,

formulate, perform, evaluate, communicate.

The educational needs of any individual or group need

to be identi® ed before courses or programmes to address

those needs are developed. Medical students have been

describes as norms, nerds and phobes (Allery et al., 1997).

Nerds, self-evidently, need no training at all and may be

useful resources for other students (and teachers). Norms

need only an introduction of the facilities available. They

may need some encouragement and support. Phobes may

never have touched a computer and may not wish to do so.

In professional practice there may be attitudinal objectives

to address before any intervention is possible. Few medical

professionals need the high-level programming skills of

applied computing specialists, but most will need some skills

to function and develop.

Many electronic learning aids have already entered

mainstream medica l education , supp lemen ting the

traditional methods of the early years and the apprentice-

ship model of the clinical years (Coiera, 1998; reddwarf,

1999). Problem-based underg raduate curr icula and

postgraduate evidence-based medicine for practitioners

are even more avid consumers of electronics tools (basi-

l.otago, 1999; www.updateusa, 1999). Newer methods of

learning using informatics tools include assymmetric

learning technologies (e.g. email support of students

remote from central support), shar ing tools across

disciplines within universities and across widely spread

learning institutions, for example in the public health

supercourse (www.pitt, 1999). Selection of the appropriate

learning technology is less straightforward because few

published evaluations of innovative tools are available.

Evaluation in this sense means the ability to infer outcomes

from speci® c mechanisms in given contexts. Some infor-

matics tools are adopted simply because they are new

(Pawson & Tilley, 1997). Rigorous evaluation will tell us

whether they are really tools or simply toys. Once the

results are known, they can be used to de® ne the place of

the new technology and further re® ne that learning activity

(Wilkes & Bligh, 1999).

Some informatics tools are easily implemented by

learners with little input from teachers. But some require

adaptation or careful integration to meet speci® c individual

or local needs if learners are to optimize the potential

bene® ts. One of the difficulties experienced worldwide in

this area is addressing the learning needs of teachers (Sulli-

van, 1999). One of the aphorisms heard at the Chicago

conference was that `People don’ t use computers: organiza-

tions do’ . Using informatics to learn and practise medicine

needs to be built into the structures of our medical schools

across all learning sites. There will be an increased

emphasis on multidisciplinary learning in this new environ-

ment. Intranets linking teaching mater ials, reference

sources and clinical records are already developing (Coiera,

1998).Web-based access to the learning hubs is also highly

desirable.

Periods of rapid change are threatening and exhilarating.

Medical teachers need to base their responses to innovative

opportunities in the appropriate theoretical framework. Since

that framework is inadequately de® ned, medical teachers

must take the opportunities our new experiences offer for

evaluation and publication of our results.

References

ALLER Y, L.A., OWEN , P.A. & ROBLING , M.R. (1997) Why general

practitioners and consultants change their clinical practice: a critical

incident study, British Medical Journal, 314, p. 870. CHMS JOINT

WO R K IN G G R O UP (1998) Infor matics in M edical and Dental

Underg raduate Curricula (London, NHSE).

COIERA, E. (1998 ) Medical informatics meets medical education,

MJA, 168, pp. 319± 320.

FR IEDM AN , C.P. (1996) The virtual clinical campus, Academ ic

Medicine, pp. 647 ± 651.

GETTY, J.P. (1999) Quoteland. http://www.quoteland.com/quotes/

author/186.html accessed 6 July 1999.

GREENES, R.A. & SHO R TLIFFE, E.H. (1990 ) Medical informatics: an

emerging academic discipline and institutional priority, Journal of

the American Medical Association, 263, pp. 1114 ± 1120 .

http://basil.otago.ac.nz:800/ accessed 8 July 1999.

http://camis.stanford.edu/whatisinformatics.htm accessed 8 July 1999.

http://reddwarf.qub.ac.uk/hci/ accessed 8 July 1999.

http://www.aamc.org/meded/msop/informat.htm accessed 8 July 1999.

http://www.imia.org/ accessed 8 June 1999 .

http://www.pitt.edu/ ~ super1/ accessed 6 July 1999 .

Medical Teacher, Vol. 21, No. 6, 1999

ISSN 0142-159X (Print)1466-187X (Online)/99/060541-02 ½ 1999 Taylor & Francis Ltd 541

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y M

ichi

gan

Uni

vers

ity o

n 11

/08/

14Fo

r pe

rson

al u

se o

nly.

http://www.rzuser.uni-heidelber.de/ ~ d16/rec.htm accessed 8 July

1999.

http://www.updateusa.com/scharr.htm accessed 8 July 1999 .

NHS EXECUTIVE BRISTOL (1999) Learning to Manage Health Informa-

tion (Bristol, NHS Executive).

PAW SON, R. & TILLEY, N. (1997) Realistic Evaluation (London, Sage).

SULLIVAN , F. (1999) Informatics and evidence based practice, in: J.

Dent (Ed.) A Practica l Guide for Medical Teacher s (London, Radcliffe

Press).

W ILKES, M. & BLIGH, J. (1999 ) Evaluating educational interventions,

British Medical Journal, 318, pp. 1269 ± 1272 .

DR FRANK SULLIVAN

Professor of Research & Development in

General Practice and Primary Care,

University of Dundee,

Tayside Centre for General Practice,

Kirsty Semple Way, Dundee DD2 4AD, UK

Email: f.m.sullivan@dundee.ac.uk

F. Sullivan

542

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y M

ichi

gan

Uni

vers

ity o

n 11

/08/

14Fo

r pe

rson

al u

se o

nly.