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Informatics Elements of a Medical School
Predoctoral Managed Care Curriculum
This document was written as a course assignment in May of
1996. We were asked to write about informatics components of a
managed-care oriented medical school curriculum. I felt it would
be of interest to other persons working on curricula for medical
informatics and managed care, so I'm publishing it here. Please
send comments and feedback to me (see footer).
See also a related presentation: An
Information Age Curriculum for Medical Students.
I will present recommendations and topics in outline form.
Note that groupware will emerge as a common element of many
recommendations.
Evaluation must be done both of the curriculum and of the
individual student. Informatics tools, including methods for
capturing, storing, analyzing, and presenting evaluations can be
implemented for both forms of evaluation. Evaluation is
fundamental to curriculum design, indeed, many argue it should be
the starting point for the entire process. An explicit
understanding of goals and objectives will determine evaluation,
and evaluation will influence content and methods. Informatics
support for evaluation is fundamental.
Informatics tools are applicable to both development and
implementation. Electronic mail, web tools, and groupware
applications can be used to gather data, solicit input, and
publish results and plans.
Groupware may play a key role in both development and
implementation. The primary criticism of problem-based learning,
other than board scores, is its cost. In the past much teaching
has been voluntary. As physician incomes fall, and clinical
obligations increase, volunteerism may become limited. Even if
physician salaries fall 50%, they will be too costly to employ
for significant amounts of time as small-group leaders. This will
be particularly critical as tuitions for medical education are
forced down. Institutions such as Duke's Fuqua school of business
[1] have used groupware solutions to do case-based learning in
the MBA program. Similar strategies may be applicable to clinical
problem-oriented education, and may allow a much greater
student/teacher ratio and less contact time.
Computer-assisted instruction (CAI) has been felt to be
applicable to medical student education. In practice, this has
been problematic. The rise of the world-wide-web and Java, and
emerging standards for multimedia and virtual-reality, may solve
age-old problems with platform dependency and distribution.
Web-based CAI should be evaluated and the possibility of medical
school consortia evaluated.
Medical informatics, including information technology, has
many implications for curriculum content, both as a topic and as
a facilitator of other topics. I'll consider the range of
possibilities in outline form, with selected comments.
- electronic medical record (EMR): Many, if not all
students, will be using EMRs and associated knowledge
tools by the time of residency completion. Orientation
and underlying concepts should be a part of the
curriculum.
- world wide web (WWW): The WWW is no fad. In one form or
another, it will be ubiquitous within the decade.
Students should be knowledgeable users.
- email and groupware: asynchronous distributed
communication will be fundamental to medical practice.
- database and data analysis: Physicians will be either
analyzing their own practices or interpreting other's
analyses, including outcomes and process measures.
Familiarity with methodologies and tools will be
important.
- analysis and understanding of systems level error:
Understanding the root causes and inevitability of error
in medicine is perhaps the most important single
contribution that can be made to student education. Leape
et al describe the issues well [2,3].
- process analysis and improvement: knowledge of CQI and
reengineering
- outcomes measurement and understanding of methodologies
- project management: physicians will be participating in,
and leading, many large and small projects. The
fundamentals of project management will be very useful.
- Bayesian Analysis (Positive Predictive Value),
simulations of testing results.
- use and misuse of guidelines
- patient-customized guidelines vs. expert systems
- reminders and rules vs. expert systems
- industrial model of decision support: "Just in Time
Information" [4]
- scanning vs. pursuit methodologies
- use of secondary resources, digests, newsletters, web
material. Increasingly clinicians, particularly in
primary care, will be relying upon intelligent digests of
the primary literature (JFP Journal Club, ACP Journal
Club, Medical Letter, Pediatric Notes, etc.) Instruction
in the use and misuse of these tools is important.
- appraisal of information sources, both secondary and
primary
- uses and limitations of the medical literature
- analyzing practice data
- simulating practice parameters and outcome data
- judging validity of data and limits to interpretation.
(informatics related)
- Electronic data and patient privacy
- Advocacy of the patient vs. advocacy of the population
vs. advocacy of the employer vs. advocacy of self: who
does the physician serve?
- History of Medicine: history of technological transitions
and social/professional adaptation, historical record of
physicians serving the global interests of society rather
than the specific interests of the patient.
- Duke Fuqua Global MBA http://www.fuqua.duke.edu:80/programs/gemba/
- Leape L. Error in medicine. JAMA 1994 Dec
21;272(23):1851-7.
- Leape L, Bates DW, Cullen D, et al.. Systems analysis of
adverse drug events. JAMA 1995 Jul 5;274(1):35-43.
- Elson R. Are Reminder systems a form of CME? JAMA 1995
Dec 20; 274(23):1836
Author: John G. Faughnan.
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