Training digital natives to transform healthcare: a 5-tiered approach for integrating clinical informatics into undergraduate medical education

Expansive growth in the use of health information technology (HIT) has dramatically altered medicine without translating to fully realized improvements in healthcare delivery. Bridging this divide will require healthcare professionals with all levels of expertise in clinical informatics. However, due to scarce opportunities for exposure and training in informatics, medical students remain an underdeveloped source of potential informaticists. To address this gap, our institution developed and implemented a 5-tiered clinical informatics curriculum at the undergraduate medical education level: (1) a practical orientation to HIT for rising clerkship students; (2) an elective for junior students; (3) an elective for senior students; (4) a longitudinal area of concentration; and (5) a yearlong predoctoral fellowship in operational informatics at the health system level. Most students found these offerings valuable for their training and professional development. We share lessons and recommendations for medical schools and health systems looking to implement similar opportunities.

Library involvement in health informatics education for health professions students and practitioners: a scoping review

OBJECTIVE

The purpose of this scoping review is to evaluate the extent of library or librarian involvement in informatics education in the health domain.

METHODS

We searched eight databases from their inception to 2019 for reports of informatics educational activities for health professionals or health professions students that involved library staff or resources. Two reviewers independently screened all titles/abstracts (n=2,196) and resolved inclusion decisions by consensus. From the full text of the 36 papers that met the inclusion criteria, we extracted data on 41 educational activities.

RESULTS

The most frequent coded purposes of activities were "teaching clinical tools" (n=19, 46.3%) and "technology" (n=17; 41.5%). Medical students were the most frequent primary audience (34.1%), though 41.5% of activities had multiple audiences. Evaluation was reported for 24 activities (58.5%), only a few of which assessed short or post-activity impact on attitudes, knowledge, or skills. The most common long-term outcome was applying skills in other courses or clinical experiences. Thematic analysis yielded three areas of outcomes and issues for the library and organizational partners: expanded opportunities, technology and resource issues, and value demonstration.

CONCLUSIONS

Limited published examples of health informatics educational activities provide models for library roles in informatics education. More librarians should report on their informatics educational activities and provide sufficient details on the interventions and their evaluation. This would strengthen the evidence base about the potential impact of libraries within informatics education.

The organization and content of informatics doctoral dissertations

This article offers suggested guidelines for graduate students who are embarking on informatics doctoral studies and anticipating the dissertation research and its documentation. Much of the guidance is pertinent for writing dissertations in other disciplines as well. The messages are largely directed at doctoral students, but some elements are also pertinent for master's students. All are relevant for faculty research advisors. The value of the dissertation is often underestimated. Too often it is seen as a hurdle to be overcome rather than an opportunity to gain insight into one's own research and to learn how to communicate effectively about it. Ideas that have been ill-formed often do not gel effectively until one tries to write about them. The main lesson is that the preparation of a carefully crafted, rigorous, logically evidence-based, and influential dissertation can be remarkably rewarding, both personally and professionally.

The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials

OBJECTIVE

The US Agency for Healthcare Research and Quality funded an evidence report to address seven questions on multiple aspects of the effectiveness of medication management information technology (MMIT) and its components (prescribing, order communication, dispensing, administering, and monitoring).

MATERIALS AND METHODS

Medline and 11 other databases without language or date limitations to mid-2010. Randomized controlled trials (RCTs) assessing integrated MMIT were selected by two independent reviewers. Reviewers assessed study quality and extracted data. Senior staff checked accuracy.

RESULTS

Most of the 87 RCTs focused on clinical decision support and computerized provider order entry systems, were performed in hospitals and clinics, included primarily physicians and sometimes nurses but not other health professionals, and studied process changes related to prescribing and monitoring medication. Processes of care improved for prescribing and monitoring mostly in hospital settings, but the few studies measuring clinical outcomes showed small or no improvements. Studies were performed most frequently in the USA (n=63), Europe (n=16), and Canada (n=6).

DISCUSSION

Many studies had limited description of systems, installations, institutions, and targets of the intervention. Problems with methods and analyses were also found. Few studies addressed order communication, dispensing, or administering, non-physician prescribers or pharmacists and their MMIT tools, or patients and caregivers. Other study methods are also needed to completely understand the effects of MMIT.

CONCLUSIONS

Almost half of MMIT interventions improved the process of care, but few studies measured clinical outcomes. This large body of literature, although instructive, is not uniformly distributed across settings, people, medication phases, or outcomes.