1. Biomedical & Health Informatics What’s There to Know? Paul Gorman Chair, AMIA Education Working Group Member, AMIA Education Committee Associate Professor, Oregon Health & Science University Internal Medicine Faculty, Providence Portland Medical Center

2. Two main categories of training Health Professionals Concepts & skills for nurses, doctors, etc. Examples: OHSU SoM, AMIA 10x10 Health Informatics Professionals Clinical Informatics  Supporting Clinical Practice  Supporting Biomedical Research Public Health Informatics Translational Bioinformatics

3. Health Professionals Next class enters practice in 2015 What knowledge and skills will the next generation of nurses and doctors need to use information in healthcare?

4. Undergraduate Curriculum OHSU School of Medicine Learning Objectives Informatics: Retrieve, manage, and use information for problem solving and decision making Reasoning: Reason deductively in solving clinical problems Evidence: Critically evaluate the knowledge base supporting good patient care Communication: Communicate orally and in writing with patients, families, colleagues, and others Quality Gap - Evaluate quality of care; identify gaps in best practices; identify steps needed to close gaps Quality Improvement: understand by way of direct involvement in quality improvement initiatives

5. Health Informatics Professionals Challenges of an integrative discipline

6. Integrative Discipline - Diverse Paradigms & Methods NaturalSocial Theoretical Practical EngineeringManagement Physiology Computer Science Anthropology Information Science Library Science

7. AMIA Activities Applied Clinical Informatics - a new medical specialty by ABMS 3 year RWJF project to develop Development of competencies Education Committee white paper MEDINFO workshop on harmonization AMIA workshop on harmonization 2008 NLM conference on competencies

8. Competencies and Curriculum in Health Informatics Hard to pin down, but worth the effort

9. Domains of Competence Skirt subset: Family Medicine Copyright © 2000 NHS Information Authority

10. SUBSETS Domains of Competence Sliver Subset: Urology Copyright © 2000 NHS Information Authority

11. Domains of Competence Speckle subset: Infectious Diseases

12. Copyright © 2000 NHS Information Authority Specialized Medical Knowledge Building Blocks of Medical Curriculum AnatomySurgeryPsychiatry

13. Integrative Domains Knowledge and Practice Transcend Boundaries Copyright © 2000 NHS Information Authority Clinical Skills, EBM, Informatics, Patient Safety

14. Stuff I’ve Tried Since 1992 Training Settings Oregon Health Sciences University  Tertiary referral center  Full complement residents & fellows Providence Medical Center  Large community hospital  Internal Medicine Residency  Family Medicine Residents

15. Demos and Showcasing Guru demos of informatics tools Lecture or rounds demonstrating tool Example: CPC w/ Decision Support Grade: C- Interesting curiosity  “That’s nice that you can do that” Technology gets in way Exceptions  MEDLINE searching, peer role models

16. Informatics Elective 2 - 4 week block rotation 1-2 residents 1 on 1 tutorials & self-directed Flexible content w/ individual projects Tailored to learner needs and interests Grade: B- Helped individuals - “over the hump” Faculty labor intensive The more focused the better

17. Morning Report Integrate tools into existing conference Large group residents & faculty Guru faculty w/ connected laptop Ad hoc knowledge support (MEDLINE) Grade: C- Occasionally helpful Distraction (prevalence of toxo in llamas) Next day answer worked better

18. Ambulatory Block Selected from menu of 1/2 day clinics Ortho, Ophtho, Podiatry, Informatics… 1 on 1 tutorial Hands-on “see one, do one, teach one” Individualized content Emphasis MEDLINE, QI projects, EBM Grade: B Good feedback, helpful to individuals Faculty labor intensive

19. Noon Conferences Existing schedule (not much space) Large group Sit-and-listen format Overviews of tools (MEDLINE, etc) Grade: B- No felt need by learners for info Not immediately related to work tasks More effective if complements other bits

20. “Informatics & EBM” Rotation Dedicated 2 week block 1 resident, latter half of second year formats: sw training, faculty mentoring, self- directed projects, ‘informatics’ rounds (ICU) Focused content areas Grade: A Time to think, at the right time Meets individual need, impacts others Projects that require skills One-two punch librarian -> faculty training Drop informatics from the name

21. Integrated EHR Use Must learn as part of practice Adequate training and support Learners benefit from added value Diabetes dashboard Quality improvement projects Not really an informatics curriculum, but normative clinical practices Grade: A More and more effective use by residents Not a separate curriculum

22. Stealth Teaching Title and content are clinical Learning objectives are mixed Clinical objectives actually minor Informatics objectives, EBM objectives the point Example: PSA screening Really about sensitivity, specificity, etc. Grade: A Integration into clinical problem and reasoning No need to make case for relevance

23. Role Modeling Routine use in practice Learning objectives on the fly Teachable moments Repertoire of lessons ready at hand Examples Medline, Epocrates, calculators on rounds Grade: A Integration into clinical problem and reasoning No need to make case for relevance

24. Results - My Opinions Failures Open ended Overview, doing it all Faculty champion Exciting technology Doing tech support Dedicated content Getting infrastructure Successes Faculty guided Task driven, focused Peer success model Useful tools Being supportive Integrating content Having infrastructure

25. Take Home Points Be a gardener: plant seeds, nurture them, be patient Get help: medical librarians, pharmacists, others Work with existing infrastructure while planning for what you’ll need Work with existing culture Keep it simple Small steps Explicit objectives Integration model: bricks AND mortar Content: explicit AND embedded