Biomedical Informatics in the Education of Physicians

WHEN I FIRST MEET WITH PRECLINICAL MEDICAL students, I make a point of asking them what they believe will receive the greatest focus of their attention once they are in clinical practice. The most common response, not surprisingly, is patients, and yet it is clear to experienced practitioners that the correct answer is information—in the service of their patients. The need for information underlies essentially all clinical work: the questions asked during a patient history, the tests ordered, the books read, and the questions asked of colleagues. A key correlate to information is knowledge, that elusive concept that justifies all the years of education and training, and that provides the background sense of what is true that allows gathering and interpreting information appropriately. Clinicians often start with data (eg, “Mr Jones’ creatinine is 5.2 mg/dL”), those individual elements that combine to allow a synthesis of observations with what is known in order to create summary statements of information (eg, “Mr Jones has renal failure”). Despite the central role of data, information and knowledge in health and medicine management and use of such concepts has generally not been singled out as a subject of study during medical education. Medical students gather data, access information, and apply the remarkable amount of knowledge that they are acquiring but tend not to study these notions as formal concepts. Much is left to osmosis, abstract introspection about good judgment, and observation of mentors. These issues are touched on when teaching clinical decision making—test interpretation and predictive value, cognitive biases, and the like—but a coherent approach to information and knowledge management and their application has generally not been part of medical education. The notion that these concepts can be independently studied and taught was energized in the last half century by the rapid proliferation of information technology and its gradual adoption in health care settings. Today, information and knowledge management are often equated with the role of computer systems, although the concepts have been relevant to clinical practice since the time of Hippocrates. A formal discipline has emerged over the last few decades, initially termed “medical informatics” but subsequently broadened to “biomedical informatics” when its relevance to the basic medical sciences, as well as clinical sciences, became clear. A recent consensus process by the American Medical Informatics Association has resulted in the following evolving definition of the field, which notably does not include any mention of the computing technology that is often a modern external manifestation of the discipline: “Biomedical informatics . . . is the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making motivated by efforts to improve human health.” Biomedical informatics is generally viewed as having 4 major areas of application: (1) molecular and cellular processes: bioinformatics; (2) tissues and organ systems: imaging informatics; (3) individuals and patients: clinical informatics; and (4) populations and society: public health informatics. Together, the latter 2 areas are often referred to as health informatics. Other informatics areas are generally subsumed by 1 of these areas (eg, nursing informatics) or are at intersections among 2 or more of them (eg, biomolecular imaging, pharmacogenomics, or consumer health informatics). Cross-cutting methods, such as cognitive science, can play a central role in medical education broadly, as well as in biomedical informatics. Given the central role of informatics notions in clinical practice, including health care technology, many observers have argued that the discipline ought to be taught to physicians in training, from the preclinical years through graduate medical education and beyond. The Association of American Medical Colleges first called for inclusion of informatics in the medical curriculum in the General Professional Education of the Physician report in 1984. Informatics education has been embraced by colleagues in nursing education more extensively than in medicine, with nursing informatics now generally a standard component of the