Are medical students ready for the digital age

There is no doubt that medicine has entered the digital age. The rapid advances in technology have and will continue to change the way medicine is practiced. Many colleagues carry handheld devices that bring medical information to the point of care. More examination rooms are equipped with computers. In hospitals, computers with Internet access are on every ward. Radiologists read their films on computer monitors rather than light boxes. Fiberoptic technology has made endoscopy, pharyngoscopy, and laparoscopy possible. The need for physicians who can speak technologic language is so great that a special field of study has emerged, called medical informatics, “the scientific field that deals with biomedical information, data, and knowledge—their storage, retrieval, and optimal use for problem-solving and decision-making.”1 Graduate schools across the country are creating master's and doctoral programs to meet the demand. As a medical informaticist, I could argue that this degree program is more intrinsic to the current practice of medicine than either the master's of public health or of business administration dual-degree program. Instead, these skills are so critical that training in medical informatics should be required at the medical school level. The need for this kind of formal training has long been recognized. In 1984, a special panel of the Association of American Medical Colleges, called General Professional Education of the Physician, identified medical informatics as an area requiring educational opportunities to prepare future physicians for practice in the 21st century.2 But little was accomplished following this recommendation, perhaps because no one knew how to implement such changes. The Association of American Medical Colleges recognized that this issue would present special challenges to medical schools that wished to design a curriculum that would integrate these skills. The association, therefore, proposed the Medical School Objectives Project (MSOP), which would develop suggestions for learning objectives, experiences, and implementation strategies to integrate medical informatics into medical school curricula.3 Here is what the project says that medical schools should be teaching their students. Medical students must be computer literate. It is not enough to be able to compose, format, and print a document on a word processor. They should be able to use software to create formal presentations, and they should familiarize themselves with the structure and function of databases. They should know about communication technologies, like cable modems, DSL, and ISDN. This knowledge will facilitate medical students' comprehension of how e-mail and the Internet work. Nowadays, computer literacy should be taken a step further to include knowledge of handheld devices and their beaming and synchronization processes. Perhaps the next most important skill that medical students should acquire is mastery in searching the medical literature. The process is more complex than simply entering a few search terms in the National Library of Medicine's database, PubMed, and receiving 3,000 articles in return. It is more efficient to develop a focused clinical question so that the answer (perhaps 1-3 articles) is relevant to patients seen in the examination room. Those patients, by the way, have become more savvy clients, able to search the web themselves for answers to medical questions. Physicians need to have criteria in mind to be able to evaluate the information that patients bring them. They may want to refer their patients to a reputable site to fulfill their information needs. In all of these areas, medical librarians are an invaluable resource. Physicians and medical students should seek out the guidance of medical librarians and participate in live or online tutorials. Physicians will be faced with using a decision support system of some kind during their career. They should understand the purposes of these tools, their strengths, and their limitations. These expert systems are not intended to take the place of the physicians' diagnostic prowess. Rather, they are available as a consultant on more difficult cases. They should be thought of as an instrument for finding the zebras. Many technologies comprise telemedicine, making health care possible in remote locations. Anyone practicing medicine today should be familiar with the telemedicine consultation, what it entails, and when it may be appropriate. A physician may be in a position to either refer patients who may not otherwise have access to a specialist for a telemedicine consultation or provide the consultation. Either way, knowledge about telemedicine is imperative. For more information on the Medical School Objectives Project and what the experts think medical students should be learning, go to www.aamc.org/meded/msop/start.htm . Students who are not receiving this education at their medical school should let the administration know that they think it's important. Don't be left behind.