The graduate training in medical information sciences in the Academic Medical Centre at the University of Amsterdam

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1 International Journal of Medical Informatics 50 (1998) The graduate training in medical information sciences in the Academic Medical Centre at the University of Amsterdam L.N. Bouman a, *, J.H.N. Zwetsloot-Schonk b, M.W.M. Jaspers b, G.L. Louter b, T. Timmers b a Department of Physiology, Academic Medical Centre, PO Box 22700, 1100 DE, Amsterdam, The Netherlands b Department of Clinical Information Science, Academic Medical Centre, PO Box 22700, 1100 DE, Amsterdam, The Netherlands Abstract Since its inception in 1987, the 4-year Medical Information Sciences (MIS) curriculum at the Academic Medical Centre (AMC), Amsterdam has gone through several major changes. The present curriculum started in The course takes 4 years, the first 3 years are programmed in integrated modules of 7 weeks in duration each. In these modules much attention is given to interactive teaching, problem based learning and private study. Typical for the Amsterdam curriculum is a strong emphasis on the role and significance of data and information in health care and its management. The authors see information technology per se as auxiliary to this orientation. Presently, about 150 students follow the courses Elsevier Science Ireland Ltd. All rights reserved. Keywords: Health informatics; Medical informatics; Education; Training 1. Introduction Some 10 years ago, at the Academic Medical Centre (AMC) in Amsterdam teachers and medical students felt the need for a separate medicine-oriented vocational program on Medical Information Sciences (MIS). It had become apparent that it was impossible for a single medical study program to pay * Corresponding author. Tel.: ; fax: ; l.n.bouman@amc.uva.nl adequate attention to all scientific and technological developments in medicine. After an initial period in which a course in MIS was offered as a degree program following part of the medical study, in 1990 the curriculum was reorganised into a fullfledged, 4-year course. Two different majors were offered, viz. the clinical major, in which medical informaticians were trained at the interface of medical technology and clinical medicine and the information systems major, in which medical informaticians were trained /98/$ Elsevier Science Ireland Ltd. All rights reserved. PII S (98)

2 152 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) to develop medical information systems in close collaboration with physicians. In 1992 the Faculty of Medicine decided to restrict the curriculum to a single, uniform course, emphasising information processes in medical practice. This has resulted in a completely revised objective based curriculum, which started in September From the start in 1990 the Medical Informatics course was the only 4-year program in The Netherlands until 1995, when the University of Utrecht started a curriculum in Medical Technical Informatics with however a much stronger emphasis on information technology. 2. Philosophy of the graduate program At the AMC-UvA the graduate program MIS combines science with practical skills, because it comprises educational, researchand service-oriented activities. The scientific aim is to acquire knowledge and understanding of the role, place and significance of data and information in medical practice, as well as the processes involved in the acquisition, storage and retrieval of data. Practical skills aim at structuring and modelling of medical data and processes, in order to optimise patient care management processes or create alternatives with the help of information science and technology. The curriculum is seen as a medical study, meaning that computer science is rather positioned as one of the auxiliary sciences than as a main objective of the course. It would neither be expedient for the medical informatician to make diagnoses or attend to the treatment of patients, nor to develop specialised software or patient monitoring systems without technical assistance. Yet, in both cases, the medical information specialist is the indispensable link between the worlds of curative medicine on the one hand and information engineering on the other hand. The graduates are trained as experts in the rapidly growing field of medical information technology and sciences. They are familiar with medical biological and epidemiological principles, have knowledge of the medical language, have insight in how physicians think and work, are acquainted with the organisation of Health Services and are sufficiently skilled in information sciences to create links between these disciplines or subject areas that could not be achieved before. 3. Curriculum characteristics 3.1. Structure of the curriculum In 1980 the Amsterdam Medical Faculty has introduced a completely new integrated and modulated curriculum [1]. In comparison to the traditional curriculum, there is much more emphasis on interactive teaching and self-instruction, problem based learning has been introduced and the number of whole class lectures has been reduced strongly. At the development of the present curriculum MIS these principles have been used as a point of departure. In short it has the following characteristics: The 4-year course consists of the propedeuse period (year 1, the B.Sc. level) and the doctoraal period (years 2 through 4, leading to the M.Sc. level). The first year serves as a phase of orientation. During the second year the emphasis is on information technology. The third year focuses on information processes in health care. The fourth year is devoted to a 10-month research trainee-ship at the end of which a thesis is written and the work done is presented orally.

3 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) Modular structure The curriculum is built on four pillars each covering a certain scientific area: Medical Biology Health Care and Clinical Medicine Information Technology Information Theory In the first 3 years the curriculum consists of modules which are self-contained course units at the end of which the student is assessed. The average study load of a module is equivalent to 7 weeks of full-time study, including private study. Each module includes elements of one or more subject areas described above. A module has a limited amount of time for tuition during lectures, practicals, etc. During the first year, 60% of the time is for private study. The amount of literature to be studied is limited, according to the amount of time which is available within the module. As an average rule, 1 h private study is considered to be required for five pages when they have to be memorised; if procedures or concepts are considered more important than facts, the ratio may be varied according to the nature of the task. The proportion of time for private study increases as the student progresses through the curriculum. The total number of modules, all given during the first 3 years, is 15. A small part of the study material is presented as line modules, meaning that the tuition is spread over a large part of the academic year. The study load is equivalent to 7 weeks full time study. The idea behind the line modules is that problem-solving skills and practical experience are better acquired over a prolonged period of time. There are three line modules, one for each year before the last year of the trainee-ship: Information in health care processes and organisation of health services. Medical research. Management of health care processes and technology assessment. Fig. 1 gives an overview of the modules in the curriculum. It must be noted that the titles of the modules do not describe an exclusive subject. Most modules contain two or more subjects from the four main subject areas described above. Therefore, any comparison with other graduate programs can only be made by a detailed analysis of the depth of discussion of the subjects in each module. The modules follow each other and each module lasts 8 weeks, with 1 day reserved for the line module. One module gives when the assessment is sufficient, seven credit points. Per module the number of participating disciplines varies strongly. In general the number and variety of disciplines is much larger in the medicine oriented modules than in those covering mainly subjects from Information Sciences The research traineeship The fourth year is completely devoted to the research trainee-ship. The student works full-time on a project. These projects are offered to the students in institutions either in or outside the AMC. The studys own Department of Clinical Information Science usually offers six positions to students. Most projects are in co-operation with clinical departments. There is a wide range of possibilities: image analysis; information analysis; information system development; and analysis of processes in health care. Most students work outside the AMC in other hospitals or healthcare-related institutions. They are supervised by a mentor of the Department of Clinical Information Science and by the local supervisor of their project.

4 154 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) Fig. 1. Overview of the 4-year curriculum in medical informatics sciences. The total duration of the traineeship is minimally 10 months. At the start a small part of this time may be used to follow specialised courses in or outside the AMC which are related to the subject of the trainee ship. Student who are not fulfilling their trainee-ship abroad, are required to return monthly for a full day to the AMC. During

5 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) these days, the students share experiences and present their ongoing work. They are trained in the systematic formulation of the goals and design of their research projects and in scientific writing and giving presentations. During these days they can also discuss their work with their mentor who is always a staff member from the Department of Clinical Information Science. 4. Organisational issues In 1995, a separate Department of Clinical Information Science was established. Until then the core staff came from the Department of Medical Physics. This decision marked a continuing commitment of the studys Faculty to Medicine and Health Care as a basis for MIS at the AMC. At the same time an integration process was started that would ultimately unite the Faculty of Medicine and the Academic Hospital into one organisation with a single board of directors. In 1997, the formal integration of Faculty and Academic Hospital of the University of Amsterdam was completed, creating the AMC UvA. This kind of organisation is unique in the Netherlands and has been set up to improve integration of education, research and clinical practice, benefiting all disciplines involved. The development of evidence-based medicine is strongly advocated. The basic organisational units in the AMC-UvA are Divisions and Service Departments. The Department of Clinical Information Science is positioned in the Division of Clinical Information and Methodology, comprising Departments such as Clinical Epidemiology and Biostatistics, Medical Psychology, the Medical Library and the Department for Computer-Assisted Education Faculty The program in MIS is not offered by a single Department. Around 80 teachers from 32 Departments in the Hospital and the Medical Faculty take part. Moreover, a substantial part of computer science teaching is provided by the departments of Computer Science at the University of Amsterdam. In terms of contact-h (including all types of education) the Department of Clinical Information Science gives about 25% of the total in the first 3 years, by far the largest contribution per department. The two second largest are Clinical Epidemiology and Computer Science (both 15%). The trainee-ship year is fully organised and supervised by the Department of Clinical Information Sciences Students The number of incoming students is gradually rising. At the start of the present program in 1994, the number of freshmen was 24, this year it will exceed 50. Most students come directly from high school, about half of them had as their first choice a study in Medicine, but were not allowed to enter because of the numerous fixus regulations. Some of them will leave the study when they are still allowed to enter Medicine, some will combine both studies and some will be happy to remain in the MIS program. To be allowed to enter MIS, students must have had final exams at high school in Mathematics, Physics and Chemistry, Biology is advised. Compared with Medicine, the study MIS is a difficult study, the efficiency after 4 years being much lower (about 40%) than in Medicine (about 60%). The data on MIS are however based on only two year groups and may change in due time strongly.

6 156 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) Discussion 5.1. Comparison with similar programs A few years ago a comparison has been made between six programs in Health or Medical Informatics [2]. Regarding the basic philosophy and the main objectives of the programs, one can roughly group them together in three categories, the informatics oriented, the medicine oriented and the health care management oriented programs. The program belongs clearly to the second category, having a strong input from basic medical science and clinical disciplines. This strong relation with medical disciplines is fruitful for both sides, it opens the way to the clinics for students and alumni from the MIS program, while at the other hand clinicians learn how to appreciate the co-operation with information specialists. This is however a process that needs time and attention, for example it appeared to be of great value for the stability and coherence of the teaching if in every participating clinical discipline one or two staff members can be found with an active interest in information sciences. The University of Amsterdam is the only University in The Netherlands which offers a graduate program in MIS. As mentioned above the University of Utrecht offers a graduate program in Technical Medical Informatics. Other Dutch Universities offer courses in Health Sciences, with a specialisation towards medical informatics at the end of the study program. Recently the authors have investigated how they can co-operage with the graduate program in Heidelberg/Heilbronn, which is an excellent exponent of the first category [3]. The two programs have been compared extensively and possibilities for exchange of modules, teachers and students have been investigated in detail. The basic outline of the two programs appeared to be remarkably similar. There is however in practically all modules a different emphasis. The Amsterdam program has more emphasis on clinical medicine, information analysis, clinical epidemiology and healthcare organisation. The Heidelberg/Heilbronn program has more emphasis on information technology, image and signal analysis and the actual development of systems. These differences were as expected and flow from the differences in program philosophies [4]. The authors do expect to be able to develop a fruitful co-operation, mainly through a limited exchange of programs and through exchange of trainee-ships and co-operation in research. Likewise the authors will explore how to further embody this co-operation in a European framework Professional ocation A system is being set up that allows to continue contact with graduates. This will allow insight into which professional areas graduates choose to work in. Also, it is the intention to have a continuous system of feedback from employers and graduates on desirable improvements to the curriculum and emerging fields of application. Due to the numerous program changes over the few years that the curriculum exists, it is not yet possible to assess the value of the program in this respect. However, informal observations among graduates suggest patterns similar to the ones reported by other authors. For example, among the Heidelberg/Heilbronn graduates about half of the graduates work after a number of years in the software industry and the other half in the medical field [5]. This similarity is somewhat surprising as the Amsterdam program is not technically oriented. Presumably, the graduates do have enough skill in areas such as information analysis and organisational issues.

7 L.N. Bouman et al. / International Journal of Medical Informatics 50 (1998) Acknowledgements The material in this paper has to a large extent been derived from the brochure Medical Information Sciences a comprehensive guide to the curriculum which is a compact English version of the study guide. It was prepared by the Department of International Affairs, AMC. Copies are available from that Department, at the same address as the authors. References [1] L.N. Bouman, Th.J. ten Cate, C.J. Ijzermans, Changing a traditional medical curriculum, in: Z.M. Nooman, H.G. Schmidt, E.S. Ezzat (Eds.), Innovation in Medical Education; An Evaluation of Its Present Status, Springer, New York, 1990, pp [2] H. Dickhaus, A comparative summary of six health/medical informatics programs, Method Inf. Med. 33 (1994) [3] F.J. Leven, Curriculum for medical informatics at the university of Heidelberg/school of technology Heilbronn, Method Inf. Med. 33 (1994) [4] R. Haux, F.J. Leven, Twenty years medical informatics education at Heidelberg/Heilbronn: evolution of a specialized curriculum for medical informatics, Method Inf. Med. 33 (1994) [5] W. Frey, R. Haux, F. Leiner, F.J. Leven, Medical informatics Heidelberg/Heilbronn: graduates experiences and job situation, Method Inf. Med. 33 (1994)