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1 international journal of medical informatics 76 (2007) journal homepage: An international summer school on health informatics: A collaborative effort of the Amsterdam Medical Informatics Program and I E the International Partnership for Health Informatics Education M.W.M. Jaspers a,, R.M. Gardner b, L.C. Gatewood c, R. Haux d, R.S. Evans b a Department of Medical Informatics, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1000 DE Amsterdam, The Netherlands b Department of Medical Informatics, School of Medicine, University of Utah, Salt Lake City, USA c Department of Laboratory Medicine and Pathology, Division of Health Computer Sciences, Medical School, University of Minnesota, Minneapolis, USA d Institute for Medical Informatics, Technical University of Braunschweig, Germany article info abstract Article history: Received 11 April 2005 Received in revised form 17 February 2006 Accepted 19 February 2006 Keywords: Health informatics Medical informatics Education International educational exchange Purpose: Today, the need for health informatics training for health care professionals is acknowledged and educational opportunities for these professionals are increasing. To contribute to these efforts, a new initiative was undertaken by the Medical Informatics Program of the University of Amsterdam-Academic Medical Center and IPHIE (I E) the International Partnership for Health Informatics Education. In the year 2004, a summer school on health informatics was organized for advanced medical students from all over the world. Methods: We elaborate on the goals and the program for this summer school. In developing the course, we followed the international guidelines of the International Medical Informatics Association IMIA. Students provided feedback for the course through both summative and formative evaluations. As a result of these evaluations, we outline the lessons we have learned and what consequences these results have had in revising the course. Results: Overall the results of both the summative and formative evaluation of the summer school showed that we succeeded in the goals we set at the beginning of the course. Students highly appreciated the course content and indicated that the course fulfilled their educational needs. The decision support and image processing computer practicums however proved too high level. We therefore will redesign these practicums to competence requirements of medical doctors as defined by IMIA. All participants recommended the summer school event to other students. Conclusions: Our experiences demonstrated a true need for health informatics education among medical students and that even a2weeks course can fulfill health informatics educational needs of these future physicians. Further establishment of health informatics courses for other health professions is recommended Elsevier Ireland Ltd. All rights reserved. Corresponding author. Tel.: ; fax: address: (M.W.M. Jaspers) /$ see front matter 2006 Elsevier Ireland Ltd. All rights reserved. doi: /j.ijmedinf

2 international journal of medical informatics 76 (2007) Introduction Health professionals are becoming more aware of the need for education in health informatics. As a result, health informatics has been introduced into an increasing number of medical and other health professional programs during the past decade [1]. Despite these developments, many medical university programs still do not offer any opportunity for enhancing the knowledge of medical students regarding the impact of Information and Communication Technologies (ICT) on the health care field. The main reason for the lack of information system training might be that most medical curricula are already full with traditional teaching activities [2]. Apparently, these medical faculties do not perceive health informatics as a subject that is important enough to give up medical contents in favor of health informatics contents in their curricula. Moreover, until recently there was a lack of consensus what health informatics contents to teach to health care professionals. Health professionals views of what they regard as important informatics education reveal the need to focus on information and its processing and not so much on technology itself [3]. A framework for developing a medical informatics curriculum for practicing clinicians, which incorporates feedback from these clinicians, has recently been described [4]. But probably the most important, the recommendations of the International Medical Informatics Association IMIA have contributed to international acknowledgements and agreement on required learning outcomes of health care professionals of different backgrounds and health care informatics specialists [5]. For certain, health informatics has already had a profound impact on health care, particularly in the workplace, where technological advances enduringly change the way health care providers work, make decisions and communicate. Health professionals, in the midst of all of this, are the obvious persons to be aware of the (future) challenges for informatics to impact the clinical area in the broadest sense. These health professionals should be aware of the broad spectrum of tools health informatics offers to medicine. In particular in view of the possibilities offered by computerized patient records, telecommunication and the Internet, health informatics has much to offer to patient care and consequently to education of future health professionals. Yet, the challenges that both health informatics and the health profession face are not only determined by an adequate implementation of ICT, but even more by an understanding of the impact of these techniques, from the individual health care professional to institutional practice to public health [6]. In this context, it is essential that health professionals are aware of the potential changes that informatics tools may bring the health care field. Health professionals should not only be able to critically appraise the pros and cons of these tools but also be able to influence clinical information systems design so that they can contribute to proper implementation of these systems in practice [7]. Therefore, it has been argued [8] that: When training health professionals, they should be acquainted not primarily with the technology of today, but foremost they should be taught the principles behind these systems. Furthermore, attempts should be made to teach general principles which are applicable to most sub-disciplines in health care. For instance, the methods to acquire, store and process patient data are applicable to all medical subdisciplines and how to use data for management and planning or for research can be used for all professional areas in health care. In training future health care professionals, we should teach them how information in medicine and health care is to be processed systematically and to use ICT appropriately and responsibly [9]. With these thoughts in mind, in 2004 for the first time, a summer school on health informatics for international medical students was organized in a collaborative effort of the Amsterdam Academic Medical Center and I E. In this paper, we report on this initiative. After introducing I E, we describe the organization, goals, content of the course, and our and students experiences with the course. Finally, we outline the lessons we learned and what consequences our first experiences with the course have had in revising both the summer school organization and contents. 2. The International Partnership for Health Informatics Education The International Partnership for Health Informatics Education I E [10 12] seeks to maintain, improve and promote medical and health informatics training and education through international collaboration. The partnership, which started in 1999, was formed by a group of six universities, the University of Amsterdam [2,13], the Universities of Heidelberg and Heilbronn [14,15], the University of Health Sciences, Medical Informatics and Technology at Innsbruck [16], the University of Minnesota [17] and the University of Utah [18,19]. The partnership worked at accomplishing its goals by diverse activities such as a student and faculty exchange program, yearly organized master classes in medical and health informatics for honors students, student workshops at main medical informatics conferences, and a joint European course on strategic information management in hospitals [12,20 22]. These activities are all directed at enhancing the education of the medical and health informatics students in the respective programs. Students in these programs share in the educational and research experience of the institutions that form I E. The I E universities felt, however, that they should not merely focus on enhancement of the education of their own students but should likewise offer educational opportunities with regard to health informatics to international medical students. 3. Course organization and management The summer school course was organized under the responsibility of the Faculty of Medicine the University Hospital of the University of Amsterdam and I E. The Faculty of Medicine of the University of Amsterdam offers a B.Sc. and M.Sc. program in medical informatics in addition to the physician training program. The international affairs office of the University of Amsterdam in collaboration with the Amsterdam Maastricht Summer University looked after logistic affairs; the printing

3 540 international journal of medical informatics 76 (2007) and dissemination of the invitation flyers, course program and materials, the announcement of the summer school through the Internet ( the arrangement of accommodations, meals, social events, lecture and computer practicum rooms. Besides, the international affairs office took responsibility in evaluating the course among the participants. The invitations for participation were distributed by sending program flyers all over the world to the Dutch embassies and to universities that offer a medical curriculum. Course fees were kept low (D 605 for 2 weeks) by organizing student accommodation in a hostel like manner and by having lecturers donate their lecture time for the course. Course fees included admission to the lectures, course materials, public transport, meals, visits to historical sites and other social activities and cultural activities. 4. Goals In designing the summer school course, a scientific program steering committee representing the disciplines of medical and health informatics, computer science, medicine, epidemiology and biometry was initiated in the autumn of This committee set the following goals for the summer school course: (1) the summer school should contribute to health informatics training of future physicians, (2) course content and course level should be in accordance with internationally agreed recommendations for health informatics training of health care professionals and (3) the course should focus on the acquisition of both knowledge and practical skills in information processing and ICT. Additionally, specific outcome competencies for the summer school were defined. It was felt that at the end of the course, participants should be able to: (A) understand the scope of potential changes informatics tools may bring to health care field, (B) critically appraise the pros and cons of these tools in changing daily health care practices and (C) critically evaluate clinical information systems designs. 5. Course contents To establish the program content for the 2-week summer school course, the program committee referred to IMIA recommendations for educating and training health care professionals in health informatics [5]. IMIA distinguishes three domains: (1) methodology and technology for the processing of data, information and knowledge, (2) medicine, health and biosciences, health system organization and (3) informatics, computer science, mathematics and biometry. The program committee used this framework with its specifications of learning outcomes to define the health informatics themes for the summer school course. Table 1 gives a (sub) specification of the themes that were addressed in the summer school program, the levels of knowledge and skill recommended by IMIA and the respective contact hours. IMIA recommends that the work load for future health professionals for education in health informatics should be comprised of at least two European Credit System (ECS) credits. The 2-week summer school course was made up of 60 contact hours and 20 self-study hours, which totalled three ECS credits. A cornerstone of the course was the variety of readings from numerous disciplines. Lecturers were from medical and (public) health informatics, computer science, health care sciences, cognitive engineering, biometry, epidemiology and biostatistics, radiology, etc. A total of 19 lecturers contributed to the course among whom five international faculty members (the authors) of I E from Europe and the US. Specific examples from the work of physicians within the AMC were used to exemplify the role of ICT in health care. Lectures on principles and methodology of information processing were followed by real life demonstrations and hands-on experiences with health care information systems and applications in use in the AMC. In addition to these experiences, students had to prepare presentations on medical and health informatics papers related to one of the themes covered in the course in international student groups. To stimulate students in exchanging and discussing their ideas on the medical informatics papers, in forming these groups, students from different nations and thus from various health care systems were mixed. So, the summer school course offered a combination of basic concepts and principles behind computerized information processing, supported by hands-on training in health informatics applications, demonstrations, computer practicums, critical appraisal of literature and of health care information systems. With this course set-up, we worked at stimulating students to learn how to critically appraise the pros and cons of ICT use in health care, and to learn how at all health care levels issues related to information management can be dealt with. 6. Attendees The summer school is predominantly directed at medical students at the level of at least 2 years before graduating with an M.D. in medicine and recent graduates in medicine. A total of 39 students sent in their application form requesting to participate in the summer school course. Due to problems encountered with visas, 19 students actually participated in the course, coming from 14 different nations: Austria, Brazil, The Czech Republic, Iran, Iraq, Japan, Korea, Moldavia, Romania, Russia, Serbia, The Netherlands, Turkey and the United States of America. 7. Course evaluation To assess whether we succeeded in fulfilling the goals we set in developing the summer school, students provided feedback for the course through both summative and formative evaluations. Students provided their comments through anonymous questionnaires at the end of the course. All 19 students returned both the summative and formative evaluation forms. The international affairs office of the University of Amsterdam disseminated, gathered and analyzed these questionnaire forms. The summative evaluation consisted of a questionnaire that was divided into two main parts. The first part of the questionnaire assessed students general opinions as regards the scientific program contents, level, quality of instruction and workload on a scale of 1 (=very bad), 2 (=bad), 3 (=sat-

4 international journal of medical informatics 76 (2007) Table 1 Course outline: themes covered, recommended IMIA learning outcomes a in terms of knowledge and skill level and related lecture hours (Lect hrs), demonstration hours (Demo hrs) and computer practicum hours (Comp pract hrs) Day Theme IMIA a Lect hrs Demo hrs Comp pract hrs Total work load 1 Data, information, knowledge in health care kl Hardware, software, computers, networks, information systems kl Advantages and current constraints of ICT in health care kl Organization of health care systems kl Health information systems general characteristics kl The role of the patient record in data management kl 2 3 History of the paper-based patient record 1 Data structures in paper-based record 2 2 Characteristics/examples of health information systems kl 1 1 Support functions of the computer-based patient record 1 Use of ICT in health care sk 2 4 Usage of computer-based patient record Data quality control in health care kl Design and structure of the computer-based patient record kl 2 3 (Structured) data entry 1 Views and structuring of the computer-based patient record 2 3 Systematic information processing in health care kl Patient logistics and ICT solutions kl 2 2 Patient management 1 Clinical paths 1 Characteristics/examples of health information systems kl 1 1 Patient tracking systems 1 4 Medical terminology and coding (systems) kl 2 4 Health related terminology and coding systems 2 Construction and representation principles of 1 1 terminology/coding systems Use of ICT in health care sk 2 2 Usage of terminology/medical coding systems 1 1 Characteristics/examples of health information systems kl 1 1 New developments terminology/medical coding systems 1 5 Medical decision making kl 3 4 Appropriate decision making 1 Constructing/using clinical guidelines/ critical paths 2 Representation of medical knowledge 1 The role of decision support tools kl 1 2 The construction of decision support tools 2 Characteristics/examples of health information systems kl 1 1 Recent developments of decision support tools 1 6 Medical signal and image processing kl 1 6 Biosignal analysis 1 Medical imaging 1 Application areas 4 Use of ICT in health care kl 1 2 Signal and image processing tools 2 7 Evaluation of health information systems kl 2 2 Role of health professionals in health information system 1 evaluation Usability evaluation methods 1 Characteristics/examples of health information systems sk 2 2 Set-up of user evaluation 1 User evaluation of a computer-based patient record 1 7 Health telematics and telemedicine kl 2 3 Telematics approaches in health care 1 Benefits and constraints of telemedicine 1 A Dutch telemedicine example 1 8 Public health informatics kl 2 4 Evidence-based practice 1

5 542 international journal of medical informatics 76 (2007) Table 1 (Continued ) Day Theme IMIA a Lect hrs Demo hrs Health care registries and information resources 1 Quality assessment and assurance 1 Record linkage 1 Preparation of journal papers in international groups Comp pract hrs Total work load 9 Strategic information management in health care kl 2 4 Hospital functions 1 Information processing in hospitals 1 Organizational information strategy 1 Strategic management of hospital information systems 1 Hospital tour Preparation of journal papers in international groups 10 International student group paper presentations a kl, knowledge; sk, skill; 1, introductory level; 2, intermediate level; 3, advanced level. isfactory), 4 (=good), to 5 (=very good). Moreover, students were asked about the amount of interaction between teachers and students, faculty s teaching proficiency, enthusiasm and attitude towards the students. Teaching materials were evaluated on comprehensiveness, and the appropriateness of course assignments. Table 2 gives the quantitative results of this part of the questionnaire. The most important results were that students indicated that they very much appreciated the fact that faculty members from different nations contributed to the course. They found the faculty s teaching ability more than satisfactory. Students in particular appreciated the amount of interaction among students and between faculty and students. Overall course content met their expectations and the course level was appropriate, and in addition the quality of instruction was high. The second part of the summative questionnaire included items related to the specific themes of the course, which were based on IMIA recommendations. Students were asked to indicate whether the course topic was informative. Students rated these questions using a scale ranging from 1 (very bad) to Table2 Evaluation results of the summer school course content, level, quality of instruction, assignments, teaching materials and faculty s abilities Rank Question Mean S.D. 1 International faculty s contributions Faculty s teaching ability Faculty s enthusiasm Quality of instruction Interaction with students Course assignments Faculty s attitude Interaction with faculty Course content Quality of teaching materials Course level Overall work load The scale ranges from 1 (very bad) to 5 (very good). 5 (very good). Table 3 provides the mean ratings and standard deviations for each of the IMIA learning outcomes covered in the summer school. Twelve of the 18 course topics were evaluated as highly informative, with ratings between 4.90 and 4.10 with the four highest ratings for the themes Use of ICT in health care, Characteristics/examples of health information systems, Advantages/constraints of ICT in health care and The role of the patient record in data management. The students evaluated the remaining six themes as rather informative, with ratings between 3.94 and 3.37 of which themes Patient logistics and ICT solutions received a rating of The third part of the summative questionnaire included three questions to assess whether we succeeded in fulfilling our goals concerning the additional outcome competencies that we set for the course participants. Table 4 gives the quantitative results of this part of the questionnaire. Students in general felt that the course enabled them to understand the scope of potential changes informatics tools may bring to health care field, that they could critically appraise the pros and cons of these tools in changing daily health care practices, and critically evaluate clinical information systems designs. The formative evaluation consisted of a free-text questionnaire. Students were asked to indicate whether they had any comments with regard to the course length, the international exchange with the other international students and faculty, and whether they would recommend the summer school to other students. Besides, students were asked to respond to the following questions: (a) what did you like best? (b) What did you like least? (c) What is the most important thing you learned? (d) What suggestions do you have for improvement? (e) What is the most important thing you learned? These evaluations provided qualitative data with cues concerning the course strengths and weaknesses. Table 5 gives an overview of the students remarks and qualifications with regard to these questions. Thirteen students remarked that the course schedule was tight but thata2weeks course was appropriate. Five students preferred a less intense course schedule and suggested length-

6 international journal of medical informatics 76 (2007) Table 3 Students opinions regarding the informative character of each of the themes using a scale ranging from 1 (very bad) to 5 (very good) are also given Rank Theme Mean S.D. 1 Use of ICT in health care Characteristics/examples of health information systems Advantages/constraints of ICT in health care The role of the patient record in data management Design and structure of the computer based patient record Organization of health care systems Systematic information processing in health care Strategic Information management in health care Health telematics and telemedicine Evaluation of health information systems Public health informatics Medical terminology and coding (systems) Patient logistics and ICT solutions Hardware, software, computers, networks, information systems Data quality control in health care Data, information, knowledge in health care Medical signal and image processing Medical decision making and the role of decision support tools Table 4 Evaluation results of the additional outcome competencies set for the course participants Question Mean S.D. To understand the scope of potential challenges informatics tools may bring to the health care field To critically appraise the pros and cons of informatics tools in changing daily health care practices To critically evaluate clinical information systems Scale ranges from 1 (very bad) to 5 (very good). Table 5 Students remarks on and qualifications of the course are given Question Students remarks Number of students Any remarks on the course length? Tight but appropriate schedule 13 Prefer less intensive schedule, course lengthened by 1 week 5 Any remarks on the international exchange with other international students? Enhanced my perspectives on health informatics 9 Learned about health informatics accomplishments in different nations 11 Would you recommend the course to others? Absolutely, No doubt, Yes, certainly 19 What did you like best? Tour through AMC 10 Demonstrations and experience with information systems 7 Patient record lectures 2 What did you like least? Decision support practicum 7 Image processing practicum 6 Any suggestions for improvement? Would have liked more students involved in the course 9 Earlier advertisement to attract more students 9 Time schedule extended 6 Less details related to construction of decision support tools, more 6 hands-on experience More physician-oriented image processing computer practicum 4 Attention to economic benefits of health care information systems 4 What is the most important thing you learned? Latest health informatics developments 12 To put ICT potentials in health care into perspective 9

7 544 international journal of medical informatics 76 (2007) ening the course by another week. Yet, these five students had their course expenses paid for by scholarships. All students indicated that they benefited from the international exchange with students and faculty. Typical comments in this context were: The international exchange has enhanced my perspectives on health informatics and Through the international exchange of ideas with students and faculty of other countries I learned what has been accomplished in the health informatics field in different countries and how nations may profit from each others results to improve their information processing by informatics tools. Every student noted that he/she would recommend the summer school course to other students. Nine students indicated that they would have appreciated more students in this year s course which would enhance the international exchange even more. Ten students liked the tour through the hospital that exemplified the AMC information strategy best. Seven students and six students liked the computer practicum on decision support tools and on image processing least; they indicated that there was too much detail provided. The remaining six students provided no comments on this question. Four students suggested including a short lecture series on the economic benefits of using informatics applications in health care. A total of 12 students indicated that the most important thing they had learned was that they now understood the latest developments in the health informatics field and what contributions to health care might be expected from this field. Of these 12 students, nine students said that their newly acquired knowledge and awareness would help them in the future to better put the potentials of new informatics tools into perspective. A typical comment was: Now I have a very good idea of what is going on in health informatics, which can be useful in further life. Now I feel I really understand the impact of informatics on health care. As a medical doctor, I hope to contribute to the implementation of these systems in health care to optimize patient care in the long run the most important objective we could set ourselves. Overall, students indicated that they saw great benefit for future medical students to attend the course. On a scale of 0 10 (10 being best), students rated the quality of the course with a mean score of Discussion and conclusions In an effort to contribute to health informatics training of future health care workers, we organized an international summer school for advanced medical students. Overall, the summer school proved to be a success; students greatly appreciated the organization, contents, level and international character of the course. The rapid developments of ICT in health care indeed ask for international approaches of educational activities in health informatics [22]. More specifically, the participation of both students and faculty members from different nations in the summer school course enhanced course participants knowledge of how health care information management is dealt with in the various countries and of health informatics recent developments in this context. This outcome highlights the fact that international courses may have a surplus value in educating health professionals to acquire knowledge of how to effectively use ICT in health care. Overall, students considered the lecturers as highly knowledgeable and proficient in the field, enthusiastic and highly interactive. Most of the goals that we set, after considering what this course should bring with regard to learning outcomes to this group, were reached. We attempted to cover health informatics topics relevant to advanced medical students. Based on students evaluations of the course content, we have arrived at the conclusion that medical informatics education of future medical doctors should cover health informatics in the sense of IMIA definition of learning outcomes for this group. Students still experienced some difficulties with the educational level of certain topics. Specifically, both the decision support computer practicum and the image processing sessions proved to be too difficult for some students. Reassessment of the agenda of these two computer practicums showed that the contents probably were not on the introductory knowledge level, as recommended by IMIA, but on the introductory skill level. The introductory knowledge level is to enable health professionals to know how these tools are constructed and may be efficiently applied in patient management. The introductory skill level however focuses on being able to some degree to represent and engineer the medical knowledge in order to construct these tools. Future medical doctors may not need to be competent in constructing these tools but in using these tools in an efficient and responsible manner in daily practice. We therefore will redesign these computer practicums to competence requirements of medical doctors as defined by IMIA. Some students preferred lengthening the course by a week to loosen the rather intensive time-schedule. These were all students who had their expenses covered by scholarships. Since course fees will go up by approximately one third, we do not plan to extend the course. Another four students recommended including a lecture series on the economic benefits of introducing ICT tools in health care. Though health economics is not a learning outcome recommended for information technology users in health care, we will introduce this theme in the course. All participants recommended the summer school event to other students, probably the most important outcome of the course. The observation demonstrates that there is a real need for health informatics education among medical students and that even a 2 weeks course may at least to some extent address the educational needs regarding health informatics of these future medical doctors. Course participants would have appreciated a larger group of students attending the summer school. The visa application process proved to be too lengthy and hindered the participation of students from certain nations in our summer school. In continuing our summer school, we intend to announce our course 6 months before its start, to enable applicants fulfilling all visa regulations in advance.

8 international journal of medical informatics 76 (2007) Summary Points Today there is a clear understanding that health professionals should be aware of the impact that ICT has and will have on health care. Moreover, it has been acknowledged that these professionals should be able to use information technologies in an appropriate and responsible way. The past decades, health informatics training has indeed been introduced into an increasing number of medical and other health related professional programs. Yet, many medical university programs still do not offer a health informatics component in their curricula. The International Medical Informatics Association (IMIA) has put forward recommendations on which learning outcomes are required for health professionals and these recommendations have contributed to international acknowledgements regarding these learning outcomes. Besides, the IMIA encourages and recommends international initiatives in developing health informatics courses for health professionals. An international health informatics 2-week summer school was organized for advanced medical students. Course contents were defined according to the health informatics learning outcomes for health professionals as recommended by the IMIA. The course proved to fulfill the medical students educational needs and the goals set by the summer school program-committee. Course participants appeared to have acquired knowledge as regards the potentials, limitations of ICT, the principles behind health information systems and skill in using and evaluating these systems. It was therefore concluded that the IMIA learning outcomes indeed cover the educational needs of future medical doctors. The participation of both students and faculty members from different nations in the summer school course enhanced course participants knowledge of how health care information management is dealt with in the various countries and of health informatics recent developments in this context. This outcome highlights the fact that international courses may have a surplus value in educating health professionals to acquire knowledge of how to effectively use ICT in health care. It is highly recommended that other universities establish health informatics courses, preferably in international contexts, to prepare students of various health disciplines for their future roles so that they can make the best possible use of ICT in their daily practice. Medical students all over the world should be offered opportunities for health informatics training tailored to their particular needs. With this idea in mind, we have started and will continue our international summer school of health informatics. We feel that especially summer school courses on health informatics for medical students can be beneficial, since the summer schedule allows for participation of students in addition to their involvement in a regular medical university program. The Institute of Medicine s vision for health professionals education stresses the necessity of informatics competencies for all graduates [23]. We likewise strongly believe that there is a need for health informatics training among all other health care professionals. Indeed similar needs for nursing informatics course tracks of practicing nurses have been noted [24]. The summer school of nursing informatics in Germany, though not internationally oriented, has proven to be successful in improving the knowledge of German nurses with regard to information management supported by ICT [7]. We recommend that other universities collaborate in establishing health informatics courses not only for medical students but for other health disciplines too. IMIA has agreed on international recommendations on health informatics education. These recommendations are to assist institutes with the establishment of course tracks in further development of existing educational activities in various nations. Yet, IMIA also encourages and recommends international initiatives concerning health and medical informatics education and international exchanges in this context. Such courses should focus on preparing students of various health disciplines for their future health professionals roles such that they can make the best possible use of available informatics technologies to support patient care, medical research and health service delivery. Acknowledgments It is impossible to thank all the people who contributed to or participated in the summer school course. Therefore, we gratefully acknowledge the contributions of all the students, faculty and administrators. references [1] E.J.S. Hovenga, Globalisation of health and medical informatics education what are the issues, Int. J. Med. Inf. 73 (2004) [2] M.W.M. Jaspers, M. Limburg, J.J. Ravesloot, Medical informatics in Amsterdam: research and education, in: R. Haux, C. Kulikowski (Eds.), IMIA Yearbook of Medical Informatics, Schattauer, Stuttgart, 2001, pp [3] N. Staggers, C.A. Gassert, D.J. Skiba, Health professionals views of informatics education: Findings from the AMIA 1999 Spring Conference, J. Am. Med. Inform. Assoc. 75 (2000) [4] E. Rose, R. Zeiger, S. Corley, P. Gorman, T. Yackel, W. Hersh, Development methodology for a next generation medical informatics curriculum for clinicians, Proc. AMIA (2003) 986. [5] Recommendations of the International Medical Informatics Association (IMIA) on education in health and medical informatics, Meth. Inf. Med. 39 (2000) [6] C.A. Kulikowski, The micro-macro spectrum of medical informatics challenges: from molecular medicine to transforming health care in a globalizing society, Meth. Inf. Med. 41 (2002)

9 546 international journal of medical informatics 76 (2007) [7] T. Bürkle, U. Schrader, Two years of German summer school of nursing informatics: did we reach the goals, Int. J. Med. Inf (2000) [8] J.J. van Bemmel, J.S. Duisterhout, Education and training of medical informatics in the medical curriculum, Int. J. Med. Inf. 50 (1998) [9] R. Haux, Health care in the information society: what should be the role of medical informatics, Meth. Inf. Med. 41 (2002) [10] International Partnership for Health Informatics Education, (last access: November 2005). [11] M.W.M. Jaspers, R.M. Gardner, L.C. Gatewood, R. Haux, F.J. Leven, M. Limburg, J.J. Ravesloot, D. Schmidt, T. Wetter, I E: an international partnership in health informatics education, in: A. Hasman, B. Blobel, J. Dudeck (Eds.), Medical Infobahn for Europe, vol. 77, IOS Press, Amsterdam, 2000, pp [12] M.W.M. Jaspers, R.M. Gardner, L.C. Gatewood, R. Haux, D. Schmidt, T. Wetter, The international partnership for health informatics education-i E: six years of experience and lessons learned, Meth. Inf. Med. 1 (2005) [13] M.W.M. Jaspers, P. Fockens, J.H. Ravesloot, M. Limburg, M.A. Abu-Hanna, Fifteen years medical information sciences: The Amsterdam curriculum, Int. J. Med. Inf. 73 (2004) [14] F.J. Leven, P. Knaup, D. Schmidt, T. Wetter, Medical informatics at Heidelberg/Heilbronn: status evaluation new challenges in a specialized curriculum for medical informatics after thirty years of evolution, Int. J. Med. Inf. 73 (2004) [15] R. Haux, D. Schmidt, Master of Science program in health information management at Heidelberg/Heilbronn: a health care oriented approach to medical informatics, Int. J. Med. Inf. 65 (2002) [16] R. Haux, Biomedical and health informatics education at UMIT approaches and strategies at a newly founded university, Int. J. Med. Inf. 73 (2004) [17] University of Minnesota. Graduate programs in health informatics, msphd.html (last access: November 2005). [18] R.M. Gardner, University of Utah medical informatics research and training program, in: R. Haux, C. Kulikowski (Eds.), IMIA Yearbook of Medical Informatics, Schattauer, Stuttgart, 2001, pp [19] G.A. Patton, R.M. Gardner, Medical informatics education: The University of Utah experience, J. Am. Med. Inform. Assoc. 6 (1999) [20] L. Gatewood, M. Limburg, R. Gardner, R. Haux, M.W.M. Jaspers, D. Schmidt, T. Wetter, International master classes in health informatics, Int. J. Med. Inf. 73 (2004) [21] R. Haux, E. Ammenwerth, W.J. Ter Burg, J. Pilz, M.W.M. Jaspers, An international course on strategic information management for medical informatics students: aim, content, structure, and experiences, Int. J. Med. Inf. 73 (2004) [22] M.W.M. Jaspers, E. Ammenwerth, W.J. Ter Burg, F. Kaiser, R. Haux, An international course on strategic information management for medical informatics students: the international perspectives and evaluation, Int. J. Med. Inf. 73 (2004) [23] Institute of Medicine, Health Professions Education: A Bridge to Quality, The National Academy of Sciences, Washington, DC, [24] B.E. Carter, R.L. Axford, Assessments of computer learning needs and priorities of registered nurses practicing in hospitals, Comput. Nurs. 11 (2003)

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