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Computer science education for medical informaticians
International Journal of Medical Informatics (2004) 73, 139—144
Computer science education for medical informaticians Judith R. Logan*, Susan L. Price Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
KEYWORDS Curriculum; Medical informatics; Computer literacy; Education; Graduate
Summary The core curriculum in the education of medical informaticians remains a topic of concern and discussion. This paper reports on a survey of medical informaticians with Master’s level credentials that asked about computer science (CS) topics or skills that they need in their employment. All subjects were graduates or ‘‘near-graduates’’ of a single medical informatics Master’s program that they entered with widely varying educational backgrounds. The survey instrument was validated for face and content validity prior to use. All survey items were rated as having some degree of importance in the work of these professionals, with retrieval and analysis of data from databases, database design and web technologies deemed most important. Least important were networking skills and object-oriented design and concepts. These results are consistent with other work done in the field and suggest that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are part of the core curriculum for medical informatics. © 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Relatively few studies have formally assessed the educational needs of medical informatics graduates. Most discussions regarding the content of medical informatics curricula that might be useful to support curriculum decisions can be divided into three categories. The first category is descriptions of individual training programs. The curriculum discussions usually occur in the context of overall program descriptions that include the history and philosophy of the program. Many examples of such discussions are available in the 1994 issue of Methods of Information in Medicine and in a series of articles in MD Computing from 1999 to 2000. While it is useful to read about the deci*Corresponding author.
sions others have made, and one can often learn from others’ experiences, it is usually unclear how decisions were made and whether the decisions were ad hoc or were based on fundamentally sound principles. A second category of information is expert opinion, usually found in summaries and recommendations from medical informatics conferences and working groups. Examples of this category are the 1999 Spring Congress of the American Medical Informatics Association (AMIA), which was devoted to health informatics education and which resulted in a published white paper [1], the educational recommendations published by the International Medical Informatics Association (IMIA) [2], and work by Covvey et al. [3]. The information in these papers is derived from the considered opinions of experienced educators and has been subjected to the sifting and refinement of group discussion and
1386-5056/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2003.11.014
140 consensus building. The main drawback to this category of information is the relative lack of specificity and granularity of recommendations regarding specific curriculum components. Their usefulness is somewhat limited with regard to determining appropriate content of individual courses, such as courses covering computer science (CS) concepts and technical computing skills. The third category is publications deriving from research studies and published literature reviews. Relatively few studies are available to help us make evidence-based curriculum decisions. We briefly describe the findings of some significant studies that do exist. Corn [4] described the knowledge needed by a medical informatician based on his discussion of informatics literature and training programs. He pointed out that the major emphasis of medical informatics in the 1990s was applications tied to healthcare delivery, including hospital and departmental information systems. Clinical research, medical education and information sciences were, as they perhaps still are, given less emphasis in literature and training programs. Hoffman and Ash [5] subsequently surveyed prospective employers of the graduates of masters level programs in medical informatics to determine the set of abilities that constitute ‘‘skill in medical informatics.’’ This survey resulted in a list of the 20 most valued skills as well as refinement of the survey instrument. Their ‘‘top 20 skills’’ can be loosely grouped into technical skills (nine categories), data analysis skills (two categories) and organizational and management skills (nine categories). The purpose of this study was to examine one segment of medical informatics education, specifically, to determine the computer science knowledge and skills needed by medical informatics graduates, as determined by survey of practicing medical informaticians. We performed the survey as part of curriculum development at Oregon Health and Science University, which has graduated its sixth class of Master of Science and Master of Medical Informatics students. This program has always embraced computer science and programming skills as part of its core curriculum. The content of that curriculum has changed considerably over the years, however. Table 1 is a summary of the current three-term sequence. The commitment to instruction in computer science remains strong, based on informal knowledge of the job placements of our graduates and a previously reported survey of former students [6]. In this project, a survey of topics and skills related to computer science was sent electronically to the graduates and employed students of this program.
J.R. Logan, S.L. Price
2. Materials and methods 2.1. Survey creation The survey consists of 16 items (Table 2) reflecting areas of knowledge related to computing and computer science. Some of these items represent conceptual knowledge about a topic while others represent computing skills. For brevity, we refer to these as topics and/or skills. Respondents were asked to rate each item, which might represent a topic, a skill, or some combination of both, just once, for importance to their work. Our preliminary version of the survey had attempted to differentiate skills and topics but this differentiation was found to be cumbersome in preliminary testing. For example, database design may be a topic to an informatician who is supervising construction or use of a data warehouse but a skill to the informatician who is proposing the design for that data warehouse. The survey items were chosen after review of our own curriculum and an informal review of the curriculum of other medical informatics programs. Some of those items have significance to us because of questions of inclusion that have arisen in our program. The preliminary version of this survey was tested on 10 students in the program who had completed the computer science sequence. Surveys were sent to these students electronically and they were requested to return comments on the items, Likert scale key, and physical layout. Each student was then interviewed separately to determine content validity. Changes were made to the survey instrument after this process and it was not retested prior to use. Subjects were asked to rate how important each topic or skill is to their work, using a Likert scale of 1—5 with the following key: 1 = ‘‘I don’t need to know anything about this topic for my work and/or I don’t use this skill in my work.’’ and 5 = ‘‘I need to know a lot about this topic and/or use this skill frequently in my work.’’ If the subjects answered 2 or higher on the topic ‘‘programming languages’’ they were asked to list which languages they use or need to know. If the subjects answered 2 or higher on the topic ‘‘database management,’’ they were asked to list the Database Management System(s) that they use or need to know. In addition, subjects were asked for their current job title, a brief description of their current work, and for any other topics or skills
medical informaticians
141
Table 1 Current curriculum in computer science for masters level medical informatics students at OHSU, listed by course and approximate order of introduction Computer science and introduction to Java programming Basic UNIX skills, the WWW and HTML Data representation and storage The structure of programming languages; introduction to object-oriented and Java programming Computer organization, data manipulation, machine language Operating systems, UNIX shells and processes, shell programming Java datatypes, operators, execution of flow Inheritance, polymorphism and exceptions in Java Algorithms: binary search, recursive algorithms, analysis of algorithmic complexity Java IO: files and file descriptors, sequential and random access files Data structures: lists, arrays, stacks, queues, trees, binary trees Indexing and hash functions Java data structures Networks and network programming Introduction to networking with an emphasis on internet protocols: circuit switching, packet switching, network addressing, protocol layers Application layer protocols: ftp, email protocols, DNS, http Introduction to Java networking: client/server programming CGI programming, HTML forms Transport layer protocols: TCP, UDP Processes and threads in Java client/server programming Network layer protocols: routing algorithms, ATM, IP Link layer protocols: LAN technology, ethernet, PPP Wireless and multimedia networking Network security: Threats, firewalls, cryptography Databases and Database Management Systems Entity-relationship modeling Hierarchical, networking and relational databases Database normalization, constraints and functional dependencies Relational algebra SQL Database interfaces: JDBC/ODBC Database interfaces: Java servlets/JSP File management and indexes Query optimization Transaction processing Data warehousing, OLAP, and data mining techniques
related to computer science that are important in their work.
2.2. Survey distribution All graduates of the Master of Science in Medical Informatics or Master of Medical Informatics programs at Oregon Health and Science University were considered eligible for this study. In addition, all current students who had completed most of the course work and were employed (other than those employed as graduate research assistants or teaching assistants) were included, giving a total of 39 eligible subjects. Two eligible subjects are the authors of this work and no valid email addresses were available for six other eligible subjects. The survey
was sent by email to the 31 subjects for whom contact information was available. Reminders were sent weekly for 2 weeks after the initial contact. Subjects can be categorized both by their background and current job description. Using the previously described categories for medical informatics applications [4] of Healthcare delivery, Clinical research, Medical education, and Information sciences, Table 3 tabulates the job descriptions of the respondents versus their backgrounds. Respondents were placed into one of three groups based on pre-masters educational background: clinicians (physicians, nurses, pharmacists, etc.), computer science and engineering, and all others. Our foreign medical graduates, all of whom have stayed in the United States, were grouped
142
J.R. Logan, S.L. Price
Table 2 Survey items Computer systems (e.g. computer architecture, machine language, storage of data, operating systems) Programming concepts (e.g. structured programming, data structures, algorithms) Object-oriented programming concepts (e.g. inheritance, polymorphism, encapsulation) Networking concepts (e.g. protocol stacks, network algorithms, LAN topologies) UNIX operating system Programming languages (e.g. C++, Java, Perl) Software engineering Unified modeling language (UML) or other object-oriented methodology Client—server applications Website development/maintenance eXtensible markup language (XML) Network management Network security Database design Database management Data retrieval/analysis from databases Respondents were asked to rate the importance in their work of each topic or skill.
with the ‘‘other’’ group because of their similar employment prospects. The results must be interpreted with knowledge of the background and training received by these subjects as students. At the time of program inception, OHSU had schools in the various health sciences only. Faculty in the Department of Computer Science at Portland State University (PSU) were recruited to teach the initial computer science sequence which consisted of an intensive introduction to C++ programming followed by courses on operating systems and computational logic. The course was also offered to PSU students with the intent of preparing students without an undergraduate computer science degree for graduate level CS courses. The series was internalized to the department over the next 3 years and with it the content changed. Currently the required computer science sequence lasts for 1 academic year and consists of sections on computer science, networking, and databases, each including instruction in Java programming (Table 1). This evolution has occurred because of several factors. Practical considerations
include inconvenience of the initial off-campus location and the high cost of external faculty. In addition, the recent merger of OHSU with the Oregon Graduate Institute has now given OHSU a School of Science and Engineering with expanded opportunities for faculty and student collaboration. Most important, however, was the change in our perception of the needs of our students. Our students vary from recent college graduates to students with advanced degrees. Their backgrounds range from majors in biological science or clinical medicine to computer science. Students with an undergraduate degree in computer science are exempted from the computer science requirement. As a prerequisite to entering the Master’s program, all students must take a programming course, but the programming language and level are not specified. The trend throughout this evolution has been away from computer programming and towards computer and information science. Writing program code has been integrated with the broader fields of computer science. Textbooks that include programming in Java along with their basic topics
Table 3 Employment category of respondents based on background Background
Healthcare delivery
Clinical research
Medical education
Clinicians (n = 12) CSa /engineering (n = 3) Other (n = 12)
10 1 4
2 1 4
1
Total (n = 27)
15 (56%)
7 (26%)
1 (4%)
Information sciences
Other
2
2 1 2
2 (7%)
5 (19%)
Total percentage is >100% because some subjects describe work in more than one category. a Computer science.
medical informaticians
143
Table 4 The importance of computer science topics to the work of medical informaticians based on results of this survey (all respondents), ranked based on average of Likert values Rank
Topic
Average on Likert scale 1—5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Data retrieval/analysis from databases Database design Website development/maintenance Programming concepts Computer systems Programming languages eXtensible markup language (XML) Client—server applications Database management Network security UNIX operating system Software engineering Networking concepts Object-oriented programming concepts Network management Unified modeling language (UML) or other object-oriented methodology
4.1 4.0 3.7 3.6 3.4 3.3 3.2 3.1 3.1 3.0 2.9 2.8 2.7 2.4 2.4 2.2
of computer science, networking and databases have been adopted.
3. Results Surveys were completed by 27 of the 31 recipients (87%). Non-responders differed from responders in that three of the four non-responders were physicians, who accounted for only 38% of total subjects. Two responding physicians are in purely clinical practices now and their responses are not included in the following results summary. Ninety-eight percent of the survey items were rated. Mean scores for the topics varied from 2.2 to 4.1 (mean ± S.D. 3.1 ± 0.6). Ranking of topics from high to low based on average score is given in Table 4. A high ranking signifies that an item was considered more important for work than a lower ranked item. In addition to overall rank, results were tabulated
by the educational background of the informatician, as previously described. The highest ranking items for each group are shown in Table 5. Given the low rating of networking topics/skills (networking management and network security), one final analysis was performed. A distinct change took place in our curriculum concerning networking with 12 of the 27 respondents having taken a more intensive networking course than the earlier students. We therefore wondered if the low rating of networking concepts and skills was because over half of the students had little education in the topics. However, the ranking of networking skills was equally low in both groups.
4. Discussion The graduates and students of the Medical Informatics Masters programs at OHSU who are working
Table 5 Highest ranking computer science topics and skills for medical informaticians, based on pre-Masters educational background
Rank
Clinicians
CSa /engineering
Other
1
Website development and maintenance Database design Client—server applications Data retrieval and analysis Computer systems
Database design
Data retrieval and analysis
Database management Data retrieval and analysis Programming concepts Computer systems
Database design Website development and maintenance Programming concepts XML
2 3 4 5 a
Computer science.
144 in the field of Medical Informatics have rated all of the computer skills and topics presented in this survey as having some importance in their work. The skills and topics of most importance were data retrieval and analysis from databases, database design, and website development and maintenance, followed by programming and computer concepts and programming skills. This study differed from that of Hoffman and Ash [5] who surveyed prospective employers, but their results add validity to this one. Of the technical and analytical skills rated highly in that study, many are the same as were rated highly in ours. Eight of their top 20 skills required databases, analytical skills and web technologies. The studies differed materially, first, because we were interested not just in skills but also in topical knowledge which, while not practiced, is important to employment (such as knowledge of programming languages without actually writing program code) and, second, because our focus was solely on computer science. It is difficult to determine how well these results can be generalized outside of OHSU. Others have reported on graduate employment but used different job classifications, making it difficult to compare our graduates with theirs [7,8]. All subjects in this study received training at the same institution, although that training varied considerably during the time of their enrollment. However, we hypothesize that our graduates, given their diverse backgrounds, are as close to a true representation of the body of academic and non-academic medical informaticians as has been reported. The strong predominance of employment rated to clinical systems is consistent with the findings of Corn [4], but research informatics is more important than suggested by his work. Medical education and information sciences still received only brief nods. The importance ratings may also be prejudiced upward because all of the respondents know the researchers and know their involvement in this course work, leading to potential reporting bias. However, even if the overall scores are inflated, the rankings are unlikely to be altered as a result of that bias. As a result of this study, we must rethink the time spent in our networking course and plan to offer an advanced database course consisting primarily
J.R. Logan, S.L. Price of a database design and implementation project. We are considering whether or not existing courses in the School of Science and Engineering can meet the needs for advanced skills in web-related areas including database interfaces and XML, or whether new courses should be developed. And finally, we have already developed and offered a course in data mining techniques to help fill the data analysis needs of our students.
5. Conclusion The core curriculum of Medical Informatics Education Programs continues to be questioned. We propose, based on this project, that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are a large part of that core. These are in the preferred skill set of employers [5], and in the useful skill set of Medical Informatics professionals.
References [1] Anonymous. AMIA Spring Congress examines health informatics training for Y2K and beyond. J. Am. Med. Inform. Assoc. 6 (4) (1999) 336—337. [2] International Medical Informatics Association, Working Group 1: Health and Medical Informatics Education. Recommendations of the International Medical Informatics Association (IMIA) on education in health and medical informatics. Method Inform. Med. 39 (2000) 267—277. [3] H.D. Covvey, D. Zitner, R. Bernstein, J.E. MacNeill, The development of model curricula for health informatics, Medinfo (2001) 1009—1013. [4] M. Corn, Getting to the core of medical informatics training, MD Comput. 16 (2) (1999) 25—27. [5] S. Hoffman, J. Ash, A survey of academic and industry professionals regarding the preferred skill set of graduates of medical informatics programs, Medinfo (2001) 1028—1032. [6] S. Price, J. Logan, The role of computer science and computing skills in a medical informatics curriculum, Proc. AMIA Symp. (2001) 1252. [7] G.A. Patton, R.M. Gardner, Medical informatics education: the University of Utah Experience, J. Am. Med. Inform Assoc. 6 (6) (1999) 457—465. [8] F.J. Leven, R. Haux, Twenty five years of medical informatics at Heidelberg/Heilbronn: discussion of a specialized curriculum for medical informatics, Yearbook of Medical Informatics, 2000, pp. 120—127.
Computer science education for medical informaticians Judith R. Logan*, Susan L. Price Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
KEYWORDS Curriculum; Medical informatics; Computer literacy; Education; Graduate
Summary The core curriculum in the education of medical informaticians remains a topic of concern and discussion. This paper reports on a survey of medical informaticians with Master’s level credentials that asked about computer science (CS) topics or skills that they need in their employment. All subjects were graduates or ‘‘near-graduates’’ of a single medical informatics Master’s program that they entered with widely varying educational backgrounds. The survey instrument was validated for face and content validity prior to use. All survey items were rated as having some degree of importance in the work of these professionals, with retrieval and analysis of data from databases, database design and web technologies deemed most important. Least important were networking skills and object-oriented design and concepts. These results are consistent with other work done in the field and suggest that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are part of the core curriculum for medical informatics. © 2003 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Relatively few studies have formally assessed the educational needs of medical informatics graduates. Most discussions regarding the content of medical informatics curricula that might be useful to support curriculum decisions can be divided into three categories. The first category is descriptions of individual training programs. The curriculum discussions usually occur in the context of overall program descriptions that include the history and philosophy of the program. Many examples of such discussions are available in the 1994 issue of Methods of Information in Medicine and in a series of articles in MD Computing from 1999 to 2000. While it is useful to read about the deci*Corresponding author.
sions others have made, and one can often learn from others’ experiences, it is usually unclear how decisions were made and whether the decisions were ad hoc or were based on fundamentally sound principles. A second category of information is expert opinion, usually found in summaries and recommendations from medical informatics conferences and working groups. Examples of this category are the 1999 Spring Congress of the American Medical Informatics Association (AMIA), which was devoted to health informatics education and which resulted in a published white paper [1], the educational recommendations published by the International Medical Informatics Association (IMIA) [2], and work by Covvey et al. [3]. The information in these papers is derived from the considered opinions of experienced educators and has been subjected to the sifting and refinement of group discussion and
1386-5056/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2003.11.014
140 consensus building. The main drawback to this category of information is the relative lack of specificity and granularity of recommendations regarding specific curriculum components. Their usefulness is somewhat limited with regard to determining appropriate content of individual courses, such as courses covering computer science (CS) concepts and technical computing skills. The third category is publications deriving from research studies and published literature reviews. Relatively few studies are available to help us make evidence-based curriculum decisions. We briefly describe the findings of some significant studies that do exist. Corn [4] described the knowledge needed by a medical informatician based on his discussion of informatics literature and training programs. He pointed out that the major emphasis of medical informatics in the 1990s was applications tied to healthcare delivery, including hospital and departmental information systems. Clinical research, medical education and information sciences were, as they perhaps still are, given less emphasis in literature and training programs. Hoffman and Ash [5] subsequently surveyed prospective employers of the graduates of masters level programs in medical informatics to determine the set of abilities that constitute ‘‘skill in medical informatics.’’ This survey resulted in a list of the 20 most valued skills as well as refinement of the survey instrument. Their ‘‘top 20 skills’’ can be loosely grouped into technical skills (nine categories), data analysis skills (two categories) and organizational and management skills (nine categories). The purpose of this study was to examine one segment of medical informatics education, specifically, to determine the computer science knowledge and skills needed by medical informatics graduates, as determined by survey of practicing medical informaticians. We performed the survey as part of curriculum development at Oregon Health and Science University, which has graduated its sixth class of Master of Science and Master of Medical Informatics students. This program has always embraced computer science and programming skills as part of its core curriculum. The content of that curriculum has changed considerably over the years, however. Table 1 is a summary of the current three-term sequence. The commitment to instruction in computer science remains strong, based on informal knowledge of the job placements of our graduates and a previously reported survey of former students [6]. In this project, a survey of topics and skills related to computer science was sent electronically to the graduates and employed students of this program.
J.R. Logan, S.L. Price
2. Materials and methods 2.1. Survey creation The survey consists of 16 items (Table 2) reflecting areas of knowledge related to computing and computer science. Some of these items represent conceptual knowledge about a topic while others represent computing skills. For brevity, we refer to these as topics and/or skills. Respondents were asked to rate each item, which might represent a topic, a skill, or some combination of both, just once, for importance to their work. Our preliminary version of the survey had attempted to differentiate skills and topics but this differentiation was found to be cumbersome in preliminary testing. For example, database design may be a topic to an informatician who is supervising construction or use of a data warehouse but a skill to the informatician who is proposing the design for that data warehouse. The survey items were chosen after review of our own curriculum and an informal review of the curriculum of other medical informatics programs. Some of those items have significance to us because of questions of inclusion that have arisen in our program. The preliminary version of this survey was tested on 10 students in the program who had completed the computer science sequence. Surveys were sent to these students electronically and they were requested to return comments on the items, Likert scale key, and physical layout. Each student was then interviewed separately to determine content validity. Changes were made to the survey instrument after this process and it was not retested prior to use. Subjects were asked to rate how important each topic or skill is to their work, using a Likert scale of 1—5 with the following key: 1 = ‘‘I don’t need to know anything about this topic for my work and/or I don’t use this skill in my work.’’ and 5 = ‘‘I need to know a lot about this topic and/or use this skill frequently in my work.’’ If the subjects answered 2 or higher on the topic ‘‘programming languages’’ they were asked to list which languages they use or need to know. If the subjects answered 2 or higher on the topic ‘‘database management,’’ they were asked to list the Database Management System(s) that they use or need to know. In addition, subjects were asked for their current job title, a brief description of their current work, and for any other topics or skills
medical informaticians
141
Table 1 Current curriculum in computer science for masters level medical informatics students at OHSU, listed by course and approximate order of introduction Computer science and introduction to Java programming Basic UNIX skills, the WWW and HTML Data representation and storage The structure of programming languages; introduction to object-oriented and Java programming Computer organization, data manipulation, machine language Operating systems, UNIX shells and processes, shell programming Java datatypes, operators, execution of flow Inheritance, polymorphism and exceptions in Java Algorithms: binary search, recursive algorithms, analysis of algorithmic complexity Java IO: files and file descriptors, sequential and random access files Data structures: lists, arrays, stacks, queues, trees, binary trees Indexing and hash functions Java data structures Networks and network programming Introduction to networking with an emphasis on internet protocols: circuit switching, packet switching, network addressing, protocol layers Application layer protocols: ftp, email protocols, DNS, http Introduction to Java networking: client/server programming CGI programming, HTML forms Transport layer protocols: TCP, UDP Processes and threads in Java client/server programming Network layer protocols: routing algorithms, ATM, IP Link layer protocols: LAN technology, ethernet, PPP Wireless and multimedia networking Network security: Threats, firewalls, cryptography Databases and Database Management Systems Entity-relationship modeling Hierarchical, networking and relational databases Database normalization, constraints and functional dependencies Relational algebra SQL Database interfaces: JDBC/ODBC Database interfaces: Java servlets/JSP File management and indexes Query optimization Transaction processing Data warehousing, OLAP, and data mining techniques
related to computer science that are important in their work.
2.2. Survey distribution All graduates of the Master of Science in Medical Informatics or Master of Medical Informatics programs at Oregon Health and Science University were considered eligible for this study. In addition, all current students who had completed most of the course work and were employed (other than those employed as graduate research assistants or teaching assistants) were included, giving a total of 39 eligible subjects. Two eligible subjects are the authors of this work and no valid email addresses were available for six other eligible subjects. The survey
was sent by email to the 31 subjects for whom contact information was available. Reminders were sent weekly for 2 weeks after the initial contact. Subjects can be categorized both by their background and current job description. Using the previously described categories for medical informatics applications [4] of Healthcare delivery, Clinical research, Medical education, and Information sciences, Table 3 tabulates the job descriptions of the respondents versus their backgrounds. Respondents were placed into one of three groups based on pre-masters educational background: clinicians (physicians, nurses, pharmacists, etc.), computer science and engineering, and all others. Our foreign medical graduates, all of whom have stayed in the United States, were grouped
142
J.R. Logan, S.L. Price
Table 2 Survey items Computer systems (e.g. computer architecture, machine language, storage of data, operating systems) Programming concepts (e.g. structured programming, data structures, algorithms) Object-oriented programming concepts (e.g. inheritance, polymorphism, encapsulation) Networking concepts (e.g. protocol stacks, network algorithms, LAN topologies) UNIX operating system Programming languages (e.g. C++, Java, Perl) Software engineering Unified modeling language (UML) or other object-oriented methodology Client—server applications Website development/maintenance eXtensible markup language (XML) Network management Network security Database design Database management Data retrieval/analysis from databases Respondents were asked to rate the importance in their work of each topic or skill.
with the ‘‘other’’ group because of their similar employment prospects. The results must be interpreted with knowledge of the background and training received by these subjects as students. At the time of program inception, OHSU had schools in the various health sciences only. Faculty in the Department of Computer Science at Portland State University (PSU) were recruited to teach the initial computer science sequence which consisted of an intensive introduction to C++ programming followed by courses on operating systems and computational logic. The course was also offered to PSU students with the intent of preparing students without an undergraduate computer science degree for graduate level CS courses. The series was internalized to the department over the next 3 years and with it the content changed. Currently the required computer science sequence lasts for 1 academic year and consists of sections on computer science, networking, and databases, each including instruction in Java programming (Table 1). This evolution has occurred because of several factors. Practical considerations
include inconvenience of the initial off-campus location and the high cost of external faculty. In addition, the recent merger of OHSU with the Oregon Graduate Institute has now given OHSU a School of Science and Engineering with expanded opportunities for faculty and student collaboration. Most important, however, was the change in our perception of the needs of our students. Our students vary from recent college graduates to students with advanced degrees. Their backgrounds range from majors in biological science or clinical medicine to computer science. Students with an undergraduate degree in computer science are exempted from the computer science requirement. As a prerequisite to entering the Master’s program, all students must take a programming course, but the programming language and level are not specified. The trend throughout this evolution has been away from computer programming and towards computer and information science. Writing program code has been integrated with the broader fields of computer science. Textbooks that include programming in Java along with their basic topics
Table 3 Employment category of respondents based on background Background
Healthcare delivery
Clinical research
Medical education
Clinicians (n = 12) CSa /engineering (n = 3) Other (n = 12)
10 1 4
2 1 4
1
Total (n = 27)
15 (56%)
7 (26%)
1 (4%)
Information sciences
Other
2
2 1 2
2 (7%)
5 (19%)
Total percentage is >100% because some subjects describe work in more than one category. a Computer science.
medical informaticians
143
Table 4 The importance of computer science topics to the work of medical informaticians based on results of this survey (all respondents), ranked based on average of Likert values Rank
Topic
Average on Likert scale 1—5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Data retrieval/analysis from databases Database design Website development/maintenance Programming concepts Computer systems Programming languages eXtensible markup language (XML) Client—server applications Database management Network security UNIX operating system Software engineering Networking concepts Object-oriented programming concepts Network management Unified modeling language (UML) or other object-oriented methodology
4.1 4.0 3.7 3.6 3.4 3.3 3.2 3.1 3.1 3.0 2.9 2.8 2.7 2.4 2.4 2.2
of computer science, networking and databases have been adopted.
3. Results Surveys were completed by 27 of the 31 recipients (87%). Non-responders differed from responders in that three of the four non-responders were physicians, who accounted for only 38% of total subjects. Two responding physicians are in purely clinical practices now and their responses are not included in the following results summary. Ninety-eight percent of the survey items were rated. Mean scores for the topics varied from 2.2 to 4.1 (mean ± S.D. 3.1 ± 0.6). Ranking of topics from high to low based on average score is given in Table 4. A high ranking signifies that an item was considered more important for work than a lower ranked item. In addition to overall rank, results were tabulated
by the educational background of the informatician, as previously described. The highest ranking items for each group are shown in Table 5. Given the low rating of networking topics/skills (networking management and network security), one final analysis was performed. A distinct change took place in our curriculum concerning networking with 12 of the 27 respondents having taken a more intensive networking course than the earlier students. We therefore wondered if the low rating of networking concepts and skills was because over half of the students had little education in the topics. However, the ranking of networking skills was equally low in both groups.
4. Discussion The graduates and students of the Medical Informatics Masters programs at OHSU who are working
Table 5 Highest ranking computer science topics and skills for medical informaticians, based on pre-Masters educational background
Rank
Clinicians
CSa /engineering
Other
1
Website development and maintenance Database design Client—server applications Data retrieval and analysis Computer systems
Database design
Data retrieval and analysis
Database management Data retrieval and analysis Programming concepts Computer systems
Database design Website development and maintenance Programming concepts XML
2 3 4 5 a
Computer science.
144 in the field of Medical Informatics have rated all of the computer skills and topics presented in this survey as having some importance in their work. The skills and topics of most importance were data retrieval and analysis from databases, database design, and website development and maintenance, followed by programming and computer concepts and programming skills. This study differed from that of Hoffman and Ash [5] who surveyed prospective employers, but their results add validity to this one. Of the technical and analytical skills rated highly in that study, many are the same as were rated highly in ours. Eight of their top 20 skills required databases, analytical skills and web technologies. The studies differed materially, first, because we were interested not just in skills but also in topical knowledge which, while not practiced, is important to employment (such as knowledge of programming languages without actually writing program code) and, second, because our focus was solely on computer science. It is difficult to determine how well these results can be generalized outside of OHSU. Others have reported on graduate employment but used different job classifications, making it difficult to compare our graduates with theirs [7,8]. All subjects in this study received training at the same institution, although that training varied considerably during the time of their enrollment. However, we hypothesize that our graduates, given their diverse backgrounds, are as close to a true representation of the body of academic and non-academic medical informaticians as has been reported. The strong predominance of employment rated to clinical systems is consistent with the findings of Corn [4], but research informatics is more important than suggested by his work. Medical education and information sciences still received only brief nods. The importance ratings may also be prejudiced upward because all of the respondents know the researchers and know their involvement in this course work, leading to potential reporting bias. However, even if the overall scores are inflated, the rankings are unlikely to be altered as a result of that bias. As a result of this study, we must rethink the time spent in our networking course and plan to offer an advanced database course consisting primarily
J.R. Logan, S.L. Price of a database design and implementation project. We are considering whether or not existing courses in the School of Science and Engineering can meet the needs for advanced skills in web-related areas including database interfaces and XML, or whether new courses should be developed. And finally, we have already developed and offered a course in data mining techniques to help fill the data analysis needs of our students.
5. Conclusion The core curriculum of Medical Informatics Education Programs continues to be questioned. We propose, based on this project, that strong emphasis on technical skills, particularly databases, data analysis, web technologies, computer programming and general computer science are a large part of that core. These are in the preferred skill set of employers [5], and in the useful skill set of Medical Informatics professionals.
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