Creating an Informatics Experience for Premedical Undergraduate Students: A Case Report

Abstract

Background

Fundamental knowledge and skills in biomedical and health informatics (BMHI) are critical for the next generation of healthcare professionals. Implementing new programs, especially those targeted toward undergraduate students who are studying to become physicians, must be flexible and fit in an already busy schedule. Here, we share our experience and approach at the University of Cincinnati College of Medicine as we created an informatics experience for pre-medical and pre-healthcare students in the Medical Sciences Baccalaureate Program (MSBP).

Methods

To create an informatics experience that supports development of students while allowing them to achieve their personalized educational goals, three strategies were considered to maximize benefit to students and ensure easy implementation of this program: (1) Synergy with an already busy schedule, (2) modularity of course and experiential offerings, and (3) measurable outcomes that are based on core competencies of medical informatics.

Results

By utilizing existing course offerings and experiential learning programs, our team created new informatics-focused research experiences and further created an undergraduate certificate that provides students with a structured yet personalized path to train on medical informatics. Specifically, the informatics experience included two research courses, three summer programs, 1 year-long program, and targeted three presentation venues.

Conclusion

This article chronicles the 5-year effort of our team to create an informatics experience for pre-medical students in the MSBP. We hope that other pre-medical programs can learn from our achievement to create their own informatics experience and tailor it to the needs of their students and resources of their institution.

Background and Significance

Biomedical and health informatics (BMHI) education is critical to train the next generation of interdisciplinary experts to utilize the power of informatics to improve healthcare delivery and patient outcomes. Given the recent advances in machine learning and artificial intelligence (ML/AI) and the potential for ML/AI and informatics to reshape healthcare, 1 it is crucial to provide fundamental informatics knowledge and skills to trainees as early as possible. A review conducted by the International Medical Informatics Association (IMIA) showed that around two-thirds of the publications about BMHI curriculum focused on in-person degree-granting programs in Bachelor of Science, Master of Science, and Doctoral of Philosophy (totaling 64.84%). 2 The rest focused on shorter periods of education, such as distance learning programs, certificates, and training programs, as well as summer school (35.16%). Most programs described in this review were standalone, degree-granting programs, revealing a gap in education for students who may be in a different degree program but on the pre-medical (pre-med) or pre-healthcare (pre-health) track. In other words, these pre-med and pre-health undergraduate students are often overlooked in the BMHI curriculum but will likely be major users and contributors to BMHI in their professional careers.

Pre-med and pre-health students are in the first phase of medical education pursuing their baccalaureate degrees while preparing themselves for a medical degree program. Anecdotally, many pre-med students have busy schedules, packed with both required courses and many extra-curricular activities that they use to prepare for their medical school applications. Because of this, they do not usually have the bandwidth nor the understanding of the importance of incorporating informatics education in their development plan.

The idea of such pre-med informatics education can be traced back to 1993. Ranum coined the term “Pre-medical Informatics” and advocated for the need for informatics literacy in the pre-med education. 3 The author further pointed out the three key components of “Pre-medical Informatics,” namely, computer science, mathematics, and library science. This pioneer paper, unfortunately, did not get much attention and has received relatively few citations. This may be because pre-med education was a new research topic in the 1990s. Researchers and practitioners were still determining the best way to utilize informatics for medicine. Another notable citation was by Carlson in 2016, who added informatics literacy through library science to a Pathway Scholars Program in Arizona. 4 To the best of our knowledge, there is no other publication on pre-med informatics education. In this case report, we addressed this gap by describing our approach to creating an informatics experience for pre-med undergraduate students.

Objectives

We believe and advocate the importance of informatics education for pre-med students. The overall objective of this education program was to train the next generation of medical professional with fundamental knowledge and skills in medical informatics and provide relevant research experience. Our team consisted of champions from the Medical Sciences Baccalaureate Program (MSBP), which is housed in the Dean's office and utilizing faculty from throughout the College of Medicine and a specific core of faculty from the informatics group in the Department of Biostatistics, Health Informatics and Data Sciences. This article reports our experience and achievement in the past 5 years (2019–2023) to create a rich undergraduate informatics experience at the University of Cincinnati College of Medicine (UCCoM).

Methods

The MSBP is a unique program at UCCoM, which provides formal medical sciences education to a population of students that is predominantly pre-med. In the United States, only 3.8% (2 out of 52) top-tier medical schools have such a pre-med bachelor's degree ( Supplementary Table S1 , available in the online version only). Some top-tier medical schools ( N  = 14, 26.9%) have a specialized program (e.g., Bachelor of Science in Medical Imaging) or their university has a pre-med/pre-health program in another college (e.g., Art & Sciences, Health Sciences, or Nursing). The MSBP was established as a major in 2015 by the senior (last) author and had approximately 400 students graduated as of April of 2024. MSBP students are academically strong, hard-working, and goal-oriented. Students receive not only formal didactic education in the medical sciences but also experiential learning in the laboratory, hospital, community, and studies abroad. The key differentiator from other pre-med programs is that the MSBP is physically located within a medical school. This student population regularly has among the highest average standardized testing scores (e.g., ACT, SAT) and high school grade point average across all majors at the University of Cincinnati. The MSBP curriculum was designed to equip students for success in graduate or professional studies in healthcare, with most students preparing for medical school admissions. Students also pursue graduate school in traditional wet bench sciences or other pre-healthcare careers such as physician assistants, physical therapy, and dentistry.

Although the original design of the MSBP curriculum did not have an informatics focus, we realized that the program's structure offered a perfect opportunity to curate “informatics experiences” that would support the development of students, while allowing them to achieve their personalized educational goals. This type of work is supported by our institution's commitment to “experiential learning”: growth and skill development that happens both inside and out of the classroom. 5 6 Additionally, the informatics experience was designed by considering three major strategies that would maximize benefit to students and ensure easy implementation of this program:

1. Synergy : Creating synergy between informatics activities and the MSBP curriculum was imperative because of the limited bandwidth and potential attrition of pre-med students. 7 Without such synergy, students' willingness to participate in informatics activities could be very low.

2. Modularity : The informatics experience should include a variety of activities to fit the different needs of pre-med students. When their interests and goals change, students can quickly adjust their development plan and select the informatics activities that best fit their new direction.

3. Measurable Outcomes : These were important because pre-med students need evidence to demonstrate their learning progress and explain how these outcomes can contribute to their goal of becoming a well-rounded medical and health professional.

With these three strategeis in mind, we reviewed the requirements and recommendations from the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM), 8 the American Medical Informatics Association (AMIA), 9 and the International Medical Informatics Association (IMIA) 10 to create a scope of our informatics experiences. Finally, the curricula of the MSBP and the Biomedical Informatics Graduate Program as well as other related programs and activities in our college and university were reviewed to identify current course offerings that would contribute to a rich informatics experience for our MSBP students.

Results

This section summarizes the key components of the MSBP informatics experience. Table 1 lists all the activities and training as part of this informatics experience, which include two research courses, three summer programs, 1 year-long program, three presentation venues, and one undergraduate certificate. Research is a central component of this informatics experience and aligns with UC's emphasis on experiential learning. Our implementation of the informatics experience was also able to satisfy the three considerations as described below.

Table 1. Activities and training in MSBP informatics experience.

Code/Acronym	Full name	Type	Offered
MEDS3030	Research Rotation	Course	Fall/Spring
MEDS5030/5031	Research Capstone	Course	Fall/Spring
SURF-MedEx	Summer Undergraduate Research Fellowship for Medical Exploration	Program	Summer
UHP Discover	University of Honors Program – Discover Program	Program	Summer
UPRISE	Undergraduates Pursuing Research in Science and Engineering	Program	Summer
RaMP	Biomedical Research and Mentoring Honors Program	Program	Spring/Fall
USS	University-wide Undergraduate Scholarly Showcase	Presentation Venue	Spring
MedSci Poster Fair	Medical Sciences Poster Fair	Presentation Venue	Spring
AMIA	American Medical Informatics Association Conferences	Presentation Venue	Fall/Spring
MedInfo Cert	Medical Informatics Undergraduate Certificate	Certificate	Junior/Senior Year

Abbreviation: MSBP, Medical Sciences Baccalaureate Program.

Synergy

Previously, the majority of MSBP students engaged in a research experience, in part because of expectations for graduate and professional school applications. Development of the MSBP informatics experience enabled MSBP students to combine their research experience with informatics activities and integrate the informatics experience into students' holistic educational experience. For example, a student interested in sleep medicine was admitted to one of the three summer programs. The student was co-mentored by a sleep researcher and an informatician and tasked to support conducting a gold standard sleep study (polysomnogram or PSG) and collect and analyze people-generated sleep data through wearables (e.g., Fitbit).

Modularity

MSBP students also had the opportunity to be advised by the informatics experience director and the MSBP program director (the first and last authors), in addition to faculty mentors and academic advisors, on which combinations of activities and training were best for their goals and capacity. The informatics experience could be as little as a single research rotation course to as involved as receiving an undergraduate medical informatics certificate (MedInfo Cert). Availability of opportunities during both the academic year and summer months provided flexibility.

Measurable Outcomes

In addition to documentation on transcripts, presentation venues helped students showcase their learning and document their achievement. Students who took the senior-year Research Capstone series (MEDS 5030/5031) are required to present their capstone project in the annual MSBP poster fair. Students were also encouraged to participate in the university-side undergraduate scholarly showcase (USS) and present their work as a poster, a podium presentation, or a capstone competition. For MSBP students who had the opportunity to present their work at informatics conferences, such as those organized by the American Medical Informatics Association (AMIA), a significant portion of their travel expenses were reimbursed by the undergraduate-specific funding at the college and the university level. For example, the informatics students presented six posters at the AMIA Annual Symposium in November 2023 in New Orleans ( Supplementary Table S2 , available in the online version only).

Informatics Experience Levels

The informatics experience can be mapped to four levels as shown in Table 2 . These levels include the individual lab, the program, the college, and the university. Taking the first author's lab for example, all new-to-the-lab MBSP students (2–3 per year) took a “3-unit” training and were paired with a senior student to work on a project. It is worth mentioning that the training received in individual labs is designed and customized by each lab director. Students could utilize the informatics activities at various levels to maintain their working relationship with a lab. For example, a student may join a lab initially as a RaMP student in the spring, continue his or her work in the summer, and later take a research rotation with another lab to gain a different experience. Moreover, by participating in various levels of informatics experience, students gained structured training with additional funding and had opportunities to present their work and receive feedback from broader research communities.

Table 2. Mapping of MSBP informatics experience.

Level	Individual lab (Wu)	Bachelor's Degree (MSBP)	College	University
Informatics Experiences	A 3-unit training: 1. Literature review 2. Human subject research 3. Python programming	MEDS3030 MEDS5030-5031 MedSci Poster Fair MedInfo Cert	SURF-MedEx	RaMP UHP Discover UPRISE USS

Abbreviation: MSBP, Medical Sciences Baccalaureate Program.

Undergraduate Medical Informatics Certificate

Table 3 shows the curriculum of the undergraduate medical informatics certificate, which was approved in December 2023 after 2 years of effort and involved multiple colleges within our university (allied health sciences, engineering, and business) and beyond (an affiliated children's hospital). The curriculum design of this undergraduate certificate utilized existing undergraduate level courses and created an undergraduate section of two graduate level courses since there were no alternatives. The first cohort of four MSBP students who had strong interest in medical informatics research graduated with this certificate in the summer of 2024, with all four students choosing to attend medical school. It is planned to expand the certificate by including bioinformatics training and new tracks for students in other majors.

Table 3. Curriculum of MSBP medical informatics certificate (MedInfo Cert).

Area	Sample course	Competency recommended by IMIA
1. Foundation	MEDS2061 (3CR) Introduction to Medical Informatics	BMHI core knowledge and skills
2. Data Management/Programming	MEDS2061 (3CR) Introduction to Database Systems and Applications in Healthcare	Informatics/computer science, mathematics, biometry
3. Data Analytics	MEDS3023C (3CR) Statistics & Experimental Design for Biomedical Sciences	Informatics/computer science, mathematics, biometry
4. Capstone	MEDS3030 (3CR) Research Rotation MEDS5030 (3CR) Research Capstone I MEDS5031 (3CR) Research Capstone II	Medicine, health and biosciences, health system organization
5. Electives	MEDS3090 (3CR) Medical Imaging: Science and Applications	Optional modules in BMHI and from related fields

Abbreviations: BMHI, biomedical and health informatics; IMIA, International Medical Informatics Association; MSBP, Medical Sciences Baccalaureate Program.

Discussion

This case report shared our achievement in the past 5 years to create an informatics experience for our pre-med undergraduate students in the MSBP. This paper details the key components of the informatics experience with examples, the mapping of the components of the four levels, and the curriculum design of the undergraduate medical informatics certificate. More importantly, most of the informatics experience was created without any financial cost because it utilized existing research and education programs and staff support. The initial financial plan was approved for the medical informatics certificate by the university admissions committee and was projected to have a budget surplus of $42,625 after 4 years with consistent enrollment of students. This paper carries forward the pioneering idea of pre-med informatics education from 30 years ago and advocates for the creation of more informatics experiences to educate pre-med undergraduate students about the importance, knowledge, and skills of medical informatics.

As a case study, the results of this paper are not meant to be generalizable, particularly as the student body and program location with the UCCoM are unique. However, other pre-med programs can learn from our achievement and create their own informatics experience and tailor it to the needs of their students and the resource level of their institution. Here we share three lessons learned. First, synergy and modularity were effective strategies to incorporate informatics experience in pre-med students' busy schedule. More than 80% of the informatics students were involved in multiple activities ( Supplementary Table S3 , available in the online version only) and were able to generate meaningful academic output ( Supplementary Table S2 , available in the online version only), which not only supports the growth of the students, but also the academic output of the university. Second, the informatics experience was created in the 5-year span in a bottom-up manner, which has pros and cons. On the one hand, the informatics experience did not grow too fast and was able to demonstrate its success before adding another activity. On the other hand, some students in the early years may receive suboptimal training or miss an opportunity because certain informatics activities did not exist (e.g., informatics-focused session of the research capstone course). The negative aspects can be overcome by a more experienced team with adequate resources (e.g., a dedicated program coordinator) and strong leadership support. Third, institution-wide conversation about the development of a certificate should happen as early as possible because medical informatics is an interdisciplinary field with growing interest. It will take stakeholders from multiple departments and education partners within the university to support a strong program. In our case, communication of our work did not reach other departments until the medical informatics undergraduate certificate went for approval. As a result, a significant amount of time was spent to justify the uniqueness of our certificate and address potential conflicts. Early conversation can help ease tension and create segmentation or even synergy in curriculum design.

As a small pilot program, we do not have much data on the long-term outcomes of joining the certificate program. Instead, we share some brief preliminary outcomes based on the current MSBP students ( n  = 18) who have participated in medical informatics activities ( Supplementary Table S4 , available in the online version only) over the past 5 years (2019–2023). Twelve of those students have graduated from the MSBP, with 9 being accepted into medical school, 2 students in graduate programs, and 1 taking a “growth year” before applying to medical school. Four of these students took part in the medical informatics certificate program and all were accepted into medical school. In total, the current MSBP students have contributed to 7 podium presentations, 20 poster abstracts ( Supplementary Table S2 , available in the online version only), and 17 peer-reviewed publications ( Supplemental References , available in the online version only). These initial positive outcomes built a solid foundation for our informatics program going forward.

Our future work has two directions. First, expanding the activities in the informatics experiences and collaborating with other certificate programs. For example, Knapke et al led the effort of creating a clinical and tractional science certificate to improve the competence of the clinical research workforce and offer pre-med students other career options. 11 12 Second, the informatics experience has been embedded in existing programs and courses without dedicated evaluation metrics. Formal evaluation and student feedback will be a critical next step to take our informatics experience to another level.

Conclusion

This paper shared our experience in creating a rich informatics experience for pre-med undergraduate students and highlighted our strategies as well as successes over the past 5 years. We will continue to grow this program to create a solid foundation for the next generation of medical professionals with strong informatics expertise, who will utilize the power of informatics to revolutionize healthcare.

Clinical Relevance

The role of medical informatics is expected to greatly increase in the future, and training students at an early stage in the pedagogy of this discipline is likely to create a workforce that is facile with the tools and techniques of medical informatics in parallel to their disciplinary knowledge of subjects in medicine. Clinicians with informatics skills can work more efficiently, utilize online resources and tools for patient education and clinical research, and work with informaticians to develop solutions to improve care delivery and quality.

Multiple-Choice Questions

1. Which one of the following is not mentioned as a strategy when designing an informatics experience:

   1. Synergy

   2. Modularization

   3. Measurable outcomes

   4. Financial stability

   Correct Answer: The correct answer is option d. All the other three options were mentioned in this case report. Financial stability is an important factor but not a fundamental consideration of our informatics experience because it is supported by the MSBP and uses many existing resources.

2. Informatics experience in this case report was mapped to multiple levels. Which one of the following includes all the levels in the right order?

   1. Individual lab, program, college, university

   2. Program, individual lab, college, university

   3. Program, college, university, national

   4. College, university, national, international

   Correct Answer: The correct answer is option a. Option b has all the four levels but puts program as the first level. Options c and d include national and international levels, which were not mentioned in this case report.

Funding Statement

Funding The creation and maintenance of the informatics experience were supported by the internal operating funds of the MSBP. We are grateful to the University of Cincinnati and the University of Cincinnati College of Medicine for allowing us the opportunity to pursue scholarship of teaching and learning as we created this certificate.