Developing new pathways into the biomedical informatics field: the AMIA High School Scholars Program

Abstract

Increasing access to biomedical informatics experiences is a significant need as the field continues to face workforce challenges. Looking beyond traditional medical school and graduate school pathways into the field is crucial for expanding the number of individuals and increasing diversity in the field. This case report provides an overview of the development and initial implementation of the American Medical Informatics Association (AMIA) High School Scholars Program. Initiated in 2014, the program’s primary goal was to provide dissemination opportunities for high school students engaged in biomedical informatics research. We discuss success factors including strong cross-institutional, cross-organizational collaboration and the high quality of high school student submissions to the program. The challenges encountered, especially around working with minors and communicating program expectations clearly, are also discussed. Finally, we present the path forward for the continued evolution of the AMIA High School Scholars Program.

BACKGROUND

Career paths in biomedical informatics are rapidly evolving as the field expands in new directions and as demand increases for computational skills in biomedicine and health care.^1–3 The field of biomedical informatics has been broadly defined as “the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, motivated by efforts to improve human health.”⁴ Biomedical informatics programs around the United States initially focused on graduate or postgraduate education, a strategy supported in part with funding from the National Library of Medicine.⁵ More recently, biomedical informatics education has included a wider range of program types, with the number of community college and university certificate programs expanding after the Health Information Technology for Economic and Clinical Health (HITECH) Act.^6–8 Additionally, state-level initiatives have brought health informatics coursework into high school classrooms (e.g., in Ohio).^9,10 However, the question remains: is biomedical informatics as a field reaching the full range of talented and highly motivated individuals who may already be capable of making substantial contributions early enough to make a difference in their educational and career trajectories?

Exposure to scientific disciplines in grades K–12 is a noted success factor in choosing a path involving scientific study at the undergraduate level.¹¹ Multiple scientific, engineering, and computing disciplines have engaged in outreach activities to provide pathways for interested youth.^12–17 The National Science Foundation (NSF) has funded a wide variety of STEM-C (science, technology, engineering, and math, including computing) outreach programs exploring how to best link interested students with potential fields of study.^18,19 One important component guiding NSF educational efforts is a strategic objective to “integrate education and research to support development of a diverse STEM workforce with cutting-edge capabilities.”^20,21

The AMIA High School Scholars Program grew out of ongoing efforts at multiple universities to engage high school students in biomedical informatics education and research. Our goal in this manuscript is to provide an overview of the program, explain lessons learned in its first 2 years, discuss future plans, and encourage the field to consider roles for high school trainees in educational and research missions.

HIGH SCHOOL INVOLVEMENT IN BIOMEDICAL INFORMATICS

The concept of providing biomedical informatics educational outreach opportunities to high school students is not entirely new. A pioneer in this area was the University of Pittsburgh, which has run a summer high school program, the Computer Science, Biology, and Biomedical Informatics program, for several years.²² Other programs, including those at Vanderbilt University and the Regenstrief Institute, have offered smaller-scale outreach efforts focused on research experiences for individual high school students. Some universities (eg, Stanford University) have high school summer programs that include biomedical informatics research opportunities.²³

A common challenge in linking biomedical informatics high school outreach efforts is the lack of dissemination opportunities for research experiences. Factors such as the timing of conference submission deadlines and meeting expectations of peer reviewers evaluating conference and journal submissions can present challenges for high school students. While several journals publish original research conducted by such students,^24–26 they are not focused on biomedical application domains. At an early educational and career stage, providing opportunities not just to publish a paper but also to interact in person with peers and experts in the field presented a compelling rationale to develop a biomedical informatics competition focused on high school students and linked to the AMIA Annual Symposium. The AMIA High School Scholars Program was designed with these challenges in mind.

OVERVIEW OF AMIA HIGH SCHOOL SCHOLARS, YEAR 1

The first AMIA High School Scholars competition was designed to coincide with the AMIA 2014 Annual Symposium. A call for participation was issued on July 18, 2014, and communicated across multiple channels, including the AMIA 2014 Annual Symposium website, the AMIA Academic Forum, various social media platforms, and word of mouth. Interested students were required to submit a 1-page abstract describing their project and a 7-minute slide presentation by September 4, 2014. A total of 12 submissions were received, from high school students working with faculty or graduate student mentors at 7 biomedical informatics programs across the United States. Submitted materials were peer reviewed by a subset of the 2014 AMIA Annual Symposium Scientific Program Committee, AMIA High School Scholars Program organizers, and additional experts in the field. Submissions were ranked based on reviewer scores, and the top 6 submissions from 7 students were selected. (One selected submission had equally contributing student co-authors.)

The 7 high school students (Table 1) presented their work in a featured presentation session entitled “High School Scholars: Building New Paths to Biomedical Informatics Education” at the AMIA 2014 Annual Symposium on November 17, 2014. Each high school student was also paired with a graduate student mentor, coordinated by the AMIA Student Working Group. High school students and their graduate student mentors were invited to a breakfast, to encourage peer networking and provide orientation to plans for the day. A unique aspect of the high school program was a tour of Washington, DC, monuments, a recreational activity allowing additional peer networking opportunities.

Table 1:

2014 High School Scholar Presentations

Scholar Name High School, State	Presentation Title	Mentor Program
Akhila Ashokan MLK, Jr, TN	Preemptive HLA Genotyping of HIV Patients for Personalized Medicine	Josh Peterson, MD Vanderbilt University
Meghana Ganapathiraju Green Hope, NC	Exploring Novel Visualizations of Survey Data from Users of Electronic Health Records	W Ed Hammond, PhD Duke University
Zeba Kokan Park Tudor, IN	Quality of Physician Documentation of Breast Cancer Family History	Jon Duke, MD, MS Regenstrief Institute
Charles Pei Upper Arlington, OH	Integrating Pathway and Gene Expression Data to Identify Novel Pathway-Specific Cancer Drugs	Atul Butte, MD, PhD Stanford University
John Prescott Pinewood, CA Sumeetha Swaminathan Monta Vista, CA	BetweenNet: A Method to Discover New Gene-Disease Associations	Russ Altman, MD, PhD Stanford University
Ethan Provonost St Paul’s, MD	Automating the Measurement of ICU Alarm Reliability	Suchi Saria, PhD Johns Hopkins University

All travel costs for the students were covered, including transportation, lodging, and meals. Funding to support the initial year of the AMIA High School Scholars Program came from a number of sources. Faculty mentors were asked to cover as much of the travel costs as possible for participants. The balance was then covered using funds raised from individuals and universities (see Acknowledgments section). AMIA waived the conference registration fees for the high school students, and the AMIA Board of Directors approved a budget to ensure all costs were covered.

Program organizers engaged in several activities related to program evaluation. All 3 organizers (INS, JTF, KMU) met throughout the planning period and after program completion to discuss program activities and identify potential paths forward. We also developed a semistructured interview instrument to collect information regarding experiences with the program. Program evaluation activities will continue in future program years, with plans to supplement interviews with focus groups and surveys.

LESSONS LEARNED, YEAR 1

We learned several valuable lessons regarding factors that supported program success in Year 1 and identified several challenges in organizing this type of program (Table 2).

Table 2:

Success Factors and Challenges in Year 1

Success Factors	Challenges
High quality of student submissions and presentations	Identifying long-term, sustainable funding
Significant engagement from students, research mentors, organizers, and others	Unique aspects of working with minors
Cross-institutional, cross-organizational collaboration	Clear communication of expectations
Financial support from individuals, universities, and AMIA	Outreach to high school teachers

Success Factors, Year 1

Multiple factors enabled the success of the first year of the High School Scholars Program. Most importantly, the high quality of submissions from students provided compelling support for the notion that including dissemination opportunities for high school students at the AMIA Annual Symposium was both appropriate and necessary. All 7 participating students were deeply engaged with their research and enthusiastic about the opportunity to present at a national scientific meeting. University research mentors for the students also provided helpful support and encouragement. Peer-networking opportunities proved to be one of the most positive program experiences, enabling students to make connections with high school peers with shared interests in biomedical informatics.

The program was also founded on a strong cross-institutional and cross-organizational collaboration. Highly engaged researchers at different universities provided program leadership, with backing from biomedical informatics senior leaders. AMIA staff provided critical logistical support and resources for publicizing and organizing submissions and peer review, with additional administrative support from Vanderbilt University. The AMIA Student Working Group provided enthusiastic partnership around the idea of peer-to-peer mentoring. By working together across organizational boundaries, we ensured that academic and logistical frameworks for the program were in place, providing a solid foundation for the program’s first year.

Challenges, Year 1

As with any program in early development stages, the High School Scholars Program overcame several challenges related to running a new program oriented toward high school students at the national level. For the first program year, obtaining funding to support student travel costs to attend the meeting was a significant challenge. Thanks to generous financial support from AMIA, individuals, and universities, adequate funding was obtained for the program’s first year. However, these funding challenges made it clear that a long-term sustainable plan was needed to support future program years.

Working with minors presented challenges beyond the scope of more traditional adult student–related challenges. First, we needed to ensure that minors were provided with adequate protection during program participation. This led to the development of a policy for protection of minors in the program, providing basic rules for interacting with minors in a professional setting (Appendix A). All individuals closely connected to the program were also required to complete training on working with minors. Second, we needed to ensure that the high school students were comfortable with travel, presentation, and meeting processes. For example, while adults might be able to pay for plane tickets or hotel rooms and then be reimbursed, this is not typically a feasible expectation for minors. Assuming that parents would pay for travel costs and be reimbursed was also not reasonable, given the program goal to support a diverse range of participants. As a result, universities and AMIA took responsibility for paying travel costs up front. Concerns of parents regarding minors traveling alone led to several students’ parents choosing to travel with their children.

We also learned that communication needed to be clearer regarding expectations of how much the high school students should participate in the AMIA symposium. While our intent was for students to attend substantial portions of the symposium, this expectation was not clearly communicated to students and their parents. Students faced both coursework requirements at their high schools and other important commitments (eg, completing college applications). Students participated in highly varying degrees, attending only portions of the symposium. In addition, it was not always clear to the students which sessions best suited their interests.

Finally, an original program goal was to include teachers from each student’s high school in the symposium. We learned that typically university programs with high school students focus only on the students. Identifying ways to include high school teachers was a significant challenge that remains to be addressed.

BUILDING ON SUCCESS, YEAR 2

In the second year of the program, 2015, we continued to build on our strong inter-organizational collaboration and other success factors. We moved forward in 2015 with a greater emphasis on clear communication, increasing high school student engagement in the symposium, and ongoing program evaluation activities. The 2015 call for participation closed on September 9, 2015, with 21 submissions from high school students working with 14 biomedical informatics programs. Submission decisions were communicated on September 30, 2015.

Given the high degree of interest in the program and our overall goal to continue expanding opportunities for high school student participation, we increased the number of program participants for 2015 to a total of 10 students. Five students were selected to present their research in podium presentations at a featured presentation session, with 5 additional students selected to present posters as part of the Monday symposium poster session (Table 3).

Table 3.

2015 High School Scholar Presentations

Scholar Name High School, State	Presentation Title [Format]	Mentor Program
Fiona Cai Stuyvesant, NY	Efficient Unsupervised Feature Selection for EMR Phenotyping [Podium]	Katherine P Liao, MD, MPH Brigham and Women’s Hospital
Rachel Hong Bishop’s School, CA	BioTurk: Crowd Verification of the Construction and Augmentation of Biological Pathways [Poster]	Olga Troyanskaya, PhD Princeton University
Hannah Huth Harpeth Hall, TN	Information Seeking Behaviors of Pregnant Women and Their Caregivers: Technology Usage and Preferences [Poster]	Gretchen Purcell Jackson, MD, PhD Vanderbilt University
Baridi Lason Jackson MLK, Jr, TN	Analyzing Workflow Patterns in Large Datasets: Exploring the Vanderbilt Outpatient Whiteboard [Poster]	Kim Unertl, PhD Vanderbilt University
Zeba Kokan Park Tudor, IN	Methodology for Cross Talk of Pathways: Case Study EGFR Pathway in Breast Cancer [Poster]	Matthew Palakal, PhD Indiana University–Purdue University Indianapolis
Mit Patel Absegami, NJ	Comparison of Query Performance of a Research Data Warehouse Stored in a Relational Star Schema Database vs in a NoSQL Document-Store Database [Podium]	Bill Shirey, MS University of Pittsburgh
Oona Risse-Adams Lowell, CA	GWAS Variants in Asthma Susceptibility in African American Youth [Poster]	Esteban Burchard, MD, MPH University of California, San Francisco
Lukas Schmit Winchester Thurston, PA	Convolutional Neural Networks for Identifying Transcription Factor Binding Motifs [Podium]	Joyeeta Dutta-Moscato, MS University of Pittsburgh
Kahmil Shajihan Sewickley Academy, PA	Panoptiq Imaging System Compared with Whole Slide Imaging (WSI) for Challenging Pathology Cases [Podium]	Liron Pantanowitz, MD University of Pittsburgh Medical Center
Brooke Striegel Lighthouse Preparatory Academy, MO	Relationship of IT Sophistication to Quality Measures in a National Study of Nursing Homes [Podium]	Gregory L Alexander, PhD, RN University of Missouri

As part of our strategy to increase student engagement in the symposium, we developed a high-level schedule that was distributed to all selected high school scholars and their graduate student mentors. Students were encouraged to attend the Navigate AMIA reception held on Sunday night during the symposium, which provided the opportunity to network with AMIA members and others and to learn more about what to expect from the symposium. Students were also specifically encouraged to attend AMIA scientific sessions with their mentors throughout the day on Monday. After the students completed their podium or poster presentations on Monday, they were also invited to attend the screening of the movie “No Matter Where,” about health information exchange, providing additional insight into the field. Students were also invited to attend the year-in-review session on Tuesday morning. Feedback from the students about these additional planned symposium activities was quite positive, with several suggestions from students for additional activities or scheduling guidance for next year’s program.

We also continued collecting program evaluation data, through a group interview with several students and one-on-one interviews with mentors and others working on high school programs.

THE PATH FORWARD

The AMIA High School Scholars Program faces multiple potential paths for future development. The need for this type of program seems clear; the best route to continue engaging with high school students at the national level is less obvious. Subsequent years will see the program grow in both participant numbers and features.

The success factors and challenges encountered in the program’s first year provided key feedback on future requirements, and we continue to learn as the program evolves. Ongoing financial support will be essential for the program to continue to develop and evolve, potentially including expansion to a larger number of students. We are thus working together with AMIA to develop a long-term funding stability plan.

Selection of the AMIA high school scholars in both years of the program to date was based exclusively on a rigorous peer-review process. In both years, selected scholars included a substantial representation of women and others typically underrepresented in biomedical informatics. In addition, there was a notable increase in the number of biomedical informatics programs submitting high school scholar work. As the High School Scholars Program evolves, we plan to continue outreach efforts to different programs and groups within the biomedical informatics field to encourage development of an even wider range of opportunities for students. Now that the program is established, we plan to begin collecting more structured evaluation data, including more detailed demographic data, to allow more in-depth analysis of the program’s impact.

One continuing area of potential expansion is to engage high school teachers in the AMIA High School Scholars Program. Reaching individual students is a significant achievement, but working with high school teachers would enable even more students to become aware of biomedical informatics career paths. To that end, as part of the 2015 call for participation, we requested that students provide contact information for an administrator at their high school. This enabled us to communicate directly with administrators regarding program expectations for students and to present career development opportunities for teachers. However, more work is still needed to understand the best ways to connect with high school teachers and to include them in informatics opportunities.

CONCLUSION

The AMIA High School Scholars Program presents a unique opportunity for high school students to disseminate the results of their research at a major national academic meeting. With adjustments based on experiences during Year 1, the program continues to evolve and adapt. Future plans include formal program evaluation and expansion of outreach efforts to high school teachers. Through this program and other high school outreach efforts at universities, we hope to expand pathways into biomedical informatics to meet the changing and expanding need for talented and engaged individuals in the field.