Engaging the next generation of physician–informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group

Abstract

Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities. Less formal and more flexible approaches can circumvent these drawbacks. Interest groups (IGs), which are organized through the Association of American Medical College Careers in Medicine (CiM) program, exemplify the informal approach. CiM IGs are student-led groups that provide exposure to different specialty options, acting as an adjunct to the traditional medical curriculum. While the primary purpose of these groups is to assist students applying to residency programs, we took a novel approach of using an IG to increase student exposure to an area of medicine that had not yet been formally integrated at our institution. IGs provide unique advantages to formal integration into a curriculum as they can be more easily setup and can quickly respond to student interests. Furthermore, IGs can act synergistically with UME, acting as proving grounds for ideas that can lead to new courses. We believe that the lessons and takeaways from our experience can act as a guide for those interested in starting similar organizations at their own schools.

INTRODUCTION

Clinical informatics is unique among medical fellowships as it is an interdisciplinary field open to any medical specialty.¹ It is one of the most recently approved medical subspecialties, receiving American Board of Medical Specialties approval in 2010.² Medical students have taken notice as technology and data have become more central to the practice of medicine. A survey of 575 medical students at 4 US medical schools found that approximately 30% had an interest in integrating clinical informatics into their careers; however, the majority of students were not aware of formal training opportunities in clinical informatics.³ While a few undergraduate medical education (UME) programs have developed courses or electives focusing on informatics, they remain the exception, not the norm.^4–6 These efforts continue to be hampered by workforce challenges in informatics, limiting the number of programs able to launch UME courses. Formal integration is further hindered by curricular time constraints, with many schools moving away from the traditional 2-year preclerkship model, in favor of a more condensed didactic curriculum that emphasizes clinical exposure.⁷ Although students will gain experience with clinical informatics in the context of using the electronic health record, this is a rather narrow focus. Students may not gain exposure to the full breadth of informatics initiatives, such as digital health, telehealth, precision medicine, machine learning, artificial intelligence, and clinical decision support tools. Moreover, students may lack perspective on the potential for innovation made possible by clinical informatics tools. Finally, the fast-paced nature of clinical informatics advancements may not only outpace formal curriculum development cycles but may not necessarily align with the specific interests of students. As such, more agile approaches, including opportunities for informal career exploration, may be necessarily to expose students to these important topics.

Exploration of popular topics and subjects in medicine is often facilitated in part by the Association of American Medical College (AAMC) Careers in Medicine (CiM) Interest Groups (IGs).⁸ CiM IGs are student-led specialty-specific groups that provide exposure to different specialty options and practice settings.^9,10 They function as an adjunct to traditional medical education, allowing students to meet with faculty, fellows, residents, and other students interested in the specialty.⁸ Most schools have multiple CiM IGs covering the breadth of Accreditation Council for Graduate Medical Education (ACGME) specialties, such as vascular surgery and psychiatry.^11,12 Some schools expand the program to include fellowship-level programs, like medical oncology.¹³ These programs have been associated with an increase in student satisfaction with career services and associated planning resources.¹⁰ Thus, IGs serve to increase students’ exposure to specific fields in medicine and prepare them to make decisions on residency training and career tracks.⁸

IMPLEMENTATION

Exploring the different options

In general, to teach a new area of study in UME, the 2 main options are formal integration into the school curriculum or a more informal/extracurricular route such as forming an IG. Both of these approaches have unique advantages and disadvantages.

There are a few notable advantages to formal integration. The most significant is curricular standardization, ensuring that students who complete the course would have similar baseline understanding of informatics. This could be measured and graded through the creation of informatics-specific competencies⁶ and milestones. Furthermore, an inherent benefit of a formal class is that there would be investment from UME leadership, providing more support and funding that may be unavailable to IGs. However, there are some disadvantages, including limited curricular time and the rigidity of a single informatics curriculum for diverse student backgrounds and interests. Thus, if formal integration is a goal, administration and course directors must be mindful of ensuring that the information taught in these courses would not only be useful, but that there would be adequate time for students to learn and apply the information. Furthermore, if clinical informatics is offered as a stand-alone elective, it may have a problem attracting students. For many students, a major goal of medical school is to move toward the residency of their choice, curating class schedules and extracurricular activities to achieve this goal. As such, students who have little prior knowledge of clinical informatics, and lack an understanding of its applications, may be hesitant to take this class. Finally, curricular changes at the UME level tend to be slow moving, with new courses taking months or longer to formalize and approve.

IGs, on the other hand, tend to have specific advantages as well. First, as a student organization, they can be set up and approved much faster than a new elective course. Second, they are agile and can more easily pivot to match student interests. Third, a lack of formal academic assessment may reduce cognitive barriers to entry; a months-long formal course with grades and evaluations may only attract those with existing interests or talents, while an informal commitment-free event may attract those both with and without prior knowledge or skill. However, this flexibility and informality may lead to more variation in the quality of the student experience, as the organization is highly dependent on group leaders, often with short tenures, to organize events and maintain the organization. The constant transition may hamper long-term improvement efforts as the goals and objectives of the organization may change over time.

Recognizing a need

Since 2012, Vanderbilt University School of Medicine (VUSM) has supported a student group known as the Student Technology Committee (STC) that liaises between medical students and administration to improve the utilization of technology in UME. The STC regularly organizes events such as an annual speaker series with health informatics professionals, as well as other events such as faculty mixers and coding workshops. As the popularity of these events grew, many students expressed interest in learning more about the intersection of medicine, data, and information technology. We recognized the need for a way to expose students to the breadth of clinical informatics, facilitate connections with mentors, and provide guidance on training pathways and career options. The decision was made between the medical students and the Vanderbilt University Medical Center Department of Biomedicals Informatics (DBMI) to start the first Clinical Informatics IG under the umbrella of the CiM program. This approach was preferred over a formal course because it would be better for understanding the current interests of the students, and it could be approved on a shorter timeline than an elective. As this was a novel concept, we wanted to be able to trial different activities and events, as well as touch on multiple aspects of clinical informatics to see what would be most interesting to the current students. Furthermore, it could lay the foundation for the creation of a clinical informatics elective down the road if this IG proved successful.

Key challenges

While we benefited from strong departmental support and established guidelines for forming a student group, we initially faced challenges with student recruitment and retention. First, despite student knowledge about information technology and its impact on healthcare, the concept of clinical informatics and its applications remained nebulous. Second, there was a paucity of baseline knowledge regarding informatics training pathways, which was due in part to the relatively recent development of clinical informatics fellowships. Third, since clinical informatics is a fellowship-level program, we could not rely on the typical CiM IG programming that centers around the preparation of residency applications¹⁰; instead, we had to develop new events and initiatives from scratch.

Takeaway and learning

While other IGs have a primary goal of supporting students as they apply to residency, the focus of the Clinical Informatics IG must be broader: instead of trying to recruit students to the fellowship, the primary focus should be demonstrating to students the importance and breadth of clinical informatics in the healthcare space and its application in their future practice.

To this end, we have found that an important first step is an introductory meeting at the beginning of each year, focused on defining clinical informatics and explaining the importance of this “niche” field in the evolving medical landscape. We achieved this by inviting guest speakers whose research was directly relevant to current trends in medicine. The goal would be not only to maximize student interest but also to frame the initial meeting to recruit students who do not fully understand clinical informatics but could understand the clinical applications. Overall, we adopted a “show, don’t tell” approach to demonstrating the wide range of activities that fall under the umbrella of clinical informatics; this included student-faculty mixers, design challenges, and workshops. A timeline of key events can be found in Figure 1, and a list of talks and seminars organized by (or otherwise available to) the group can be found in Table 1. These processes and events can be used as starting points for similar organizations at other institutions.

Figure 1.

A timeline of inception and notable activities put on by the interest group.

Table 1.

A sample of talks and seminars that were given to students in the interest group, or that students were invited to attend

Year	Talk topics
2018	Clinical application of precision medicine
2019	Leveraging clinical informatics to create a start-up
2019	What is clinical informatics and biomedical informatics?
2020	The role of informatics in pandemic medicine
2021	Using large data sets to improve personalized medication response
2021	Tableau workshop
2021	Ethical complexities with open notes
2021	Innovative care delivery models
2021	Clinical decision support tools and their use in practice
2022	Machine learning in healthcare
2022	Interpreting data and data visualization

Metrics for initiation and success

Although starting a student organization is likely quicker than creating and approving a formal course, it nonetheless represents a significant time investment for students and involved faculty. We benefited from a similar organization, the Student Technology Committee, which could be used to gauge student interest before embarking on creation of a separate and more tailored group. Broadly speaking, we recommend trialing a few events before investing the time to apply for organization status. This has the added benefit of providing an opportunity for student organizers to assay the interests of other students, allowing them to customize initial organization events to best meet their members’ needs.

A challenge associated with our informal approach is defining and measuring success. We recommend a combination of short-term and long-term goals to assess the viability of the organization. In the short term, we believe that there should be a focus on growing the organization through a combination of departmental partnerships and large-audience events. Possible metrics could include member engagement (eg, attendance at scheduled events), member retention, and member outcomes (eg, connections with mentors or research outputs). In the long term, it would be useful to query alumni to ascertain any lasting impacts of participation in the group, to include an assessment of which informatics skills, if any, have been most applicable to their career.

It is important to also state that when choosing between the 2 options, IGs and a formal course will inherently have different goals. A course is likely going to try to build on an existing interest while an IG can do that and create interest in those who may be unsure. This distinction is important because we believe that success for an IG can be defined broadly as a group which has sustained membership, or year-over-year growth in participation, and alumni feel that they not only learned more about clinical informatics and career options but also acquired useful skills they would not have had they not joined this group.

CONCLUSION

Clinical informatics is an exciting and dynamic field of considerable interest to many medical students, but student exposure to the field has been historically limited. Vanderbilt University medical students responded to this need by creating the first CiM Clinical Informatics IG in the United States. Though IGs are traditionally not part of the formal curriculum, they act as an important supplement, reacting to student interests in order to guide activities and initiatives. Furthermore, as IGs are primarily student driven and can quickly adapt to changing needs, they can act as important proving grounds for new concepts and ideas, laying the groundwork for new courses if there is consistent interest. We believe that the takeaway and lessons we have learned from running this organization can act as a guide for medical students who may be interested in starting similar organizations at their own schools. Overall, we hope to inspire the next generation of clinical informaticians to serve as leaders in our increasingly technology-driven healthcare system. While we are aware that the majority of medical students will not pursue a career in clinical informatics, we nonetheless believe that those who participate in these IGs will better understand the scope of the field and will be more likely to apply informatics principles to their future practice.

FUNDING

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

AUTHOR CONTRIBUTIONS

WTQ, CHL, MGC, EM, JSA, CSG, and KBJ contributed to the conception and design of the work. WTQ, CHL, and MGC contributed to drafting the original article. WTQ, CHL, MGC, EM, JSA, CSG, and KBJ contributed to critical revision of the article and final approval of the submitted version.

CONFLICT OF INTEREST STATEMENT

None declared.

Data Availability

No new data were generated or analyzed in support of this research.