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THROUGHOUT MOST OF this century, physicians cared for their patients by making judgments based on information that was at best incomplete and at worst incorrect. Both the volume of what was actually known to be true and the ability to access this information were severely limited. The information gap applied to the individual patient's medical record as well. If a patient was admitted to a hospital with chest pain, it was impossible to retrieve a copy of a prior electrocardiogram for a direct comparison with the new one; the old one was entombed in the files of the patient's private doctor.
Physicians have long been tormented by gaps in information, because their ability to assist patients is directly related to the quality and quantity of information available. Their quest for instantaneous access to "all that is known," however, will soon no longer be quixotic. The explosive growth of information technologies will enable physicians to browse a limitless virtual library, which already includes links to every paper published in biomedical science during the past three decades. Scores of time-tested medical books are appearing online on a daily basis. The online availability of a patient's complete medical record is also being realized. Soon physicians will have electronic access to lab data, narratives of office visits, and visual material, such as electrocardiograms and X-rays. Terminals linking these vast databases will be in the private office setting, on the hospital floor, and even in the car or airplane.
Not only will there be an instantaneous link to what is known, but also the quantity of that knowledge will continue to expand at an exponential rate. Eventually we will know the structure and function of every molecule in the human body, in health and in disease. There will be drugs that stimulate or inhibit the action of each of these molecules. Diagnostic tests will identify these abnormal components and ensure diagnosis for most of the common conditions. There will be a spectacular influx of answers, real answers.
Physicians of the future will have fingertip access to an immense amount of information that will dramatically improve the practice of medicine. With the gift of information, however, comes the responsibility of knowing how to use it. The unwary user will drown in the deluge of data. Our future physicians must learn to navigate these potentially treacherous seas and develop skills in locating, evaluating, and correctly applying information.
The College of Physicians and Surgeons has begun to implement a variety of curricular changes to provide students with these abilities. First, we are redefining the traditional medical core curriculum, which serves as the springboard for explicit, substantive searching of the wealth of information on a chosen topic. Second, we have woven into the program an informatics curriculum that will teach students how to organize successful searches of the vast databases. Third, we are encouraging students to integrate the computer into their daily practice of medicine. Basic sciences faculty are placing course materials online so that students will gain skill in obtaining information through the electronic format. Clinical faculty are asking students to use various programs that assist in diagnosis, treatment, and general patient management, as well as to search routinely in medical databases for definitive answers to diagnostic and therapeutic questions. Last, the faculty is developing learning objectives and activities that will train students to assess the veracity and utility of information obtained from their searches and to make decisions when the available information or answers are inadequate.
The information curriculum will be taught by experts in information processing. In this regard, virtually the entire faculty qualifies as expert; this is what they do every day, a critical part of their academic role. The majority of the faculty, whose specialized biomedical and clinical research interests previously distanced them from the traditional core curriculum, are uniquely equipped to teach students how to retrieve, analyze, and evaluate information obtained through electronic searching. Expanding the pool of available educators in the information curriculum will reduce the time demand placed on individual faculty members. This ability to enhance teaching by marshaling research expertise is especially important considering the escalating competition for funding and the pressure of reduced clinical reimbursement schedules. Equally advantageous, by employing the faculty in a more sophisticated examination of topics of special interest to them, the curriculum can become a more satisfying experience for both faculty and students.
The computer is no longer an elective component of a physician's "black bag"; it is a mandatory tool. However, we can realize its value in improving the lives of our patients only if physicians are able to recognize when information is in fact knowledge. By designing a curriculum for the electronic age, P&S is striving to help the 21st century's doctors build a foundation of sound, up-to-date knowledge for their professional judgments.
Related links...
Department of Medical Informatics, CPMC
Telemedicine Initiative, National Library of Medicine
HERBERT CHASE, M.D., associate professor of clinical medicine, is a basic scientist and physician who directs the interdisciplinary first-year basic sciences curriculum at P&S. He is project director of a grant to establish an electronic curriculum in basic medical science, sponsored by the U. S. Department of Education; he has won several teaching awards from the university and its students.PHOTO CREDIT: Jonathan Smith.
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