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Basic Medical Science Education Must Include Medical Informatics

Suptendra Nath Sarbadhikari

Page 4

Topics

Statistical Analyses

Many (practically all) of the statistical methods applied to biomedical research are better done with computers, especially multivariate analyses and higher order calculations. Earlier only the simpler statistics that were calculated by pocket calculators (within a few hours) were used in research. Now, computers can solve complex problems in seconds (which previously would have taken days or months). Interestingly, not only statistical analyses for research findings, but also for day to day applications like CT scan or MRI are done by computers with very high computational power.

Another important area of biostatistics is the meta-analysis of various controlled cases to reach a rational conclusion for EBM.

2. Medical Informatics in Relation to the Basic Medical Sciences

Medical Informatics could be used for:

  1. Research and Teaching of Basic Medical Sciences – Model building, theory development and innovative experimentation. The aim should be building new knowledge from existing ones, structuring and assimilating the knowledge in terms of cause-processeffects. Standardization of the approaches for reaching a decision is also required.
  2. Applied Research – Formal experimentation with proper evaluation.
  3. Engineering applied to basic medical research – Specific tool building and development.
  4. Implementation of applications for basic medical education and research Operation, maintenance, management, updating of the applications and training for the users.
  5. Planning and policy development – Role of information technology in health care delivery and medical education.

This sort of a ‘fused’ or ‘sandwich’ discipline requires expertise from various (apparently unrelated) fields and can, therefore, cater career openings to a multitude. Professionals with backgrounds in many of the diverse disciplines can join the bandwagon and contribute fruitfully, he gross application may be in the field of “Academic medical informatics” – Research and development, i.e., educational support. The eligible candidates are usually health care delivery professionals (students, teachers and practitioners) who have pursued some training in medical informatics.

Some examples of applied importance are given below. Building a proper knowledge base for basic medical sciences and updating it dynamically with the progress in research, albeit seemingly rather mundane, is of utmost importance. Here the necessity for proper training arises. Even for utilizing all the available electronic educational resources, some minimum expertise is called for.

PCCAL Consortium at School of Pharmacy and Pharmacology, Bath University, UK, produces CAL (Computer Aided Learning) courseware to teach pharmaceutical and life science students, marketed in association with CoACS (www.coacs.com/PCCAL). Similarly, www.mdl.cuhk.edu.hk/mdlcal/psilink.html gives links of various useful Internet Resources on Physiology. The other Internet Guru is http://bubl.ac.uk/link from where through the Life Sciences link, going to the Main Subject menu, one can get a multitude of links to Physiology, Pharmacology, Anatomy, Biochemistry, Pathology, Microbiology and others. Finally the greatest of greats Google (www.google.com) can take you anywhere, provided the keywords are very specific, otherwise it will simply come up with millions of useful (and not so useful) materials. Once a student (and teacher) has access to these animated tutorials, not only will the boredom typical of a classroom vanish, but difficult concepts can be grasped very easily.

Let us take a concrete example. An experienced teacher in Physiology may easily visualize how a skeletal muscle contracts and relaxes, what is the mechanism of power stroke, what is the role of calcium and magnesium and so on. However, for a beginner, the three dimensional structure of the muscle fiber and its nerve connections seem to be incomprehensible. But, if the student starts with an animated version of muscle contraction, along with its explanations, the concept is etched powerfully in the long term memory. This sort of benefit accrues for the Korotkoff sounds or the heart sounds (normal and adventitious) as well through animated tutorials. In which stage of erythropoiesis the nucleus is extruded, that is rather difficult to memorize initially, but if one “sees” the process, it becomes rather easy to remember. Competitive antagonism of drugs and some body enzymes can also be visualized through such tutorials and then it is much less boring to keep in mind how do the phenomena occur. All this reminds us of the old Chinese proverb “I hear, I forget; I see, I remember; I do, I know”.

For doing, there are various simulators available now in the market. The National Library of Medicine (National Institutes of Health, Bethesda, Maryland) has the Visible Human Project (www.nlm.nih.gov/research/visible/visble_human.html) where 3-dimensional anatomical structures of the whole human body are available system wise. Various other universities throughout the globe also offer various types of simulators for biomedical education and research. The reader is strongly encouraged to do a ‘Google’ search on any topic of his/ her choice with ‘tutorial’ as a keyword. Innumerable high quality full lectures with animations can be visualized and downloaded (many times free of cost, with due acknowledgements) from the World Wide Web.

3. Necessity as a Core Subject

For the purpose of research, training and logistic or administrative issues, it may not be possible to integrate and collaborate successfully at an individual level. Therefore, a number of academic units for medical informatics are already well established in many European countries and the USA. India is globally connected to the Internet. The major public Indian networks include Educational and Research Network (ERNET) of the department of Electronics (DOE); Scientific and Industrial Research Network (SIRNET) managed by the Indian National Scientific Documentation Centre (INSDOC) for CSIR and the NICNET set up and managed by the National Informatics Centre (NIC). The Ministry of Human Resource Development has made available the INDEST Consortium for accessing numerous reputed journals online. In India, some courses on Bioinformatics (in Information Technology or Biotechnology, but not MBBS) also offer Medical Informatics as an Elective. NIC and some private organizations often offer short term courses in medical informatics to doctors-but that is certainly not enough!

Now most of the highly esteemed and famous journals are available as an online version, and that too before the hardcopy is available in the market. With ISDN connectivity being provided by the BSNL and VSAT connectivity being provided by ISRO, the telecommunication activities are usefully increasing in all fields including the healthcare delivery sector. With India aiming at launching men in space as part of Vision 2020, properly functioning infrastructure for e-Health is very much essential. Isolated activities in this regard are being carried out in the various centers or schools for biomedical engineering, electrical/electronics/communication engineering and artificial intelligence research units. However, collaboration between all these units is essential.

In India, the Computer Society of India (CSI) has formed a Special Interest Group in Medical Informatics (SIGMI). The Indian Association of Medical Informatics (IAMI) is actively involved in spreading Medical Informatics awareness through its website (www.iamindia.org) and the online Indian Journal of Medical Informatics. Also there are other organizations like Medical Computer Society of India (MCSI) and National Institute of Medical Informatics (NIMI) related to Medical Informatics.

Even manuscript submissions are accepted electronically entirely in many reputed and indexed journals with high Impact Factor and Prestige Factor. (Interestingly, this article too has been submitted and processed electronically only!)

Multimedia interaction including edical Simulation using Virtual Reality or VR10 is now becoming a powerful tool for education related to medical science and technology. Building a successful simulator also requires proper teamwork. While the medical and bioengineering group can give inputs related to anatomy, physiology, tissue characteristics, combined with the cognitive sciences group (like clinical psychologists) they can give proper idea of clinical skills, and grouping with computer scientists they can give idea about the haptics or tactile feedback information. Similarly the cognitive scientists and computer scientists together can assess the metrics measurement. Therefore if all these three groups combine fruitfully, workable medical simulators can be developed, focusing on specific but small psychomotor clinical and surgical skills. Virtual Reality can be of immense help in such simulated training of students and practitioners, without causing pain or bleeding or tissue damage to the patient and also avoiding the chance of HBV or HIV inoculation during surgery. In some countries abroad, now practical examinations are taken on simulators. This does not cause pain or adverse reaction in any subject, and also demonstrates the examinee’s psychomotor skills to a great extent.

Another important aspect is the prescribed or proposed syllabus. In view of the fast changing world of medical informatics, it is of absolutely essential to formulate a flexible syllabus rather than a rigid one. Only this sort of an attitude or mindset can make medical informatics useful to medical students and researchers alike. Otherwise they will have to learn the obsolete techniques which would have no practical application at all and their potential will not be exploited to the full extent.


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