Monday, March 19, 2018

Physician Training in Clinical Informatics: One Size Does Not Fit All

Readers of this blog know that although I believe that formal recognition of physicians through board certification is great for our field and those who work in it, its implementation as a subspecialty and the requirement of formal ACGME-accredited fellowships as the only pathway to certification are detriments.

Two recent events bear this out. One recent happening is the increasing number of OHSU medical students who seek informatics training during medical school, such as a combined MD/MS program similar to the joint MD/MPH degree that many medical schools offer. The other is a publication of a supplement on the topic of the value of competency-based, time-variable education in the premier journal of medical education, Academic Medicine.

In essence, is a two-year, on-the-ground fellowship the only way to prepare physicians for practice in clinical informatics? As one who has been involved in the training of physicians for careers in informatics by diverse pathways, I take exception. After being halfway through the third year of our ACGME-accredited fellowship at OHSU, I certainly believe it is probably the gold standard for clinical informatics training. Yet it is not clear to me it is the only way, especially for the substantial number of physicians who come to informatics long after they completed their primary medical training and complete one of our graduate degree programs. Or even those who obtain such education during their primary training, such as the students in our MD/PhD program or those who may choose to pursue an MD/MS pathway.

Some question whether I am opposed to rigor in informatics training? Indeed I am not, but I believe there are many approaches to rigor in informatics training. A two-year, time-based fellowship is not the only path to rigorous training in the field.

My preference would be for there to be many pathways to formal clinical informatics training, all with appropriate rigor. All of them should include both substantial coursework to gain the requisite knowledge of the field, and the appropriate hands-on in-the-trenches training to experience the “real world.” Medical training is increasingly abandoning the “time on the ground” model; should not informatics too? I can easily envision a multifaceted path to informatics training where there is an appropriate amount of knowledge-based education (e.g., master’s degree in medical school or mid-career) followed by an appropriate amount of project work (either within the master’s or external to it).

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