Information Technology and Medical Education

Educators do not seem much interested in the clinical viewpoint of medical education, so here it is anyway. Medical education equates to the delivery of medical information -- much more than it is possible to teach.  Medical schools should be obligated to provide current medical information from the first year of medical school and throughout the life of the graduating physician --- Current forms of accessing medical information, CME or GME are completely inadequate and obsolete, locked up in copyright, cost and limited by the distribution of the printed text.

Currently there is no realtime source for the total sum of medical knowledge and the leading edge of information growth. Physicians and students alike need such a source that is up-to-date, real time, 24/7. That source should contain it all, terminology and diagnostic criteria as currently understood by the medical school and the specialties.[1] Every medical school should provide total medical terminology, information and knowledge for every student and graduate at no cost by secure 24/7 online access.

Given such a source of current medical information, indexing the relational database could offer an ongoing differential list of diagnostic possibilities for each-and-every sign, symptom and laboratory finding. Despite advances in medical science, missed diagnosis continues to plague the profession. A correct and timely diagnosis seems more likely with instant access to lists of all the possibilities, criteria for diagnosis and brief summary. Statistical analysis of those lists should be ongoing and realtime offering simple probabilities for both single positives and combinations. This statistical process will be essential for assimilating genomic data and applying it to personal medical care.

Information technology offers an unlimited repository of knowledge accessible through a relational database. The computer never forgets. It lends itself to statistical analysis, but it does not think.  Thinking is the job of the student and the physician. That critical clinical thinking and the basic sciences remain the educational challenges of the medical school. Medical information is so vast and so rapidly changing that it has long since grown beyond the capacity of any one physician to learn and forget much less to remember. Diseases and treatments fall into familiar patterns. A hundred and fifty, or so, conditions fall easily into a recurring pattern of diagnoses. A one-page encounter form can cover the needed ICD codes required for insurance. That recurring pattern, however, leads to premature assumptions and missed diagnoses. We often overlook rare disease possibilities and some not so rare. Rare diseases are indeed just that, but the problem is there are so many of them. Additionally, increasing numbers of Immigrants bring in problems common to their home country but rare in the US.

Physicians keep up to date with expensive seminars and long hours reading expensive journals at home but nonetheless slowly fall behind. The older a physician grows, the more he or she forgets. The wisdom builds while the content shrinks.

We suffer a scarcity of primary care physicians. We need more of them in rural communities. Traveling to a conference or accessing journals may present problems of time and money for a rural physician. A limitless source of medical information at the fingertips may help. Primary care physicians need to fill the gaps between specialties and cover a broader spectrum of medical challenges. The medical information system described will help met that need. The access to current terminology will help with continuity of care or at least communication providing the primary care physician with the same common terminology and reference as the referral center. Furthermore, having access to the same information as the specialist, will add a significant sense of self worth to the role of primary care.

Proprietary systems like Epocrates provide some of the needed medical information. None of the proprietary systems, however, lists everything, nor do they have the ability to stay current. Furthermore, sales and sponsors motivate the content; they emphasize drugs and treatment more than diagnosis. The only valid treatment in the face of wrong or inadequate diagnosis is the patient’s own power of recovery. Medical schools need to provide an umbilical cord for student and to the lifetime of the graduate physician. We have an obligation in medical education to lead the way and to the pursuit of excellence.

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[1] A word of caution, often overlooked by non-clinical educators, information should be limited to medical students and graduate MDs --- those with the ability, education and dedication to care for patients. Providing that information to various assistants and alternative providers will cut off the supply and even the existence of Primary Care Physicians. Another mandate that should go without saying but today is often ignored; physicians must all freely exchange information techniques and knowledge between one another.