A Call to Support Informatics Curricula in U.S.-Based Residency Education

Clinical Informatics at the Graduate Medical Education Level

Domains of clinical informatics (CI)—such as telemedicine,[1] large language models,[2] and artificial intelligence (AI)[3]—have touched the lives of medical trainees in recent years. Now more than ever, it is crucial to unlock the potential of CI-related education in undergraduate medical education (UME)[4] [5] [6] [7] [8] [9] [10] and graduate medical education (GME). Prior literature regarding medical students suggests that there is interest in CI but a lack of clarity around opportunities for CI training, mentorship, and careers.[11] Recent literature has highlighted guidelines for standardizing CI education at the UME level[7] and fundamentals for CI curricula for medical schools including AI and data management.[10] CI departments have created combined UME and GME[12] initiatives as well as specific hospital-wide programs for residents and fellows across all specialties.[13] Individual programs in internal medicine,[14] pediatrics,[15] emergency medicine,[16] [17] and psychiatry[18] have been described.

At least three decades ago, educators were incorporating CI content into residency education (Norwalk Hospital created CI curricula for residents in 1992).[19] The Association of American Medical Colleges (AAMC) first issued a report on informatics and population health in medical school curricula with suggested learning objectives in 1998.[20] The American Academy of Family Physicians first published informatics curricula guidelines in 1996, most recently updated in 2016,[21] although these are distinct from the Accreditation Council for Graduate Medical Education (ACGME) requirements, which do not explicitly include CI content for family medicine residents.[22]

Radiology and pathology educators have addressed the CI gap in GME in their respective specialties. Notably, in 2016, multiple pathology associations including the College of American Pathologists, Association of Pathology Chairs, and Association for Pathology Informatics came together to publish pathology informatics curricula, called Pathology Informatics Essentials for Residents (PIER), tied to ACGME program requirements.[23] Radiologists have called for expanded education in AI and curricula in key areas such as imaging informatics.[24] [25]

Four major clinical specialties—internal medicine, pediatrics, family medicine, and emergency medicine—represent almost three quarters of subspecialists boarded in CI[26] and 60% of CI fellowship graduates.[27] These specialties are critical in training future board-certified CI physicians and physicians with CI skills. All of these specialties cite “using information technology (IT) to optimize learning” as an ACGME competency and include quality improvement, population health, and social determinants of health as aspects of the ACGME competencies.[22] [28] [29] [30] ACGME emergency medicine milestones include “using technology to accomplish and document safe health care delivery” and “using IT to improve patient care”;[28] ACGME internal medicine program requirements state that residents should be able to “[apply] technology appropriate for the clinical context, including evolving techniques,” use telemedicine, use population-based data;[29] and ACGME family medicine milestones include patient care with “telephone visits” and “evisits.”[22] ACGME and AAMC have published telehealth competencies and milestones, which are being adopted nationwide.[31] These competencies address components of CI education but stop short of a comprehensive approach to CI integration into residency curricula.

Educational efforts in CI have implications for the CI workforce pipeline. Early exposure to CI can spark interest in CI careers and enhance trainees' knowledge around CI. Early exposure during medical school has correlated with career choice in primary care,[32] radiology,[33] and surgery.[34] Work in biomedical informatics has emphasized the importance of exposure to informatics opportunities as early as high school in engaging underrepresented minorities and women in future careers in biomedical informatics.[35] Specialized residency tracks in areas such as hospitalist medicine,[36] leadership,[37] and clinical education[38] have helped to build skills and influence career decisions including pursuit of leadership positions. Compared with earlier stages of medical training, residents possess practical clinical experience to inform use and understanding of informatics tools and often serve as “frontline” users for many clinical workflows. Resident engagement in hospital IT systems has been shown to have institutional impact beyond direct impact on residents and increasing resident interest in CI careers.[6] It is especially crucial to quantify CI education at the residency level, as it has implications for the diversity of the CI workforce. CI fellowship applicant data suggest significant gaps between genders and races[39] [40] [41] with similar gaps in CI fellowship graduates.[27] Surveying residents who have completed CI curricula may provide perspectives on creating a more diverse, learner-friendly environment.

Protection of Human and Animal Subjects

Participation was voluntary and does not pose undue risk. This was a remote unmoderated study and was fully implemented in Qualtrics. The study protocol was reviewed and approved by the Boston University Medical Campus/Boston Medical Center Institutional Review Board (H-42611: “Evaluation of Clinical Informatics Residency-Level Training”).

Publication History

Received: 17 May 2023

Accepted: 23 October 2023

Accepted Manuscript online:
25 October 2023

Article published online:
20 December 2023

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