Keywords
education - medical informatics - professional training - master of science program
- curriculum - strategies for health IT training - workforce
Background and Significance
Background and Significance
Our medical informatics program was founded in 1972 as a joint program by the University
of Heidelberg and the Heilbronn University of Applied Sciences as one of the first
medical informatics programs in the world[1]
[2] and combined the strengths of Heidelberg in medical research and patient care with
the technical expertise of Heilbronn. Our program offers a computer science–based
approach to medical informatics and has graduated approximately 2,000 medical informaticians
to date.
There are a variety of definitions for the terms biomedical informatics, medical informatics, and health informatics.[3]
[4] In this article, we consider the terms to be interchangeable as others have done
in publications on biomedical and health informatics education.[5] In our program, we use the term medical informatics because it is a literal translation of its official name in the German language.
The program is compliant with the informatics program recommendations of the German
Society for Informatics and has a special focus on application and at least 50% computer
science–specific courses. The program has traditionally offered very broad topics
including software engineering in medicine, information systems, e-health solutions,
and medical signal and image processing. To ensure that our education supports a wide
range of job descriptions, we evaluated the program with a survey of its graduates
and the results were published.[6]
[7] Originally, the program was designed as a 4.5-year program with diploma degree.
It was transformed into a bachelor's program in 2007 and a consecutive master's program
starting in 2010.
To keep pace with the developments in the field of medical informatics, the curriculum
is continuously updated[8]
[9]
[10]
[11] and is currently in its 8th revision. One of the driving forces behind the revision
of the master's program was the rapid emergence of new topics in the field such as
data science, which gained in importance in recent years.[12]
[13]
[14] A new revision always requires significant educational and administrative effort.
Any revision must be approved by the councils of the two universities, which fortunately
developed a well-synchronized process. However, to reduce overall effort and to incorporate
new topics, a flexible solution was needed. In addition, we had seen a constant demand
from students for more flexibility and choice based on the professional orientation
they wish to pursue after graduation. Therefore, with the 8th revision of our program,
we restructured our master's program completely to allow more flexibility for current
topics and allow students more choices.
Objectives
The aim of our paper is to present our new concepts for graduate medical informatics
education and to share our experiences. We complement this theoretical perspective
with insights into the perceived appeal of, satisfaction with, and manageability of
the program from the students' perspective based on a survey conducted among advanced
students and graduates who were exposed to the new curriculum.
Background and Methods
Concepts and Quality Control of the Medical Informatics Master's Program
The medical informatics master's program is a 2-year program with 120 credits over
four semesters compliant with the European Credit Transfer and Accumulation System
(ECTS). Each semester, 30 credits can be obtained. A total of 15 students are admitted
each semester.
The University of Heidelberg is accredited by an agency approved by the German Accreditation
Council. The university established a comprehensive quality management process for
its degree programs and uses a variety of methods like surveys among students and
alumni, self-reporting, and external reviews at least every 5 years. Additionally,
the educational experience for each course is evaluated by the students every 2 years.
A committee of professors, academic staff, and students meets once a semester to discuss
problems in the curriculum or its implementation. If required, revisions of the program
are based on the information received from all the above sources.
Concepts for the 8th (and Latest) Revision of the Medical Informatics Master's Program
The latest concept was developed based on the identified need for a flexible curriculum.
Specifically, three main drivers were identified by analyzing the results of Heidelberg
University's quality measurements: (1) The rapid emergence of new topics in the field
of medical informatics that must be incorporated into the curriculum seamlessly and
without heavy administrative effort; (2) students' expressed desire for course choice
and individual study programs; and (3) the need to attract a wider variety of students,
including students from related disciplines (e.g., computer science).
The program consists of two parts, one of which is compulsory and the other elective
in nature. The compulsory part of the program consists of courses that provide 50%
of the credits in the first semester and a master's thesis ([Fig. 1], blue modules). The program's flexibility is based on three core components: (1)
A large catalog of elective courses; (2) areas of concentration that bundle elective
courses in an important subject of medical informatics ([Fig. 1], green modules); and (3) introductory alignment courses for students who do not hold a bachelor's degree in medical informatics but in another
field ([Fig. 1], module M3).
Fig. 1 Basic concept of the medical informatics master's program. Numbers in brackets indicate
credits. Compulsory courses are shown in blue. Mandatory area of concentration (AoC)
courses are shown in green. Module M3 can contain introductory/alignment courses from our bachelor's program. M7 and M8 contain elective courses that can sum up to
a second area of concentration.
Catalog of Electives
The current catalog of electives contains more than 60 courses ([Supplementary Table S1], available in the online version). Each course is offered once a year. The catalog
is an appendix to the master's curriculum and can be modified before each semester
with little administrative effort unlike a curriculum revision which must be reviewed
and passed by the councils of the two universities. Moving the modifications to the
catalog allows new topics to be added quickly and topics that are no longer in demand
to be removed (driver 1). The electives belong to one or more areas of concentration
([Supplementary Table S1] [available in the online version], column AoC) and can be selected by the students
assuming they meet the constraints imposed by the areas of concentration (driver 2).
Areas of Concentration
To ensure a degree of coherence in the courses selected by students, we introduced
the concept of areas of concentration ([Fig. 1], green modules). Five areas bundle elective courses of 30 credits to provide students
with a solid foundation in one important domain of medical informatics. The areas
of concentration are bioinformatics, data science, computer-aided diagnosis and therapy systems, information management in medicine, and software engineering in medicine. Over the course of their studies, students must complete at least one area of concentration
by successfully completing all courses belonging to that area ([Supplementary Table S1] [available in the online version], column AoC).
Each area of concentration consists of three specific core subjects (area qualification)
and a practical training experience, which together accounts for 15 credits ([Supplementary Table S1] [available in the online version], area printed in bold). The area qualification
courses provide the core knowledge in the respective area, while the practical training
ensures that the knowledge translates into applied competencies. The remaining 15
credits can be selected from the remaining electives indexed with the area of concentration.
The remaining 45 credits ([Fig. 1], gray modules) can be selected either in a way that the student completes a second
area of concentration or freely according to individual's interests.
Introduction/Alignment Courses
For students without a bachelor's degree in medical informatics (driver 3), we offer
15 credits of introduction/alignment courses ([Fig. 1], M3), which we carefully selected from the courses of our bachelor's program. Students
with a bachelor's degree in general or non-medical computer science can acquire missing
knowledge in the field of medicine. Students with a bachelor's degree in medical engineering
can acquire missing informatics and software engineering skills. Students with a medical
informatics background may choose from any of the elective courses from the catalog
of the master's program for this module.
Survey of Advanced Students and Graduates
To evaluate the concepts of the new master's program, we conducted a survey among
advanced students and alumni who were exposed to the latest curriculum. We designed
the questionnaire to assess the experience of students and thus judge the attractiveness
of the program to prospective future students. We also aimed to understand the perception
by current students and graduates of the distinctive components of the program.
Study Population and Survey Implementation
All alumni (exposed to the new curriculum) and advanced students of the new curriculum
who had completed at least 75 credits were invited via email to participate in the
online survey (n = 53). We provided a link to the survey and sent a reminder once. Students with 75
credits and more were selected because they have already completed most of the coursework
required.
Survey Construction
The survey included four sections, each composed of a series of questions (cf. [Supplementary Appendix 1] [available in the online version], for the translated version).
-
Demographics
General information about the participants' prior education and their career interests.
Due to the relatively small size of the target group, it was not feasible to inquire
about demographic details such as age, gender, or their highest degree attained to
ensure anonymity. Consequently, it is not possible to distinguish between alumni and
current students.
-
Knowledge of the program
A priori knowledge about the program's concept and the influence of its components
such as the areas of concentration, electives, and introduction/alignment courses on choosing our master's program.
-
Perception of program flexibility and course quality
Perception of the program's flexibility, the areas of concentration, and the special
courses. Additionally, we inquired about the acceptance of the introduction/alignment courses, the perception on a variety of areas of concentration, and the quality of a special
research-related course.
-
General evaluation
General evaluation of the program and students' overall satisfaction.
We used 4-point Likert scales for single choice questions and a 5-point scale when
a neutral response was appropriate. For analysis, we counted the responses at the
different response levels that did not subject them to further descriptive statistics.
We provided a free text comment option for 12 questions. We used the free text comments
qualitatively to supplement the findings obtained from the quantitative data.
Results
Curriculum
Compulsory Courses
The following courses were required for all students (compulsory courses): clinical medicine (6 credits), research in biomedical informatics (2 credits), practical training in biomedical informatics (4 credits), and project management (3 credits).
In the practical training in biomedical informatics, the students collaborate in small groups of three or four to conduct a systematic
review on a current topic in medical informatics. The objective of the course is to
have students from diverse backgrounds (due to the nature of their bachelor's degree)
contribute collectively to a medical informatics topic. The first version of the resulting
manuscripts is distributed among the students in the other groups and the two supervisors
for peer review. The final results are presented and discussed with all students and
faculty to facilitate critical thinking and team building among the new students in
the program.
Introduction/Alignment Courses
We offer introduction/alignment courses for the following topics: software engineering, programming, databases, statistics,
medicine (basics), medical documentation (basics), information systems in healthcare
(basics), healthcare management, medical image processing (basics), medical signal
processing (basics), process management in healthcare, interoperability, and processes.
Compulsory Courses in the Area of Concentration
To complete an area of concentration qualification, the students must pass the associated
core subjects listed at the beginning of [Supplementary Table S1] (available in the online version), one applied/hands-on course from the area of
concentration, and additional electives worth 15 credits. The practical training in
the data science area is divided into two smaller applied training pieces. One of
them is performed jointly with medical students where students attempt to solve an
applied clinical informatics task in an interdisciplinary fashion over the course
of a semester. We consider the experience of working in a multidisciplinary team an
important skill to be acquired in our medical informatics education.[15]
Catalog of Electives
The current catalog of electives includes 67 subjects, most of them worth 3 credits;
14 courses are worth 6 credits (see [Supplementary Table S1] [available in the online version]). The credit point increments were standardized
to multiples of three to obtain high flexibility when combining electives. Approximately
75% of the courses are assigned to more than one area of concentration. The courses
ethics and personnel law and management are included in all five areas. There are 18 courses dedicated to one area of concentration
only. One example for this is the Frank – van Swieten Lectures, an international course delivered jointly with other universities.[16] All students learn the topic of strategic management of information systems based on the standard textbook for this topic[17] and visit a department in their local university hospital to analyze its information
systems and processes. Subsequently, they model their observations according to the
methods that were taught. At the end of June, all students gather for 3 days at the
site of one of the participating universities. During this joint symposium, the information
systems of all participating university hospitals are presented and systematically
compared. Currently, Amsterdam, Leipzig, and Heidelberg/Heilbronn are participating.
In the previous years, faculty and students from Braunschweig, Hall in Tyrol, and
Antalya also participated in the Frank – van Swieten Lectures. Other programs may participate in the future.
Another special course is the research project, which is worth 12 credits. In this course, senior researchers propose research projects
for one or two students, which are then reviewed by the examination board to ensure
the suitability and scientific nature of the project. The objective is for the students
to conduct a research project independently under the supervision of the senior researcher,
culminating in the production of a scientific paper. The research project is not assigned
to a specific area of concentration. Any topic related to medical informatics may
be proposed.
Survey Results
The 8th version of the curriculum went live in October 2020. Since then, 99 students
enrolled in the medical informatics master's program, 10 of whom transitioned from
the previous curriculum to the new version. By now, 27 of them graduated, 18 are currently
writing their master's thesis, and additional 8 students have accumulated at least
75 credits (as of February 2024). Our survey targeted this specific cohort of 53 students.
A total of 28 students or graduates responded to the survey, which corresponds to
a 53% response rate. More than half of the participants received a bachelor's degree
in medical informatics (n = 16/28; [Fig. 2], left panel), six in biomedical engineering and four in computer science, and two
in other academic disciplines. A total of 12 participants indicated an interest in
pursuing a career path in industry (43%), 4 in academia (14%), and 10 are interested
in both and remain undecided (36%). Two participants are interested in other areas
(7%) (Q2, see translated questionnaire in [Supplementary Appendix 1] [available in the online version]).
Fig. 2 Field of bachelor's degree of survey participants (left panel, n = 28) and selection of areas of concentration (right panel, n = 41). Note that 41 areas of concentration were selected in total because 13 participants
selected two areas. Answers from Q1 and Q20 in the translated questionnaire ([Supplementary Appendix 1]). CSo, computer science other; DS, data science; DT, computer-aided diagnosis and
therapy systems; IM, information management in medicine; MedT, medtech or similar;
MI, medical informatics; Oth, other; SE, software engineering in medicine. Note that
bioinformatics had not been selected yet.
Areas of Concentration and Catalog of Electives
Before starting the program, 11 participants were fully aware of the areas of concentration
and the available selection process for the areas of concentration (39%), while 17
had a general idea of the area of concentration selection options (61%; Q3). This
feature of the program influenced the decision of most participants (86%) to enroll
in our medical informatics master's program ([Fig. 3], Q4). Before starting their studies, 9 participants were fully aware of the possibilities
in the extensive catalog of electives (32%), 13 had a general idea (46%), and 6 were
unaware of these possibilities (21%; Q5). Flexibility in electives was a factor in
the choice of program for 73% of the 22 participants who were aware of it ([Fig. 3], Q6). Of the 12 participants who did not have a bachelor's degree in medical informatics
2 were fully aware of the option to take introductory/alignment courses (17%), 6 had a general idea (50%), and 4 were not aware of this option (33%; Q7).
Six of the eight participants who were aware of the option responded that it influenced
their decision to enroll in the program (75%; Q8). Nine of these participants (75%)
took advantage of those options and chose to take introduction/alignment courses (Q9). Four of them reported that the courses were somewhat helpful for further study
(44%), four reported that they were not helpful (44%), and one participant was uncertain
about the courses' effectiveness (11%; Q10).
Fig. 3 The degree to which the options of choosing areas of concentration and the high number
of elective courses influenced the decision to study the medical informatics master's
program (Q4 and Q6). Out of 28 participants 6 mentioned that they were not aware of
the high number of elective courses and are therefore not represented in the upper
bar.
Students perceived the wide variety of courses as positive although some limitations
were identified (Q12–Q16). More than 75% of participants found the wide range of choices
liberating, a pleasure, and an opportunity for personal growth ([Fig. 4], left panel). However, 64% of the participants also found it challenging and 39%
of the participants found it confusing ([Fig. 4], right panel).
Fig. 4 Participants' perceptions of the wide range of courses offered (Q16–Q20). Left panel:
positive aspects; right panel: negative aspects.
The areas of concentration data science, information management, and software engineering
were chosen almost equally often (n = 12/11/12, [Fig. 2], right panel, Q20). The area of concentration computer-aided diagnosis and therapy
systems was chosen by six participants, and the area of concentration bioinformatics
has not been chosen yet. A total of 13 participants selected courses that allowed
them to complete two areas of concentration (46%). Out of the 28 participants 27 (96%)
had at least some notion at the beginning of their study of which areas they wanted
to study and all of them pursued this notion (Q21, Q22). All participants rated the
thematic bundling of the area of concentration as just right (Q24).
Assessment of Specific Courses
Students rated gains in personal learning from the practical training biomedical informatics generally as high ([Fig. 5], left panel, Q25–Q29).
Fig. 5 Learning gains of participants in certain aspects due to the practical training biomedical informatics (left panel) (Q25–Q29), n = 28, and the research project (right panel) (Q31, Q32), n = 10. MI, medical informatics.
Of the 28 participants 10 did a research project to earn 12 credits (36%). Seven of
them utilized this experience as a foundation for pursuing a master's or doctoral
thesis (70%). Three of the participants were influenced by the research project to
consider a career path in research (30%). All participants enhanced their scientific
expertise through the research project ([Fig. 5], right panel, Q31, Q32).
Overall Satisfaction
Of the 28 participants, 7 (25%) expressed partial satisfaction with the selection
of topics offered to them during their studies. The remaining participants indicated
satisfaction or high satisfaction ([Fig. 6], Q35).
Fig. 6 Satisfaction with the selection of topics in the program (Q35), n = 28.
Discussion
Just as technological advancement and knowledge in medicine are growing rapidly, medical
informatics as a discipline is constantly evolving, with different topics emerging
frequently. The frequent changes make it difficult to adapt a medical informatics
curriculum to emerging topics.[18]
[19] Therefore, we developed the 8th revision of the Heidelberg/Heilbronn master's curriculum
in medical informatics carefully with more flexibility to add new electives and to
allow electives to be assigned to areas of concentration, in which students can qualify.
The notion of areas of concentration fulfills the requirements formulated by Sapci
and Sapci that health informatics programs should consider specialized tracks that
include specific skills to meet the diverse needs of healthcare and industry.[13] However, our decision against specialized tracks with fixed courses resulted in
the ability to offer a wider range of electives to students by assigning courses to
one or more areas of concentration.
Our survey showed that the participants appreciated the flexibility offered by the
elective courses and the opportunity to build an area of concentration. This aspect
of our program influenced their decision to enroll in our master's program in medical
informatics and generated satisfaction with the program until graduation and beyond.
However, we learned that the wide range of options can be confusing and challenging
and may require additional counseling of students.
A curriculum with a large catalog of courses like ours requires more effort in terms
of semester planning. Since several subjects may run in parallel, choices can be difficult.
Over time, we developed a scheduling strategy that ensures that courses belonging
to the same area of concentration can be taken without conflict. Students who combine
courses from different areas of concentration must make sure that the courses can
be taken without conflict.
The option of introduction/alignment courses was not very important to students and those who chose alignment courses reported
only partial benefits. In contrast to these student perceptions, some of our lecturers
reported that it would have been helpful for their classes if more students had chosen
introduction/alignment courses.
The participants were very satisfied with the selection of topics offered in the program
and the thematic bundling of topics into areas of concentration. The area of concentration
bioinformatics was not attractive for students. One reason may be that bioinformatics
is a field for which dedicated programs with bachelor's and master's degrees are offered
competing with our efforts. Further, significant differences in the culture of the
two disciplines, clinical informatics and bioinformatics,[15]
[20]
[21] seem to make it difficult to integrate them in one educational solution.[15]
[22]
We were pleased with the overall satisfaction of the participants with the design
of the master's program. This is particularly noteworthy as some students started
during the coronavirus pandemic, and most of the courses could only be offered virtually
in the early semesters. We had anticipated that virtual courses would have caused
some dissatisfaction.
Limitations
We cannot rule out the possibility that our study sample was biased and that only
students and alumni in the target group who were satisfied with their studies responded.
Since the response rate of 53% is high, there is however a good chance that the respondents
were representative. As the survey was anonymous, participants could not expect any
disadvantage from negative feedback. Despite the high response rate our survey was
still limited due to the low number of graduates and advanced students for this revised
curriculum. In addition, our survey did not reach students who may have rejected our
program because our curricular concept seemed too flexible or confusing.
Conclusion
Medical informatics is a broad discipline. The workforce needs to reflect this as
demands of experts exists in a wide variety of fields,[19] such as health IT units,[23] clinical research informatics, decision support, and deep neural network training
for clinical use. This diversity makes it difficult to characterize the workforce,
training needs, and requirements.[4]
[24] The recommendations of the International Medical Informatics Association (IMIA)
aid considerably to systematize these needs.[19] Graduates of different programs around the world have encountered good job opportunities.[7]
[25]
[26]
Offering a high flexibility to our students has motivated them to join our program
and led to a high satisfaction. This was made possible by designing the curriculum
in a way that (1) courses can be assigned to areas of concentration, and (2) each
course has a scope of 3 credits or a multiple of this, so that courses can easily
add up to 15 credit modules. The curriculum design results in a large catalog of courses
from which students can choose a wide range of topics. However, this variety can also
be a challenge. Therefore, we must look at how we can better support students to understand
the options and to facilitate their selection process. For further development we
need to consider whether it is necessary to offer introduction/alignment courses and whether the area of concentration bioinformatics makes sense in the context of
a medical informatics curriculum.
Despite the inspiring results of the survey, we cannot conclude yet that our program
leads to good outcomes and a solid foundation for the professional careers. This will
require a more detailed survey, when more students have graduated and have had careers
in their profession. When a relevant number of graduates who are further along in
their professional careers exist, we can evaluate their satisfaction with the content
and design of the medical informatics master's program in relation to their professional
activities. We will continue to closely monitor emerging topics to adequately educate
the future medical informatics workforce. Our novel concept will make it easy to adapt
the course catalog to the new demands.
Clinical Relevance Statement
Clinical Relevance Statement
Digital health is increasingly finding its way into medical care. To successfully
develop methods and tools that can be used in clinical routine, it is necessary to
train medical informatics specialists who understand healthcare processes and the
needs of clinical practitioners.
Multiple-Choice Questions
Multiple-Choice Questions
-
When implementing master's program in medical informatics, what should be offered
to students to make the program attractive?
-
High flexibility of elective course
-
The same fixed sequence of courses for each student
-
Narrow program that clearly specializes in one field of medical informatics
-
High number of compulsory courses
Correct Answer: The correct answer is option a. Our survey revealed that a lot of students chose
our program because of the high flexibility offered by the catalog of elective courses.
-
What can be offered in a master's program in medical informatics to students that
do not have a bachelor's degree in medical informatics, but in another field?
-
Alignment courses
-
More compulsory courses
-
Specialized tracks
-
Practical training
Correct Answer: The correct answer is option a. Alignment courses is the correct answer because
it offers courses from a bachelor's degree program that can be selected by students
to build a common foundation with students who have a bachelor's degree in medical
informatics.
