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Distance learning in biomedical informatics

By William Hersh / April 2004

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I always find it amazing that small decisions can end up having such large consequences in one's life. In 1999, after getting a number of inquiries as to whether courses in our biomedical informatics could be taken over the Internet, our program decided to take an exploratory plunge into distance learning. We had no previous experience with distance learning, but since no one else was doing it in our field, it seemed to provide great opportunity. In five years time, we have become the largest distance learning program in our field and have learned a great deal, not only about technology, but also about education.

It should not be surprising that a field like biomedical informatics would be amenable to distance learning. It is a field that many people enter after they are already established in a health care profession, although an increasing number are entering the field directly. Health care itself is fundamentally an information science. Much of clinical practice involves gathering, synthesizing, and acting on information. The field concerned with the management and use of information in health and biomedicine is called biomedical informatics [1].

The Field of Biomedical Informatics

Biomedical informatics is motivated by the growing concern that information is not being used as effectively as it could be in health and biomedicine. On the clinical side, recent reports from the Institute of Medicine (IOM) have reviewed research findings related to information use and expressed concerns about medical errors and patient safety, the quality of medical records, and the protection of patient privacy and confidentiality. A more recent report, "Crossing the Quality Chasm" ties all these problems and potential solutions together in a vision for a health care system that is safe, patient-centered, and evidence-based. A variety of solutions are required to address the information-related problems in health care, with many involving the use of computers and related technologies.

Similar information challenges exist on the research side of biomedicine, with new advances in genomics and biotechnology changing the face of biological research. New biotechnologies such as gene microarrays generate vast amounts of data in experiments. Furthermore, new discoveries require scientists to access and manage much larger quantities of knowledge, which they, and the systems that house the knowledge, are challenged to do.

One major challenge for the field is the adjective in front of the word "informatics." Some have argued that the adjective "medical" in front of informatics is inappropriate because it implies the work of medical doctors and not the rest of health care and biomedical science. There is a growing tendency to use the phrases "biomedical informatics" or "health and biomedical informatics." The subareas of the field can then be broken down and defined according to the classification of Shortliffe [2], who described four levels from the focus on the cell to the population:

  • Bioinformatics: molecular and cellular processes, such as gene sequences and maps
  • Imaging informatics: tissues and organs, such as radiology imaging systems
  • Clinical informatics: clinicians and patients, including applications of nursing, dentistry, and other clinical specialties
  • Public health informatics: populations, such as disease surveillance systems

Biomedical informatics is a heterogeneous field, comprised of individuals with diverse backgrounds and levels of training. In addition, because the field is so new, there are few jobs that absolutely require a degree or other formal training in the field, although this is likely to change in the near future. Most individuals enter biomedical informatics at the graduate or postgraduate level after a background in other areas, such as medicine, nursing, computer science, biology, or librarianship. As such, those entering the field are adult learners who do not want to give up their regular jobs to study informatics. For them, the flexibility of distance learning is very appealing.

Distance Learning in Biomedical Informatics

Although biomedical informatics is a field that promotes the use of information technology in general, most educational programs use traditional classroom approaches. The medical informatics program at Oregon Health & Science University (OHSU) began offering courses via distance learning in 1999 after many inquiries as to whether our courses were offered online. Particular interest was expressed at our booth in the Career Exposition at the American Medical Informatics Association (AMIA) Annual Symposium.

The goals of OHSU's educational programs in biomedical informatics are to train individuals for employment in both academic and industry settings in a variety of jobs involving aspects of information use and technology. A variety of programs are offered to meet the needs of students with diverse backgrounds and interests. The original degree program was the Master of Science in Medical Informatics, which was launched in 1996. In 1999, we began to offer individual courses via distance learning, and the following year we launched the online Graduate Certificate program. Our next step was the Master of Medical Informatics program, a non-thesis master's degree available both on campus and online. A Ph.D. program was launched in fall, 2003, at which time all degree programs were renamed Biomedical Informatics.

Our approach to distance learning is to use the technologies that make the most sense pedagogically for each course. Most of the courses make use of:

  • Voice-over-Powerpoint lectures
  • Threaded discussions
  • Traditional books, as well as Web sites for reading materials
  • Multiple-choice questions for self-assessment
  • Term papers or projects, submitted electronically

Lessons Learned

Since we began offering distance learning, we have tried to study and publish our experiences. In an analysis of our first year's experience [3], we found students were for the most part satisfied with the decisions we made with regards to pedagogic and technical approaches. Students found the voice-over-Powerpoint lectures were helpful in describing the material and that the absence of video, which would have increased bandwidth requirements, was not a detriment. They also felt positively toward the interactivity of the threaded discussion boards. One statistic I found particularly fascinating demonstrated that distance learning can be more interactive than the traditional classroom. Our analysis of postings to the threaded discussion boards showed that, on average, every student posted 2.5-3.5 messages. It is unlikely that each and every student in a face-to-face classroom situation makes about three comments per class period!

Four years into our experience, a clear picture has emerged of the type of student who studies medical informatics, his or her motivation for pursuing medical informatics education, and what success he or she might have in meeting his or her goals. Over half of the nearly 200 students who have matriculated into the program are physicians of some sort. The next largest group consists of non-physician health care professionals, with backgrounds in areas such as speech pathology, physical therapy, dentistry, and nursing. Of the students without health care backgrounds, most have science or social science backgrounds.

Many of the students taking our courses desire to focus their career in the health and biomedical IT industry in a variety of settings: academic, hospital, and industry. They are predominantly interested in the applied side, as opposed to the research side of the field. One interesting phenomenon is that a number of students have taken IT-related positions before completing the program, some after only completing the introductory course. A number of students have no desire to complete our entire program, and instead enroll just to take individual courses, which we do not discourage.

Another phenomenon we have witnessed is the blurring of distinction between distance and on-campus learning. The program views courses delivered online and live as equivalent, and we aim to cover the same content and provide comparable learning activities over similar periods, i.e., academic terms. A number of our on-campus students prefer the convenience of distance learning and ask to enroll in distance learning classes. A small but increasing number of classes are taught as hybrid classes, with students on the campus and online.

While OHSU's distance learning program in biomedical informatics was one of the earliest and remains one of the largest, there are a growing number of new programs, many of which can be found listed on the AMIA Web site. As the field matures, such programs are likely to grow. I have personally found distance learning to be very rewarding, as it combines two of the things I enjoy most in life: teaching and technology.


1. Hersh WR, Medical informatics—improving health care through information. Journal of the American Medical Association, 2002. 288: 1955-1958.

2. Kukafka R, et al., Issues and opportunities in public health informatics: a panel discussion. Journal of Public Health Management & Practice, 2001. 7: 31-42.

3. Hersh WR, et al., Implementation and evaluation of a medical informatics distance education program. Journal of the American Medical Informatics Association, 2001. 8: 570-584.


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