Integration of Biomedical Informatics into a Clinical Reasoning

Integration of Biomedical Informatics into a Clinical Reasoning Curriculum for Medical Students Herbert Chase, MD, MA Professor of Clinical Medicine (In biomedical Informatics) Columbia University Medical Center 1

Disclosures and Objectives Disclosure: I and my spouse/partner have no relevant relationships with commercial interests to disclose. Learning Objectives: After participating in this session the learner should be better able to: • Describe the major elements of a clinical reasoning curriculum • Identify ways that biomedical informatics can be integrated into a clinical reasoning curriculum 2 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Biomedical informatics is usually taught in a stand-alone course 3 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Students often perceive biomedical informatics as… Geeky tech (and not relevant) The electronic medical record 4 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

How can we integrate biomedical informatics into the mainstream medical curriculum? 5 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Biomedical informatics is a natural fit with a clinical reasoning curriculum 6 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Clinical reasoning: The core skill of medical practice Patient’s history and physical Working diagnosis Diagnostic Reasoning Therapy Testing Effective testing Clinical decision analysis Best evidence Clinical reasoning bias 7 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Clinical reasoning topics 1. Diagnostic reasoning 2. Effective testing 3. Best evidence 4. Decision analysis 5. Clinical reasoning biases 8 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Diagnostic tools 9 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Diagnostic reasoning Conditional probabilities 10 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Efficient testing Sensitivity and specificity 11 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Efficient testing Conditional probabilities 12 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Decision analysis Optimizing therapeutic choices 13 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Decision analysis Precision medicine 14 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Best evidence Information retrieval strategies 15 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning Best evidence Data mining vs RCT 16 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

BMI in Clinical reasoning biases: base rate neglect CDS provides accurate probabilities 17 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Preparing students for their future Patient’s history and physical Diagnostic Reasoning Accurate and timely diagnosis CDS Working diagnosis Testing Therapy Clinical decision analysis Effective testing Clinical reasoning bias Evidence-based therapy Bias-free approach 18 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Opportunities for BMI faculty • BMI faculty are experts in • conditional probabilities • information retrieval • decision analysis • BMI faculty can participate in an integrated clinical reasoning curriculum 19 AMIA 2018 Informatics Educators Forum #IEF 18 @AMIAinformatics

Herbert Chase, MD, MA hc 15@cumc. columbia. edu 20