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ELSEVIER International Journal of Medical Informatics 45 (1997) 3-8

Education and training in medical informatics, statistics and epidemiology in EuroMISE

Jana Zvkrova ‘+*, Rolf Engelbrecht b, Jan H. van Bernmel’

* European Center for Medical Icformatics, Statistics and Epidemiology, Charles University and Academy of Sciences,

Pod oodcirenskou vt?i 2, 182 07 Prague 8, Czech Republic b h4EDIS Institute, Gesellschaft fiir Strahlungsforschung, Neuherberg, Germany

’ Department of Medical Infbrmatics, Faculty of Medicine and Health Sciences, Erasmus University, Rotter&m, The Netherlands

Abstract

The paper gives information on education and training covered by the Joint European Project (JEP) entitled ‘Education in the Methodology Field of Health Care, EuroMZSE (European Education in Medical Informatics, Statistics and Epidemiology)‘, that has been running for 3 years (1993-1995) under the umbrella of the European TEMPUS-PHARE programme. Training and education in EuroMZSE consists of three overlapping methodological branches: Medical informatics (MI), medical statistics (MS) and epidemiology (E). The teaching scheme has been developed in cooperation between 11 universities in the European Union and Charles University in Prague (four medical faculties, the Faculty of Mathematics and Physics and the Faculty Hospital) together with the Academy of Sciences of the Czech Republic (Institute of Computer Science). The paper shows EuroMZSE targets, structure of EuroMZSE courses and conferences and gives further views to the future in this field of education. 0 1997 Elsevier Science Ireland Ltd.

Keywords: Medical informatics; Medical statistics; Epidemiology; Education

1. Introduction

The Joint European Project (JEP) entitled ‘Education in the Methodology Field of Health Care, EuroMZSE (European Educa- tion in Medical Informatics, Statistics and

* Corresponding author.

Epidemiology)‘, has been running for 3 years (1993- 1995) under the umbrella of the Eu- ropean TEMPUS-PHARE programme, giv- ing educational assistance to teachers and researchers from Central and Eastern Eu- ropean countries. This article describes the overall goals and experiences in EuroMISE;

detailed information about the aims of the project are given elsewhere [I].

1386-5056/97/$17.00 G 1997 Elsevier Science Ireland Ltd. All rights reserved

PIISOO20-7101(97)00025-l

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Training and education in EuroMISE con- sist of three overlapping methodological branches: Medical informatics (MI), medical statistics (MS) and epidemiology (E). The teaching scheme has been developed in coop- eration between 11 universities in the Eu- ropean Union and Charles University in Prague (four medical faculties, the Faculty of Mathematics and Physics and the Faculty Hospital) together with the Academy of Sci- ences of the Czech Republic (Institute of Computer Science). The list of all JEP orga- nizations is given in Table 1. Three core groups of university teachers from participat- ing organizations harmonized the develop- ment of courses, teaching materials and tools, and they also prepared the structure of lec- tures for EuroMISE courses given at Charles University in Prague. Two core groups (MI and E) were coordinated by the Erasmus University Rotterdam, The Netherlands and the MS core group by the Ruprecht-Karls University of Heidelberg, Germany. Overall coordination of the project was performed by Charles University of Prague, Czech Repub- lic and contracting tasks were handled by the MEDIS Institute, GSF, Neuherberg, Ger- many.

The key issues of the educational pro- grammes of the EzuoMISE TEMPUS- PHARE project were to promote multidisciplinary approaches and to focus on healthcare issues that received insufficient at- tention in traditional training. The Eu- voA4ISE guidelines put emphasis on a wide range of scientific knowledge, including a thorough understanding of health concepts [2-41. Moreover, education and training in this field is helping to bridge the gap between technological innovation and healthcare practice. The rapid development of medical informatics highlights the importance of methodological disciplines for education, re- search and quality assurance in health care PI.

Organization Country code Contribution

Charles University CZ C in Prague First Medical Faculty Third Medical Faculty Faculty Mathe- matics and Physics Medical Faculty in Hradec Kralove Medical Faculty CZ C in Pilsen

Faculty Hospital in CZ Prague

Academy of Sci- ences of Czech Republic Institute of Corn- CZ puter Science

Catholic University B MI

of Leuven Free University of B E

Brussels University of D C, MS, MI

Heidelberg GSF-MEDIS In- D C. MI

stitute Neuher- berg

University of Mar- D MI burg

University of Bor- F MS deaux II

Aristotle University GR E

of Thessaloniki Dublin University IRL MS Erasmus University NL C, MI, C

of Rotterdam University of Lim- NL MI

burg University of UK MI

Manchester

Table 1 Organizations involved in the EuroMISE project

MI, medical informatics; MS, medical statistics; E, epidemiology: C, coordination.

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2. EuroMISE targets

Charles University, in comparison with other universities in the Czech Republic, gives the largest panel of courses and to- gether with the Academy of Sciences of the Czech Republic, has the most extensive re- search projects in different medical disci- plines. Nowadays, science and higher education have a close relationship and show increasing interdisciplinary cooperation. This cooperation offers to enrich the different dis- ciplines with a wide range of knowledge that might offer new insights regarding the solu- tion of existing problems, e.g. assisting spe- cialization in some medical discipline with the help of the methods and the terminology offered by the disciplines teaching in the Eu- roMISE courses. One of the most important tasks is to strengthen new educational activi- ties and to create the basic infrastructure for the penetration of medical informatics methodologies and tools in medicine and health care.

Therefore, the main targets of the Euro- MISE project were: 1. To analyze and use elements of existing

curricula of medical informatics, statistics and epidemiology in order to introduce a European dimension into medical and health professional education;

2. to support Charles University in introduc- ing and improving its structural capacities in higher education and establish the higher education EuroMISE Center with modern teaching facilities that might sup- port the international cooperation in giv- ing high-level courses in this field;

3. to develop a modular structure of the EuroMISE courses, and to prepare teach- ing materials and tools in the English language;

4. to assist teachers in this field in multiply- ing their knowledge, especially for teach-

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ers from Central and Eastern European countries; to organize retraining/updating scholar- ships at EU universities and to give, in addition, language courses for Czech uni- versity teachers participating in the project; to run EuroMISE courses for participants from Czech, Central and Eastern Eu- ropean countries and to assess their knowledge and experience; to organize workshops and conferences in this field to widen the knowledge on a European level; to join a European teaching network for higher education in the field of medical informatics, statistics and epidemiology.

All targets mentioned above have been sat- isfactorily accomplished during the 3-year project.

3. EuroMISE courses and conferences

Following the suggestions of the core groups (MI, MS and E), a structure was developed for the EuroMISE courses in the field of medical informatics, statistics and epidemiology and the programme was of- fered for the first time in 1994. The structure of the courses in 1994 was: four 1 -week inten- sive course modules on different medical in- formatics topics and a l-week course during the EuroMISE 94 working conference ‘Medi- cal Informatics Education and Research’ [6]. At the working conference, mainly medical- informatics research topics were presented by the participants of the 4-week courses. The EuroMISE course teachers presented their experience with medical informatics educa- tion at EU universities and shared their knowledge in how to teach and present pa- pers at scientific meetings. Another working conference was organized 1 year later, the EuroMISE 95 working conference ‘Informa- tion, Health and Education’. The selected full

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communications of this working conference are presented in this issue [7].

4. Further information on EuroMISE courses

4.1. Admission

Students were admitted to the programme on basis of: 1. A master’s degree or equivalent degree, 2. Knowledge of English.

4.2. A ttendance

The EuroMISE courses of the first year were addressed to Czech University teachers, physicians and health researchers and given in 1994. The second series of EuroMLSE courses was given in 1995 for participants from Central and Eastern European coun- tries (university teachers, physicians, health researchers). The courses had the same dura- tion and structure. Each course was open for 24 participants.

4.3. Duration and structure

The lectures and practicals were given as four l-week modules. Practicals were given in the teaching laboratory of the EuroMZSE Center, established with the support of the TEMPUS-PHARE programme and equipped with 12 HP 486 PC’s connected into a Novell network. Each week consisted of 40 h of teaching, divided into lectures and practicals. After each week, the course module was eval- uated by the participants. The evaluation was anonymous and was used for quality im- provement in the next courses. Students an- swers were very positive concerning content, structure and level of the course. They mostly expressed problems with misunderstanding of some concepts in English due to the language

barrier. Native english speakers or teachers with very fluent English were sometimes go- ing too quickly, the pronunciation of non-na- tive English teachers sometimes also gave problems.

The Medical Informatics courses consisted of 200 h of teaching, specifically 160 h of direct teaching (lectures and practicals) and 40 h devoted to preparation of the lectures presented by the students at the EuroMISE Conference. Moreover, a period of 3 months was given to the students to prepare a final thesis on some subject taught during the courses. The Medical Statistics and Epidemi- ology course had the same structure.

4.4. Teachers

Lectures and practicals in &roMISE courses were prepared and presented in 1994 and 1995 by participants of EU projects at Charles University in Prague. The thesis of each participant was elaborated using com- puter equipment of the EuroMISE Center. In 1995, Czech teachers did also lecture in the EuroMISE courses.

4.5. Topics

The following topics were covered by the Medical informatics courses: 1. Introduction to medical informatics; order-

ing of medical informatics applications: In- formation and communication in health care. Coding and classification. Standard- ization of medical informatics. Databases and database management systems.

2. Computer-based patient record; quality as- sessment and data protection: Overview of developments in computer-based patient records. Communication in primary care. Technology and quality assessment. Data protection and security. Ethical and legal issues in medical informatics.

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3. Hospital information systems; biosignals and images: Overview of development in hospital information systems. Compo- nents of hospital information systems; networking. Future of hospital informa- tion systems. Biosignal and image inter- pretation and processing.

4. Decision support in medicine; knowledge acquisition and processing: Statistical deci- sion analysis. Knowledge based systems in medicine. Neural networks. Evaluation of decision-support systems.

Topics covered by Medical Statistics and Epidemiology courses included: 1. Basic medical statistics: Basic concepts,

descriptive statistics, principles of estima- tion and hypothesis testing, overview of statistical test: parametric vs. nonpara- metric, independent vs dependent groups, contingency tables, correlation, simple lin- ear regression.

2. Design and analysis oj’ epidemiological studies: Measures of disease frequency and of effect of risk factors. Confounding and effect modification, stratification. De- sign and analysis of cohort studies. De- sign and analysis of case control studies.

3. Clinical epidemiology: Risk assessment. Evaluation of diagnostic procedures. De- sign and analysis of prognostic studies. Design and analysis of clinical trials. Evaluation of quality measurement.

4. Multivariate modeling of biomedical data: Overview of multivariate methods. Multi- ple logistic regression. Model building strategies. Application to clinical and epi- demiological examples.

5. Conclusions and views to the future

It seems that the approach used in educa- tion and research in medical informatics sa- tisfies the present educational and research

needs in the Czech Republic as well as in other Central and Eastern European coun- tries. The university teachers and students trained in the EuroMZSE courses will be able to further disseminate the acquired knowl- edge and skills. This should help in accelerat- ing the development of education and research to the current European level. It opens possibilities for long-term future coop- eration among all European countries.

The long-term effect of higher education consists of a rapid increase of people with adequate education in modern healthcare sys- tem, and ensures that staff involved in health care receives appropriate multidisciplinary training and will be able to promote the results of medical informatics research into practice.

The teaching activities in the field of medi- cal informatics, statistics and epidemiology provided by the European Center of Medical Informatics, Statistics and Epidemiology of Charles University and the Academy of Sci- ences (the EuroMZSE Center) based on the results of the EuroMISE project can be di- vided in several areas: l Undergraduate courses in medical infor-

matics, statistics and epidemiology for stu- dents of Medical Faculties and the Faculty of Mathematics and Physics of Charles University.

l Postgraduate courses for Czech physicians, informaticians, statisticians and other health researchers.

l Specialized continuing education courses for selected medical/health disciplines. Postgraduate and continuous education

courses in English were also given in the framework of the European cooperation via the EuroMZSE project. In 1996, the Medical Informatics course was running without the support of the TEMPUS-PHARE project, but with the support of the Erasmus Univer- sity Rotterdam and the Limburg University

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Maastricht, The Netherlands, the Ruprecht- Karls University, Heidelberg, the Phillips University, Marburg, the MEDIS Institute, Neuherberg, Germany and the University of Manchester, Institute of Science and Tech- nology in Great Britain.

Further activities in the field of education will be developed also through participation of the EuroMISE Center in ‘IT EDUCTRA’, a project running under the Fourth Frame- work programme of the European Union [8] and by further cooperation with EuroMISE project universities. Information on develop- ment of teaching and research activities in this field can be received from the www server of the EuroMISE Center (http://eu- romise.uivt.cas.cz). The Czech teachers who took the EuroMISE courses in 1994 and 1995 have started to be involved in teaching activi- ties organized by the EuroMISE Center. The new teachers from the Czech Republic, Poland, Hungary and Romania (more than 70 certificates were passed in the Charles University Aula Magna for successful com- pletion of the international TEMPUS-Eu- roMISE courses in 1994 and 1995) are now facing the challenge to improve the training

opportunities in the field of medical informat- its, statistics and epidemiology in these coun- tries and to contribute to positive changes in the health-care sector.

References

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