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There's a new dimension to the knowledge and experience physicians must have to practice effectively and prudently due to the explosion of computer use.
Regardless of what purpose you believe medical school fulfills, there are some points on which there should be general agreement:
• Every disease or condition has a root cause. Scientific knowledge, when available and understood by the physician, enables more rational diagnosis and treatment.
• Appreciating the variety of knowable things can aid a physician in identifying situations about which they have insufficient knowledge and for which it may be prudent to get assistance.
• Diagnosis and treatment have quasi-experimental overtones. Those trained in the scientific method and scientific modes of thought are likely to perform better than those that merely follow recipes that they have memorized. Medical school is a fitting venue to acquire this knowledge and, for the last 50-plus years, the curriculum has accomplished these objectives reasonably well.
The recent explosion of interest in computers and the demand that they be made an integral part of the healthcare delivery process has introduced a new dimension to the knowledge and experience that a physician must have to practice effectively and prudently.
Medical schools, hewing to the general trends in education, have not incorporated instruction in computer science and computational thinking into their curricula. As a result, medical school graduates lack the basic knowledge that is needs to make full, effective, and safe use of computer technology in medical practice.
The Association for Computing Machinery and the Computer Science Teachers Association have released a joint report entitled "Running on Empty: the Failure to Teach K–12 Computer Science in the Digital Age." The findings, opinions, and conclusions expressed in this report, while aimed at grades K-12 seem to be equally applicable to medical school. I have taken the liberty of paraphrasing several portions of the executive summary, deleting some material and inserting references to medicine and medical school to make the point more transparent.
• "Computer science and the technologies it enables now lie at the heart of [medicine and medical] scientific enterprise. As the digital age has transformed the world and workforce, [medical] education has fallen woefully behind in preparing students with the fundamental computer science knowledge and skills they need for future success. To be well-educated [physicians in] the 21st century, [medical students] must have a deeper understanding of the fundamentals of computer science.
• "Paradoxically, as the role and significance of computing has increased, quality computer science education is being pushed out of the education system …
• "Numerous factors are contributing to this growing crisis… [The] policies underpinning the [medical] education system are deeply confused, conflicted, or inadequate to teach … computer science as an academic subject. [Instruction must be offered and it must be] quality instruction… supported by a policy framework that sustains teacher development; certification and continuing education; appropriate curriculum development; and student access and interest. When it comes to computer science education, this framework is failing.
• "…efforts to improve 'technology literacy,' … are focused almost exclusively on skill-based aspects of computing (such as, using a computer in other learning activities) and … [ignore] the conceptual aspects of computer science that lay the foundation for innovation and deeper study in the field (for example, develop an understanding of an algorithm).
• "There is deep and widespread confusion within [medical schools] as to what should constitute, and how to differentiate, technology education, literacy, and fluency; information technology education; and computer science as an academic subject. …generally, computer science is not considered … as part of the 'core' curriculum…"
Computer fluency does not equal computer literacy and literacy does not insure a deep understanding of computer science or the ability to incorporate its theory and principles into medical practice.
Were the K-12 education system to rectify the deficiency in computer science education overnight, it would be years before new medical students arrive adequately prepared and schooled in the fundamentals. Until then, if medical schools do not rise to fill the void they will continue to graduate physicians that are poorly equipped to deal with the challenges posed by using, evaluating, and choosing EHR and other medical computer technologies.