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Goal 4. A Strong and Diverse Workforce for Biomedical Informatics Research, Systems Development, and Innovative Service Delivery

"In health care as much as or more than in other human endeavors, knowledge is power, and the redistribution of access to knowledge will mean an inevitable redistribution of power over the decisions that affect the delivery of health care and the makeup of the health care workforce."[56]

NLM has funded and shaped biomedical informatics education and training for 30 years. It currently supports eighteen university-based multidisciplinary informatics training centers with a total of 270 fellows in basic science, clinical medicine, public health, and information sciences.[57] Priority in selecting fellows is given to physicians and other health care professionals.

NLM’s intramural research divisions also provide advanced post-graduate informatics training. The Library’s extensive programs to teach biology faculty, students, and library-based bioinformatics specialists to use molecular biology and genomic databases and tools reach more than 7,000 people each year.[58] NLM supports the Woods Hole "short course" in Biomedical Informatics.[59, 60]

NLM’s history of providing educational opportunities for librarians is even longer. In addition to the opportunities for librarians in its informatics training programs, NLM currently supports post-masters training of health sciences librarians through the NLM Associate Fellowship program,[61] and short courses in the use of NLM’s electronic services offered through the National Network of Libraries of Medicine and via the Internet. The Library provides individual fellowships for those interested in developing the combined subject matter and information science expertise required to serve as an advanced information specialist in a particular context, e.g., as a member of a clinical team, within a biological sciences department, or within a public health context. NLM partners with the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Library Association, and the Association of Research Libraries to support educational symposia on specific topics, mid-career leadership training opportunities for librarians, and scholarships for library school students, with an emphasis on minority recruitment.

Over the next ten years a greatly expanded and more diverse workforce of clinicians, informaticians and librarians will be needed to develop and deploy systems to support basic, clinical, and translational research in the genomic era, to deliver just-in-time health and emergency response information, to link electronic health records, decision-support tools, and relevant knowledge, and to ensure permanent access to digital information.[62]

NLM should help to meet this need by continuing to adapt its existing educational programs and by increasing its focus on K-12 education. Expanding the cadre of biomedical librarians and informaticians will depend on expanded science literacy in the population as a whole, a process that begins with a child’s first science and mathematics lessons, and on generating enthusiasm for careers in the biomedical information sciences at a much earlier age.

Recommendation 4.1. Develop an expanded and diverse workforce through enhanced visibility of biomedical informatics and library science for K-12 and college students.

The 21st century health infrastructure’s requirements for a diverse population of biomedical informaticians and biomedical librarians can be met only through an aggressive recruitment and retention program that targets K-12 and college students.

NLM and its outreach partners have a natural opportunity to promote interest in careers in biomedicine in general and in librarianship and informatics in particular, while increasing awareness and use of health information services among K-12 students. There is anecdotal evidence that community-based outreach efforts are already helping to recruit minority candidates into librarianship. Encouraging young people to pursue careers in the sciences is already a stated goal of NLM’s exhibitions and its associated K-12 educational materials and programs. NLM should develop more systematic approaches to integrating recruitment with outreach and assess their impact.

Currently most recruits to NLM-funded post-graduate training programs discover an interest in biomedical informatics or health sciences librarianship serendipitously. Serendipity must give way to the development of programs to inform young people about the exciting career opportunities that exist in health and biomedical informatics and librarianship in the early years of college and high school, including the high quality, rigorous training programs to which they can apply. The nature of these careers and the existence of the training programs may be largely unknown to college career development offices.

NLM Associate Fellows. NLM Associate Fellows, 2005-2006.

Stimulating the recruitment of large numbers of underrepresented minorities into biomedical informatics remains an unanswered challenge. New initiatives are urgently needed, such as the formation of a national network for biomedical informatics recruitment, with participation sought from the NLM-funded graduate training programs. This existing training platform offers an exceptional opportunity to create an alliance of graduate training programs that could engage in special outreach activities to stimulate interest in and access to biomedical informatics careers among minority undergraduates. Existing national meetings that attract minority undergraduates in the life sciences are a fertile ground for experimenting with these efforts (e.g., Annual Biomedical Research Conference for Minority Students and the Society for Advancement of Chicanos and Native Americans in Science.)

Recommendation 4.2. Support training programs that prepare librarians to meet emerging needs for specialized information services.

Training class. Training class at the University of Texas, El Paso, part of the NLM Environmental Health Information Outreach Program (EnHIOP).

As the amount and types of digital data relevant to biomedicine and health continue to grow and the sources and locations of relevant information continue to proliferate, finding, analyzing, and making efficient use of the best information for the task at hand becomes increasingly difficult. Many basic, clinical, and health services researchers are struggling to manage and keep track of their own electronic datasets, which are often inaccessible even to colleagues in the same institution. At the same time, nationally available research databases and computational tools are evolving and expanding so rapidly that research faculty and students are unable to keep up with resources that are directly relevant to their work. In health care settings, busy clinicians usually need quick access to current synthesized information that is directly relevant to specific patients - whose particular attributes (e.g., age, medications, other diseases, access to social services) may not match those in available guidelines or evidence sources. Public health workers often need to interpret health and medical information in the context of housing, economic, environmental, and other data that relate to multiple determinants of health. Their most appropriate source of information may be undocumented "lessons learned" in public health interventions in similar jurisdictions. Patients and other members of the public often need personal interaction and assistance in identifying and interpreting electronic information relevant to their questions.

In all of these cases, there are opportunities for librarians to provide valuable and cost-effective services tailored to the needs of specific groups. Existing examples of such services include library-based bioinformatics specialists who teach and participate on research teams within biological sciences departments,[63] clinical informatics specialists or ‘informationists’ who synthesize information for other members of health care teams,[64] patient education specialists, and hospital librarians who serve on emergency response teams. NLM should continue to support training opportunities that prepare librarians to provide specialized services to meet emerging needs. The Library should also continue to support studies that explore new roles for librarians and evaluate the impact of the specialized services they develop and provide.

Recommendation 4.3. Continue support for formal, multidisciplinary education in biomedical informatics to increase the supply of informatics researchers who can work at the intersections of molecular science, clinical research, health care, public health, and disaster management.

The exponential growth in data generated by patient-specific genetic sequencing, large scale clinical research studies, electronic health records, and sensing devices provides new opportunities to speed scientific discovery, improve the efficiency of clinical research, enhance patient safety, and promote rapid translation of research results into improved health care and public health practice. Systems that integrate genomic data with electronic health records to provide patient-specific decision support and to identify populations likely to benefit from specific public health measures are now conceivable.

Turning these opportunities into usable information systems will require an expanding cadre of informatics researchers capable of crossing traditional boundaries between basic research, clinical research, health service research, health care, public health, and disaster management to conceptualize, build, and test informatics innovations that support a more integrated approach to all of these endeavors. Over the past 20 years, NLM has emphasized the importance of multidisciplinary informatics training, encompassing medicine, computer science, library and information science, linguistics, and engineering. The Library has promoted the expansion of biomedical informatics training and research programs to encompass expertise and problems in the biological sciences, health services research, public health, consumer health, and disaster management.

In addition to continuing to strongly encourage informatics education and research in all of these areas, the Library should promote greater attention by its funded training programs to informatics that supports more efficient clinical research and more rapid translation from basic science to clinical research studies and from clinical research to practice.

Other organizations have supported additional slots within NLM-funded informatics training programs. Several NIH institutes and the Department of Veterans Affairs have added capacity in this way from time to time.

The Robert Wood Johnson Foundation currently supports public health informatics tracks in four of the training programs. Given the huge need for advanced informatics researchers across the spectrum from basic science to health information for the public, NLM should continue to look for additional opportunities to partner with other organizations interested in building the informatics research workforce.

Girls basketball champions and NLM visitors.

2006 Girls Basketball Champions of Buckland, Alaska, plus NLM visitors.

FIGURE 2. University Medical Informatics Research Training Programs Supported by NLM

Map of University Medical Informatics Research Training Programs supported by NLM

  1. Program in Biomedical Informatics, Harvard-MIT Division of Health Sciences & Technology 
  2. Biomedical Informatics Research Training at Yale, Yale University 
  3. Medical Informatics Research Training Program at Columbia, Columbia University Health Sciences 
  4. Pittsburgh Biomedical Informatics Training Program, University of Pittsburgh at Pittsburgh 
  5. Johns Hopkins Health Sciences Informatics Training Program, Johns Hopkins University 
  6. Training of Toolmakers for Bio-Medical Informatics, Medical University of South Carolina 
  7. Vanderbilt Biomedical Informatics Training Program, Vanderbilt University 
  8. Regenstrief Informatics Research Fellowships, Indiana University - Purdue University at Indianapolis 
  9. Computation and Informatics in Biology and Medicine, University of Wisconsin Madison 
  10. Health Informatics Division, University of Minnesota Twin Cities 
  11. Biomedical and Health Informatics Research Training, University of Missouri Columbia 
  12. Training Program in Computational Biology and Medicine, Rice University 
  13. University of Utah Medical Informatics Training. University of Utah 
  14. Biomedical Informatics Training Program, University of California Irvine 
  15. Training Program for Imaging-Based Medical Informatics, University of California Los Angeles 
  16. Graduate Training in Biomedical Informatics, Stanford University 
  17. Training Program in Health Informatics, Oregon Health & Science University 
  18. Biomedical and Health Informatics Training Program, University of Washington