A career in medical informatics

Mohammad Al-Ubaydli explains how to have a career in medical informatics¹

If you want to understand why I love technology, take a look at my hearing aid. Just before starting my house job, my nightmare scenario was of being deafened by the vacuum cleaner during the ward round while my consultant barked orders at me. So I invested in a funky, digital hearing aid. With the flick of a switch, the machine promptly filters out all noise, and homes in on the speech of the person I am facing. It is quite amusing to watch my (very nice) consultant needing to ask the cleaner (very nicely) to switch the vacuum off.

Technology helps me to be a good clinician, despite my disability. Using information technology within the NHS enables the clinician to increase his or her abilities. Unfortunately, the NHS has been particularly slow in introducing computers into the system. But things are improving.

This article is about steps you can take to improve your computing skills. The more useful this exercise becomes for you, the more you can delve into the area. If, like me, you become hooked, there is the possibility of focusing your career on the new specialty of medical informatics.

Some myths

But before I get that far, let me clear up a few myths on learning about computers. Firstly, you are never too old to learn, and computers are not the exclusive domain of your children and grandchildren. It was my father who taught me how to use a computer, and his skills were self taught.

Secondly, you do not need to have a degree in computer science before you are allowed to play with a computer. Remember that every day as a doctor you learn new skills by applying the "see one, do one, teach one" principle on living patients. Learning on a computer is far easier (and safer).

Finally, just because you are not going to specialise in medical informatics, it does not mean you cannot improve your clinical practice by learning about computers. In the same way, just because most doctors do not become surgeons, it does not mean most doctors should not learn how to suture.

Where to start

Books

So, how do you begin dabbling in computers? The simplest and cheapest way is to get a book. From personal experience, I recommend the "dummies' guide" series of books (www.dummies.com/). Don't be patronised by the title. The books are simply designed quickly to get your skills to a level good enough to be useful. Even if these books are not your style, there are hundreds of other books for all levels and most tastes. This is not a neglected market.

Free courses

But learning from a book can be a lonely pursuit. Sometimes it's good to have a teacher setting the pace and going over the difficult concepts. A surprisingly good (and free) solution to this is the Barnes and Noble University. Barnes and Noble is the largest chain of bookstores in the United States (and the world). Its website, although not yet beating Amazon's, has an interesting feature. The university section runs courses continuously. You can sign up for these for free, and most of the courses revolve around computers. The company's hope is that you will buy the "set text" from the website, but it is certainly not a requirement.

Formal tuition

At some point, you may decide you need formal tuition. For me, it was the local polytechnic. I took a gap year before joining medical school, and I still look back fondly to that year for the academic freedom it gave me. At the beginning, various lecturers advised me on the best courses to take. Unlike at medical school, I was allowed to disagree with all of their opinions, study what I wanted, and skip everything else. The teaching was excellent, and the students were from an entertainingly diverse range of backgrounds.

Most universities and polytechnics offer the European computer driving licence, as explained in a previous career focus article.²

An increasing number of universities are now offering courses devoted to using computers in a medical setting. University College London, for example, runs an excellent MSc in health informatics. Health professionals from around the country are gently introduced to the issues involved in deploying information technology and then given a solid understanding of how to assemble solutions.

A career in medical informatics

Such an education sets you up for a career in medical informatics. The NHS has great need for such professionals, and posts are springing up at a quickening pace. During medical school I spent a lot of time at the Clinical and Biomedical Computing Unit (CBCU) in Cambridge. The team, led by Jem Rashbass, combines excellent information technology skills with a playful curiosity. Every gadget is tried out to see how it might improve clinical practice. After graduating, I worked there as a full time researcher for six months. It was a steep but enjoyable learning curve and provided a different mindset as I began my house job.

Networking

My experience in working in CBCU also illustrates an important point in searching for such jobs in information technology. I did not answer an advert in the press or search the internet for job postings. Rather, I asked around for any doctor at my university who was doing computer research. Almost every answer I got included Dr Rashbass as the expert, so I made a trip to his lab. As this new specialty evolves, with no formal career structure yet in place, you must use your networking skills to find out about the jobs available.

A stint in the United States

Furthermore, as part of your career plan, you must consider a stint in the United States. Institutions there are years ahead in usage of information technology, and their budgets dwarf anything the NHS has contemplated to date. The budgets of the National Institutes of Health, in Washington, and Stanford Medical School, in San Francisco, are about as big as they come. The people at the National Institutes of Health, for example, are responsible for Pubmed, while Stanford's Ted Shortliffe is a living legend in these circles. Furthermore, the United States already has a large and prestigious college of medical informatics.

There are many opportunities for making the trip across the Atlantic. During my elective, for example, I worked at the Los Alamos National Laboratory, the birthplace of the atom bomb. My work was in peacetime, you'll be glad to know, and related to World Health Organization schedules for influenza vaccination. My work also got me a comfortable car (rental paid) and a comfortable salary. Meanwhile, my colleague, Laura Dean, landed a contract designing websites for the National Institutes for Health. Again, the salary was refreshing, but, even more importantly, the intellectual and social life in the institute is extraordinary.

On our return to the United Kingdom, it was disappointing to see the state of the nation's information technology infrastructure. But we see opportunity. The NHS is undergoing change at an incredible pace, and new positions are being created. An education in medical information technology is increasingly important as the NHS upgrades its facilities. Some day every hospital in the land will be as digital as my hearing aid. Mohammad Al-Ubaydli is a doctor and programmer. Currently he is working as a preregistration house officer at the Queen Elizabeth Hospital in King's Lynn, Norfolk. He also lectures and consults on the use of handheld computers in medicine. Recently, he co-founded Medical Approaches, a non-profit organisation, which provides a free, peer reviewed medical textbook for use on all handheld computers (www.handheldsfordoctors.com, www.medicalapproaches.com)

1. Profile on Mohammad Al-Ubaydli. BMJ 2002;324:S78 (www.bmj.com/cgi/content/full/324/7337/S78).
2. Johnson C. The European computer driving license. BMJ 2002;324:S35 (www.bmj.com/cgi/content/full/324/7332/S35).