Teaching a Diploma in Medical Informatics using the World Wide Web

Dr. Richard Pascoe and Dr David Abernathy
University of Otago


In this paper is discussed the preliminary development of a Diploma in Medical Informatics which will comprise courses offered entirely through the Internet in the form of World Wide Web documents and electronic mail. Proposed use of such educational technology for the delivery of these courses within a distance learning environment is based upon a conversational framework developed by Laurillard (1993) and an associated classification of this technology according to the length to which elements within the conversational framework is supported.

Keywords: Diploma in Medical Informatics, World Wide Web (WWW), Distance learning, Educational Technology


Medical Informatics is formally defined as ``the field concerned with the cognitive, information processing, and communication tasks of medical practice, research and education including the information science and technology to support these tasks.'' (Shortliffe, 1990). Medical informatics is an emerging discipline important to clinical medicine and in medical education. Many medical schools are recognising its importance and establishing programmes which attract graduates from a variety of backgrounds: doctors in specialist or general practice, nurses, other health care workers, computer scientists, present and potential health service managers some of whom become future managers of health information systems.

The Diploma in Medical Informatics (DipMI) starting in 1998 is being developed jointly by the Departments of Computer and Information Science, University of Otago and the Department of Medicine, Wellington Clinical School. The DipMI will be taught in a distance learning environment with participants located through out New Zealand and hopefully internationally. The participants will be expected to have access to the Internet for 2 reasons: first, to gain practical experience of what information technology contributes to Medical Informatics; and second, to participate in the DipMI since an objective is to deliver this Diploma entirely through the Internet using the World Wide Web (WWW), Email, and other such electronic media.

Development of this diploma has been guided by three issues:

  1. what is the general background of the student. Familiarity with the various student backgrounds is an important issue, discussed in Section 2, when considering the level of detail to include within courses forming the DipMI;
  2. what are the students expected to have gained from completing the DipMI. The authors have identified various skills and knowledge, discussed in Section 3, that they believe students should have acquired on completing a Diploma in Medical Informatics; and
  3. what are the most suitable educational methods for assisting students from (1) to (2). In particular, those methods most suited to distance learning through the Internet.

Education through the Internet using inter alia the WWW is an emerging trend, and this Diploma will be capitalising on the increasing body of technical knowledge and educational theory associated with this trend. In Section 4 is discussed our approach to delivering a DipMI using this new technology to stimulate and educate people in the field of Medical Informatics.

Students Enrolling for the Diploma

  The authors' expectations of the type of students who will enrol for the DipMI are: doctors in specialist or general practice, medical researchers, medical academics, and present and potential health service managers some of whom become future managers of health information systems. A common requirement for anyone belonging to one of these four groups is that they must be a medical graduate.

The authors expect that all students will be computer aware; however, there will be markedly different levels of expertise in their use of computers. With this in mind, all students will be expected to participate in a workshop at which fundamental skills associated with accessing the course material will be taught. This is essential since the entire course is based on the use of the World Wide Web. Another result of the varying levels of computer expertise is that a course will be provided within the DipMI to assist those people from any group who need to gain experience and expertise in the use of some standard software packages such as word processing, electronic presentations, spreadsheets, and databases. Another paper will be offered for those people who believe they are sufficiently proficient in these basic computing skills. In this paper, other more advanced skills for accessing and manipulating material will be presented together with general computer science concepts.

The DipMI is designed to ensure that each group is given both a general perspective on the field of medical informatics and a perspective relevant to their own medical background. For this reason there will be a medical informatics survey paper, in which everyone will participate to gain a general perspective of the different aspects associated with medical informatics. Other papers will be offered to explain in greater depth the use of computers in medical research, the teaching of medicine, evidence based medicine, and the management of patient records. Everyone will also be expected to complete a paper which is based on a project in which each student pursues some research of their own interest using their individual background knowledge together with knowledge gained from participating in the other papers. This structure of the DipMI based upon the authors expectations of the background of students enrolling for such a DipMI is summarised in Figure 1.

Figure 1: Structure of proposed Diploma in Medical Informatics with arrows indicating possible progression through the various courses constituting this Diploma. Students are required to complete 4 courses to achieve a diploma.

Expectations for students completing the Diploma

  Graduates of the DipMI will be able to effectively use computers and associated technology to solve a medical problem when appropriate. This requires that students have a general understanding of computers and associated technology so as to know where solutions may be found and how to select the most appropriate for a given problem.

Graduates will have a good understanding of how to use standard software packages for word processing, presentations, numerical and image analysis, and in particular storage and retrieval of medical data. Throughout the DipMI, emphasis will be placed on use of the Internet for locating resources, including materials for each course constituting the DipMI, and for collaborating with other health professionals.

Graduates will also have an understanding of principles underlying various approaches to information processing. These approaches include artificial intelligence and natural language processing and understanding them will allow students to evaluate the advantages and disadvantages of new medical software packages such as those for processing computer based medical records, drug interaction avoidance, and diagnostic assistance.

Use of Educational Technology

  As a starting point for developing the delivery of this Diploma, use is being made of a framework for the effective use of educational technology defined by Laurillard (1993). Central to this framework, summarised in Figure 2, is Laurillard's belief that: `the learning process must be constituted as a dialogue between teacher and student'.

Figure: Conversational framework (Laurillard, 1993)]

As shown in Figure 2, the framework comprises 12 elements (numbered 1-12) some of which are specific types of interaction between teacher and student, while others are involved with individuals reflecting on feedback of these interactions and adapting their environment accordingly.

New educational technology is being introduced with the use of computers in the learning process. Examples of this new technology include: hyper-media, such as hypertext (WWW) and multimedia, computer simulations, micro-worlds, email, collaborative environments, such that many people participate in discussion through computers, and so on. Laurillard classifies various types of educational technology according to their ability to support the 12 elements of the conversational framework presented in Figure 2. Her classification is summarised in Figure 3.

Figure: Media comparison chart (Laurillard, 1993)

The observation made by Laurillard from this classification is that some combination of the different types of educational technology is needed to adequately support the conversational framework she believes accurately represents the learning process. To this end, in the next Section the authors describe the combination they have initially chosen for use in delivering the proposed Diploma in Medical Informatics.

Delivery Media Adopted for this Diploma

The World Wide Web is an exciting medium through which to deliver a DipMI. The course material can be modularised and then each module can be linked to others containing relevant material. Students can start on any module and, if necessary, follow links to other modules to learn about any background information they have skipped. Thus all modules can be presented at once and students can determine their own path through the modules and can follow this path at their own rate of learning. If the modules contain links to ancillary material beyond the course requirements, students can pursue their own interests in more detail.

Students can form their own interpretation of course content by introducing new links within the WWW documents and by annotating the content of these documents. Providing a facility by which a teacher can view these alterations to the original course material will enable feedback to the student, thereby achieving elements 1-4 of the conversational framework shown in Figure 2.

The content of a WWW document can be presented in a variety of ways. active graphics, for example, where as the mouse moves across a graphic image explanations can pop up describing components of the image. Use of video, and animation can also capture a person's interest and imagination. Obviously the creative use of Java applets widen even further the opportunities for presenting course material.

As well as permitting a higher degree of personal interaction with the teacher through email contact, the course will foster group interaction among the students by containing group projects. Students will communicate with the group members about the project using a mailing list which will be monitored and contributed by the teachers.

Development of this diploma in Medical Informatics is in a very early stage and our adoption of Laurillard's approach to the use of new educational technology provided by computers is an excellent starting point. Over time our own experiences will suggest innovative methods for using an increasing variety of technologies to improve the delivery of the courses and to give the DipMI a character all of its own.


Laurillard, D. 1993, Rethinking University Teaching: A framework for the effective use of educational technology, Routledge.

Shortliffe, E. H. Perrault, L. E. 1990, Medical Informatics, Addison-Wesley Publishing Company 1990.

Dr Richard Pascoe
Computer & Information Science,
University of Otago,
Dunedin, New Zealand
Telephone: +64 3 479 8321
Fax: +64 3 479 8311

Dr David Abernathy
Wellington School of Medicine
University of Otago,
Wellington, New Zealand
Telephone: +64 4 385 5999
Fax: +64 4 385 5552


Richard Pascoe and David Abernathy 1996. The authors assign to the University of New Brunswick and other educational and non-profit institutions a non exclusive license to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive license to the University of New Brunswick to publish this document in full on the World Wide Web and on CD-ROM and in printed form with the conference papers, and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the authors.

N.A.WEB 96 - The Second International North America World Wide Web Conference http://www.unb.ca/web/wwwdev/ University of New Brunswick.