TEACHING DECISION ANALYSIS TO PRE-CLINICAL MEDICAL STUDENTS

Purpose: In August 2007, The University of Arizona College of Medicine (COM-P) started a new four year medical school campus in Phoenix in partnership with Arizona State University (ASU). At the same time, a new Biomedical Informatics (BMI) department was created within the ASU Fulton School of Engineering. One of the unique features of the new medical school curriculum was a very significant focus on BMI comprising over 75 hours of sequenced and integrated instruction in BMI topics.

Method: We organized the instruction into three themes, focused on Data (first year) Decisions (second year) and Patient Safety/Quality (3^rd and 4^th years).  A primary focus of the decision theme was a 19 hour weeklong MS2 block of instruction in biases in decision making, normative decision theory, and assessment of patient utilities.

Result: After an introduction into cognitive biases in decision making, students were given the task of developing a decision tree for H.Pylori diagnosis and treatment. They built their models incrementally over 3 days, assisted by BMI faculty and library staff to find literature and data to build their models. Results of their models were presented to the class for discussion. The week concluded with presentation from a local CMIO and VPMA about their experience with implementation and integration of decision support into their clinical environments.

Conclusion: Students successfully completed the small group exercises, and independently located (and used) commercial decision analysis software to complete their tasks. Evaluations of the block showed a bimodal distribution. While many students found the exercise useful, others felt it was not a topic for the board examinations and not relevant to their current education.  The challenge is that pre-clinical students who are focused on the board examinations may not see the relevance of decision analysis before they reach their clinical instruction. Ongoing evaluation of the success of an early introduction to decision sciences will be important as students reach their clinical years. Students from COM-P are joined by their Tucson classmates in their 3^rd and 4^th years for clinical rotations, and this presents a natural study to examine the effects of early decision sciences education on the clinical years of education. In addition, efforts to include decision sciences in the national board examinations should be a priority.