What is a polyp? "A polyp is a neoplasm that produces a macroscopically visible projection above a mucosal surface and projects into a lumen, e.g. the colonic lumen," according to the information which flashes on a computer screen in UCD's department of anatomy. Judging by the illustration beside these words, this translates into bad news for the patient, because a polyp is not an attractive entity. In glorious yellow-white colour, it looks like a nuclear mushroom cloud turned on its side, a little explosion of harm on the horizon of the colon. There is, one supposes, a strange beauty to it, as long as it's not on your colon.
Yet the fact that this information is available to medical students at the push of a button - along with similarly detailed descriptions and depictions of benign tumours, radiological techniques and sections across the human clavicle - represents significant progress in medical education. It makes UCD's medical school one of the most advanced in the world in the area known as "healthcare informatics".
Health informatics is, in its most general sense, the use of information technology and computer-stored clinical data to advance medical education. "What was here before was the traditional medical curriculum, where subjects were taught in the traditional manner," says Dr Patrick Felle, acting director of the Centre for Healthcare Informatics at UCD. "In anatomy, students would have a lecture, go into the dissection room and dissect a body. If they wanted to do research, they would go into a library and order the book, or if they saw a paper they were interested in, they could write and get a copy." Similarly, practising GPs who were trying to keep up with developments would buy a new textbook, attend meetings on the area in question or visit a medical library when they were in Dublin. "Developments in information technology have changed that completely," Felle says. "Almost all information is being delivered digitally on the World Wide Web. All major journals are on the Web. All new research papers are published on the Web almost immediately and researchers are contactable through the Web."
These developments have led UCD to revolutionise its medical training. Last week, the Minister for Education, Micheal Martin, officially opened a new computer-aided learning facility in the UCD Medical School at Earlsfort Terrace, developed by the medical school and computing services in UCD and supported by Apple Ireland. The centre contains 100 Power Macintosh computers in two labs, all linked to the UCD network and all with Internet access. The labs have state-of-the-art data projection and audio systems, so a lecturer can demonstrate to all students simultaneously.
As a result, while students will still spend time in the dissection room, they will also spend a great deal of time accessing information by computer and engaging in "self-directed learning" using interactive teaching packages and self-assessment examinations. There is already an element of self-directed learning in pathology, anatomy and physiology, and the medical school is working on extending it to histology and microbiology.
UCD has run a course in healthcare informatics since 1990 through the university's computer science centre, but two years ago the Centre for Healthcare Informatics was set up by the medical school with responsibility for educating undergraduate and postgraduate students about the uses of information technology.
First-year students are now being taught about computing and the Internet as part of their medical education, with security, networks, confidentiality and the ethics of handling digital information alongside the more traditional aspects of pre-clinical training. It is planned to integrate this teaching into the whole curriculum throughout the students' time in medical school.
"We really concentrate on this because we think the Web, or whatever succeeds the Web, is where it's at for offering information," Felle says. For example, five years ago a student or doctor seeking information on the "disease of the day" would go to the library, look up the monthly Index Medicus containing the list of articles and papers published that month and, if the journal in question was not immediately available, would then have to order a copy of the paper.
The US National Library of Medicine now offers a database called "Mediline", which contains nine million papers and is constantly being updated. Users can examine abstracts of papers or, in the case of some documents available free on the Web, can view entire papers. It is hoped that at some point in the future schools or individuals with a subscription to a particular journal will also automatically have access to its papers on the Web.
Meanwhile, the pathology department in UCD has replaced almost all microscope-based teaching with a computer-based course developed in the department, and interactive teaching packages are being used in other departments, including Beyond Vesalius, an anatomy package developed by the that US National Library of Medicine. These programmes use high-definition pictures and illustrations, as well as video sequences, to teach students elements of the core curriculum, in addition to enabling them to explore other areas of interest to themselves. Previously, such in-depth exploration of the human body would have required the constant presence of a very experienced lecturer. "The amount of information to be learned in medicine is increasing exponentially and the amount of contact time with academic staff is decreasing," Felle says. Using the self-directed system, students can progress through the body of knowledge available and "if they have a problem, they can come to the staff. It means that there's much more high-quality interaction between students and staff."
Using a package called TopClass, developed by WBT, formerly a UCD incubation company, an examinations system has been set up which will allow students to sit an exam at their computer, provide them instantly with their results and send a copy of those results back to the lecturer. Eventually, it is planned that all material will be delivered by single-user interface through TopClass via "Intranet". "In practical terms, it will bring us more up to date with changes in the area and will make us one of the most advanced medical schools in the world," Felle concludes. "It will have major implications for teaching. Teaching will have to change a little bit, but it will be an improvement."
