The overall gist of CI fellowship is to gain understanding about the subspecialty as a whole, what other people are doing with it, and how you can apply this to your own interests. Given it’s massive scope, it would be impossible to gain expertise in every area of course. Instead, our basic structure works around teaching you the fundamentals of the specialty (see Gardner’s article) and it’s use in decision making / care processes. There is also a focus around information systems (such as basic knowledge about programming principles, data structure, security, etc.) as well as the change management process.Overall, I think it’s good to consider what you can do with informatics. I separate it as follows: academic (use data to advance our knowledge), operational (implement and upgrade tools and workflows), and innovative (design/create the tools to be implemented). You can do any variation of those three, but in the end, you will probably be doing some version of that. Examples include the adacamician who teaches CI exclusively, the researcher that focuses heavily on one aspect of clinical medicine, and the chief medical information officer who focuses heavily around EHR / tool implementations and upgrades. Compare that to people who work in the startup space and those who work for the large EHR vendors. The subspecialty is quite expansive.
Work experience will vary based on the program, but as a whole interacting with different specialties should be a given. Most CI programs plan around an 80/20 model, where 20% of your time is spent working clinically in your department (read for me: EM attending seeing patients) and 80% of your time is spent doing informatics work. Some of this was administrative, such as meetings / etc. Some of this was for me to take classes online. But the majority of the time was to allow me to work on my own projects. No specific focus on pathology was given, since the majority of my work was to help out the ED (my home specialty) and the operating room workflows (since that was a project I had interested in). As a whole, UIC was fairly flexible and worked around my interests. (As an example, I spent a lot of time at UIC’s Electronic Visualization Lab).
Academic, Operational, Innovative. See above. Glad you liked my distinction.
Because of the rigorous nature of the operating room (both the duration of surgical residencies and daily time commitment for the job), it is probably more difficult for the surgical specialties (e.g. gen surg, OB/GYN, ortho, neurosurg) to get into this field. That said, I’ve seen general surgeons and OB/GYN’s apply to CI fellowship, so by no means is that a given. Radiology and pathology have a slightly higher stake in the data side (because of whole-slide imaging and storing imaging studies), but the data side of clinical medicine is just as important. While each specialty may have a different take on how they can utilize informatics, I think all can stand to benefit. Short version: do whatever specialty you want, and the informatics parts will follow.
I doubt it, but that decision really has to be made individually. (Exception: the vast majority of people in pathology programs will do a fellowship after residency…because that’s their culture).
80% informatics, 20% clinical. It depends on the program as to whether you will be considered an attending or a resident/fellow when you are practicing clinically. I’m starting at Carolinas HealthCare System in Charlotte, NC, specifically so that I could pursue the academic / operational / innovative structure you’ve heard me talk about previously. Fingers crossed as to how things will pan out, so I can’t really give you the day-to-day just yet.