Want to Improve Informatics? Don’t Forget About First-Generation College Grads

Guest post by Kim Unertl, PhD, Associate Professor in the Department of Biomedical Informatics, Vanderbilt University Medical Center, and Director of Graduate Studies for the Biomedical Informatics MS/PhD Program at Vanderbilt University.

Who Belongs in Informatics?

I often ask colleagues and trainees about how they decided on a career in biomedical informatics. Over the years, this question has elicited a pattern of responses often involving a chance encounter where the person discovers that there’s a field that connects computer science with health. These were topics they were interested in but weren’t sure how to combine.

Looking for a career in informatics? NLM supports research training in biomedical informatics and data science at 18 U.S. educational institutions. For more information, visit our External Programs Division Grants and Funding and Research Education Program (R25) web pages.

Much of my work now focuses on expanding access to training and career pathways in biomedical and health informatics so that more talented young people learn about informatics earlier and in a more purposeful way that helps them understand that there’s a place for them in the field. A major goal is to increase diversity in biomedical informatics so that informatics better reflects the diversity of the U.S. population and can develop more equitable innovative technology solutions to major health challenges.

One large population that could benefit from increased emphasis in recruiting and networking efforts are first-generation college students, especially those from groups under-represented in the field.

Navigating Academia without a Safety Net

The fact that I’m a successful faculty member at an R1 university (an institution that conducts high research activities) is an improbability. Neither of my parents graduated from high school. My dad earned his GED, joined the Marines, and completed a carpentry apprenticeship program thanks to the GI Bill, which provides benefits and programs to veterans. My parents shared an unshakeable belief in the importance of education for their children, but my siblings and I had to figure out how to navigate the unfamiliar world of higher education ourselves.

The whole process was very lonely, confusing and overwhelming. Even today I regularly feel like I’m missing key behind-the-scenes information about how academia and research environments work. In addition, the skills I developed in managing independently and figuring things out, although crucial in helping my educational trajectory, are not well-aligned with the collaborative nature of science.

I’m far from the only person with this experience. A large proportion of K-12 students in the United States have parents who did not complete an undergraduate degree. This affects every aspect of their educational path. Data consistently show that if you have at least one college-educated parent, you have higher odds for finishing a bachelor’s degree and completing an advanced degree, which has multiple long-term financial implications. Around 13% of the U.S. population holds an advanced degree such as a Master’s, Professional, or Doctorate. Recent studies have confirmed that the odds of a tenure-track faculty member having at least one parent with a PhD are 250 times higher than having a parent without a PhD. The gap is further compounded when these faculty members are also part of other under-represented groups in categories such as gender, race, and ethnicity.

Why Does This Matter?

All of us involved in biomedical research and academic training should care about this reality. Every time a career path is closed to someone, we are missing out on what that person could contribute to their field, to patients, to public health, to their communities, and to the world. The systems that serve to lock under-represented and first-generation students out of opportunities keep amazing and talented individuals from achieving their dreams and goals. The next idea that revolutionizes medical care, cures a disease, invents a device, or identifies ways to address health equity issues may never have a chance to blossom because a student might not see an academic or research career as a viable option. We all lose as a result.

You Have a Role to Play

The good news is that we can all help to improve access to the field for diverse, first-generation students and trainees. We can all open doors to higher education opportunities and scientific career paths, starting with building connections with K-12 students. Mentoring high school and undergraduate students through the Vanderbilt Biomedical Informatics Summer Program (VBISP) has been some of the most enjoyable and worthwhile work of my career.

Developing and supporting programs that provide access to research opportunities through internships is another way we can open doors into scientific research for more people. This can take many forms – running an internship program, serving as a mentor for a summer intern, presenting a talk at a seminar, or financially supporting high school students’ participation in informatics summer programs. Every contribution has the potential to make a significant difference.

We also know that opening doors is not enough. Once students begin an undergraduate or graduate STEM degree program, we need to ensure that training environments are equitable and inclusive. First-generation students need support to help navigate higher education and to start out on their research careers. Information that many take for granted about how to navigate academia and research environments can present an isolating mystery for a first-generation student. Many feel as if they do not belong. Making what has been described as the hidden curriculum of higher education more transparent can help students move forward on a pathway towards a successful career and eliminate some of those feelings of isolation. Addressing topics such as coping with imposter syndrome and collaborating with a mentor can provide skills and confidence, as can regularly checking in about mental health and connecting students with peers with shared experiences.

First-generation students have so much that they can contribute to science. Leaving them sitting on the sidelines when science needs everyone on the playing field is a loss for all of us.

Dr. Unertl gratefully acknowledges Ellen de Graffenreid, Mia Garchitorena, and Jessica Ancker for feedback on drafts of this post.

In addition to her work at Vanderbilt University and the Vanderbilt University Medical Center, Dr. Unertl directs the VBISP and is co-director for the American Medical Informatics Association High School Scholars Program. Her research focuses on interactions between people, process, and technology in health care, especially related to clinical workflow, and on development of new pathways into biomedical informatics.

NLM is Celebrating 40 Years of Biomedical Training

Guest post by Richard C. Palmer, DrPH, JD, Acting Director, Division of Extramural Programs, National Library of Medicine (NLM), National Institutes of Health (NIH).

This summer, NLM is marking its 40th year of supporting Biomedical Informatics and Data Research Training (T15). This is an amazing accomplishment, and I extend my congratulations to all the past and present institutional training grant directors, trainees, and NLM staff that have helped mature the field, grow the scientific workforce, and prepare this country for a biomedical revolution. This revolution harnesses the power of data to improve scientific exploration, clinical care, public health practice, and personal health.

Although almost 40 years have passed, NLM is more committed than ever to support career training, which is a central component of the NLM Strategic Plan. Recently, NLM released a new R25 program focused on supporting innovative educational programs and research experiences aimed at preparing talented and diverse students for future careers in biomedical informatics and data science. NLM also recently awarded 18 T15 grant awards, the largest number of awards made to date, to help ensure an available data-driven biomedical informatics and data science workforce. About 170 graduate and postdoctoral students will be trained annually by the T15 program to meet this growing workforce demand. NLM recognizes that we need to invest in training to ensure that a well-trained informatics and data science workforce exists to address the health needs of this nation.

Personally, I am amazed with just how fast the biomedical informatics and data science field has grown in the past 10 years. I entered this field with a study that aimed to build a clinical decision support tool to help manage fall risk for older adults—I vividly remember the headache associated with the interoperability (a computer or software inability to exchange and utilize data or other information) of data sources. Since then, I have witnessed rapid change occurring—due in part to the continued advances in computing, data storage, and standardization—that has allowed biomedical informatics to quickly advance. This change is occurring rapidly. To harness this acceleration in the acquisition, storage, retrieval, and use of information in health research and for the biomedical enterprise, we need a highly skilled workforce, and the demand for scientists trained in these areas and who can apply these skills to health and biomedicine is higher than the current supply. NLM’s commitment to training is helping ensure that a workforce capable of leading innovation exists.

Since joining NLM, I have had the opportunity to learn more about NLM’s T15 training program and the impact it’s had. Forty years is a long time, so I pieced together data to identify a common trend: The majority of the T15 trainees move on to research-oriented roles in academic institutions, not-for-profit research organizations, governmental and public health agencies, pharmaceutical and software companies, and health care organizations. Those in training over the past 10 years published 2,350 articles, with nearly 23% of these publications being highly cited, and were associated with 23 patents. In addition, T15 trainees are taking on leadership roles in academia, health centers, and research organizations. Even NIH’s own Dr. Josh Denny, who leads the All of Us program, and Dr. Michael Chiang, Director of the National Eye Institute, are former T15 trainees.

Just recently, I was able to participate in my first T15 trainee conference hosted by the University at Buffalo, SUNY and saw what research T15 trainees were involved with. What impressed me was the passion these trainees had for the science and their commitment to tackling pressing biomedical issues. Trainees are conducting research in areas including basic biomedical research, health care delivery, clinical and translational research, public health surveillance, and consumer health. Given their level of engagement, there is little doubt that many current T15 trainees will build successful scientific careers that will benefit society tremendously. At NLM, we are committed to training and fostering the development of the next generation of biomedical informatics and data scientists and look forward to the scientific advances they make. They say time flies when you’re having fun, and the last four decades sure have flown by. Here’s to another 40 years of NLM-supported training!

Dr. Palmer oversees NLM’s grant programs for research, resources, workforce development, and small business related to biomedical informatics and data science. Prior to joining NLM, Dr. Palmer was a Health Scientist Administrator at the National Institute on Minority Health and Health Disparities. He has over 25 years of extramural research experience and has been an investigator on NIH and CDC funded research grants. Dr. Palmer has conducted research in health care and community-based settings aimed at addressing health disparities, understanding health care decision-making, and improving health outcomes and disease management among older adults.

Want to learn more about NLM’s support for training?

View a panel discussion on Lindberg and the Advancement of Science through Research Training held during the 2022 Lindberg-King Lecture and Scientific Symposium: Science, Society, and the Legacy of Donald A.B. Lindberg, MD on September 1. The panel addressed the leadership of Dr. Donald A.B. Lindberg, former NLM director, in the advancement of science through research training with emphasis on the field of informatics.

Using Large Datasets to Improve Health Outcomes

Guest post by Lyn Hardy, PhD, RN, Program Officer, Division of Extramural Programs, National Library of Medicine, National Institutes of Health.

Before the advent of algorithms to determine the best way to treat and prevent heart disease, a health care provider looking for best practices for their patients may not have had the resources to find that best method. Today, health care decision-making for individuals and their health care providers is made easier by predictive and preventive models, which were developed with the goal of guiding the decision-making process. One example is the Patient Level Prediction of Clinical Outcomes and Cost-Effectiveness project led by Columbia University Health Sciences.

These models are created using computer algorithms (a set of rules for problem-solving) based on data science methods that analyze large amounts of data. While computers can analyze facts within the data, they rely on human programming to define what pieces of data or what data types are important to include in the analysis to create a valid algorithm and model. The results are translated into information that health care providers can use to understand patterns and provide methods for predicting and preventing illness. If a health care provider is looking for ways to prevent heart disease, an accurate model might describe methods—like exercise, diet, and mindfulness practices—that can achieve that goal.

Algorithms and models have benefited the world by using special data science methods and techniques to understand patterns that guide clinical decisions, but identifying data used in their development still requires practitioners to be conscious of the results. Research has shown that algorithms and models can be misleading or biased if they do not account for population differences like gender, race, and age. These biases, also known as algorithmic fairness, can adversely affect the health of underserved populations by not giving individuals and health care providers information specific to and that directly addresses their diversity. An example of potential algorithm bias is creating an algorithm to treat hypertension without including variated treatments for women or considering life-related stress or the environment.

Researchers are focusing on methods to create fair and equitable algorithms and models to provide all populations with the best and most appropriate health care decisions. Researchers in our NLM Extramural Programs analyze this data through NLM funding opportunities that foster scientific inquiry so we better understand algorithmic effects on minority and marginalized populations. Some of those funding opportunities include NLM Research Grants in Biomedical Informatics and Data Science (R01 Clinical Trial Optional) and the NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed).

NLM is interested in state-of-the-art methods and approaches to address problems using large health data sets and tools to analyze them. Specific areas of interest include:

  • Developing and testing computational or statistical approaches to apply to large or merged health data sets containing human and non-human data, with a focus on understanding and characterizing the gaps, errors, biases, and other limitations in the data or inferences based on the data.
  • Exploring approaches to correct these biases or compensate for missing data, including introducing debiasing techniques and policies or using synthetic data.
  • Testing new statistical algorithms or other computational approaches to strengthen research designs using specific types of biomedical and social/behavioral data.
  • Generating metadata that adequately characterizes the data, including its provenance, intended use, and processes by which it was collected and verified.
  • Improving approaches for integrating, mining, and analyzing health data in a way that preserves that data’s confidentiality, accuracy, completeness, and overall security.

These funding opportunities encourage inquiry into algorithmic fairness to improve health care for all individuals, especially those who are underserved. By using new research models that account for diverse populations, we will be able to provide data that will support the best treatment outcomes for everyone.

Dr. Hardy’s work and expertise focus on using health informatics to improve public health and health care decision-making. Dr. Hardy has held positions as a researcher and academician and is active in national informatics organizations. She has written and edited books on informatics and health care.

Celebrating Independence Day: Fortitude in Philadelphia, 1776

Guest post by Susan L. Speaker, PhD, Elizabeth A. Mullen, and Erika Mills, History of Medicine Division, Library Operations, National Library of Medicine, National Institutes of Health.

Stories of the momentous political events of the American revolution can often leave out the broader context in which they happened, and the concurrent day-to-day challenges Americans faced, particularly to their health. In honor of this year’s Independence Day celebrations, let’s pull back the curtain and peer into Philadelphia in 1776.

In the spring and summer of 1776, the Second Continental Congress gathered in Philadelphia to debate declaring independence from King George III and the British Parliament. Accounts from that time clearly convey the delegates’ fears about the possible consequences of fighting for independence: the American army, vastly outnumbered by British forces, could lose the war; their leaders could be executed as traitors; supporters could have their property confiscated; and the occupying British army could wreak havoc on towns and cities. But British rule wasn’t the only threat to life and liberty during this time. Disease posed yet another significant threat.

A portrait of Dr. Benjamin Rush
Dr. Benjamin Rush, a prominent Philadelphia physician and signer of the Declaration of Independence, split from many of his medical peers over the suspected origins and best treatment of yellow fever. In his book, An Account of the Bilious Remitting Yellow Fever, as It Appeared in the City of Philadelphia, in the Year 1793, Rush chronicled his approach to the disease and experience treating yellow fever patients.

The Continental Congress included many well-educated delegates, and Philadelphia itself (then America’s largest city with about 30,000 residents) was a center for science, commerce, and medicine. Philadelphia was home to America’s first medical college (at the University of Pennsylvania, 1765), first general hospital (Pennsylvania Hospital, 1752), and the American Philosophical Society (1743). Five of the Declaration signers were physicians, including Benjamin Rush. While medical, scientific, and public health knowledge was steadily advancing in the late eighteenth century, it was often inadequate when illness struck. Most of our modern understanding of the physiological, biochemical, and microbial causes of disease wouldn’t develop for another century.

Philadelphia, like most cities of the era, was crowded, and by current standards, filthy.  Sewage and other waste flowed in open gutters and ditches; animal manure was everywhere. Washing and drinking water often came from the rivers. Diseases such as typhoid and dysentery were common as was malaria (transmitted by mosquitoes breeding in standing water). Occasionally, yellow fever (another mosquito-borne disease) invaded the city, taking a terrible toll. When such epidemics arrived, the well-to-do often left town, while poorer folk, including slaves and servants, stayed, caring for the ill, burying the dead, and risking their own health.

A letter written by Dr. Rush to his sister.
In this letter to his sister, written during the yellow fever epidemic, Dr. Rush described the “deep and universal distress” in Philadelphia. He mentioned “190 fresh graves” in the churchyard and “nearly deserted” streets.

The health of the Continental Army, led by George Washington, was also a constant worry. Army camps were much like small cities where crowding and poor sanitation provided ideal conditions for disease transmission. The lack of proper food and shelter made soldiers more susceptible to illness. Many military leaders knew, even before disease microbes were discovered, that cleanliness, proper waste disposal, adequate diet and clothing, and other measures were keys to keeping troops fit for battle. One of Washington’s first general orders, in 1775, addressed measures for maintaining soldiers’ health; such orders would be frequently repeated throughout the War of Independence, as camp commanders didn’t always comply.

A sketch of a nurse tending to a solider in the revolutionary war period.
Sketch of a nurse tending to a solider. Washington began to inoculate and quarantine troops to control and minimize the impact of the smallpox. His decision was bold and dangerous, as inoculation brought risk of death, although far less frequently than if contracting smallpox naturally.

Washington’s health-related orders also addressed inoculation against smallpox, a dangerous and highly contagious disease. Inoculation was risky as it used material from an infected person (rather than vaccination using cowpox material, which was developed later) to produce (one hoped) a mild infection and consequent immunity. Civilians also took a chance with the procedure; an outbreak in Boston in 1776 spurred Abigail Adams (wife of John Adams) to get herself and her children inoculated against it, though it took several of them weeks to recover.

An illustration of the Cinchona tree.
The bark of the Cinchona tree, a source of Quinine, was the bark in the “bark and wine” cure.  Madeira wine was the wine portion of the cure.  Secretary of the Treasury and leading Federalist Alexander Hamilton favored the “bark and wine” treatment for yellow fever.

These health burdens on the population, in Philadelphia and elsewhere in the colonies, were ubiquitous but insufficient to sway the colonies in their determination to be free of British rule. In spite of their administrative concerns and personal health complaints, the delegates to the Second Continental Congress made history on July 4, 1776.

After the revolution, Rush wrote an essay: “An account of the influence of the military and political events of the American revolution upon the human body” and another: “The result of observations made upon the diseases which occurred in the military hospitals of the United States, during the late war” an early usage of the nation’s new name.

You can find Rush’s essays in NLM Digital Collections and learn more about the health and politics of the early years of the United States NLM’s exhibition Yellow Fever in Alexander Hamilton’s America.

Dr. Speaker has been Historian for the Digital Manuscripts Program in NLM’s History of Medicine Division since 2002. She conducts research, selects documents, and writes in-depth contextual narratives for the Profiles in Science project, and she carries out other historical work including articles, blog posts, presentations, and oral histories on a variety of topics. She is also the historical consultant for the NLM Web Collecting and Archiving Working Group.

Elizabeth Mullen is Manager of Web Development and Social Media in NLM’s History of Medicine Division.  As managing editor of Circulating Now, she is privileged to work closely with many creative and dedicated NLM staff members and a wide range of historians, artists, curators, students, educators, and members of the public who have found meaning in the collections and shared their enthusiasm for the history of medicine.

Erika Mills is an exhibit specialist for the Exhibition Program in NLM’s History of Medicine Division. She has co-curated exhibitions on a collection of images from the World Health Organization and the first history of the NLM as presented in the institution’s first exhibition. Ms. Mills has worked at NLM since 2005, starting out as the community outreach coordinator for the Exhibition Program.

At the Intersection of National Library and Public Health Weeks: Celebrating NLM’s Many Roles

Guest post by Robert Pines, MS, Writer/Editor, and Sarah Ashley Jolly, MPH, Writer/Editor and Graphic Designer (Contractor), NIH National Library of Medicine (NLM) Office of Communications and Public Liaison.

This week marks both National Library Week (April 3-9) and National Public Health Week (April 4-10) and we are pleased to recognize this intersection of NLM’s work. While the importance of each observance on its own is clear, their connection may not be as obvious. From our vantage point in the NLM communications office, however, we see the many roles in which NLM staff members and contractors are engaged, and how libraries and public health are linked to create a healthier world. As such, we are pleased to share just how NLM embodies this overlap in observances as a center for information innovation that supports and advances public health.

NLM is the world’s largest biomedical library and engaged in activities as diverse as our global community of users. NLM staff members and contractors are motivated by a desire to serve scientists and society, and are involved with training, community engagement, literacy campaigns, information dissemination, and more. Public health is at the core of NLM’s mission, and it drives the work we do as a library that delivers information directly to stakeholders.

“…to assist the advancement of medical and related sciences and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health.

-NLM Authorizing Language

Inspired by many of the daily themes of National Public Health Week, we spoke with six colleagues representing different parts of NLM to hear — in their own words — how their work in a library contributes to public health.

Racism: A Public Health Crisis

“NLM has been an active participant in the NIH-wide UNITE Initiative, which seeks to identify and address structural racism within the NIH-supported and broader scientific community. We’ve worked to recruit change agents from across NLM to advance racial and ethnic equity through a commitment to reform our own policies, practice, and procedures. This effort is rooted in a recognition that we have a responsibility to serve as exemplars for the change we wish to see.”

Maryam Zaringhalam, PhD
Data Science and Open Science Officer, NLM Office of Strategic Initiatives

Learn about the NIH UNITE Initiative and diversity at NLM.

Public Health Workforce: Essential to our Future

“Trainees who come to NLM have a passion for advancing healthcare, and we provide an environment where they can apply their unique computational skillsets to address public health questions. Among other contributions, their work here has improved our understanding of different diseases and created systems that help other researchers and clinicians better serve their patients.”

Virginia Meyer, PhD
Training Coordinator, NLM Intramural Research Program (Contractor)

View training opportunities at NLM.

Community: Collaboration and Resilience

“NLM cultivates long-term partnerships with communities to help address challenges and opportunities around health equity and information access. For over 30 years, for example, the Environmental Health Information Partnership (EnHIP) has enhanced the capacity of minority-serving academic institutions to engage with environmental health information. EnHIP has had a great impact with almost 150 community-based projects focused on awareness and usage of NLM resources.”

Amanda J. Wilson 
Chief, NLM Office of Engagement and Training

Read about the NLM Office of Engagement and Training and its work with EnHIP.

“The Network of the National Library of Medicine (NNLM) is committed to providing equitable access to high-quality health information. We make NLM tools and resources available to those who need them in order to build a knowledgeable, resilient health care workforce and public. Through NNLM’s work, individuals are able to make informed decisions about their health, research and public health professionals have the resources they need to make change, and the public health of the nation is improved as a result.”

Martha Meacham, MLIS, MA
Project Director, NLM Office of Engagement and Training

Discover the work of NNLM.

World Health Day: Health is a Human Right

“At MedlinePlus en Español, our team of translators facilitates access to content from NLM using thoughtful translations that consider the breadth and variability of Spanish-speaking audiences. We are proud to enable access to high-quality health information by reducing language barriers and bridging cultural gaps so consumers can make informed health decisions.”

Javier Chavez 
Team Lead, MedlinePlus en Español

Explore MedlinePlus and MedlinePlus en Español.

Accessibility: Closing the Health Equity Gap

“Accessibility is critical to closing the health equity gap. NLM promotes accessibility by ensuring NLM’s videos include audio description, captions, and proper color contrast so that blind, sight-impaired, or deaf audiences can find and learn about NLM’s various tools and resources.”

Andrew Wiley 
Video Producer, NLM Office of Communications and Public Liaison (Contractor)

Photo of Andrew Wiley

Watch our audio described videos and read about accessibility at NLM.

As echoed in the words of our colleagues, NLM staff members and contractors are dedicated to providing stakeholders with the resources and information needed to create a healthier world. Their work at the intersection of these two observances demonstrates the essential nature of libraries to public health.

We hope you will join us in celebrating National Library and Public Health Weeks. Connect with NLM to learn more about the roles that we play.

Robert Pines is a writer/editor in the NLM Office of Communications and Public Liaison who works on web and digital projects. He also co-chairs the NIH Social Media Collaboration group. Robert holds a Graduate Certificate in Front-end Web Development from the Harvard Extension School, a Master of Science in Management: Public Relations from the University of Maryland University College, and a Bachelor of Arts in International Studies and Business Administration from American University.

Sarah Ashley Jolly is a full-time contractor and serves as a writer, editor, and graphic designer in the NLM Office of Communications and Public Liaison. She is passionate about creating communications materials to distill important and complex topics that are easy to understand, engaging, and visually appealing. She holds a Master’s in Public Health from Emory University with a certificate in maternal and child health, along with two Bachelors of Arts degrees in history and anthropology from Mississippi State University.

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