The biomedical informatics short course at Woods Hole/Georgia: Training to support institutional change

2.1.History of the Woods Hole Marine Biological Laboratory

The MBL was established in 1885 as a research station for the US Bureau of Fisheries in Woods Hole, Massachusetts, a small fishing village at the time, located on the southwestern-most point of Cape Cod. Situated between the Gulf Stream, which brings southern marine fauna, and Cape Cod Bay, with its resident northern fauna, the MBL was ideally placed to harvest specimens for marine biologists across the country. The disadvantages of long-distance transportation of living specimens soon led biologists to come to the site of the specimens, especially in the summer when relieved of their teaching duties. Medical researchers became interested as well, when they learned of the practical advantages of studying marine organisms, such as squid (with their giant axons), sea urchins (with their large ova) and horseshoe crabs (with their accessible optic neurons) as models for human biology. The scholarly community grew, as research faculty brought their trainees, and the MBL began offering courses, some of which have run for over 50 years. To understand the appeal the educational experience at the MBL, read Gerald Weissmann’s collection of essays in The Woods Hole Cantata [3].

2.2.Marine Biological Laboratory facilities

The MBL comprises a collection of buildings around Woods Hole’s Eel Pond, a tidal pond in the center of town (Fig. 1). The complex includes a highly rated, comfortable dormitory with a cafeteria and café. It also features classrooms and laboratories for research and training. What it did not have, in 1991, was anything like a computer laboratory. The original statement of work provided for establishment of such a lab (in Phase II alluded to above). Initially, the plan was simply to use wet-lab space. This entailed moving some lobster tanks and putting boards over lab sinks to accommodate desktop personal computers.

Fig. 1.

The Marine Biological Laboratory in Woods Hole, Massachusetts.

2.3.MBL Short Course faculty

Don engaged Daniel R. Masys M.D., Director of NLM’s Lister Hill National Center for Biomedical Communications, and David Lipman M.D., Chief of NLM’s National Center for Biotechnology Information, as faculty. Don recruited Homer Warner M.D., Ph.D., Chair of the Department of Medical Informatics at the University of Utah, as course director. Homer, in turn, brought Peter Haug M.D., from Utah and Paul Clayton Ph.D., previously from Utah but then Director of the Center for Medical Informatics at Columbia University; Paul brought Robert Sideli M.D., from Columbia. Together, they provided good domain coverage for what were, at the time, the major themes in medical informatics: clinical information systems, decision support systems, library databases, and genetic sequencing.

2.4.MBL Short Course curriculum

According to faculty involved in the initial course offering, very little advanced planning of the actual lectures had occurred (Fig. 2). After an initial rocky start, the students were granted their request for a course syllabus, which became the guide for development of subsequent course materials [4]. Evaluations were generally good, with many comments about the need for and appreciation of structured materials [5]. Afterward, the annual report provided this summary:

Fig. 2.

Lectures for the first session of the course, June, 1992.

3.1.Evolution of the NLM Informatics Short Course

Don took the student evaluations to heart and tapped Dan Masys and NLM Computer Science Branch Chief Lawrence (“Larry”) C. Kingsland III Ph.D., to pull together reading materials on the course topics and assemble them into 30 black binders for the students. As a result, the second and subsequent years went much more smoothly. The course continued to be held in a classroom for didactic sessions and the wet lab for hands-on exercises. The lab had 15 personal computers, roughly half Macintoshes and half Windows-based personal computers. Students were paired up – usually one librarian and one physician to each machine [7].

3.2.MBL Short Course faculty progression

Homer Warner continued as nominal course director, but the selection of lecturers and lecture topics was left to Dan Masys and Paul Clayton. Most faculty were re-invited each year. Few declined the opportunity to spend a week participating in lectures with fellow leaders in the field, socializing with informatics friends, and enjoying scenic Woods Hole. As word of the course spread, informaticians and former students alike began asking Homer, Dan, Paul and Don to invite them to be on the faculty. Dan retired from NLM in 1994 to move to the University of California-San Diego. He therefore became eligible to serve as course director; Don signed him on immediately.

Fig. 3.

Cathy Norton, Director of the Library at Marine Biological Laboratory and Woods Hole Oceanographic Institute.

Fig. 4.

David Remsen teaching squid neuroanatomy to students in the MBL Marine Resources Center.

While the faculty presented most of the lectures and hands-on tutorial sessions, it was the MBL staff who really made the course function coherently. Cathy Norton was quickly recognized as the key to the entire operation: smart, funny, engaging, and knowledgeable. All who knew her would agree that she was larger than life (Fig. 3). Cathy also involved David Remsen, who helped teach technical classes and led tours of the Marine Resources Center, handing live squid, sea urchins and horseshoe crabs to the students (Fig. 4) while he explained how studies of their biology had led to Nobel prizes for MBL researchers¹. Cathy’s duties as a justice of the peace provided her with many stories with which to regale the students. She performed marriage ceremonies for several MBL short course faculty (myself included) and renewed vows for one of the students and his very surprised wife. Cathy was nevertheless a librarian at heart, and by 1994 she had become the director of the MBL/WHOI Library. The informatics course was a pet project, to which she devoted enormous energy, personally seeing to the care and comfort of all faculty and students. She was the quintessential hostess and manager. The 900 MBL Short Course students she oversaw undoubtedly remember her well. She continued in her leadership role as Principal Investigator on the NLM Informatics Short Course grant until 2011, when she retired from the MBL. Sadly, she passed away in 2014. She has left indelible marks on the course and all who were involved in it.

Many other MBL staff contributed to the success of the course, ranging from travel and accommodation logistics to technical support and leading hands-on laboratory sessions, including Diane Rielinger M.S., M.L.I.S. (who took over as course principal investigator), John Furfey M.L.S. and Jennifer Walton M.L.I.S.

3.3.NLM Informatics Short Course topics

The subject matter of the course evolved annually, based on contemporarily important and popular topics. Faculty were added to cover the additional topics, but there was no formal, longstanding syllabus. Rather, the NLM Informatics Short Course was a survey curriculum designed to expose students to general areas and provide sufficient depth to challenge them. It taught students that there was much more to know. As a way of providing some coherence, Dan Masys introduced the idea of a theme for the week and initially chose Alpha-1 Antitrypsin Deficiency, since it had known genetics (including a gene sequence), a serious but treatable clinical presentation, a good differential diagnosis, and easily accessible information in various databases and online resources [5]. Individual faculty embraced this guidance to varying degrees. As described below, the course content became more varied and more intense over the ensuing quarter-century.

Dr. Lindberg usually provided high-level context for the course, presiding over the welcome session, usually the evening before the first day of classes. His introductory comments encouraged students to interact with faculty and each other - in and out of class. He told them not to leave at the end of the week with any burning questions unanswered. He also provided lectures on various topics, ranging from bioinformatics to national policy. He usually presided over the closing session on the last day and made sure that all those questions did get answered. But most of all, he was available during the week to the students before, between and after classes, and at meals. Students were thrilled to share stories and pick the brain of someone who was a legend in his own time and Director of the National Library of Medicine.

4.1.Doubling down on the NLM Informatics Short Course

As popularity of the course grew, Don decided in 1999 to move from one session per year to two, each with 30 students. Dan Masys then asked for help with directing the course, and in the tradition of “see one, do one, teach one”, I was added to the faculty for the new fall course and became its director the following year. Dan continued as director of the spring course until 2005, when he moved to Vanderbilt University. I remained course director through 2015, with help in some years from Clement McDonald M.D. (Lister Hill Center Director) and Joyce Mitchell Ph.D. (Chair of Biomedical Informatics at the University of Utah).

The shared workstations and paper-based materials gave way to individual laptops (Windows-based or Macs), and the class moved out of the lab to a large, airy room in a building called the Little Club, situated on Water Street, next to the WHOI pier. It was not unusual for class to be interrupted by large research vessels coming to dock in full view of the class. During inclement weather, waves added excitement, breaking on (but not through) the windows.

4.2.Continued changes to MBL Short Course contents

Lecture topics continued to evolve (see Figs 5 and 6). The disease-of-the-week changed to hereditary hemochromatosis, with an elaborate patient case that included medical history, family history, physical findings, laboratory results and medications, which many of the faculty worked into their lectures. Dan added a “Vanderbilt Day” to the spring session that included informatics faculty from Vanderbilt to talk about end-to-end informatics development at the enterprise level. When Dan stepped down as course co-director and moved to Vanderbilt, he was able to return in the more relaxed role of faculty member when I continued the Vanderbilt Day tradition.

Fig. 5.

Lectures for the spring 2009 session of the course.

Fig. 6.

Lectures for the fall 2013 session of the course.

4.3.MBL Short Course student projects

The notion of hands-on laboratories continued to be a mainstay of the course. The admissions process became more formal, with applicants being evaluated for prior computing skills. Applicants were selected who seemed to have the basic skills needed to keep up with the laboratory exercises, and the exercises became more sophisticated. Where early students were learning about PowerPoint, Excel, and HTML, later students were learning about personal databases, publishing web sites, and integrating the two. Students were grouped into teams to develop projects together, allowing less technically confident students to learn from more advanced users.

Eventually, the course began to schedule the didactic lectures during the day and the laboratory sessions as evening workshops. We began to integrate the daytime topics into the projects. In the spring of 2009, Steven Phillips M.D. (NLM Associate Director) joined the faculty. For several years, he gave a lecture on Disaster Informatics that included activities and research programs in the NLM’s Disaster Information Management Research Center (DMIRC). This inspired the MBL staff to alter the evening project to be development of web sites for disaster management that made use of DIMIRC’s tools, including patient locators and hospital capacity trackers. The “disaster” they chose to prepare for was the Zombie Apocalypse. MBL Staff enthusiasm gave way the final evening to them showing up as zombies to attack the class.

As fun as the zombie theme was, it was a little far afield of the daytime lecture themes. However, the disease-of-the-week case was a patient who acquired paralytic shellfish poisoning from eating at a local seafood restaurant, so we decided to use a red tide outbreak as our disaster. What we didn’t know was that there was a small red tide outbreak on Cape Cod that week. When area residents started searching the web for information, they happened upon the students’ websites. This caused quite a bit of consternation because the sites described a fictitious scenario in which hospitals were filling up with victims. Confusion ensued as people started calling news organizations to ask why they were covering up the outbreak, leading those organizations to contact MBL leadership who was, of course, totally unaware of our students’ projects and unable to explain why MBL websites were publishing misleading information. It all got straightened out, with students’ sites being placed behind the MBL firewall, but for a while it was reminiscent of Orson Welles’s 1938 War of the Worlds radio broadcast.

4.4.MBL Short Course social events

No description of the course would be complete without commenting on the social aspects of the week. In addition to the opening reception and meals and break times, students and faculty alike often found the energy for some decompression time after the evening workshops. This usually entailed commandeering several of the large round tables at the Captain Kidd, a local watering hole that was literally a stone’s throw from the Little Club. A common pattern was for there to be a small gathering of a few faculty and students early in the week, with growing numbers each evening, sometimes achieving perfect attendance by the last night. Another treat was a traditional New England clambake one evening. Very few actual clams were involved. Steamed Maine lobsters were the main attraction. Many students over the years added learning how to eat one to their list of educational experiences for the week. Although Don did not usually appear at the “The Kidd”, he and Mary were reliable participants for other activities.