00100	.sec OVERVIEW
00200	
00300	In  response to a  stated need for bringing  computer technology into
00400	medical education,  and eventually into the  delivery of health care,
00500	we propose to train  current and future educators of medical students
00600	in  the art  and science of  applying computers  to medical problems.
00700	Stanford  University already  has many faculty  and students actively
00800	working  on cross-disciplinary problems of  biomedical computing.  We
00900	intend  to exploit this  active research and  teaching environment in
01000	the service of teaching individuals about the techniques and problems
01100	of using computers in medicine.
01200	
01300	.sec OBJECTIVES
01400	
01500	We  propose to train  people who can integrate  knowledge of computer
01600	science  with   medical  and   biomedical  expertise   by   providing
01700	interdisciplinary  classroom  and  research  training  in  biomedical
01800	computing.  Three educational opportunities will be made available to
01900	trainees: (i)  special  new seminars  in biomedical  computing,  (ii)
02000	existing University courses, especially in the Computer Science Dept,
02100	and  (iii)  research   projects  that  will  provide  supervision  on
02200	individual pieces  of  research.   (The  environment in  which  these
02300	research projects operate is discussed in more detail below.)
02400	
02500	<<Seminars>.  Prof. Feigenbaum and Dr. Buchanan will lead a series of
02600	seminars on  biomedical computing for the  trainees.   We will expect
02700	every trainee to participate  in these seminars, mostly to teach them
02800	about the topics  to be discussed, but also to  give them a forum for
02900	common problems  and a  sense of  community.    Because  of the  wide
03000	variety of  applications of computers in  and around Stanford Medical
03100	School and  the larger  Stanford community,  a number  of  additional
03200	faculty will  discuss  their  own research  and  their own  views  of
03300	computers in biomedical work.
03400	
03500	<<Courses>.    The courses  routinely offered by the COMPUTER SCIENCE
03600	DEPARTMENT will  be  available to  the  trainees.  Trainees  will  be
03700	expected to take about  two courses each academic quarter, the number
03800	and  subjects depending on their  own computing background.  Trainees
03900	will  take  courses in  programming,  artificial  intelligence,  data
04000	structures, computer  design and  computer systems.      Non-clinical
04100	medical  school courses, such as  biostatistics or computing seminars
04200	offered by various departments  (last year in ***) will be available.
04300	Additional  courses outside  the COMPUTER SCIENCE  DEPARTMENT and the
04400	Medical School  that would interest some trainees  would also be open
04500	to them, such as courses in statistics and operations research.
04600	
04700	<<Research>.    An  important  requirement on  the trainees  will  be
04800	individual  research under the  supervision of one  of the affiliated
04900	faculty listed below.   We strongly believe that first-hand, specific
05000	knowledge  of computing problems  in one medical area  is a necessary
05100	complement  to the  general knowledge  gained from  course work.  The
05200	nature of  an individual's research project  will naturally depend on
05300	his/her interests,  experience  and degree  goals, but  will  involve
05400	writing programs and working closely with people who design and write
05500	them.    The biomedical computing research environment at Stanford is
05600	unique.   Because of  the NIH-sponsored SUMEX/AIM computing resource,
05700	several  research projects  around the  country are  "housed" at this
05800	local  facility.  In  addition,  the  training faculty  are  actively
05900	involved in several local projects.
06000	
06100	In  summary,  our  objectives  are  to  train  people  in  biomedical
06200	computing by providing:
06300	
06400	1) training  in computer  science to  medical faculty  and  potential
06500	teachers  of medical  students, including  potential computer science
06600	faculty members whose career goals will take them into medical school
06700	environments;
06800	
06900	2) a  research environment  and supervision  for individual  research
07000	projects that will  integrate computer science techniques, especially
07100	AI techniques, with medical and biomedical problems.
07200	
07300	.sec RESOURCES
07400	
07500	.ss Computer Science Department
07600	
07702	The Computer Science Department aims to acquaint students with the
07704	technological and intellectual roles of automatic digital computers,
07706	and to educate research workers in computer science.  In spite of
07708	the diversity of the applications, the methods of attacking problems
07710	with computers show a considerable unity, and computer science is
07712	concerned with the underlying principles.  The field is still young,
07714	and the student will find many more questions than answers.
07716	
07718	The Department has competence in artificial intelligence, combinatorics
07720	and analysis of algorithms, design of computer and program systems,
07722	mathematical theory of computation, and numerical analysis.
07724	
07726	Since computer science is inherently interdisciplinary, graduate
07728	students of computer science are encouraged to include in their study
07730	program a good deal of work in other departments.  The CSD combines
07732	a well-respected faculty, a diverse program of courses and
07734	sophisticated computing facilities to offer a high-quality research
07736	and educational environment to its students.
07800	
07900	.ss On-Going Research Projects
08000	
08100	Several research projects at  Stanford provide a rich environment for
08200	individual research as  well as illustrative problems for discussion.
08300	Projects with which the Principal investigators are actively involved
08400	as  part of (or  overlapping with) the  Heuristic Programming Project
08500	are  (i) MYCIN, (ii) Heuristic  DENDRAL, (iii) X-Ray Crystallography,
08600	(iv) MOLGEN.   These are discussed in separate appendices.
08700	
08800	Numerous other projects  around the Medical School make sophisticated
08900	applications  of computers  for data acquisition  and analysis, e.g.,
09000	the drug  interaction  warning system  in  the hospital  pharmacy,  a
09100	patient  monitoring  system  in   the  intensive  care  unit  of  the
09200	Cardiology  ward of  the hospital,  and a  premature infant screening
09300	system in the Genetics Research Center and Pediatrics.
09400	
09500	Joint  efforts by the  Heuristic Programming and  MYCIN projects have
09600	resulted in a  "production-system" framework to facilitate developing
09700	more medical  reasoning  programs  like MYCIN.       Besides  MYCIN's
09800	knowledge  of  bacteremia  diagnosis  and  therapy  we  have  encoded
09900	knowledge of meningitis diagnosis and therapy.  Other research groups
10000	have  used this  framework to  encode knowledge  of venereal diseases
10100	(Univ.    of West  Virginia) and psychiatric  disorders (Univ.     of
10200	California at Irvine).   These running programs are valuable teaching
10300	aids for  trainees.  This  general framework  will help  trainees  to
10400	develop medical  reasoning programs  in their  own areas  of  special
10500	interest.
10600	
10700	There are limitations on  the framework, of course, and understanding
10800	these  would be an important  part of learning about  it.  One of its
10900	chief virtues  is giving  system designers  the ability  to  separate
11000	medical  knowledge from the  computer program that uses  it to reason
11100	about different problems.
11200	
11300	
11400	*** <Put descriptions of projects listed in separate Appendices> ***
11500	
11600	.ss SUMEX/AIM Computer Facility
11700	
11800	The  National research  resource for  applications of  AI to medicine
11900	(AIM) is  based at  Stanford, with  Prof. Lederberg  as PI.While  the
12000	facility is available on a national basis to qualified investigators,
12100	local access to the  professional and technical staff is an important
12200	asset for our trainees.   The present project will qualify for access
12300	to SUMEX-AIM as a STanford  subproject with respect to AI research by
12400	trainees.
12500	
12600	
12700	*** <more SUMEX description here> ***
12800	
12900	.sec TRAINEES
13000	
13100	There are  four types of trainees with whom  we have already had some
13200	training experience.   We would continue soliciting applications from
13300	all four groups and tailor the training program to the backgrounds of
13400	the  trainees.   The  four groups are  discussed briefly  in the next
13500	four subsections.
13600	
13700	.ss Post-MD Clinical Fellows
13800	
13900	The  MYCIN project, under  NIH funding, supports  clinical fellows in
14000	Infectious Disease and  Clinical Pharmacology.   This project has not
14100	been  funded to train  physicians in computing,  but has nevertheless
14200	given them a good  enough background to initiate their own biomedical
14300	computing research or to teach about uses of computers in medicine.
14400	
14500	Under the training program,  we would extend the effort to strengthen
14600	the computing background of  these clinical fellows by involving them
14700	primarily in  the  seminars  .  Their  day  to  day contact  with  an
14800	advanced  research project  exposes them  to the  concepts covered in
14900	many of the CSD courses, so  we would not insist that MD's spend much
15000	of their  time in  classes.    We  would expect  the MD's  not to  be
15100	particularly  interested in obtaining an  advanced degree in Computer
15200	Science, and would make their training less dependent on course work.
15300	
15400	.ss Medical Students Preparing for Academic Careers
15500	
15600	Several  medical students  have  inquired  about the  possibility  of
15700	studying at Stanford for short  periods of time while "on leave" from
15800	their  medical schools.   We  have accommodated one  student from the
15900	University of  California medical school at  Irvine for Fall Quarter,
16000	1975-76.  All of these  inquiries have been initiated by the students
16100	-- we  have  not solicited  them,  nor have  we  been able  to  offer
16200	financial support.
16300	
16400	In one  academic  quarter it  is only  possible  to provide  a  basic
16500	framework for  thinking about  biomedical computing  and supervise  a
16600	small  programming (or other) research  project.   Under the training
16700	program, we  would be able to provide  financial support for students
16800	to allow them to spend as  much time as they need to become effective
16900	teachers. In  one  year these  students would  be  able to  obtain  a
17000	Master's degree  in computer science if they  wished, as described in
17100	the administrative section below.   We would urge them to do so.
17200	
17300	.ss Interdisciplinary PhD Students
17400	
17500	Training  interdisciplinary students is  particularly appropriate for
17600	the  goals of  the NLM, especially  when the  research spans computer
17700	science and  medicine, or computer science and  one of the biological
17800	sciences.   Stanford encourages  such interdisciplinary work and thus
17900	attracts  unique individuals  even without  solicitation.    We would
18000	expect that  the availability of training  money for supporting these
18100	individuals would increase the attractiveness of Stanford.
18200	
18300	The MYCIN project began as the PhD research project of one individual
18400	in   an   interdisciplinary  program   spanning   Computer   Science,
18500	Biostatistics  and Clinical  Pharmacology. In slightly  more than two
18600	years, this person took  enough courses and performed the research to
18700	satisfy the PhD requirements of the University.
18800	
18900	.ss  PhD  Students  in  Computer  Science  Interested  in  Biomedical
19000	Computing
19100	
19200	It is  important to make potential Computer  Science faculty aware of
19300	medical computing  problems  in order  to  establish bases  in  other
19400	universities for communication with their own medical and pre-medical
19500	students.  We  have found a great interest among  students in the CSD
19600	in medically  related problems, and we support several  of them to do
19700	research on various aspects of these problems.
19800	
19900	Under  current  Heuristic  Programming  and  MYCIN  Project  research
20000	support, we are training seven PhD candidates in the Computer Science
20100	Dept.    in medical computing.      Five of these persons are working
20200	closely with  the MYCIN  project  at present,  although only  one  is
20300	supported by that project.    Their research has dual aspects: on the
20400	one hand,  it focuses on the fundamental problem  of managing a large
20500	amount  of medical knowledge in  a complex program, and  on the other
20600	hand, it aims for  a high performance medical reasoning program. That
20700	is, the  students already working with us are  building a strong base
20800	for  teaching careers that  will intersect with  medical teaching and
20900	research.
21000	
21100	.sec TRAINING EXPERIENCE
21200	
21300	As mentioned above, the  Heuristic Programming and MYCIN Projects are
21400	already collaborating  with and training several  persons in much the
21500	manner envisioned  by the  NLM.  In  this section,  we present  brief
21600	sketches  of some  of these  persons to  indicate in  more detail the
21700	extent of our involvement.
21800	
21900	Physicians:  (S.Axline, F.Rhame, V.Yu, J.Heiser)
22000	
22100	Medical Students: (D. Ludwig, C.Risk)
22200	
22300	Interdisciplinary PhD: (T.Shortliffe)
22400	
22500	Computer Science Department  PhD Candidates:  (R.  Davis, J.  Aikins,
22600	B.Clancey, B. VanMelle, L. Fagan)
22700	
22800	
22900	.sec ADMINISTRATIVE DETAILS
23000	
23100	.ss SUPERVISION
23200	
23300	Trainees will be supervised by Prof. Feigenbaum, Dr. Buchanan, and R.
23400	Davis.   This extends from  normal advising to  selection of suitable
23500	research projects,  and includes  helping with  course selection  and
23600	problems of finding one's way around Stanford.
23700	
23800	.ss RECRUITMENT AND ADMISSIONS
23900	
24000	To a  small extent  Stanford  already attracts  both medical  and  CS
24100	students  who actively  seek the opportunity  to learn  about, and do
24200	research  in, medical  computing.  The  Heuristic Programming, MYCIN,
24300	and SUMEX  projects are known to  many as the center  of such work at
24400	Stanford.       Thus  we  receive inquiries  from more  students  and
24500	post-doctoral fellowship applicants  than we can financially support.
24600	Upon  starting the  training program proposed  here we  would hope to
24700	respond favorable to the better candidates.
24800	
24900	We  will announce  the availability of  training positions throughout
25000	medical schools and  computer science departments around the country.
25100	At professional meetings and  speaking engagements we will arrange to
25200	talk  with groups of  interested people, much  as we do  now. We will
25300	interview  candidates in  person whenever possible,  and by telephone
25400	otherwise.
25500	
25600	For prospective trainees who seek  a PhD degree, either in the CSD or
25700	in an interdisciplinary program, the CSD admissions committee will do
25800	the  preliminary screening  of  candidates  together with  all  other
25900	applicants  to  the  department.  The  chairman  of  that  admissions
26000	committee and  Prof. Feigenbaum will make the  final selection of the
26100	candidates to be admitted to this program.
26200	
26300	.ss DEGREES
26400	
26500	Trainees who seek a degree will be in one of three degree programs of
26600	the University.
26700	
26800	The University's basic requirements for the doctorate (residence,
26802	dissertation and examination) will be satisfied for PhD candidates
26804	in the CSD.  In addition the CSD requires that doctoral students
26806	pass a comprehensive exam covering introductory level graduate
26808	material in major areas of computer science and a qualifying
27100	
27200	Candidates for an interdisciplinary  PhD degree are first admitted to
27300	the CSD  and  then map  out  a special  program  of course  work  and
27400	research,  supervised  by  an  interdisciplinary  faculty  committee,
27500	culminating in a "special" area PhD.
27600	
27700	The third  degree  program  we will  offer  is more  appropriate  for
27800	persons with  an MD degree who wish to  establish some credentials in
27900	computer  science without  fulfilling all  the requirements necessary
28000	for a PhD  degree.  This is a program leading  to a Masters degree in
28100	Computer Science.  The requirements for an MA degree will be tailored
28200	by the CSD to the  trainees in this program.  In paerticular, some of
28300	the  courses normally required  for MA candidates will  be waived for
28400	trainees   (computer  hardware,   numerical  analysis,  computability
28500	theory), leaving them free to substitute other courses.  They will be
28600	expected to  complete 42 course units, as are  all MA candidates, but
28700	will have more flexibility.  In addition, these persons will be given
28800	a  specail examination for the  MA degree covering the  core CS areas
28900	(programming   techniques,    languages,   sytems,   and   artificial
29000	intelligence), instead of all areas.
29100	
29200	
29300	.sec BUDGET
29400	
29500	We request support for five years to cover expenses of the
29600	training program.
29700	
29800	Personnel:  EAF 20%
29900	            BGB 20%
30000	            25% of one FTE faculty member in Computer Science 
30100	            (to be split among R.Floyd, D.Knuth, G.Danzig,
30200	             C.Green, T.Winograd -- with their consent)
30300	
30400	            Research Associate 100%
30500	            Secretary 50%
30600	            Visiting Lecturers (honoraria)
30700	
30800	Trainees:  3 post-docs
30900	           3 predoctoral students
31000	
31100	Travel: 
31200	
31300	Terminals: Purchase 3 terminals (approx $10,000)
31400	
31500	Computer Time:  SUMEX-AIM  (no charge for AI research work)
31600	                SCIP (approx $6000 per year -- $500/mo.)
31700	
31800	Office Expenses:  Phone
31900	                  Supplies
32000	
32100	Hardware Purchase: 256K memory for SUMEX  (approx $100,000)
32200	
32300	TOTAL:  Approx. $210,000 in first year
32400	                  90,000 in years 2-5
32500	
32600	
32700	
32800	.ss BUDGET NOTES
32900	
33000	Computer Time.  The STanford Center for Information Processing (SCIP)
33100	is  the facility  at  which  much  biomedical computing  is  done  at
33200	Stanford.  In  order to demonstrate these  programs and interact with
33300	these research  groups, the trainees will need to  have access to the
33400	IBM 370 computer at SCIP. Money must be budgeted for terminal access,
33500	computer time and file storage on this machine.
33600	
33700	
33800	Travel.   Travel money  is to  be used  for three  purposes:  to send
33900	trainees to conferences, to  bring visiting lecturers to Stanford for
34000	this  program,  and   to  provide  for  interviewing  and  recruiting
34100	prospective trainees.
34200	
34300	Terminals.  We  will need  to  provide terminals  for access  to  the
34400	SUMEX-AIM and  SCIP computers.  Purchase price  is almost exactly the
34500	same as  two  years' leasing  cost, so  we  have requested  money  to
34600	purchase the three terminals we will need.  (2 Datamedias, 1 TI -- ?)
34700	
34800	Personnel.  The  CSD  faculty listed  will  contribute a  small,  but
34900	significant, fraction  of their  time to  training the  students  and
35000	post-doctoral fellows  supported  by this  program. They  are  listed
35100	together  under one  quarter-time equivalent  in the  CSD to simplify
35200	budgeting and accounting.
35300	
35400	Office  Expenses.   The  most  significant  expense is  for  computer
35500	terminal paper (for the TI  terminal). We estimate using *** rolls of
35600	heat-sensitive paper  per month at *** per  roll.  Phone and supplies
35700	are estimated to be 20% of the Heuristic Programming Project totals.
35800