#MDigitalLife is a WCG program designed to learn from and to showcase physicians who are blazing new trails in the digital world – changing the way that medicine is practiced and better health is realized. You can find previous posts here.
“If we teach student doctors with books and lectures, they’re more likely to treat their patients by reading and talking at them. If we instead train medical students using more interactive methods, they’re more likely to engage their patients in a way that’s more meaningful over the long term – by using multimedia, online tools and mobile applications.”
Aaron Stupple, 4th Year Medical student at SUNY Upstate Medical School
Aaron Stupple – a former high school science teacher – is on a committee that’s tasked with updating his medical school’s curriculum. As strange as that sounded to me, according to Aaron it’s not uncommon to involve students in that ongoing process. But what may be more unusual is how Aaron would like to upgrade that curriculum.
The first part of Aaron’s vision for recreating – err, I mean updating – the classes doctors take is to broaden the traditional focus. “It’s well known that practice management is rarely taught in medical school.” Beyond that, “We often talk about when a patient needs follow-up, for example, but we never learn methods to actually get that patient to come back.” “‘How to manage your [practice’s] office’ is not part of today’s curriculum,” says Aaron. But those are important realities in the life of a doctor today. Additionally, students rarely learn the details of reimbursement, even though they are central to developments in policy and innovations like prescribing medical apps. Citing an article on KevinMD about prescription apps, Aaron noted the system of reimbursements was mentioned last – almost as a footnote. But accommodating traditional payment schemes is actually a huge obstacle to the broader adoption of new technologies and processes. “When today’s medical education actually does focus on the healthcare system, it is entirely based on the current economic ecosystem.” Nobody is talking about what happens when and if Accountable Care Organizations (https://www.cms.gov/ACO/) become the norm, or weighing the pros and cons of alternative payment schemes like Direct Primary Care (http://www.dpcare.org).
But it isn’t just the content that Aaron thinks needs to be updated … it’s also important to re-think the ways that doctors learn. Aaron shared with me a construct that, for him, begins to describe some of the things that med schools could do to deeply enhance future physicians’ learning experience – and the kind of counsel that they’ll be able to give to their patients in the future. This architecture for change has three major components:
SHARING – Networking students with each other and the wider community. Today, med students are lone wolves. There’s little opportunity to work meaningfully together. Med Schools would do well to create platforms for students to learn in community … what we in the corporate world might think of as an advanced, social-enabled intranet. In fact, what Chris Porter (a teaching surgeon) is doing at OnSurg.com might serve as an effective model for this component of Aaron’s vision. Practically speaking, this isn’t about students creating content – it’s more about interacting with each other around existing content, and then augmenting it with explorations of their passion. In this way, topics like policy and social justice, global health and special populations, and cutting edge developments can become a central feature for interested students.
TEACHING – Teaching needs to involve more than a textbook, a lecture hall and a pedagogue. Today’s medical school, according to Aaron, is half vocational and half didactics – yet there’s very little connection between the clinic and the lecture hall. Being able to bring them together – adding a more visceral experience to the lecture, and more detailed content onto the hospital floors- is Aaron’s “Holy Grail.” “I can imagine a really simple way to do this … it’d involve hooking up the teacher and learner with the tools they already have in their pockets. We could connect clinicians who come in and lecture on a simple microblogging platform like Yammer or Twitter – and all of a sudden, we’d have bridged those two disconnected worlds.
Medical school is one of the most stratified, siloed and hierarchical environments you can imagine – and it means that we miss enormous opportunities to mentor future doctors in hugely impactful ways.” When everybody’s connected, this can change. In addition to benefiting the med students, Aaron believes that there are clear benefits for the med school as well. Once their students leave, they are gone – and they belong to someone else. They lose most of the value of the relationships built with medical school faculty and classmates. Newsletters and email are the order of the day, but are so clunky. Social media tools, on the other hand, are easy and omnipresent. If med schools were more active in promoting simple digital communication, it would promote a longer-term association between the school and its students, more support from alumni, as well as promoting lifelong learning.
CLINICAL CARE – The way that doctors actually deliver the best care to their patients is changing. There are all kinds of tools that help to deliver not only the best diagnosis, but a clearer way of communicating a treatment path to different patients. Aaron believes that the first tools to be introduced need to be mobile- or tablet-based apps – specifically point-of-care apps. “When you’re trying to figure a person’s risk of a blood clot, they can use an app to do that. The right app can help you to articulate not only the risk of high cholesterol in a 35 year old vs. a 65 year old, but also can help to learn new ways to make that distinction. Using apps and other interactive media as a teaching tool changes the format in the classroom and exponentially sparks different kinds of learning.
“I’m convinced that digital health tools will play a major role in delivering healthcare in the future … and med schools can have a ‘ground zero’ role in introducing those tools into the system.”
Imagine how hard it must be for a practicing clinician to “play around” with new tools. In Aaron’s reckoning, it’s not that doctors don’t want to change the way they do things – it’s that they just don’t have the leeway to experiment in their daily practice. Yet we know that a key in modern innovation is the ability to hypothesize, prototype, test, and tweak – particularly in community with others. This has the potential to make med schools a “dream lab” for health technology companies and other innovators. Now imagine being able to put a potentially revolutionary new device prototype into the hands of a few super-smart people to play around with and see how things might work, all under the guidance and positive criticism of teaching faculty.
“You don’t need mega-scientists at Johns Hopkins to play around with apps, devices, and blogs. ANY medical student could potentially be an important part of the development process for new products, tools, and processes.” And while most of us grew up believing that necessity was the mother of invention, Aaron believes (and I agree) that many of the most groundbreaking innovations – especially in healthcare – weren’t made because people were asking for them. Aaron quotes Jared Diamond regularly – “invention is the mother of necessity.”
When I asked Aaron about the ethics of companies letting medical schools play around with their inventions, his response was a good one. “Don’t get me wrong. There are many issues that need to be carefully thought through. One of them is the ownership of intellectual property when med students are performing, essentially, a co-creation role with a company [and potentially their own medical school]. Another is the associated group of ethical questions. But when you think about it, could medical schools be a more ideal test bed? They’re by their nature academic centers that are highly visible and dependent on a reputation of credibility and integrity. I don’t think it will be that hard to accommodate the ethical considerations.” Additionally, Aaron pointed out that the most likely candidates for this kind of testing aren’t going to be physiological agents like medicines, but tools to enhance diagnosis and patient behavior change. And the risks are inherently lower there all the way around.
“No idea is 100% wrong … forget the binary decisions. To move a discussion forward, let’s focus on what can we all reasonably agree on.”
These are big changes that Aaron’s talking about – so big that he knows he can’t begin to tackle them all by himself. And that’s what makes the community of physicians, medical students, and others in the health ecosystem so valuable. When Aaron started med school, he didn’t have any digital presence beyond a personal facebook page. But he had an instructor, Robert West (a PhD in biochemistry and another passionate advocate for the advancement of medical education), who launched an ambitious elective course called Personalized Medicine 101. Dr. West introduced twitter as a connectivity tool in the context of promoting deeper learning. He encouraged Aaron to get “out there” on twitter, so he gave it a shot. Soon, Kent Bottles encouraged him to start a blog to help him express his thinking in logical ways, and MDigitalLife alumnus Bryan Vartabedian who convinced him that his writing was not only worth reading – but was worth investing his precious time in. Though Aaron admits that “I couldn’t believe that I had anything valuable to say in the beginning,” he was shocked and pleased at the response he got through both channels. They’ve helped him to connect with hundreds of people with whom to share and learn.
“When you write about what you’re experiencing in med school, it actually forces more rigorous thinking and learning.”
Aaron’s writing has proven to be interesting enough that he’s attracted a broad audience of healthcare folks – though he feels that he’s writing to medical students and “idealistic clinicians” – the people that are interested in trying new ways to be more effective doctors. And one of the reasons he’s so focused on that audience is that he sees lots of people “encouraging med students to get involved in social media, but there isn’t really anyone that is helping them to figure out what is appropriate and what isn’t in terms of interacting with patients online.” For doctors in the facebook generation, this kind of interaction can take some getting used to. Probably a lot like getting used to the fact that your decisions have the potential for life and death.
As a result, Aaron drafted a social media policy for Upstate. While it hasn’t been implemented yet, just being able to engage the university in that kind of discussion has been pretty gratifying for him. Because even though he’s developed a nice online following, he describes his fellow students’ reactions to his work as “bemused.” “They mostly think it’s dumb,” he says,”I recently gave a presentation on using social media to a group of med students, and they were absolutely NOT into it.”
That’s a problem for lots of doctors today – which doesn’t surprise me. That it’s a fact for med students as well DOES surprise me. Aaron takes consolation in the fact that he’s got great role models like Dr. V, Dr. Bottles, and others, but he has also managed to connect to other med students who are operating in the same vacuum. Aaron specifically mentioned two folks whom I’m following online – Michael Moore and Danielle Jones. All three are doing brilliant work, and I’m looking forward to seeing them lead a whole new group of doctors into the future.
Be sure to connect with Aaron:
On Twitter: http://twitter.com/astupple
On his blog, Adjacent Possible Medicine: http://adjacentpossiblemed.blogspot.com/
and on LinkedIn: http://www.linkedin.com/pub/aaron-stupple/18/558/6bb