Stanford Med X Live! Undergraduate Medical Education



hi welcome back everybody to medical education in the new millennium today we're going to be talking about reimagining medical education we're very lucky to have dr. prober here to speak with us on that but first our ignite speaker lynn dye is an MD Canada at the Keck School of Medicine at the University of Southern California she's a graduate of Stanford University she has been involved in numerous medical education initiatives including then launch of Stanford Ames labs innovative online course to prepare anesthesia interns for residency she continues to serve as a facilitator and researcher for multiple online courses run in the aim lab and recently presented early-stage results as american society for anesthesiology annual meeting so I'll turn it over to Lynn welcome to medical education in the new millennium a new course from the Stanford University School of Medicine this interdisciplinary course is produced by Stanford medicine X and features talks from thought leaders and innovators from medical education instructional design cognitive science online learning and emerging technology over the course of 11 weeks we'll consider how to build educational experiences that address the unique learning preferences of today's millennial medical students and residents address gaps in the current medical education system and explore what might be accomplished when all healthcare stakeholders are included in the conversation if you are joining us for the first time a quick reminder that there is a simultaneous conversation happening on Twitter right now using the hashtag MedX christopher snyder otherwise known as I am Spartacus is the in-class moderator for today's program and will be taking questions from social media so please make sure to start up your Twitter client to join in the online conversation and interact with today's speakers please also make sure to like our facebook page at WWF SEO com ford / stanford MedX please note you are watching a live online program and there is a delay between real-time events and the live stream you are watching tweets from our in class guests will appear before you see the real-time events they're tweeting about unfold on the video live stream good evening thank you dr. Joshi for the introduction we've bond incredible talks by dr. dan schwartz and dr. Brian brought a beating of the couple of past weeks about how to incorporate what we know about human cognition and learning as well as a patient voice to medical education today I'd like to share my experiences in medical school to help frame what we've learned about these innovations and to start thinking about how you can apply them to today's doctors and training who are part of the demographics called millennial learners so what is nautical school anyway some equate medical school to learning a new language they say that the vast amount of material that we have to learn is akin to drinking from a fire hose or worse a tidal wave due to the growing body of biomedical knowledge this is my small group at USC yes we're evil my eager medical students and during our first and second year of medical school known as the preclinical years that dr. Joshi was talking about we dissected a cadaver together in anatomy lab went through labs together and got to go into the county hospital to interview patients and get our feet wet and patient care and starting the first week of medical school but we're more than just eager medical students and most models of medical education have traditionally assumed that learners are blank slates and empty vessels that simply need to have knowledge poured into them but more and more medical schools are looking for diverse student bodies and well-rounded students my group is no exception to this rule surprisingly we get along pretty well despite our personality differences however I've learned that our learning styles together as a group have been mediated by what we are reading new and our prior associations and experiences before coming into medical school and thus shaping us into divergent career paths as you can see here so right now I'd like to do a short experiment I'm going to play a familiar tune on my violin and I want you to just think about what emotions and memories that evokes for you so how many people have heard that melody before everyone does anyone remember what they were doing at the time that they first heard that melody well I can tell you my experience and I was seven years old sitting in my mom's minivan and I heard the song on the radio and it was actually one of the first pieces that inspired me to learn to play the violin so it's a special piece for me so this is a great example of how our memories are cued by emotional events and in this case listening to a nostalgic piece of music probably triggered memories on all of you guys music is one of the few activities that involve the whole brain I'm not surprisingly holding benefits not only for learning language but improving memory and focusing attention as well as physical dexterity and coordination so we've already use technology to scale the experience of listening to music and now we're just beginning to see how we can harness similar sensory experiences and medicine in ways that can be used to teach people so I've learned that medical schools not one size fits all my classmates all enter this unique educational experience with their own prior knowledge experience and associations and to me personally multi-sensory learning through music has helped me as a millennial learner challenge that knowledge build upon it and retain more I'm transferring this to medicine i feel that utilizing emotions and multiple sensory modalities for our future medical innovations and will help cater to the different learning styles that is inherent to any medical school class so with that and I hope that the innovations that we are going to be talking about throughout the year and will make learning more fun continues engaging thank you so at this time I'd like to introduce dr. Charles prouver dr. probers senior associate dean for medical education and professor of pediatrics microbiology and immunology at stanford university school of medicine dr. probers been involved in multiple medical education projects throughout his career he has directed a number of undergrad and graduate student courses in the classroom and at the bedside I served as associate chair for education in the department of pediatrics and has lectured locally nationally and internationally on infectious diseases and medical education as senior associate dean he oversees undergraduate graduate and postgraduate medical education at Stanford the first we're going to go to a promo in 2015 medicine x will be launching a new program called medicine x n this special conference right before medicine x 2015 will focus on medical education and what might be accomplished when all health care stakeholders can engage in a conversation about changing the culture of medicine through educational innovation of course we'll discuss the role technology can play in medical education but we'll also look at gaps in our current educational system such as participatory medicine shared decision-making patient engagement cost transparency patient safety and reducing car and cross-cultural competence what other gaps might we address at medicine X ed let us know what you think by tweeting our hashtag medics and make sure to sign up online to learn more about medicine X ed and how you can get involved you thank you very much for the reduction Lin you clearly are literally a difficult act to follow so no violin no musical instruments and no songs but I am happy to speak with all of you for a few minutes on medical education in the new millennium or reimagining medical education and I'd really like to focus on three broad areas in my comments and one of them is trying to argue that there is a need for change so we've been doing medical education for a long time in various different forms but it's time to change a second area of focus will be a model for your consideration in terms of what a reimagine medical education might look like in the new millennium and third is to touch upon one implementation strategy for our consideration so with regards for a need to change the first big paper or treatise in medical education was published over 100 years ago by a guy named Flexner hence the name flexner report and the flexor report defined for the first time in 1910 a model for education and the model for education was based upon the novel ideas that we should have some criteria for finding our medical students as opposed to before that it was first come first serve more or less that we should establish a scientific basis for medical practice and let's call that preclinical education at least that's what we call it today and then we should follow that that should be about two years in length and then we should follow that with clinical education which is like an apprenticeship through various different specialties and that's all called the clinical phase of education and that two plus two equals four still and that four-year curriculum is more or less been the way it has existed for over a hundred years and there's nothing wrong with that model we're creating great physicians who will do many different things but there are opportunities for change and the first articulation in book form of opportunities for change as the book on the right which I'm also holding up about educating physicians this is sort of the modern Flexner report it was published by colleagues at the University California San Francisco and it basically said there's a way to reconsider how we educate students so they argued for this need to change I would further argue the need for change is based upon these three interacting circles we have a modern learn the Millennial student and the modern learner is different from the ones that Flexner first encountered or this kind of student I was first of all they're different in terms of how the access information and how facilitated they are at many of the technologies and we all enjoy today there's also a modern health care system at least we hope it's a modern health care system with important changes that are taking place in terms of the delivery of healthcare to a changing population a population with multiple chronic diseases for example and there's a modern curriculum a lot of course has been learned over the last hundred years in fact so much so the biomedical revolution so much so that nobody can cram it into their minds even if they wanted to in the four years or pick any number of years so we need to be sensitive to that to pick carefully what curriculum should be and then to teach to that modern curriculum this is an example of a word cloud on what learning can happen in the e space and in fact in the middle of this word cloud is this kind of learner and we're all used to this kind of learner this is a bit of a fabricated picture I suppose with an individual with a at this age with a computer an iPad of some sort or iPhone and a headset if you come into our medical school classroom today at Stanford or at USC or others this is not an atypical looking picture other than the students are a little bit older now the problem with education in general often is that the students may not be as stimulated to learn look at this character sleeping in the corner and this is not a new picture of education this is from 1350 now what some of our classrooms look like or maybe not so much with the sleeping learner but with the absent learner so students are choosing to acquire their information outside of the classroom by watching videos of the lectures or another method oh jeez so we probably should meet the students where they are which is not necessarily in the classroom so I had the opportunity a couple of years ago to work with a guy named chip Heath and publish a paper in the New England Journal of Medicine on arguing that maybe we should have lecture halls without lectures and the basis of the argument was it is much more engaging and sticky made to stick if in fact you teach students in the context of stories rather than a sage on the stage and the book paid to stick is authored by chippy and his brother dad and in it it talks about how you make stuff stick it's not particular brilliant particularly brilliant it was but it was a New York Times bestseller and one of the core lessons in the book is tell it in the context of a story and it will stick deliver lots and lots of different loosely associated facts and it will not stick so education medical education and much education as an educator you want it to stick with the learner so based upon that we're working to try to make the classroom look more like this picture than the previous picture of a classroom this picture showing lots of students engaging with the material and with each other rather than being lectured to so what's a possible model that can kind of pull this together in medical education well I relied upon another colleague Sal Khan who who's quite remarkable and Sal has published also a book mostly he runs the Khan Academy which is amazing in reimagine education in the K through 12 space but also sell published this book the One World schoolhouse which argues about a model of Education again that is more engaging and is more collaborative hence the One World schoolhouse and is more Democrat ID and therefore disseminate a bowl if that's a word to different parts of the world and in the paper that Sal and I published in a journal called academic medicine we suggested this is a way to reimagine medical education and this is the picture of that reimagine ation and I'm going to walk through three parts of the picture this part this part and then the bottom part and this part is the core curriculum and medical education and in my opinion we should be sensitive in creating that core curriculum so that it is minimized not for the sake of being minimalist but do we pick the most important foundational information that is ever great meaning we know it to be true it's been around for long enough that we've tested it we know it to be true we want to test modern scientific discovery methods but in terms of the core information we should teach that which is venable foundational evergreen and you can do it through videos or you can do it through books or you can try to get people to come to the classroom the second piece is the interactive part bring the students together in a richly interactive environment which could be as somebody talked about earlier in our meeting today the anatomy laboratory which is deeply memorable for medical students when they're working with their kedavra that is interactive learning or in the simulation suite as is depicted in one of those pictures or in simply and I don't really mean simply interacting with each other as learners from broad disciplines and the third piece is what I refer to as deeper dives and the deeper dives are after the student has got the minimal information which is made to stick then allow the student to explore their own specific passions and explore them deeply whether their biochemistry community health political science biomedical engineering each student has got their own passion and let them develop those passions individually based upon what they care about and what their school is best at as opposed to try to teach every student everything about whatever you can think of so that's a model for consideration so what's a possible implementation strategy is that you could deliver it in MOOCs and you guys know what MOOCs are because you're what see you're watching one and deliver content to a large number of students and certainly that is an effective way of delivering to large numbers of learners a but be careful it's not simply the delivery of the information on a memory stick from one persons computer to the other person's brain if you want to make it stick you got to make it interactive so we've spent time at stanford developing smiley very smiley face which is an akurum an acronym for the Stanford medicine interactive learning initiative and we call it that purposely a because it's an acronym but also because it underscores that it is the interaction which will make the material stick and we have developed in this process strategies for faculty to more fully engage their students in the classroom after the students have acquired the basic knowledge on short videos that we create from any of the courses an extension of this is one specific example which I'll end with is a collaborative and interactive project which we're leading with a variety of schools listed here with funding from the Robert Wood Johnson Foundation and it tries to bring this model that I've described to life one that it's collaborative and we agree upon what the core material is and two is that when we create the material we pay attention to the content and delivering the content and to the interaction and we started this program and here's an arrow of our production by first of all having the schools to try to come to agreement on what the core content is any particular in specific area it happens to be in microbiology and immunology because I do infectious diseases and it's a comfortable space for me to lead we then design the curriculum in individual content modules and the content modules are created by videos that first a short video that tells a human story articulated in cartooning but the real stories scripted by faculty of taking care of those kind of patients to try to underscore this is what it's about it's about the patient the patient's at the center the story is followed by a series of short voiceover PowerPoint presentations of the core key foundational evergreen facts and after the students of a choir that they come to the classroom for facilitated interactive sessions so this is a project under development we're at this phase now we've been developing this content for the last six months and we will be implementing the content at those different schools starting in January of 2015 and then of course we'll be evaluating it because we may think it's a great idea but we need to prove it's a great idea or actually prove it's not a great idea before we blossom into other parts of the preclinical curriculum this is a picture from the course that we created to try to allow the students to have a framework for what we're teaching and the curriculum is based upon understanding the various aspects of microbiology shown on the right hand side of the slide in the context of the host the immunologic system that tries to control the microbes show it on this slide side of the slide and when these two pieces come together the patient who's always at the middle of what we care for develops a clinical illness that the students and ultimately physicians need to recognize to diagnose it to treat it to understand how it spreads and ultimately to prevent it and so with that framework we run the framework through the entire curriculum using that interactive model that I've described and we hope that this reimagining of medical education will be more stimulated because stimulating because it's centered in patients stories and therefore will become more memorable that it is made to stick thank you very much for your attention you don't know how long is before thank you dr. program and we're going to do a Q&A session now and so anyone have first questions for dr. program good yeah oh yeah oh that one yeah Thanks so one of the one of the topics we've talked about here and one of the aspects of MOOCs is that they're open and you mentioned Sal Khan and I'm wondering outside of K through 12 when we're talking about medical school sort of education what's the opinion or direction you think these organizations Stanford and other institutions you said we'll take in sort of letting anyone participate in these sorts of experiences well thank you for that question it's a very important one so I believe that education should be available to everybody whether it's k through 12 education or professional education in this case medical education and the way that we are packaging the content that I described is easily exportable to other schools who may be interested in it and in fact you already been approached by their schools within the United States and my overall dream is to then export it to places that don't have the faculty resources and facilities to be able to host this kind or develop and host this kind of education so into the developing world obviously there will need to be modification of the content adding some material which to make it relevant to whatever part of the world it's in make it accessible by language and so and taking away some material which really won't be overly relevant at other parts of the world but as Sal Khan has demonstrated in the Khan Academy he is now in every country in the world with his content translated in those countries actually by volunteer translators mostly and it is being enjoyed and used very very broadly I have the same view in terms of medical education in terms of democratizing it and if it's useful for schools so be it what makes what will make individual schools individual schools will make the schools unique and is what makes them unique today is the interaction which takes place in those schools with those faculty and those peer students who work together so schools will remain unique the only common part for the schools use this content is OB using the same content thank you so we've been getting a lot of questions on Twitter but first I wanted to ask a question of my own so the medical field is situated in this contract where medical students have to pass test after test and many students end up studying solely for the exams how do you mediate this and utilize third-party and applications like question banks into your new curriculum that you're proposing so that's a question that especially a medical student would ask who's gone through the licensing are some of the to licensing examinations USMLE which stands for United States medical license examination step one and step two are taken during medical school step 3 typically during internship and these are the bane of medical educators existence and they also are the bane of medical students who really as you're implying or stating are what students focus on and so the challenge must be and as you and your question exemplifies that to make this content not only sticky but for the students to understand oh this is relevant to the test as well I begun conversations with the National Board of Medical Examiner's who oversee the USMLE exam to talk about taking the content that we create in this course and ultimately the others if they regard it as valuable as well which I think they will and redesigning the exam or at least recasting the exam in the context of the content that we've identified as being core so that there won't be a disconnect between what some schools are teaching and the student thinking but that's not relevant to the examination there'll be an overlap and that's a longer term project in the shorter term many schools have come to the conclusion and it's a bit of a sad conclusion that's not really sad but it's a bit of a sad conclusion that we're going to do our best at stimulating and educating our students and then we're going to give them six weeks or eight weeks for them to study for the dreaded boards where they cram all information into their brain is maybe you did so they can do well on the board and so this of two parts that we really want to teach the students and out what they feel they have to learn that's not ideal in any way so our attempt is to try to pull those together so I'd like to shout out to twitter at courage sings asking for clarification on the patient stories part are the patients telling their stories or are they told by faculty so thank you for that question so the way that we have constructed it the very best patient story is one that comes from the patient mouth patients mouth sitting in the room and we we do that when we can but the Impractical part of that is you especially for infectious diseases which tend to be acute problems they happen and they go away or they or the patient it doesn't survive obviously can't arrange to bring those patients into the classroom so the story has to be told in a way which feels authentic and is authentic and is gripping so what we've settled on and we're evaluating this is we have a very skilled she's a physician and an illustrator who tells the story in this framework using this framework all of the time and it's a story that has illustrations which are cleverly written cleverly drawn that brings the different pieces together and they're true stories so the stories are developed with the expertise of a faculty member who's dealt with patients who have that disease so these are true stories obviously anonymized that are then told in a storybook fashion they're told over about a seven minute period and they try to nail as much as possible some of the core microbiology and immunology concepts that are relevant to the patient you can imagine such a story especially today about Ebola virus though we're not going to bring a patient infected with Ebola virus into the classroom obviously hopefully but we couldn't tell the story and make the points and it's not as powerful as the patient being there but it feels very authentic because it's a real story hi um I think oftentimes it's an commonly held notion that at elite institutions for pre medical education that professors are oftentimes just absolutely brilliant researchers but not really teachers and there's been a lot of frustration among students for that reason and I'm just wondering if there's been any thought about restructuring pre medical education and helping things stick for pre-medical students so you mean for for undergraduate students hoping to go to medicine not under gotcha for pre-medical students so it is true that being a brilliant scientist doesn't make you a brilliant educator but it's equally true that a brilliant scientist can be a brilliant educator so they're not completely disconnected and they're very very skilled teachers who are billion scientists are not so brilliant scientist I think it is very important to capture the best delivery system that works whether it's for a pre-med student or a medical student or a practicing physician I think that helping the brilliant scientists or the not so brilliant scientists look at strategies for making their content more accessible is critically important and that may be from technologic things including the technology of instead of talking for an hour talk for ten minutes six times or whatever because of attention span but it also i think is important either to partner that brilliant scientist or whomever with the knowledge that telling a story about why that basic science principle is so important telling a story about that so for example a thing that pre-medical students often study because have to and i'm sure many of the love it is chemistry organic chemistry biochemistry and we have bio chemistry course of the medical school and some students love it because their biochemistry oriented and some are not so crazy about it so our biochemistry course we completely did what I've described our bio chemistry faculty created short videos to get over to get through the biochemical concepts which are foundational they then bring the students together and we have about a hundred medical student 90 they bring them together in a large classroom divided in tables of seven and they give them a problem which requires biochemical principles to think about but it's about a patient with typically a metabolic disease and as the students talk about the patient in the context of their biochemistry knowledge it makes it much more engaging and memorable so it's really it is about patients again to make it memorable whether that specific model will work for undergraduate students as well as medical students we could debate but I think that's what needs to be done thank you I have a personal experience I study medicine in China and I feel like in the in work a good doctor and the bad doctor difference is how can they collect the story understand talk the story to the student is easy for them to understand but in real life work the people who good at click the whole story is good stock a doctor's it some doctor is not a tasker the patient history how do they feel they cannot collect the whole picture so still they cannot make very good decisions to piss on that so you're absolutely correct that some of the other skills that we want our medical student to acquire beyond the facts and how the facts relate to the patient illness is how to find out what the patient is feeling how they're suffering and to empathize with the patient so separate from what I've talked about and to your point we spend a lot of time in teaching and working with students in their communication skills in general and also specifically how to get a medical history we typically start as is true in many schools of doing that with what we call standardized patients who are actresses and actors who feign illnesses or fame the script of an illness job is to work with that standardized patient and optimize their ability to get the story correctly up and in a sensitive way we film those interactions the students watch their films with a with a faculty member and tell them how they can improve in those different areas and then the students of course eventually get into the hospital and see real patience and practice those skills but you're absolutely correct a very critical part of becoming a physician as we talk about reimagining medical education and stickiness of material and think about how much material every day just grows and grows that the average student is expected to know and the average doctor expected to hold everything can't become sticky and if everything is memorable then Emily something will become less marble so what's the role of cognitive aids in the future of medical education is it something to encourage and the second part of the question would be how much information should a doctor be required to know and at what point is there too much information so that's a very good question and there are several parts of the question and so again the concept of tried to identify and it will take faculty of medical schools doctors to identify what the core knowledge is is is critical so knowing what really you need to know that just becomes part of you that foundational material I would argue that foundational material hasn't changed dramatically it's changed obviously but over the last 20 or 30 years the guiding principles remain very similar their new innovations and new antibiotics developed a new lots of stuff but in terms of the foundational material it can be identified and that is what I want to stick in terms of the details and the new treatment so I do infectious diseases for a living I publish a major textbook on pediatric infectious diseases which has got chapters on antibiotics and I do not remember or care to remember the doses of the antibiotics that we put in our chapter I'm sure what we put in there but I don't try to remember them I mean I have as everybody else has a device of course they carry the information and there are very good and reliable apps use that to get the right ones for accessing the most relevant information and frankly if I were a patient I'd rather see my doctor look up the dose of a drug that they're going to give me except if it's in the operating room where you wanted to go a more quick I'd like them to look it up and confirm it rather than to think they know it so I think much of the bio medical knowledge that is out there is something which has been nicely summarized in different sorts of electronic format and can be and should be readily accessible we have to teach the students the smart ways to hunt for the material the smart and reliable ways because there's obviously a lot of stuff you can find that is not valid whatsoever so we have to teach the search methodologies and we have to teach the methodologies for determining with what you find is actually accurate so how you critically analyze the scientific literature and so forth so I think it's extremely important that much of the information be carried in in a digital brain and then is operated by a brain that understands the whole concept of illness and has a foundational framework in this case for infectious diseases the foundation is understanding microbiology and immunology so it seems like a lot of your approach is most applicable to preclinical education how would you take these ideas and apply to clinical education thank you that's that's a wonderful question as well so I think there are equal opportunities in so we have been talking about undergraduate medical education and specifically the first two years but also in the second two years of medical school where the students are in their clinics there is foundational knowledge in each of the clinical disciplines that the student will pass through rotate through there's in Pediatrics which is my specialty in internal medicine in anesthesiology and so forth and of course dr. chu and his colleagues have created a lot of very valuable information online for anesthesiology for the residents and it can be used for the medical students and it is foundational knowledge in anesthesia there are certain foundational concepts in pediatrics that I want all the students to know and it can be delivered in short snippets that they can watch at their leisure as many times it takes to get it and then their flipped classroom is when they go into the Children's Hospital and they see the patients who have the illnesses that they've either read about or had the material delivered so if there's an equal opportunity in the clinical part of training as there is in the preclinical for the core knowledge but the flip part of the classroom in the clinical part is our hospitals in our clinics in the preclinical part it's our simulation labs and our lecture halls low lectures the same is true by the way if you extend that up into residency and again anesthesia with dr. Chu's leadership has demonstrated this in educating anesthesia residents so they're in the same place when they are you know starting the core part of their anesthesia training there's opportunities for that in other disciplines as well and the same is true in continuing medical education which is for practicing physicians who are out there without a lot of time that they have for doing their different things but when they have time they can get a dose of this online and then their flipped classroom is there practice so I think it's the model is equally apply Herbal across the spectrum of medical education into an earlier question back into pre medical education um you mentioned earlier that there's a slight disconnect between this new model of learning and also the outdated sort of examination methods and how then do you plan to evaluate this in like a couple years so forth thank you so I I'm not examinations are very important so I didn't want I don't want to imply that the examinations are outdated or you know bad in fact there's a lot of learning theory and and experience that says if you quiz persons along the way of acquiring their knowledge the quizzing process helps to embed the knowledge so I think those kind of quizzes just for test of did you get it learning are very important and then having examinations that are well developed that bring together the principal synthesize and see if they can be applied in a real scenario that's reliable as well so with the disconnect which has occurred though is the students are mostly fear of the things that they fear they mostly fear getting a high score on the examination and as Lynn said there are third-party providers of material to study to get those high scores and so the disconnect is the medical schools are trying to do their best to educate their students and what the core knowledge is and the students are using a third-party provider to study to acquire that core knowledge the two have to be harmonized and we have to make sure that the core knowledge we're teaching is what's on the test and the students feel they're getting it both at the same time this is kind of a loaded question with an obvious answer but it's popular so if the goal is to prove that medical students have facility with knowledge and can apply it to clinical context and yet the fear is what's my step one score when it's a pass/fail exam why not have all the medical schools simply petition us Emily not to report scores so there's a there's a desire to do that so the gen for those who don't live in this space which is which is a lot of people in this room and the examination that we've been talking about the USMLE is as a number associated with it it was really meant to be a pass/fail examination was developed as a pass/fail examination the number was considered was set because of different state licensure requirements but the number is take it on a life of its own right you give something a number then everybody looks at the number and higher the number the better in this case in Gulf it's the other way around so the number has taken on this life of its own so everybody's saying well that's what's messing stuff up so get rid of the number and and many medical school deans that I share conversations with are of the opinion that that's a great idea and actually the national board is is fine with that idea as well they don't really care in fact you know they're they they agree with that more or less but the pushback are for the principal users of the number at this point which are the residency programs recruiting the students so they are not so interested in losing the number because the number not only is it convenient and scaled it is easy to look at which is a convenient part and if you're seeing a thousand applications in a highly competitive discipline you could use as one of your first screen the number but it makes no sense to use the number but people do it because it's convenient it makes no sense because the number is representing the knowledge acquired in the first two years of medical school and the student has even seen a patient yet and it's being used by residency programs that are bringing the students in to do clinical stuff so it doesn't make a lot of sense and most people at the program director level meaning the residency programs level I acknowledge that but and of course whatever there's a button sentence that means that not really being acknowledged and the number is used so it's it's a and so there's activity in that space again my conversation with a national board and Dean stalking and so we'll see what happens over time so I really appreciate you being here tonight and I think what you've been discussing as far as the use of video the use of smaller chunks of instruction is really great and likely to become pretty ubiquitous I'm curious what you think what what's the next wave what's the the tide that's still a little further out that most people haven't seen yet as far as using technology to push better education in med school that's a great question i think that so part part of it is more of the same which is not a new tide obviously so if this works in a course then it should work in the other courses and so forth so that's not but i think that where technology could help us and is already helping us in some segments and pres many segments is in assessment of what the student has learned so one example of course is simulation which is which is not new and has used a lot by our school in many other schools that probably can be used a lot more in assessing the students competencies because at the end of whatever you do what you care about is how competent the person is not how many years you held them in a medical school or wherever else you're holding them so having technology help us advance the assessment of the learner is really the competency of the learner is really I think a very important next wave ought worry sort of partly on that wave but if we if we can advance our ability to measure competencies we can then also get rid of the notion that medical school or other professional schools have to be again of a fixed duration because they don't have to be it's as quickly as you want to acquire the knowledge or can acquire the knowledge you should be able to move on there's practical issues here but then you should be able to move on so you I could imagine having a duration of matriculation for a professional school whether it's law school or medical school or business school that ranges widely between individual learners because of the frequency the speed at which they're acquiring the information or they've got other stuff to do maybe they're working you know to pay their tuition or whatever so I think that one has the ability to then change the duration but you can do that only with more of the same more innovations as what you're asking about but in in the area of I think assessment is a big area so I imagine a lot of medical school faculty are very used to the old system of lecture where they experienced that in med school and they've done that for a long time how are you training these faculty to be able to do something different like facilitate these interactive activities right so I have no data to support the percentage that mode to give so so so be it but first of all just getting faculty engaged interested in a new model of learning and whether its medical school faculty or other professional faculty I've put them in three buckets by percentages and so this is the no basis part there's about seems to be maybe twenty percent of faculty so it's a t20 but this is actually 26 t20 there's twenty percent of faculty or so who are interested engaging and following a new wave or you know doing something which makes sense and going for it and there are the early adaptors and the early players and whatever you want to say there are about twenty percent of faculty who will go to their grave and you know squeaking and howling that you know everything's being messed up by anything that relates you smells like this initiative and then there's sixty percent we're probably just watching to determine is this going to work and am I going to get involved after they begin to get involved you're absolutely correct there there needs to be some training and the training on creating online videos there's some people actually just very good at its back to the question about you know some wonderful scientists may not be able to deliver the message clearly so may some may not same in the online space there are some people and we've had a growing experience with this who are just really good when they're in front of a blank screen by themselves talking and others freeze up but they don't freeze up with an in front of a large audience so training just in the creation of the videos that's a small piece training for the interactive sessions is going to require I think a lot effort and we're just beginning down that pathway because we don't even know at this point what the most powerful interactive sessions are going to look like so in this course that we're developing there's a bunch of different varieties we're creating to try to evaluate which one seemed to work for the teacher and the learner I'm optimistic I just generally optimistic but I'm optimistic about the faculty ability in this space because in medicine at least most of the clinicians who are out seeing patients they are used to teaching in an interactive way their patients hopefully they're interacting with them and also the students are at the bedside with them so i think they inherently have developed these skills or develop these skills over that experience but you're correct in pointing out faculty development in any space the old one or the new one is very important to assure excellence in teaching so I have a personal stake in this question but how can you see multimodality in multiple disciplines helping medical education such as music the arts the humanities similar to the exercise that we did this earlier in the class today right and so a wonderful question and I think multiple the more modalities you can put into the learners mind in terms of you people talk about there's the visual learner and the auditory learner and whether there really are those differences i'm not sure but i think that different types of experiences such as music such as art do stimulate different learners in different ways and i think together they are synergistic with each other so i think that the piece that you played for example and bringing you know back memories you could I could imagine putting that piece and I was thinking of it's a frenetic kind of peace and I can imagine you know you feel like you really need to move quickly because you're you're listening to that Thun Thun is not the right word to that music and and I can imagine playing that piece and asking people about so if this makes you feel anxious what are you anxious when you know getting into some sort of psychotherapy in terms how people are thinking there's a lot of activity in some schools and sub segments of our school of taking art there was a reference in the conversation about the Rodin Museum and going and looking at rodan sculptor looking at the problems that some of them may have had with their hands and how you could fix that how an orthopedic surgeon could fix that that really is linking in the power of that art with the power of the orthopedic surgeon there other people who take their medical students into museums of paintings and talk about what are you seeing in this painting and helping to build diagnostic skills because you see that the subtleties in the eyes the subtle tea in the color of the skin there is literature & medicine one of my friends and colleagues who teaches here at Stanford as Abraham Verghese and his writing about it they typically have they have a medical flavor for example cutting for stone is a very powerful entry into that rich literature it's fiction but into the rich literature that really allows you to start thinking of the story so so I think there's a wonderful opportunity to connect the humanities and the sciences together yes even in medical school or perhaps especially in medical school thank you do you feel the technique applies equally to primary preventive care versus research and tertiary care and I'm trying to gauge whether you know what role do you see is a physician in preventing disease rather than treating disease yes certainly a large part of medical education needs to focus on the prevention and this happens to be again in the area that I care a lot about because I do infectious diseases so bugs and stuff and you know a lot of the action that we take around bugs is to try to figure out how to how to prevent them and a lot of our teaching is in that area because that's really where the that's really where the the pound for the dollar can be obtained whether it's your vaccination or through other strategies of preventing acquisition of infectious diseases you know prop wearing proper protective equipment you're taking key care of patients with Ebola and is in our pediatric practice and again this is my own focus but in a pediatric practice teaching pediatricians when their pediatric residents about prevention is critical guidance about accident prevention you know starting with action car seats you can't get out of the hospital as you probably know unless you put your baby in a car seat and strap them incorrectly and demonstrate that and then you're allowed to drive away that's prevention so teaching about prevention in medical schools is very important it's already done a lot and it needs to continue to be a large part of the focus and the methodology the pedagogical methodology of teaching about prevention I think is more or less the same the subjects a bit different so we have time for one more question like observe all those kind of treatment or diagnosis process yeah so the question is is it difficult to find the patience for our students to work with and the answer is generally no it's not difficult there's there's a patient's that I referred to earlier in the conversation the standardized patients who we pay the actresses and actors and they're not difficult to find and then there are the real patients at our hospitals and clinics and my experience with those patients is they welcome the opportunity to have somebody benefit potentially benefit from their illness to learn from their illness I think it it it it provides one positive thing for what they're experiencing illness is obviously negative and again I the patients are generally very receptive to and interested in talking to and therefore teaching our students so that it's really not a problem I'm just an occasional patient who only wants to be seen by your doctor and you'll pick the doctor's name and really are very adamant about that but that's unusual it occurs but that's unusual so we'd like to shout out to some of our online members see Anna McKinnon and Marie Cunningham dr. Ryan matt and nick and Christoph trap thank you for joining us online and thank you dr. prober for sharing your rich experiences in medical education I'm sure we've all gained a lot from this experience regardless of where we're coming from if you like what you see in this class be sure to check out our online course engage and empower me a new online class from the Stanford University School of Medicine we are featuring presentations from patients and experts on participatory medicine through this course we hope to empower you to take part in creating a more inclusive and collaborative healthcare system the course can be found at class stanford.edu as a reminder this program is made possible by support from the Stanford University School of Medicine Department with anesthesia Stanford aim lab Stanford Hospital and Clinics and the agency for Healthcare Research quality if you haven't yet done so please take a moment to like our facebook page at WWF ace book com forg / Sanford med X so you can continue the conversation online and stay informed of program updates from all of us here at Stanford medicine X we want to thank you for joining us today and remind you to join us again next Thursday October 23rd at 6pm pacific standard time for another edition of Stanford medicine act live featuring a new class on medical education from the stanford university school of medicine called medical education in the new next week we are featureing Northwestern University associate professor of anesthesia dr. Christine Park for all of you out there taking time to tune in with us tonight thank you for joining us in being part of the conversation a special thanks to our guest panelists this evening from all of us at Stanford medicine X we'll see you next time you

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