The Inevitable Evolution of Medical Education

Posted by Erika Greelish on October 23, 2020 | No Comments

Remember floppy disks?

I asked my 11-year-old son if he knew what a floppy disk was and was surprised that he did. His answer: “Basically, they’re a super old version of a USB.”

Despite the fact that these days floppies are more useful as drink coasters than as tools for storing information, they continue to be iconic in tech culture—literally: See the “save” icon on your Word toolbar.

The persistence of the floppy disk represents a greater truth about how we manage information with respect to technology. Even though technology has developed at an exponential rate, human beings (yes, especially older human beings) have difficulty adjusting to new ways of managing ever-increasing amounts of new information.

One area where this has become manifestly problematic is in educational delivery models across the board, and medical education is no exception. Dr. Peter Densen, an infectious disease specialist and Emeritus Professor of Internal Medicine, maintains that by 1950, medical information had doubled from all previous years. By 1980, it had doubled again, and before the decade was out, it had doubled again. By 2010, the doubling timeframe was 3.5 years, and Dr. Densen estimated that by 2020, the doubling of medical information would occur in just 73 days.

No human being, no matter how young, bright, and well-caffeinated, could ever hope to keep up learning such a vast compendium of knowledge. Yet medical education is still largely modeled on traditional curricula that is built around memorization and practice-based learning, according to findings of a 2019 research study by JMIR Medical Education. Doctors-in-training trying to learn and master all of the medical information out there is like trying to backup a modern hard drive on floppy disks.

Several attempts at redefining the outdated paradigm of medical education have occurred over the last 40 years, as reported by the Israeli Journal of Health Policy Research. However, these efforts have been “fraught with resistance” and stymied by “inertia, power and ego struggles,” contends the article’s author, Dr. Schmul Reis. Reis believes that it is not just updating the technical or technological aspects of the curriculum that is critical. There are many complex components at play, but the main argument is that competency should be evaluated based on competency and outcomes, rather than “inputs” (e.g. time in training, performance on multiple-choice examinations, etc.) Whether or not this is a paradigm shift in the right direction continues to be a hot topic of debate.

Some hospitals are attempting to reduce the number of hours clinical staff spend on mundane and repetitive tasks. One new initiative touted by the American Medical Association with the goal of decreasing physician burnout is “getting rid of stupid stuff.” Piloted in Honolulu by Dr. Melinda Ashton, the program asked medical personnel to identify documentation procedures they felt were “poorly designed, unnecessary, or just plain stupid.” Through adjustments made as a result of these surveys, thousands of hours were saved, leaving doctors and nurses more time to spend with patients and engage in meaningful experiences.

Regardless, the amount of information continues to grow and technology becomes more sophisticated by the day. Dr. Densen states, “Knowledge is expanding faster than our ability to assimilate and apply it effectively; and this is as true in education and patient care as it is in research. Clearly, simply adding more material and or time to the curriculum will not be an effective coping strategy.” Ultimately, medical educators and practitioners must ask: How can integration of useful technology help doctors work smarter instead of harder?

As the practice of medicine enters the age of AI, we already know that machine learning is effective in helping those in healthcare fields accomplish quotidian tasks more quickly as well as organizing and prioritizing workflow. What if we could use AI tools to help support doctors improve their competency and outcomes from the very beginning of their medical education?  The authors of the JMIR Medical Education research study conclude:

As the rate of medical knowledge grows, technologies such as AI are needed to enable health care professionals to effectively use this knowledge to practice medicine. Medical professionals need to be adequately trained in this new technology, its advantages to improve cost, quality, and access to health care, and its shortfalls such as transparency and liability. AI needs to be seamlessly integrated across different aspects of the curriculum.

Without a doubt, new technologies such as AI and deep learning can help medical professionals sift through the mountains of information and interpret relevant data. Training today’s up-and-coming physicians to understand both the advantages and limitations of utilizing AI to complement irreplaceable human abilities seems to be an inevitable necessity. Just as floppy disks evolved, so too must educational models.

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