If you were going to launch a new medical school to teach students how to leverage technology in healthcare, how would you do it? The trend seems to be to combine medicine with engineering (see table below). The University of Melbourne even has a track. If I were starting a new medical school focused on technology, here are a few questions I would ask to guide curriculum development:
How transformational do you want to be?
John Prince, previous head of the medical school, told me in 2019 that our medical school curriculum hadn’t changed since the 1800’s. Larry Weed, father of the SOAP note and problem-oriented medical record, said since the 1970’s that we are doing it all wrong in healthcare, and it starts with education. Knowing there are necessary constraints due to accreditation, where would you want your new medical school to fall on the spectrum between tradition and complete transformation? Here are a few transformational principles I would want to integrate into the new curriculum:
Humility about what it means to be a physician - the understanding that the unaided mind cannot manage the amount of information needed in healthcare today, and that is why we need tools. Francis Bacon said
The unassisted hand, and the understanding left to itself, possess but little power. Effects are produced by the means of instruments and helps, which the understanding requires no less than the hand. And as instruments either promote or regulate the motion of the hand, so those that are applied to the mind prompt or protect the understanding.
When Richard Sackler (the evil mastermind behind OxyContin) graduated from medical school, an uncle wrote to him
...today you have become more than a man.” To be a physician, is to be “the chosen of the Gods.” He was joining an elite priesthood, and doing so with every conceivable advantage. (from Empire of Pain)
Larry Weed whose last book is titled Medicine in Denial said
Medical education seeks to instill medical knowledge and 'clinical judgment.' In doing so, medical schools give students a misplaced faith in the completeness and accuracy of their own personal store of medical knowledge and the efficacy of their intellects. What is done to students in medical school is the antithesis of a truly scientific education.
Train as we play - Liz Molloy says we need to “train as we play.” Healthcare will only become more interdisciplinary yet most training is done in silos of specialties rather than learning how to work in teams.
How can we better leverage technology in healthcare delivery?
Engineering is the focus of these new medical programs, but “healthcare is mainly an information business. The quality, efficiency and outcomes of care depend on effectively capturing and managing patient information.” If that is true, then critical skills for the new era go beyond technology to include reasoning in uncertainty and partnering with algorithms. A recent NEJM article Preparing Physicians for the Clinical Algorithm Era says new regulations are a
first step toward ensuring that such algorithms meaningfully improve patient care. The next and larger step, however, requires focusing on human users: teaching physicians how to use CDS effectively. Using CDS requires understanding probabilistic reasoning and practice incorporating algorithmic output into clinical decision making.
My curriculum would also ask why healthcare lags behind other fields in implementing all the great technology that already exists. We would examine the gap between technology and demonstration of improved clinical outcomes and what it takes to bridge that gap. Over the last six decades, a lot of insight into how to bridge that gap has been published, but it’s sprinkled across many different disciplines. As a Centre, we are pulling together that evidence into a methodological framework . Students could innovate as part of their learning, using the Validitron to co-design and test out their ideas and partnering with healthcare delivery organizations to pilot and hopefully scale some of them. Sounds like great fun, doesn’t it! With the new Centre for Collaborative Practice and our growing partnerships, perhaps we can make some of these hypotheticals a reality.
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An art show called Fragments by Wade Kramm made me think about how we only see parts of reality, colored by our fields of study, and emphasized for me the need for interdisciplinary collaboration.
Some new MD programs
Joint Harvard-MIT Health Sciences and Technology Gain a deep understanding of the fundamental principles underlying disease…and undertake a meaningful research project. |
University of Technology Sydney Bachelor of Engineering (Honours) Bachelor of Medical Science Produce graduates with professional qualifications in medical science and engineering who are well prepared to pursue a career in either field, or one that combines the skills of both. |
Arizona State University School of Medicine and Advanced Medical Engineering Integrate clinical medicine, biomedical science and engineering in a new approach to medical school that will create “a new kind of physician engineer.” |
Texas A&M University’s Engineering Medicine program to earn both an M.D. and an M.S. in engineering Medicine and engineering have long been taught in separate silos, but the rapid growth of wearable technologies, biomedical devices and digital health—born from the convergence of these two fields—necessitates integrated training. |
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