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How would Steve Jobs reengineer medical school?

How would Steve Jobs reengineer medical school?

The following is a guest blog by Dr. Sanjay Sharma, Professor, Ophthalmology and Epidemiology, Queen’s School of Medicine.

A few years ago, I was stopped cold in my tracks by the response delivered to my question posed to our second year medical students:  “What disease needs to be ruled out in an elderly woman who presents with sudden visual loss and jaw claudication?” A cat’s meow, emitted from a student computer, was apparently the answer – instead of the “giant cell arteritis” that I sought. It was at that precise point in time that I realized that many students used precious class time to contribute to “Ouch Charlie’s” YouTube-financed college fund, reconnect with long-lost kindergarten classmates on FB and hammer out 140 character observations to their legions of eagerly-anticipating followers.

While driving home, I remember thinking, “what is wrong with today’s Snapchatting, Instagram-posting, GOT-loving students? Don’t they know that how hard we work on our lectures?” As these thoughts were zipping through my brain, I glanced down at my iPhone and was, once again stunned by its elegant design and simplicity.

In my driveway, I thought how Steve Jobs, might have interpreted the day’s event. How would he re-engineer our current system founded on the 1-hour didactic lecture to meet the expectations of today’s digital generation?

Once home, I was stopped in my tracks for a second time in the day, as I saw a series of wet, blue footprints that had been freshly applied to our white kitchen floor. Following them, I found our, then 10-year old son, Evan, delicately balanced on the top of his stepladder, applying another layer of vibrant blue acrylic paint to the top of his 72-inch canvas. As I watched him expertly apply layer after layer, I asked him where he learned how to do this (I certainly hadn’t taught him), to which he simply responded, “YouTube.”

And with that response, the reality of modern education became clear. It was no longer about Cecil’s and Harrison’s, or thoughts conveyed on Gates’s default blue powerpoint slides. And it certainly was not about the fact that we put five hours into developing a great lecture a decade ago. Quite simply, it is about what they want, how they are wired and how they learn.

That night, I designed the blueprint for medskl.com – an open-access medical education site. I considered how it would look, what it would do, and how it would serve the needs and wants of a new generation of medical students.

Now some 3 years later, thanks to the efforts of a small team of dedicated editors, animators, videographers and coders to support 180+ leading global faculty – we have just formally launchedmedskl.com.

What exactly is medskl.com? It is a FOAMed (free open access medical education) platform that will provide digital lessons to the next generation of physicians. Our content library, once completed, will consist of 200 modules, roughly paralleling the MCC objectives. Each module is taught by an award-winning medical professor from a leading medical school.  Here Queen’s professors teach side-by-side with those from Harvard, Hopkins and Stanford to an audience of global students, 24/7.

And to appeal to visual, text-preferred and auditory learners, alike, medskl.com’s lessons are delivered in 2-minute white board animations, written summaries, and Ted Talk-length lectures.  Eighty-five modules are now live and all 200 will be complete by the end of the year.

We are thrilled with the initial response to medskl.com. Most Canadian and many US medical schools have expressed interest in incorporating our lessons to support their flipped classroom strategy which sees students consuming content outside of the classroom, allowing more value-added interaction to be delivered in traditional class time. In the short 6 weeks since launch, users from over 50 Universities have logged on to start consuming our lessons to augment their medical education.

As we anticipate the continued rapid uptake of medskl.com, we also look back and thank all the forward-thinking advisors and content providers who took our early calls, gave us real and crucial feedback, and who above all provided fuel to nurture the idea. Our hope is that medskl.com will one day have significant impact on medical education – globally. I hope that Steve Jobs would have approved.

Donald Forsdyke

Thu, 06/22/2017 - 13:10

OTHER ALTERNATIVES. This, like some other internet-based offerings, is being contrasted with, to quote, ” our current system founded on the 1-hour didactic lecture.” But there are other alternatives. Decades ago, in the pre-internet era at my London UK medical school we learned in small groups tagging along with our medical teacher as he/she saw patients. There were relatively few formal lectures, but they were very good. And Socrates was everywhere, challenging us, sometimes embarrassing us, making us think. They were wonderful teachers and I, for one, cannot imagine any better way of learning medicine. I suspect that by now the London medical schools have succumbed to the allure of gee-whiz technology. If so, I hope that, rather than Steve Jobs, they follow the lead of Salman Khan (https://www.khanacademy.org/test-prep/mcat).

Donald Forsdyke

Richard

Thu, 06/22/2017 - 13:10

Dear Donald,
I think you point out, correctly, that a one-size-fits-all approach to education is not likely to meet the varying learning styles of our students. This underscores the importance of having a rich menu of opportunities for our students, including “old-fashioned” Soccratic teaching coupled with “new-fangled” internet-based virtual reality encounters.
Thanks for commenting,
Richard

Richard

Donald Forsdyke

Thu, 06/22/2017 - 13:11

In reply to by student

NEED TO GET AT ROOT OF PROBLEM.

Debates such as the present tend to distract from consideration of the historical roots of the medical education problem. Professors are hired to teach, administer and do research. These three have to be properly balanced, as I believe they were when I went through medical school. An article by US molecular biologist, David Aperion (1979; Fed Proc 38:2649-50) pointed out that in the 1970s the competition for research funds had intensified and the size of the biomedical research force outgrew the funds available. Whereas before that time research funding decisions had largely depended on talent at research, now they depended on talent at research marketing.

Instead of writing one research grant application every 5 years, researchers who lacked marketing skills found themselves writing several applications every year. Even funded researchers were writing applications as an insurance policy against loss of funds. The selective gate for gaining a stable position at a medical school now relied on an entirely different set of skills. Time spent on administration or preparing ones teaching, was time taken, not from research, but from writing research grant applications. To teach well, or administer well, could mean academic suicide.

This environment led to a plethora of new educational approaches and, with the advent of the internet, even more are in the pipeline – a focus of lively discussions. But the real solution to improving our education system will be through reform of our research funding system. Currently, input is being requested by Commissions both in Canada and the USA on how the funding system can be reformed. Readers providing input should note that much, much, more than biomedical research is at stake. See: http://www.sciencereview.ca/eic/site/059.nsf/eng/home

Donald Forsdyke

Thanks Donald,

I agree thta there is an existential threat to reserach in Canada at this time. I’m not sure that currently, on the ground, we have much of a problem about the two missions of reserach and education. I believe we are delivering on both of these, but resource restrictions are currently more profoundly affetcting reserach compared to education.

reznickr

Sorry Richard. I can’t let you off the hook. With grant application success rates at below 20%, an inordinate amount of professors’ time must be spent writing more applications. That means less time for teaching and other activities. Research and teaching are inextricably linked. Sort out the research system and there will be less need for the “new fangled.”

Donald Forsdyke

Arun Mathur

Thu, 06/22/2017 - 13:13

Hello Sanjay,

It was a pleasure to see an interesting and insightful blog from a fellow medical school classmate. It is interesting that we are reconnecting in the digital medium. Many of the CEO’s of the 80’s and 90’s, including Steve Jobs, Bill Gates etc. saw the way of the future (or maybe created the way of the future). They created the technology that has become a mainstay of our lives 20 years later. Interestingly these same people carefully regulated and sometimes banned these technologies from their children for fear of the detrimental social and learning effects these may have on our future leaders.

Nevertheless the technology is hear to stay. I have had the same observations on my family practice residents in clinic or in the O.R. The crux of the matter is how the “entertainment learning” is delivered to the next generation, and when it is being delivered. I built a beautiful home theatre in my home yet my kids prefer to watch their movies on their iPhone or iPad, late at night on a tiny screen being streamed from some remote site at low resolution while cuddled under the covers in bed. The current generation wants their knowledge, learning, morality, education, communication, social interaction etc etc over the portable hand held medium whether smartphone, smartwatch, tablet etc. The second point is that they want it on demand. the concept of “right education at the right moment” is important for effective absorption of medical learning in the current medical student. This could be in a didactic lecture, it could be at the patient bedside, it could be in bed late night or on beach in Hawaii. For a particular student it could be all of the above based not he circumstance or mood of the student. Not catering to this flexibility, which the entertainment and media industry has already learned, will result in a less efficient learning model. I agree with the previous poster regarding the small group problem based bedside learning model, but this is only one facet of a multifaceted teaching model that will be necessary as we move forward in this new digital on demand era.

I hope your family is doing well. Lets connect sometime.

Arun

Arun Mathur, BSc, MD, FRCSC
Medical Director-Surgical Program
Staff Urologist
Adjunct I Assistant Professor, Queen’s University Family Medicine
Lakeridge Health Corporation and R.S. McLaughlin
Durham Regional Cancer Centre
Oshawa, Ontario
Tel: 905-721-3551
Fax: 905-721-6697

Arun Mathur

Arun,
Thanks for your thoughtful comment to Sanjay’s blog. You make some great points about the educational preferences of our millennials. This is requiring tremendous adaptation by our teachers and educational administrators. I would argue we are adapting, but not fast enough.
Again thanks for your comments,
Richard

Richard

Lisa Jones

Thu, 06/22/2017 - 13:14

Hello, I am an educator, and as such, I often talk about Steve Jobs with my students. I constantly remind them that Steve Jobs is irrelevant because because he neglected his basic health needs to the extent that he eventually died of cancer. I remind my students that it was irresponsible of Steve Jobs to leave his own children orphaned without a father. I have no respect for Steve Jobs. Apparently he was also not philanthropic . This is not the kind of man i recommend that my students emulate.

I know medical students who are currently enrolled at Queen’s. I am appalled with their lifestyle, especially their diet. If I were to re engineer medical school at Queen’s, I would adopt a holistic approach and include more programs that addressed preventative medicine. I would also develop programs wherein only the medical students who would eventually graduate from medical school would be the students who have adopted a lifestyle that will help them be more of a role model to their patients. I am sure this objective could be achieved through appropriate testing just as monitoring of ethics is achieved via the the specific courses that certain students have to enroll in at Queen’s.

Lisa Jones

I believe that Dr. Sharma was drawing an analogy to Steve Jobs with respect to his ability to have been a disruptive thinker, rather than a global indication of support for Jobs and all of his actions. With respect to your views about the importance of lifestyle, they are welcome. There is no question we have an increasing emphasis on lifestyle teaching in our medical school. In fact, in addition to services provided by the school, two years ago our students initiated a Wellness Month that is marked by peer support in making healthy life choices (diet exercise, etc). That said, however, I don’t believe that we should be choosing medical students based on their personal lifestyle choices, nor do I believe promotion from medical school should be predicated on adherence to a specific lifestyle.

Thank you for your comment,

Richard

Richard

Adam Mosa

Thu, 06/22/2017 - 13:14

I am late to the discussion, but perhaps input from a current medical student would be valuable here. A few days into clerkship, I have just completed two years of mixed didactic and small group learning. In my opinion, the curriculum at Queen’s has been excellent – balanced, responsive, and incremental. In the spirit of my new role as a clerk, here is the problem list as I see it:

1. In a class of 100 medical students, there is a huge variety of learning styles. Some, like myself, still enjoy lectures and seek the sense of sympatico with generations of physicians who learned in this way. The ‘digital generation’ has more than a few bibliophiles. Innovation should not seek to totally replace what worked for many and continues to work for some.

2. Regardless of learning style, my classmates would all agree the first 2 years of lecture had true diamonds. Clinical experience, narratives, advice not found in textbooks, and the ability to model professional behaviour all make in-person lectures invaluable. White-board animation may help learn content, but I don’t think it delivers the same bang in terms of how to become a doctor.

3. There are good and bad lectures. Reopening a presentation to tweak percentages and recommendations as new studies are published is usually obvious. There are experts (luckily many at Queen’s) who know how to make provocative and modern lecture slide decks. It’s worth re-engineering the slide deck and presentation before getting rid of the lecture entirely.

We are like architects using the pre-clinical years to build a foundation for clerkship and our careers. One unassailable truth of modern medical education is that we have too many building materials to choose from. I personally gravitate towards the materials that I have seen supporting productive careers.

Adam Mosa

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