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Medical Education, Medical Schools, Medicine and Society, Stanford Medicine Unplugged

Does medical school unfairly glamorize the medical profession?

Does medical school unfairly glamorize the medical profession?

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

discovery walkAny Stanford student knows all too well that the immense campus, with its seemingly eternal sunshine and endless rows of palm trees, can make it difficult to want to get outside and experience the real world. When it comes to medical education, this creates a very real concern: Is it possible to experience the full diversity of our health-care system when you are living in the so-called “Stanford bubble” – an idyllic college campus in one of the wealthiest counties in the United States?

I’ve certainly felt the effects of the Stanford bubble, but interestingly, working with a diverse population of patients has not been my primary challenge. Stanford has a wide net of connections with the Peninsula region and larger Bay Area – from clinics serving the urban underserved in East Palo Alto to flu vaccination programs reaching a rural population in the Central Valley farmlands. Those experiences are widely accessible to anybody who seeks them out.

No, my problem with the Stanford bubble is not about the patients – but rather the doctors. Doctors are known for being overworked and stressed, right? It certainly doesn’t seem that way in our bubble, where speaking with our outstanding pre-clinical faculty about their careers brings inspiring stories of cutting-edge research achievements, clinics filled with fulfilling cases and grateful patients and many years of training bright up-and-coming doctors. On the contrary, my faculty mentors speak highly of the balance they’ve found in their professional lives – clinic one day, research the next and teaching in between.

But is this really representative of the real world? When you step outside the realm of “academic medicine,” the picture seems to change considerably. It’s not a secret that, among physicians nationwide, burnout is widespread and pervasive – afflicting 46 percent of doctors in a recent study. Burnout was defined as “emotional exhaustion, depersonalization and low personal accomplishment.” To be honest, I can’t say that I’ve ever observed anything like that in my pre-clinical years, let alone in 46 percent of our faculty. As pre-clinical medical students, burnout is something that we hear about constantly, but witness never, allowing us to convince ourselves that it’s just some abstract idea that doesn’t apply to us.

I’m constantly inspired by my teachers and mentors here at Stanford. I will consider myself incredibly fortunate if I manage to step into their shoes at some point in my career. But part of me that wonders if we’re really seeing the full picture as pre-clinical students. We’re being shielded from the “front lines” – the thousands and thousands of primary care doctors who work tirelessly under the strains that our health-care system imposes on private practice physicians. Are we being set up for an unpleasant surprise later on? How can we possibly avoid being part of the 46 percent if we don’t have a good awareness that it exists? Perhaps it’s time to start bringing these questions into the medical school bubble.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Norbert von der Groeben

Medical Education, Medical Schools, Medicine and Literature, Stanford News

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger Child Pic JAMA PedsWhen Amy Chua’s book, “Battle Hymn of the Tiger Mother” was published in 2011, Jason Nagata, MD, was in medical school at the University of California, San Francisco. He caught on to the humor (which escaped some of the book’s reviewers), and the anecdotes resonated with him – reminding him of his own strict and intense upbringing. “It was very funny and very controversial,” he said. “A lot of that book stuck with me from the child’s perspective.” He started to share some of those memories with people around him and found that his fellow med school students had similar stories, too. He wrote about his experiences as a “tiger child” in a funny and touching essay (subscription required) published online today in JAMA Pediatrics.

When I connected with Nagata, we spoke over Skype because he was working in Ecuador as part of his global health residency. He noted that despite the negative press Chua’s book received, he believes that strict childhood training helped prepare him for medical school. “The tiger mentality is prevalent throughout medicine,” he said. “It was intense as a child, but it prepared me well for medical training – the hours and the intensity.”

But Nagata had to learn the hard way to make room in his schedule for rest. After a particularly intense time during medical school, he developed an ulcer that landed him in the hospital. His recovery took more than a month. He explored writing as a way to reflect and think through his experiences as a student and later as a doctor. When he came to Stanford, he attended the Medicine and the Muse writing workshops to hone his writing chops. His current essay is just the latest in a series.

Although he makes time for rest, he still has plenty of drive and intensity. He mentioned that he was planning a trip to the Galápagos Islands and to hike Mount Chimborazo, the highest mountain in Ecuador, the weekend after we spoke. After he completes his residency at Stanford, he’ll start a three year fellowship in adolescent and young adult health in July 2016.

Nagata describes his own mother’s unusual path from NICU nurse to graduate student in chaplaincy. “She exemplified the tiger mom and probably works even harder than I do,” he said. “I got a lot of my habits from her.” She doesn’t demand as much from Nagata these days, but her Tiger mom spark isn’t completely gone. When he told his mother about the upcoming essay, she quipped that she was planning to write a rebuttal to JAMA Pediatrics “in her own tiger mother vein,” he said.

Previously: For group of Stanford doctors, writing helps them “make sense” of their experiences
Photo of Jason Nagata as child, courtesy of Jason Nagata

Medical Education, Medicine and Society, Stanford Medicine Unplugged

Learning how to learn medicine

Learning how to learn medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

A few weekends ago, I saw a patient with bloated shins at our school’s free clinic, and I marked in my notes that she exhibited “peripheral edema,” an esoteric phrase that means little to those outside of the medical community. That experience only highlighted the tendency in medicine to inflate common bodily functions into opaque medical jargon. Its use can be frustrating for patients who are trying to understand their illness — and at times even for the uninformed medical student who is trying to learn about his patient.

As medical students, we feel as if we’re training to become glorified breathing-and-walking medical dictionaries

It doesn’t help that the list of jargon is endless. Itchiness becomes pruritus. Listening to the body’s internal noises condenses into auscultation. When you urinate, you’re really micturating, and if you have trouble doing so, you also have dysuria. Having a rash turns into having erythema. An abnormally large liver translates to hepatomegaly. An unhealthy level of cholesterol is labeled as hyperlipidemia. Chest pain is referred to as angina. Even the simple act of sweating is termed hidrosis. For vast majority of the first two years of medical school, we spend our time learning this vast and complex language that seems to have a word or phrase for every single bodily event — health and unhealthy, normal and abnormal.

But that is what medical training and much of medicine are — making observations of the human body and noting them with memorized jargon. And once we have acknowledged all the relevant observations, we connect the dots to form a story. If we’re astute and lucky enough, that story will end with the name of the disease along with its possible treatments and cures.

One would think that in order to provide adequate treatment to our patients, our education would possess more depth into the mechanisms behind drugs and diseases. But we only graze their physiological and molecular basis. It isn’t a reflection on our lack of curiosity. Rather, unfortunately, medicine is still limited by our dearth of knowledge. Despite the trillions of dollars poured into research, our advances in human genomics, and the fancy gadgetry, the human body remains a stubborn black box. Most of the time, all we can do is look at the inputs and outputs. Take aspirin, for example. Cardiologists recommend patients with a history of cardiovascular disease to take a baby aspirin every day to reduce their chances of a heart attack. But how this drug — first discovered by the ancient Egyptians — leads to decreased risk of death still remains a mystery.

These days, patients can sequence their entire genomes at a speed and price that was unimaginable a decade ago. They can scan their entire bodies to produce images with unprecedented detail. But in a unexpected twist, in order to confirm a diagnosis, physicians may still resort to the primitive practice of taking a gross piece of tissue from the patient and viewing it under a compound microscope, a contraption invented nearly half a century ago. Our expensive technology has been only able to expand our ability to observe and has done little peel back the veil covering the underlying mechanisms of human diseases.

But that is not to say that we should lose faith in medicine and underestimate the importance of labeling our observations. For the patient, putting a name on an abnormality, even if there may be no treatment available, can be comforting and give hope for recovery. For the caretaker, being able to identify an important physical finding can point to a set of suspect diseases. For my patient, leg swelling strongly suggested that he might be suffering from congestive heart failure.

As medical students, we must feel as if we’re training to become glorified breathing-and-walking medical dictionaries. Make no mistake — we are. We’re learning to make observations, note them down, and make sense of them down the road. And we shouldn’t underestimate the power of this process. It is at the core of the scientific process, and it’ll be how we ultimately serve our patients.

Steven Zhang is a second-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail.

Photo in featured entry box by Patrick

Medical Apps, Medical Education, Medicine X, Patient Care, Technology

A look at using smartphone apps for patient-centered research

A look at using smartphone apps for patient-centered research

The usefulness and power of mobile apps in research was one of the last topics at Medicine X yesterday. One of the panelists in the late-afternoon “Clinical research in the palm of your hand” session was Stephen Friend, MD, PhD, who told attendees how willing most patients are to share their health data for science. “If you give someone a choice and ask them, ‘Do you want your data to be looked at by qualified researchers around the world?'” people usually say yes, reported Friend, president of the nonprofit biomedical research organization Sage Bionetworks.

Panelist Michael McConnell, MD, professor of cardiovascular medicine at Stanford, can certainly attest to this: He’s principle investigator of a study, MyHeart Counts, that has seen tens of thousands of users offer up their heart-related data for study.

Stanley Shaw, MD, assistant professor of medicine at Harvard, shared thoughts on how having an ongoing data connection with patients can feel for a physician-researcher: “I had a surprising sense of immediacy when I started looking at… data. We had people upload information such as their blood glucose levels. You can see people cranking the level down day by day over weeks or months. It really does remind you of that pact between an individual and their physician and that it’s a privilege to take care of patients. It’s very exciting.”

Also exciting is when apps are shown to have a direct impact on a patient’s care or quality of life. Friend gave the example of a program that reduced emergency room visits and hospitalizations by allowing providers to keep track of patients via an app. “If someone has been holed up in their house for four days, we can send someone to find out why,” he said. And if a patient stops taking a daily walk, that provides the medical team with clues as well.

Of course, not every patient— especially one with a chronic illness — is going to bother logging onto an app to share data every day, said Yvonne Chan, MD, PhD, assistant professor of emergency medicine at Mount Sinai Hospital. “We talk about access and engagement,” she said, but different types of users are going to engage with an app differently. For example, asthma patients with severe, poorly-controlled baseline disease are easy to engage and keep — especially if they happen to own a smart phone. Such patients are highly motivated to better control their disease and stay out of the emergency room.

“But people with minor disease that’s well controlled, maybe they have better things to do,” she said. Apps could be designed to engage different patient populations; maybe that asthma app could have a mode that included more entertainment for patients who are less sick and less motivated.

More news about the conference is available in the Medicine X category

Medical Apps, Medical Education, Medicine X, Patient Care

Engaging and empowering patients to strive for better health

Engaging and empowering patients to strive for better health
Nancy M-D on stageMedicine X yesterday featured a series of talks on a topic that is near and dear to the heart of many conference attendees: Empowering and engaging patients. Marty Tenenbaum, PhD, a former consulting professor of computer science at Stanford, began the session with a moving talk on how difficult and frustrating it was to find the right therapy after he was diagnosed with metastatic melanoma 17 years ago.

“I spent a lot of time in the stacks of Stanford reading medical journals. They all agreed on one thing, which was my dire prognosis. I thought, there’s gotta be something better than this,” he said. Tenenbaum’s ordeal prompted him to create a nonprofit, called Cancer Commons, which helps connect cancer patients to the therapies that have the best chance of curing them.

Howard Look, president and CEO of the app Tidepool, said it “was like crawling through broken glass” to get access to his daughter’s blood glucose data when she was diagnosed with type 1 diabetes in 2011. “We quickly discovered how hard it is to calculate the right dose of insulin,” Look said, driving the point home by showing a series of texts he once received from his daughter, Katie:

Katie: “Dad, I’m low. I’m 52 and dropping.”
Howard: “That’s okay, you have your juice boxes right?”
Katie: “I can’t find my juice boxes.”
Howard: “I’ll come get you.”
Katie: “I don’t know where I am.”

“This is a scary moment if you are a parent,” he said. “You might think that when the stakes are this high there must be a way to manage your diabetes with some sort of software or app. At the time, there wasn’t one.” This motivated Look to design an app that helps diabetic patients get and use to their blood glucose data effectively. “When you liberate the data, you empower the patient and enable them to engage however they want to engage,” Look said.

Next, Brian Loew, founder and CEO of Inspire, talked about the online community of patients and medical professionals in that social network. Many patients have reporting feeling more able to discuss certain issues with their doctors after first talking with their peers in Inspire, he said. “How do I travel with a wheelchair? How can tell my kids I have cancer?  These are questions that are often easier to ask of a person who has done or experienced it,” Loew explained.

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Events, Medical Education, Medicine X, Stanford News

Learning from patients by walking in their shoes

Learning from patients by walking in their shoes

digital storytelling workshopWhere else but at a medical conference in Silicon Valley would you hear the term “empathy hack”? The concept of the empathy hack unites the acknowledged need for education geared toward fostering empathy in health-care providers with the innovative, disruptive mentality of the valley. The result is “One Day,” a pilot project led by Rice University’s Kristen Ostherr, PhD, and Roni Zeiger, MD and CEO of, who shared their hacking concept with attendees at a Stanford Medicine X | ED workshop yesterday.

The concept behind “One Day” is to pair a patient and a learner (a medical student, doctor, researcher, hospital administrator, or educator) and have the learner experience a day in the life of that patient, with everything that entails, including self-treatments and physical challenges caused by the patient’s illness.

The learner receives a “kit” containing materials that simulate the condition of the patient for the learner, i.e.  a thin straw and air pack to simulate a nebulizer used by patients with cystic fibrosis, or leg weights to be worn to simulate the drag caused on limbs by Parkinson’s disease.

Once patient and learner are matched, they agree on a form of communication for the day, with modalities including SMS Text, Facebook chat or texting with video, audio and photographs. The learner then follows the actions of the patients during the day, whether administrating nebulizer treatments or trying to negotiate crossing a street quickly with limbs that are weighed down.

After describing the project, Ostherr and Zieger asked attendees to brainstorm ideas for expanding this model to be used for other patient illnesses and experiences. Participants in the outdoor workshop were doctors, patients and medical educators, and their responses included chronic pain, diabetes, homelessness patients, and palliative care and end of life treatment. Caroline Okorie, MD, a Stanford pediatric pulmonologist, said she would like to see an exercise like this for teenagers dealing with CF: “They really have a unique issues, even in comparison to adults.”

A patient who has been dealing with chronic pain for years suggested that learners should deal with multiple challenges, as many patients do. “It may not just be that the pain is your back, that can lead to shoulder pain, or headaches, and all this happens at once.”

Zieger and Ostherr, who hope to bring the project to medical schools, emphasized the simplicity of the model: The kits cost approximately $30, and HIPPA concerns are handled by informed consent filled out by the patient participants. It’s small investment for the potentially-eye opening and revelatory experience of health-care providers walking in the shoes of a patient, even just for a day.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Kristen Ostherr and Roni Zeiger (both standing) courtesy of Stanford Medicine X

Events, Medical Education, Medicine X, Patient Care, Precision health, Technology

“No ordinary conference”: The magic that is Medicine X returns to the stage

"No ordinary conference": The magic that is Medicine X returns to the stage

Larry Chu welcoming attendeesMedicine X, Stanford’s popular conference on emerging technologies and medicine, returned to the stage today.

The conference, which was proceeded by the first-ever Medicine X | Ed, is now in its fourth year, and the momentum and magnitude of the event has steadily increased since it began.

Last year, more than 4,000 participants in 69 countries took part in the Medicine X experience via Twitter, making it the most-discussed academic conference in the world. Its past successes were reflected in the theme for Medicine X 2015: “Great Xpectations.”

After executive director Larry Chu, MD, welcomed attendees with a reminder that they “all belong here,” Lloyd B. Minor, MD, dean of the medical school, officially opened the conference with remarks that encouraged this engaged audience to take action and seize opportunities to improve health care. “This is no ordinary time in our history, and Medicine X is no ordinary conference,” he said. “We are here today to have discussions and generate ideas about how to leverage the power of information and the latest technology to improve health for people in our own communities and across the globe. Health care is truly the opportunity of our lifetime.”

Minor talking“Since last year’s Medicine X conference, Stanford Medicine has launched a bold new initiative — our vision to lead the biomedical revolution in precision health,” he said. “Precision health as the next generation of precision medicine: Precision medicine is about sick care, precision health is about health care.” Everyone participating in this event is an important part of moving this conversation forward, he explained.

Eric Topol, MD, chief academic officer at Scripps Research Institute and bestselling author, went on to give an opening keynote on ways we can use new technologies to democratize medicine and involve the patient in his or her own care. “We have views of the human being that we never had before,” Topol said, referencing smartphones and other technologies that people use to monitor their health metrics.

These new technologies are important because they’re interactive and easy for patients to use, and they allow patients to become more involved in their health care, Topol explained. He showed an image of the iconic black doctor’s bag. “These are vintage tools,” he said. “This is my bag,” he explained, pointing to an image of a several digital tools.

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Media, Medical Education, Medical Schools, Medicine X, Technology

Integrating digital literacy into medical education

Integrating digital literacy into medical education

21474271319_dc2d63f449_zBertalan Mesko, MD, PhD, has cracked the code on convincing medical students that digital literacy skills are equally as important as clinical knowledge. Seats in his Social MEDia course fill up within 45 seconds of registration opening. Former students report a 100 percent satisfaction rate with the class, and 80 percent of those enrolling in the course heard about it from a classmate. How does Mesko do it? As it turns out: daily educational challenges promoted on Facebook, an arsenal of high-tech gadgets and lots of chocolate.

On Thursday at Stanford Medicine X|ED, Mesko shared his secrets with medical educators on how to develop a digital literacy curriculum that will engage millennial learners and keep pace with the ever-changing landscape.

A self-describe medical futurist, Mesko launched his class on social media in medicine in 2008 when Facebook and Twitter were still in their infancy. “I wanted to design the curriculum for students to prepare them for the future that is coming toward us,” he said. “My goal was to help them understand how to use these tools to be more productive and stay up to-date.”

Early on, the curriculum centered on his experience with social media tools, such as blogging, Twitter and Facebook. But as the field of digital media and medical devices has evolved, so has the class. These days, he’s constantly updating the coursework to the point where he never gives the same lecture twice. “Platforms come and go, but it’s the concepts and practices that really matter,” said Mesko, who teaches at Semmelweis University in Hungary. “Whenever I talk about these topics, I do everything live.”

Most students have been active on Facebook, Twitter, Instagram, Snapchat and other social media accounts, long before they enroll in Mesko’s class. However, he still believes it’s important to provide an introduction to social media; discuss search engines and the Google story; and provide instruction on medical blogging, crowdsourcing and mobile health.

“Students need some fundamental digital knowledge before diving into the topics of e-patients and how to empower patients,” said Mesko, author of the recently released book My Health: Upgraded . “Additionally, many students don’t fully understand the privacy polices of these services. I tell them to remember that there is no difference between offline or online conduct.”

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Events, Medical Education, Medicine X, Stanford News

At Stanford Medicine X | ED, breakthroughs and a prescription for change

At Stanford Medicine X | ED, breakthroughs and a prescription for change

Medicine X Ed

As editor of Wing of Zock for the past four years, I’ve had the honor of learning about hundreds, perhaps thousands, of innovative ideas to reimagine medical education. On the first day of the inaugural Stanford Medicine X | ED conference Wednesday, I got enough new ideas to fuel a year’s worth of posts. A diverse lineup of presenters — educators, students, and patients — collectively created, through words, images, videos, and music, a vision of a possible future for medical education. They reported on promising innovations in medical education that aim to better prepare the doctors of tomorrow. Accompanied by colored lights, diffuse video backgrounds, and a varied soundtrack, the high-energy atmosphere that is the hallmark of Stanford Medicine X pervaded a conference on medical education.

Designed to be different in every way from traditional academic meetings, Med X | ED features numerous icebreaking and networking opportunities; a low-key product exhibit area; announcements by Gary Williams, the voice of the San Francisco 49ers (“the voice of God”); and constant visual reminders of its living mascot, Zoe, a French bulldog owned by MedX executive director Larry Chu, MD. Attendees received glowsticks in their registration packets that they used to reward effective presenters.

“Jazz and glowsticks. Things not found at traditional #meded meetings,” tweeted Bryan Vartabedian, MD, a gastroenterologist from Baylor University in Houston.

The trappings, rather than making the content seem less serious, instead make it more accessible, more memorable. The entire conference is an incarnation of the Von Restorff effect, a concept I learned just this morning, that posits that we are more likely to remember things that are unusual, or fun, or inappropriate. While you might not remember the last session you attended on interprofessional education, you would remember the one Paul Haidet, MD, delivered. Haidet, a general internist and health sciences researcher at Penn State University Hershey, used three recordings of the same jazz standard, “Waltz with Debbie,” to illustrate the ways in which small teams can collaborate. It’s likely that many attendees were searching iTunes for the tracks afterward.

Taking its theme from Chu’s opening remarks, in which he said, “The care we receive tomorrow depends on the doctors we prepare today,” the schedule featured 10-minute Ignite! talks, panel discussions, and keynote presentations by Howard Rheingold (described here earlier) and Abraham Verghese, MD. Topics ranged from the collaborative redesign of a mental health unit in Nashville to the use of whiteboard videos to encourage healthy behaviors to the rise of medical student communities of practice. Leveraging technology and social media, it’s clear that medical schools are trying to address the needs and learning styles of this generation of learners.

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Events, Medical Education, Medicine X, Stanford News

“How might we…” redesign medical education?

“How might we…” redesign medical education?

Sarah Stein Greenberg at MedX Ed3What does “medical education” really mean? In its current form, it means four years of medical school with mostly synchronous, live instruction by a faculty member, followed by three to seven years of residency. But what if we took all of our existing notions about medical education and threw them out the window? What if we went back to the drawing board, to design from scratch a new model of medical education that no longer assumes that knowledge acquisition happens in a single, continuous four-year span? That no longer assumes that faculty members are the arbiters of that knowledge? That no longer assumes that teachers and learners must be co-located? That no longer assumes that people learn by sitting and listening?

In her keynote address at Stanford Medicine X | ED this morning, Sarah Stein Greenberg, executive director of the at Stanford, outlined what happened when her team took apart similar assumptions about college. They then created a new model using design thinking tools and techniques. (The title of this post references a key design thinking technique: problem solving by asking, “How might we…?”) The resulting construct, known as Stanford 2025, relies on four “provocations:” open loop university, paced education, axis flip, and purpose learning. The latter suggests that students pursue educational paths based on a mission rather than a major.

“Most everyone has had some kind of experience with education, and these core ideas really seem to resonate with people from a wide variety of fields,” Greenberg said. She also noted that much invention and innovation is coming from outside the academy.

The is “radically interdisciplinary,” bringing together students from all seven schools at Stanford to equip them with a common vocabulary that allows them to navigate the complexity of working within diverse teams. Its approach encourages a bias toward action, to experiment and prototype and test, and to think through challenges incrementally. Its deployment engenders creative confidence and resourcefulness in practitioners, Greenberg says, and leads to “profound learning experiences” as well as “spectacular failures.” Health-related projects have looked at encouraging organ donation, medication adherence post-cardiac arrest, devices for children with club foot, and a breathing apparatus made of paper for children with asthma.

The Med X | ED emphasis on patient inclusion as planners, experts, and participants echoes design thinking principles. “The end user is always at the heart of a project, and that doesn’t mean we send out a survey,” Greenberg says. “That means that we really try to go and walk in the shoes of the end user, to have empathy for the experience of the end user. The idea that people are subject matter experts in their own lives is a core tenet of design.”

Jennifer J. Salopek is founding editor of Wing of Zock and can be found on Twitter: @jsalopek. A modified version of this post originally appeared on Wing of Zock.

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Sarah Stein Greenberg courtesy of Stanford Medicine X

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