Bon Ku, MD, hated medical school. With its heavy focus on memorization, the century-old model of two years in classes and two years learning in clinics didn't work for him. Ku, now an associate professor of emergency medicine at Thomas Jefferson University, also isn't a fan of the health-care system in the United States.
So he, and the other speakers on the "Design thinking inside out" panel at Medicine X Sunday morning, are working to change the system by integrating design thinking into medical school training and patient care. Together, the speakers painted a clear portrait of what design thinking means to them.
It begins with patients, the speakers agreed. Ku sends his students out onto the streets of Philadelphia to improve their ability to talk with regular people, a skill that helps humanize their patients. Joyce Lee, MD, associate professor of pediatric endocrinology at the University of Michigan Medical School, integrates patients into the research process -- and that extends beyond having patients on a focus group, she said. "I'm lucky to work on Type 1 diabetes, because it's clear that the experts live with the disease. We have a group of patient partners and they've been helping us drive the show... We have to involve patients, because ultimately that will help us identify the best problems [to tackle]," she explained.
For Matthew Trowbridge, MD, an associate professor of emergency medicine at the University of Virginia School of Medicine, design thinking is one way to prepare students for a career characterized by change. "Health care is changing so fast that for a first-year medical student, it's almost impossible to predict what clinical care will look like during their career." He called it "almost irresponsible" to not provide students with a structured response to manage change.
Inspired by last year's Medicine X, Trowbridge returned to Virginia and, within weeks, welcomed the first cohort of medical students into a design thinking course focused on solving problems like a high number of inpatient falls. While working together, the students develop their creativity and leadership capabilities, Trowbridge said.
Design thinking also allows participants to expand their ability to work while surrounded by ambiguity and uncertainty, states that speaker Jay Baruch, MD, an associate professor of emergency medicine at Brown University, called the "ambient reality" of medicine. "We focus so much on knowledge and evidence. The truth of the matter is all the information I have cannot help me with the most critical aspect of what I do, which is learning to ask to right questions."
Design thinking is one way to tackle what Trowbridge called "wicked problems," systemic challenges like childhood obesity. What can one physician do about such a large, intractable problem? Work with others to develop large, system-wide changes that could make a difference. "My actual superpower as a design-thinking physician is I can tolerate ambiguity. I can tolerate tension," Trowbridge said. "If you can't handle that you collapse in on a solution too fast."
Panel moderator Kirsten Ostherr, PhD, a professor of English and director of the Medical Futures Lab at Rice University, asked the speakers if they could offer any advice on introducing design thinking into an institution. They did.
Medical students like their design-thinking course served "raw," while administrators would prefer it crafted to meet certain competencies, Trowbridge said. "I don't think either side is totally wrong, or totally right."
From Baruch: "Nurture your collaborations... Be compassionate and understanding of the people above you and be persistent."
And Ku: "A lot of my colleagues still think that design is making bright, shining objects. The challenge is making them understand that health care is a result of bad design."
And Lee concluded, appropriately, right where they started: "Bring patients to the table."
Previously: Learning how to use design thinking to improve the patient experience, Abraham Verghese: "It's a great time for physician leaders to embrace design thinking and "Join me in reinventing health," Medicine X speaker Susannah Fox urges
Photo of Bon Ku and Joyce Lee courtesy of Medicine X