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Using technology and more to reimagine medical education

Using technology and more to reimagine medical education

Over on The Health Care Blog, Michael Painter, MD, JD, shares his thoughts from a recent meeting at Stanford’s medical school inviting medical education leaders to debate big questions in their field. Painter, a senior program officer at the Robert Wood Johnson Foundation, explained that meeting participants discussed ways that educators can use technology and other tools “to help create a durable culture of health for all.”

From the post:

In 2013 we extended a $312,000 grant to Stanford Medical School that will support work by five medical schools, Stanford, Duke, University of Washington, UCSF and University of Michigan, as they create a consensus knowledge map of the critical things medical students should learn.

Why a knowledge map? The simple answer: because there isn’t one, and we need one if we’re going to build massive core online medical education content.

Why change now? There’s building pressure on fortress academia: pressure to push health care toward high value, pressure for health care to center itself on the patient rather than the professional, and pressure from technology, specifically the ability to move previously closely held knowledge of the expert more efficiently to the learner.

Here’s where this mapping effort also starts to get interesting. It wouldn’t be that surprising if these education leaders ticked through all the reasons why change is too hard—why it can’t or won’t happen. Instead something marvelous is happening: they’re challenging each other to examine the time they spend with their students—asking if they ignite the kind of passion in their learners that others ignited in them.

An even more hopeful sign—these leaders want to connect the teaching of new healers—from the beginning—with the key partner: the patient. Their early reimagining is fixed on patient and story.

Previously: A closer look at using the “flipped classroom” model at the School of MedicineCombining online learning and the Socratic method to reinvent medical school courses, Using the “flipped classroom” model to re-imagine medical education and Stanford professors propose re-imagining medical education with “lecture-less” classes

Medical Education, Medical Schools

Using digital resources to redefine the medical education model

iPad_032514Today on MedCrunch, Stanford medical school alumna Stesha Doku, MD, examines how digital resources can enhance the traditional medical school curriculum to ” help health-care professionals succeed in their goals to deliver quality care.” Highlighting online learning sites such as PodMedics, which offers medical and surgical video tutorials, Doku writes:

What we gain from the growth of such applications and more general sites such as Khan Academy is that the physical classroom is becoming less relevant. It’s not so much a question of the classroom being not enough, but rather if the classroom is the correct place to deliver our learning materials in the first place. If so, are we delivering distilled and most importantly relevant information?

While we value those who are ‘smart’ in medicine, we must make more effort to value those who can translate their knowledge into improving outcomes and progressing our field. This may mean spending less time on acquiring knowledge that has no application. This may also require spending more time practicing application.

As reported previously on Scope, the School of Medicine is developing the Stanford Medicine Interactive Learning Initiatives, which utilizes the “flipped classroom” model to make better use of the fixed amount of educational time available to train doctors.

Previously: Social learning in a medical photo-sharing app for doctors, A closer look at using the “flipped classroom” model at the School of Medicine, Combining online learning and the Socratic method to reinvent medical school courses, Using the “flipped classroom” model to re-imagine medical education and Rethinking the “sage on stage” model in medical education
Photo by Stanford Ed Tech

Medical Education, Medical Schools, Stanford News

At Match Day 2014, Stanford med students take first steps as residents

At Match Day 2014, Stanford med students take first steps as residents


Last Friday, small envelopes containing big news were handed out at the Li Ka Shing Center for Learning and Knowledge. During Match Day 2014, med students at Stanford and around the country learned where they would be paired to begin residency, and thus the next phase of their lives and careers. My colleague Tracie White was on the scene when Stanford students opened their letters. She reports:

The 81 students matched in 19 different disciplines in a total of 15 different states. California topped that list with 17 percent of all the graduating students.

Seventy percent of the 81 students matched with their first choice and 90 percent with one of their top three choices. At the top of the list for medical specialties was internal medicine, with 19 students. Pediatrics came in second, with nine students.”It was a long, painful process,” said Kevin Chi, his shaking hands holding the letter that told him he had matched in pediatrics at Stanford, his first choice. He hugged fellow student Tania Rezai, who had matched to a family medicine residency in Santa Rosa.

Kira and Erick Westbroeks, pictured above with their baby, will be moving to Baltimore; Erick Westbroek matched in neurosurgery at Johns Hopkins.

Previously: Matching into family medicineImage of the Week: Match Day 2013My parents don’t think I’m smart enough for family medicine: One medical student’s storyMatch Day 2012 decides medical students’ next steps and A match made in heaven? Medical students await their fate
Photo of the Westbroeks by Norbert von der Groeben

Medical Education, Medical Schools, Stanford News

Match Day 2014: Good luck, medical students!

matchday13-1-031513Medical students at Stanford, and thousands more around the United States, will gather this morning at 9 AM Pacific time for the annual Match Day celebration. Students will join family, friends and faculty members as they nervously clutch white envelopes, which indicate where they’ve been “matched” for their residencies and play an important role in shaping their futures. We wish students at Stanford and around the country the best of luck!

Match Day, for those not familiar, is the annual event where students learn where they’ll spend the next four to seven years of their lives completing residencies. To determine the post-graduation assignments, the nonprofit organization National Resident Matching Program uses a computer algorithm that aligns the choices of the applicants with those of the residency program.

This morning, my colleague Tracie White will be joining students on the Stanford campus to capture the ceremony and excitement. Watch for her story later on Scope.

Previously: Matching into family medicine, Image of the Week: Match Day 2013My parents don’t think I’m smart enough for family medicine: One medical student’s story, Match Day 2012 decides medical students’ next steps and A match made in heaven? Medical students await their fate
Photo by Norbert von der Groeben

Medical Education, Medical Schools, SMS Unplugged

Top 10 reasons I’m glad to be in medical school

Top 10 reasons I’m glad to be in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Stanford School of Medicine class of 2013 before the Dean's Welcome Reception and Stethoscope Ceremony on Friday, August 23, 2013.  ( Norbert von der Groeben/Stanford School of Medicine )A friend of mine e-mailed me this blog entry awhile ago. Titled “10 things you need to give up to become a doctor,” the piece describes “your free weekends,” “your desire to change the world,” and eight other similarly positive items as areas of life that medical students need to sacrifice on their path to becoming a doctor.

As I read through this entry, my mood grew increasingly dismal. By opting to go to medical school, had I really committed myself to a lifetime that, according to the author, would be devoid of creativity, good health, big dreams, and more? I refused to believe that was true.

So, instead of dwelling on aspects of my life that may or may not be compromised on my path to becoming a physician, I want to highlight parts of my life that have been enriched by my medical school experience thus far. Here we go: The top ten reasons (organized loosely by importance) that I’m glad to be in medical school:

10. Four extra years of free two-day shipping via Amazon Student
I’ve ordered everything from tuning forks to trash bins – and I look forward to my future purchases being delivered via drones. Thanks, Amazon!

9. Daily dose of cheaper-than-Starbucks caffeine
For everyone paying $2.95 for a latte at Starbucks, be jealous! Stanford medical students get $2.70 lattes (+ an extra 25 cents off if you bring your own mug) at the Med Café every day.

8. 24/7 gym access
The 4th floor of Li Ka Shing is strictly for medical/bioscience students only and houses study rooms, a lounge, and a gym. Not that I ever have the urge to work out at 4 AM, but if I wanted to, I could!

7. Having friends come to me when they’re sick and feeling like I can diagnose them
Friend: “I’m feeling a little sick.”
(Five minutes later)
Me: “Actually, come see me again in like 4 years.”

6. Sleeping in scrubs like it’s no big deal
Because, really, they’re the most comfortable pieces of clothing I own.

5. Living life on pass/fail
It feels like this is the first time in my life where I’ve been given the freedom to learn at my own pace, in my own style. There are very few assignments in medical school, and as such, we can take the material presented to us and decide for ourselves how to master it. I can’t describe how incredibly refreshing this approach is.

4. Being on a text-message basis with role model physicians
Following my first patient encounter, one of my advisors texted me, saying: “You are a skilled, empathetic interviewer. I greatly enjoyed working together yesterday and look forward to more experiences.” Needless to say, my advisor’s thoughtful, compassionate words completely made my day.

3. Full-length white coats
At Stanford, medical students receive white coats that are just as long (i.e. up to our knees) as coats worn by MDs in the clinic – a constant reminder that there are no hierarchies: We are part of a single medical team, with the shared goal of caring for someone in need.

2. Being surrounded by inspired, motivated classmates
From founding non-profit organizations to creating World Health Organization reports to winning international awards for their research, my classmates are among the most accomplished, friendly, and down-to-earth individuals I have ever met.

1. Finding meaning every day of my life
Whether it’s through a patient visit, an anatomy lecture, a morning at pediatrics rounds, or a standardized patient encounter, I’m reminded every day that what I’m learning is directly linked to caring for others.

Hamsika Chandrasekar is a first-year medical student at Stanford’s medical school, with an interest in medical education and pediatrics.

Photo by Norbert von der Groeben

Health Policy, Medical Education, Medical Schools

Future doctors have a lot at stake, even if they don’t know it: A student’s take on the Affordable Care Act

“You’re going into medicine? Let me give you a piece of advice: Don’t.”

A community physician said those words to me more than three years ago, right before I started medical school, and I’ve heard variations on the theme ever since: Medicine is a thankless profession. Contrary to popular opinion, it’s hardly the path to riches. You can’t spend enough time with patients. It’s depressing.

In recent days, I asked several peers at different medical schools what they thought of the ACA. The overwhelming answer: “I don’t know enough to have an opinion.”

Now I stand poised to enter the world of MDs. And with the passage of the Affordable Care Act, my classmates and I, the newest generation of doctors, look out at the horizon without knowing the shape our careers will have. We are reasonably sure about one thing — along with providing unprecedented access to insurance for Americans, the new health care law will change how we practice medicine, including how many patients we see and possibly how we get reimbursed.

Yet when the endless wave of media coverage crashes over us, it’s rare to find an examination of how the law will affect us, your future health-care providers. Instead, we get a big dose of political posturing from all sides.

Why does this matter? Because the first and probably saddest truth I can tell you is that most medical students know very little about the Affordable Care Act, or about insurance and health economics in general. We get the occasional lecture about health systems, but the information shows up on none of our exams or evaluations. In recent days, I asked several peers at different medical schools what they thought of the ACA. The overwhelming answer: “I don’t know enough to have an opinion.”

I find myself in a unique position. Thanks to Stanford and NBC News, I’m spending the year learning more about health journalism. So I’ve pulled my head out of the textbooks and hospitals and gotten a chance to really see how health-care issues affect communities. If not for this opportunity, I probably would have been one of those students who knew next to nothing about a law that will alter my career.

As medical students, we’re exposed to certain physicians who don’t consider costs and money; they tell us that such thoughts are not only unbecoming of a physician but also a distraction from caring about your patient.

I don’t see it the same way. Physicians are meant to be advocates for patients, and that means pursuing appropriate medical treatment in the context of a patient’s real life. Being uninsured is a health problem, pure and simple. A 2009 study revealed a direct correlation between lack of insurance and increased mortality, suggesting that nearly 45,000 American adults die each year because they have no medical coverage.

Whether or not you support the Affordable Care Act, that figure alone makes it our business to care about this issue.

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Medical Education, Medical Schools, NIH, Science, Science Policy

Medical school leaders to Congress: Stop NIH budget cuts

Medical school leaders to Congress: Stop NIH budget cuts

In a letter (.pdf) to Congress yesterday, nearly 200 medical school deans and hospital CEOs expressed their “grave concern regarding the impact of the continued cuts, especially those imposed by sequestration” on NIH-supported research. The group of leaders, including Stanford’s Lloyd Minor, MD, went on to say:

Sequestration already has resulted in the loss of $1.5 billion from the NIH budget in FY 2013. This reduction comes at the end of a decade that has seen NIH lose more than 20 percent of its purchasing power after inflation. As a result, the percentage of promising research proposals that NIH is able to fund has fallen to less than 17 percent, an all-time low. Furthermore, NIH estimates it will lose a total $19 billion from its budget if sequestration is allowed to continue for the next eight years, delaying progress for patients awaiting the chance for a better

Enacted and proposed cuts in NIH funding threaten current and emerging basic research opportunities across the country, as well as the clinical studies that are essential to bring scientific discoveries from the bench to the bedside. Further, these cuts also will discourage young people from careers in medical research, risking the loss of the next generation of innovators and their ideas.

Previously: Senate proposes to increase NIH’s budget in 2014, NIH director on scaring young scientists with budget cuts: “If they go away, they won’t come back” and Sequestration hits the NIH – fewer new grants, smaller budgets
Via Association of American Medical Colleges

In the News, Medical Education, Medical Schools, Stanford News

Guidance on picking a graduate adviser

Guidance on picking a graduate adviser

Professor Russ Altman speaks with MD/PhD students Andy Loening, center, and Raag Airan, right, who are members of the first group of students to enroll in the new bioengineering department.I recently spent an evening chatting at a table filled with first-year graduate students at Stanford’s Biosciences Orientation dinner, which made me particularly interested in reading an advice article from Stanford’s Ben Barres, MD, PhD, published today in Neuron.

This is a practical advice article from a well-respected scientist on how new graduate students should go about picking a good mentor. Barres, a professor of neurobiology, said that he picked a wonderful mentor as a student – “through sheer dumb luck” – and he wants to share what personal knowledge he’s gleaned over the years as a researcher and an advisor of students himself. He writes:

…It is the guide that I wish someone had handed to me the day I entered graduate school. I write this with some trepidation, as I am certainly not a Nobel Laureate…  But, as I always tell my students, the real Prize is enjoying doing science. This is a Prize that I have won. I want my students – and every aspiring young scientist – to win it too.

Choosing a good mentor is extremely important to the future success of a young scientist. The Stanford students who I talked with at the dinner were aware of this fact and were also constantly reminded of it by the speakers. And I could see it was a matter of intense concern for them. I know a step-by-step guide on how to go about this somewhat daunting task would be much appreciated.

More from the piece:

…[Why] do some talented students succeed as scientists whereas others do not? This is a question that has long intrigued me. I see it around me every day. Students who have always loved science from a young age enter graduate school, but some of these students leave not enabled to be a successful scientist and/or demoralized, having somehow lost their passion for science. I will argue here that for most students, selecting a good research mentor is the key

First, let me mention what a student should never ever do. An adviser should not be selected solely because he or she is the one researcher at your university that happens to work on the precise focused topic that you think you are most interested in (usually whatever you worked on in an undergraduate lab). In my experience, this is exactly what nearly every graduate student does!

Begin your search for an adviser by casting as broad of a net as possible, Barres advises. Try lab rotations in different areas, then create a broadly defined list of potential advisers in your general field of interest. Next, screen for scientific ability and mentorship ability. Barres even gives tips on how to find lists of former students to check out what they are doing now as a possible screening method. Basically, students should do what they’re good at: Research.

Previously: First-year science graduate students enter brave new world, Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook and Distinction with a difference: transgender neurobiologist picked for National Academy of Sciences membership
Photo by L.A. Cicero/ Stanford News Service

Medical Education, Medical Schools, Neuroscience, Science, Stanford News

First-year science graduate students enter brave new world

First-year science graduate students enter brave new world

grad students talkingIn an effort to help the newest accomplished crop of science graduate students as they dive into their roles as “researchers exploring the unknown,” Stanford Biosciences recently held an orientation dinner warning of an uncomfortable new reality: feeling stupid. I attended the dinner and recently reported in Inside Stanford Medicine:

“The importance of succeeding in science is the ability to embrace your stupidity,” said Dan Herschlag, PhD, senior associate dean of graduate education and postdoctoral affairs, speaking to the crowd of about 120 diners in the Li Ka Shing Center for Learning & Knowledge. “And being comfortable with that adventure.”

Each student was asked to read an essay that had been left on their seats. It was the “The importance of stupidity in scientific research,” by Martin Schwartz, a microbiologist at the University of Virginia. “One of the beautiful things about science is that it allows us to bumble along, getting it wrong time after time, and feel perfectly fine as long as we learn something each time,” Schwartz writes. “No doubt this can be difficult for students who are accustomed to getting the answers right.”

“If we don’t feel stupid that means we’re not really trying,” he adds.

The 126 new students, who come from 19 countries and 82 undergraduate institutions, represent a wide variety of scientific disciplines and have already made great accomplishments in their fields. And yet, in chatting with several of the students, I learned it wasn’t uncommon for them to find themselves floundering a bit in a sea of insecurity. Don’t worry if you don’t feel like you like you belong, the faculty told them; the future will be challenging, but you’re definitely prepared.

Theresa Logan, who is entering the neurosciences program, told me it was a relief to hear the faculty talk about the “imposter syndrome” – the hidden belief that you aren’t supposed to be here among all these smart people. “Some of us apparently are thinking ‘Why did they ever accept me? It must be a mistake.’ It’s nice to know I wasn’t the only person who felt that way,” she said.

Previously: Stanford’s largest medical class ever starts school and No imposters here: Stanford grad students reassured as they begin school
Photo by Norbert von der Groeben

Bioengineering, Medical Schools, Stanford News

Stanford’s Clark Center, home to Bio-X, turns 10

2532648329_1c08aaaf3bNot every academic research center is known for its social vibe or aesthetic appeal, but Stanford’s James H. Clark Center gets scientists to look up from their microscopes and appreciate the view.

The three-story, 146,000-square-foot research center houses Stanford Bio-X, which comprises biology, medicine, chemistry, physics and engineering and takes an interdisciplinary approach to creating new knowledge of biological systems for the benefit of human health.

As Stanford Report notes, the Clark Center, which is celebrating its 10th anniversary, was “created as a social experiment in collaboration.” Facets of the architecture, such as an open courtyard at the center of the complex, facilitate social gatherings. The round space has also welcomed events, concerts, and a site-specific dance piece (watch at 2:20-4:15 here).

Bio-X director Carla Shatz, PhD, told Robin Wander, “Not only are the space and the aesthetics gorgeous, but the labs are state of the art and the ability to flow from one lab to the next is liberating after spending years in research buildings with long hallways.”

From Stanford Report:

“The architecture of the Clark Center provided the catalyst for developing a master plan and an architectural ‘kit of parts’ that has established a strong and consistent identity for the School of Medicine precinct,” said David Lenox, director of campus planning. “The floating red roof lid, the limestone cladding and the proportion of the fenestration of the Clark Center inspired the design of the Li Ka Shing Center for Learning & Knowledge as well as the Lorry I. Lokey Stem Cell Research Building.”

Shatz reflects on Bio-X and the Clark Center’s history in a new 1:2:1 podcast with the medical school’s chief of communications, Paul Costello.

Photo by Stanford Live

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