How technology will revolutionize medical training

Recently, I attended the annual AAMC meeting where the question, “What will medical education look like in 2033?” was asked in a session called “Lightyears Beyond Flexner.”

After this thought-provoking session, I too pondered academic medicine’s fate. I would like to share my reflections in this forum.

Without question, technology stood out as a major theme in this conference. And for good reason: clearly it is already permeating every corner of our academic medical lives. But as technology outpaces our clinical and educational methods, how exactly will it affect our practices in providing care and in training physicians?

Our educational systems will evolve in ways we cannot predict. But in reality, the future is already here as transformations are already afoot. MOOCs — massive open online course for the uninitiated — like Coursera are already providing higher education to the masses and undoubtedly will supplant lectures in med schools and residencies. In a “flipped classroom” era, MOOCs will empower world renowned faculty to teach large audiences. Meanwhile, local faculty can mentor trainees and model behaviors and skills for learners.

Dr. Shannon Martin, a junior faculty at my institution, has proposed the notion of a “flipped rounds“ in the clinical training environment, too. In this model, rounds include clinical work and informed discussions; reading articles as a group or having a “chalk talk” are left out of the mix. In addition, medical education will entail sophisticated computer animations, interactive computer games for the basic sciences, and highly intelligent simulations.

Finally, the undergraduate and graduate curricula will have more intense training in the social sciences and human interaction. In a globalized and technologized world, these skills will be at a premium.

But why stop at flipped classrooms or even flipped rounds? Flipped clinical experiences are coming soon too.

Yes, technology will revolutionize the clinical experience as well. Nowadays, we are using computers mainly to document clinical encounters and to retrieve electronic resources. In the future, patients will enter the exam room with a highly individualized health plan generated by a computer. A computer algorithm will review the patient’s major history, habits, risk factors, family history, biometrics, previous lab data, genomics, and pharmacogenomic data and will synthesize a prioritized agenda of health needs and recommended interventions.

Providers will feel liberated from automated alerts and checklists and will have more time to simply talk to their patients. After the patient leaves the clinic, physicians will then stay connected with patients through social networking and e-visits. Physicians will even receive feedback on their patient’s lives through algorithms that will process each patient’s data trail: how often they are picking up prescriptions, how frequently they are taking a walk, how many times they buy cigarettes in a month. And of course, computers will probably even make diagnoses some day, as IBM’s Watson or the Isabel app aspire to do.

Yet even if Watson or Isabel succeeds in skilled clinical diagnosis, these technologies will not render physicians obsolete. No matter how much we digitize our clinical and educational experiences, humans will still crave the contact of other humans. We might someday completely trust a computer to diagnose breast cancer for us, but would anyone want a computer to break the bad news to our families? Surgical robots might someday drive themselves, but will experienced surgeons and patients accede ultimate surgical authority to a machine? A computer program might automatically track our caloric intake and physical activities, but nothing will replace a motivating human coach.

With all of these changes, faculty will presumably find time for our oft-neglected values. Bedside teaching will experience a renaissance and will focus on skilled communication. Because the Google generation of residents and students will hold all of the world’s knowledge in the palm of their hands, they will look to faculty to be expert role models. Our medical educators will be able to create a truly streamlined, ultra-efficient learning experience that allows more face-to-face experiences with patients and trainees alike.

So where is academic medicine headed beyond Flexner? Academic physicians will remain master artists, compassionate advisers, and a human face for the increasingly digitized medical experience.

Paul Bergl is an internal medicine physician who blogs at Insights on Residency Training, a part of Journal Watch.

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  • southerndoc1

    “Physicians will even receive feedback on their patient’s lives through algorithms that will process each patient’s data trail: how often they are picking up prescriptions, how frequently they are taking a walk, how many times they buy cigarettes in a month”

    How you them eggrolls, Mr. Goldstone?

    Count me out, both as patient and physician.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    What southerndoc1 said.

    Plus, if all goes according to this particular plan, computers will absolutely replace physicians, as we currently understand the term “physician”. Why would any computerized, algorithmized and fully tracked & analyzed patient need any face-time with a physician? Why would the medical robotics industry care very much if patients or doctors “crave” anything? We will not be in a position to “accede” authority.
    So we may still have a mass of electronically “educated” people attending to the computerized devices that track and treat the human subjects in this global laboratory, and they may still be called “doctors”, but they won’t be physicians.

  • Dave

    MOOC will undoubtedly be a game changer for preclinical classes in med school, and it can’t come fast enough. A number of top notch teachers have already made commercial products aimed at med students studying for board exams; it’s only a matter of time before teachers of similar quality start offering comprehensive classes in the preclinical sciences. The truth is that having 100 students come to a lecture is a woefully outdated mode of transmitting information, and that time could be better spent elsewhere.
    As for tech replacing physicians, my response to this has always been: computers will definitely replace physicians…..right after they replace patients.

  • J.L. Creighton

    “Physicians will even receive feedback on their patient’s lives through
    algorithms that will process each patient’s data trail: how often they
    are picking up prescriptions, how frequently they are taking a walk, how
    many times they buy cigarettes in a month.”

    No.

    Just, no.

  • J.L. Creighton

    “Noooo, they will not. So not. So so not. I’ll move on.”

    Amen.

  • guest

    If the Google generation of residents and medical students will hold all of the world’s knowledge in the palms of their hands, so too will their patients, since everyone can Google. In that case, why go to a doctor?

    I frequently ask the residents and med students to Google stuff as we are going on rounds and questions come up. About 80% of the time I am underwhelmed by the quality of the answers that Google (in their hands) provides. Another good chunk of the time I am amused by the looks of astonishment on their innocent little faces when I produce the answer before they can locate it on Google. So far I am not that impressed by technology producing a streamlined, or ultra-efficient learning process.

  • Shirie Leng, MD

    Afraid I have to agree with the prevailing winds of this comment stream. Your vision is pollyanna-ish at best. I’m afraid you might be right about all this technology coming, but don’t for a minute believe it will actually make anything any better for doctors or patients.