Health care’s tech renaissance during the pandemic [PODCAST]

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“Just as the pandemic has forced massive technology adoption in the delivery of care, we will see the rapid, widespread implementation of innovative solutions that medical education has desperately needed for years. Technologies like computer-based training, adaptive learning using artificial intelligence, video game-based learning, and extended reality such as virtual reality and augmented reality can close the educational gap. Virtual colonoscopies can be practiced 100 times before touching an actual patient. Many companies innovating in this space are seeing tremendous market interest in the wake of the pandemic. Most of these new technology-based educational tools can be used remotely, synchronously, or asynchronously, often without a teacher or proctor present. Although training will always require clinical experience, innovations at the bedside will also provide a major advantage over the traditional educational path. Hence learning can continue, and learning losses minimized. This is the way forward for most, if not all, institutions in the foreseeable future, and institutions that adopt these technological solutions will outpace those that resist.”

Eric Gantwerker is a pediatric otolaryngologist.

He shares his story and discusses his KevinMD article, “Health care’s tech renaissance during the pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Eric Gantwerker. He is a pediatric otolaryngologist, and he wrote the KevinMD article “Health care’s tech renaissance during the pandemic extends to medical training.” Eric, welcome to the show.

Eric Gantwerker: Thank you so much for having me. I appreciate it.

Kevin Pho: So we’ll get into your article a little bit, but first off, can you share your story and your journey to where you are today?

Eric Gantwerker: Yeah, absolutely. I grew up in Chicago. I went to undergrad at the University of Illinois. I actually was a chemical engineer before I changed into medicine, pre-med. I went to Rush Medical College in Chicago, then went on to residency in otolaryngology in Cincinnati, and then completed my otolaryngology fellowship training in pediatric otolaryngology at Boston Children’s in Boston.

Following my fellowship training, I actually got a master’s in medical education. My specific focus was on educational technology, educational research, and the cognitive science of learning and games. Out of that, I got some consulting opportunities in the technology space, and that’s sort of what brought me to today, where I split my time 50-50 between academic clinical practice and working for a technology company.

Kevin Pho: Excellent. Tell me some of the challenges that you had overcome to kind of move into that health care technology space as a physician.

Eric Gantwerker: Yeah, there was a lot. So number one, skill set. I wanted to expand my own skill set and try to learn more about the technology space, and specifically about educational technology. So the number one thing I had to do was expand that skill set.

The other was that there was a cultural obstacle that I had. In fact, one of the pillars in my own specialty, who I finally met, you know, he was one of the fathers of pediatric oncology. I met him at a dinner, and he asked what I did, and I said I split my time with a technology company and clinical practice. He said, “What a waste of your education,” and walked away. So there was definitely a cultural obstacle that I had to overcome in people who are like, “Why are you doing stuff outside of medicine? Why are you going into this other area?”

And so it’s been hard trying to split my time 50-50 between clinical practice and the technology company. Trying to balance that time and find mentors in that area has also been difficult.

Kevin Pho: How do you answer that question to people who question your commitment to medicine by having interests outside of clinical medicine?

Eric Gantwerker: Yeah, it’s a tough question. And I think, you know, you actually had a podcast with Akash Sharma and Amelia Bueche, who were talking about that three-legged stool. That three-legged stool used to be, you know, practicing medicine, doing education, research. I think that another leg of those stools is now interests outside of clinical practice. Number one, because of burnout, which was something that they talked about, but also because I think that there are opportunities that we have as physicians to provide to society, using our expertise in other areas outside of clinical practice or adjacent to clinical practice.

I think technology is one of those spaces where we can actually lead that discussion and actually try to bring our expertise to that world. Otherwise, it’s going to develop without us. And so usually my answer is we have an opportunity to make change in society for the better and for health care, and I’d rather be part of that discussion than be on the sidelines.

Kevin Pho: And what are some of the specific things that you did to expand your skill set into this technology space?

Eric Gantwerker: That’s a great question. So the first thing was, when I got my master’s, I had relatively open ability to sign up for classes that I liked and that I wanted to. And so I did go into the technology and innovation entrepreneurship-type space, and so took classes at the education school, the public health school. I took classes at MIT, also all sort of focused on educational technology and trying to understand that skill set better.

The other was opportunities that came to me. So the video game company that I work for now has rapidly expanded my skills and understanding of how video game psychology and technology can actually lend itself to education. And so I think understanding that, and just immersing myself in that world, and, you know, consuming all the content on augmented reality, virtual reality, and AI and medicine, and learning from other people in the medical health care digital space, has been really, really eye-opening for me and expanded my knowledge and skill set.

Kevin Pho: Great. So let’s transition now into your KevinMD article, “Health care’s tech renaissance during the pandemic extends to medical training.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Eric Gantwerker: Yeah. So one of the things that I started noticing was the immediate impact of the pandemic. Our hospital closed to anything elective, so we no longer had patients coming in for elective clinics or procedures, and basically everything was shunted over to taking care of acute care COVID patients. And so one of the immediate impacts was that patients didn’t have access. If you had some medical problem, you couldn’t just go see your doctor unless it was an emergency or COVID-related. The other was that the hospital revenue dropped off the cliff, because a lot of revenue is generated from those elective cases, from those elective procedures, and from seeing patients in clinic.

And you started to see telemedicine and telehealth really start to take hold. I saw some of my senior colleagues who were struggling with technology, and it sort of hearkened back to me thinking about education and how education could benefit so much more from technology. And so I sort of made that analogy with, OK, medicine has needed telemedicine, probably, in general, and it’s existed for many years, but we’ve never adopted it. Part of that was financial, and part of it was sort of that resistance to change and resistance to technology.

And so that’s what sort of got me thinking about this, and understanding how we can actually see the pandemic as a silver lining, to try and actually force technology adoption into an area that we were traditionally very slow to adopt.

Kevin Pho: So give us some examples of how you think technology can intersect with medical education.

Eric Gantwerker: Yeah. So I think the two biggest problems we’ve seen are the learning losses from lack of physical presence, in both knowledge and skills. From a knowledge standpoint, we see that didactics are now being removed to remote. So we see a lot of people leveraging teleconferencing. We see a lot of people using more collaborative-based software solutions, and even game- and software-based solutions, I think, are starting to try and fill that gap, both synchronously with other people as well as asynchronously. How can we create content that people can consume on their own without actually having to be co-located with a facilitator or actually with patients?

And then from a skill standpoint, we have this experiential learning loss of actual physical skills. And so again, we’re starting to see virtual reality, augmented reality, all these technologies where people can go in their home and practice these skills before they’re actually coming to see patients or actually performing the procedures in real life. We’re starting to see those really start to gain traction, and you can see these VR companies and these VR surgical companies really starting to explode, specifically during the pandemic.

Kevin Pho: Is there anything lost from an educational standpoint, virtual versus real life? Are there any studies comparing the two?

Eric Gantwerker: Absolutely. So we’re starting to see a little bit more of those. Right now, as far as the hype curve is concerned, we’re still very optimistic, and I think we’re going to start to realize where those technologies really excel. One of the problems has always been the mechanical aspect of surgery, and a lot of people have talked about the haptics, haptics being that physical ability to manipulate and feel force, perceive force, and the actual tactile feedback from the devices.

And so I think we still aren’t there yet. That’s probably what we would call the holy grail in simulation, trying to create that haptic feedback and that force feedback that you just can’t get with some of these technologies. But I still see a lot of huge opportunities, because if you learn a lot of the skills and know what to look for, then your brain can actually focus on the mechanical aspect of actually enacting that plan, and you don’t have to hyperfocus on everything all at once.

Kevin Pho: So right now, how many medical schools are using some of the technologies that you describe as part of their education? I know that there are some medical schools that have virtual gross anatomy labs, for instance, but how many of these academic facilities are using something like that, or even, like, training surgeons remotely?

Eric Gantwerker: Yeah. So training surgeons remotely, I’d say, is probably very, very few. I think a lot more people are trying to look at anatomy labs and seeing if we could actually use either synthetic materials, and there are actually some cadaver companies that are trying to make 3D-printed synthetic materials for dissection, as well as virtual reality. So places like Cleveland Clinic and Case Western are very well known for using one of the augmented realities for their anatomy courses.

I still don’t think we’re there yet, where we can completely replace them, but I do see more and more schools looking to add those types of experiences to enhance the learning, not necessarily replace just yet. So I would say the majority of institutions are looking to at least dip their toe in and see what the possibility space is. Very few, I think, have fully integrated into their curriculums.

Kevin Pho: So what do you see the next few years bringing when it comes to technology and medical education? What do you feel is the technology that’s closest to fruition, and what do you see as the technologies that are kind of further off?

Eric Gantwerker: Yeah. So I think right now, obviously, digital therapeutics are really starting to hit the ground running. We just had, obviously, a medication, or a game, prescribed for ADHD. So I think one of the things you’re starting to see very, very quickly is digital therapeutics and point-of-care solutions. One of the things that we’ll see in health care practice is that more of these decision support tools are going to be at the ready, and so we actually need to create curriculum and education around teaching people how to use those, right? So at what point do you use a decision support tool or one of these AI-enabled data repositories to help you actually practice medicine?

Probably one of the next biggest things is adaptive learning. We already see this with NEJM. So the New England Journal of Medicine has a solution where they actually use adaptive learning, which means that if you answer a question a certain way, it can actually detect whether you know that, how well you know that, and over a series of questions, it actually dynamically serves you content, so content is specific to your needs. So I think adaptive learning is probably the first and foremost that I would like to see involved more, and that we’re already starting to see more and more.

I think the robotics, we already see robotics definitely taking hold, and being able to do robotic bronchoscopy using a joystick, obviously, with the functional robotic surgery systems. All of those types of things, I think, are the here and now, and we can actually train residents and trainees on those actual devices. I also see software-based simulation really starting to take off. People are getting better at coding, at creating these software-based simulations, these patient simulators. I think we’ll see a lot more of those.

I think AI and big data is probably a little bit further off. We still don’t quite know how to use it. We don’t know how to use it in education just yet, but I think with software-based solutions feeding a lot of data back about our learners, we actually might get some really great insights into how people learn, how to be most efficient with how people learn, and using those adaptive learning platforms.

And then the last thing, I think, is extended reality, so augmented reality and virtual reality. We’re still figuring out how best to use those. I think those are still a few years out, because we still have people who are using virtual reality in, I would say, not the best way to leverage it for educational purposes. So we’re still trying to find our sweet spot with VR, and I still think that’s a few years out.

Kevin Pho: We’re talking to Eric Gantwerker. He’s a pediatric otolaryngologist, and he wrote the KevinMD article “Health care’s tech renaissance during the pandemic extends to medical training.” Eric, I’m sure a lot of listeners who listen to your story may be inspired to move into that health care technology space. What would you recommend their first steps be if they want to pursue that route?

Eric Gantwerker: I think that’s a great question. Really, when it comes down to it, you have to understand your own skill set. So for me, it was building out that skill set. You don’t have to get a master’s. You don’t have to go out and do a bunch of coursework. Even doing reading and getting yourself acquainted with what that space is, and where your own passions and skill sets lie. So, understanding my passion. My passion was education, my passion was educational technology, and building my skill set there.

The next step was actually finding either mentors or opportunities, so opening yourself up to those opportunities, thinking outside the box, being bold, trying to see where your skill set will allow you to leverage those skills that you just built. And I think one of the things we’re getting better about is building communities of physician innovators and entrepreneurs, and technology is a really strong component of that. And so, obviously, subscribe to different groups, start following different people, start reaching out.

One of the things that I’ve really learned in this space is that when you reach out to different people who are really high up in these organizations, who are also physicians, as a physician, they’re actually very willing to speak with you and mentor you. That’s been a huge surprise to me, that these people in these very high positions in technology companies are actually willing to share their expertise and their knowledge and be mentors. I think you just have to be the one to take that first step and reach out to them.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Eric Gantwerker: You know, as always, I say be bold, be innovative, and don’t accept the status quo. Try to be on the edge, trying to force technology and adoption in the future, and trying to think creatively about how we can solve some of these problems, and be a solutions expert. That would be my advice.

Kevin Pho: Eric, thank you so much for sharing your time and insight, and thanks again for being on the show.

Eric Gantwerker: Thanks so much for having me.

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