MEDICAL EDUCATION IN, AND FOR, AN EXPONENTIALLY CHANGING WORLD
CCME, Winnipeg, CANADA, April 30, 2017 My background
• A former teacher at all levels • A former consultant at the Boston Consulting Group • A thinker about k-12 and tech (7 books, 100s of articles and essays) • Coiner of the term “Digital Native” What I try to do
• See new perspectives • Spot trends early • Generate original ideas • Find solutions Key Caveats
• I’m from the U.S.
• I’m not a physician
But…
• I have a strong background & interest in science
• I know a lot about technology and K-12
• I do research
• I have original ideas The most diverse nation on earth?
Only 35 M, but a leader What you do is Incredibly important Medical schools in world: 1,935 Pop. (M) # Med Schools 1,388 China 130 1,343 India 219 326 USA 147 Canada: 17 schools 264 Indonesia 32 Brazil 84 211 4 in top 50 (top 4%) 197 Pakistan 34 192 Nigeria 22 12 in top 250 (top 13%) 165 Bangladesh 96 143 Russia 60 130 Mexico 40 My 4 escapes from death
Ruptured appendix (age 3) Torsion of Testicle (age 13) Prostate Cancer (age 51) Type II Diabetes (age 55) “The Epley Maneuver” used to treat benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals.
BUT NOW… You are in the center of enormous change We all live in a world evolving incredibly rapidly, and… No matter how fast, or how much, you think the world is changing, it is, in fact, changing faster, and more. AND… No matter how much you think we know, we are still only at the beginning Known part of universe (w/o dark matter/energy) 10% Cells in our body that are “human” (w/o dark DNA in biome) 5% Known amount about the brain
3% We live in “exponential times”
“It’s humbling” “Acquire …above all, the grace of humility.”
Sir William Osler (1849-1919) Let me cut right to the chase The medical world is on the cusp of really, really big changes
The state-of-the-art in medicine Is rapidly evolving— Forces of change are transforming education and health for both individuals and the system.
Dermot Kelleher, MD Dean, Faculty of Medicine The University of British Columbia There will be “radical transformations” in medicine in coming decades
Jeffrey Flier, MD Former Dean Harvard Medical School “Half of what we teach you during four years of medical school is going to turn out to be wrong or irrelevant by the time you graduate.”
Edward Hundert Dean for Medical Education Harvard Medical School
“The content of medicine will be turned on its head, because so much of what we don’t understand about diseases will be revealed ... It is a completely different medicine than we understand today”
— Larry Smarr, PhD UCSD & Calit 2
The preventive medicine of the 21st century is going to identify the earliest disease transitions and reverse them.
Leroy Hood, MD President and co-founder, Institute for Systems Biology
So we are clearly at the start of a huge transformation…
…yet we still have many places —and will continue to have many places— WITHOUT state-of-the-art
• Data • Knowledge • Equipment • Facilities • Practices • etc
Much of Our Current Medicine is:
Conservative and slow changing
Hierarchical
A lot more “data free” than many think
Full of people with “strongly-held opinions”
Research has documented the phenomenon of decreasing quality of clinical performance with increasing years in practice:
The more years of practice experience a physician has, the more out-of-date his or her practice patterns may be. Student Perspective:
“We are not on the cutting edge”
“The way they learned is what they expect of us.” Medical students GIVEN THAT
Current medicine Future medicine
Is our well-established Is exponentially different, system but still a few years off
AND We need to serve the old world as we move to the new ISSUE
HOW DO WE TRAIN DOCTORS
• For our current medical practice AND
• For the practice of the future?
A USEFUL TOOL?
Peter Hinssen’s
“DAY AFTER TOMORROW” FRAMEWORK WHAT WE EMPHASIZE NOW
TRADITION TODAY
DAY AFTER TOMORROW TOMORROW
Source: Peter Hinssen WHERE THE VALUE IS:
DAY AFTER TOMOR- TOMORROW ROW TODAY TRADITION
Source: Peter Hinssen Healthcare is going to the day after tomorrow faster than ever before.
--Peter Hinssen WHAT WE TYPICALLY DO IN REFORMS
TRADITION TODAY
DAY AFTER TOMORROW TOMORROW
Source: Peter Hinssen WHAT WE NEED TO DO
TRADITION TODAY DAY AFTER TOMORROW TOMORROW
Source: Peter Hinssen We need to simultaneously prepare:
“The doctor “The doctor of today of the day and after tomorrow” tomorrow” We need to simultaneously teach:
Current Future (Exponential) Medicine Medicine Why?
“…the next generation of patients will demand this.”
Oncologists working with Watson (per Ginni Rometty, CEO, IBM) How? DAY AFTER TOMORROW MEDICINE TECHNOLOGY is becoming exponentially more powerful
We can now collect, store and analyze orders-of-magnitude more data
Everything becoming information-based
SCIENCE is exponentially changing (tool-driven revolution)
We are beginning to understand:
• Flows and interactions • Patterns • Systems BIOMEDICAL SCIENCE is exponentially changing
New data, New devices, New tools Quantified self, scientific wellness, data flows, -omes
- Systems approach being applied to everything
Getting closer to understanding underlying mechanisms of disease and wellness What we KNOW is exponentially changing
Huge Shifts in Perspective Huge Shifts in Information Deep Shifts in Understanding Of disease and wellness Genomics Humans Transcriptomics Proteomics are a Metabolomics Co-species Epigenomics Phenomics Exposomics What we can MEASURE, STORE and SEE is exponentially changing
Sensors Storage “Insidables” Dense dynamic data clouds Dashboards WHAT WE CAN DO is exponentially changing
Predict Prevent Personalize
The VISION of MEDICINE is exponentially changing
It’s NOT just the digitization of existing medicine, but
A NEW DIGITAL WAY The VISION of MEDICINE is exponentially changing
“a completely new digital care delivery system … unfettered by the analog framework of our past.”
— Stefan Bini, MD The VISION of MEDICINE is exponentially changing
“a better process that does not look like the current process of medical care.”
Isaac “Zak” Kohane, MD Head, Biomedical Informatics Harvard Medical School The VISION of MEDICINE is exponentially changing
“Multidisciplinary, with computational experts, genetic experts, clinicians working in a team to create qualitative – or quantum – differences in care.”
Isaac “Zak” Kohane, MD Head, Biomedical Informatics Harvard Medical School But wait… There’s more! The MEDICAL CARE PARADIGM is exponentially changing
From individuals:
Patient MD Care To teams: Medical Family Friends Care Team Technology Payer
MD Patient CARE
Other Health Hospital Professionals Employer Industry Profound Shifts in Medicine
Individual Team Capturing little Capturing everything Unusual cases highlighted/studied All cases available Private data Shared data Educated Guessing Precision Reactive Proactive Populations Individuals Averaged Personalized Disease Wellness and disease Data & monitoring Intermittent Data and monitoring continuous All in person Much remote Acute case treatment Early Prevention & Reversal Long lab to bedside time Quick lab to bedside time Treating proximate causes/symptoms Treating Deep Underlying Causes 55 percent wrong treatments Very few wrong treatments By hand By machine
Profound Shifts in Doctoring Autonomous Team “Shut up” Patient whisperer/coach Strong opinions tightly held Strong opinions weakly held Med school as event Med school as process Educated Guessing Precision Reactive Proactive Populations Individuals Averaged Personalized Disease Wellness and disease Data & monitoring Intermittent Data and monitoring continuous All in person Much remote Acute case treatment Early Prevention & Reversal Long lab to bedside time Quick lab to bedside time Treating proximate causes/symptoms Treating Deep Underlying Causes 55 percent wrong treatments Very few wrong treatments ”Art” and “Craft” Information driven By hand By machine Individual diagnoser and treater Executor of consensus strategy Solver of clinical problems Finder of clinical problems Applied scientist Patient coach to wellness Care giver Relator Center Periphery NOW WITH… MEDICAL INFORMATICS GOALS 1. To create an information commons of heterogeneous data that will be useful to researchers, doctors and patients
2. To improve diagnoses and treatments, e.g. improved automated diagnosis systems to Generate new models of diagnosis. remove subjectivity of clinical interactions.
3. To reimagining the clinical encounter, with just-in-time data and decision support
4. To connect all the –omes
5. To train doctors to ask relevant questions
Medical students need to be just as adept in advanced computing and data analysis as in biology and patient care.
Chirag J Patel, PhD Assistant Professor Department of Biomedical Informatics Harvard Medical School INFORMATICS POP QUIZ (JUST ONE QUESTION)
“If a test to detect a disease whose prevalence is one in a thousand has a false positive rate of 5 percent, what is the chance that a person found to have a positive result actually has the disease?”
2 percent
The test will yield 50 false positives in a population of 1,000, but only one patient will actually be ill—so a positive test result would mean that a patient has only about a 2 percent chance (1: 51) of having the disease.
More than three-quarters of the respondents in the study got this wrong. The most common answer was 95 percent. AND… It’s all getting faster — exponentially
Knowledge discovery Drug discovery Knowledge acquisition (Watson) Genome Sequencing Time to test (cont’s monitoring) Clinical Trials Time to tools/improvements Diagnosis Time to reach patient (telemedicine) Doctor Access Time to cure Lab to Bedside Speed of collaboration (J. Mattison) Time to Recovery
Medical school? (3 yrs) And there’s even more! People are Changing too!
There are lots more of them!
They’re increasingly digital natives, with new attitudes, new relationships to tech, & different expectations Digital Natives: Kids who want to be doctors
• Different experiences • Different relations to technology • Different expectations about doctoring Digital Natives: Medical Students
“I grew up hands-on & instantaneous. We’re so used to getting our hands dirty and getting it right away.”
— First year medical student Digital Natives: Doctors
• Want all information continuously • Resent having to do anything that should be automated • Need their screens, (and hone their “screenside manner”) Digital Natives: Patients • Want more information (and find it) • More willing to collect data • More willing to share their data • More interested in participating in their own care • Don’t accept “we can’t” Digital Natives: Patients
More empowered, informed, “datafied” & technology dependent
increasingly demanding Digital Natives: Patients
“Today, the best predictor of a doctor ordering a genetic test is knowing whether the patient asked for it.”
Kyu Rhee, MD Chief Health Officer IBM Watson Health
And yes, there’s more!
FUTURE New Social Values are coming
Social Values are Changing:
• From accepting “best efforts” to demanding state-of-the-art
• From sick care to well care and prevention • From “people who may be like me,” to me • Toward less concern about privacy
People will be willing to give up privacy in exchange for medical services that tell you the first day cancer cells start spreading in your body.
— Youval Harari Homo Deus: A Brief History Of Tomorrow
We have a generation of people who are not hindered from the past and can think aloud and very openly about what the future can bring to them.
— Stefan Bini, MD “…the next generation of patients will demand this.” So what are medical schools doing in the face of all this? Canadian and U.S. Medical Schools are
• Creating new curricula and ETA’s • Changing pedagogies (Team-based, Flipped, CBCL) • Creating mixes of pre-clerkship & clerkship • Adding clinical from day 1 • Adding scholarly research • Changing admissions policies • Shortening the total time But is it enough? a lot of [medical school] curricular reform is like shifting the chairs on the Titanic .
-- Richard Schwartzstein Gordon Professor of Medical Education Harvard Medical School “we are doing them all together, and in an amazingly integrated sort of way.”
-- Edward Hundert Dean of Medical Education Harvard Medical School “The essence of this reform is giving students the tools to think differently.”
-- Richard Schwartzstein Gordon Professor of Medical Education Harvard Medical School YES, BUT… WE NEED BOTH
Current medicine Future medicine
Today and Tomorrow Day After Tomorrow All those changes are for
Today and Tomorrow
And NOT for
THE DAY AFTER TOMORROW
e.g.
Tomorrow = Patient-centered Care
Day After Tomorrow = True Patient Centricity Is anyone teaching Day After Tomorrow Medicine? EXAMPLES
Launched new “Foundation” curriculum + U of T: “We’re making changes to prepare students for the practice of medicine in the 21st century.”
Launched new “Pathways” curriculum w/CBCL + Harvard: New Medical Informatics Department
Launched new “Presence” Initiative + Stanford: “Leading the Biomedical Revolution in Precision Health” AND IT’S NOT JUST THE “TOP” SCHOOLS
e.g. Thomas Jefferson University (Philadelphia)
Curriculum, Pedagogy, Patients + Admissions Entrepreneurship Holistic AFMC
THE FUTURE OF MEDICAL EDUCATION IN CANADA (FMEC)
• collective vision for reform and innovation in undergraduate medical education
• collective vision for reform and innovation in post- graduate • • continued professional development (now underway). AMA
"ACCELERATING CHANGE IN MEDICAL EDUCATION” Initiative 32 schools comprise the AMA's Accelerating Change in Medical Education Consortium
ChangeMedEd™ 2017 National Conference “Creating the Medical School of the Future”
Chicago, Sept 14-16, 2017 US$ 415. WHAT WE NEED TO DO
TRADITION TODAY DAY AFTER TOMORROW TOMORROW
Source: Peter Hinssen What will the “Task of the Doctor” be in the future? Yesterday and Today’s Task: “Solving Clinical Problems”
“That’s the task of the doctor — solving clinical problems”
-- Richard Schwartzstein, MD Gordon Professor of Medical Education Harvard Medical School Tomorrow’s Task:
“Solving Clinical Problems”
“Patient-Centered Care” Desirable traits of physicians:
- Make good decisions for their patients: smart and knowledgeable, willing to learn and change their practice with newly acquired knowledge, develop better ways of treating patients.
- Relate well to their patients: Communicate well and understand the cultural context in which care is given, AND advocate for their patients!
-- Gabriel Garcia, MD Associate Dean of Admissions Stanford Medical School Day After Tomorrow’s Tasks?:
“4P Medicine” (Predictive, Preventive, Personalized & Participatory)
“Scientific Wellness”
“’Scientific wellness’ is an utterly major thrust that has been previously completely ignored.”
Leroy Hood, MD President and co-founder, Institute for Systems Biology
ANOTHER
PERSPECTIVE Yesterday
MD Today and Tomorrow
MD Day After Tomorrow
MD Doctor as Interface
c3po Doctor visit of the future? Will we Always need a person in there? “The role of patient coach will never go away”
Leroy Hood, MD President and co-founder Institute for Systems Biology
“The new drug is the empowered clinician.”
Daniel Kraft, MD Exponential Medicine Singularity U. But there’s even more FUTURE we can do!
MEDICINE Given the changes that are coming… …in addition to:
• Creating new curricula • Changing pedagogies (Team-based, Flipped, CBCL) • Creating mixes of pre-clerkship &clerkship • Adding clinical from day 1 • Adding scholarly research • Changing admissions policies • Shortening the total time
We can do more, Institutionally and personally LESSONS FROM
• K-12 • Tech World + RECOMMENDATIONS
LESSONS FROM K-12 (1)
• We select our teachers on the wrong criteria • We train them to do the wrong things and give them useless information to teach • We overemphasize testing and teach to the tests • We have the wrong concept of our students • We have the wrong goals for our students LESSONS FROM K-12 (2)
1. Future focus is more important than current focus. If you know what the future looks like, and you don’t focus on getting there you waste a lot of peoples’ time and money
2: Relationships are far more important than content. AND personalized is always better (personalized on what, not how) 3: The “secret sauce” is T.R.I.C.K.: “Trust, Respect, Independence, Collaboration & Kindness” LESSONS FROM THE TECH WORLD
1. Speed up! + Revise & iterate continuously (Tech brings out new features daily, new products every 3 months; Harvard’s curriculum revisions took 3 years)
2. Be evangelists for the future, not the past
3. REQUIRE technology: Make candidates master ALL simulations; Video EVERYTHING MY OWN RECOMMENDATIONS BE READY TO CHANGE
• strong opinions — but weakly held.
• “Extend AND abandon”
ASK
Are we maximizing our new students’ capabilities? Or forcing them into an old mould?
What can/should my students be teaching me?
LEARN
Am I learning about / focusing on / teaching
PRECISION (4P) MEDICINE:
Predictive, Preventive, Personalized, Participatory
LEARN
How much do I know about / how comfortable am I with MEDICAL INFORMATICS? Do I spend part of my time learning more on a regular basis? How does it apply to what I do/teach? What informatics have I included in my curriculum and teaching? How could I learn/include more?
INNOVATE
Am I thinking about innovating for BOTH Today and Tomorrow medicine and Day After Tomorrow medicine ?
(i.e. am I thinking BOTH incrementally and disruptively)?
COMBINE
TODAY AND TOMORROW and DAY AFTER TOMORROW in everything you do
DELETE
Saint Louis University (SLU) School of Medicine found that certain courses, particularly anatomy, biochemistry, and cell biology, either contained unnecessary details that were not of particular clinical importance, or had redundancies that could be folded into other courses. By eliminating this material, SLU was able to reduce the length of the first two years by ten weeks. GET REAL
Do my students interact only and frequently with real patients (e.g. via remote)
From day 1?
MAKE VIDEO UBIQITOUS
Video every medical encounter:
- patient POV - MD POV - Rounds - Nurses - Other medical professionals - Procedures
We’ll need to resolve privacy issues (police bodycams) WATCH
How often do I watch online videos (at 2x) to find the latest about Day After Tomorrow medicine?
MAKE
What videos have I made relative to Day After Tomorrow medicine? E.g.
Concepts? Details? Cases? What else can I video?
ASK
Have I added the “though the patient’s eyes” factor?
Used it for evaluation?
ENCOURAGE
How much do I encourage my students to think about Day After Tomorrow Medicine?
Is it only extracurricular?
Does a large part of what I think about and do prepare students for exponential future medicine? CARE & ACCELERATE
How much do I personally care about accelerating the arrival of Day After Tomorrow medicine?
Do I do anything —consciously or unconsciously —to stand in its way?
SPEED UP
How can I contribute to speeding up Today and Tomorrow medicine, so that we can have more time for Day After Tomorrow medicine?
Do I totally re-think (and re-design) my courses / supervision every year in light of new developments? INTEGRATE
Am I teaching students “screenside manner” along with “bedside manner”
Am I working to better integrate science, clerkship and Day After Tomorrow medicine?
EMULATE
Ask “Who in my field is more future-oriented than I am?
Who can I /should i emulate?
Can I use their approach / material? I SELF-EVALUATE
Where can I add value relative to Day After Tomorrow medicine? What can I add that my students can’t learn on their own?
What is the value that I as an individual can bring, and how can I share that widely?
MOVE FORWARD
What have I personally done toward making the medicine I teach more preventive, predictive, proactive, personalized and participatory?
What have I done towards teaching/incorporating precision medicine?
EXTEND MEDICAL EDUCATION
Downward Upward
Pre identify, pre-admit Fix & add to CME candidates (HBS-like)
Have them come in knowing the science; Pass Part 1 boards before Make CME enrolling? part of degree
Anatomy, physiology to (e.g. every 2 yrs) Elementary / middle school? Pathology to High School? Limit term of MD degree Let kids watch in real time (or video) If no real ed. NB: Kids can now manipulate genes
EXTEND
Am I thinking about how to extend pathology differential diagnosis etc. downward to high school?
Am I helping extend anatomy, physiology, in elementary school? CREATE CHANGE AGENTS
Create “change agent doctors” —
with armor against co-optation
ASK
Am I preparing my students to be MEDICAL CHANGE AGENTS i.e. to stand up against—and work to change— the existing bureaucracy and system?
With what strategies?
Is there a new “hidden curriculum” here?
This extent of change has never been seen before No coping strategies Things change before we’re ready We may already be missing the boat
Profession & System demands
Science Patient demands MD demands
Information demands If physicians are not already overwhelmed… They soon will be! Doctors need a lifeboat !
Our lifeboat = technology THE FEAR:
Humans need to merge with machines to remain relevant
— Elon Musk ??
PERSPECTIVE
A DIFFERENT
Medicine as a whole is now a knowledge-processing business [in service of patient care]
Isaac “Zak” Kohane, MD Head, Biomedical Informatics Harvard Medical School Machines are improving exponentially to help with much of what we do, i.e.
Biomedical research Patient History & monitoring Differential diagnosis Drug discovery Treatment Surgery Monitoring/Follow-up "Over time I think we will probably see a closer merger of biological intelligence and digital intelligence"
— Elon Musk IBM:
Not replace, augment IBM’s WATSON
MSK, Mayo Clinic et al. now using it — would you go to an Oncologist without it?
Now trying to get into medical schools (med schools: “watchful waiting”) Opportunity to train it!
7 Things to take away from this morning Change is coming faster and going further than you think We need to teach
Current Future and (Exponential) Medicine Medicine
simultaneously Focus reforms on The Day After Tomorrow See technology as your lifeboat Iterate like crazy VIDEO EVERY INTERACTION! EMULATE c3po, i.e. relate equally well to tech and people Good Luck, Master Docs! Tricorder x-prize ($2.2 M) Awarded to Final Frontier Medical Devices
for a device that can diagnose 90% of ER situations at home
April 15, 2017 Live long and prosper!
àâéèêîôçùû ÀÂÉÈÊÎÔÇÙÛ ê àâéèêîôçùû ÀÂÉÈÊÎÔÇÙÛ
Boards
Medical school quality depends on nat’l boards
Student – will doing something new affect my board scores?
Things needed to pass the boards only a subset of medical knowledge VIDEO
Booths in every office and hospital?
Two way – you tube responses
Bedside manner, magic words, tricky things, unusual diagnoses
Games (cyber rounds) I don’t want to practice the medicine I learned 30 years ago. I want to practice the medicine of today
Gabrial Garcia, MD Stanford Medical School For a variety of reasons—some out of reasonable caution, but some out of institutional inertia–medicine has been slower than other disciplines take advantage of the new insights and the new productivity that you can get through data science process automation.
Isaac “Zak” Kohane, MD Head, Biomedical Informatics Harvard Medical School Stephen Moorman Problem-based, team-based, flipped still not uniformly accepted
We teach what we were taught, what we’ve always taught. We have no option.
Gradual transition to asking all qs w/in a clinical context. Scenarios w/in lectured
3 mos 10 K questions to prepare for boards
Med students not good at organizing what they memorized in a logical way Memorizing OUR approach to diagnostics
Now: Predicting the weather 4 days after it happened. Stephen Moorman (2) Fear that Watson will replace thinking, nurses will replace doing
Is there a simulation of bedside manner? Of screen-side manner?
Maniquins better with sound turned off.
OSCIs (actors) Objective structured clinical exams
Vets Horses- Equine pgmes for diagnosis Pediatric neurology, companion animals for therapy
VR-not well accepted – not going to result in higher board scores. Best predictor: 1st yr gross anatomy grade
Students not tracked after graduation ( we do track patients’ health, compliance
shadow Shadow shadow Much in the medical world is changing—exponentially 17 Canadian Medical Schools
School City Class size 1 University of Saskatchewan College of Medicine Saskatoon 83 2 Université Laval Faculté de Médecine Québec City 201 3 McGill University Faculty of Medicine Montréal 185 4 Université de Montréal Faculté de Médecine Montréal 281 5 Université de Sherbrooke Faculté de Médecine et des sciences de la santé Sherbrooke 6 McMaster University Medical School Hamilton, Waterloo, St. Catharines 203 7 Northern Ontario School of Medicine Sudbury, Thunder Bay 64 8 Queen's School of Medicine Kingston 100 9 Schulich School of Medicine & Dentistry London, Windsor 171 10 University of Ottawa Faculty of Medicine Ottawa 164 (116 English Stream, 48 French Str.) 11 University of Toronto Faculty of Medicine Toronto, Mississauga 259 12 Dalhousie University Faculty of Medicine Halifax 110 13 Memorial University of Newfoundland Faculty of Medicine St.John's 80 14 University of Manitoba College of Medicine Winnipeg 112 15 University of British Columbia Faculty of Medicine Vancouver, Victoria, Prince George, Kelowna 288 16 University of Alberta Faculty of Medicine and Dentistry Edmonton 162 17 Cumming School of Medicine Calgary 157 Paradigm changes are hard to achieve because most scientists are incredibly conservative and are unwilling to give up what they learned early in their career AAMC https://www.aamc.org/initiatives/meded/meded_initiatives/
The Core Entrustable Professional Activities for Entering Residency
AAMC Project on the Clinical Education of Medical Students
Can medical training be
more parallel, more life-long, and more just-in-time? What changes are coming bottom-up (vs. just top-down)?
What about boards when Watson can pass?
“MCC Assessment Evolution initiative” WATSON Reads and understand English
Learns ( on own & w/training by MDs)
Speed: all patient records, all texts all journals in minutes
Augment, not replace
WATSON Not optimistic about medical schools
Requires training by MDs
Precision searches: right article to right MD at right time
Stratification of treatment options
Learns WATSON Began with oncologists
In use at MSK
Most contracts B2B
Member of the team?
Understands, reasons, learns
WATSON A problem that took six months the patient almost died. Watson was fed the same information but the doctor had. The three top answers where the same, But the fourth was the eventual diagnosis. I’m the doctor said if I’d have that information I would’ve tried to rule it out. WATSON
“ the amount of information that is being generated … is outstripping the ability of the professionals to consume them” shadow Shadow 44 Learning objectives:
1. To challenge todays status quo for medical education in the face of exponential change
2. To address the increasingly difficult challenge of "keeping up”
3. To help adapt to the new generations of patients and doctors Learning objectives:
1. Challenging the status quo about how we think about medical education 2. Being in the profession of keeping up 3. Dealing with the new generation of doctors and patients àâéèêîôçùû ÀÂÉÈÊÎÔÇÙÛ ê àâéèêîôçùû ÀÂÉÈÊÎÔÇÙÛ MY OWN RECOMMENDATIONS
1. Be ready to change: Have strong opinions — but weakly held. “Extend AND abandon”
2. Learn about / focus on / teach Precision (4P) Medicine: Predictive, Preventive, Personalized, Participatory
3. Think / do “TAT + DAT” in everything
4. Create “change agent doctors” — with armor against co- optation