medicine x | ED

Li Ka Shing Center, Stanford University
April 22-23, 2017

Saturday from 8am-6:30pm

Sunday from 8am-4:10pm

Join us on our livestream here!

keynote speakers

ERIK BRODT, Assistant Professor of Family Medicine, OHSU

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Erik grew up near Chippewa Falls, Wisconsin and spent summers with family in the rural areas around Bemidji, Minnesota. Erik received the 2015 Board of Regents Diversity Award from the University of Wisconsin–Madison for his dedicated service to the Native American communities in Wisconsin as an advocate, teacher and scholar. He established the Native American Center for Health Professions (NACHP), to improve Native health and wellness by increasing Native voice across all elements of health professions, in 2012 at the university.

Native presence at UW-SMPH increased by over 800% and Native American applications increased by over 250% during Erik’s tenure at the university.

Dr. Brodt returned to the Pacific Northwest in 2015 as a faculty member at OHSU. In addition to caring for patients, Dr. Brodt is currently PI on a program to improve Native American Health outcomes and develop Native American Health Professional training programming at the university.

S. CLAIBORNE “CLAY” JOHNSTON, Dean, Dell Medical School

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Clay Johnston is the inaugural Dean of the Dell Medical School at The University of Texas at Austin. His ambitious vision includes building a world-class medical school by creating a vital, inclusive health ecosystem that supports new and innovative models of education, health care delivery and discovery – all with a focus on improving health and making Austin a model healthy city. Clay is also a Neurologist, specializing in stroke care and research. He was formerly at the University of California, San Francisco where he served as Associate Vice Chancellor of Research and founding director of the Center for Healthcare Value. Clay is a graduate of Amherst College, completed medical school at Harvard University and received a PhD in epidemiology from the University of California, Berkeley.

NEHA SANGWAN, CEO and Founder, Intuitive Intelligence

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Neha Sangwan, MD, CEO and founder of Intuitive Intelligence, is an internal medicine physician, international speaker and corporate communication expert. Her private practice and corporate consulting focuses on empowering individuals, organizational leaders, and their teams with the tools for clear, effective communication. She addresses the root cause of stress, miscommunication, and interpersonal conflict, often healing chronic conditions such as headaches, insomnia, anxiety, and depression.

She is the author of TalkRx: Five Steps to Honest Conversations that Create Connection, Health and Happiness.

DAN SCHWARTZ, Dean of Stanford Graduate School of Education

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Dan Schwartz, Dean of Stanford University Graduate School of Education will give the opening keynote at Medicine X | ED on April 22, 2017.

A member of the Stanford faculty for 15 years, Schwartz oversees a laboratory that develops teaching and learning technologies. His extensive teaching background in diverse settings includes years spent teaching reading and math to adolescents in urban and rural communities. Among many honors, he was named Graduate School of Education Teacher of the Year for 2015.

Schwartz holds the Nomellini & Olivier Professorship in Educational Technology at Stanford. With his lab, he has designed numerous computerized instructional tools, including teachable agents, choice-based assessments and a pre-school mathematics program called Critter Corral. He is the author of numerous landmark papers on the transfer of learning and the role of perception in higher-order cognition. His most recent book translates the science of learning into practice, The ABCs of How We Learn: 26 Scientifically Proven Approaches, How They Work and When to Use Them.

program overview

Gaps in medical education focus on recognizing, identifying and addressing issues important to advancing the unmet needs of todays educators and students. These might include topics such as underserved communities in healthcare, mental health issues in medical education, patients as educators, cost transparency in health care, bridging data with storytelling in medical education, reducing preventable harm and improving patient safety, interdisciplinary learning and lifelong learning and rethinking continuing medical education (CME).

LEARNING LABS

These 45 minute classroom sessions provide presenters an opportunity to lead a group of learners through a “how-to” style tutorial on novel teaching methods that incorporate thoughtful use of technology to engage the Millennial learner.

Bedside Education in the Art of Medicine (BEAM)

 Margaret Chisolm

Medical educators are challenged today as never before to help learners develop into humanistic clinicians. Advances in science and technology have illuminated the molecular and genetic underpinnings of many disease processes but have not led to a concomitant understanding of the humanistic and personalized aspects of illness.

Changes in healthcare delivery models are transforming both inpatient and outpatient clinical practice, leading to shorter inpatient stays and greater emphasis on ambulatory care, which frequently is fragmented. The electronic health record is a repository of information but creates additional barriers between doctor and patient. Although the patient is at the center of every clinical encounter, the complexity of medical practice today often leaves patients feeling that their doctors do not know them as individuals. In addition, physicians-in-training tend to experience a reduction in empathy towards patients as their clinical training progresses.

One didactic approach demonstrated to be effective in helping medical students deepen understanding of the human condition and retain empathy is reflective practice. While reflective writing is the most frequently used method to promote introspection and deeper consolidation of new ideas among students, there is robust evidence that other art forms such as storytelling, dance, theatre, music, literature and the visual arts – can also help deepen reflection and understanding of the human aspect of medical practice.

We are developing an arts-based humanities medical education smartphone app (BEAM) to be used by clinical teachers to broaden learners’ understanding and shine a light on what it means – for patients and clinicians – to be human, live well, experience loss, encounter disease, and engage in a therapeutic relationship. BEAM will be a modular, online resource that a clinical teacher in any location will be able to access to deliver brief, focused, and humanistic patient-centered teaching in either hospital or ambulatory care settings.

Content will be drawn initially from an online collection of essays on “Art and Images in Psychiatry,” as well as poetry and music collections contributed by expert clinicians. With time, arts-based content from other sources will be added (e.g., crowd-sourced) and rated by a global community of medical educators.

All modules will include brief, focused discussion questions designed to spark reflection on the meaning of a particular patient’s condition. In this 60-min session, we will lead a group of learners through a “how-to” style tutorial – using offline content for the app – to show how BEAM will be able to engage the learner.

The session will consist of 1) 10-min intros/goal-setting, 2) 10-min overview of BEAM, 2) 20-min of small group activities around arts-based content (visual and literary content with reflective prompts), 3) a 15-min debrief of small group experiences, and 4) a summative 5-min individual reflection writing activity

Preparing medical students as leaders in innovative care: Curriculum redesign for quality in health systems

Elizabeth Baxley, Tim Reeder and Donna Lake

Medical students must be trained differently if they are to contribute to meeting the societal goals of better care, better health, and lower cost for all — the Triple Aim. A key success factor for the magnitude of curricular change is the presence of incorporating new competencies (Patient Safety (PS) /Quality Improvement (QI), Team & Health Sciences Delivery) and applied clinical experiences for the doctor of tomorrow. The leaders of tomorrow’s health care systems will need to be skilled in how to create optimal care environments utilizing effective leadership skills and interprofessional care teams during QI activities within health systems.

Curricular transformation is needed to help future physicians be better prepared to meet the challenges of a complex and rapidly changing healthcare system. Leaders In INnovative Care (LINC) Scholars, is a longitudinal program of advanced study in health systems science (HSS) for competitively selected medical students designed to bridge this gap in medical education. This program includes an M1 summer program and longitudinal experiential learning throughout medical school, utilizing academic faculty from a variety of health professions training programs, health system leaders and patients and families to provide focused, longitudinal training in advanced health system science competencies. Clinical exposure, classroom and applied experience led to proficiency in patient safety (PS), quality improvement (QI), population health and interprofessional team-based care. LINC emphasizes leadership and change management skills through clinical systems level experiences.

Commitment to students was obtained from medical school and hospital leadership. The course emphasizes person-centered care, leadership, QI principles, economics, and change management skill development. Conceptual foundations are provided through enhanced clinical exposure, readings, small group discussion, and team-based care. Patient navigation, mentored QI projects, leader interviews, clinical observations, and determinants of health “windshield tour” provided experiential learning.

Preliminary data showed a significant increase in PS/QI knowledge. Post course critiques reported improvements in overall understanding of HSS; identification of outcome measures and data tools for change projects; financial impacts on health systems; leadership attributes; and the ability to lead a QI group. Long-term evaluation will focus on increased skills and contribution to QI in the health system. All participants contributed to ongoing quality improvement activities at the health center and scholars have presented their scholarly work. Qualitative interviews were performed and identified that foundational learning through enhanced real world clinical experiences were critical for learning.

The LINC model provides comprehensive, interactive training in HSS competencies such as impact of medical errors, assessment of systems of care, and the ability to lead interprofessional teams to create reliable and safer healthcare environments. Students contributed to ongoing quality improvement activities at the health center. They created and led interprofessional learning sessions throughout the campus and will complete a Capstone Practicum leading to graduation with a Distinction in Health System Transformation and Leadership. Scholars indicated that foundational learning through enhanced clinical experiences and application in real world situations was critical for learning. Substantial faculty and institutional commitment for both design and execution of the program was required.

PANEL

These 45 minute panel sessions provide an opportunity to engage in a discussion around novel topics of medical education. We encourage panels that are composed of Everyone Included™ stakeholders (e.g. learners, educators, interdisciplinary contributors, patients and caregivers when possible).

The wellness think tank - improving physician wellness and resiliency in emergency medicine

Nikita Joshi, Michelle Lin, Adaira Chou, Christopher Doty, Nicole Battaglioli and Arlene Chung

The issues of wellness, burnout, and resiliency have recently got much more attention across nearly all health professions. Emergency Medicine (EM) specifically was singled out as one of the specialties with highest risk for burnout at >60%. Recent studies suggest that burnout may erode professionalism, influence quality of care, increase the risk for medical errors, and promote early provider retirement.There has been much discussion around the general “UN-wellness” of clinicians, and we now feel that there is a dire need for action. As a response to this need, we have launched the Academic Life in Emergency Medicine (ALiEM) Wellness Think Tank. The Wellness Think Tank is a private virtual community comprised of EM residents across North America and leaders in wellness, like Jason Brooks, PhD who is a Peak Performance Coach and Strategist. Our umbrella vision of improving physician wellness has helped us to secure funding and sponsorship from individual donations and vested organizations such as US Acute Care Solutions. The issues we address through virtual discussion, strategy development, and consensus building include: suicide prevention and burnout, best practices in clinical work scheduling, litigation stress, imposter syndrome, and performance psychology.

We have developed a dynamic and varied curriculum with multiple facets. Some of our specific tracks are working to create a “best tech” list of apps and other technologies that can improve individual wellness and develop an inventory of best practices to emphasize wellness in residency training programs. We also aim to provide exposure to various techniques that can be used to improve well-being, such as mindfulness, meditation, performance psychology, and positive psychology. Through interactions with our wellness experts we will engage in important conversations about recognizing colleagues at risk, bullying and disruptive behavior in medicine, and physician mental health as a whole.

Our ultimate goal is to create a culture of wellness within Emergency Medicine so that we may prevent burnout, depression, and perhaps eventually physician suicide, which has plagued our vocation and negatively affected patient care. With our panel, we will bring together the stakeholders of educators, industry, and patients who have been involved with the creation and sustenance of the Wellness Think Tank. We will share our experiences and lessons learned.

Joining forces to improve the gap in caring for the military-connected

Anita Navarro, Steven Haist and Henry Klapholz

Joining Forces (JF) is an initiative led by First Lady Michelle Obama with the aim to improve the education, employment and wellness of military members, veterans, and their families. JF has become an example of how a national initiative can create timely educational interventions and ultimately improve patient care by leveraging collaboration across national health care education associations, medical licensing organizations, medical schools, and federal agencies. This session will discuss how various stakeholders have worked to educate and assess learner competencies related to improving the health of those who serve and addressing gaps in caring for this patient population.

WORKSHOP

These longer 45 minute sessions provide presenters with an opportunity to delve deeply into a topic to share unique expertise with a diverse group of passionate Medicine X | ED delegates. Workshops are limited to a maximum of 30-35 people.

Inspiring physician leadership

Doug Skrzyniarz

Whether they know it or not, aspiring physicians will all be leaders one day. As health care providers, inter-professional team members, amongst their colleagues, employees, and in their community, physicians will serve as leaders to thousands of people throughout their life. The question is whether they will be an effective or ineffective leader.

Medical schools across the country and world are incredible learning institutions to train our future physicians. Virtually all of this instruction is focused on scientific content. 7 years ago, I created a program at the Wayne State University School of Medicine to help inspire leadership development. Initially titled “Medicine and Political Action in the Community (MPAC” and now titled “Leadership and External Affairs Development (LEAD),” LEAD is the only program in the country that provides formal leadership development training, instruction on health policy and politics, advocacy skill instruction and practicum training.

The objectives of LEAD include providing a basic introduction on leadership development & external affairs areas including government relations, community affairs, philanthropy, healthcare finance, and public/media relations; provide a basic understanding of health care policy reform & health disparities; instruct on effective advocacy strategies and techniques; and provide real world advocacy opportunities including organized medicine resolution writing and a Lansing advocacy day.

The goals include inspiring transformational physician and community leaders; creating lifelong advocates for their patients, community and profession; and creating lifelong supporters of the importance of external affairs.

The program holds 18 lectures per academic year. The lectures are a mix of formal faculty and notable guest lectures. The students also participate in a day-long advocacy practicum in Lansing where they put their learned advocacy skills to work.

LEAD started with approximately sixteen 1st and 2nd year students and has grown to approximately 100 per year. The program has become an opportunity for medical students to learn how they can affect the community around them, channel their propensity to improve population health outcomes, and begin their transformational leadership journey.

The LEAD program has been a welcome addition to our curriculum. However, I strongly believe all medical schools across the world should in incorporate formal leadership development and advocacy training. The premise for all medical schools is that we are not just training physicians…we are training physician leaders.

The presentation would include a conceptual explanation of the program, how it is organized, why it is important, what the long term impact may be, and a “tool kit” description of how any medical school could develop such a program.

Competencies, milestones and entrustable professional activities – a perfect match

Adrian Philipp Marty, Pedro Paulo Tanaka, Aileen Marie Adriano and David Creighton

Entrustable Professional Activities (EPAs) are tasks or responsibilities that faculty entrust to a trainee to execute and those are executable within a given time frame; observable and measurable; and suitable for entrustment decisions. EPA’s are an assessment framework for competency based medical education that shifts the focus from competencies assessed separately, to an integrated appraisal of a trainee’s ability to perform a clinical task with a specified level of supervision.

Descriptions in the literature of the implementation and validation of EPAs in the assessment of medical trainees have been mostly limited to graduate medical education.

Participants in this interactive workshop should be able to: a) define the concept of EPAs and how to construct them; b) describe how to integrate EPAs in the context of Milestones and core competencies in a program of assessment; and c) identify and discuss challenges in implementing EPAs/milestones/competencies in a program of assessment.

Activities have been incorporated to each objective of the workshop, where participants will be able to discuss in pairs, round-tables and debrief with a group of experts on EPA’s (please see WS outline attached). Learners would be expected to apply EPA concept as an assessment immediately after in their program.

Using simulation for InterProfessional Education (IPE) in patient safety and communication

Kam Mccowan, Teresa Gwin, Amin Azzam, Celeste Villanueva, and Michael Negrete

Preparing health professions students to provide effective team-based care is an essential step towards increased quality and safety. InterProfessional education (IPE) occurs when two or more professions learn with, from, and about each other (Reeves 2011) and is a means to develop effective teamwork. Inter-professional education amongst medical and nursing students offers unique opportunities to disrupt traditional hierarchies and lead to more teamwork.

Samuel Merritt University is a Health Science University with programs in undergraduate and graduate nursing (including nurse practitioners and CRNA) as well as occupational therapy, physical therapy, podiatry and physician assistant. Working with SMU students from multiple disciplines, medical students from the UC Berkeley-UCSF Joint Medical Program, and psychology trainees from JFK University, we use simulation-based and Problem-Based Learning to train students to develop, practice, and reflect on the practice of inter-professional error disclosure and management.

The art of observation: Enhancing clinical skills through visual analysis

Samuel Rodriguez, Genna Braverman, Audrey Shafer and Yinshi Lerman-Tan

“The Art of Observation: Enhancing Clinical Skills Through Visual Analysis” is a workshop proposal based on the Stanford Medical School Elective and the Stanford Undergraduate Seminar. Working with the Cantor Arts Center staff and Stanford Art History PhD candidates, participants will spend the first half of the session in the Cantor Galleries actively looking at and describing works of art. The session will be facilitated by museum educators and course faculty. The second half of the class will take place in the Cantor Classrooms where participants will reflect on the process of “observation” and we will give introductions to the themes of “narrative medicine” and “ambiguity in art and medicine”. We will give an overview of or experiences with building a medical humanities course and touch briefly on expanding medical humanities education through the various training levels from pre-med to the attending level.

Workshop size will be limited to 18 participants who will be split into two groups of eight for the gallery portion and regroup for the classroom discussion during the second half.

What medicine can learn from humanities: Promoting intellectual and emotional engagement, increasing patient-provider connections, and improving medical student and physician wellness

Lois Leveen


Learning Objectives

This interactive workshop will demonstrate how to design and deliver medical humanities engagements to bring together medical students, healthcare providers, and patients and their families. Participants will experience how humanities content and approaches can be used to:

  • Engage the intellectual and emotional capacities of medical students and physicians
  • Support an understanding of and comfort with problem-solving in contexts when there isn’t a single, quantifiable correct answer
  • Build “teamness” among interprofessional healthcare professionals
  • Develop a shared culture and improve compassionate communication between healthcare providers and patients/families
  • Encourage reflection on significant themes such as love, grief, family, etc. that often go unexamined in medical school and medical practice

Overview

The purpose of the humanities is to make meaning of the world and our experiences in it. This should be congruent with, rather than discrete from, the purpose of medical education and practice—yet the humanities and medicine are seldom well integrated. Although individuals are typically drawn to careers in medicine because they want to do meaningful work, medical students’ and physicians’ day-to-day responsibilities can leave little time, structure, or support for the kind of reflection that is essential to “making meaning.” Participants in this workshop will experience how the humanities can be used to provide opportunities for meaning-making in ways that promote reflection and connection between medical students, interprofessional teams of healthcare providers, and patients and families.

The workshop design draws on a growing evidence base about the power of humanities engagements to shape our understanding of healthcare, wellness, illness, and the end-of-life. Although narrative medicine courses often focus on literary works that represent patients, caregivers, and illness, this workshop incorporates literary works and visual art on more varied topics. Together we will examine content that opens up reflection and discussion, using the humanities to explore perspectives and topics that are integral to health and healthcare, yet which often go undiscussed in traditional medical education. Participants don’t need any background in or knowledge of the humanities, and the leader encourages attendance by those who identify as patients as well as by medical educators, medical students, and healthcare providers.

Leader:

Lois Leveen, PhD, Kienle Scholar in Medical Humanities, Penn State College of Medicine
A novelist, poet, scholar, and educator, Dr. Leveen holds degrees from Harvard University, the University of Southern California, and UCLA. She is a frequent presenter at museums, libraries, universities, and educator training programs across North America, most recently leading a humanities workshop at the International Conference on Physician Health, co-sponsored by the AMA, BMA, and CMA, as well as a six-week seminar on medical humanities hosted at the Portland Art Museum.

ORAL PRESENTATION

Oral presentations offer presenters an opportunity to provide a presentation of work to a large breakout audience. Presentations are 10-12 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Creating and launching a multi-tiered health informatics curriculum

Beth Breeden and Kevin Clauson

Informatics was identified as a core competency in the education of all health care professionals by the Institute of Medicine (IOM) in 2003. Paralleling the IOM recommendations, educational organizations including the Association of American Medical Colleges (AAMC), the American Association of Colleges of Pharmacy (AACP), and the American Association of Colleges of Nursing (AACN) proposed incorporation of informatics across their curricula. However, implementation of informatics educational efforts remains fragmented, even within professions.

Recognizing those challenges as well as the need to prepare students for a changing practice environment, a multi-tiered health care informatics curriculum was created and launched at a college of pharmacy. Programmatic offerings include dual degree and degree-certificate programs combining pharmacy and health informatics, standalone master of science in health care informatics and certificate in health care informatics, core and elective curricular offerings, experiential education rotations, a summer internship, and a postgraduate specialty residency in informatics.

Since 2011, of the 101 enrolled and graduated students, the majority (74%) representing nursing, medicine, dentistry, information technology, etc., participate in the standalone and certificate programs. The dual program (i.e., doctor of pharmacy/masters in health care informatics and doctor of pharmacy/certificate in health care informatics) participant group has increased to 19% of the total since its addition in 2013. Seven percent of students in the program crossover from a master of business administration degree program. The core approach of all aspects of the multi-tiered curricula was designed for a focus on the health sciences, business and management, and information technology elements of health care informatics.

The overall approach was developed to enable selected or comprehensive adoption of this educational model, while featuring sufficient flexibility to employ a tailored approach as needed. This approach offers an adaptable model to stakeholders interested in enhancing health care informatics opportunities for their students.

Does a virtual reality curriculum for pediatric residents addressing influenza vaccine hesitancy decrease rates of influenza vaccine refusal?

Francis Real, Dominick Deblasio, Andrew Beck, Nicholas Ollberding, David Davis, Bradley Cruse, Daniel McLinden, Zeina Samaan, Thomas Dewitt and Melissa Klein

Objective
Communication skills can be difficult to teach and assess in the busy outpatient setting. These skills are particularly important for effective counseling in influenza vaccine hesitancy, a common occurrence in primary care practice. Though physicians can affect caregivers’ attitudes toward vaccination, physicians report uneasiness discussing vaccine hesitancy. We hypothesized that physician-patient communication training using virtual reality (VR) can decrease rates of vaccination refusal.

Methods
This study was conducted at the Cincinnati Children’s Hospital Medical Center (CCHMC) Pediatric Primary Care Center (PPCC). The PPCC is a large academic pediatric primary care clinic that cares for a predominantly underserved population with nearly 90% receiving Medicaid. An immersive VR curriculum was created to teach pediatric residents best-practice communication skills when discussing influenza vaccine hesitancy. This pilot curriculum consisted of three VR simulations during which residents counseled graphical character representatives (avatars) who expressed vaccine hesitancy. A virtual clinic designed to replicate an actual clinic room at the PPCC was created and using an Oculus Rift headset, the learner was immersed in the virtual clinic room (figure 1). The avatars were created to represent the racial backgrounds of patients and families seen in the PPCC. Each avatar could assume different body positions to suggest an emotional state, and audio was recorded and synchronized with an avatar’s facial expressions and mouth movements to create a realistic experience. The caregiver avatar’s verbal and non-verbal responses to the resident’s counseling were driven by a facilitator based on a standardized algorithm. Participants were randomized to the intervention (n=24) or the control group (n=21). Only residents in the intervention group underwent the VR curriculum. Post experience, a survey was administered to assess residents’ attitudes toward the VR curriculum. Impact of the curriculum on clinical care was assessed through difference in influenza vaccine refusal rates between the intervention and control groups in the three months following the VR curriculum.

Results
Participants included postgraduate level (PL) 2 and PL3 pediatric residents. All eligible residents (n=45) participated. Ninety-two percent of the intervention group residents (22/24) agreed or strongly agreed that VR simulations were similar to real-life patient encounters. The majority of these residents felt that VR was equally effective to standardized patient experiences (p < 0.001). In patients aged 6-59 months, residents in the intervention group had a decreased rate of influenza vaccination refusal in the post-curriculum period when compared to the control group (27.8% v. 37.1%; p=0.03).

Conclusions
This pilot study suggests that immersive VR might be an effective modality to teach communication skills to resident trainees.

From surviving to thriving: Promoting the prioritization of well-being in medical training

Jordyn Feingold

It is estimated that between 25-75% of physicians suffer from burnout. Symptoms of emotional exhaustion, depersonalization, and a low sense of personal accomplishment afflict physicians as early as medical school, into residency training, and throughout medical practice, with potential consequences for patient healthcare outcomes, public health, and the costs of our health system. While medical institutions can do more to support physician, trainee, and medical student self-care, physicians cannot wait for institutional change in order to pursue well-being. A construct for physician flourishing is proposed, borrowing from and building off of prior validated constructs of psychological and physical well-being.

This proposed model, known as REVAMP, focuses on six elements that comprise physician flourishing (relationships, engagement, vitality, accomplishment, meaning, and positive emotions). Waiting to intervene until physicians are burned out and suffering has high costs; proactive approaches such as those suggested within REVAMP can be adopted as early as undergraduate medical school education to help physicians-in-training cultivate optimal well-being. Flourishing physicians deliver the highest quality patient care. It is time to help our healers flourish.

Implementing a computational thinking skills curriculum for physicians-in-training

Sary Beidas

Background: The paradigm of education, supported by the government, has emphasised STEM with principles of computational thinking (CT) as one of its core components. For example, in schools, Alice and Scratch are two programming applications developed for children to promote CT skills. In 2010, ushered by the HITECH act, technology use in clinical medicine skyrocketed. However, education in support of complex technology use is usually limited to several hours of training (described as “buttonology”) which significantly contributes to low physician satisfaction,burnout, patient safety issues, and low efficiency. Education of the next generation of physicians lags in outdated 20th Century education practices. Hence, there is a gap in medical education to integrate CT skills that promote interaction with complex technologies in meaningful ways.

Objective: Implement a curricular module focused on the principles of computational thinking to physicians-in-training (PIT).

Methods: Orange Park Medical Center (OPMC), is a 200 bed community hospital in Jacksonville, Florida. A new internal medicine residency training program was started at OPMC in July 2015. We developed and implemented a new curricular module designed to encourage computational thinking skills in PIT. The primary components of the module include: basic data & visualization science, modeling and simulation, system thinking, and computational problem solving skills. Using multiple educational strategies to include flipped classroom instruction, small group sessions, monthly large group didactic research seminar, short videotaped files, and other digital artifacts to support their learning. In support of the curriculum, PIT are introduced to an open source application, R-programming for statistics which allows users to experience a programming paradigm that is relevant to their research or quality improvement project. In addition, R provides the necessary tools to expose the learner to the 4 components of CT.

Results: All 20 residents in the internal medicine residency have R installed on their laptops. The current PGY-2 residents have all been introduced to CT and R. Among the 20 residents, 6/10 PGY-2 residents and 3/10 PGY-1 residents have experienced at least 1-4 weeks of rotation in research where they engaged in learning CT and R to support their research project. All 9 residents have given the curricular activity a favorable rating. Challenges include making the learning stick so that residents continue to develop their R skills.
Conclusion: Post graduate medical education should introduce trainees to CT skills to fullfill ACGME program requirements that require trainees to engage in research or quality improvement projects. Acquiring new CT skills during the formative training years may have additional benefits during patient care activities that intersect with high complexity technological environments .

Informed consent vs. talk therapy: Who decides when a transgender person can medically transition?

Charlie Blotner

The National Institutes of Health recently announced that they have designated lesbian, gay, bisexual, and transgender (LGBT) people as a health disparity population. The rationale for this designation has to do with the mounting evidence that the LGBT population has less access to health care and experiences higher of burdens of diseases such as depression, cancer, and HIV/AIDS. A study by Stanford University School of Medicine itself found that when surveying 176 medical schools, the median reported time dedicated to teaching LGBT-related content over the course of the entire curriculum was 5 hours. A third of those responses reported that their schools spent zero hours on LGBT health-related content during clinical training. While the extent of the causes of health disparities for the LGBT population are not yet fully understood, we have the power to educate current and future providers on how to better improve the lives of their LGBT patients.

I intend to discuss the gatekeeper model versus the informed consent model in the context of the World Professional Association for Transgender Health (WPATH) standards for transgender (trans) individuals seeking to start hormone replacement therapy (HRT) and or gender reassignment surgeries. The benefits and dangers that these models pose are crucial for providers to be aware of when treating their trans patients. Trans patients have been expected to undergo extensive talk therapy in order to access medical interventions and start HRT in recent years. However, with a lack of finances and access to health care to begin with, this step and pillar of the gatekeeper model and WPATH as a whole is extremely dangerous for an already vulnerable population in delaying care. While medical attention to trans people is starting to increase (see: Lancelet 2016 Transgender Health series), we still can and need to do better.

Take-a-ways from my presentation would include:
– Increased knowledge of the current WPATH standards of care and problematic models of starting hormone replacement therapy and having gender affirming surgeries
– Empowerment to taking changing the standard of care
– An understanding of hormone replacement therapy and general overview of gender affirming surgeries
– Acquisition of transgender health care resources
– Empathy surrounding medical transition

Location, location, location: Matching lifelong learning and real-time, local health care needs

Sara Miller and Allison Gardner

The health and welfare of many residents of rural communities in the United States (US) is diminishing as a result of skyrocketing rates of injection drug use. Without a robust harm-reduction infrastructure in place, several regions have recently witnessed an unprecedented rapid increase in infectious diseases associated with unsafe injection practices including exponential increases in hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. For example, between 2006 and 2012, the rate of new HCV infections increased 364% among individuals aged 30 years or younger in rural regions of Appalachia; 73% of these infections were linked to injection drug use. More recently, a single rural county in Indiana reported 174 confirmed cases of HIV in 7 months; for context, 5 cases were reported in the entire 12-months of 2014. In review of this epidemic, experts warn that several signs illustrating an intensifying epidemic were present prior to the identification of the new HIV infections.

Many warn that another outbreak of HIV similar to the one that struck rural Indiana is not a remote possibility for other communities in the US. In fact, the Centers for Disease Control and Prevention released the results of an analysis identifying 220 counties nationwide, most in rural areas, with the same dangerous mix of opioid misuse, poverty, and scant availability of healthcare resources that are driving rising rates of acute HCV infections among injection drug users and contributed to the Indiana HIV outbreak.

For healthcare professionals in rural communities, there may be no better match between critical need and commitment to lifelong learning. Many of these clinicians are professionals who have received little education on infectious diseases and have little opportunity to apply such education until very recently. For educators, the optimal path forward for the development of relevant and practice education which would facilitate positive change in rural communities struggling with the consequences of injection drug use is not one that takes a “one-size-fits-all” approach. Relying on national prevention and care efforts developed in urban areas of the country is unlikely to be successful. Rather, education that focuses on local needs and local harm-reduction solutions, informed by the experiences of other rural clinicians who face and have worked to address similar barriers in their own communities, is needed to engage clinicians in a relevant, meaningful way and effect tangible practice changes in rural America.

This session will discuss the unique needs and opportunities for matching continuing medical education with real-time local needs. We will use case-studies to outline success and lessons learned from the evaluation of need for, and implementation of, rural focused certified education designed to support clinicians’ on-the-ground efforts to address their communities’ local health crises.

A patient’s perspective on the importance of teaching spiritual competencies to medical students

Eric Nelson

At the 2016 Stanford Medicine X conference, I moderated a discussion that considered the importance of teaching spiritual competencies to medical students (attached). Participants included a physician turned chaplain/medical educator, a professor of medical humanities, a holistic physician, and a clinical psychologist/mind-body research scientist.

Although I was the only one without an M.D. or a Ph.D. after my name, I am someone who has been cared for and benefited by doctors and nurses who I would consider spiritually competent.

For the last five years, I’ve also written about the link between spirituality and health from my perspective as a Christian Scientist. As part of this work I’ve interviewed a number of prominent physicians, psychologists and researchers, including Dean Ornish, Founder of the Preventative Medicine Research Institute; Margaret Chesney, Director of UCSF’s Osher Center for Integrative Medicine; and Emma Seppala, Science Director of Stanford’s Center for Compassion and Altruism Research and Education.

In one of my columns, published on KevinMD.com (attached), I referenced the work of Dr. Harvey Chochinov. Whenever he meets a new patient, Chochinov likes to ask, “What should I know about you as a person to help me take the best care of you that I can?” It’s a question he has found helps both patient and doctor dial in to their innate spirituality, and in so doing, promote better health.

Even if spirituality is a word the patient is not accustomed to using or a subject the physician is averse to addressing, it doesn’t make it any less relevant. Defined by the American Academy of Family Physicians as “the way you find meaning, hope, comfort and inner peace in your life,” spirituality is something that concerns all of us.

The good news is that health care professionals are beginning to recognize the unique role they play in addressing the complexities of their patients’ lives, their fears, even their capacity to maintain a sense of connection with the divine during times of crisis. Although tending to such needs has long been considered the domain of chaplains and clergy, studies confirm that there is both the demand and the opportunity for this responsibility to be shared by everyone involved with the care of patients.

I found this to be true when, as a teenager, I was airlifted to a hospital following a serious accident. My injuries included two broken legs, a broken hand, internal injuries, and extensive cuts and bruises to my face. Although I don’t recall anyone on the medical staff asking me if there was anything they needed to know about me as a person in order to take better care of me, I found them to be both respectful and responsive to my spiritual needs. And with good results.

It’s this story that I’d like to share at the Stanford Medicine X | Ed conference in order to illustrate both the importance and the benefit of doctors and nurses making a conscious effort to honor the spirituality of their patients.

 

Meet me halfway: A patient-centered paradigm to address SGM-related health needs

Subhashree Nayak

Sexual and gender minority (SGM) populations experience significant health disparities including higher rates of chronic disease, anxiety/depression, and substance abuse disorders than heterosexual, cis-gendered counterparts, and as a result, yield poorer physical and mental health outcomes. This is exacerbated by the SGM community’s low rates of engagement with healthcare systems. One contributing factor is the lack of knowledge and clinical skills necessary to define and address the needs of SGM patients among providers, a phenomenon that contributes to the alienation and disengagement of SGM patients from healthcare systems.

Ill-defined and non-standardized SGM health curriculum in medical schools contributes to gaps in provider knowledge. Implementing current understanding of health disparities experienced by SGM communities and clinical skills tailored to define and address medical needs of SGM persons in medical education curriculum has emerged as a priority for medical schools in recent years, yet remains incremental in progress and challenging to develop. SGM-related medical education curriculum often focuses on broad public health concerns, however this often minimizes holistic, personalized, and patient-centered clinical intervention. Thus, we have developed a paradigm to more systematically address SGM-related health issues that is centered around the patient’s journey of sexual and/or gender identity development.

In this presentation, we will define three stages of sexual and/or gender identity development in SGM persons, highlight potential challenges that SGM patients encounter within each stage, and propose appropriate interventions that can be made on the part of the provider in order to best address the needs of the patient. This curricular paradigm is designed to familiarize medical students and providers with common elements of SGM patient narratives, foster empathy and rapport between providers and SGM patients, and increase provider awareness of SGM needs in a patient-centered fashion. A personalized medicine approach has the potential to better engage SGM patients and increase their retention within healthcare systems and ultimately improve health outcomes. This curricular paradigm seeks to address and contribute to the reduction of health disparities impacting SGM persons and communities and is consistent with the major public health goals outlined by the US Department of Health and Human Services: Healthy People 2020 Initiative.

Teaching shared decision making across disciplines for health care professional students: Creating online educational material with live assessment and feedback using simulated patient coaches

Tsuzumi Kanaoka, Manish Mishra, Nan Cochran, Robin Paradis-Montibello and Glyn Elwyn

Shared Decision Making (SDM) is becoming a standard clinical recommendation by the Institute of Medicine and many other major medical associations. Although SDM is often described as the pinnacle of patient centered care, it is not routinely taught in healthcare professional education. When medical student and resident communication skills regarding SDM are formally assessed, the results are below the level of anticipated proficiency. Two major obstacles to developing SDM education are the lack of SDM trained faculty and the lack of research in effective SDM training structure. To solve this problem, the Dartmouth Institute for Health Policy & Clinical Practice developed a novel, online SDM training model. This program delivers online teaching modules, graded assessments, and two sessions for the learners to practice SDM in a virtual, live simulated encounter. The web-based encounter is with specialized patient actors – called standardized patient coaches (SPC). The students were given real-time coaching and feedback with grading after each interaction. We recruited students from local MD, PA, and RN training institutions to study the changes in SDM communication skills after each practice sessions with the SPC. The preliminary results show an average increase of 20 out of 100 points between the first and second videoconferencing session. This highlighted the importance of multiple practice sessions beyond didactics. There was also a focus on collecting qualitative data with structured feedback sessions with each cohort. The overall reactions from the students are overwhelmingly positive and appreciative. We are currently exploring various avenues to distribute this educational material to as many users as possible.

The empathy project

Jules Sherman and Seamus Harte

For this experimental class funded by the medical school and supported by the d. School, we used storytelling as an innovative method to teach medical students empathy. Over a 10-week period, students participated in a group project to tell the story of a patient through a 5-minute video. This course was entitled, “Gaining patient perspectives on disease through storytelling” and taught by a collaborative team: Henry Lee, Assistant Professor of Pediatrics at the School of Medicine, Jules Sherman, MFA Design and Seamus Harte, MFA Film/Video instructors at the Hasso Plattner Institute of Design (d.school) at Stanford.

Rationale
Everyone would agree that empathy is one of the most valuable characteristics of a physician, but perhaps harder to develop than the core basic and clinical sciences that are more formally taught during medical school. Although the Stanford School of Medicine has innovated several approaches to instilling empathy in students, there is still a gap in creating formal curricula in this area.

With that goal however, a traditional lecture to teach empathy would seem quite inadequate. Storytelling can be a powerful method to allow an individual to gain perspective on another person’s life, or give some insight in allowing one to “walk a mile in someone else’s shoes.” Storytelling has been used in other disciplines for training and reflective practice.

Even more than watching a video of a story, one can gain even more empathy for a person or group of people by telling the story oneself. For example, our student’s projects focused on patients with IBS/Crohns and parents with babies in the NICU. Students used a framework taught in the course to plan a story. Then they created the video story and presented it to an audience that included clinicians, patients and their families. We hypothesized that this process would increase students’ empathy not just for patients with chronic disease, but also for patients and their families in general.

A medical student or resident enters into a patient’s room for a brief period of time, invading their sphere in a period of time when they may be at their most vulnerable. Building empathy prior to such encounters may place the student in a better framework to understand both the clinical course of a patient as well as the emotions and challenges that patients face. This is likely to improve the communication skills of the physician student, and patient receptiveness and satisfaction.

In addition to increasing empathy, we also believe that the exercise of storytelling can motivate students to learn more about a subject or help retention of content. Knowledge may be better absorbed when the learner is engaged with the topic emotionally. Although this aspect of learning was not be formally tested as part of this class, it would be an area for further exploration in subsequent stages of this project.

Specific educational aims:
To develop a medical student curriculum for increasing empathy for patients and their families.
To increase patient-centered communication between medical students and patients.
To introduce disease states in a way that will motivate and inspire students to learn more about those topics.

The impact of 360 virtual reality in global surgical education

Brian Conyer and Jeff Loo

Based on research by the Lancet Commission on Global Surgery:
– There are currently 5 billion people who lack access to safe and affordable surgical care
– There surgical workforce is currently 1.1 million
– In order to meet 80% of global demand in 2030, the surgical workforce must double to 2.2 million

There is a bottleneck when it comes to educating the next generation of surgeons. Our presentation will discuss the impact of 360 degree virtual reality in global surgery education.

The power of medical student narratives in destigmatizing mental illness

Barbara Lam, David Lee, Franco Pillsbury, Daniel Lowenstein, Darin Signorelli and Brad Meier

In the past decade, medical schools have made a deliberate effort towards improving the mental health of its students. Responding to higher rates of burnout, depression, and suicidal ideation among medical students compared to age-matched populations, institutions across the nation have added comprehensive wellness programs and stress-reducing changes to their curricula. However, these interventions focus on providing mental health services and removing stressors. They do not directly address the stigma of mental illness among peers or within the greater medical community, a stigma that poses a significant hurdle to seeking help.

In 2008, UCSF School of Medicine responded by creating a transformative event called Mental Illness Among Us (MIAU). It provides a student-only space for classmates to discuss their personal experiences with mental illness. In the week prior to the event, a classwide survey is administered to measure rates of poor mental health, depression, and suicidality among peers. During the event, the survey results are reviewed and a panel of student speakers share their stories of mental illness. Afterwards, attendees break out into small group sessions to process and discuss the event.

The power of MIAU stems from leveraging the relationships formed between peers during medical school. Mental illness is normalized in a meaningful way when the presented data and patient stories come from one’s own classmates. A 2013 study validates the program’s efficacy as an intervention, demonstrating significant improvements to psychometric parameters including Social Distance and Mental Illness: Clinicians’ Attitudes scores. MIAU has immediate effects among participants, leading to a more informed and compassionate student body, and likely has beneficial long-term effects, changing the culture of the medical profession as students advance in their education.

An equally important strength of MIAU is its portability to other institutions. News of MIAU spread from UCSF to the Keck School of Medicine of USC through an American Association of Medical Colleges (AAMC) spotlight newsletter on wellness. With guidance from UCSF, USC students were able to establish the program at their own school in 2015. At this time, we are working with students at UC Davis and UCLA to recreate the event at their schools.

Medical students face unique stigma against seeking care: fear that a psychiatric diagnosis will brand them as incompetent or unreliable providers. By empowering students to be the patients in this patient-as-educator model, MIAU explores the culture of mental illness in medicine in ways that other interventions cannot. It is a compelling event that invokes the power of storytelling and calls on the bonds between classmates in a way that statistics cannot. By sharing this program and replicating it at other institutions, we hope to catalyze a much needed culture shift at medical schools across the country.

The power of one

Andrew Elder

In recent years, the teaching and assessment of trainee doctors has increasingly centred on science, evidence and technology and drifted from its traditional focus on individual patients, whether at their hospital bedside, in our clinics, or in their home. Teaching is more likely to be delivered in the lecture hall, the skills laboratory, the conference room, remote from the patient, than in their presence. Assessment of bedside clinical skills is undertaken on simulated rather than real patients, if such assessment ever happens.

The reasons for these changes are complex and include educators’ perceptions about the acceptability of bedside teaching to patients and its potential impact on their wellbeing; a desire in the educational community to protect learners from undue stress and anxiety and standardise their educational experience and assessment; and the relegation of the individual patient story, the case report, to the classification of “anecdote”, the weakest form of evidence in the science of evidence based medicine.

We do not argue against newer, technology based pedagogic methods, but believe that the balance between their use and traditional methods has swung too far away from the bedside, that assessment focusses too much on knowledge and not enough on bedside skills, that rebalancing is required. We argue that the sheer diversity of the patient experience cannot be captured in scripted and standardised simulated patient encounters, and that the power of one human story can have as much impact on learning as ten thousand stories summarised in the form of a randomised controlled clinical trial. What, after all, is clinical experience other than an accumulation of personal knowledge borne from multiple individual patient encounters?

Although science, evidence and technology will continue to deliver many advances in the care of patients, and in the teaching and assessment of our future doctors, there is a pressing need to re-emphasise the pedagogic value of the contact between a single patient and their doctor. Value that applies to the patient too, for it is this direct contact that facilitates trust, understanding and the creation of a true therapeutic bond.

This presentation will stress that individual patient stories remain as important as ever before in the teaching and training of future doctors, and that individual doctors, through the power of their presence at the bedside of their patients, can make contributions to their care at least as valuable as that afforded by any drug, investigation or procedure. It urges the reestablishment of the patient as the centre of learning for our future doctors, of the value of individual narrative and anecdote, of the importance to patients of their individual encounter with their doctor, of the power of one.

The Regenstrief teaching electronic medical record: Using an everyday clinical tool for learning and evaluation

Blaine Takesue, Bradley Allen, Kenneth Lazarus, Krista Hoffman-Longtin and Debra Litzelman

There is a significant gap between the subjects health professional students learn in school and the skill set they will need as practitioners. Topics such as clinical informatics, patient safety, and quality measures are only now receiving more attention in many medical, nursing and other health professions schools. These issues along with topics including team healthcare, population health, and healthcare policy are part of an emerging science, health systems science, that focuses on how the health system delivers care.

The Regenstrief Institute and Indiana University created a platform to address instruction for many of the subjects covered in the health system science domain. This platform is a branch of a tool that practitioners use every day, an electronic medical record (EMR). The teaching EMR (tEMR) is the latest version of the Regenstrief Gopher, a production EMR that was first used clinically over 40 years ago.

The tEMR is a modular computerized provider order entry (CPOE) interface which can be modified based on the role of the user. Through this interface, users can access patient information from a database of 10,000 misidentified patients. Misidentifying the patient database in an automated process proved to be a significant development hurdle. While it is relatively easy to misidentify coded data, a larger hurdle comes from misidentifying text reports. The ultimate goal of the misidentification process is to protect both patient and provider identities. The challenge was and remains to protect individual’s identities while keeping text reports readable and meaningful.

The tEMR leverages functionality created for clinical use to support curricular needs. For example, we pivoted the clinical decision support infrastructure to deliver just-in-time educational content as well as potentially just-in-time evaluation to learners. Similarly, we redirected our implementation of OpenInfobutton and ported real-time natural language processing functionality to the tEMR to support curricular requirements. Both of these systems could be leveraged for content delivery as well as learner evaluation.

Although we initially promoted the tEMR’s innovative content delivery as its strength, we believe the ability to evaluate learners based on their user data will be as important or more important than the content delivery functionality. For example, the system can generate questionnaires or content based on a learner’s current as well as his/her previous interactions with the system, providing a formative evaluation framework. One could imagine utilizing this formative evaluation capacity to create a curriculum in which students could identify their subject matter weaknesses or conversely could demonstrate their steps toward subject matter competence.

In another unexpected, but welcome turn of events, schools outside of Indiana University (IU), expressed interest in the system. We’ve spent the last year changing from a small research team into a team dedicated to the use of the system both inside and outside of IU. With additional funding from the Regenstrief Foundation and the American Medical Association, we have been able to implement the system at the University of Connecticut School of Medicine, the University of Idaho School of Medicine, and several health professions school at the University of Southern Indiana. Next year we will welcome the Sydney Kimmel School of Medicine at Thomas Jefferson University, the Heritage College of Medicine at Ohio University and the Purdue College of Pharmacy. Our other indispensable partners include Eskenazi Health and Indiana University Health.
An objection we have heard is the tEMR is not “Epic” or “Cerner.” We think this an advantage. An important goal of this project is for learners, to think about how technology can help and not hinder their healthcare practice. Surveys show that physicians are not happy with their EMR. We believe part of proper healthcare information technology instruction should focus on teaching learners what EMR should do not what they currently do. The tEMR contains functionality not available in commercial EMRs, like real-time NLP and the patient list generator. Providers created this functionality for providers. Control of the tEMR code allows our team to interact with learners to create a better tEMR. We hope, by showing future healthcare leaders how technology should help to manage data and knowledge, they will be prepared to ask the critical questions and demand the appropriate functionality from commercial EMR vendors.

RAPID REPORT

Rapid reports are an opportunity to provide a rapid presentation of work to a large breakout audience. Presentations are 5 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

A novel method of applied instruction in oncology

Stacy Cooper, Caitlin Hanlon and Harry Goldberg

We have developed an application for medical education that has the potential to improve patient outcomes by linking treatment plans with the biomedical basis of disease. We have applied our model to the complex analysis of methotrexate dosing for oncology patients, but we expect our system can be broadly applied to a variety of specialties.

The dissemination and integration of new medical information and the underlying science into current treatments is crucial for improving patient health. For medical trainees providing patient care during the day, this learning takes place during various didactic sessions and lectures. Night-team members do not often have access to these educational experiences and consequently are at a significant disadvantage when having to make difficult decisions with respect to patient care. High dose methotrexate (MTX) is an essential component of therapy for many oncologic conditions. However, the efficacy of MTX depends upon its levels being kept within a narrow therapeutic window — having too little MTX available makes the drug ineffective, while having too much can cause severe side effects, such as kidney damage. Maintaining this delicate balance relies upon sophisticated numerical analyses within a complex dosage scheme as well as having an understanding of the underlying science of disease.

Our solution, MethoTracks, is an application that uses data visualization and on-demand learning to facilitate accurate and informed monitoring of MTX levels. MethoTracks is designed to reduce inherent complexities in MTX treatment and enable medical trainees to focus on learning and understanding instead of rote application. We believe MethoTracks will significantly improve patient safety and establish a link between treatment regimens and the underlying science. MTX dosage compliance is the model we have used in this study, but we are confident that this approach can easily scale to other areas and will improve both short-term and long-term patient outcomes.

Gaps in medical education: Establishing a better model for doctor-patient communication through interpersonal clinical work

Jennifer Walker

Doctor-patient communication is one of the largest complaints by patients in terms of their healthcare when it comes to chronic illnesses. Doctors are given the medical and formal training but very little effort is spent creating better communication skills or providing solid, realistic ways to connect with patients that engage them in their own healthcare. Creating a strong partnership should be the goal of all doctors, and healthcare providers, to manage the varying aspects of chronic illness such as medication, mental health, and at home methods that will support the path of care. I have created a three-part educational map to establish these skills for up and coming doctors/health care providers that provides the opportunity to foster empathy, compassion, a realistic understanding of the life of a patient, and a path for better communication that creates a solid doctor-patient team for building a more well-rounded quality of life for patients.

3-pronged approach to creating a better model for doctors and patients to communicate-
1. Classes on interpersonal communication skills that include relationship building. These classes must not be geared toward public speaking skills or speech. They must specifically deal with communication during stressful times, listening skills, body language, verbal and non-verbal cues, etc.
2. Analytics – Quantitatively exploring words, their power, and how they change/influence the disabled community and those with chronic conditions. This area deals specifically with extracting information via social media, and patient advocacy organizations – analyzing words and their effects and then quantifying the results to help track patient trends and responses to care.
3. Spending personal time with patients with chronic conditions that elicit the doctor/healthcare provider to provide support and help for daily tasks. Not a time for medical tests, blood work, or diagnoses. This portion requires doctors and healthcare providers to become intimately familiar with the life and personal struggles with patients – including mental health issues that may arise and the inclusion of alternative methods of care for areas such as pain management.

The full instruction regarding this series of interpersonal curriculum will include sample polls, a PowerPoint presentation, and gathered patient experiences to expand the scope of this need. The session’s goal will be to make clear that a doctor’s care doesn’t stop at diagnosis and prescribing medications, but is a more intricate and well-rounded effort that encourages, provides hope, and inspires patients to make the right health choices in their daily lives. It will also provide doctors and healthcare providers the opportunity to cultivate empathy and connection via experiencing the kinds of choices a patient with a chronic condition must make and listening to his or her stories.

Bridging the medical education gaps in South Africa with a digital platform

Vanessa Carter

The shortage of Medical Education facilities in developing countries like South Africa has had major repercussions on the local economy. In 2014, it was reported that there were more than 36 000 applications for the 1 770 places available for first-year students in South Africa’s eight medical schools. For many, it has been disappointing that they were not getting the opportunity to study, despite ticking all the boxes. A growing population and lack of investment have been some contributing criteria.

As this crisis worsens, students protest for free education because of the burden of poverty and high fees.

We often stereotype medical education to a PhD, but an all-inclusive health workforce consists of all the stakeholders whose main activities are aimed at enhancing a healthy population. They include doctors, nurses, caregivers, pharmacists, laboratory technicians, social workers, patient advocates — and management and support workers such as financial, officers, cooks, drivers and cleaners. Pressing global health issues like infectious disease cannot be managed without a well-trained and comprehensive team.

Infrastructure issues like connectivity in South Africa are being addressed for the Sustainable Development Goals. In an ideal digital world, the following could be considered to improve access and close gaps in medical education:

A central online platform should be developed which acts as an entry point to find resources like Online Communities, MOOCs, Live Lectures, Thought Leaders, News about Emerging Technology, Disease Control Information, Policy, Events etc. The design must be simple and visual to improve navigation and participation.

Live Lectures could be filmed in virtual reality to improve the experience. Collaborating with organisations like MSF or rural clinics might help E-Interns gain RWE. Live surgery, (e.g #VRinOR) could also be accessible. Education could be offered to empower citizens who want a qualification as a community health worker to assist with diseases like TB & AIDS. (Women are prominent candidates). As part of their qualification, they should receive equipment like an iPad to capture data from patients and share animations to educate them about self-care and adherence. Perhaps even earn incentives.

Digital technology allows learners to choose which language they prefer to learn in. Communities can be created for different areas, e.g.; medical students, nurses, spiritual healers, volunteers, caregivers, pharmacists, patient advocates. Data from these collective community conversations could be useful to defining issues to adapt curriculums in real-time. By connecting with patient communities they have access to narratives which patients choose to share which can be used as case studies for students and lecturers to discuss in private rooms. Patients could apply for research projects distributed by the education community. Feedback from users will be integral to perfecting the design and function

Digital nursing: Bridging the gap between health care and innovation

Theofanis Fotis

The presentation will introduce the idea for the development of a new future nursing workforce, called Digital Nursing.

In the current, rapidly changing due to technology innovation, environment, healthcare practitioners and patients are bombarded and introduced continuously to new developments of digital technologies. As a result the divide between humans and digital technologies is widening. The current academic curricula globally, are missing out on following the fast pace of these developments.

A proposed solution for this gap in education is the development of a content focused on the development of specific digital skills for healthcare practitioners and especially nurses at the bedside. Through education and research engagement, we will manage to develop a workforce with those digital skills that will enable nurses to use digital technologies, identify risks, protect patients and furthermore engage in the research and development of these new technologies.

The presentation among others will refer to a newly developed module offered to post graduate healthcare professionals at the University of Brighton in UK. The uniqueness of this module is that refers to professionals working in different environments (hospital, community) with no prior knowledge or education on health informatics with the aim to provide them with specific digital skills for their everyday practice on caring for patients.

The aim of this new educational development is to develop a workforce called Digital Nursing that will be able to bridge the gap between health care and innovation and reduce the patient-technology divide.

Medical education and electronic health records--missed opportunity

David Leander

Electronic health records have grown incredibly over the past several years due primarily to the 2009 HITECH Act, which ended up spurring over $40 billion in spending to implement these complex systems. However, more and more data is coming out each day painting a picture of physician burnout and frustration over these new technologies that are adding documentation work to clinicians without yet realizing the intended potential. For patients as well, this new technology has presented a potential disruption in clinical flow, and at the same time, has opened up patient access to their charts in a new way.

Medical education has yet to address this gap in education around training and access to electronic health records. However, as physicians are currently given training and are still frustrated, additional education is necessary around these complex systems and how students can learn about them in a more comprehensive way to be able to understand how changes can be made. Without understanding the available features and functionalities, clinicians must accept the defaults created by the teams working on these systems.

For students as well, this presents a challenge as student views of the electronic medical record are different typically than their supervising attendings, so it is hard to transfer knowledge from attending to student in the same way as clinical knowledge. Also, physicians who are currently using the system may not be able to provide the best advice on how to use the system due to their experience with the system.

In the next generation of physicians, I want to help prepare students for rotations and residency by training and teaching the electronic health record and how it can be used to its potential. We live in an era of “note bloat” and filtering through extraneous information and are missing out on the clinical decision making at the expense of other priorities. I am currently working on this as a medical student at Dartmouth in collaboration with our pre-clinical course directors. I hope to introduce students to the electronic health record during 1st and 2nd years in an intuitive way that does not detract from existing pre-clinical priorities.

Preparing faculty to teach health system science: The teachers of quality academy

Elizabeth Baxley, Luan Lawson and Jason Higginson

Medical students must be trained differently if they are to contribute to meeting the societal goals of better care, better health, and lower cost for all — the Triple Aim. A key success factor for the magnitude of curricular change is the presence of committed faculty who understand, practice, and can teach students how to create optimal care environments utilizing effective care teams. Yet, today’s clinical teachers are challenged with simultaneously learning about, and teaching, health system science while simultaneously delivering care in a changing environment.

A year-long Teachers of Quality Academy (TQA) was established to increase the number and types of faculty engaged in leading curricular innovation that prepares learners for working in redesigned health care delivery systems. The design of the TQA emphasized creation of a learning community of faculty working together to gain competency in patient safety, quality improvement, interprofessionalism and population health within the context of the clinical delivery system in which they practice and teach. In addition to gaining competence in these areas, the TQA completed a Credential in Medical Education to promote teaching, curriculum design and evaluation innovations.

Faculty from all health science programs and clinical departments were recruited to apply for the TQA program providing formal nomination from their department leadership. Participants completed the IHI Open School Certificate independently, consisting of 16 online modules, followed by six two-day Learning Sessions, covering key HSS topics. Training combined online, didactic, small group and experiential learning through completion of QI projects. Health system leaders were engaged early in program development ensuring mutually beneficial collaboration during project implementation. Participants worked in small groups providing feedback and support for ongoing clinical improvement activities. Scholarly productivity from this work was encouraged and participants presented their QI project at a campus-wide QI symposium. Participants could earn a Credential in Medical Education, tailored to the needs of health professions educators focusing on skill development for designing innovative HSS curriculum and creating new pedagogical methods for delivery. Faculty learned educational leadership, curriculum development, and assessment skills through applied projects and feedback from peers and course leaders. All TQA were required to complete a HSS curricular innovation, presented at Medical Education Scholarship Day.

31 faculty committed to TQA after Learning Session 1; attrition of 4 faculty (13%) occurred due to competing demands. 26 participants completed the IHI Open School Certificate and all six Learning Sessions. All completed QI activities that improved some aspect of care delivery in the local healthcare system and community. All clinical improvement projects qualified for Process Improvement CME; 375 AMA Category 1 credits awarded. All participants enrolled in a graduate education course and submitted educational products for use in the curriculum. Eight completed the Credential in Medical Education. 26 participants presented their QI project at a university-sponsored QI Symposium and 25 presented curricular contributions at the inaugural Medical Education Day. Three projects included the design of new simulation exercises to improve communication skills among medical and nursing students; establishment of new faculty partnerships for IPE opportunities; and activities to enhance understanding of roles and responsibilities among health professions students. Eleven TQA participants presented their work at nine national meetings, and seven served as faculty in two learning sessions. Twelve TQA participants taught in the LINC Scholar summer immersion course and one became co-director of the distinction track. Seven are formally engaged in further development of the longitudinal medical student curriculum in HSS, including integration and assessment of the 27 educational modules contributed by TQA participants.

The TQA model provides comprehensive, interactive training for interprofessional faculty to gain knowledge and experience in PS, QI, IPE and Population Health. These faculty are actively involved in development and implementation of new curriculum in these competencies for health professions students

POSTER PRESENTATIONS

Poster presentations offer an opportunity to share your work with an international audience at Medicine X. Presentations will take place throughout the conference with special designated times for poster viewing. First authors should plan to be next to their posters to answer questions during these times.

‘Consulting the CaseBank’: A retrospective study on the impact of role-play cases on undergraduate medical student revision

Laura Jones, Dave Eastwood and Jonathan Guckian

Aim:
To evaluate the use and benefit of ‘ready-made’ role-play cases in final year medical student revision.

Introduction:
Simulation has been shown to lead to improvements in medical knowledge and comfort in procedures, in addition to proving a reliable tool for teaching topics such as communication skills. [1] Indeed, ‘Kinesthetic’[2] learners learn best with practice or simulated scenarios[3], such as role play.
At the time of writing, there did not exist a free, online ‘bank’ of pre-developed cases in order to facilitate role-play for medical students. There is also a lack of focused review in the literature of the impact of role-play in clinical histories in the context of undergraduate medical education.

Methods:
Sixty-four ‘ready-made’ cases were written, featuring student instructions, patient instructions and examiner instructions. These centred on core clinical presentations in medicine, surgery and medical specialties. Example discussion questions were provided at the end of each case to test knowledge, whilst the overall format mimicked the Mosler [long case] structure utilised at Newcastle University Medical School.
The cases were hosted on Medisense.org.uk, a medical education website designed for visual, auditory and kinaesthetic learning. The series was released on 17th May 2015.
The impact of the cases is to be assessed in two ways. Primarily, numbers of case downloads or ‘hits’ are to be counted, with individual case ‘hits’ to be compared and contrasted.
Secondly, a focus group containing current Foundation Year One doctors is to be consulted. These doctors are based in the North East of England and attended Newcastle University Medical School. The focus group will be asked about their access to the cases, their ease of use, limitations of such a learning resource and the perceived impact this case series had on their learning needs prior to finals examinations.

The above data collection was focused on the period 17/05/15- 31/12/15.

Results:
Evaluation of results is ongoing. Early collection of data indicates X case ‘hits’ in the above time period. The most popular case was ‘Perry Arrest’, a Multiple Myeloma presentation.

Conclusion:
Current indications from discussions in the focus groups and data collection suggest that this is a unique, popular resource, which students have found easy to access. This project will continue to evaluate the impact of such a resource on learning needs of final year medical students prior to clinical examinations.

Closing the gap between evidence based practice and shared decision-making: A test of change

Jamie Gray, Henry Lee and Nicole Capdarest-Arest

Objective
As medical education moves towards a focus on competence, determining the appropriate juncture to introduce advanced evidence-based practice (EBP) skills is critical. Application of evidence is the final stage of the EBP cycle, and is an opportunity for clinicians to actively educate and engage their patients in shared decision-making (SDM) through the disclosure of information. Ensuring patients understand their options, and why a particular course of treatment has been suggested, is a core component of shared decision-making,which is vital to evidence-based practice (and an issue that has been discussed in critique of EBP). The primary objective of this project was to improve student confidence and ability to effectively find, translate and deliver medical evidence in a meaningful way to patients. It was also a way to explicitly highlight the interdependence of EBP and SDM to students.

Methods
Medical students partake in an information literacy session during their pediatric clerkship rotation. In preparation for this session, students are required to submit an assignment wherein they identify a case-related question, search for a relevant article, appraise it and then reflect on the experience. Individual feedback is provided to each student by course instructors. A follow-up debrief session occurs to discuss the experience. In order to bring SDM to the forefront, the instructors piloted a redesign of the debrief session. In addition to reflective discussion of the assignment, a translational activity was introduced requiring students to distill their found scientific article to talking points a patient can understand and relate to. Students then immediately simulate delivery of that information in pairs. Post-activity, the group comes together again to share experiences (i.e., think-pair-share style). A brief 2 question evaluation is distributed to students at the end of the session to help ongoing refinement of this curriculum.

Findings
This is a new approach and data collection is in progress.

Conclusions
We anticipate being able to draw conclusions from data collected before Medicine X | Ed. Our goal is to enhance student awareness and confidence in EBP and SDM from the onset of their clinical experiences.

Creating new solutions for the patient with atopic dermatitis

Roberto Takaoka

Atopic dermatitis (AD) is a chronic skin disease with a complex pathogenesis, increasing prevalence and difficult management. On a recent survey conducted on the Internet, nearly 80% of patients suffering with AD showed dissatisfaction with their treatment. The common perception is that doctors do not know how to manage the disease. Patients complain that doctors do not show a clear knowledge of the disease and fail to provide any emotional support. Consequently patients report seeing many doctors to treat their condition. There is a strong need to create new solutions for the patient with AD.

Design thinking is a creative innovation methodology originally used by designers to enhance the look and functionality of products. More recently, this process has also been used to tackle complex social and healthcare problems. Consequently, we have started to use design thinking principles (empathy, collaboration and experimentation) to improve the treatment of patients with AD.

Design thinking is a human-centered approach that, when applied to healthcare, involves listening closely to patients’ needs and problems. These problems may include common, but not always acknowledged complaints brought on by the disease, such as compulsive itching, bullying, depression and high cost of medication. Through a series of established steps, new solutions to improve the quality of care can be created. These solutions can include the creation of support groups for patients and families, more collaboration among healthcare professionals and more scientific meetings dedicated to AD.

Design thinking allows effective solutions to appear from patients themselves rather than being imposed by the healthcare professional. It also involves working in collaboration with a multidisciplinary team that includes patients and their families, doctors, psychologists, nurses, social workers and others. Educational programs for patients and parents can improve the understanding about the disease and improve adherence to treatment. But explaining how the disease works and what medication to use is also not enough. Doctors and the educational team should go beyond the disease and have a broader view of the many aspects involved in the pathological process.

Contrary to the belief that medication alone can treat and solve all problems, design thinking shows that in order to be effective, the management of AD must constitute a much broader approach, encompassing emotional, social, cultural and financial factors.

Developing novel educational experiences for undergraduate students

Elaine Reno, Gavriel Roda and Jay Lemery

Introduction
Wilderness medicine encourages its participants to develop skills in teamwork, leadership, and improvisation. Similarly, interdisciplinary collaboration has become an area of interest in improving efficiency of medical teams. There are few courses available that foster the uniqueness of wilderness medicine. Even less apparent are courses that invite the pre-health community to participate in learning these skills. Particularly in a present where pursuing a medical career has become increasingly competitive and demanding, we seek to provide an example of how these different gaps can be addressed, and how the

Methods
The Emergency Wilderness Medicine course at the University of Colorado Anschutz Medical Campus seeks to accomplish the following objectives: (1) to engage pre-health students in learning about different professional avenues within medicine, (2) to promote a collaborative environment where students can further their basic medical skills, and (3) to encourage students to think creatively about medicine, teamwork, and the medical field as a whole.

Typical courses last approximately two weeks in duration. The first week focuses on exposing participants to a series of different lectures, including “how to perform a primary assessment” and “how to ace your graduate school interview.” A panel of current health professionals is also assembled, incorporating the perspective of RN’s, paramedics, and physicians. The second week takes place in the wilderness setting and aims to give students a chance to practice their basic life support skills in the wilderness setting.

Course success was measured through surveying course participants. Approximately 150 students were surveyed over a 3 year period. Individual lecture/activity success was evaluated on a 10-point scale, with 10 being the highest ranking and 1 being the lowest. Participants were also given overall course evaluations with the same scale and survey format.

Results
This model has received resounding positive feedback from its students, who rated the course an 8.96/10 in improving their knowledge of the medical profession and 9.30/10 overall, averaged across our 5 surveyed courses. Students also reported that a short course was able to introduce them to the professional aspects of medicine as a career with an overall rating of 9.0/10.

Conclusion
Current undergraduate, pre-health students have a unique importance in the medical field with an opportunity to alter the trajectory of medicine. By creating courses that are interdisciplinary and in nature, pre-health students are given vital lessons in collaboration, innovation, and leadership that will enable them to become satisfied and exemplary in the medical field. Long-term data on student outcomes has not yet been collected, however, current feedback suggests these courses provide positive influence on student journeys towards medicine.

Lost in transition

Marlajan Defusco

With the advent of improved surgical techniques, more effective medications and advanced technology, adolescents and young adults with chronic illness are not only surviving, but thriving in adulthood. A new generation of adults that pediatric specialists once thought wouldn’t survive are now living long enough to develop “adult” problems, such as hypertension, type II diabetes, high cholesterol, etc. Pediatric specialists don’t necessarily have the knowledge base to care for these adult problems, and adult specialists may not have enough experience to treat these new arising issues when there is an underlying pediatric chronic disease.

And therein lies the problem. Should this unique population of patients continue to see their pediatric specialists or transition to adult healthcare? And, who should be responsible for facilitating this transition to ensure patients get the proper care they need?

My proposal, Lost In Transition, would focus on the importance designing of a formal program to bridge the gap between pediatric and adult healthcare. So often, adolescents/young adults with chronic illness don’t get the education they need and wind up being lost to follow up, unfortunately finding themselves extremely ill by the time they get to a hospital. Health care providers work incredibly hard to keep them alive as children to see them to adulthood, but often we fail them once the patients become adults.

Positive psychology in medical education

Dushan Bosotov

Positive psychology addresses a subject traditionally not considered in the medical education and that for students of medicine, touches directly during their years of training. Faced with high rates of burnout from early in the medical education that will intensify during residency, will serve the students to find a discipline that provides psychological and social strategies that can help both as professionals and as students in the area of health to cope with this situation more effectively.

To live in somatic, psychological, social and spiritual balance, besides the mere absence of problems, is the goal that each human seeks to reach in their life. It is at this point where the positive psychology takes place. If we increase the positive thoughts, the positive emotions and the positive behaviors, to balance the three domains of individual well-being (the personal, the professional, and the happy life) we will create a virtuous circle which will enhance the current well-being of students of medicine, as future doctors. Most importantly, it could convey a better care and overall patient well-being by way of a more than just “simple” healing of their physical and mental illnesses.

In my personal case, the positive psychology concepts and practices have given me tools to face patients and most importantly to compare what I have been thought thus far. Thus, I seek to emphasize not only the disease and its cure, but I care not only about the physical or mental but rather both combined including even the social aspects of the person I have in front of me. Therefore, besides caring for their discomfort, I also care to promote the positive aspects of the patient. The patient should be treated as a unit, making him or her aware of their own minds’ healing potential. As specific and effective drugs that exist and help with the disease or disorder in question, it is essential for one to understand and help the patient who suffers as a unique and irreplaceable being that needs a personalized therapy, beyond simple healing of their illness. The recovery of one patient who suffers from depression is never equal or slightly similar to the one who practices psychological well-being. Our mind is very powerful and often everyone forgets it.

In summary, I’d like to give an emphasis to the need to incorporate the concepts of positive psychology in the medical schools’ curriculum. The traditional style, which corrects failures and weaknesses of the students should be complemented with positive psychology tools in order for these students to identify their strengths and qualities so they can be empowered. It will also aid to reduce the prevalence of depression and “burnout” and will help students to lead a happy and meaningful life. In fact, the positive psychology not only will aid on a personal development while in training, but it can bring large advantages in the doctor-patient relationships and in the healing potential of the medical profession.

Residents as teachers

Daniel Migliaccio

Medical students consider residents to be a pivotal part of their clinical education and view them as role models. In a similar light, residents are expected to spend a quarter of their training interacting with and evaluating medical students. Moreover, residents report that teaching is an important component of their learning experience. Structured resident as teacher programs are emerging across the nation as an avenue to improve teaching skills among residents. It has been demonstrated that these programs have multiple beneficial effects, including improved attitudes, behaviors towards clinical teaching and the resident-medical student relationship.

Amongst Stanford Emergency Medicine residents and Stanford Medical Students rotating in the emergency department, it is evident that there is a lack of resident to medical student feedback and that there is an overwhelming desire to facilitate this between both parties. 10/12 (83%) of medical students state that they would appreciate resident feedback and 11/12 (92%) stated that they do not receive regular feedback from residents. 21/30 (70%) residents stated they would like teaching in feedback techniques and 14/30 (47%) stated comfort in their current ability to provide feedback to medical students.

Overall Objectives

  1. Apply a novel curricular offering for training emergency medicine house staff as teachers.
  2. Give examples of effective Trainee as Teacher programs by becoming familiar with varied approaches to teaching skills development.
  3. Dissect the barriers to the resident being able to participate as an educator.
  4. Review practical teaching techniques in different clinical contexts.
  5. Develop a multifaceted approach to the evaluation of trainee teaching skills curricula
The power of functional medicine-trained doctors and coaches to create patient-empowered health care

Sandra Scheinbaum

Rather than prescribing “a pill for every ill,” Functional Medicine practitioners address the underlying root causes of chronic illness and typically begin with diet and lifestyle changes. In order to guide patients from “where they are to where they want to be,” Functional Medicine doctors often add health coaches to their collaborative care team. Rather than acting as the “expert,” coaches guide patients from “where they are to where they would like to be” by applying positive psychology and a strengths-based orientation. By helping clients become empowered to take charge of their health and move towards optimal wellness one step at a time, the Functional Medicine doctor and health coach are disrupting the conventional healthcare model.

Instructional technologies focus on presentation techniques to optimize engagement and instruction, such as animation and audio and visual techniques (e.g. Keynote, Prezi), creating audio podcasts using professional audio techniques, using mobile apps to create instructional content, 3D printing for medical education, surveying, polling, data collection, and analysis, and editing videos and images.

LEARNING LABS

These 45 minute classroom sessions provide presenters an opportunity to lead a group of learners through a “how-to” style tutorial on novel teaching methods that incorporate thoughtful use of technology to engage the Millennial learner.

No budget? No problem: Easy, low-cost eLearning for anyone by anyone

Tao Le, Warren Wiechmann, Yun Chu and Scott Helf

Introduction and Rationale:
Education technology is often expensive, proprietary and complex. However, there has been a recent proliferation of free, low-cost or easily accessible learning technologies that can be implemented by any educator (including students for peer to peer learning and patients) with minimal technology support. Despite the increasing availability of affordable and accessible tools, educators still lack experience in implementing them in an instructionally sound manner. This workshop will feature interactive presentations with live demonstrations followed by facilitated small group activities.

Session Objectives:

  1. Describe low-cost technologies for learner-friendly presentation, engagement and assessment
  2. Explain low-cost technologies for learner assessment and education analytics
  3. Discuss practical and instructionally sound use case scenarios for low-cost learning technologies

Activities and Schedules:
The audience will be encouraged to bring their laptops, tablets, and smartphones to participate in the live demonstrations. Internet access will be required. The focus session is outlined as follows:

Principles (10 min). In the large group setting, we will discuss the rapid evolution of affordable and accessible e-learning tools and the learning science underpinning their use.

Application (30 min). In the large group setting, we will provide live demonstrations of the different classes of learning technologies including digital tools for presentation, engagement, and assessment. Audience participation through smart devices in strongly encouraged.

Practice (20 min). In small groups, participants will be given a choice of a hypothetical case scenario in which they work as a team to design a learning solution using low-cost learning technologies.

Humerus Hacks: Mnemonics, podcasts, and putting the laughter back into medicine

Karen Freilich and Sarah Bush

“What ribosomal subunit does gentamicin bind to? 30S. This is a question first year medical students are often asked, and it usually stumps everyone except the lucky few with a photographic memory. But what if the antibiotic gentamicin was a gentleman? A 30-year-old gentleman who tended to have mostly a negative personality (to match his mostly gram-negative cover), yet was married to the beautifully positive Staphenie (to remember the gram-positive Staphylococcus). Unfortunately, the gentleman and Staphenie have a tendency to fight, leading to hands on hips (just about the kidney area…) and hands on ears to cover up the yelling (…inner ear complications). Can you see where we’re going with this?

Medical mnemonics have always permeated medical school, everywhere apart from the classrooms itself. They allow a means to remember overwhelming quantities of information whilst allowing laughter and curse words to break through the tension and stress of medical school. It is no surprise to learn that the demands of studying rank as the top stressor faced by medical students across Australia, as per beyondblue’s National Mental Health Survey of Doctors and Medical Students in 2013. It is no longer news that medical students have poor mental health, secondary to difficulties with work-life balance, sleep deprivation, financial debt and overwhelming responsibility at a young age. Enabling medical education to be engaging and exciting is a worthwhile task to slowly reduce this burden on students and young doctors.

In our final year of medical school we turned the mnemonics and quirky, simple stories we used to pass our medical degree into a podcast for medical students and junior doctors called Humerus Hacks. This podcast has become so much broader than we had first intended, with listeners ranging from occupational therapy students to patients across the world. We believe strongly in free, open access medical education (FOAMed) and in creating content that is fun and engaging.

Through 60 minute Learning Lab, we would educate medical students, doctors, and educators in our two main areas of expertise: firstly, the art of creating medical mnemonics, and secondly, the how-to’s of creating podcasts for education. The classroom would entail interactive discussions and activities, in which all participants would leave with practical skills regarding informal education and using podcasts as a platform to deliver content. Throughout this classroom we will discuss the burden of mental illness amongst medical students, and how creating innovative content can reduce this burden. Additionally, we would be more than happy to adapt this content to fit any of the other categories.”

WORKSHOP

These longer 45 minute sessions provide presenters with an opportunity to delve deeply into a topic to share unique expertise with a diverse group of passionate Medicine X | ED delegates. Workshops are limited to a maximum of 30-35 people.

The Stanford Virtual Heart: A 3D virtual reality congenital heart disease atlas

David Axelrod and David Sarno

Congenital heart disease (CHD) is the most common congenital defect, affecting 40,000 newborns per year. Because congenital heart lesions are complex three-dimensional (3D) structures, visualizing the anatomy and physiology of these conditions in standard two-dimensional (2D) images is a perennial challenge for trainees. The study of CHD requires a thorough understanding of the anatomy and physiology of unique, challenging, and complex cardiac defects. Virtual reality (VR) represents a powerful opportunity to advance the education and close the gap between the standard education and the 3D understanding of CHD. We are now building a VR CHD atlas that will launch congenital heart disease education into an exciting, immersive, and more effective learning environment.

This interdisciplinary project draws from the expertise of world-renowned Stanford Children’s Heart Center, in addition to our partners in cutting edge healthcare visualization, Lighthaus Inc. We hypothesize that the VR congenital heart atlas will measurably improve trainees’ understanding of specific congenital heart defects. As we develop The Stanford Virtual Heart, we will initially evaluate its efficacy in educating trainees in three congenital heart defects (tetralogy of Fallot, transposition of the great arteries, and hypoplastic left heart syndrome). We will also give live demonstrations of the project, to describe our design and development process so the audience can benefit from the knowledge that we’ve gathered during the design and production process.

Each VR heart defect begins with a normal heart that can be explored and will then “morph” into a heart with the selected cardiac lesion. The learner can then “fly” through the heart and explore each cardiac chamber, valve, and vessel. Then they can perform a simplified surgical repair of each defect.
We are also developing a ‘modular’ virtual heart—one where trainees step into a virtual environment and put a heart together piece by piece. The pieces (vessels, chambers, valves, septa) snap together and the heart ‘comes to life’ when all the pieces are assembled. This model creates the basis for substituting in pathologic anatomy — stenotic vessels or valves, septal defects, transposed arteries, and hypoplastic chambers. The user then sees the effect each of these has on the blood flow and physiology.

The final anticipated work product will be the highest fidelity and complete VR model of CHD available to the medical community. This work product will not only create an immersive learning environment for future trainees but may also assist surgeons in selecting optimal interventions and families in understanding the defects.

Medical students, residents, and pediatric cardiology fellows will benefit from learning about congenital heart disease in this immersive environment. We will also present this VR atlas at international meetings, promoting The Stanford Virtual Heart as a leader in the field of medical education.

ORAL PRESENTATION

Oral presentations offer presenters an opportunity to provide a presentation of work to a large breakout audience. Presentations are 10-12 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Envisioning a ‘Muse’: An open, networked information ecosystem for medical education

Amol Utrankar and Jared Shenson
In the instant, open, and participatory ecosystem of the Digital Age, medical education remains slow to change, siloed within institutions, and over-reliant on passive learning. The forces of academic publishing, institutional isolation, and resource constraints on curriculum development restrict the diffusion of innovations in content and pedagogy as medicine evolves exponentially. For a generation that must know and do more than ever before, medical education must be collaborative, evenly-distributed, and adaptive.

To bridge this gap, we envision ‘Muse’: an online curriculum exchange representing a convergence of an information repository, social network, and learning management system. Medical schools will publish their curricular materials as free, open-access content for use by educators and learners. Creative Commons licensure will facilitate attribution, content adaptation, and iteration. Platform features for search, post-publication peer review, instructor and learner feedback, and social metrics will scale the strongest content, accelerating an inter-institutional diffusion of innovations and reducing redundancy.

An information ecosystem like Muse will empower medical schools to continually discuss, share, and iterate upon content in a ‘living curriculum’ that evolves with advancements in medical science, clinical practice, and learning theory. It will enable faculty to redirect efforts from developing redundant content to selecting the strongest content and supplementing it with active learning approaches to improve comprehension, retention, and application. It will allow emerging medical schools to launch at lower cost. And most critically, it will develop learners who are best equipped to navigate a changing healthcare system and provide patients with the cutting-edge care they deserve.

In sharing our vision for Muse, we aspire to encourage reflection on the current constraints to diffusion of innovations in medical education and to inspire the development of innovative solutions. We will first consider the current context of information exchange and curriculum development in undergraduate medical education. A theoretical framework and rationale for a next-generation solution in curricular innovation will be proposed. The impact of these potential solutions on stakeholders across the continuum of medical education will be explored. Finally, we will propose a process for overcoming the technical and sociocultural barriers to their implementation. By creating a conversation on how medical education can best capitalize on the affordances of the Digital Age, together we can motivate collaboration and accelerate change in the teaching, study, and practice of medicine.

Whiteboard, Camera, Action: The creative use of multimedia and storytelling to address America’s opioid epidemic

Kyle Rosenberger


In 2016, as a response to the opioid epidemic, the White House issued a call for medical schools to prepare their students in best practices, in line with the CDC guidelines, for handling prescription drugs. In realizing the severity and importance of the opioid crisis, the Heritage College realized the need for an innovative and memorable way to educate students. Aside from relying on a traditional approach to content delivery (e.g. PowerPoint lectures) the Heritage College is in the process of creating a mini-documentary film that blends art, storytelling, and real-world video footage. The goal of this approach is to humanize and personalize the opioid epidemic, while also serving as a tool for professional development.

Using whiteboard-video production software, the production team will tell the story of Marcus, a 28-year old who has a seemingly ideal life until an injury lands him in hospital and he eventually becomes addicted to prescription opioids. This story is based on the real experiences of an individual who eventually died from a drug overdose. The main idea for this portion of the video is to capture the attention of the students through an artistic rendition of an individual’s path to addiction.

Then, the team interviews physicians, pharmacists, students, and most importantly, patients in recovery for prescription opioid addiction. Through these interviews, students will get first-hand information about the opioid epidemic, how it will impact them as a future physician, how hard it is for people who struggle with opioid addiction, and how they can get involved. This portion of the project includes footage from across the state of Ohio, including the major metropolitan areas of Columbus and Cleveland, and rural areas including Appalachian Ohio, demonstrating that the epidemic is not isolated to just one area of the state or population.

Finally, the film includes another whiteboard video taking students back to Marcus’s original story. As they address Marcus’ first visit to his physician, students will be asked the important question, “What could they have done to make Marcus’ story different?”. From here, the narrated video will review the recently published CDC guidelines on prescribing opioids, explore alternative pain management treatments, and describe options for helping individuals who may be struggling with addiction. Students will be also informed on the action they can take to help in the fight against this epidemic.

We hope to demonstrate how the creative use of multimedia can engage students as they learn about the needs of the communities in which they will work as physicians, more so than traditional, lecture-based classes. Also, we hope to demonstrate how tools such as art, storytelling, and visual material can be more compelling and personal for students, facilitating deeper connections between students and the communities they will serve in medical practice.

Initial experiences in developing and piloting HoloAnatomy for medical students

Susanne Wish-Baratz, Scott Simpson, Jeffrey Mlakar, Galen Tingle, Catherine Simonson Shick, Henry Eastman, Robert Gotschall, Kerrin Sunshine, Lauren Ulrey, Erin Henninger and Mark Griswold

Purpose
The School of Medicine at Case Western Reserve University (CWRU) has committed to a new approach to medical anatomy as it moves into a state-of-the-future Health Education Campus. The building will be outfitted with exceptional technology and learning spaces, but it will not include a dedicated cadaver dissection laboratory. In preparation for this, the Gross Anatomy and Radiology course will be transitioning from a primarily dissection-based curriculum to one that will have two components: a 2 week cadaver dissection ‘boot–camp’ at the medical school’s existing facility followed by an integrated technology-based curriculum in the new building that will include virtual anatomy using the Microsoft HoloLens, medical imaging, and physical diagnosis with a goal of full implementation in the 2019-2020 academic year. Microsoft’s HoloLens is a wearable Windows 10 computer that enables the user to interact with holograms in a mixed reality environment. Anatomists, curriculum experts, and technologists at CWRU are currently creating a HoloAnatomy curriculum that will be suitable for first and second year medical students. Here we report on our initial experience with our first block of the virtual anatomy curriculum. In this demonstration, thirty-two first and second year medical students participated in a HoloAnatomy lesson given by two members of the anatomy faculty focused on thoracic anatomy. Informal pre- and post-test surveys were provided for student input and feedback.

Results: The hardware worked seamlessly as an instructor led eight groups of four students simultaneously in our first-ever holographic anatomy classroom. What began as a technical trial turned into a lesson that lasted over an hour. Despite the relatively rudimentary anatomy being taught, 87.5 percent of the students reported to have learned “something new about human anatomy” and 100 percent of them were “interested in participating in a future HoloLens class.” The experience provides further evidence that HoloLens and HoloAnatomy are valuable tools that provide new ways of teaching anatomy to medical students.

Medical education: Scaling up international production and diffusion of virtual medical cases via the MedicActiV platform

Clement Goehrs and Xavier Abadie

Today the gap between theoretical clinical training and physicians’ real-life experience with patients is widely recognized. Yet, improving medical education is crucial, since better training means better care for patients.

Students and professionals must be given the opportunity to work on as many real-life cases as possible, without putting real patients at risk. Current classical training methods do not fit the rapid growth of medical knowledge. Medical education needs more realistic and immersive instructional technologies to prepare tomorrow’s clinicians.

Digital technologies have a major role to play in filling this gap but are still underrepresented in clinical training. Moreover, there is no roadmap for the transition and no consensus on the instructional technologies that will lead to new standards of medical education. In all likelihood, the coming years will see the birth of multiple, isolated pilot projects in medical schools in the US and around the world.

This talk will demonstrate how digital solutions like virtual clinical cases can improve medical education, focussing on 3 points:
– the educational advantages of virtual clinical cases and virtual reality
– the benefit of improving collaboration between patients, clinicians, education experts, and 3D engineers
– how an innovative international platform, MedicActiV, based on partnerships between a technology start-up, SimForHealth, and medical schools on all continents, has the potential to propel medical knowledge forward.

Sim in your living room: Development of a bespoke online deteriorating patient simulator

Jonathan Guckian, Thomas Johnson and Robert Ker

BACKGROUND
Simulation is well established in undergraduate and postgraduate medical curriculae[1] and evidence suggests simulation gives students greater confidence in recognising and responding to clinical deterioration in adult patients[2]. Indeed, ‘Kinesthetic’[3] learners learn best with practice or simulated scenarios[4].
At the time of writing, there did not exist a free, online ‘simulated’ patient in order to facilitate management of the deteriorating patient. There is also a lack of focused review in the literature of the impact of online simulation programs in undergraduate or postgraduate medical education.

METHODS
An online patient simulator, entitled ‘PatientSim’ was developed and hosted on www.medisense.org.uk, a free medical education website. The simulator ran through a clinical scenario, specifically chest sepsis, with students choosing options to manage the patient and react to changes in observations.
The scenario was developed specifically for new Foundation Year One doctors, and 23 FY1s were recruited to test the simulator. The doctors were recruited from the Medisense mailing list.
For evaluation, a pre-test was shown prior to accessing the simulator, and an identical post-test was required. Questions were based on the topic of sepsis management. Results of both tests were compared.

RESULTS
82.61% of respondents reported having had experience of both high and low fidelity simulation.
Considering pre-test & post-test data, there was no statistically significant difference between pre and post-test performance.
Respondents scored the simulator an average 4.3/5 on ease of use, 4.17/5 on relevance to level of training and 3.91/5 on increase in confidence following use of PatientSIm.
Respondents felt PatientSim improved their ability to identify high EWS &to manage a deteriorating patient, with marginal improvement on use of a structured approach & knowing to ask for help.
Users were then invited to participate in a questionnaire, which used Likert scale to assess the ease of use and relevance of the resource. Confidence in these domains was scored out of 5. This questionnaire also asked respondents about their experience with simulation.

CONCLUSIONS
This study demonstrates that this online patient simulator is easy to use and relevant, demonstrating improvement in confidence in several key domains. This study was limited in that the sepsis scenario featured was considered ‘basic’ by respondents. This may have impacted on confidence scores above. Average scores in pre-tests were high (3.6/4), which may add weight to this. Further study remains on-going, assessing the impact of this scenario on a medical student population, rather than this high-performing, simulation- aware group. Alternatively, adapting a more complex scenario with more in- depth pre and post test questions may yield different results.

RAPID REPORT

Rapid reports are an opportunity to provide a rapid presentation of work to a large breakout audience. Presentations are 5 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

#SixSecondStudying: The use of the 'Vine' application as a tool in medical education

Jonathan Guckian, John Spencer and Stuart Maitland

Background
There exists a wealth of ‘Web 2.0’ resources, including social media and podcasts which offer new methods of learning in undergraduate medical education. Twitter is a microblogging service, which involves sharing 140 characters of text, boasting 284 million monthly users. The application ‘Vine’, allows the sharing on Twitter of six second long videos. These loop, on repeat, and are embedded into websites and social media. Prior to this study in 2014, Vine had not been documented as being used in medical education.

Method
Sixty-nine Vine videos were designed, in a series called ‘#SixSecondStudying’. These covered basic clinical topics and were shared on the Twitter account for Newcastle University Medical Education Society (@MedEdNcl). Video views were counted, alongside changes in the number of followers of the @MedEdNcl account. Questionnaires were sent to users of MedEdSoc Newcastle’s mailing list, assessing the ease of use and relevance of the videos.

Results
The #SixSecondStudying videos were viewed 76,564 times. The questionnaires received 100 responses. 91% of users believed the #SixSecondStudying videos were easy to use. 80% felt the series was a ‘relevant revision aid’. 91% indicated that they would recommend #SixSecondStudying to a friend as a revision aid.

Discussion
This study has demonstrated that videos produced using Vine can be a popular learning tool for medical students. We have shown that the relevance and ease of use of a series such as #SixSecondStudying are key reasons for the use of such an application.

Lost in translation: A mobile app for Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Jason Satterfield

Background:
Despite advances in evidence-based teaching, the transfer of SBIRT skills from classroom to clinic continues to be problematic. Students may demonstrate SBIRT proficiency in the classroom yet fail to use SBIRT in clinic. To address the challenges, the San Francisco SBIRT Interprofessional team developed a mobile app to facilitate skill transfer.

Objective:
This theory-based, mobile app serves as a reference guide, clinical tool, and data collection tool. The Theory of Planned Behavior (TPB) was used to conceptualize the obstacles and facilitators of skill translation: beliefs about SBIRT, social norms, and perceived behavioral control. Initial TPB-based surveys tailor the student’s experience by assigning exercises designed to increase behavioral intent to do SBIRT. This abstract describes the app and beta testing results.

Methods:
22 Nurse Practitioner students were asked to use the app for 8 weeks in clinic. Learners completed a TPB-based onboarding survey to tailor app experience and to use the app with patients. Learners completed questionnaires regarding SBIRT usage at the end of each week. TPB surveys were repeated at the end of beta-testing followed by debrief interviews. The primary outcome was self-reported SBIRT utilization as measured by percent of patients screened and percent of at-risk patients receiving a brief intervention.

Results:
Beta-test outcomes were used for app and study design improvement. From weeks 1-4 to 4-8, numbers of patients seen increased from a mean of 5.14 to 7.00 per respondent. The mean number of Brief Interventions also increased from 0.38 to 1.00 per respondent. The mean number of Screened patients decreased from 2.63 to 1.33 per respondent. Pre-Post TPB survey scores showed an increase for each TPB category and increased behavioral intent to do SBIRT (Attitudes/Behavioral Beliefs from 3.99 to 4.35; Subjective Norms 3.37 to 3.75; Perceived Behavioral Control 3.32 to 3.61; and Behavioral Intent 4.27 to 4.37). The mean System Usability Scale score (n=19) was 65.8, indicating acceptable quality but needed improvements. Focus Group findings suggest useful features of the app were the Apply and Review sections. Learners utilized the screeners and reviewed referral steps and brief intervention instructions. Learners found the Report function was the least useful of the app.

Conclusions:
A mobile app to facilitate the transfer of SBIRT skills from classroom to clinic was successfully developed and pilot tested with an initial group of learners. The app was of acceptable quality although all features were not equally useful. Learners showed improvements in brief interventions but had unexpected decreases in number of patients screened. Results showed an increase in behavioral intentions to do SBIRT and improved SBIRT knowledge and attitudes. App usage was highly variable and survey adherence was problematic. A larger randomized trial is currently testing the effectiveness of the app on skill translation.

Low-cost 3D-printed liver models in education of medical students

Jan Sylwester Witowski, Michał Pędziwiatr, Piotr Major and Andrzej Budzyński

Three-dimensional (3D) printing in all areas of medicine has been intensively developed recently. However, the implementation both in medical schools as well as hospitals is still difficult primarily due to high costs and expensive industrial-grade printers. I would like to present a cost-effective technique of preparing 3D-printed liver models that preserves the shape and all of the structures, including the vessels and the tumor.

Described models can be used for medical education at all stages – from anatomy, pathology, all the way to surgery. Models developed have been used to teach problems such as: blood supply of a liver (anatomy), Couinaud’s classification (anatomy/surgery), hemihepatectomy surgery (surgery), liver cancer (surgery/pathology).

Ophthalmology podcast: Successful, high impact, third world, low budget production

Harikrishnan Vannadil, Divya Pillai, Unnikrishnan Vannadil and Sandeep Gupta

INTRODUCTION:
Podcasts are a very popular media of entertainment today. Podcasts have been used by many artists around the world to disseminate their voice to countless audiences. The content thus disseminated comprises of music, talk shows, opinions and lectures. The power of podcast needs to be harnessed for medical education. In many developing countries, there exist a shortfall of quality medical educators as well as resource material. Podcasts have the capability to conduct classes and lectures at far flung areas with a lower bandwidth compared to videos.

OBJECTIVE:
Primary objective – To utilise the capabilities of podcasting to disseminate knowledge and help medical students as well as specialty residents understand ophthalmology topics well, in a lucid manner.
Secondary objective – To attain reasonable quality in terms of production and content with minimal resources and training.

MATERIAL AND METHODS:
Starting Dec 2015, ten episodes of podcast were written and produced by an ophthalmology resident. Script of the content was formalised after thorough study and research of basic ophthalmology topics from standard textbooks and literature. Text was refined by a voice artist for simplicity. Text was read by the voice artist in a home recording system. Each episode lasted 20 minutes.
Recording system used was a simple headset microphone set (make: Microsoft) with a laptop computer with an open source audio editing software (Audacity). The audio was cleaned, corrected for pitch and background music added. Recording and editing of each episode took 60 to 90min. The file was uploaded to commercial hosting server (soundcloud) with ID3 tags. An associated domain name was registered in the name of the podcast channel. After complying with the requirements of iTunes, the podcast featured in Apple iTunes along with other podcast directories.

This process was repeated for all the ten episodes. The participants of this project were not native English speakers nor have they received any professional training in this direction.

RESULTS:
Over six months, a total of 10 podcast episodes were published and performance noted. 10 episodes of podcasts generated 2267 plays in total till Sept 2016. The highest played episode was the 10th episode with 386 plays. The channel saw the maximum listeners from the USA with 1308 listeners (57.70%), followed by India with 308 listeners. 52% of listeners were returning listeners. Repeat plays were highest with one listener playing 17 times. The listeners increased with every new episode. The total downloads were at 73.

CONCLUSION:
Podcasts on the basics of ophthalmology is a successful and well received project. Usage statistics showed a good reception across the globe. Although produced in a non-English speaking country by students and amateurs, the podcast had a good listener base. The top listeners being from a first world English speaking country is a proof that the quality in terms of production.

POSTER PRESENTATIONS

Poster presentations offer an opportunity to share your work with an international audience at Medicine X. Presentations will take place throughout the conference with special designated times for poster viewing. First authors should plan to be next to their posters to answer questions during these times.

'Tips for New Docs': The use of a novel mobile application to aid transition between medical student & junior doctor

Jonathan Guckian, Thomas Johnson and Robert Ker

INTRODUCTION
Mobile applications are being used increasingly in clinical environments by healthcare professionals. The transition from medical student to junior doctor is recognised as a challenging process, with patient safety implications. There is little evidence in the literature focusing on the use of mobile applications to aid this transition via instructional content.

AIMS
This study aimed to develop a mobile application for junior doctors in England, and evaluate its use and subsequent impact on trainee confidence.

METHODS
A mobile application ‘Tips for new docs’ was to be developed, featuring instructional guides written by junior doctors, focusing on common ward based scenarios. Download data for the app was to be gathered via Google analytics and Apple App store. Focus groups would gather qualitative feedback from UK junior doctors on their use of the app.

RESULTS
The app was released on 19th July 2016, and hosted on Medisense.org.uk, a free online medical education platform, in addition to ‘Google Play’ and Apple’s ‘App Store’. The app was made available for free worldwide but specifically advertised in the North East of England. To date the mobile application has received 1700 downloads. The focus group established that the mobile application made new doctors feel more ‘comfortable’ and ‘at ease’. Moreover it was felt that the application helped improve user confidence managing complex jobs ‘out of hours’. A survey further reviewing user feedback remains on-going.

CONCLUSIONS
The study has found that mobile applications can prove to be popular amongst newly qualified doctors. Mobile apps such as ‘Tips For New Docs’ may play a role in improving user confidence by acting as an adjunct to local hospital ‘induction’.

TECHNOLOGY HUB

Technology demonstrations offer a chance for delegates to get hands-on demonstrations of cutting-edge education technologies so they can best understand the unique affordances and applications in medical education.

Lecture keeper, reinforcement and medical learning

Aaron Brown and Emeka Ajufo

As students search for ways to squeeze more hours of learning into their day, there has been a growth in the field of study tools. Much of that growth has been in the form of condensed review materials or apps that quiz you on current topics students are responsible for learning. These choices will work when there’s no time to crack open Robbins, but what about the occasion where you can’t see or use a screen? As developers and students alike are searching for new and effective ways to learn, one style of learning that’s not been considered is auditory.

Since the advent of the cassette tape, millions have relied on recorded lectures to study languages and culture. However, in the context of medicine, “[listening] is a skill that is often neglected or omitted entirely.” (Hopper, 2007) Applying the same techniques to medical school studying will allow students to refresh the day’s material while at the gym or making their way home from class. Many medical schools have implemented ways to record lectures so that students may view them online and download them for viewing, or listening, at their own convenience. Though some consider the repeating of auditory materials to be “passive learning”, Lecture Keeper will keep track of a student’s progress, allowing students to report their confidence with the material presented and tracking the number of times the material has been reviewed.

Research has also shown that “non-explicit stimulus elements… can be learned during unattended exposure” (Green et al., 2016) Progression through material will be tracked as well: Students will be able to pause one lecture, start another, then go back without losing their place. Lecture Keeper will also offer flash card support so that the student’s mastery of the material will continuously be reinforces. All in all, the Lecture Keeper app will give students an opening into a whole new and effective way of mastering the material of basic sciences.

As schools progress more toward a “flipped classroom”, allowing students to learn in the way that they find works best, this tool will be essential in every student’s kit.

Virtual reality simulator: EyeSim

Anuradha Khanna, MD

EyeSim is a neuro-ophthalmic virtual reality simulator for mastering clinical examination skills through deliberate practice and enhancing concept clarity through anatomical correlation. It is a stereo and interactive neuro-ophthalmic simulation with 360 degrees anatomical view and a virtual patient with pupil and cranial nerve dysfunctional states. A color coded anatomical simulation of the visual pathways is available with the option of simulating visual field dysfunction with lesions at various locations along the pathway.

EyeSim provides a safe but immersive environment to better prepare medical students for clinical rotations and decrease patient burden from repetitive and bright lights. Interns and Residents from Emergency Medicine, Internal Medicine, Primary Care/Family Medicine, Pediatrics, Neurology, and Neurosurgery would greatly benefit from training on the virtual eye simulator in order to emphasize identification of must-not-miss diagnoses and enhance comfort with neuro-ophthalmic examination skills which are often deferred to an ophthalmologist. These specialties can focus on relevant simulations such as identifying cranial nerve dysfunction, anisocoria, strabismus, visual field defects or an afferent pupillary defect.

Using multiple technology platforms to connect, educate, and engage far-flung care teams

Brenna Harrington, Tiffany Hackett and Gregg Miller

 

As the healthcare industry continues to consolidate, colleagues become more geographically spread nationally, and even globally. As a result, communicating with members of the care team across boundaries and practice lines is becoming increasingly more difficult.

This emerging reality – the difficulty in sharing information, insights and ideas – leads to a loss of community, causing care team members to feel disconnected or unengaged, and can result in poorer outcomes and disparities in care.

Recognizing the need for innovative yet workable solutions, CEP America, a national multi-specialty provider of onsite clinicians for hospitals and other facilities, searched for a better way to connect its 2,000 physicians, 1,500 advanced practitioners and other team members.

The solution was CEP Community, a multi-platform tool used for continuing medical education (CME), team collaboration, communication and overall connection, no matter where a clinician is located, the practice line, or area of interest or need.

The goal for CEP Community is to create a network of providers that facilitates the ability to discuss/share ideas, information, documents and content to bridge connections with all members of the CEP team. There are different connectivity options for various topics, creating a network of knowledge, resources and support for providers to tap into when needed. For example:
– A rural PA with a question on procedural sedation can quickly access the Clinical Education page and get immediate input from colleagues on steps to take.
– Female physicians wishing to advance their careers and support colleagues can participate in a subgroup, Women in Medicine.
– Nurses in busy EDs can connect with psychiatrists and other colleagues to get tips on how to manage agitated patients.
– Physicians can engage in discussions about optimal clinical patient management and collaborate on important decisions in “real-time”.
– A subgroup of the CME community channel, CE Connect, utilizes tools and technology to help share educational content across the organization, creating a better-rounded CME program.

On the clinical education page, colleagues can also share best practices, literature updates, and innovations published from a range of social media tools to help promote select educational content, and bring more of the out, in.

Impressive Early Results and a Strong Future
Just under a year old, the program continues to grow. From June to August of 2016, the number of engagement and page views for CEP Community grew from 13,000 to nearly 19,000.

In a lively, informative and interactive panel presentation, attendees will learn from the platform and concept developers how to:
– Build communities through engaging distance learning platforms
– The value-add of incorporating multiple technology options into education and engagement initiatives
– Strategies for increasing and sustaining participation
– How an engaged provider community leads to better patient outcomes and improved performance

Engagement learning design focuses on engaging all stakeholders in medical education, engaging learners in ways that appeal to their unique learning needs, just-in-time learning, engagement with a diversified audience, the power of storytelling in medical education, progress monitoring and strategies to engage and invest learners in their educational growth, patients as educators, applying design thinking principles to education, online, distance, and blended learning.

LEARNING LABS

These 45 minute classroom sessions provide presenters an opportunity to lead a group of learners through a “how-to” style tutorial on novel teaching methods that incorporate thoughtful use of technology to engage the Millennial learner.

It’s all in the palm of your hand: Mobile technology to improve medical education

Richard Hobbs

Objectives:

Participants will:
1) Appreciate the utility of tablets as a tool for engagement learning
2) Explore many inexpensive and easy-to-use apps and platforms for medical education
3) Learn how to teach with tablets in a variety of busy medical education settings (clinics, hospitals, classrooms)
4) Discuss best practices for using tablets and apps in medical education and curriculum design

Introduction:
Technology has revolutionized the practice of medicine, though we rarely incorporate the use of that technology into the instruction of medicine. Instead we rely on the same antiquated educational modalities we have used for decades. As a result, neither our learners nor our current faculty have ever been taught how to make technology work for them and not against them. This workshop will demonstrate practical, high-yield, easy-to-implement ways to use mobile technology, specifically tablets, for medical education.

Description:

Dr. Hobbs has been using tablets, specifically the iPad mini, to educate medical students at the University of North Carolina since 2014. His goal is to deliver on the promise of mobile technology to change the way we educate our learners. Participants in this hands-on, practical workshop will explore many useful apps and platforms to teach learners of all levels, disciplines, and learning styles and in a variety of settings. We will also discuss some of the educational theory and best practices that render the tablet a powerful tool when teaching with either just-in-time learning, distance learning, or even to improve engagement in the classroom.

Much of the time will be spent in active demonstrations of teaching with specific apps and platforms. With busy clinics and busy hospital rounds the norm, many of these teaching demonstrations will focus on educational content that is engaging, easy to prepare, rapid to deliver, and high-yield. Some examples include teaching bedside exam, promotion of patient-doctor communication, and using just-in-time learning to prepare students for their next patient. For those that teach in larger group settings, we will discuss ways to “flip” the classroom and make lectures more interactive.

Discussion will also cover some best practices for using mobile technology to engage different types of learners, particularly millennials and introverts. Some examples include social media case-based learning at a distance, creation of “game show” style mini-didactics, and self-study aids.

Finally, Dr. Hobbs will demonstrate how tablets can be at the center of purposeful curriculum design and will very briefly discuss the logistics of setup and maintenance required for anyone interested in a similar design. There will also be time for participants to use tablets (provided by the presenter) to practice what they have seen demonstrated. A worksheet will also allow for participant reflection and commitment to how they may integrate mobile technology at their own institutions.

OneED Mindfulness Project: Getting started and maintaining momentum in your health care workplace

Shahina Braganza and Ashwini Amaratunga

Over the last few years, the practice of Mindfulness has gained increasing recognition for its role in personal and professional wellbeing. Neuroscientific evidence for the benefit of Mindfulness is mounting: individual practice leads to numerous psychological and physiological benefits eg improved emotional intelligence, increased compassion and decreased burnout.

There is now increasing evidence for group practice of Mindfulness. It has been incorporated into many high profile workplaces eg. Google, Harvard University and Goldman Sachs. In fact, Google is the birthplace of the Search Inside Yourself Leadership Institute (SIYLI), whose practices we have adapted for our Mindfulness project.

So, the question is no longer ‘Is Mindfulness practice worthwhile?’ but rather ‘How do you make it happen in your organisation?’.

We embarked on the OneED project in the busy Gold Coast Health (Australia) Emergency Department – approx. 13 000 total patient presentations per month.

We utilised the change management approach of Appreciative Inquiry (AI) to embed our practice over a 6-month period across all ED staff (clinical and non-clinical). The basic tenet of AI is that an organisation will grow in whichever direction people in the organisation focus their attention.

We trialled and focused on which activities were the most engaging and accessible to staff, looked at why they were effective, and then replicated more of what worked (and less of what didn’t). This allowed for organic growth of the concept of Mindfulness within our ED and – through a kind of social osmosis – into the wider organisation.

Building on progress already made by others, we would like to share how we introduced Mindfulness group practice into our workplace: what it has taken to make it meaningful, sustainable and accessible to all staff.

The learning lab will provide participants with a toolkit of Mindfulness activities to be trialled in their own workplaces with a focus on the following:

1. Introducing the concept of Mindfulness into their own complex workplaces  2. Examples of achievable Mindfulness practice in a busy health care setting 3. The types of resources and ‘buy-in’ required to get started (and to keep going)

Learners will participate in several Mindfulness practices including short meditations, brief videos, journaling and mindful listening. We will relate these experiences to the concept of Mindful leadership, and how to be constantly flexible and adaptable in the delivery of programs to a large and diverse cohort of healthcare workers.

Participants will experience a profound connection to other workshop participants, and this will enable them to appreciate the power of a practice that only takes a few minutes to get started. They will leave the workshop with an appreciation and understanding of the concept of group Mindfulness, and with a toolkit of practices that can be applied immediately, through their own leadership, in their own workplaces.

Taking our learners on an adventure – storytelling in health professional education

Victoria Brazil and Resa Lewiss

Good storytellers – like good educators – activate our brains and stir our emotions. We don’t forget them. Although it may be that everyone can tell a story, we know that not everyone does it well. Current practice and medical education research posit that educators who use stories to teach, are more effective than those who read bullet points from a slide. The reasons are both obvious and perhaps not so obvious. Stories provide the listener an experience far more robust and experiential. Stories allows the learner to match her/his own experiences with the story being told. As such, there is an assimilation in the brain of learners.

Publications in the Harvard Business Review and advice given to speakers for TED style conferences advise that persuasive messages should be told through the sharing of personal stories. Theoretically, we agree; however not if the delivery is poor. This learning lab will offer participants the chance to consider storytelling in their educational contexts.

We will focus on 2 areas:
1. What kind of stories are effective
2. How to tell those stories well

Drawing on lessons from film and theatre, and from the nascent field of ‘narrative medicine’, we’ll review the features of a good story – one that is familiar (or at least believable) for our audience, where our usual assumptions about life or work are questioned, and where we are left feeling there might be other, better ways forward.

We’ll consider how to tell that story – whether on a stage, in a classroom, or on paper. The level of detail, the words used, and the length are all important. We will touch on ‘performance art’ – using voice and body language to reinforce the messages in our story.
Formats will include brief videos to prompt discussion, and sharing personal experiences as teachers and learners. There will be opportunity to practice with feedback.

Participants will leave the workshop with a set of principles:
1. How to determine the appropriateness of a story
2. How to identify major categories of stories
3. Which skills are required to tell that story for maximal impact
4. How to structure a story: Beginning, Middle, and Powerful End

Transforming attending rounds: Integrating tech into bedside education

Anoop Agrawal

Teaching rounds for the modern-day attending pose numerous challenges. Duty-hour regulations, infection control protocols, interruptions from clinical activities have placed constraints on the time available to teach. Advocates for bedside teaching rounds have stressed the need for composing “teaching scripts” to effectively teach clinically relevant pearls. Memorizing and recalling such scripts can become burdensome. Moreover, the education literature is recognizing that solely an oral discussion of educational concepts is insufficient in meeting the needs of how learners acquire information. The majority of learners are self-identified as multi-modal, i.e. learning by utilizing visual, auditory, receptive and/or kinesthetic modes. Mobile tablet devices offer unique solutions via digital whiteboard apps to address these growing needs. These apps allow integration of figures depicting pathophysiology, algorithms, tables, etc., along with annotation ability. The attending can create an interactive library geared towards a ‘teaching rounds curricula.’ The use of digital whiteboards can enhance learner engagement and help overcome time limitations by having teaching materials and scripts at the ready.

In addition, with the increasing prevalence of mobile tablets such as the iPad and the iPad mini in the hands of medical students and residents, specific apps provide unique ways to employ this educational technology on teaching rounds. Collaborative whiteboard apps allow multiple devices to share the same digital space in real time creating a transformative educational experience. This collaborative space concept offers learning to be synchronous and asynchronous, extending the attending’s educational impact and interactions beyond just the few hours on rounds.

Ideal, teaching rounds involve the patient and are performed as patient-centered rounds. The education of medical students and residents does not need to be separated from education of the patient. The same apps can be utilized by patients or the content generated from them can be digitally shared with patients.

This session will help participants acquire the skills to create a digital teaching script, discuss best-practices on how to utilize the iPad on teaching rounds, and how to utilize a collaborative board on and away from rounds. Ten iPads with all necessary applications will be provided for the audience at large.

PANEL

These 45 panel sessions provide an opportunity to engage in a discussion around novel topics of medical education. We encourage panels that are composed of Everyone Included™ stakeholders (e.g. learners, educators, interdisciplinary contributors, patients and caregivers when possible).

Applying user-centered design thinking to create patient engagement strategies on a medical-surgical unit

Theodora Tran and Patrick Kneeland

Practical and financial pressures have placed a renewed focus on the human experience of healthcare from both the patient and provider perspective. We sought to develop an innovative, interdisciplinary, and collaborative user-centered design process for experience improvement on a 24-bed medical inpatient unit.

To do so, we conducted a 1-day, experience improvement design session with participants from across the clinical spectrum: nurses, physicians, pharmacists, case managers, process improvement specialists, and medical students. Significant background work to understand and engage the patient perspective in the design included several rounds of real-time patient interviews on the unit and over 20 hours of patient and care team observation.

The design session consisted of facilitated brainstorming followed by a series of team design cycles. The end product was 4 innovative “Always Event” prototypes that were brought back to the unit for implementation and further iterative design. These included (1) “The Admission Time-out,” a novel approach to onboarding patients to the floor, (2) “The Smash-up!” a twice-monthly educational interaction with nurses and physicians on the floor to exchange perspectives of mutually misunderstood workflows, (3) “One good thing” embedded into each nursing huddle, and (4) a new strategy for engaging patients in the use of the whiteboard. 100% (n = 16) of participants found the design session to be effective or very effective at creating an opportunity for collaboration across disciplines and all found the session to be effective or very effective at promoting the development of strategies for improving the experience of care..

Interdisciplinary experience design events such as these can be an effective way to co-develop strategies for healthcare experience design and to re-engage healthcare providers around creative reconnection to professional purpose. While these approaches seem resource intensive on the front end, they are more likely to promote whole-unit engagement and interdisciplinary, self-driven collaboration around shared goals when compared to traditional top-down improvement efforts.

Panelists will also include: Lindsay McGuiness and Natasha Vandeford

Are games the solution for medical training of millennials (and everyone else)?

Bradley Tanner, Mary Metcalf and Brian Tanner

The presentation highlights concepts and examples related to the potential of challenging and engaging game experiences to aid medical and health skills development. The talk reviews evidence that well designed games can confer problem solving skills and effect change in knowledge, attitude, confidence, and skills. Successful games borrow established design and development standards from the entertainment game industry as seen in first-person shooter games, mystery games, or a find-and-seek (e.g., Pokeman Go) games. Successful game design and development strategies focus on user experience, choice, exploration, self-expression, creativity, matching challenge with skills, receiving feedback, and expanding social connections through communication with other players.

A multi-player, exploratory, and immersive game is a format familiar to the audience of Millennials. Health professional or lay students expect game-based learning to be a similarly personalized experience that rewards cooperation, improvement, and group success. They want an immersive and motivating experience that depends on intrinsic reward rather than extrinsic motivation. Such enthusiasm and engagement can arise from standard multi-player game elements: narrative, mechanics, environment, an avatar with health/strength elements, co-players (real and computer-generated), choice and quick/medium/slow decision-making, feedback, levels of improvement, and the thrill of success.

Sophisticated learning games where learners investigate history and findings, establish diagnoses, and determine treatment in rich game environment offer an opportunity to rethink how we establish and refine medical and health-related skills. In a medical game, instead of building a civilization, causing mayhem, or working with a team of players to destroy the other team, the end goal is the acquisition of skills and understanding necessary to navigate the complicated science and psychological principles of health care. These well designed games can help medicine navigate the radical changes happening as we move from older models of health care to models emphasizing patient empowerment, easier data access, team models of treatment, and most importantly prevention vs. treatment of disease. Since ongoing change is inevitable, game frameworks must be flexibly designed to allow for easy upgrades, revisions, and repurposing for novel topics.

Pedagogy based on immersive games can become the standard by which training is based and overtake older lecture/didactic models, “gamification” of existing approaches, and resource intensive solutions including problem-based learning, team learning, and simulated/standardized patient-based training. Existing and future games offer stakeholders in the ever expanding field of medicine a unique way to master knowledge and skills.

Patient and family designed curricula in all levels of physician education

Joan Forte Scott and Laura Steuer

At Stanford Health Care we have had a Patient and Family Partner Program for over 8 years. The current program consists of 150 patient and family partners who participate in 16 Patient and Family Advisory Councils (PFACs), a Patient/Family Faculty Program, a Peer 2 Peer Program as well as improvement activities throughout the organization. The Program is a national model and one of the largest and most developed in existence.

Within the program, story telling has long been a powerful mechanism to educate and change provider behavior. In the last year, the speaker program evolved to a faculty program with patients and families not only speaking at the invitation of physician and nurse educators,but actually designing the curricula- in other words, determining what physicians need to learn to best serve their patients and families.In this process, many gaps in traditional education have been identified and addressed. Curriculum has been co-designed in courses through the Simulation Center, in a medical school elective and in ongoing education through the hospital and clinics. Through this panel of patients, family members, physicians, educators, students and administrators, we will provide examples of successful work and through our own experience provide guidance to others.

Panelists include: Alice McCarty

WORKSHOP

These longer 45 minute sessions provide presenters with an opportunity to delve deeply into a topic to share unique expertise with a diverse group of passionate Medicine X | ED delegates. Workshops are limited to a maximum of 30-35 people.

Teaching design thinking to future doctors: experiences from design programs in medical schools.

Bon Ku

This is a unique opportunity to learn from the small but growing number of educators who are re-imagining medical education through design thinking. We will invite educators to candidly share their experiences of teaching design thinking to medical students. Workshops leaders will include: Matt Trowbridge, University of Virginia (confirmed); Bon Ku, Thomas Jefferson University (confirmed); and Stacey Chang, Dell Medical School (pending).

In this workshop, attendees will learn the following:
1. How to incorporate design thinking within undergraduate medical education
2. Gain tips and tricks from current design thinking programs
3. Challenges to introducing human-centered design in medical school

Be our guest: Applying guest experience principles to health care

Jonathan Snydal, Nick de La Mare, Jordan Presnick and Stacy Stevenson

What can hospitals learn from the redesign of Disney World’s guest experience? How might we design a digital health product using guest experience principles from some of the best restaurants in the world? Is it possible to boost patient engagement and satisfaction using the same methods employed by five star hotels and resorts? Absolutely! We have found that some of the best innovations happen when you apply lessons learned in one industry to a new context. We have distilled our experience in the hospitality industry into five Guest Experience principles and using co-creation techniques we will explore how they can be applied in healthcare in the future.

The power of the story in medical education

Devanshi Mehta

As a current first year medical student at Dartmouth’s Geisel School of Medicine, medical education is of prime importance to me as my peers and I experience it in our day to day lives. Entering medical school marked a profound transition in my life from patient to provider. I remember sitting in the lecture hall during my first day of class not believing the new path my life was about to take. Seven years prior to that day, I was sitting within the closed walls of a room in the Eating Disorder Unit at the University Medical Center at Princeton battling an illness that almost took my life. Recovering from anorexia taught me many things-it was more than just treating physical symptoms. It was a matter of trusting providers, going through countless hours of therapy, doctor visits, and requiring a great amount of inner strength and courage to defeat. The recovery process became a muse that inspired to give back and go into medicine, better the community, and teach my peers through the power of a recovery story.

My undergraduate institution first gave me the opportunity to transition my personal war with mental illness to something that would be helpful to a greater community. I took the initiative to combat mental illness by resurfacing and leading a mental health organization, Active Minds. Through this organization, I have gone on to share my story and encourage other mental illness recovery speakers to educate students at Penn, the faculty, and the senior administration. Our work didn’t go unnoticed, and I was eventually approached by The New York Times, Philadelphia Magazine, ESPN, and did a live news segment for the Huffington Post on college mental health. I have also met with Dr. Alan Louie, Director of Education and Associate Chair of Psychiatry, at the Stanford School of Medicine to share my work at the University of Pennsylvania and discuss ideas on how to improve medical education. Through these experiences, I have realized the power of using patients as educators.

At Medicine X, I propose to lead a workshop to demonstrate the importance of integrating patients and their stories into medical education and the impact this has on producing doctors that are ultimately more empathetic and aware. I will start with sharing my own recovery story as an example and then switching to discussing the important learning points and logistical structure in having a patient come in to tell a story, and conclude giving guidance and takeaways on how medical schools can integrate more patient exposure in line with the year 1 and year 2 curriculum. After this workshop, the audience should leave with a more profound understanding of the importance of using patients as educators and the power of the story in producing a new generation of physician-leaders.

Transforming education via human-centered design and scenario planning

Lisa Howley, Jean Wright and Ann-Somers Hogg

In an era of unprecedented change, health care providers are being asked to meet new expectations, adapt to changing technologies and innovative models of care delivery. This change requires continuous improvement in the education of healthcare professionals and a commitment to learning in ways that have not been fully realized by many academic medical centers. Design principles provide an effective means for innovation and creativity to flourish. This session will share a case study of one large independent academic medical center to demonstrate how design thinking can be effectively used as a strategy to enhance the organization’s investment in and approach to learning. Knowledge of this strategic approach will better equip participants to transform their institutions into learning organizations.

During this workshop, we will provide a deep dive on the following:
1. How we addressed a specific organizational challenge with human-centered design and scenario planning tools
2. What design thinking is and how to lead a successful design thinking session

Participants will also have the opportunity to ideate and define how they could apply design thinking and scenario planning tools to a challenge they face in their current environment.

At the end of the session, participants will…
• Know how one health system used design thinking and scenario planning tools to tackle a critical organizational and medical education challenge
• Understand when and how scenario planning serves as an effective tool to tackle a challenge, and what benefits arise from this approach
• Appreciate how to lead a design thinking session
• Walk away with a high-level plan for how to utilize design thinking for a problem they are facing

ORAL PRESENTATION

Oral presentations offer presenters an opportunity to provide a presentation of work to a large breakout audience. Presentations are 10-12 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Comics for contraception education: Harnessing power of narrative communication

Aparna Sridhar and Rebecca Roher

Emerging research suggest comics can serve educational purposes. As a communication medium comics have proven their benefits for use in health education. Comics can help young readers, or those of any age, by combining pictures and words, giving visual cues as to what the text is explaining. Comics use narrative communication. This includes a coherent story with identifiable beginning, middle and end, which provides information about scene, characters, and conflicts; raises unanswered questions or unresolved conflict; and provides resolution. In the past, comics have been used to educate about health issues such as hepatitis C information, cervical cancer education and safe sex behavior information with moderate success. As comics are a novel and creative way to learn and teach about illness, we believe the themes and structure of this medium will resonate with an increasingly large number of younger medical professionals such as students.

Contraception education is key for medical students. Teaching contraceptive methods to medical students as well as patients encompasses explaining the mechanism of action, usage, effectiveness, risks, benefits and alternatives. Each contraceptive method has a unique set of characteristics. At the University of California Los Angeles, we have started collaborating with illustration specialist Rebecca Roher to develop a series of contraceptive comics. The first comic in the series educates reader about intrauterine devices (IUDs). The comic narrates the details of IUDs from a patient-provider interaction perspective helping readers to better understand contraception decision-making and importance of structured counseling. We have conducted pilot testing of this educational material among providers and patients. The comic is available in the form of a mobile application for easy dissemination. We have obtained grant funding from Society of Family Planning to create more contraception comics.

We propose a presentation with the following objectives:
1. Understand the evolution of comics in medical education
2. Development of ‘Birth Control Tales’ comics for contraception education
3. Findings of preliminary research from pilot testing of the educational material
4. Challenges involved in using comics for medical education

Inclusive health care innovation

Charlie Goldberg and Preetham Suresh

Efforts to innovate in health care often exclude key stakeholders. Patients, physicians, nurses and staff live at the center of the health care space, have intimate knowledge of its challenges, yet typically don’t have the time, energy or expertise to address many of the problems that they encounter. At the same time, engineers and entrepreneurs with the unique skill sets to address these issues are kept at a distance, unable to connect with the ‘boots on the ground.’ This needs to change.

To develop a space where everyone learns, shares and problem solves together, we created an elective in Healthcare Innovations for our pre-clinical medical students. Over the course of ten, two-hour multi-format sessions, our students gained knowledge, skills and experiences that will embolden them to take the next steps in the innovation process.

• Presentations by MD-Patient pairs who discussed both the technical and personal stories of how innovation has impacted them. For example, an orthopedic surgeon and a patient status post total hip arthroplasty both spoke on the benefits and remaining challenges with this procedure.
• Panel discussions of physicians and engineers who identified clinical problems and used team-based approaches to develop and deliver solutions.
• Presentations by software programmers, physicians and the police who co-developed apps used in the field as point of care assessment tools.
• Visits to labs where students were exposed to assorted technologies (e.g. virtual reality, biosensors) whose clinical applications are still being established.
• Interaction with simulation based technology, where students heard the iterative process from MD-Engineer teams who were creating customized solutions to address gaps in training.
• Presentations by App developers who created tools to educate an array of learners
• Activities focused on design philosophy, during which students were exposed to effective ways of identifying problems and generating solutions.
• Presentations by basic scientists, whose work doesn’t yet have direct application. They discussed their motivations, challenges, and the process of working with clinicians to translate projects into products.
• Observerships where students interacted with providers in specific clinical environments, tasked with identifying challenges that MDs, patients, and allied health care workers experienced.

Innovation needs to be viewed as accessible to anyone in healthcare. While the sky’s the limit, it requires a willingness to engage, collaborate and take that first step. Our class promoted curiosity and excitement about innovation, moving the students to consider this as a viable area for growth and exploration. In the future, when our students encounter a hurdle in healthcare, their instincts won’t be to throw up their hands in frustration. Rather, they’ll have a vision of what’s possible, be positioned to connect with others, and feel empowered to act as agents of change.

NephMadness: Medical education, social media and basketball

Joel Topf

Background
NephMadness is an educational campaign that takes place entirely on the internet through a mixture of tweets, blogs and an interactive website that allows learners to participate in the project. NephMadness leverages social media and Free Open Access Medical Education (FOAMed) to highlight advances and important issues in nephrology. NephMadness began in 2013 and, by the time of MedX, will have completed its fifth iteration.

Methods
The curriculum takes the form of an online game that mimics the NCAA basketball tournament, March Madness. Participants attempt to predict the winners of hypothetical contests between nephrology concepts. The NephMadness field consists of 32 concepts from 8 different domains of nephrology. These 32 concepts are arranged in a bracket of head-to-head, single-elimination competition, i.e. concept A faces concept B and the winner then faces the winner of concept C versus concept D. Each round eliminates half the field until there is a champion. Each concept is explained by editorial content created by a team of nephrologists with experience in social media. Additionally, the organizers draft content experts, our selection committee, to assure that the material is both accurate and representative of the future of nephrology.

As the contest runs over three weeks of March, additional content is generated by the organizers, experts in the field and participants. Each edition of NephMadness generates over 100 pages of medical education.

A blue ribbon panel of leaders in nephrology education determine the winners of each head-to-head match-up. Participants play the game by filling out brackets and trying to predict the winners of each head to match up (2^31 combinations). NephMandess has a website that allows people to record their predictions and automatically scores the brackets.

Results
From 2014-2016, NephMadness had 1,113 entries. Nephmadness has seen steady growth in both the number of entries and the number of tweets using the hashtag #NephMadness. In 2016 we had 486 people tweet #NephMadness, 4,521 times. In 2013 this was 77 participants and 484 tweets. In 2016, 37% of the entries were from outside of the United States, an increase of more than 2 fold from 2015. Web traffic to the hosting site, the American Journal of Kidney Disease blog, is triple its monthly average and is regularly the single highest traffic day of the year.

Conclusions
NephMadness is a unique spin on medical education that takes it out of the wards and textbooks and transform it into a gamified, interactive campaign that populates the social media channels that learners are already engaged with. The mixture of free, evidence-based, expert editorial with twitter and blogs is a novel method of delivering high quality continuing medical education that could serve as a template for future projects.

Reimagining medical education with design thinking, 3D printing and co-creation

Robert Pugliese

In JeffDESIGN, the first design thinking program within a medical school, we teach medical students how to apply human centered design to solve healthcare problems. Students experience the rapid cycle of the design thinking process: empathy, problem definition, iteration, prototyping, and testing. I will describe our experience and lessons learned from the development of a 3D printing course called Design for Disability. The objective for the course was to introduce medical students to 3D printing and how to design for an end user with a disability. Students familiarized themselves with 3D printing technology by printing and assembling upper limb prosthetic devices for an 8 year old child with a hand deformity. They then worked with a 16 year old with a spinal cord injury to co-design adaptive devices that might help him with activities such as writing or using a remote control.

A secondary objective for the course was to create an inclusive and interdisciplinary learning environment for medical students to better prepare them for real world, team based problem solving. Medical students collaborated with industrial design students, pharmacy students, and occupational therapists to identify needs of an end user and prototype a solution. Throughout the design process, the interdisciplinary team learned to “design with” instead of “design for” an end user with a disability. This approach reinforced the importance of including the patient in the design process and ensured that our solutions were meaningful for the 16 year old with a disability.

Attendees from this talk will learn the following: 1) how to launch a 3D printing course to a diverse group of novice learners without a technical background; 2) how to co-create and co-design with a person who has a disability; 3) how to use design thinking to create adaptive devices; 4) how to address the challenges of creating a unique real world learning experience.

Reversing the national chronic pain and prescription drug epidemic

Tomer Anbar

Chronic pain is the largest and costliest health epidemic in the U.S. – more than the total affected by heart disease, cancer, and diabetes combined. Over 100 million Americans suffer from chronic pain, of which 50 million are partially or completely disabled at an annual cost of $635 billion dollars, not inclusive of pain in children, seniors, or military personnel and veterans. It is estimated that returning soldiers from the Gulf will add at least $340 billion to the toll in the coming years. Pain commonly devastates families, rendering its casualties disabled, unable to work, facing difficulties interacting with family, friends, the workplace, and contributing to depression and anxiety, problems sleeping, and often leading to high blood pressure, obesity, diabetes, irritable bowel syndrome, and a host of other systemic health issues. Chronic pain represents 80% of costs in the Workers’ Compensation system, placing heavy burdens on employers and injured workers, as the availability of effective evidence-based care is limited. According to the Institute of Medicine, only 5 of the nation’s 133 medical schools provide training in the treatment of chronic pain, which is a major contributor to drug abuse. The CDC has officially declared that prescription drug abuse in the United States is an epidemic. Overdose deaths involving prescription opioid analgesics continue to increase. 37% of Americans say the country is losing ground on the problem of prescription drug abuse. While highly effective solutions are available, most suffering from chronic pain and prescription drug addiction will never receive appropriate treatment.

Chronic pain and prescription drug abuse rehabilitation in the form of an evidence-based biopsychosocial interdisciplinary paradigm has represented for well over 30 years, the cultural transformation the National Institutes of Health (NIH) and Institute of Medicine (IOM) have called for and identified as the most effective way of reversing chronic pain and comorbidities, improving function and decreasing overall medical costs. The issues remain that 1) most stakeholders are unaware of such evidence-based solutions, and 2) access to such care is difficult to come by, and 3) reimbursement does not correspond to evidence-based practices. This presentation will present systemic solutions by 1) creating awareness among stakeholders including patients, providers, legislators, and payers regarding best practices; 2) providing treatment recommendations to UR and employers/payers; 3) describing business practices that both promote and prevent patients from receiving such evidence-based care; and 4) identifying tools such as wireless telemedicine, mobile health, and personalized and genomic medicine as a mean of extending effective treatment for pain and prescription drug rehabilitation throughout the United States and worldwide.

Student Patient Alliance for Better Health

Nancy Cuan and Kristie Hsu

Student Patient Alliances (SPA) for Better Health is a new part of the SHIELD (Stanford Healthcare Innovations and Experiential Learning Directive) elective course for medical students. The SPA for Better Health elective is housed at the Stanford Coordinated Care Clinic, a model primary care practice with a high functioning interdisciplinary team focused on delivering patient centered care. The elective engages all stakeholders as learners and teachers in a dynamic format utilizing multiple learning modalities and design thinking to tailor the learning experience to the individual students.

As early as the second month of medical school, students are matched into a SHIELD cohort based on their learning goals. Each student matching into SPA for Better Health is partnered with a patient at Stanford Coordinated Care based on the student’s interests and the patient’s needs and desire to teach. After learning the patient’s life story, the student works closely with the patient to develop innovative modalities for tracking and implementing health goals and action plans. This interaction is based on principles of design thinking and behavioral change. With the patient as the teacher, the student gains a unique perspective on the realities of living with chronic medical conditions and the challenges and rewards of working on behavior change.

The student is immersed into Stanford Coordinated Care as a team member who contributes to the team by adding the perspective of a health coach who has seen the patient in multiple settings (in the home and in primary care and specialty visits). In turn, each team member, including the patient care coordinator, pharmacist, dietician, librarian, and others, adds a piece to the student’s learning.

A third component of the learning experience allows the student to partner with a patient care coordinator to work on a personal health care goal. In seeing the barriers to achieving personal health goals, the student can better appreciate the challenges of behavioral change.

While each of the components of this learning experience engages the student as a teacher to some extent, the fourth part most engages the student as a teacher. With the guidance of a preceptor, the student works on a project of choice based on the experience at Stanford Coordinated Care. The student presents the outcomes of this project to the team to help improve patient care and/or clinic operations.

The curriculum for this course involves a dynamic process as the student checks in weekly with the team and the team touches base regularly with the patient on the learning progress. Any changes to the curriculum can be made in real time. In addition to the direct patient and clinic experiences, students use online courses, books, didactic sessions, and workshops throughout the course.

Telehealth Has arrived, but how do we get everyone to use it?

Patricia Handschiegel and Vik Bakhru

Telehealth and telemedicine have demonstrated early clinical success. The technology is in place. Yet, few physicians and patients are using these solutions. This presentation will take the telehealth/telemedicine discussion to its critical next stage: How to get physicians and patients to adopt and use the technology. Using historical examples of successful efforts to move consumer and businesses to new innovations combined with truisms of human adoption of technologies, Dr. Bakhru will share simple, efficient strategies and tactics that attendees can use to migrate doctors and patients to telehealth/telemedicine technologies when medically appropriate. The session will also share what to expect after doctors and patients have adopted telehealth/telemedicine solutions, including ongoing technology management, data security, and other factors. Additionally, Dr. Bakhru will include where and how to leverage telehealth/telemedicine technologies to grow your business for a complete, comprehensive look at getting the most value out of these exciting new technologies.

The benefits of eliminating live lecturing: results from a highly successful “flipped” medical histology course.

Jeffrey Marchant

Medical education commonly uses live lectures to deliver content and students then “process” the material on their own in preparation for an exam. Often preparation occurs in condensed sessions just prior to the exam and results in poor long-term retention. In addition, little faculty input can be provided to students during this processing period. Delivering live lectures is simply not a productive use of faculty time and effort; instead, their time should be spent working with students in class to assist them in moving the new content into their working memory – specifically, engaging them in content recall and challenging them to work with the new information.

This approach results in significantly increased learning efficiency since faculty can help students navigate around problem concepts, and also results in greater long-term retention. We have eliminated live lectures in our histology course and instead use a flipped classroom approach. All content is delivered via pre-recorded lectures (“histovideos”, 20-30 min each) and additionally, a syllabus, virtual microscope and online practice questions. During the “interactive classes” we use a series of MCQs, (both image- and text-based) and give self-selected student groups two minutes to discuss each question. At the end of the 2-minute period groups hold up color-coded cards with their chosen letter answer. Color-coding allows faculty to quickly assess student responses (mostly one [correct] color indicates understanding, a rainbow indicates uncertainty) and to see which groups have correct/incorrect answers (iClickers do not provide this group-specific information).

The questions are discussed by the faculty using explanatory PowerPoint slides that follow each question and plenty of time is given for student questions and discussion. We have 1.5 hours for class and have found that 12 questions, plus explanatory slides, fill the time (there is no break).

We find that (data is from Fall 2015):
1) Students come to class well-prepared: 77% of students spent 31-90 minutes preparing for each class; an additional 21% spent less than 30 minutes. In addition, when asked, “How effective were the histovideos for your class preparation and overall learning?” the students rated them 4.9/5.0.
2) 84% of students wished that preparation videos were used in other classes.
3) >80% of students come to class (it is not mandatory).
4) No off-topic activities (email, texting) occur. Although these are common in live lectures, the interactive class approach, moving from question to question, does not grant the students sufficient “free” time to be distracted) .
5) Real teaching happens in this setting since there is a continuous back-and-forth dialog; most lecture settings just offer unidirectional content delivery.
6) Students are very comfortable asking questions with this format.
7) Faculty find these classes more rewarding and enjoyable than giving traditional lectures.
8) The overall course rating was 4.75

The power of patient storytelling to increase engagement and promote empathy in education

Kristen Terlizzi and Mary Song

Medical school education across the country has a goal to become more patient centered. The best way to accomplish this is to embed more patient stories into medical school education. Patients and families share a common theme that physicians need to “treat the person” and not the “disease.” Medical schools can help instill this mindset in their students by having patients elucidate the emotional, social, and spiritual ramifications to any illness. No one can better relay this connection than our patients and their caregivers.
Patient speakers bring a new voice to presenting clinical information while simultaneously providing students with unique insight into the patient perspective. A skilled speaker can take her audience on a journey where the learnings are shared and experience is empathized, thus sharing a universal message fit for any audience. Patient storytelling allows the stakes to be real for both the speaker and listener, leading to a much more memorable and poignant lesson than one from a textbook.
Kristen Terlizzi is a patient speaker on Stanford Health Care’s Patient & Family Partner Program Speaker’s Bureau.  Kristen will share her story and how patient storytelling is utilized in medical school education and hospital settings with physicians.  We will explore the role of patients as the educator with the power of storytelling from the patients’ and caregivers’ perspectives, along with sharing tips on how to train and recruit patient and family speakers.
We are in a revolution of patient engagement in healthcare. Patients are becoming educated experts in medical conditions and successful care plans often become a partnership between patient and physician. Employing patient storytelling in medical education promotes student engagement and prepares them for this evolving culture.

 

RAPID REPORT

Rapid reports are an opportunity to provide a rapid presentation of work to a large breakout audience. Presentations are 5 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

The future of medical school: A core competence model?

Anu Atluru

Learning and retaining medical knowledge is a greater challenge for students today than ever before. In 1950, the doubling time of medical knowledge was estimated to be 50 years, and by 2020, it is projected to be just 73 days. The progressive need for medical students to isolate and retain essential information has been complicated further by the increasing importance of standardized examinations, particularly the formidable USMLE Step 1. Taken together, these factors have encouraged the proliferation of third-party test preparation resources. Pre-clinical medical education — traditionally the first 18-24 months of medical school — has effectively been outsourced to third parties.

This is a controversial notion, one that has received a multitude of reactions from medical educators, learners, administrators, and others involved in the medical education ecosystem. As a National Delegate for Medical Education for the AAMC Organization of Student Representatives, I previously collaborated with other student and faculty leaders to conduct a survey of medical students nationwide, showing that students have indeed shifted focus from institutional curricula to third-party educational resources. Earlier this year, I authored a perspective article discussing this phenomenon, and calling for these third-parties to be taken seriously as disruptors, and their products as disruptive innovations.

In this talk, I examine the evolving competitive landscape in medical education, the challenge to stakeholders — including medical students, traditional academic institutions, and third parties — and the potential for radical impact to the U.S. undergraduate medical education model. Taking the current phenomenon of reliance on third-party learning materials one step further, I explore the viability of a new model of medical education — a core competence model.

A core competency is a proficiency that enables an organization or company to deliver unique, unimitable value to customers, thereby providing a competitive advantage; non-core competencies do not provide any competitive advantage. Thus, outsourcing non-core activities frees up capital and resources to focus further on core competencies. If the goal of medical school is to prepare students for post-graduate specialty training in residency, I argue that experiential learning via clinical clerkships is the primary core competency of medical school — not didactic, pre-clinical knowledge delivery. Would it then be feasible to formally outsource pre-clinical medical education as a “non-core” activity? With the continued emphasis on medical education reform, this may enable medical schools to focus their resources on doing one thing best, providing fundamental clinical training, rather than doing everything better.

Improving the quality of patient information about labor epidural analgesia

Alexander Butwick

Many websites and blogs contain an astonishing amount of misinformation about the effects of epidural labor analgesia on the mother, developing fetus, and neonate is widespread. Mothers-to-be may misinterpret this information and choose not to request an epidural for managing their labor pain. Furthermore, mothers with high-risk medical or obstetric conditions who may otherwise benefit from epidural labor analgesia may be at risk of major medical/obstetric complications if they choose to go without an epidural. It is impossible to control or police the accuracy of the information about epidural online. Providers who lean towards a more natural or non-medical approach to labor and delivery have inherent biases against the use of epidurals.

A group of obstetric anesthesiologists have decided that enough is enough. Some of these MDs have used social media to provide more balanced information about the benefits and risks of epidurals. Others are voicing their concerns on the blogs and websites of those who promote misinformation. Mothers deserve to receive a detailed and accurate representation of what an epidural involves. Obstetric anesthesiologists are starting to use online resources to enhance how patients are receiving information about pain relief. We hope to work with others to better improve knowledge and understanding of these practices for future mothers-to-be.

Oh the places you’ll go! Teach at a distance using social media

Richard Hobbs

Objectives: Participants will: 1) Appreciate the benefits of real-time, interactive, distance learning from a curricular design and accreditation standpoint 2) Learn to utilize social media to create a community that engages geographically separated learners 3) Participate in a brief, interactive clinical case demonstration Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

Participants will: 1) Appreciate the benefits of real-time, interactive, distance learning from a curricular design and accreditation standpoint 2) Learn to utilize social media to create a community that engages geographically separated learners 3) Participate in a brief, interactive clinical case demonstration Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

1) Appreciate the benefits of real-time, interactive, distance learning from a curricular design and accreditation standpoint 2) Learn to utilize social media to create a community that engages geographically separated learners 3) Participate in a brief, interactive clinical case demonstration Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

2) Learn to utilize social media to create a community that engages geographically separated learners 3) Participate in a brief, interactive clinical case demonstration Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

3) Participate in a brief, interactive clinical case demonstration Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

Background and Description: Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

Medical education is increasingly reliant on educational and clinical training sites distant from the primary institution. This results in significant variability in the quality and content of education, as well as geographical and psychological isolation from the larger learning community. These barriers are a threat to the comparability of education that is mandated by governing bodies and a source of concern for students who worry about their exposure to key areas of medicine. One way to bridge these gaps is to take advantage of common social media platforms to create shared learning environments. In these environments, learners can maintain connection to distant peers and educators, all while engaging in active, group instruction, delivered directly to their handheld device. Teaching simultaneously at multiple sites also ensures that all learners are exposed to the most important, core material. At the University of North Carolina School of Medicine, Dr. Hobbs has been using social media, specifically GroupMe, to deliver real-time, interactive medical cases to students scattered throughout the state. This platform allows push notification of information and allows multi-media presentations to be easily created and re-used. This talk will open with a brief discussion of the benefits of this curriculum design element both for students and medical educators. Finally, participants will participate in a demonstration of this technology, both from the user perspective and the educator role. The goal of this presentation will be that participants may return to their home institutions capable of using social media to bring learners together.

Using patient perspective sessions to increase preclinical undergraduate medical student empathy, motivation to learn, and recall

Tami Hendriksz  

Patient Perspective sessions are an innovative curricular approach designed to address the issue of limited patient interactions in the preclinical years by engaging real patients to present their medical stories. The goals of this early introduction of patient interaction are to combat empathy erosion, reduce academic burnout, and improve memory retention during the first 2 years of medical school.

At our institution, the topics of the patient perspective sessions match the physiologic system the students are studying at the time. The patients are encouraged to talk about their experiences with a particular disease process as well as their experiences in the health care setting, with an emphasis on the physician traits that they most and least appreciated. A clinical faculty member is present at all of the sessions to help facilitate the discussion and answer any questions that the patients themselves were not able to answer, such as those in reference to disease pathophysiology or health care systems.

The objectives of the patient perspective sessions are 2-fold: (1) to increase patient contact time during the preclinical years, thereby enhancing empathy toward the patient experience and increasing awareness of patient-physician relationships, and (2) to increase curiosity, interest, and humanism regarding the disease processes discussed, thereby motivating learners and making the material easier to remember.

This curricular model can be relatively easily replicated across different medical schools. Results of a preliminary study suggest that these sessions have the potential to help increase empathy toward patients and increase retention of material. Most of all, students reported enjoying these sessions. This enjoyment may help increase empathy and motivation and decrease burnout and depression during the first 2 years of medical school.

POSTER PRESENTATIONS

Poster presentations offer an opportunity to share your work with an international audience at Medicine X. Presentations will take place throughout the conference with special designated times for poster viewing. First authors should plan to be next to their posters to answer questions during these times.

Developing a digital vaccine based on Neuropsychology & Cognitive Behavior Therapy to reduce the risk of lifestyle disease

Bhargav Sri Prakash

The intersection between Neuroscience and Behavior Design is an emerging framework for thinking about strategies to reduce the risk of lifestyle diseases. Behavior Design can become even more powerful when focused upon influencing preferences at an early stage in life, when lifelong habits take root. This is supported by longitudinal evidence of the impact of the quality of primary education content, structure and methods, in the first few years of life. This exposure through early education is known to be a crucial period in predicting individual lifetime outcomes. As a potent combination of rapid cognitive, emotional and social development, this period of early life is significant for establishing a foundation for lifelong food and lifestyle habits. “fooya!” is a mobile App that harnesses immersive gaming technologies (VR) and machine learning to deliver personalized behavior reinforcement and health education for children and adolescents, through breakthroughs in learnified entertainment. Learnification is the underlying technique of education, which contextually embeds learning loops within entertainment, especially games, to maximize levels of user engagement and retention. Through the creation of this evidence-backed technology intervention that embeds lifestyle behaviors, there is increasing evidence of the persistent influence of such an intervention upon food habits. These statistically significant outcomes have been shown during multiple randomized and controlled clinical trials done by researchers at the Baylor College of Medicine’s Children’s Nutrition Research Center, Johns Hopkins University Bloomberg School of Public Health’s Center for Communication Programs and other groups of independent researchers. “fooya!” demonstrates that statistically significant health outcomes can be achieved as the result of the compelling narrative-driven gaming-enabled user experiences, which incorporate metabolic science, Nutrition, Neuroscience and Psychology, to leave a cognitive imprint about healthier lifestyles in the minds of children. This has been shown to empower children to self-regulate through greater levels of self awareness, even as the technology allows them to be positively influenced by their peers as a result of competitive game compulsion loops and social mechanisms. This evidence backed approach mechanistically supports a method to developing a personalized “Digital Vaccine” powered by Artificial Intelligence, which can positively condition nutrition-lifestyle behaviors at scale, to meet a goal of preventing non-communicable disease, reducing risk of obesity/malnutrition along with associated health risks, and increasing cognitive ability among children, as a result of better nutrition.

All together now: Integrating the medical student experience

Ann Poznanski, Dawn Cooper and Dawn Dewitt

Elson S. Floyd College of Medicine is designing an innovative curriculum to integrate all aspects of the medical student learning experience. A clinical case-centered approach, along with the latest technology delivery system is coordinating and delivering all learning objective for clinical, inter-professional, scholarship, and leadership with the foundational basic sciences. Principles from research on cognitive integration and educational theory drive the integration of the learning program within the larger health sciences campus and leverage connections with multiple health professional training programs. The goal of fostering inter-professional learning across the health sciences colleges and training sites, in innovative and transformational ways, is to produce better care and improve the work life. An additional outcome is improved teamwork and increased trust among healthcare providers. The curriculum delivery spans four geographically dispersed campuses, and utilizes a combination of linked e-delivery platforms to create network intelligence and universal access.

What's your story? Storytelling workshop with Stanford medical students

Ruth Marks

Stories – told to my classmates, teachers, and patients – have been the most memorable part of my first year of medical school. I don’t think this is unique; narrative structure makes events memorable and significant. There’s a growing body of research in psychology, English, and neuroscience about the power of story to shape what we think about (our preoccupations) and what we care about (our values). In medical school, I’m learning how frequently doctors engage in storytelling – explanations about the progression of a disease and how it will fit into a patient’s life are often framed in narrative.

Yet, I have also observed that there is very little space dedicated to oral and written storytelling in the pre-medical curriculum (either to its practice or the examination of its craft). Describing patient experiences, stories we hear in bioethics class, or tales of anatomy woes don’t have a large place in our formal or even optional curriculum. Last spring, I proposed a series of storytelling “interventions” to provide space for medical students to tell the stories that affect them and examine how storytelling could lead to more authentic engagement with coursework, patients, professors, and friends.

The what’s your story? Storytelling Workshop was the first of these “interventions.” What I found is that many medical students, myself included, needed to learn the very basics of storytelling. What is a story? How is it different from a topic? What details do I as a medical student have permission to share? How can I tell stories that are honoring and not exploitative of the suffering I see every day in the hospital? I teamed up with Laurel Braitman, Writer-in-Residence at Medicine and the Muse at Stanford Medicine, to create a storytelling retreat for twenty-five medical students.

We had a few guiding principles: the retreat should be open to any medical student, regardless of their background in writing or storytelling, it should be off campus, and the guests artists should teach students to find their voices and tell the stories that matter most.

We met at Soul Food Farm the first weekend of October, camped in the olive groves, and learned how to tell better stories. In my presentation, I’d like to share the story about how this weekend retreat came to be, a few of the lessons we learned about how to tell better stories, and share some insights from the students’ feedback about what storytelling means to them and their future practice of medicine.

Global Village network community

Deirdre Munro and Olive O’Connor

I am an Irish midwife passionate about kindness, compassion, research and global networks. I work as a midwife lecturer, Health Service Designer and a proud team member of the World Health Innovation Summit.


The Global Village Network community evolved from the birth of a simple idea conceived at the International Confederation of Midwifery 2014 where the Global Village of Midwives was born onto twitter. Here midwives, families, health care providers all over the world share knowledge, think tank, innovate, research and support each other. This innovation achieved an International Fellowship awarded by the England Centre for Practice Development, Canterbury University England. Four Global Village Midwives are listed as top 300 women leaders globally. Many strong leaders in the global village are frontline care givers and students. One rule = ‘Kindness Always’. I am a proud change agent having graduated from the School for Health and Care Radicals.

TECHNOLOGY HUB

Technology demonstrations offer a chance for delegates to get hands-on demonstrations of cutting-edge education technologies so they can best understand the unique affordances and applications in medical education.

3D4Medical's "Complete Ortho" - Patient education, engagement and empowerment; simple, shared and secure.

Spencer Robinson and Niall Johnston

Leveraging 3D4Medical’s award-winning expertise in 3D anatomical education, Complete Ortho was launched for use by physicians during patient clinic visits to reinvent and revolutionize Patient Education, Engagement and Empowerment; when patients clearly understand their care options as provided by their doctor, the results are better healthcare and ultimately better outcomes.

Delivered via iPad, Complete Ortho illustrates, explains and personalizes patient anatomy, pathology and procedure/treatment options through interactive 3D images and animations. These images and animations are buttressed with comprehensive eLiterature, thereby delivering the most thorough, streamlined and simple educational platform for patients.

All content from the Careplan is then shared directly with the patient via email through a HIPAA secure portal. Put simply, patients take the point-of-care consult home to share and review with family, eliminating much of the anxiety and fear commonly associated with simply not knowing while simultaneously advancing their understanding of their healthcare options. More, physicians and staff are able to effectively manage each patient’s Careplan through a personalized Patient Utilization Dashboard.

At present, Complete Ortho is available to all Orthopedic, Spine and Sports Medicine physicians. Additional platforms for Cardiology, Physical Therapy, OBGYN, Internal Medicine, Gastroenterology, and Urology will launch in 2017/18, with still more to come through collaborative partnerships with Academic Institutions, Clinical Groups and Innovation Centers.

3D4Medical has also made a Patient-Only version of Complete Ortho available for FREE at the iTunes App Store. Engage directly with the anatomic models, pain-specific pathologies and related treatment options to be the most educated patient possible. Empower yourself to empower you healthcare.

The future of patient-first healthcare is now with Complete Ortho: Education, Engagement and Empowerment; Simple, Shared and Secure.

PCOR and CER focuses on meeting the needs of today’s learners that are largely unprepared in their training to understand how to incorporate patient-centered outcomes research (PCOR) and clinical effectiveness research (CER) into their work. Submissions to the PCOR and CER track will involve presentations that promote the teaching and principles of PCOR/CER, incorporation of PCOR/CER data in medical education, and implementation of these strategies for patient involvement in medical education.

ORAL PRESENTATION

Oral presentations offer presenters an opportunity to provide a presentation of work to a large breakout audience. Presentations are 10-12 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Compassionate care in the classroom: Helping future pharmacists understand their patients

 Joe Deweese and Tom Campbell

A core component of the education of a student pharmacist at one college of pharmacy in the southeast is the Applied Christian Values course series. This series of courses was developed at the founding of the college to help provide students with a biblical worldview framework to be servant-leaders in the field of pharmacy. This series is taught to first-, second-, and third-year student pharmacists in a concurrent manner with a 3-year rotating curriculum. The course meets ten times each year (five meetings per semester) with a large group presentations, panel or other session followed by small group break-out discussions using full-time faculty as small group facilitators. The course covers a wide range of topics from values, beliefs, and worldviews to compassionate care to ethics and pain and suffering. The course is taught by faculty, practitioners, care-givers, patients, and community members from various perspectives.

Through this series, students learn to understand themselves and the patients they are serving, which helps our students empathize with patients. During the compassionate care content year, we invite a panel of community members including patients, parents, and other caregivers, and we ask them to discuss their experiences with the healthcare delivery for themselves or their loved ones. This eye-opening experience allows our students to see how the healthcare system is viewed from the patient and family member perspective–both the good and the bad. This new perspective enlightens the students to the strengths and weaknesses of the healthcare delivery system, and provides ideas for how to improve the process and the experience of patients and family members.

Finally, this sessions also allows our students to be reminded of the real reason for their pursuit of the profession of pharmacy: loving service and compassionate care. Our students learn to see patients and family members as real people–not as a series of lab values and diagnoses. They learn to consider the spiritual and emotional impact on the patients and family members. Importantly, they learn to sympathize and empathize with patients through hearing their stories and relating these stories to their own personal or family experiences. This approach helps humanize patients in the eyes of our students and provides them with renewed perspectives on effective compassionate caregiving.

Patient collaboration: Re-imagining adolescent transition at an academic medical center

Ruth Bush, Noelle Lipkin Leveque, Erika Jorquera, George Chiang and Cynthia Connelly 

Background:
Adolescents with spina bifida (SB), the most common neural tube defect in the United States, which annual affects 1500 to 2000 live births, require complex multidisciplinary coordinated care for optimum health and development. Adolescent patients affected by chronic childhood disease often have problems finding adult providers who have training in childhood-onset diseases and find challenges in making the transition to adult medical systems when making the transition from pediatric to adult medical system. Research identifying patient-centered needs related to the transition from adolescent to adult care, especially in multi-lingual, multi-cultural communities, is needed.

Purpose:
A Patient Centered Outcomes Research Institute (PCORI) Pipeline to Proposal award provided the means to build an interdisciplinary team of patients, parent advocates, students, health care providers, and researchers to examine adolescent health care transition and to identify relevant patient-centered outcomes for adolescent transition to adult care.

Methods:
We created a network of patient and family stakeholders who were invested in identifying the transitional issues facing our predominantly Latino spina bifida population, through structured focus meetings facilitated by researchers, a bilingual premedical student, and a nursing PhD student. Participants were asked to think about specific events in their life relevant to transition to adult care (e.g., risks associated with the transition; ability to communicate with clinical providers; experience making appointments; access to transportation; etc.). The participants described the fears, frustrations, uncertainties, and barriers that came to mind.

Results:
Adolescents, parents, and clinical stakeholders expressed a strong desire to be able to work with a trained individual to provide personalized care coordination, as well as identifying barriers to transitions, i.e. social isolation, lack of transportation, physical restrictions. and financial limitations. Adolescents want to meet adult healthcare providers who are willing to be partners in the transition and suggest social media and other electronic programs should be incorporated in the transition. In addition to identifying future educational areas to address regarding transition, health care students were exposed to a shared partnership model in which patients and providers are using findings to guide research.

Conclusions:
Participants provided critical guidance to identify meaningful adolescent transition to care issues and to create structure for the next phase of a targeted program. Their input will determine patient-centered approaches to the transition process and will define which services they feel are essential to care continuity. The project also demonstrated effective methods to involve all stakeholders, including patients and caregivers, in health care education about participatory decision making and clinical practice.

Rheumatoid arthritis patient characteristics and willingness to participate in research

Seth Ginsberg

Background CreakyJoints (CJ) is an international online arthritis patient community offering education, support, advocacy, and the opportunity to participate in research. In 2014, CJ partnered with the University of Alabama at Birmingham (UAB) to create ArthritisPower (AR-PoWER ARthritis Partnership with Comparative Effectiveness Researchers), a Patient-Powered Research Network. ArthritisPower is part of PCORnet and is supported by a multi-year investment by PCORI. ArthritisPower aims to conduct patient-centered comparative effectiveness research and has a patient governor group and research advisory board to ensure the relevance and transparency of research activities. ArthritisPower includes an online portal and innovative mobile application to engage patients and collect diagnosis, symptom, and medication data. ArthritisPower already launched studies and collaborates with other PCORnet networks and external organizations on research activities. Recent Findings CJ members completed an online form preparatory to launch of ArthritisPower. The online survey captured demographic, diagnosis, treatment, and willingness to participate in research. Of 2,147 patients with RA, 970 registered CreakyJoints members completed the survey on their willingness to participate in research during 2014-2015. Most patients (68%) had never taken part in research, but nearly all (93%) would do so if the study was recommended by their doctor. Similarly, patients would be willing to participate if invited by a medical school/hospital (87 percent), non-profit organization (79 percent), or the government (73 percent). A majority (75%) would refuse to divulge their Social Security Number (SSN) to researchers and half would refuse to give the last 4 digits of their SSN, compared with the 20% and 34% who would refuse to share email address or medical records for research. In another survey, members of CreakyJoints participated in one of six nominal groups held in June 2015. Each of the six groups generated a set of educational topics and then rank-ordered them within each focus group. Eight educational themes emerged that were related to 28 unique educational topics. Among the individual items rated as “Extremely Important” by a majority of patients were: How arthritis affects more than just your joints (86 percent), What are the signs that the medication is not working (84 percent), and Importance of knowing about how the disease will progress even if the news is bad (83 percent), among others. Conclusions These studies demonstrate that people living with arthritis are willing to participate in research and have concrete ideas about the questions that need to be answered in order for them to make informed healthcare decisions with their doctor. Considering patients as unique stakeholders is vital to maximize the relevance and patient-centeredness of future research endeavors.

Transforming health care and medical education through clinical big data analytics

William Paiva and Elvena Fong

Health care is undergoing significant transformation, and digital health data is at the center of this change. According to the Centers for Disease Control, nearly 80 percent of the nation’s health care institutions have converted to an electronic medical record (EMR) system from the old paper-based system. New technologies like smartphone applications are also creating new stockpiles of digital data. Genetic data is growing as well; scientists can sequence a person’s entire DNA within 24 hours and for less than $1,000. Collectively, the amount of digital health data is expected to grow from 500,000 to 25 million terabytes over the next five years.

Why do we care that our health information is now in a digital format? How does it benefit all of us?

People who work in health care—and every industry for that matter—are smart, well trained, and do their best to stay up-to-date with the latest research, methodologies and trends. However, it is not rational to assume individuals have the depth of knowledge or data access to deal with every situation they encounter. Furthermore, the health care field is already understaffed, and this issue will only get worse as the looming mass retirement of baby boomers from the health care workforce creates an unprecedented supply-and-demand crisis.

Digitized health data has the potential to help mitigate this troubling situation. Predictive medicine uses computing power and statistical methods to analyze EMR and other health-related data to predict clinical outcomes for individual patients. Beyond health outcome forecasting, predictive medicine also can uncover surprising and often unanticipated clinical associations.

Oklahoma State University’s Center for Health Systems Innovation (CHSI), through its Institute for Predictive Medicine (IPM), is a leader in the exploding field of predictive medicine thanks to the unprecedented donation by Cerner Corporation of its HIPAA-compliant clinical health database, one of the largest available in the United States. Specifically, this dataset represents clinical information from over 63 million patients and includes admission, discharge, clinical events, pharmacy, and laboratory data spanning more than 16 years.

Over 20 full-time CHSI employees and nearly two dozen graduate students are working to execute the CHSI mission to transform rural and Native American health through data analytics. Further, CHSI has a number of ongoing partnerships with academia, health systems and corporations to extract value from digitized health data.

One example of CHSI’s numerous predictive medicine projects is an effort to help physicians determine whether the performance of particular cardiovascular drugs varies by gender or race, or both. Conversely, this study will help indicate which drugs perform poorly or even cause complications in these populations. Other CHSI studies are designed to give physicians insight into whether patients with a particular disease are likely to develop or already have an associated disease, which will aid in co-managing these conditions and lead to better health care. Another project is designed to help hospitals use data on patient demographic characteristics, comorbidities, discharge setting, and other medical information contained in comprehensive EMR systems to determine if patients are at high risk for being readmitted for disease-associated complications. If patients are considered high risk, they can get the care and support necessary to prevent frequent cycling through the health care system.

Predictive medicine can also lead to the creation and implementation of tools for managing larger patient loads, which can aid health care providers in dealing with supply-and-demand problems. For instance, CHSI has developed a clinical decision support system that can detect diabetic retinopathy with a high degree of accuracy using lab and comorbidity data available through primary care visits. This algorithm addresses the very real challenge of low patient compliance, particularly among rural and underserved populations, with annual ophthalmic eye exams, which are the gold standard for retinopathy detection and preventing vision impairment or total vision loss. CHSI is extending this work to other common diabetes-related microvascular complications with the goal of developing a comprehensive suite of tools that can help increase prevention and management of these complications among the nation’s growing diabetic population.

The transformation of health care delivery is not a distant vision but rather a current reality thanks to predictive medicine tools and insights. To quote the famed historian, explorer and philosopher Winwood Reade, “While the individual man is an insoluble puzzle, in the aggregate he becomes a mathematical certainty.” These words epitomize the power and potential of digitized health data to truly revolutionize health care as we know it. OSU’s Center for Health Systems Innovation (http://chsi.okstate.edu), a joint venture between the OSU Spears School of Business and the OSU Center for Health Sciences, will be at the center of this evolution by bringing critical, game-changing ideas and processes to health care for the present and the future.

Come learn how we are incorporating digital health data into our medical school educational processes to catch this wave and prepare next generation practitioners.

PCOR and CER cannot replace doctor-patient individualized care, yet

Joseph Gulfo 

Despite advances in genomics, epigenomics, and the promises of “big data” approaches, individualized medicine occurs best at the doctor-patient level. Clinical trials, no matter how large, gauge the “average patient” response. Even when specific biomarkers are employed, a normal distribution of response is seen. So, it is critical for physicians and patients to understand that “good medicine” has still not been reduced to science, rather, a good measure of titration via trial and error is still needed. This is the reason that we need as many therapies in the medical armamentarium, as possible.

Take, for example, eteplirsen (Exondys) for the treatment of muscular dystrophy. The drug was approved in September 2016 based on results from a small, nonrandomized study. Data were presented on 12 patients who took eteplirsen for four years and compared to matched control patients from Italy and Belgium. A randomized study was not possible to conduct due to ethical constraints – administering placebo to patients while requiring multiple muscle biopsies over an extended period offers no possible benefit. Results of the 6-minute walk test indicated that boys taking eteplirsen walked 162 meters further than the control group, and ten of the 12 boys on the drug were still able to walk after four years, versus only three of 13 in the control group. FDA commented, “Know that if these results were from a well-designed and interpretable trial, there likely wouldn’t be much to talk about,” meaning, the data were quite compelling, but from the wrong kind of study in FDA’s view.

At the Advisory Committee meeting in April 2016, Dr. Bruce I. Ovbiagele, chairman of neurology at the Medical University of South Carolina, who voted against approval, said, “Based on all I heard, the drug definitely works, but the question was framed differently.”

Panelists were instructed to consider only data from well-controlled studies, which flies in the face of FDA’s initiative to capture the voice of the patient in decision-making. “Well-controlled” implies randomized, multi-arm studies. But, randomized two-arm studies are not the only trials that are considered capable of providing substantial evidence; historical controlled trials are adequate according to the law. Further, competing standards were given to the Panel – one calls for a safety determination first, followed by an effectiveness determination, while the other calls for the effectiveness determination first, followed by safety. This is important for eteplirsen, which is very safe, but the effectiveness data from controlled clinical trials are not considered definitive by many. According to the first standard, as long as the drug is proven to be safe, any clinical benefit is meaningful and should result in approval.

POSTER PRESENTATIONS

Poster presentations offer an opportunity to share your work with an international audience at Medicine X. Presentations will take place throughout the conference with special designated times for poster viewing. First authors should plan to be next to their posters to answer questions during these times.

The 'Transitionalist' pneumonia reduction pilot

Rita Ghatak

Aging Adult Services (AAS), based on the Transitions of Care Model, is using technology and innovations to address readmission reduction, patient wellness and post discharge care. AAS chose Pneumonia (PNA) for a pilot at Stanford Health Care as it continues to be a severe health problem in the United States, responsible for close to 1 million hospital admissions and nearly 140,000 hospital readmissions per year. Approximately 1 in 5 patients with PNA is readmitted to the hospital within 30 days of discharge. Important reasons for readmissions are illness as well as issues related to discharge follow up, medication reconciliation, care compliance, lack of teach back and inadequate psycho-social support.

The pilot plan was to select high risk patients using a Risk of Readmission tool and provide comprehensive in-hospital planning and home follow-up for high-risk older adults hospitalized for PNA. While TCM is nurse-led, it is a multidisciplinary model that includes physicians, nurses, social workers, discharge planners, pharmacists and other members of the health care team in the implementation of tested protocols with a unique focus on increasing patients’ and caregivers’ ability to manage their care. Patients with AAS consults had reduced PNA readmission by approximately 6% from hospital wide PNA readmission rate.

With focus on transitional care through the continuum, care coordination and home visits by the AAS RN Transitional Care Coordinators was endorsed by patients as very valuable; medication reconciliation discrepancies were found during home visits; & linkages with PCP, home technology, health partners, resources, teach back, etc’, helped outcomes. These interventions could become part of a comprehensive disease management ‘Transitionalist” program in any medical center or contracted out. Pilot should be replicated with a larger sample.

RAPID REPORT

Rapid reports are an opportunity to provide a rapid presentation of work to a large breakout audience. Presentations are 5 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Nothing about us without us: Halving the impact of mental illness

David Noble

At the age of 50 I have achieved many things across a diverse range of interests. I’m the Director of Medical Services at our local hospital. I’m a senior consultant anaesthetist. I’m the President of the local branch of the AMA and I have my own technology company that develops cloud based platforms that deliver patient centred outcomes. I also have Bipolar Disorder.

Today I come to you not as a doctor, or as a patient but as a hybrid; the clinician patient.

The question we need to ask, and answer, is this… “Was I successful despite my illness or did my illness somehow provide me with an advantage to achieve the outcomes I wanted?” Sir Winston Churchill, Martin Luther King and Abraham Lincoln all had depression; yet they were also some of the greatest crisis leaders of modern times. Bipolar Disorder is referred to as “CEOs disease”.

Patient Centred Outcomes should be about optimising the potential of the person, the patient; not making the patient conform to our own constraints and limitations.

In response to my own personal experiences as a clinician patient I set out to develop advanced analytics and machine learning process that optimises human potential and focuses on patient centred outcomes. It is a technology that can help halve the impact of mental illness within a generation. In the next 10 minutes I am going to empower you to do just that – halve the impact of mental illness within a generation.

Everyone Included™ focuses on including all health care stakeholders–including patients and caregivers–in medical education. Patients will be included as teachers and students in medical education where they will learn about the basic principles of PCOR, how to become better advocates, be engaged, engage others, and be partners on a research team.

PANEL

These 45 panel sessions provide an opportunity to engage in a discussion around novel topics of medical education. We encourage panels that are composed of Everyone Included™ stakeholders (e.g. learners, educators, interdisciplinary contributors, patients and caregivers when possible).

Applying team science principles to the support of medical education

Bari Dzomba, Cheryl Attinger, Stacey Carmo, Robin Anderson and Tomi Dreibelbis 

This didactic panel presents a Science of Team Science case study at Penn State University where everyone is included in the transformation of support for the medical education program. The purpose of this panel discussion is to provide an in-depth look at the relationship of three professional support areas within the medical education mission and how the application of Science of Team Science concepts is influencing innovation in the areas of faculty teaching metrics, standardized patient simulations and quality and assessment reporting.

Team science is a collaborative effort to address a challenge that leverages the strengths, expertise, and collective inputs from intradisciplinary and interdisciplinary professionals trained in different fields. These team members come together to integrate their expertise and perspectives into a single endeavor to accelerate innovation (National Academy of Sciences, 2015). Team characteristics and dynamics, leadership, communication styles, and other environmental factors will be highlighted in this presentation. The learner will hear how these teams connected for various quality improvement processes and collaborated to achieve breakthroughs that would not have been attainable by individual or additive efforts.

Collaborative relationships within a medical school is one of the most important considerations for the future of medical training (Blake, 1905). Over one hundred years has passed since Harvard Medical School published this statement, yet many medical schools and health systems today still engage in cultures where silos and fiefdoms exist. Penn State University College of Medicine is an institution that is leading the way in Medical Education transformation and innovation. This panel is comprised of Education, Clinical, and Technology faculty and staff who have taken the concepts of team science and integrated those into transforming processes that support the medical education program. The processes described here are functions that exist across medical schools in the US, and include Faculty Teaching Metrics, Objective Structured Clinical Exams (OSCE), and Evaluation and Assessment of Health Science Education programs. This panel will start by operationally defining a team, and describing the level of interaction and integration of the Penn State teams supporting Medical Education. The panel will discuss the elements required for successful teams including trust, membership, shared vision, psychological safety, conflict resolution, communication, negotiation, individual versus group identities, team networks, challenges, and leadership.

Patients as partners: Learning and leading together.

Alison Cameron

It is increasingly accepted that patients like myself who live with and manage long term conditions are a potential source of leadership alongside clinical and managerial leaders. But how in practice do we develop a group of patients/carers with the confidence and ability to share the leadership task?

Background

I was diagnosed with Post Traumatic Stress Disorder after the death of my colleagues in the course of my work in international relations. The consequences included loss of my health, my home, and my identity. I experienced what I term an “assets freeze” where I was seen and saw myself as nothing but a set of needs to be met. I decided to try to use my experiences to push for change.
In order to be effective in my new role as an active patient engaged not only with my own health but in promoting change on across the system, I needed help to reconnect with old skills and develop new ones. While positional leaders have access to a multitude of professional development programmes there are still relatively few opportunities for people like myself whose leadership potential is added to by considerable lived experience. While there are “patient leadership” training courses to be found these tend to take place in separate silos with a risk of reinforcing “them” and “us” assumptions.

I believe the key to developing effective Patient Leaders is shared learning across these professional/patient divides with #everyoneincluded.

Content

I will share my key learning from the opportunities I have had to learn alongside healthcare professionals citing practical examples:
• My Leadership and Improvement Fellowship of the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) of North West London alongside clinicians and other healthcare professionals.
• My participation as first Patient Leader to do so in the Mary Seacole Programme of the NHS Leadership Academy. I studied alongside a mixed group of professionals many of whom were at the front line of service provision.
• My current participation in the Elizabeth Garrett Anderson Programme of the NHS Leadership Academy working towards my MSc in Healthcare Leadership and award in Senior Leadership from the Academy with support of my NHS team led by Helen Bevan who has supported my transition back to the workplace after a gap of 17 years.

Take home message

The experience of shared learning has enabled me to work more constructively and collaboratively. Moving from “angry patient” mode to “collaboration” has been a vital aspect of my personal and professional development and has increased the value of my work to the wider health and social care system. Participants will be able to take away practical ideas for creating opportunities for patients, carers and healthcare professionals to learn together as equals and consider what kind of roles need to be created in order to make best use of the range of assets Patient Leaders can potentially bring to their organsations.

Building disease specific educational tools and resources

Monica Weldon, Kristin Smedley, Julie Gortze, and Carrie Ostrea

 

Background:

Optimizing care for the rare disease community must be a community effort. Physicians play a role through diagnosing and treating the disorders they recognize, and which have treatments, but rare disease patients and families face more significant challenges than simply dealing with symptoms. Appropriate care requires collaboration between clinics, educational facilities, pharmaceutical industries, patient advocacy groups, researchers, insurance companies, and of course, patients themselves. This level of cooperation is the way to improve outcomes for everyone involved. Discussing strategies, creating solutions, and implementing programs designed by, and for, the population that will use them, is how we move forward as a community.


This presentation explains the role each discipline plays in the rare disease community and how foundations of support are strengthened by merging all resources. Engaging medical students with patient organizations early on leads to better understanding of obstacles patients and families must maneuver to achieve appropriate medical care. Rare disease organizations provide a voice for patients through advocacy and creates a portal of distribution for information. Pharmaceutical companies enable new drug protocols to be implemented per patient need. Educational facilities offer consistent programs to benefit students with medical problems and provide access to meeting educational goals. Awareness to the general public provides more opportunities for understanding, support, and funds raised for needed programs and research. Best potential for improving patient and family quality of lives lies through collaborative efforts between all involved in rare disease space.

Animal-assisted therapy, teamwork training and patient-centered care

Natalie Abbott and Alexandra Buchanan 

Service and companion animals have increasingly become an important part of healthcare. Although a 2014 survey by the Human Animal Bond Research Institute reported that healthcare practitioners had a generally positive attitude towards animals, including improved job satisfaction;1,2 data are limited and information on incorporation of therapy animals as part of the healthcare team and in medical education is lacking. There are several types of animal-assisted interventions (AAIs); however, all utilize trained therapy animals and handlers and have specific therapeutic goals.a Animal assisted activities (AAAs) are typically less structured and may involve such things as a “meet and greet” with a therapy dog for inpatients; whereas a therapeutic horseback riding program (eg for individuals with cerebral palsy) is an example of animal-assisted therapy (AAT). An increasing number of studies suggest benefits of AAIs, including for pediatric patients.3 Although most studies to date are small, with mostly qualitative outcome measures, a recent multicenter investigation of pediatric patients with cancer suggested benefits of therapy dog visits including decreased heart rate.4

The principles of Crisis Resource Managementb have been extensively utilized for teamwork training in medicine; particularly in anesthesiology. Specific purposeful education in debriefing enhances communication between all members of the healthcare team. For pediatric patients in particular, we suggest that tools to decrease anxiety, improve cooperation and decrease sensory overload are beneficial. A central principle of patient-centered care is that clinical decisions are respectful of and responsive to individual patient preferences, needs, and values. As such, animals, notably therapy dogs, can be important care facilitators in the provision of patient-centered care for vulnerable patients in these settings.5,6 Although healthcare providers may be aware of AAT, currently there is minimal available information discussing techniques for incorporating therapy animals into the health care team; particularly in relatively high stress situations such as the emergency department or the perioperative setting where this may be particularly beneficial for patients and caregivers. Furthermore, tools to incorporate AAT into teamwork and simulation training in medical education are lacking. Because AAT may be particularly valuable to enhance communication for vulnerable patients, incorporation of animals into formal communication skills training for health care professionals is suggested. This presentation will utilize storytelling to recreate several clinical scenarios with low fidelity simulation and role-play. By use of the principles of Crisis Resource Management the scenarios will be discussed with a focus on the potential value of use of AAT to improve quality of care for patients by use of a shared decision-making approach. The objectives are to encourage interaction and dialogue between presenters and attendees.

 Panelist will also include: Alexandra Winter and Michelle Giuffrida
Walking the walk: Initiatives towards co-creation and collaboration with patients and families in medical student education

Rajesh Mangrulkar, Kelly Parent, Genevieve Allen and Greg Merritt

For more than 100 years, American medical education emphasized the acquisition and application of biomedical scientific knowledge, with a minor but growing focus on communication skills and empathy. While the model has evolved to become more balanced over the past 2 decades, there has been a systematic absence of the patient/family voice in the co-creation of this new model of medical education. Over the past decade, the University of Michigan Medical School (UMMS) has partnered with the Health System’s Patient and Family Centered Care (PFCC) to co-create educational sessions for students. However, as the medical school has embarked on its curricular transformation to a new model where students are immersed in more experiential and exploratory environments from day 1, it has significantly expanded its collaboration with this unit, as both co-creators and co-implementers of curricular experiences, assessment activities, admissions work, and on competency committees.

Our proposed Medicine X | Ed panel presentation will walk session participants through “networked intelligence” perspectives of Everyone Included™ stakeholders. Panel participants will present innovative educational approaches and lessons learned surrounding the effective engagement of patients/families in UMMS’s newly transformed medical education system including:
1) Executive planning: serving as members on the Curriculum Policy Committee and Medical Student Competency Committee.
2) Curriculum design: conducting focus groups with learners and patients/families to understand where gaps exist in medical education, “what matters” to people receiving care, how we may partner to reduce harm and improve outcomes as well as the mindset and learning preferences of medical students.
3) Curriculum implementation: selecting and educating patients/families to serve as didactic educators providing the foundation for patient and family centered philosophy, effectively share stories, facilitate small group reflection and discussion, and mentor students through open dialogue about illness, health care team experiences, and health care system navigation.
4) Admissions: contributing to interview evaluation criteria, participating in simulation scenarios, and evaluating candidate performance on structured interviews.
5) Learning support: monitoring student progress and designing a model where patients/families may serve as coaches for students not meeting certain competencies.

Additionally, the panelists will discuss the extension of this model into inter-professional education and expansion to residents, fellows, and attending physicians to ensure that what is being learned in the classroom is being supported and reinforced in patient care areas. Finally, while it is too early to determine how these initiatives influence behavior and patient care over time, a preliminary evaluation of medical student perceptions and acceptance of engaging patients/families in education processes will be shared.

WORKSHOP

These longer 45 minute sessions provide presenters with an opportunity to delve deeply into a topic to share unique expertise with a diverse group of passionate Medicine X | ED delegates. Workshops are limited to a maximum of 30-35 people.

Co-creating new physician-patient interaction models and medical education strategies to support them

Denise Silber, Brandi Sinkfield and Hugo Campos

The quality of the interaction between patients and healthcare professionals is a key factor in the quality of patient outcomes. Yet the great variation in the quality of patient-physician communication is widely recognized. Note, for example the Ochsner review article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/.

One of the reasons for the insufficient quality of patient-physician interactions resides in the fact that communication is not a key component of medical education. Additionally, patients are at best given a marginal role in the conception and execution of the educational process.

Our proposed workshop will be prepared and facilitated by a multi-disciplinary team including a patient, a physician, an educator, under the coordination and supervision of a digital communications strategist.

The workshop’s goal is to identify solutions to these problems, through a co-creation Everyone-Included approach in phases, one phase during the months that precede the conference, another during the session, and follow-up with interested participants.The “before” phase: The workshop will be preceded by an “Everyone Included” online survey (January-February, 2017), which will itself be created with an “everyone-included” method. Survey questions for patients and caregivers, professionals, and other healthcare stakeholders will aim to define the current context of physician-patient interactions, their strengths and weaknesses. Survey results will provide content for workshop participants.

During the session: Working in multi-disciplinary groups, participants will define desirable patient-physician interaction models and the medical education tools that will help orient future patient-physician interaction.

ORAL PRESENTATION

Oral presentations offer presenters an opportunity to provide a presentation of work to a large breakout audience. Presentations are 10-12 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Race matters in medical school: Moving from colorblind to colorbrave medical education strategies

Catherine Lucey 

The imperative to diversify the medical profession to solve the challenging problems that exist in biomedical science, health and health care is clear. Medical schools have worked to diversify their matriculating classes using holistic review in their admissions processes, seeking to gain a full picture of the potential contributions of each applicant, rather than relying solely on exam scores and grade point averages. While medical schools are increasingly admitting more diverse classes, diversity in residency and fellowship programs, particularly those in the most competitive specialties and at the most competitive institutions, has lagged. Furthermore, faculty diversity in the nation’s medical schools remains low and stagnant.

In investigating this leaky pipeline from medical students to medical school faculty, we found that equitable opportunities in access to medical school are not always followed by equitable opportunities for success in medical school. Personal, interpersonal, and cultural issues within medical school are more burdensome for minority students than their not-minority peers. Structural issues related to medical school grading policies, national award requirements, and residency, fellowship, and faculty selection amplify these challenges, resulting in inequity in opportunity for a myriad of career paths for minority students. Ensuring that all students have an equitable opportunity to pursue all careers, regardless of race, ethnicity or other elements of diversity, will require institutions to move from the current strategy of colorblind educational practices to “colorbrave” educational strategies.

Patient-centered care: When concordance requests go too far

Eloiza Domingo-Snyder

Demographic changes sweeping the nation and mandates to provide patient centered care present hospitals with new challenges. Substantial patient-provider literature exists documenting patients’ expressed preference/demands for gender, language and race concordance with providers. Research shows increased quality of concordant patient-provider encounters with respect to empathy, decision-making and patient satisfaction. Despite documented advantages, hospitals must carefully balance patient preferences with anti-discrimination laws and hospital diversity/inclusion policies. Making work assignments based on patient preferences for or against certain demographic groups could violate Title VII of the Civil Rights Act.

While there are certain Bona Fide Occupational Qualifications (BFOQ) exceptions to anti-discrimination laws such as religious stipulations related to modesty, no clear guidelines exist on how staff should respond to concordance requests when patient accommodations qualify as a discriminatory practice. Providing concordance accommodations for any characteristics including gender, race and ethnicity, and language, while seemingly innocent and following the standard of patient centered care, can cause significant problems for hospitals, clinics and individual providers. First, keeping track of patient requests and attempting to modify schedules and work assignments based on those requests substantially complicates patient care for healthcare administrators. In some cases, patient health could be compromised due to care delays caused by waiting for a provider with the “correct” demographic characteristics to be available.

A larger problem may be the effect on hospital employees themselves, in relaying the message that they are not adequate in certain settings. This presentation lays out a clear set of guidelines for how hospitals should handle all patient concordance requests.
• All patient concordance requests need to be addressed in a respectful but firm way, clearly explaining which requests will and will not be accommodated
• Reasonable accommodations can only be made if they include BFOQ exceptions and can be supported by indisputable clinical, spiritual and emotional benefits. Accommodation requests based on personal preferences which could be influenced by explicit or implicit bias are not appropriate
• If accommodations are to be made, they should be done in a way that minimizes interference with typical hospital protocol
• Providers should consult with bioethics and legal experts when handling concordance requests. They should also make every effort to understand the patient/family’s rationale for making such a request.

By following the guidelines laid out in this presentation, healthcare organizations can successfully navigate patient preferences while complying with laws and policies designed to foster diversity & inclusion for all.

Social rx: Prescribing social support for chronic disease management

Kerri MacKay and Sara Kearley

The circle-of-chairs support group is not a mental image that a lot of patients in 2017 conjure up when they think of their social support system. Social media like Twitter and Instagram, and blogs, are the basis many patients and caregivers use to cultivate relationships with others like us–sometimes dealing with the same diagnosis, but often, creating cross-disease networks of support.


From both the patient and caregiver sides, we will share how social media support changes how we approach managing chronic disease–Sara as mom and caregiver to two boys with type 1 diabetes, and Kerri as a patient with asthma. Taking into account benefits and risks, we will explore how physicians might consider the recommendation of online social support as an addition to the chronic disease management prescription–as a compliment to medication–and provide examples of physicians who already make this a regular part of their patient-centric care for patients and caregivers, while ensuring patients understand the crucial role of their physicians in regard to modifying treatment or making a diagnosis: that some things simply cannot be taken online.

“Everyone Included” for curriculum design: Peer-to-peer creation of a low-cost, customizable medical education curriculum

Tao Le, Yunxiang Chu, Kristine Krafts, and Catherine Johnson

Background
In the past decade, we have seen a transformation in how we engage with information and education (1). Learning can be instantly accessible, participatory, and low-cost or even free via platforms like Coursera, Khan Academy, Wikipedia and Quora. However, medical education has been slow to change. Hundreds of medical schools in the US and internationally continue to develop and maintain instructional materials for their own curriculum in isolation at great cost and redundancy. In addition, medical students and patients often express a desire to actively participate in the educational design and development process, and medical education can be designed to meet those goals.

Introducing ScholarRx
To address these challenges, we are developing ScholarRx, an innovative, low-cost, digitally-deliverable curriculum composed of topical “building bricks” which are modular, customizable and easy to interconnect in order to meet the specific needs of any medical school curriculum (2). The content will be delivered by a next generation personalized social learning platform that will support modern education strategies like flipped classroom, just in time teaching, and team-based learning. Most notably, our curriculum program will be completely authored by medical students under the guidance of faculty – a first of its kind (3,4). Content will be anchored by patient and caregiver stories that connect students to the patient narrative and promote humanism and professionalism. Medical schools will be able to contribute their own curricular materials to the platform, benefitting other schools and learners while further driving down costs.
Over the course of a year, we have interviewed or surveyed hundreds of medical students, patient advocates, faculty and administrators to understand their needs and challenges. We also reviewed other efforts to develop reusable or sharable curricular resources. We then developed a framework for the curricular content repository and a delivery platform. To test the framework, we are creating a single-system module curriculum pilot that will demonstrate core features of our curriculum platform. The core components will include:

1. Detailed course texts (“bricks”)
2. High-quality, labeled images
3. Large bank of high-quality assessment items
4. Case-based material for PBL, TBL and self-study
5. Patient and caregiver stories to promote humanism and professionalism
6. A complete set of customizable PowerPoint slides for lectures
This pilot will be evaluated at four partner medical schools in early 2017 to assess educational outcomes, faculty and student acceptance, and feasibility for scaling into a comprehensive curriculum ecosystem.

Implications
If effective, ScholarRx could be used in medical schools worldwide as a cost efficient, high quality, customizable curricular platform driven by medical students for medical students and featuring the patient narrative. This could significantly reduce cost of medical education and democratize access to high quality, humanistic education in underserved populations and countries.

Designing a health care culture that cares for the caregiver, too

Renata Khoshroo Louwers

In the context of life-threatening illnesses such as advanced cancer, caregivers often become the “glue” between the patient and healthcare providers. By default, caregivers become storytellers, nurses, and therapists. Today’s culture silently expects caregivers of seriously-ill patients to assume those roles while also coping with the emotional challenges of the diagnosis. The result? Caregivers are chronically exhausted, frustrated, and often become sick.

This oral presentation will draw on the speaker’s experiences in the healthcare system during the year her (now deceased) husband was treated for metastatic bladder cancer. It will also draw on interactions (as a patient advocate) with other caregivers to the seriously ill. It will touch upon her husband’s last two weeks of life at the Zen Hospice Guest House in San Francisco and how this mindful-care model gave her real relief as a caregiver. It will recognize that while the system includes many well-intentioned individuals, the culture overall often burdens caregivers instead of supporting them.

The speaker will suggest a framework that could serve as a starting point for cultural change. She will illustrate each point with real-life caregiver examples:

(1) Calibrate to the Caregiver – Medical culture ideally would calibrate to the severity of a given caregiver’s situation. Today it doesn’t consistently do a good job of that. For example, there is often a lack of acknowledgement of the significantly different needs of the caregiver of a patient who is in remission from cancer compared to a caregiver of a patient who is likely to die from cancer. How can the culture quickly recognize and respond to the intensity with which caregivers to the seriously ill are living?

(2) Minimize Repetitive Storytelling – Today’s medical culture asks the caregiver to constantly repeat the story of the illness. How can the culture draw on technology and other tools to minimize the repeated storytelling that so fatigues caregivers to the seriously ill while still ensuring that critical information is shared?

(3) Enhance Continuity – Interactions with healthcare providers, particularly in the hospital, are often cursory, fragmented, and one time. Care is sliced into many narrow siloes with each provider delineating a specific role. For the caregiver this creates a seemingly endless string of interactions with people they will never see again. How can the culture minimize these of cursory and fragmentary interactions with providers?

(4) Cultivate Mindfulness – Healthcare providers are often rushed due to patient loads and administrative duties. How can we create a culture that values presence and promotes a serene rather than harried mood for caregivers?

The presentation will challenge listeners to consider how they can collectively address these questions and design a healthcare culture and medical education (using creativity, technology, and compassion) that will support rather than burden caregivers.

Meeting diverse students in their backyard: non-traditional programs for providing mentorship to students interested in medicine

Robert Trevino PhD, Alden Landry MD, Kameron Matthews, MD JD, Brandon Henry MD, and Brandi Freeman, MD

Many diverse groups of learners are considered disadvantaged when applying to medical school, including students from underserved communities, students raised in rural areas, students from lower socioeconomic backgrounds, and students considered underrepresented in medicine based on race and ethnicity. Based on recent data, students with an academic background including education from a community college could also be at a disadvantage when applying to medical school. Often, these students are also ones negatively affected by a lack of educational opportunities or by other social circumstances impacting their progress in the pipeline to medicine. Furthermore, students from these diverse backgrounds are also more likely to serve patient populations which represent shared experiences, which could include geographic region, socioeconomic status, race/ ethnicity, or cultural background.

In order to strengthen the pipeline to careers in medicine to better include those diverse learners, we need to rethink our traditional strategies for providing outreach and support. As noted by the AAMC study, Altering the Course: Black Males in Medicine, many feel that more exposure to mentorship would help students to become more successful applicants to medical school. Often these diverse learners are searching for academic support and mentorship yet struggle to find health professionals willing to support their career goals. Many non-traditional programs have been developed to fill the void including e-mentoring programs, tours to promote careers in the health professions and group mentoring.

During the session we will discuss examples of successful non-traditional mentoring programs that have been created over the past 5 years including the Tour for Diversity in Medicine. The Tour for Diversity has reached all of the diverse learners mentioned above through a novel approach in providing educational awareness and mentorship by visiting the students at their home universities, often away from the academic medical home many health professionals are used to. Through academic advising, storytelling, hands-on experiences, and tiered mentorship, the mentors engage and empower the students to continue in their journeys to medical school. The mentors embrace their shared experiences with the students, often providing stories about both successes and hardships along their path to medicine. We will also discuss the lessons learned from the programs including the importance of parental engagement, understanding stressors students face outside of the typical academic pressures and identify ways for academic institutions to collaborate with novel programs to support diverse student success.

Life as a patient advocacy entrepreneur, journalist, and academic

Robert Schultz

In his talk, Robert will explain how he was suddenly introduced to the biotechnology world through a company he founded to help people who suffer with cystic fibrosis, and the role that the Massachusetts Biotechnology Council and the CF Foundation played into his product’s strategy. Being from Boston and having connections into the philanthropic world, Robert was able to recognize the role that venture philanthropy plays in the biotechnology and hospital ecosystem. He developed a parallel career as a journalist with several Boston-based health publications, and was exposed to the academic world as a biotechnology industry researcher with Bentley University’s Center for Integration of Science and Industry. However, these world’s did not seem relevant until one day when Robert’s family received the bad news that Robert’s father-in-law has a glioblastoma, the worst type of brain tumor. Using his previous experience navigating patient advocacy organizations, Robert founded Tunza to help patients and their families who are experiencing a crisis related to rare diseases and cancer. Robert created the “Healthcare Innovation” MBA course at the University of Massachusetts-Boston to teach others how to utilize his best practices and methods for healthcare innovation success in order to help others who suffer with unmet needs.

Patient and health care professional collaborations - shaping the future

Claire Snyman

In 2010 I heard the words no one ever wants to hear: “You have a brain tumor.” I was 34 and mother of a 4-year-old and was diagnosed with a rare benign brain tumor, a colloid cyst. Surgery was not an immediate option, so I was monitored with yearly MRI scans. In 2012 my tumor grew, resulting in hydrocephalus, requiring immediate surgery.

After my surgery at Johns Hopkins Bayview Medical Centre with Dr. Alfredo Quiñones-Hinojosa (affectionately known as Dr. Q), I wanted to learn more about how brain tumors impacted both my and other patients’ quality of life. I recruited my online brain tumor support group to participate in a study I had developed on diagnosis, symptoms, treatment and postoperative recovery. The results were enlightening and I wondered how health care professionals could use this information in patient care.

I approached Dr. Q, then the Director of the Brain Tumor Surgery Program and Professor of Neurological Surgery and Oncology, and his team at Johns Hopkins University who embarked with me on a new study, adding two scientific measurement tools: The Henry Ford HDI (Headache Disability Index), to measure disability of headaches, and the SF-36 (v2), to measure Quality of Life (QoL). My key objective for getting this information published was to increase access to information for individuals with colloid cysts as well as the health care professionals treating them.

For me, this was a great example of how collaboration between health care professionals and patients can truly work and help make medical practice more patient-centered and participatory. “The impact of surgical resection on headache disability and quality of life in patients with colloid cyst” was published in May 2016 in Cephalalgia, the International Headache Society’s peer-reviewed journal. I could not have been happier about this achievement for the brain tumor community, or more grateful to the team at Johns Hopkins for making it happen.

This is how patients help support science: by being their body’s advocate, becoming an informed patient, and partnering with their medical team to the benefit of everyone involved. How can opportunities such as these be utilized to the benefit of both the patient population and health care professionals treating them?

My presentation will focus on steps in this process, forward thinking and how patient and health care professional collaborations can help shape the future!

Project connect

Ash Amarnath 

In medicine, through years of learning and a dedication to a life of service, we are taught to diagnose and treat disease. Unfortunately, this knowledge is simply not enough to make a lasting difference. Diabetes or high blood pressure can be managed with medication, a blocked artery can by bypassed but these are just short term fixes. By failing to see the whole picture, the person behind that disease and the socioeconomic factors in play, we are failing our patients. As Dr. Atul Gawande said in his book Being Mortal, “We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being.”

Connection to each other and belonging to a community is something that we all strive to achieve. Yet many of us live in solitude even in the most populated areas. What if we could fill that void by establishing a sense of connection within a community? Could this stimulate people mentally and physically to be the best version of themselves? What if we could empower our patients to be community leaders and educators? Would this inspire them to enable well-being on a larger scale? These are the questions we hope to answer.

Project Connect is a pilot community-level intervention to reduce the risk and prevalence of obesity and reduce projected health care costs among low-income Californians. The primary outcome we are seeking among participants is reduced BMI. In order to achieve this outcome, Project Connect will move beyond simply providing education and techniques to improve diet and physical activity. Though these are critical components for reducing obesity, formative research findings point to more fundamental needs, such as improved social connection and safety. Project Connect is taking a whole person approach to improve the well-being of individuals, families, and communities. This approach is founded on the growing evidence for the interconnectedness of mental, social, and physical health and a greater understanding of how the family, social, and built environments influence health and well-being.

In order to develop effective and appropriate interventions, the Project Connect team conducted extensive formative research with luminaries from around the country, low-income men and women and community leaders across the state of California. A need for greater social connection and improved safety were ever-present themes. This goes to show that health is truly in the hands of not only the providers but everyone including patients, local law enforcement, urban planners, and even politicians play an important role.

Pediatric cancer Nanocourse for families

Charles Keller, Jonathan Agin and Andy Woods

Background
Childhood cancer is the leading cause of death by disease for children in the United States. Nevertheless, only four new childhood cancer specific drugs have gained FDA approval since 1978. In the childhood cancer community, families are increasingly interested to learn and to have a role in the search for effective treatment options for their children. This grassroots level of engagement is especially true for the many forms of childhood cancer without effective initial treatment options or for those diagnoses with poor outcomes following relapse or recurrence. Families want to know what they can do to help, as well as what they can do to lead. We provide families this opportunity through an annual “Nanocourse”.

Approach
The annual Pediatric Cancer Nanocourse is hosted by Children’s Cancer Therapy Development Institute (cc-TDI.org, a 501c3 nonprofit biotech). The Nanocourse is an intensive, weeklong structured immersive experience for families impacted by childhood cancer, high school and college students who have survived cancer, as well as anyone interested in effecting making a unique impact for children with cancer. The goal is to train parents, caregivers and members of the public to act as informed, empowered liaisons between laboratory researchers, clinical trial investigators and the community. The course covers end-to-end the research & drug development process, as well as cc-TDI’s approach to accelerate therapies into clinical trial.

The key to this program is transparency and respect of families as stakeholders. Participants get the training they need to ask informed questions, full access to our lab and the training to move research forward. There is no minimum or maximum age limit; in fact, a 13 year old student-cancer survivor was one of the highest performing attendees of the Nanocourse.

Participation is generally limited to 12-15 individuals. While primarily attendees are not trained scientists, we have high expectations for what they will learn and accomplish in this short but packed week. In addition to special topics requested by each years’ participants, the attendees receive:

• a didactic overview of childhood cancer treatment, biology, pathology, and clinical trials
• an introduction to the scientific research process: how research works, what barriers exist, and how to overcome challenges and make progress on rare childhood cancers
• daily mentorship and hands-on opportunities to shadow our research scientists in the laboratory
• the opportunity to build a network of informed and empowered advocates who can drive the cure of rare cancer

During the week, participants self-select a group research “Roadmap” project. Teams pick a type of childhood cancer, critically evaluate resources and progress towards uniform cure, and write a manuscript for the scientific and medical literature.

The work produced has been remarkable. Teams had their results published in peer-reviewed journals, including:

Hepatoblastoma: A Need for Cell Lines and Tissue Banks to Develop Targeted Drug Therapies. Front Pediatr. 2016 Mar 21;4:22, and
A diffuse intrinsic pontine glioma roadmap: guiding research toward a cure. Pediatr Blood Cancer. 2014 May;61(5):765-7.

A recent participant was so inspired by the opportunity, he obtained a small grant that allowed him to spend an additional six weeks at cc-TDI studying the cancer his child is battling. As a result, he obtained funding for cc-TDI’s research and secured specific cell lines of the cancer for study (see the video at http://www.cc-tdi.org/single-post/2016/07/14/Welcoming-Andy) and is making a career transition from stone and tile mason to childhood cancer researcher.

Participants help us improve the Nanocourse each year by giving direct feedback to us on their experience, the faculty and the course of study and we use that feedback to make the course more robust each year.

Results
We are always heartened by the level of motivation and energy participants bring to the laboratory. We know from years working in this field that families want to know everything possible that will help their child and need an opportunity to take charge. Their continued engagement and commitment following the return to their respective communities has been overwhelming. Participants have become the best advocates for childhood cancer research and drug development, whether advocating for or raising funds or (importantly) holding researchers accountable for tangible results.

In short, families who participate in the Pediatric Cancer Nanocourse have become integral leaders in the mission of creating new and more effective treatments for pediatric cancer.

Conclusion
The Pediatric Cancer Nanocourse began as a unique experiment to engage families of children diagnosed with cancer in research. The result is a newly trained team of advocates who are actively helping cc-TDI and the broader childhood cancer research community move faster towards new treatment options to make childhood cancer universally survivable.

Strings on a marionette: The hidden interactions that create a patient experience. Insights from a patient and designer.

Nuzi Barkatally

At Dollar Shave Club, my role as an experience designer (XD) is to be an advocate for the user, designing a cohesive and continuous branded experience across all channels for our customer. I’m part of a team that designs products, processes, interactions, and services that ladder up to an experience our customer feels and engages with. Sometimes our customers don’t see all the workings that create a positive branded experience, but it is up to us as designers to keep those strings hidden, and to not ruin the magic of the show.

What does this have to do with healthcare? Well, my role as an experience designer is a huge contrast to my role as a patient. For the past 14 years I’ve battled a chronic illness called Crohn’s Disease. In this other world my role is reversed. I’m on the other side of the show. As a patient navigation the healthcare experience, there isn’t a whole lot of magic, and because I’m a designer, I see all the hidden strings that can make an experience a positive or negative one.

At Dollar Shave Club we take great care in designing every detail of our customer experience down to the error states on a form. These types of hidden interactions have shown to dramatically affect the customer experience. We need to ask ourselves what are the hidden interactions in the healthcare experience? How can these hidden interactions ladder up to a positive patient experience? And how do we prioritize these hidden interactions for the most impact? In this talk, I will answer all of these questions while sharing my insights as both a patient and designer living in two worlds.

THE PATIENTS' TIME HAS COME: How listening to patients will redefine health care safety and revitalize service delivery

Elizabeth Rankin

In April 2016 I published a book: THE PATIENTS’ TIME HAS COME: Listening to Patients Will Redefine Health Care Safety and Revitalize Service Delivery.

My book is all about “nothing about patients without them” recognizing that the medical community benefits by patient input and together the relationship is strengthened by this acknowledgment WHEN PRACTISED.

As a former professional nurse and many times a patient I knew the care I’d received when I had my heart attack could have been better so I decided to frame the problems I’d encountered and put together the tools and templates professionals and patients would need to help one another work together.

One example is the curriculum I’ve proposed and outlined (Template) where Patients As Mentors are involved in the teaching-learning process at the point of entry for medical students by having patients tell their stories to broaden and enhance the approach beyond studying the signs and symptoms that texts convey. The course proposes ways that strengthens the collaboration process that isn’t captured in the teaching process during typical lectures or while reading medical textbooks. My course increases the opportunity for students and lecturers to think and express their words more meaningfully while conversing with patients and reduces the likelihood of resorting to medical euphemisms and semantics.

I outline and provide tools that assist patients and professionals to become participatory by creating a grass-roots research survey beyond the initial clinical research process, so both physicians and patients are mindful to track and report medication side effects.

The student technology committee, a novel approach for student-centered development of medical education technology: Purpose, process, and impact

Amol Utrankar, Jared Shenson, Julian Genkins and Anderson Spickard

In recent years, we have achieved near universal support of the notion that patients should be involved as stakeholders in discussions and decisions surrounding their care. This philosophy is a core tenet of the “Everyone Included” mission. Surprisingly, this philosophy is seldom extended to medical education, in which the users of a curriculum and its supporting technologies (i.e., learners) are infrequently included as makers or shapers in the design, implementation, or revision processes. The disconnect is particularly problematic at a time when technology is increasingly central to content delivery, instructional pedagogy, assessment, and patient care. We are missing a key opportunity to learn from and best support our digital native students, many of whom are well-accustomed to identifying and incorporating digital resources into their workflows. The outcome is an education technology infrastructure built upon educators’ perceptions of student needs and attitudes, which often do not align with realities.

To resolve this gap, students at the Vanderbilt University School of Medicine, with administrator support, established a Student Technology Committee (STC), composed of learners passionate about the intersection of medicine, technology, design, and education. The committee’s purpose is four-fold: to facilitate ongoing dialogue among students, administrators, and technology support staff; to advise introduction or revision of educational technologies; to develop, pilot, and evaluate student-built educational technologies or digital resources; and to promote awareness of technology and biomedical informatics applications in medicine and education across the school community. The STC model enables continuous learner input to inform rapid-cycle development of tools and resources that are responsive to their preferences. The committee also instills clinically-relevant exposure to quality improvement, design thinking, and technological innovation.

In this presentation, we will establish the rationale for a STC, drawing analogies to user engagement practices in consumer product design and clinical medicine. Best practices—securing stakeholder buy-in, selecting representatives, and developing rules and procedures for governance and function—will be outlined for institutions aspiring to replicate the model. Several case studies, such as the transition to a home-grown learning management system and the implementation of a mobile app for competency-based learner evaluation, will be discussed, with an emphasis on the impact of student involvement on the design process and its outcomes. Finally, we will present reflections and feedback from committee members, fellow learners, administrators, and staff on how the STC’s activities impact their respective roles.

In summary, the Student Technology Committee is a collaborative, user-centered archetype for developing educational technologies to assist today’s learners in becoming excellent 21st century physicians.

Through the eyes of patients and students: Enhancing ophthalmology education

Sheena Khanna, Suzann Pershing and Sarah Kucharski

In recent years, partnership with patients has moved beyond shared decision making in their medical care to also including them in health policy, medical conferences, and healthcare as a whole(1). However, medical education has still traditionally been shaped by the perspectives of educators. While it requires much planning and coordination to overhaul entire curricula, an alternate approach could be to target improvement of individual specialties that contribute to core skills of a physician. For example, ophthalmology is traditionally underrepresented in medical school curricula yet is vitally important, as recognition of key eye exam findings by physicians across many specialties can be life-changing for patients(2). Only 20% of medical schools in one survey had required ophthalmology rotations(3), yet proficiency with funduscopic findings can lead to the identification of chronic diseases such as diabetes or hypertension(4). We propose a roundtable discussion inclusive of patients, medical students, and educators to gather perspectives on current training for providing eye care. We believe that adding input from patients and medical students will provide a novel perspective and allow for more effective and well-rounded training.

We have convened a team consisting of a patient representative, Sarah Kucharski; a medical student, Sheena Khanna; and an educator, Suzann Pershing, MD. After thoughtful discussions amongst the team, we propose to collect perspectives of a larger group of patients, medical students, and educators. Currently, there is limited patient input, and students are involved in curriculum design via feedback delivered through curriculum committees. However, curriculum committees involve students reporting to curriculum directors and administrators, and the inherent power differential may lead to withholding of certain criticisms for fear of indirect repercussions. Our project will foster open communication and aim to eliminate power differentials by collaboration across groups.

This project will assess perspectives on ophthalmic education in medical school through interviews of patients and students as well as discussions for collaboration between stakeholders. By bringing all parties to the table, we hope to uncover gaps in the existing framework and define opportunities for curriculum enhancement. The oral presentation will feature a patient, a medical student, and an educator in a collaborative discussion that highlights the perspective of all parties and future directions.

POSTER PRESENTATIONS

Poster presentations offer an opportunity to share your work with an international audience at Medicine X. Presentations will take place throughout the conference with special designated times for poster viewing. First authors should plan to be next to their posters to answer questions during these times.

Combining innovative technology and medical education for rural and underserved patients

Andrew Richards

50% of hospitals in the US are considered rural. Many face challenges that are unique to their location and the population they serve. The Elson S. Floyd College of Medicine is working to address these challenges in part through their Technology Incubator. By working directly with patients, students, faculty, and providers in rural / underserved communities the Technology Incubator is providing innovative technology to the people that need it most. More than just creating new technology, the Incubator works in conjunction with the school’s curriculum through hackathons, partnerships, and other joint ventures to instill creativity, entrepreneurism, and innovation when it comes to delivering care in the rapidly evolving world of medicine. As we expand the scale and scope of the Incubator we are looking for innovators that want to make an impact on the rural and underserved communities across the country…and the world.

The patient centered podcast

Scott Shepherd

A complaint commonly heard in the primary care office is, “my doctor doesn’t listen to me.” Current media tells us that most primary physicians only have 10-12 minutes per patient and I think most of us can agree that is not enough time to listen to complaints, make a diagnosis, provide education about the acute complaint and then provide meaningful education on chronic conditions. What if your patient could get that education in the waiting room, or in the car on the way to the appointment, or even in their local library if they have limited resources?

Welcome to Patient Centered Podcasting. This is a podcasting service led by medical students as a form of community service and outreach during their didactic years of medical school. Students identify patients who struggle with compliance and control of chronic conditions because of a lack of understanding in their disease process, medications, or community resource scarcity to name a few. Patients are surveyed about what barriers to care they have both in the community and at home, as well as things that have and have not worked for them in the past. Answers to these questions are researched by students and responses are supported by evidence in peer reviewed journals as well as their text books from school. Students then record an interview with the patient as a podcast and upload it to a website associated with the school so other patients with similar challenges and obstacles can receive the same education. Areas of focus are diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, obesity and tobacco abuse. The patients in the community drive the nature of the education and students gain an understanding of what challenges patients face to remain compliant.

Holistic health care, personalized medicine & the practitioner of the future

Erik Goldman

The emergence of holistic medicine over the last 20 years has been driven by patients/consumers. All evidence suggests this interest is growing, and not likely to let up. The medical community is scrambling to catch up.

Like many innovations in healthcare IT, holistic/functional medicine has historically been excluded from and marginalized by mainstream care systems–and often for the same reasons: Institutional inertia, entrenched interests, unwillingness to be the first to change.

This has created a massive disconnect between the needs and desires of the public for more humanistic, holistic & preventive medicine and healthcare systems’ willingness and capacity to meet those needs.

Innovations in both holistic medicine & health IT are putting very powerful new tools –genome testing, microbiome analysis, food allergen tests, QS trackers–directly in the hands of ordinary non-medical people. They often expect guidance from practitioners on how to use these tools & make sense of the information they obtain. Few practitioners are prepared to fulfill that expectation.

This talk will focus on the convergence of the holistic medical movement, innovations in personalized medicine, and self-care technology. I will create a portrait of what tomorrow’s primary care professional could be, identify existing obstacles, and outline a pathway for overcoming them.

The presentation will feature data from Holistic Primary Care’s annual practitioner surveys exploring physician engagement with holistic modalities & healthcare IT. It will also include lessons learned from holistic/integrative centers at major institutions like Cleveland Clinic, Scripps, and Duke, as well as perspectives gleaned from my 30+ years as a medical journalist.

RAPID REPORT

Rapid reports are an opportunity to provide a rapid presentation of work to a large breakout audience. Presentations are 5 minutes in length. Oral presentations are organized into theme sessions, and each session will have a designated session chair as moderator.

Residents as change agents

Adam Rizvi

Health care systems around the world are facing the need to be agile, adaptive, and ever-evolving in the face of shifting healthcare priorities, technologies, sociopolitcal and financial realities. It is vital that all members of the healthcare continuum be educated in various methods of leadership, management, and guiding systems change. Trainees (Medical Students, Residents, and Fellows) in particular would benefit considerably from this targeted education as they are often at the front lines and are the first to recognize the need for systems change. Educating this and related groups would provide the knowledge, skills, and attitudes needed to effect change systemically. The result would be a healthcare system that thrives, and one that values transformative leadership, collaboration, and meaningful change.

How the patient in me has shaped me to be a better doctor?

Shruthi Narayan

The summer of 2012 is still etched in my memory vividly. I was completing my 3rd year of haematology training and had also started on medical leadership training. My husband was in his first year as a Consultant Haematologist, our son was now 10 years old, we had a lovely family trip to Sri Lanka and we were just about to become home owners for the first time. But I had not felt right throughout summer and when headaches seemed to become a constant companion and in fact worsen, I was forced to pause and get evaluated. BP checks at home constantly gave an error message and one record of a systolic pressure of >200 prompted me to get an urgent appointment with the family physician. To cut a long story short, an initial BP record of 237/147 prompted a series of urgent investigations and set me on a life changing journey which has defined the rest of my life. I have been diagnosed with chronic kidney disease, the aetiology of which has not been determined and is on a gradual declining trend. Reflecting on my experiences so far, I can remember the initial shock, denial, self-pity, impatience, frustrations but also the gradual acceptance of the diagnosis, its implications and impact on life – my body telling me how I feel, the increasing tiredness but mentally still dissociated and wanting to do more. It has also made me value my support network comprising of family and friends who have supported me and have helped me immensely through this process. But above all, what strikes me the most valuable from these experiences is how my experiences have shaped me to be a better doctor and a better person. We forget that our patients indeed are living, walking libraries and very much an under- utilised resource! From fundamental changes such as becoming a more empathetic listener to thinking at every contact from the patient’s perspective, understanding the fears and frustrations and providing valuable time to every consultation, this journey has changed me. The recognition of the inevitable vulnerability in the patient along with the expertise makes one a great doctor. I have also through my own personal experiences realised how little there is by way of support for doctors in training who become unwell and how this can be optimised.

I firmly believe that for quality to be at the heart of everything we do, it must be understood from the perspective of patients. Just gathering patient feedback is a limited exercise unless something constructive is done with the findings to bring about improvements. Integrating involvement of patients and families in their care is about a positive change in the current patient-clinician dynamic so that clinicians work with patients to encourage and respond to their greater involvement and patients take a stronger interest in being involved.

This presentation would talk about my health journey and how my personal experiences have helped me get to where I am today. My case study proves that we need to be able to harness the knowledge and experiences and ideas of our patients to help design a better health care – a more personalised, patient centred care. My main objective would be to share with the Medx audience my experiences and reflections, how each and every patient can help shape healthcare that is provided and help promote discussions regarding how we could provide the opportunity to become part of the health care designer team.

Learning exchange: Community-enabled technology

Daniel McLinden, Melida Busch, Sarah Myers and David Davis

In The Penguin and the Leviathan, Yochai Benkler wrote, “once you open the possibility that people are not only using the web as a platform … but to pool their efforts, knowledge, and resources … the possibilities for what they can create are astounding.” Pooling resources and talent in online communities has led to the development of a variety of products and services; well-known examples include the Linux operating system, Firefox web browser, and Wikipedia. Taking a cue from Benkler, our belief is that the best ideas for improving healthcare may be found in an existing care centers; our challenge was to make it possible for a geographically dispersed community of clinicians, scientists, patients, and parents to pool their resources and talent, learn from each other and support the work of improvements in care and outcomes for children and adolescents with chronic disease.

In 2012 a team was formed to respond to this challenge and created a Learning Exchange; an online collaborative knowledge-sharing platform which serves as a community commons for a Learning Health Network. Working with ImproveCareNow, a community where patients, parents, clinicians, and researchers work together to improve the health and care of children and youth with Crohn’s disease and ulcerative colitis; the ImproveCareNow learning exchange (icnexchange.org) was launched in 2013. When launched, the ICN Exchange provided a 21st Century community commons for sharing processes and tools organized by the Chronic Care Model framework of pre-visit planning, population management, data quality, and self-management support.

As of September 2016, 960 registered users in 89 ICN care centers have contributed 2500 resources. The median number of visits to the site in 2016 was 498 per month, which represented the work of an average of 167 users per month. The ICN Exchange has become an integral resource for the ImproveCareNow community and is, to the best of our knowledge, unique in healthcare. Using this model a Learning Exchange for Cystic Fibrosis (cf.learnexchange.org) was recently launched and is in a nascent stage.

The ICN Exchange has been successful not because of technology but because of a focus on community engagement. Our ethos of focusing primarily on community has been difficult for outsiders to grasp and we continue to be confronted by the belief that great technology alone (i.e., “a better website”) will create an environment in which transparency and collaboration comes naturally. We will share what we have learned about the interplay of technology architecture with community architecture. We will illustrate this point with examples from both our successes and our failures. We will discuss balancing idealized technology development processes with the, at times, messy process of co-producing, implementing and sustaining a common space for a diverse and complex community.

We are Alfred

Erin Washington

The patient perspective is an under-represented voice in healthcare education. Embodied Labs wants to change that. Embodied Labs is an educational technology company that envisions a world where health care providers and caregivers are able to better understand the perspectives of vulnerable patient populations. By embodying a patient in one of our lab modules, healthcare workers in training are able to “walk a mile in a patient’s shoes” and experience what it is like to live with a particular disease or condition.

We are building a library of immersive, interactive patient experience labs that are delivered to learners via a cloud-based platform. Each lab includes a virtual reality experience created by combining live action 360 film computer generated imagery (CGI), and real-time hand tracking to allow the learner to embody a patient and experience his/her 1st person point of view–in addition to assessments, learning outcome/competency tracking, Alfred’s medical record, key terminology, facilitator guide, and more–all designed for a range of healthcare training programs.

Our first product, The Alfred Lab, allows the learner to embody a 74-year old African-American man named Alfred who has high frequency hearing loss and macular degeneration. In the 7-minute experience, as Alfred, you eat birthday cake with your family, experience a day dream without your impairments, visit the doctor, take a cognitive test, and speak with the doctor after receiving hear aids. We will create 3 more labs for geriatric education by the end of 2017 that will teach learners about dementia/cognitive impairment and end-of life decision making. We envision that health care providers and caregivers will use our products to become empathetic problem solvers that are optimally equipped to provide high quality care to their patients!

Medicine X | ED has been partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Engagement Award Initiative (EAIN-3989)

Great Talks from the Stanford Medicine X Main Stage