Tuesday, November 5, 2013

Advocacy in Academic Medicine

Today’s blog covers advocacy from a variety of angles, and reflects my thoughts over what I learned from the #AAMC13 meeting over the last 24 hours.

Advocacy within Social Media

The University of Utah is taking a huge presence at this meeting with its Innovations theme.  At a booth set up in the exhibit hall, they were interviewing folks coming through to provide brief reflections.  I was able to spend a few moments reflecting on what the impact that social media can have on medicine and medical education.  What a timely opportunity to focus on what so many great folks have done parlaying the importance of vaccines for communities, as well as providing truthful, succinct messages to society.  See the audio interview here.

Advocacy within Education

Daphne Koller, who started Coursera, spoke to the participants on the power of what MOOCs (Massive Online Open Courses) can do, not just for the schools or professors who host them, but for society as well.  I was moved by the stories from student learners from sub-saharan Africa and others who became more educated from their use of Coursera.  The potential ramifications of the betterment of the entire planet: wow!

Advocacy within Continuing Education

I attended a workshop on CME in which Don Moore described a tool that integrates the IHI Model for Improvement with PI CME (Performance Improvement CME) to help clinicians better understand the pieces needed to make improvement science and lifelong learning relevant to their day-to-day practice.  Some in the community have questioned how Maintenance of Certification actually “helps” them provide better care for their patients.  This session helped clarify the potential benefits of the Maintenance of Certification program.  We also heard from Mary Turco and George Blike about a concept at Dartmouth called “Value Grand Rounds”, which itself showcases improvements in the health system, but also itself has the opportunity for members of a team to see the fruits of their labor, and also drives them to want to get better.

Advocacy for Research

At the Town Hall meeting, Dr. Darrell Kirch answered questions from the audience about a variety of topics.  One comment hit home: the public is “scientifically illiterate”.  A new initiative by the AAMC entitled “Research Means Hope” focuses on how the public can better understand why research funding is so desparately needed, because the end product of research should be improved patient livelihood. 

Advocacy for Graduate Medical Education

Also at the Town Hall meeting, a question was raised about the “rate limiting step” in producing new physicians in the United States—namely, the shortage of residency positions for graduates of medical schools, who themselves have increased enrollment by 25-30% over the past few years.  Atul Grover discussed bills in Congress that aim to address the “GME crisis”: HR 1180, HR 1201, and Senate 577.  We hope that these campaigns can be successful in providing the resources for the physicians of the future, hoping to achieve the ultimate goal of improved patient outcomes in our communities.

Advocacy for Me

I was honored to have met Dr. Lewis First as well, the editor of the journal Pediatrics, and a giant in the world of pediatrics.  His own career embodies the best of academic medicine, and the best of how physicians can make a difference.

A hearty thanks go out to the AAMC on a fantastic meeting, with so many opportunities for reflection, for networking, and for the opportunity to improve the education of future physicians and leaders in health care.

Monday, November 4, 2013

Technology Meets Humanism: #AAMC13-Style

Sunday, November 3, 2013, certainly did not disappoint at the AAMC 2013 meeting in Philadelphia.  I had the opportunity to attend many great sessions.  This blog will touch on two of them.

Digital Literacy

The session on digital literacy was as engaging as any I’ve ever attended.  The speakers brought cases from real life to discuss with the participants.  Table exercises provided the substrate for meaningful interaction among people who literally met two minutes ago.  There were some quotes that hit home for the audience.  All come from the speakers, Bryan Vartabedian, Neil Mehta, Warren Wiechmann, and Jennifer Salopek.

“Every provider should be prepared to deal with unsolicited requests via digital media.”

“On public platforms, physicians are under no obligation to respond to solicitations from prospective patients.”

“Patients put their trust in us, and it is our obligation to educate them in real and digital environments.”

“We are in the age of the public physician.  We need to function in this new environment.”

This session really hit home for me, as I realized that there are great folks studying this new field, which itself is moving as fast as a teenager’s thumbs on a smartphone texting a friend!

The group launched an extremely helpful resource toolkit for digital literacy, found here. This toolkit is a work in progress, but marks an important step for those educators who need help in teaching the future generation.

How Doctors, Nurses and Consumers Can Make One Another Better

This session was a real treat, as the speaker was Anna Quindlen, the Pulitzer Prize-winning author.  She spoke with no slides whatsoever (what a concept at a medical conference!).  However, one could hear a pin drop in the room (which required an overflow room to accommodate all those who wanted to hear her speak).  Anna spoke from the heart about real-life interactions with the medical profession, some of which shed a light on the humanism that still exists in medicine, and others which provided, well, simply put, an “opportunity for improvement” regarding communication interactions with patients and families.  Given my interest in using emerging technology in medicine and medical education, I really loved these comments (paraphrased here):

 “There is no technology that can take the place of humanism; despite technological advances, human touch is more necessary than ever before.”  

And this one, reflecting on her own work as a writer, was truly profound: 

“In the drama of my own body, I have become both the story and the reporter.”

I think the session can best be summed up from this statement by the moderator, Richard Levin: 

“We must keep the ‘care’ in healthcare.”  

Yes, we must!  Anna, thank you for sharing your stories with me and so many others.

I think these two sessions provided a perfect intersection between the need to “push technology” while still “going back to the basics” of humanism in medicine.  Lest those who feel technology is obliterating the human connection, I would tend to disagree: the lunchtime discussion with the digital literacy speakers demonstrated to me that we can have both humanism AND technology together. 

Yes, we can have our cake AND eat it too!

Sunday, November 3, 2013

#AAMC13: Saturday November 2, 2013 Reflections

It is currently the first night of my time in Philadelphia at the 2013 AAMC meeting.  I’ve only been here a little over 24 hours, but today has just been phenomenal for thinking about the future of medicine and medical education.  This blog is a few reflections from the day.  There were many other sessions that I attended, but these are some key elements from a few of the sessions that had a great impact on me.  The credit truly goes to the speakers whom I heard discuss these topics.

CME (Attribution: David Price)

The old way of thinking about CME is this: a “credit” required to justify “widgets” of learning.  This is shifting to a new CME/CPD model: aligning education with the gaps/needs of our communities.  In this new model, we can study why things work or don’t work.  For example: Does it work?  Can it work in real life?  How/why does it work?  Does it work better/cheaper?   What I think the challenge will be is finding the linkage to determine how the education is created, disseminated and implemented across health care systems.

Teaching Costs of Care/Value in Health Care (Attribution: Chris Moriates, Vineet Arora, Neel Shah)

The ABIM Foundation created a wonderful program as part of the Choosing Wisely Campaign which was a competition for programs/schools to present educational innovations to teach this important topic.  The criteria for this necessitated that the innovations be FINER: Feasible, Interesting, Novel, Ethical and Relevant.  Ultimately, interventions needed to address “COST”: Culture, Oversight, Systems Change, and Training.  3 speakers from different institutions highlighted their innovations, which demonstrated a variety of techniques to tackle this critical component of health care. My take home is that the health care providers have an obligation to our patients and society to tackle the issues of health care costs stemming from the unsustainable strain that these costs are putting on society.  This program showcases the fact that medicine as a field, under the leadership of the ABIM Foundation, is not pointing fingers at others (insurance companies politicians, or lawyers, for example), but rather is looking introspectively at how can we make a difference in addressing the cost issue.  The issue is real, but we are no longer burying our heads in the sand.

The Future of Medicine and the Need for More Residency Training Positions

I had the fortune of having dinner with our Associate Dean for Medical Student Affairs and 3 medical students from the IU School of Medicine.  We all reflected on the day, and what we all can take from the conference so far.  One big theme from that discussion is that advocacy is alive and well in the current generation that is going through school and training now.  Advocacy can take many forms, such as helping the disenfranchised, educating patients and families about the importance of vaccines, and/or even lobbying Congress to secure more positions for residency training.  The future of health care needs more physicians: medical schools have responded by increasing enrollment (and adding new schools), but the “bottleneck” is truly at the GME level.  In order to alleviate this, the number of residency positions need to increase.  This is not just a way to help students secure a residency position, but is the ultimate path towards addressing societal need for more health care providers.

Thank you, AAMC, for a wonderful first day of learning, camaraderie, discussion and interaction.  I look forward to the next few days as well!