(Fourth of five articles in the Vision for a New Education series)
“Your connection with the audience is emotional. They can’t be told to feel a certain way. They have to discover it themselves.” — John Lassiter
The following story imagines a day in the life of a student at a networked Medical Studio. Such studios will improve pre- and inter-service learning from preclinical sciences through residency and beyond in modular facilities that provide an ideal learning environment for practice-based learning and evidence-based education.
A day in the Studio
John wakes up and checks his email while eating breakfast. He has three messages regarding the ethics paper he and his team are submitting online on end-of-life care for peer review later that day. The top papers will be submitted for publication and the authors will present a teleconferenced TED-style talk to the global medical studio community at the end of the month.
After responding to his mail, John heads into the studio. From a distance he can see the two-story glass and wood building standing in the shade of a grove of trees. When he arrives, a number of his peers are starting work at their laptops, four at each modular table. This is the early morning crew, the students that wake with the sun. A couple of his peers are working at a whiteboard and discussing the effects of parathyroid hormone on calcium levels. Another small group sits on couches discussing the case study they are preparing to submit and yet others are already fully immersed in the surgery simulation center on the second story balcony.
John grabs a coffee from the kitchen then sits down at his table that he shares with three other students. Dappled light streams into the room. Overhead, a series of beautiful images hang from the exposed rafters. At first glance, they look like abstract expressionist images, curves and spatterings of bright red, blue and grey. But John knows these are actually endoscopic images from otology patients shot by a peer. The hanging imagery is regularly rotated and takes its place between more persistent images of famous scientists, physicians as well anatomical diagrams and biochemical schematics. John always loves coming into this space. It is intense, dynamic, playful, inspiring.
John logs into the Watson practice-based learning system and notes that his peer, Billy, has answered his question regarding ACE inhibitors and that the answer has been verified by a teaching assistant. The majority of his time online is divided between patient cases in one of the virtual clinics and problem sets surrounding key biomedical science. He is currently in the midst of a planned two-week virtual cardiovascular rotation and so checks in on his patients and completes questions related to their management. It is a similar experience to being on the wards and having to present his assessment and plan and answer questions regarding the patient’s condition and management.
Watson prompts him to consider reviewing cardiovascular pharmacology questions as a follow up to work he had completed last week. There are questions on three new pharmaceuticals. However, he is most excited to work through a new virtual patient case and so jumps right in, watching the video of a patient and answering questions as he progresses. After utilizing the studio library to look up information on pressure volume loops, he realizes that the concept is still not clear and posts a question for consideration by the learning team. Dr. Hazlet, this month’s faculty advisor, decides to schedule a 15min teaching session at 11:30am and the rest of the class is alerted via Watson’s shared calendar. When John finishes his case, he receives digital certificates for the successful completion of the case and, from the progression metrics, knows that he will soon pass the general cardiovascular clinical competency barrier. When he first started at the clinic the introductory questions led him to discover key physiology and communication principles, while later cases and questions reinforced the anatomy and pathology and still later cases developed his ability to provide evidence based management. While other of his peers moved on more quickly to other blocks, he stayed to unlock further learning opportunities by proving expertise in areas of cardiovascular health and disease.
After another hour and a half of working with Watson, by which time the studio has filled appreciably with other medical students, John heads to a live Q&A session where another cardiovascular question has been queued up by his professor for reflection. A lively discussion ensues regarding the treatment of hypertension, which inspires John to read more deeply into the existing literature. Teaching assistants have transcribe the key points of the discussion into the Q&A database for reference by other students who did not attend the talk. Cardiovascular medicine has always been an interest of John’s as his grandfather had died from a myocardial infarction when he was young and he hopes to make inroads on both prevention and treatment someday.
Leaving the Q&A, John joins four of his peers in the global health workspace. Sitting at a board room table surrounded by live screens showing the latest data from the CDC, WHO and other public health organizations, as well as new papers and data that his peers wish to highlight, John feels the importance of his work on this project. His team briefly teleconferences with another studio group from overseas and make plans for their next meeting.
At 11am John joins 20 of his peers for a new 5 minute 3D animated film that depicts the function of the electron transport chain and in particular ATP synthase. John was never very interested in biochemistry but after seeing one of the previous animations and answering questions about a patient with a mitochondrial disorder during his work in the virtual neurology clinic, he has found himself more and more fascinated with the mechanics of cellular energy.
Soon after the film, John is in the “radiology reading room,” a small theater dedicated to high-volume image reading. In 30 minutes, he has described over 100 right upper quadrant ultrasound images as either normal or abnormal and immediately received feedback from the system as it revealed a professional radiologist’s read and pointed out relevant anatomy. He is quickly developing intuition as to when a image just feels wrong, something that used to take years of training.
Over lunch, which John shares with newly arriving students and near graduating, intern-level clerks that will be progressing to their apprenticeship at the hospital, he discusses the various career paths available to him. He appreciates the varied level at the studio for the perspective the older students provide and for the informal teaching opportunities that constantly spring up. He is amazed at how fast certain students progress, but notes that most students seem to have their share of strengths and weaknesses. All have something of value to both learn and teach.
At 2pm John meets with one of the teaching assistant to discuss his progress. Data from his daily tasks on Watson is cued up — there are no surprises there — and the assistant asks if John has any concerns. As he doesn’t, they dig a little deeper into the data and note that he is only at the 70th percentile in his pharmacology questions in the cardiovascular block. The TA asks if he has a plan of attack. John lets her know that he had decided to bundle pharmacology after finishing the physiology and pathology content of the cardiovascular course. The teaching assistant supports John’s plan but states that pharmacology has historically been noted by Watson to be more effectively learned in small doses via repeated exposure. They look at de-identified data from several communities of students showing different approaches and learning curves and John decides to modify his learning plan.
It’s now 2:30pm and time to head to the free clinic for his clinical service. He had learned the basics of the history and physical in the first month of school and then was immediately and meaningfully involved in patient care by acting as a medical scribe and also taking H&Ps on a weekly basis.
Right off the bat, he was great at the basic physical exam but found engaging patients with the right questions and the right time in a natural manner to be a challenge. Nonetheless, he is excited by his progress and by the amount of clinical knowledge he has learned as a medical scribe. This service also provides a useful task-shifting service for the senior residents and attending physicians.
John returns to the studio at 5pm for the weekly lecture. Every single one of these talks has been incredible. Each speaker has been a top scientist-medical practitioner as well as a consummate stage presence. Some use stunning visuals or silent films as they speak, projected on the four walls surrounding the audience, some stand still at the center of the room without aids and tell stories, some dissect cadavers as they talk through the procedure, some speak to coming technological, cultural and economic revolutions in health care. Each of these talks has motivated John to continue to study and practice. To work hard on understanding his real and virtual patients and to try to deeply understand the wondrous biopsychosocial system that is the human condition.
John is looking forward to tomorrow as he will spend the morning at his genetics research lab after which his health design workgroup is meeting to work on a wireless device for home use to support decreased hospital admissions and improved cardiovascular health outcomes. He has also blocked off two hours to work on basic surgical procedures utilizing the VR system, which he always enjoys and makes learning anatomical structures exciting. It will be a good day.