(Part three of six in the Vision for a New Education series.)
The natural conclusion to the principles found in the previous Design Principles for the New Medical Education is a network of low-cost, efficient and high-quality education studios utilizing a technology enhanced, high volume, deliberate practice-based curriculum to educate the next generation of innovative and compassionate health care providers and grow the global healthcare workforce.
The Medical Studio represents a retooling of Maria Montessori’s classroom for the adult learner and is a lean and elegant education, designed from the ground up to meet the needs and demands of the 21st century learner and workforce by streamlining information delivery and quality improvement, increasing learning efficiency and making the highest quality medical education available anywhere there is need. From Stanford to Rosebud, to Rwanda, these networked and modular studios could redefine individual and collaborative learning while ending disparities in access to the best possible healthcare education.
The world needs more and more broadly trained healthcare providers. A strong and growing healthcare workforce is critical to health outcomes as well as social, economic and political stability in developing and developed countries. It advances local economies and builds a stable middle class, returning initial investments many times over. Unfortunately, many places in the world lack the training capacity to supply an adequate health care workforce.
Simultaneously, the quality of US medical education has been stagnant. While the conditions have become more humane, there has been little change in the basic approach to medical education since the 2010 Flexner report.
The solution to both problems is to build a network of medical education studios that can efficiently and effectively train new generations of doctors, nurses and associated healthcare providers. Advances in our understanding of learning, training and skill acquisition, improved learning technologies, increased access to computing, and assessment data enabled regulatory compliance now make it possible to provide innovative and high quality healthcare education at low cost.
Process innovation and technology supported analytics are transforming healthcare and offer the opportunity to do the same for education, providing superior preservice and supplemental clerkship, residency and continuing medical education while saving significant time and cost.
We can now create educational efficiencies by moving beyond the laborious, expert-led, synchronous, classroom approach to learning to an education based on individual deliberate practice and collaborative project based learning that take place in a technology enabled studio environment. Across multiple fields, research has shown that focusing effort on facilitating individual deliberate practice, i.e. training, is the most effective use of resources. The Medical Studio curriculum will utilize a large volume of digital cases, problems, projects and skill simulations that closely mirror the actual cognitive and procedural aspects of healthcare practice. This frees students to learn at their own pace, while engaging the critical thinking skills and individual accountability necessary for their fluid integration into ever evolving healthcare systems.
While this novel approach shares aspects of both case-based and problem-based learning models, it is radically different in implementation and execution. By utilizing technology to provide instant feedback and individualized challenges in a studio environment, students participate in constant individual practice, develop a growth mindset and derive benefit from the variety of their peer’s expertise and experience while interacting with experts when they have the most to benefit. This shifts and automates repetitive teaching tasks. Educators are freed to answer new or difficult questions, inspire, coach and serve as curators (i.e. educational designers) for the problem-based online learning environment — an environment that serves as a simulation of the hospital, clinic and lab. These new roles are empowered by continuous learning data collected daily through our educational technology. The data highlights individual and community learning trends and curricular roadblocks and helps faculty identify and target individual student needs.
As a studio model, reminiscent of Maria Montessori’s approach to early education, our design will exploit individual student strengths through formal and informal collaboration to accelerate the learning process while providing a much more enjoyable and accountable educational experience for both learners and educators. The practicality of this approach is in no way antithetical to the development of broad knowledge and critical thinking skills required by the physician-scientist. In fact, we expect that our model will inspire a much deeper curiosity and desire to explore, qualities central to scientific thinking and so necessary for the next generation of healthcare practitioners. It achieves this by focusing on solving increasingly difficult real-world and theoretical challenges, giving students, at once, more time and autonomy, and providing more consistent and individualized quantitative feedback.
The learning metrics, curriculum content and knowledge objectives will be defined in collaboration with partner schools and the associations that oversee licensure across the various medical specialties. With a focus on practice, experts will be tasked to create or repurpose cases, problems, projects and skill simulations and provide learning metrics that will efficiently facilitate the development of expertise. By sharing resources across the network, time can be saved for deeper engagement with knowledge that is of particular interest to individual students and partner schools.
Central to the Medical Studio design philosophy is the vital impact of the environment on learning and the learner.
The Medical Studio takes into consideration both the virtual and physical environment, and realizing that transformation requires repetitive effort, acceptance of failure and deep resilience, it aims to provide an uplifting environment that supports and inspires learners during their training. The model physical environment is designed as a place for individual growth and group collaboration. It features naturally lit, high-ceilinged, flexible spaces useful for both types of work and furniture adapted to the tasks at hand. It contains medical and surgical simulation spaces and provides areas for relaxing and reflection. The studio space respects the learners autonomy while encouraging collaboration. It provides faculty and staff with appropriate tools for deep engagement with students and student learning data and positions faculty to have maximum impact in both small and large group settings.
Likewise the virtual environment will be simple, engaging and constantly evolving. Using basic design cues, it draws learners into virtual clinics and labs where they care for patients and track their own progress as learners. Clean and minimal design is a central principle, not an added feature, of the learning model and necessary so that content and learning activities can be effectively evaluated. The technology accelerates learning by focusing learner efforts and enhancing curricular improvement via data facilitated editorial.
Motivation and inspiration will be kept high by carefully modulating a variety of daily, weekly and monthly activities. The time students spend at the studio is enlivened with a careful balance of individual practice and interactive group work, adding projected media, high impact lectures and exciting simulations built to engender wonder and awe. This humanistic and theatrical approach to the learning experience will make the Medical Studio not only efficient and effective, but enjoyable and inspiring.
Critical evaluation of the Medical Studio at every stage is of paramount concern. Education in general and medical education in particular has lacked strong evidence for any particular approach to learning due to long standing institutional constraints, poor data collection and a piecemeal approach to innovation. Utilizing a controlled setting, such as the Medical Studio, will allow us to optimize learning while collecting real-time data to provide a comprehensive and continuous view of students for assessment and curricular evaluation. Our virtual environment will track a rich data set that includes practical accomplishment on key clinical reasoning steps across each clinical field. Knowledge metrics will be designed to provide finely grained assessment feedback on key patient care indices as well as physical skills, scientific and clinical reasoning and management competencies. Key summative evaluation metrics will include outcomes on existing standardized exams and clinical evaluations as well as validated instruments that are designed to assess knowledge, engagement, clinical competence, cultural sensitivity, and interpersonal teamwork skills.
The quality and impact of the data in the Medical Studio will revolutionize healthcare training. The learning technologies are developed with continuous feedback and evaluation as core principles. This data collection will inform both the learning process and the Medical Studio’s impact. It will facilitate learning optimization as well as transparency in our outcomes.
The data rich environment of the technology enhanced medical studio streamlines and improves the administration of educational licensure, accreditation, regulation and compliance. Our studio will be collecting thousands of data points every day on our students, aligning assessment with evaluation and providing a transparent educational system based on learning metrics. With such a system, compliance can eventually be automated and quality improvement based on a rigorous comparison of learning metrics with student effectiveness in hospital.
The culture of our medical profession begins with the medical school admissions policy and evolves through the educational process and professional modeling by peers, staff and faculty. Twenty first century health care requires innovation and teamwork as well as a continuing commitment to evidence-based medicine and clinical practice. A new low-cost, high quality biomedical health system can only be achieved if future generations of doctors are ready and able to critically appraise every aspect of the health care system, the quality of their lives in that system and the value they bring to medicine. Medical innovation culture is addressed directly by the educational design. The efficiency created by the practice-based precision learning environment model leaves room for reflection and creative thought and will, through rigorous practice, train evidence based practitioners, critical scientists, culturally sensitive communicators, adaptive team members, and empowered systems innovators.
Cultural competency and locally appropriate curriculum content are of paramount concern. The networked approach to basic clinical content is in no way antithetical to local needs or specialization. More importantly, networking studios will bring students and faculty into much closer contact and forge new bonds of interdependence and collegiality.
Medical school must be less expensive. Building a network of educational studios focused on learning allows for numerous process, learning, technology and compliance efficiencies. At scale, a network of medical studios will create a lean central administration system while providing ideal learning facilities and technologies at low cost.
The networked studio model creates savings in compensation, facilities maintenance and operating costs, all major medical school budgetary expenses. These cost savings come from minimal staffing, limited technology and facility needs and educational efficiency. Saved resources can be utilized by individual schools to foster their particular mission and vision.
More importantly, this model would allow for a significant lowering of medical education costs and provide for extremely low cost training for communities in need. Students in the US would not come away burdened with debt that is increasingly skewing the healthcare landscape and supply/demand curve.
The Medical Studios will provide low-cost, high-quality education that guarantees critical professional healthcare competencies and streamlines regulatory compliance thus improving medical education and increasing international healthcare capacity. The blended curriculum and practice-based approach to education in a studio environment will foster curiosity, professionalism, teamwork, creativity, and a fierce satisfaction in exploration and discovery. It will respect the uniqueness of the individual’s perspective while providing convergent biomedical knowledge and clinical skills outcomes. And it will ensure competency in the application of biomedical science to the team-based management of patients. It represents a novel approach to the process, business and administration of learning that exploits technology and learning science to exponentially improve education outcomes. This system will inspire a new generation of healthcare workers and catalyze expansion of the healthcare workforce thereby improving community health and wellbeing around the world.
Commonly asked questions
What are the problems this design innovation addresses?
- A glacially slow improvement rate in educational effectiveness.
- Lack of CQI in education
- Lack of data driven evaluation of education based on patient-care and community health outcomes
- Lack of individualized educational processes
- Lack of a shared community of well edited resources
- Lack of appropriate use of technology or analytics to support learning in medicine
- Ineffective use of human resources, especially faculty time
- Lack of a coherent data structure to quantify clinical reasoning and management expertise and ensure continuous improvement for students and curricula
- Lack of data to provide evidence based education
- Lack of correlation between curricular evaluation and student assessment
- The high cost of medical education
- Lack of focus on practice, the core element to learning
Why do these problems need addressing?
Cost, effectiveness, efficiency, culture, wellness. Training and education needs more scientific rigor and the world needs more health care professionals. In addition, the doctor’s value to the patient will reach beyond memory and diagnostic ability and require a deep capacity to inquire, empathize, innovate, create, challenge, communicate and lead. Our education will need to be more intelligent and adaptive to meet this challenge. Education needs to be less costly so future doctors have less disincentive to provide services to the disadvantaged.
What is the innovation to address the problem?
Networked Medical Studios based on the underlying precision learning environment model and the learning theory that supports practice-based learning. PrBL places a priority on just-in-time feedback, low fidelity simulation, informal, networked communities of practice and a meaningful set of metrics to facilitate learning, evaluation and educational innovation.
What implications does the innovation have for the future training of physicians and practice of medicine?
- Students will achieve competency in medical knowledge, reasoning and management skills that lead to high value patient care more efficiently
- The studio system will provide the framework for continuous educational improvement through evidence-based and data rich evaluation
- Increased time will be preserved for inquiry, empathetic reflection, innovation, creation, communication and leadership
- With a rich and creative culture, students will become enthusiastic participants in quality improvement over their lifetime
- Studio situated, practice-based learning will provide a much deeper sense of satisfaction with the process of becoming a doctor
- Networked studios will significantly lower costs. They will facilitate economies of scale, lead to faster innovation through inter-school collaboration and decrease overhead
- The Medical studio model, curriculum and technologies will provide insight for national and international educational standards while offering additional use inter-professionally
- Asynchronous learning allows students to move at different paces
Who will this innovation benefit?
- Patients and health communities who will reap the benefits of a practice based education where students will more quickly become experts and have more time to develop skills in systems change, patient care and design innovation
- Medical students, nurse practitioners, emergency medicine technicians, and paramedics both here and abroad, in low and high resource settings
- Teachers who will have a more challenging and rewarding role to play
What would the data structure look like in practice?
Something like this: