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Leveraging Technology Toward the Pursuit of Excellence

New York, NY

In 2015, the Josiah Macy Jr. Foundation convened the conference, “Enhancing Health Professions Education through Technology.’’  The conference attendees identified several key areas at the intersection of education, clinical care, and emerging technologies.  These focus areas included: supporting lifelong learning across the continuum from undergraduate levels through clinical practice as part of an interprofessional team; improving support for faculty development in the selection and effective use of educational technologies; accelerating the move to competency and milestone-based education; bridging the gap between educational and clinical missions; using local and national health data to inform curriculum content and learning experiences; and finally, sharing effective educational innovation strategies across all schools and levels. In the intervening two years, much has changed in health professions education and in the world of technology. 

Supporting the Undergraduate-Graduate Educational Continuum
There have been great strides made to better quantify the development of health professions learners as they progress through training. The AAMC has released the Physician Competency Reference Set and Core Entrustable Professional Activities. In parallel, the ACGME core competencies have evolved into complex program-specific Milestones. These new frameworks provide common vocabularies to describe our learner’s growth and mastery.  By implementing them, medical schools and residency training programs are electronically capturing the measurement of skills that were previously only anecdotally observed.

Collecting all of these data is a tremendous effort.  Given how new these initiatives are, the rewards are largely unrealized.  One critical need is a better connection between the undergraduate medical efforts from the AAMC, the milestones from the ACGME, and those of all the other health professions.  Schools want to make sense of this mountain of digital data and track competency development across the entire education continuum, not limited to the silos each framework covers. In addition, the learners themselves generally do not access the data collected about them, much less use the data to self-direct their learning. There is a great opportunity for schools to partner in the development of new knowledge support systems that help us continuously improve our educational programs and empower our learners to maximize their success. 

Virtual and Augmented Reality
Virtual reality (VR) and augmented reality (AR) have seen dramatic advances since our original 2015 report. With widely-available commercial VR systems such as the Oculus Rift and HTC Vive, and newly released AR devices including the Microsoft Hololens, many schools are rethinking their curriculum to leverage the educational power of these emerging technologies. In healthcare, VR and AR devices have been used to treat patients and even plan complex surgeries. Many medical schools are looking to these technologies to solve the challenge of including visual topics such as radiology in anatomy courses. Case Western and Cleveland Clinic are building new education facilities that replace cadaver labs with holographic learning spaces. Other schools are using a blended approach using the cadaver for high-fidelity tactile gross anatomy instruction and VR technology for corresponding radiology studies and dynamic physiologic processes. There is no doubt that as these devices become less expensive and companies such as Apple, Google, and Facebook invest billions in them, they will become a part of the clinical and educational armamentarium in health. Their role in health professions education remains largely unknown and I am hopeful that these early pilots will better inform their success.

Mobility and Location-aware Educational Resources
Mobile devices such as phones and tablets have become indispensable companions. As was mentioned in a recent blog post, mobile devices are a key link between our patients and their care teams. Many schools issue tablets to students populated with an array of educational, reference, and clinical decision-making apps. A new innovation is ‘location-aware’ content that uses small inexpensive bluetooth transmitters, called iBeacons, to trigger a phone or tablet to open a specific app or website when nearby. This allows schools to link content to the specific areas their students learn or practice in on their devices. Examples of how we are using this at NYU include launching the student’s Emergency Room shift evaluation on their iPad automatically when they leave the ER; opening their iPad anatomy course manual to the specific section when they visit different areas of the lab; and taking attendance in our team-based-learning groups automatically when they walk into the room.

Though much has changed in the worlds of technology, education, and our healthcare delivery system, the overall needs and opportunities identified in our original report remain the same: that intelligent use of education and information technologies support the linkage between education and delivery systems to create a Continuously Learning Health System. In this system, teachers, learners, and clinical data inform continuous improvement processes, enable lifelong learning, and promote innovation to improve the health of the public. This is a true imperative for those who choose to move beyond sustaining the academic medicine enterprise towards the pursuit of excellence.

Marc Triola, MD, FACP, co-chaired Macy’s April 2015 conference. Dr. Triola is an Associate Professor in the Department of Medicine at NYU School of Medicine and Director of the NYU School of Medicine Institute for Innovations in Medical Education.

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