The recent Macy Conference proceedings from April 2015 provide a “vision for a continuously learning health system.” What does this mean when translated to our education and training infrastructure? Health science educators have been tinkering around the edges for a while now. Are we ready for changes that can help us realize the interdisciplinary training goals that we’ve been aiming for that include competency-based and technology-enhanced methods? Some of the work at Tufts University over the past two decades may provide some ideas for discussion.
Have all content available all the time: If we are aiming for “continuous learning,” then the current course-by-course systems don’t make sense. Relevant content must be available and integrated throughout training and practice. Tufts has taken the first step which is to have all content available all the time to all students and faculty. Tufts’ previously class-based curriculum has been online and accessible 24/7 to all students and all faculty through any device for many years through TUSK, an open software system. Students can access materials across the curriculum, whether to preview future topics or to review content before clinical application which begins from day one. This system helps eliminate unnecessary redundancy, increases intentional reinforcement throughout the curriculum, and supports the concept that clinical expertise is cumulative and requires back-and-forth dialogue between basic and clinical sciences throughout training. Adding learning analytics to enable incremental mastery at a personalized pace is still in very early development, but the potential is evident. And the idea of integrating real patient data (that is HIPAA compliant) with continuous quality improvement approaches that seamlessly bridge early education with residency training and professional practice will help us move towards the ideal clinical training and delivery system of the future.
Share content across disciplines: Another feature at Tufts is that our medical, dental and veterinary schools all share the same curriculum management system, so that content can be shared across schools. Before zoonotic diseases became a hot topic, our medical and veterinary schools were already experimenting with shared problem-based learning cases. We tracked medical students looking at veterinary resources and vice versa, and found cross-school activity even without the cases as prompts. Alas, we haven’t taken advantage of this feature, but have shown that it can be done, and has value. All content is “machine-tagged” using the National Library of Medicine’s Unified Medical Language System that is common across all health sciences, enabling standardized searches across the entire content repository. Christian Medical College (CMC), Vellore, India, where we assisted in implementing the same open software system almost a decade ago, uses one installation for medicine and many of its allied health sciences. This provides a major benefit for their core basic scientists who teach across CMC’s many programs. They store all their content in one place, and pull out any combination of content, down to individual slides or videos, as needed to tailor their teaching units for each batch of students. Consider the possibilities as we advance interdisciplinary training. While Tufts has been an early supporter of the (very) slowly evolving “open content” movement, open content alone is insufficient. Collectively, we need to push for interoperability of proprietary systems to enable easy sharing across disciplines and institutional boundaries.
Save face-to-face time for what it does best: Technology-enhanced training is powerful and will continue to improve. However, we need to remember that we’re not replacing faculty (as some faculty thought back in the 1990’s when we started this work). Instead, we can eliminate mostly ineffective “talking heads” and focus faculty-student time on the hard “soft stuff”—developing relationships, communication skills, clinical problem solving, difficult discussions, team building, modeling, mentoring, and all the other areas that technology can enhance, but not replace. To attain our desired outcomes for increasingly diverse learners, let’s apply a continuously learning approach with our teaching—using and testing and revising the combination of methods, with or without technology, that work.
I welcome your thoughts.