The Future of Emergency Medicine Education
- Nov 3rd, 2014
- Rob Cooney
Rob Cooney, MD
EM Attending Physician/Associate Program Director
Conemaugh Health System
Edited by Alex Koyfman, MD
Trying to predict the future is a task that is riddled with risk. There is a very high potential that I will be wrong and my thoughts will end up being complete baloney. I’m okay with this. According to Strengths Finder 2.0, I’m futuristic, meaning that I’m inspired by the future and what could be, and hopefully will inspire you. With this in mind, two quotes that I believe should frame our conversation:
“The future is already here, it’s just not very evenly distributed.”
“We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10.”
With these in mind, here are some trends that I see emerging.
The Role of Technology
I believe that this one is pretty obvious. Technology has changed our lives in almost every aspect. Who knows what will come next? We have some fairly incredible technology at our fingertips: high fidelity simulators, portable supercomputers (i.e. smart phones), and a wealth of Web 2.0 technologies. Technologies that would have taken years to learn a decade ago can be quickly learned and utilized by educators and learners alike. Each passing month brings new examples of how educators are harnessing blogs, wikis, Twitter, and apps to supplement classroom instruction. As online content continues to improve in terms of quality and availability, I believe that we will see an evolution in instructional delivery. Didactic lectures will likely give way to other delivery models, such as peer instruction, problem-based learning, case-based learning, or project-based learning. Instructors will be able to add a significant value in the limited amount of time together with learners. Educational materials will increasingly become “on demand” for quick reference during clinical shifts. Learners may even begin to take advantage of the overlap between educational psychology and technology. For example, apps, such as Anki, allow learners to use technology to harness the power of spaced repetition to increase their learning effectiveness.
Technology will also influence how we work clinically. We’ve already seen the change that the introduction of ultrasound (EUS) into clinical practice has made. Newer technologies will contribute as well. Think about how Google Glass could influence how we interact with prehospital providers and patients. Can you imagine “seeing” the patient and the monitor in the ambulance as you talk the paramedic through the management? As they wheel into the department, you can now view your own monitors. As you prepare to intubate, the vitals are there, but so is your checklist. As you run through it, the items are in direct view and you don’t even have to take your eyes off of the patient. Such potential. . .
A Focus on Outcomes
Medical education has jumped on the outcomes bandwagon with a fervor that hasn’t been seen since the original publication of the Flexner report. Specifically, competency-based medical education (CBME) is all the rage. With this focus will come new metrics regarding the assessment of medical learners. Technology, as mentioned above, will likely play an increasing role in these assessments. For example, could a standardized patient wear Glass to provide a first-person view of a learner’s interview? The potential for feedback from these types of interactions is quite powerful. Learners will be able to harness this technology to demonstrate their outcomes as well. Imagine a digital portfolio that includes photos or videos of select learner interactions with patients. With the ability to mash up media, a learner could take a recording of their interview and then offer their own reflective commentary on it within their portfolio. They could also potentially record procedures in this fashion. Now, instead of simply filling out a form to capture numbers, they can demonstrate their actual skill in performing the procedure. This is a huge advantage from an assessment standpoint in that, we, as educators, can now apply more objective criteria to the assessment of our learners.
As we get better at capturing objective, robust, reproducible assessments, we will move towards the true realization that competency-based medical education promises. Learners will no longer be considered competent simply because they completed a preset amount of time. If they meet their educational milestones, they have the potential to advance. Likewise, for trainees failing to meet the milestones, more time can be granted for them to demonstrate the attainment of competence. As educators, we will also be able to critically evaluate our curriculum and adjust accordingly to the learner’s needs. This will promote a much higher degree of learner centeredness within medical education. While this holds great promise, this will not be an easy task in the United States given our current funding system. Ultimately, we will need to determine a method to make training duration more flexible.
Learner Centered Education
With the merger of CBME and technology, we will increasingly be able to customize education for our learners. As learners progress through their education, they will demonstrate mastery of a series of topics and will likely have their choice as how to demonstrate the mastery. As Curtis Bonk has written, “We live in the age of the learner, and it’s about time” (The World is Open, p. 306). Learners will increasingly demand a customized education. In fact, they will likely create it. In our hyper-connected world, each passing day brings more tools for doing exactly that. Online learning (de-learning) and mobile learning (M-learning) will allow learners to connect with each other and learn wherever they are whenever they want to. Free Open-Access Meducation (#FOAMed) is just one resource that is allowing this to occur. Dr. Bonk also lists e-books, open source software, MOOCs, and alternate reality environments (Second Life) as potential resources for increasing the learner centeredness of education. It is also likely that games will play an increasing role in learning. I can envision a future in which a learner dons a 3-D headset, such as Oculus Rift, that is paired to a motion sensor, such as the Microsoft Kinect or Leap Motion to provide alternate reality simulation. In combination, these tools could easily allow the learner to practice procedures that are difficult to learn. With proper design, difficult airways and rare procedures could become commonplace simulations for our learners. Ultimately, all of these resources will connect and learners and educators alike will be able to create Personal Learning Networks.
Focus on Quality
In 2013, Thomas Nasca, CEO of the ACGME addressed the participants at the Council of Residency Directors. The purpose of his keynote was to address the upcoming changes with the core competencies in the introduction of the Accreditation System and milestones. As he outlined the need, his commentary on the study by Landrigan, et al struck a nerve. The study was a 10 year review of patient safety improvements. The authors found that harm remained quite common despite significant efforts to improve patient safety. When I first read the study, I felt that improved recognition of patient harm over the course of 10 years may have explained some of the lack of improvement. Dr. Nasca feels differently. As he explained, the average longevity of a physician is 30 years. Since the study evaluated a 10 year period, we can estimate that one third of the physicians within this population were new graduates. In his opinion, Dr. Nasca explained that the failure to improve patient safety is a failure of our medical education system to train physicians with appropriate skills to foster safe medical practice and improve the quality of care that they deliver.
The skills needed to improve patient safety and quality will be increasingly required of medical learners. At the residency level, the Clinical Learning Environment Review (CLER) visits have made this readily apparent. Unfortunately, there is still a significant skill and knowledge gap within our medical faculty regarding this topic. We will likely see an increasing demand for physicians trained in quality improvement to help bridge this gap, provide faculty development, and lead change initiatives that involve learners.
As the quote above noted, the future is already here, it just isn’t very evenly distributed. All of the trends and tools that I’ve noted above already exist. Some are already in use within medical education, but many are not. So take a look around. See what is happening in industry, K-12 education, and undergraduate education. Take a look at what our learners are doing on their own time. As Abraham Lincoln has already said, “The best way to predict your future is to create it.” So bring these advances into medical education and let’s create the future together.
- Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., … & Harris, K. A. (2010). Competency-based medical education: theory to practice. Medical teacher, 32(8), 638-645.Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., … & Harris, K. A. (2010). Competency-based medical education: theory to practice. Medical teacher, 32(8), 638-645.
- Bonk, C. J. (2009). The world is open: How web technology is revolutionizing education. John Wiley & Sons.
- Landrigan, C. P., Parry, G. J., Bones, C. B., Hackbarth, A. D., Goldmann, D. A., & Sharek, P. J. (2010). Temporal trends in rates of patient harm resulting from medical care. New England Journal of Medicine, 363(22), 2124-2134.