Technology is changing many aspects of life and work, as well as the way Yale School of Medicine (YSM) students learn.
“For alumni and students, you know that the Yale System is the core of medical education at Yale. But today we have creative and novel technologies that enable that system in new ways,” said Nancy J. Brown, MD, Jean and David W. Wallace Dean and C.N.H. Long Professor of Internal Medicine, as she welcomed YSM alumni, students, faculty, and staff to the inaugural webinar, Reimagining Medical Education: Using Technology to Educate, Innovate, and Captivate, in the school’s Innovation in Medical Education series.
The four-part series that began on November 4 is designed to showcase “how that innovation enhances our already unique education,” Brown explained. The next session, on January 26, will focus on how simulation is used in medical education at YSM, followed by discussions of the adoption of telehealth in YSM’s clinical skills program and how innovation is being incorporated into the school’s pharmacology training.
The theme of the series aligns with one of the medical education priorities of Jessica Illuzzi, MD, MS, deputy dean for education and Harold W. Jockers Professor of Medical Education—to develop innovative approaches to medical education that are irrevocably engaging and compelling, enhanced by increased use of simulation and evolving technologies and resources. In her remarks, Illuzzi referenced how medicine looks a lot different than it did even a decade ago and will continue to evolve along with technology. In addition, she stated, “the learning style of our students has evolved as they become ever more technologically-savvy."
The panel’s moderator, Associate Dean for Curriculum Michael Schwartz, PhD, was appointed the inaugural director for innovation in medical education in July 2021, demonstrating the school’s commitment to enhancing medical education through technology. Schwartz shared the history of how YSM has been using technology to enhance student learning through devices like iPads and iPad Minis since 2010.
One theme of Schwartz’s remarks was the important role of students in decision-making about what technology to incorporate, since students know what will be useful, versus leadership and faculty trying to anticipate what might be useful. He noted the importance of ensuring students with different levels of tech-savviness pilot technology, since it has to work well for all users.
When a participant asked how faculty stay ahead of changing technology, Schwartz again pointed to students, explaining they “become technology educators for our faculty.” When students first had iPad Minis on the wards in 2013, during rounding, residents and attendings often turned to students to quickly access patient data in EPIC and other online information. This helped to integrate students into teams and allowed for bi-directional teaching and learning. As mobile devices have become more common in clinical spaces, residents and attendings are increasingly modeling their use in patient care.
Schwartz described how use of iPad Minis on the wards also improves interactions with patients and shared how during COVID-19, when telehealth was being used extensively, the iPad Minis importantly gave students access to electronic medical records on and off-site.
In 2010, when YSM first introduced iPads in the pre-clerkship curriculum, it was one of three medical schools to use the technology. By fall 2011, the entire curriculum was delivered through iPads, allowing students to receive faculty members’ most current lecture notes and presentations and to annotate these course materials.
Four faculty panelists shared how they have been using technology to enhance their teaching. William Stewart, PhD, associate professor of surgery (gross anatomy), described how the anatomy lab now has 40 dissection tables with networked iMacs on an adjustable arm. Additionally, he and a team have created 24 interactive iBooks for use in anatomy that are also available to other institutions through the Apple bookstore.
Associate Professor of Emergency Medicine Rachel Liu, BAO, MBBCh, who is the director of point-of-care ultrasound (POCUS) education, noted that since 2015, POCUS transducers paired with iPads and other tablet devices have been available in all YSM educational physical exam practice rooms. Each year, Liu explained, 16 students are trained in the use of these devices and how to teach their peers. This has enabled students to practice POCUS on their own and enhance their ability to learn normal anatomy, physiology, and pathology. Using POCUS, a student will “see the spleen for the first time in their medical career,” Liu stated.
Technology altered how clinical skills were taught during the pandemic, changes that according to Jaideep Talwalkar, MD, associate professor of internal medicine (general medicine) and pediatrics and director of clinical skills, will have staying power because they enhanced learning. Pre-pandemic, small groups of students practiced clinical skills with each other in the clinical skills practice rooms, with faculty providing feedback. COVID restrictions forced creative adaptation. Students practiced on roommates, family members, or even mannequins, using mounted iPads at home if they did not have access to the school’s cameras, with faculty observing remotely providing formative feedback. Students engaged with standardized patients on iPads as they practiced the actual physical exam on a mannequin. Faculty brought iPads to hospital rooms so that students, who could not be physically present, could talk with patients and their team members and participate in care discussions remotely.
The portability and versatility of these tech-driven solutions improved clinical skills training because students were more engaged, there was increased access to faculty and patients, and more opportunities for physical exam practice and feedback.
Deliberate practice—premised on Dr. Anders Ericsson’s concept that people get better at a skill when they practice toward a discrete goal, receive immediate feedback, and have the chance to practice again—led Christine J. Ko, MD, professor of dermatology and pathology, to develop an app that trains people to visually recognize skin cancer. People look at images of skin lesions in a range of skin types and are asked to identify which lesions are skin cancer. Ko has visions of the app expanding to other diseases, specialties, and physical examination skills.
Schwartz hopes that in his new role as director for innovation in medical education he will be able to encourage and support more new applications of technology to enhance learning.