Panel 4: Play like a Pro: Best Practices for Virtual Care Education
July 19, 2023ID10145
To CiteDCA Citation Guide
- 00:00So the next session,
- 00:01this panel is called Play Like a Pro,
- 00:04best practices for Virtual Care Education.
- 00:06Here we thought we would immerse
- 00:07our learners in a little bit
- 00:10more of an actual sense of Okay.
- 00:12We've talked in theory about
- 00:13a lot of these things.
- 00:14Let's talk in practice about what
- 00:16works well and what doesn't work well.
- 00:18And we're very fortunate to have Doctor
- 00:21Toya James Stevenson here with us from
- 00:23Indiana University Health Physicians.
- 00:25Again, I'm I met her through this
- 00:28process and have been just very
- 00:30impressed with her role in the AA
- 00:33MC Telehealth Advisory Committee.
- 00:35What she brings to the table in terms
- 00:37of her understanding about teaching and
- 00:40learning in this telehealth environment.
- 00:42She is her clinical practices in
- 00:45GI and she's actually done a lot
- 00:47of work in virtual care access
- 00:49and quality as it relates to GI.
- 00:52And and so I'm very excited to have
- 00:55her share with us her thoughts
- 00:57as she moderates this session.
- 00:58So I'll turn
- 00:59it over now to her.
- 01:02Thank you, Lee.
- 01:03I appreciate the opportunity to
- 01:06lead this panel discussion on best
- 01:09practices for virtual care education.
- 01:12As we had spoken about before,
- 01:14we wanted to slowly progress
- 01:16into getting into the granulars
- 01:19of exactly how you would impart.
- 01:22Knowledge on to learners and so
- 01:26our objectives were to discuss
- 01:28some of the methods for educating
- 01:31and embracing website banner.
- 01:33And so we're going to use some
- 01:35simulations to exhibit this review
- 01:37approaches to structure the virtual
- 01:39delivery model and the environment.
- 01:41For learning,
- 01:42because there could be several
- 01:44different approaches that could
- 01:46fit within a practice,
- 01:48share best practices on team structure
- 01:50and integration while embedding
- 01:52the learner through role clarity,
- 01:54optimization of the role on the
- 01:57team and incorporating this into
- 02:00telehealth as we care for patients
- 02:02and incorporate their caregivers.
- 02:05And then also consider approaches to
- 02:08incorporating peripheral advices to enhance.
- 02:12The visit and the encounter.
- 02:14So as many organizations have come
- 02:19to rapidly integrate telehealth
- 02:24since the public health
- 02:26emergency was declared in March,
- 02:28what we are seeing is that there are
- 02:31gaps in the knowledge that we have as
- 02:34physicians because we weren't trained
- 02:36many of us in telemedicine and so
- 02:39we're having to rapidly educate our.
- 02:41Self educate our providers on best practices
- 02:45not only for interacting with the patients,
- 02:48but for incorporating learners
- 02:50into their environment.
- 02:52So next slide.
- 02:54So with that I'd like to
- 02:58introduce our panelists.
- 03:00Doctor Ronald Weinstein is the founding
- 03:03director of the National Awardwinning
- 03:05Arizona Telemedicine Program.
- 03:07He's an academic pathologist who was the
- 03:11department chair for over 30 years and is
- 03:14a pioneer in the field of telepathology.
- 03:17He received the American Telemedicine
- 03:20Association's President's Leadership
- 03:23Award and currently continues to work
- 03:26at the University of Arizona as the
- 03:29director of their telemedicine program.
- 03:31Doctor Neil Nyak is the is an
- 03:34instructor of emergency medicine
- 03:36at Weil Cornell Medical College.
- 03:39He joined the group in 2015 and practices at
- 03:44the Medical Center and in lower Manhattan.
- 03:47And he is the director of the Emergency
- 03:49Medicine Simulation Education and
- 03:51he's going to show us basically
- 03:55how he works to train the trainer
- 03:57through simulation techniques.
- 03:59Doctor Bart Demershock,
- 04:02who may may not be able to join us
- 04:06today because he is on telestroke call,
- 04:08is a professor of Neurology
- 04:10at the Mayo Clinic.
- 04:11He's the Medical Director for the Center
- 04:14of Connected Care and has had extensive
- 04:17research and clinical experience in
- 04:19Telestroke and Laura Christopherson.
- 04:22Works alongside Dr.
- 04:24Demir Shaw,
- 04:25where she serves as the Operations
- 04:27Manager for the Center of Connected Care.
- 04:30Kelly Wittebolt is an emergency
- 04:32medicine physician at Mass General,
- 04:33where she is public published extensively
- 04:36on the use of peripheral devices.
- 04:39She and Doctor Weinstein will help
- 04:41us to develop a better understanding
- 04:43of how telemedicine peripheral
- 04:45devices or medical devices can be
- 04:47used to augment the patient care.
- 04:49And so we will lead off with Neil who
- 04:52will share some simulation videos.
- 05:03Great.
- 05:07So thank you for that wonderful introduction.
- 05:09Thank you for having me here.
- 05:11So I want to start a little bit before
- 05:13we get into how we actually train it
- 05:15about how our program actually started.
- 05:17And it was simply with trying to get medical
- 05:20students and experience in in telemedicine.
- 05:24And so we started it as I'm a
- 05:26simulationist with giving them an
- 05:28experience by doing a simulation.
- 05:30And so we had them see a
- 05:32standardized patient over video.
- 05:34From a controlled setting and what ended
- 05:36up coming up in the debrief was less about
- 05:39the how to turn on the camera and how to,
- 05:43how to, how to navigate the system,
- 05:46but much more about the interaction itself.
- 05:49And what we realized is
- 05:51that the website manner,
- 05:52the the clinical corollary of
- 05:54telemedicine to bedside manner was
- 05:56what they wanted to talk about.
- 05:58And so as our program kind
- 06:00of expanded and developed.
- 06:01We realized that this was the
- 06:03crux of what we wanted to teach.
- 06:05And what we also realized is,
- 06:07as Doctor James Stevenson said,
- 06:08a lot of us have been thrown into this
- 06:10without any previous training in this at all.
- 06:13And so a lot of us were novices when it
- 06:16came to website manner or at least beginners.
- 06:20And so we were all starting
- 06:21kind of from the same space,
- 06:22the page whether we were already
- 06:25practicing clinicians that had,
- 06:26you know,
- 06:2720 years of experience or if we
- 06:28were the first year medical student.
- 06:31And So what we did is we developed
- 06:35this program for all comers who were
- 06:38interested in telemedicine to really
- 06:40understand the aspect of website manner
- 06:42and how to apply to their processes
- 06:44and their telemedicine practice and
- 06:46so the program that we developed.
- 06:49Starts with a flip classroom model.
- 06:51And so this flip classroom model
- 06:52is a module that goes over some
- 06:54of the basics and lighting,
- 06:55camera angles and some of the medical
- 06:58legal aspects of telemedicine.
- 07:00What is the Ryan Haid act and
- 07:02where do you need licensure?
- 07:04And this is basically to get
- 07:05everyone kind of on the same page.
- 07:07A lot of our learners are coming
- 07:09in with different experiences
- 07:10and especially post COVID,
- 07:12A lot of these experiences were
- 07:14just on the fly from home on zoom.
- 07:16And so we had to kind of you
- 07:18know before COVID,
- 07:18we had to convince people
- 07:20why this was important.
- 07:21Now it's we have to backtrack a
- 07:23little bit and make sure that people
- 07:24understand that once a lot of these
- 07:26regulatory relaxations go away,
- 07:27what do we need to know,
- 07:29how do we need to do it.
- 07:30And once they have that groundwork
- 07:32knowledge base, we bring them in, in person.
- 07:36Previously it was in a classroom,
- 07:37but now it's all virtual to do
- 07:40some experiential learning.
- 07:41And so we actually have them
- 07:43participate in simulations and
- 07:45do our long debriefs using the
- 07:47video from their simulations.
- 07:48And so,
- 07:49as was kind of stated in the last
- 07:52last panel, people being able to watch
- 07:56yourself on camera taking care of a patient
- 07:59is awful and awesome at the same time,
- 08:02but it's an awesome way to learn.
- 08:05And we have to get used to seeing ourselves
- 08:07on camera because that's the only way
- 08:09we get comfortable being on camera.
- 08:10And so we use these videos to
- 08:13engage in a discussion with our
- 08:15participants asking them about how
- 08:16what they think about their lighting,
- 08:18what they think about their framing,
- 08:19what they think about their
- 08:21website manner as it pertains to
- 08:23presenting themselves to the patient.
- 08:25And we talk about why that's important
- 08:27not only from a standpoint of you know
- 08:29in New York where a one party recording
- 08:31states your patient can record you at any
- 08:33point in time and post it on Facebook.
- 08:35Book.
- 08:35And so you want to put your
- 08:36best face forward,
- 08:37but also from a aspect of
- 08:41engaging with the patient.
- 08:43If we don't engage with our patient,
- 08:44if we don't reach through the screen
- 08:46and really make that connection,
- 08:48we're never going to be able to
- 08:50show that empathy that was that
- 08:51is also so important and so,
- 08:53so really understanding how lighting affects.
- 08:56That and how camera angles
- 08:57affect that aspect of it,
- 08:59How having a background that's
- 09:00not distracting allows you to
- 09:02take care of your patient and not
- 09:03be not have your and have your
- 09:05patient actually listen to you.
- 09:06You know,
- 09:07you can only imagine what it might be
- 09:08like counseling a patient on diabetes
- 09:10when you have a giant jar of cookies
- 09:12in your background because you're
- 09:13sitting on your kitchen table at home,
- 09:15right.
- 09:15And so we dive into this through
- 09:19this experiential learning process.
- 09:21And then.
- 09:22For many of our our practicing providers,
- 09:25we do an optional refresher in
- 09:27their environment to help them
- 09:29set up their environment to be
- 09:31optimal for telemedicine.
- 09:32But with their undergraduate and our
- 09:34graduate medical education learners,
- 09:36we do the first two aspects of
- 09:38this next slide.
- 09:42So how do we actually do this?
- 09:44Well, we play a video and
- 09:45this may be a pre video.
- 09:48Hi, tell me what's going on. Hey.
- 09:52I'm having this eye problem on
- 09:55the inner side of this bottom lid.
- 09:57It's been red, a little swollen
- 09:59over the last couple days
- 10:03and so we may ask the patient or we
- 10:04may ask the provider who did this.
- 10:06So if you were the if you were the patient
- 10:08and this is what you saw in camera,
- 10:11would you trust them as your medical doctor?
- 10:14And it's amazing how many
- 10:15different answers we get for that.
- 10:16Most people will kind of shy away and
- 10:19never never like themselves on camera.
- 10:21But if you start pointing out
- 10:23some of the redeeming qualities,
- 10:24you can also start pointing out
- 10:26some of the other aspects of
- 10:27it which they can improve on.
- 10:29And so using either some sort
- 10:31of debriefing technique,
- 10:32you can really start keying
- 10:34in on some of these aspects,
- 10:35such as your framing isn't optimal,
- 10:37so you're not the center of the screen.
- 10:39If you want your patient
- 10:40to really listen to you,
- 10:41you have to be front and center,
- 10:43so get yourself in the middle of the screen.
- 10:45Your lighting, right,
- 10:46causes this glare into the camera.
- 10:48So optimizing your lighting so
- 10:50that it's more uniform and not so
- 10:53spotlighting can really help with that.
- 10:54And having someone in your background
- 10:56may or may not be a HIPAA violation
- 10:58based on who it is and whether
- 10:59your patient's okay with it.
- 11:01And so discussing that with your
- 11:03patient or whether you're using a
- 11:04medical scribe is really important
- 11:06for that medical legal aspect.
- 11:07And so after our session,
- 11:10they may have a situation like this.
- 11:11Next slide.
- 11:14Hello, I'm Dr. Greenwald.
- 11:15Can you see and hear me OK?
- 11:17You can, yes. OK.
- 11:18Before we get started,
- 11:20a little housekeeping.
- 11:21Just confirm your name
- 11:23and date of birth for me.
- 11:24Joanna Flores,
- 11:2712/23/1995. OK. And what location
- 11:29are you calling from today? 50 W St.
- 11:32New York, NY 10006. OK, Terrific.
- 11:37Thanks for confirming that.
- 11:40And so as we do this iterative process
- 11:43of reflecting on your own videos,
- 11:45we see a lot of the students evolve in their,
- 11:47the way that they approach their encounters.
- 11:50They start asking,
- 11:52they start leading their encounters
- 11:53with some of these questions,
- 11:54these kind of housekeeping
- 11:55questions that are so,
- 11:57so important to the documentation and the
- 11:59medical legal aspects confirming that
- 12:01they have a license where the patient is,
- 12:03but just like bedside manner is
- 12:05not just that initial presentation
- 12:07and how you look on camera.
- 12:10How you look in person, website manners,
- 12:12not just how you look on camera.
- 12:14And that initial presentation to your person,
- 12:16It's about understanding the entire
- 12:18patient encounter and that art of medicine.
- 12:20And as we heard on the previous panel,
- 12:22empathy is a huge part of that
- 12:24patient interaction and understanding
- 12:25where the patient is coming from
- 12:27and how to provide care to them in
- 12:29the environment that they're in.
- 12:31And this is,
- 12:32I think where a lot of people get
- 12:34stuck with telemedicine and they try
- 12:35to take what they do in person and move
- 12:37it and block into the virtual realm.
- 12:39And we can't do that.
- 12:40We have to teach a different set of
- 12:42skills to actually care for a patient.
- 12:44And it's because the environment now,
- 12:45the room,
- 12:46the virtual care room is now
- 12:48half the patients and half ours.
- 12:50So we don't have as much control over it.
- 12:52The room isn't set up for us.
- 12:54We don't have this, you know,
- 12:55the bed located where it is and
- 12:57the Thalmascope on the wall and
- 12:59the lighting perfect in the room.
- 13:01For an encounter.
- 13:01And so we have to work with our patient
- 13:03to really set that up and engage
- 13:05them in taking care of themselves
- 13:07or helping us take care of that.
- 13:09We have to ask them to rearrange their
- 13:12furniture or rearrange their lighting,
- 13:14get to a better spot to make a
- 13:16better connection so that we can
- 13:18actually do an exam.
- 13:19We need to incorporate their hands
- 13:21as our hands in the exam to try
- 13:23to make sure we can reliably get
- 13:25an exam and we need to incorporate
- 13:27their home environment and what is
- 13:29accessible to them in their plan
- 13:31to allow us to take care of them.
- 13:32And so in the discussion we're able
- 13:34to cover all these topics and really
- 13:36kind of expand people's minds as to
- 13:38what it actually means to have good
- 13:40website manner over telemedicine.
- 13:42Thanks.
- 13:44Next we will have is Laura here. I'm here.
- 13:50I'm just waiting for my video to be enabled.
- 13:53Oh, OK.
- 13:56You can go ahead and get started, Laura.
- 13:57It'll kick in in a minute.
- 13:58Grab it, grab it. There we go.
- 14:00Hey, you're in the same office
- 14:02as the other person from Mayo. I
- 14:04know. I would like to use their background.
- 14:10Thanks for having us here today.
- 14:12So within the Center for Connected Care,
- 14:15we're Mayo Clinics home for telemedicine.
- 14:18We developed an education curriculum
- 14:20to educate our care teams and care
- 14:22teams and staff and accelerate
- 14:24our adoption and diffusion of
- 14:26telemedicine within our practice.
- 14:28So in this presentation,
- 14:29we're going to be offering
- 14:31our recommendations for best
- 14:33practices for structuring and
- 14:35delivering telehealth curriculum.
- 14:36That's really based on our experience
- 14:39and I will say lessons learned beginning
- 14:43with conducting a needs assessment.
- 14:46So to conduct the needs
- 14:48assessment with your learners,
- 14:49we recommend focusing on three key areas,
- 14:52curriculum content,
- 14:54curriculum design,
- 14:55and curriculum implementation.
- 14:57For our needs assessment,
- 14:59we conducted interviews with
- 15:00providers and other care team
- 15:02members within our practice,
- 15:04and we also included some support staff
- 15:06so our operations administrators who
- 15:09support those care teams to ensure we
- 15:12captured the full spectrum of needs.
- 15:14We did include individuals who
- 15:16had depth of experience with
- 15:18telemedicine and those that did not.
- 15:20We also interviewed residency
- 15:22and fellowship program directors
- 15:24to differentiate the needs of
- 15:27practicing physicians from those
- 15:28of trainees or student learners.
- 15:31So in the area of curriculum content,
- 15:33we wanted to learn more about what
- 15:35types of content were needed or
- 15:37wanted by the practice and as we
- 15:39look to develop our curricula.
- 15:40We wanted to know how to structure the
- 15:43content such as aligning by telehealth
- 15:45competencies versus specific solutions.
- 15:48So video telemedicine or video visits
- 15:51would be an example of a specific solution.
- 15:55Additionally,
- 15:55we recommend gauging interest in
- 15:59structuring the content by roles.
- 16:01And gathering information to help you
- 16:04determine whether to take a broad or
- 16:06a more focused approach to develop
- 16:08education to either tailor it to the
- 16:10specialty practice and solutions,
- 16:12or whether to develop generalized
- 16:14education that can be broadly applied.
- 16:17So for curriculum design,
- 16:19we recommend gathering information
- 16:21about what types of curriculum
- 16:23would be useful for various topics.
- 16:25For example,
- 16:26does the practice report that
- 16:28asynchronous learning?
- 16:29Such as a video or a module would
- 16:32be better for them?
- 16:33Or are they really looking for
- 16:36things like observed simulations,
- 16:38Simulations that they can participate in,
- 16:40or experiential learning as being
- 16:43most effective or more easily
- 16:45adopted in their practices?
- 16:48And then for curriculum implementation,
- 16:50we were interested to get practice
- 16:52feedback on preferences for
- 16:54implementation with an eye towards
- 16:56selecting an approach that would really
- 16:58drive the adoption and utilization
- 16:59of telemedicine in our practice.
- 17:01So for our needs of assessment,
- 17:03we were specifically interested in
- 17:05feedback about a super user train,
- 17:07the trainer model and taking a
- 17:10required versus voluntary approach
- 17:12to telehealth education adoption.
- 17:15And then finally,
- 17:16we wanted to know from our practices
- 17:18what metrics they wanted related
- 17:20to their consumption of telehealth
- 17:22education and go to the next slide.
- 17:30So in addition, we offer several
- 17:33recommendations for content design,
- 17:35implementation and assessment
- 17:36of telehealth education.
- 17:38In developing our telehealth program,
- 17:41we really took an agile approach or I
- 17:44guess you could say where did you go
- 17:45approach to developing the content.
- 17:47And we did this so that we could
- 17:50quickly respond to the education
- 17:52needs within our practice.
- 17:54We did learn a lot along the way,
- 17:56and as such we are offering our
- 17:59best practices based on some
- 18:00of those lessons learned for
- 18:02curriculum content and design,
- 18:04implementation and assessment.
- 18:06So for curriculum, content
- 18:08and design, we recommend considering
- 18:10the domain and the user role
- 18:13when developing the curriculum.
- 18:15So for example, best practices
- 18:18for communicating with patients
- 18:20asynchronously via secure message
- 18:22might vary depending on which care
- 18:24team member is communicating with the
- 18:26patient and then how also how that care
- 18:29team has structured their workflows
- 18:31for who's managing secure messaging.
- 18:34So that's just a a good example of how the
- 18:38way that the care team is approaching the.
- 18:41The telemedicine can can drive
- 18:44the way you structure education.
- 18:46Other considerations include
- 18:47considering the format and where
- 18:49the learner will use the education.
- 18:51I'm considering how their needs varied
- 18:54depending on their prior experience,
- 18:57whether they're very experienced
- 18:59or they're a novice,
- 19:00the context,
- 19:01and then how the complexity of the topic
- 19:03might lend itself to specific formats.
- 19:07So for implementation we recommend
- 19:10ensuring buy in from the key
- 19:13stakeholders and leadership groups,
- 19:14specifically focusing on those who have the
- 19:16most to gain from using that education.
- 19:18As a start,
- 19:19we've had a lot of success by working
- 19:22collaboratively with our early adopters.
- 19:24These groups are really the most excited to
- 19:27implement telehealth and they can really Dr.
- 19:29adoption in our practices.
- 19:32Particularly with using education,
- 19:34they can also be a really rich source
- 19:36of feedback to infer to inform our
- 19:39early versions or prototypes of
- 19:41education that we can then refine
- 19:43before we disseminate to a larger
- 19:45group for the entire practice.
- 19:48Role models can also be leveraged
- 19:49to encourage others to implement
- 19:51the education into their training
- 19:53programs as well as using testimonials
- 19:55from those role role models.
- 19:58And then we really recommend emphasizing
- 20:00the what's in it for me to drive
- 20:03the adoption of the telehealth
- 20:05education during implementation.
- 20:07Finally,
- 20:08we recommend setting goals
- 20:09even if they're modest.
- 20:11It doesn't have to be
- 20:14intense analytics, just some some
- 20:17goals and analytics that you can use
- 20:20to drive and measure adoption along
- 20:23with gathering regular feedback.
- 20:26Whether that's qualitative or quantitative,
- 20:28but just using that feedback to improve
- 20:31the education program over time.
- 20:33So just to summarize,
- 20:35these best practices are really
- 20:37based on our experience to date.
- 20:40We are learning a lot as we
- 20:42develop and implement telehealth
- 20:43education into our practice,
- 20:45so we're happy to share some
- 20:47of those lessons learned,
- 20:48sometimes painfully right.
- 20:50So I look forward to hearing from you
- 20:52all when we get to the question and
- 20:55answer about what your best practices
- 20:57have been and also just hearing kind of
- 21:00where you're at in regards to telehealth,
- 21:02education and the challenges
- 21:04that you're facing,
- 21:05especially post post COVID or mid COVID,
- 21:09however you look at it.
- 21:10Thank you.
- 21:15Okay. Hello everybody.
- 21:16Thanks for including me in
- 21:19this amazing symposium.
- 21:21I'm learning every minute
- 21:23and thoroughly enjoying it.
- 21:24Before I get on to this slide,
- 21:26I will make a few definitions. So.
- 21:28So when we think about computer science,
- 21:30the computer is central and the
- 21:33peripherals are all the devices
- 21:35that hook into the computer.
- 21:37So in the case of.
- 21:38Telemedicine,
- 21:39the peripherals are the medical
- 21:40device and each one has its own
- 21:43story in terms of its evolution,
- 21:44its innovation, its conceptualization,
- 21:46its role in medicine and enhancements
- 21:50that are coming down the road.
- 21:52So peripherals are are very
- 21:54important to the practice,
- 21:56but in addition to being important,
- 21:57they're the linkage to our study of
- 22:00innovation and they can provide a very,
- 22:03very rich curriculum in in that area.
- 22:06And I do want to address that a little bit.
- 22:09In this talk,
- 22:11my own personal involvement in
- 22:13telemedicine dates back 50 years to
- 22:161967 and back then I was employed
- 22:19in a dual track as a pathology
- 22:22resident as well as an NIH funded
- 22:25laboratory director with a special
- 22:27interest in medical imaging and
- 22:31because of my involvement in.
- 22:35Medical imaging.
- 22:35I was drawn into the preliminary testing
- 22:37of television microscopy equipment.
- 22:40We would call that telepathology Today.
- 22:42That could be used for sending video
- 22:44images of blood smears from the
- 22:47Logan International Airport to to
- 22:50the Massachusetts General Hospital
- 22:53Telediagnostic Clinic 2.7 miles away
- 22:56for stat readouts by pathologist.
- 22:59And at that time,
- 23:00the research question focused
- 23:01on the need for color TV.
- 23:03In telemedicine and interestingly it
- 23:06was decided not necessary and showing
- 23:09that not necessary for teledermatology.
- 23:13I wonder about that,
- 23:15but because of the my preclinical
- 23:19and pre implementation studies,
- 23:23I was given the honor of signing
- 23:25out the first telemedicine case.
- 23:28Telemedicine microscopy case coming
- 23:30from the Logan Airport the next
- 23:33year in 1968 and shortly thereafter
- 23:35was informed that I had become the
- 23:38first resident to actually sign out
- 23:40a telemedicine case and that made
- 23:43history have been involved really ever since.
- 23:46Now one of the faculty members in
- 23:49the program was Doctor John Knowles
- 23:51and he was the general director of
- 23:53the Massachusetts General Hospital.
- 23:56And he was a brilliant educator who
- 23:59was totally immersed in medical
- 24:01student and resident education.
- 24:03And you'll see in a moment why
- 24:05that was important.
- 24:06Just historically, he was also interested.
- 24:09Interesting because he became general
- 24:12director of the MGH at age 35,
- 24:15and 10 years later, at age 45,
- 24:18he came, became president of
- 24:20the Rockefeller Foundation,
- 24:21but always remained very,
- 24:24very interested in telemedicine.
- 24:26Now and he was also one of my mentors
- 24:29and and and helped promote my career.
- 24:32Now he teamed up with a a a famous
- 24:35medical student a brilliant medical
- 24:37student at Harvard Medical School
- 24:39who was in his fourth year and
- 24:41and it already published almost
- 24:43I think 8 or 10 books and but so
- 24:46the star of the show was the six
- 24:48foot 9 inch tower of a man
- 24:50the HMS senior student
- 24:53named Michael Crichton.
- 24:55And of course, Michael Crichton
- 24:56went on to become a famous author
- 24:59of Jurassic Park and about 30 other
- 25:01novels and the famous movie director.
- 25:05But they put their heads together
- 25:07to define with the optimal,
- 25:10with the optimal core aspirational
- 25:14core competencies would be for medical
- 25:17students rotating through telemedicine.
- 25:19And they decided one thing
- 25:21would be the patient encounter,
- 25:22which has been the major
- 25:24subject of today's discussion.
- 25:26But they also thought it was very important
- 25:29and cultivating and understanding of
- 25:31the process of medical innovation.
- 25:33And I was just delighted that in panel #3,
- 25:38Julian Jenkins brought up innovation and
- 25:40that was going to get up and applaud.
- 25:43So anyhow,
- 25:45Crichton rotated through the
- 25:48pioneering program.
- 25:50A couple of months before he graduated,
- 25:52it was the same time that he was
- 25:54finishing up Andromeda Strain,
- 25:55so graduation he was publishing
- 25:58those two books Now.
- 26:00The half million dollars he made was
- 26:02for the rights to Andromeda Strain,
- 26:04but nevertheless his book on entitled
- 26:08Nonfiction book entitled 5 Patients.
- 26:10The patient examined included a very
- 26:13informative chapter on telemedicine
- 26:16and his work up on telemedicine.
- 26:18And his insights into how
- 26:20telemedicine would be leveled into
- 26:23the general study of innovation.
- 26:25So in that chapter,
- 26:28Crichton meticulously records his mentor's
- 26:31work up of an actual telemedicine case, Mrs.
- 26:35Sylvia Thompson.
- 26:35And when he was sitting over at the
- 26:38side of the room rapidly taking notes,
- 26:40anytime you would see Michael Crichton,
- 26:42he was always rapidly taking
- 26:44notes or walking down the hall.
- 26:46At 69 inches,
- 26:47she had just flown from Los
- 26:50Angeles to Boston,
- 26:51had walked to the New Logan
- 26:54Airport Walk in Clinic,
- 26:55had some chest pain,
- 26:57intermittent chest pain which
- 26:58emerged while they were flying over
- 27:01Ohio and was worked up remotely
- 27:03over television by a doctor over
- 27:05on the mayor's general campus.
- 27:06Doctor's name was Raymond Murphy.
- 27:09She turned out to have pneumonia.
- 27:12Crichton describes her reaction
- 27:14to her telemedicine.
- 27:15Experience in a highly quotable way,
- 27:18she said.
- 27:18Quote, my goodness,
- 27:19it was just like the real thing, UN quote.
- 27:21And she never heard of telemedicine
- 27:23when she walked into the room.
- 27:25So this set the tone for probably
- 27:2780 or 85% of future patients
- 27:30reactions to telemedicine.
- 27:31Not everybody loves it,
- 27:33but generally it works very, very well.
- 27:36But Crichton,
- 27:37being Crichton,
- 27:38goes much much further and with
- 27:41the help of John Knowles.
- 27:42Set up appointments to talk to the
- 27:45leading gurus at Harvard Medical
- 27:47School of the Massachusetts General
- 27:49Hospital and at MIT about the
- 27:52futures of future of technology and
- 27:54what were really the hot topics,
- 27:57and the Crichton describes those
- 28:00with remarkable foresight.
- 28:01The technology is being pioneered
- 28:03in Boston at that time,
- 28:05and at that time they had what was
- 28:08becoming a medical informatics unit,
- 28:11a very famous one.
- 28:13And and so he studied the things
- 28:15that would become highly relevant
- 28:17to medical practice And now in
- 28:19hindsight we can see how they turned
- 28:22out 50 years later.
- 28:24And what he looked at in particular
- 28:26were such thing as a I algorithm
- 28:29driven patient interview systems
- 28:31and he also looked at the power of
- 28:34networking of electronic health record
- 28:36systems And of course those are the
- 28:38things that are about to already have
- 28:41revolutionized the practice of medicine.
- 28:43So it showed that you know,
- 28:46everything that you would could
- 28:48teach about innovation today will not
- 28:50be outmoded in the next few years.
- 28:52And a lesson learned was a
- 28:56modern telemedicine rotation.
- 28:57Clinical rotation does benefit
- 28:59from instructions on processes
- 29:01of medical innovation,
- 29:03and telehealth devices per se
- 29:06become the tools for teaching
- 29:08medical students about innovation.
- 29:11Innovation, next slide please.
- 29:17OK. So these are some of the
- 29:20telemedicine medical devices
- 29:21that are 21st century physicians,
- 29:23black bag if you will,
- 29:24the telemedicine kit.
- 29:26And so telemedicine devices
- 29:29are the equivalent to socalled
- 29:31professionals peripherals, I'm sorry,
- 29:34as defined in computer science.
- 29:38Finally, I would like to make a point.
- 29:43About innovation,
- 29:44that I think is critically important,
- 29:47and some of the more senior
- 29:49faculty members who have been on
- 29:51university committees over the
- 29:53years can really relate to this.
- 29:55This really involves telemedicine
- 29:57and telehealth in a major
- 29:59way and a very urgent need.
- 30:02There is an urgent need for
- 30:04medical schools to take a stake.
- 30:07Claim a stake in the area of
- 30:10healthcare innovation, Education,
- 30:11telehealth gives us the golden
- 30:14opportunity to make that claim.
- 30:17As several speakers have mentioned,
- 30:19today, medical schools are
- 30:21late in coming to the table.
- 30:24Now I tell that to people and our faculty,
- 30:26and they just can't get that straight.
- 30:28They say, well, that just can't be the case.
- 30:29We're always at the lead.
- 30:30No, you're not at the University of Arizona,
- 30:33our nursing school,
- 30:34and our school of public health.
- 30:36Have offered very popular courses
- 30:39on telemedicine for over a decade
- 30:42and in some cases have laid claim
- 30:45to that as their area their their
- 30:48their area in in education.
- 30:51So I think that the universities,
- 30:54the way that universities work once
- 30:56a college or a department to claim
- 30:59declares ownership of an education
- 31:02franchise it tends to be in their.
- 31:05Education portfolio for perpetuity
- 31:07and the subject matter for innovation
- 31:11should be part of medical schools.
- 31:14And I think that they will.
- 31:16We can leverage studies of medical
- 31:18devices as an example of medical
- 31:22device innovations that can become
- 31:25a centerpiece of our curriculum.
- 31:27Okay. Thanks.
- 31:28Next slide, I think there's one more slide.
- 31:34OK, this is and my final slide.
- 31:37This is the point I would like to make.
- 31:39You know we're now post Flexner Centennial
- 31:43and what we're seeing is a mass migration
- 31:48of medical science coursework for medical
- 31:51schools and to undergraduate colleges
- 31:54and currently the University of Arizona
- 31:57is putting a new curriculum in place.
- 32:00Which is called BS in Medicine,
- 32:02not medical science, BS in Medicine.
- 32:05And this is a collaborative
- 32:06effort of our College of Medicine,
- 32:07Nursing, Pharmacy,
- 32:08Public Health and our College of Law.
- 32:12And it takes, it's,
- 32:14it's it's basically cloning what's
- 32:16happened in our College of Business
- 32:18where our Bachelor of Science in
- 32:21Business is our number one freshman
- 32:23major and the number 2 freshman major is.
- 32:27Bachelor of Science and Public Health
- 32:30and the third one now is going to be
- 32:33Bachelor of Science and Medicine.
- 32:34And I would predict that within 10 years,
- 32:36all preclinical medical science will
- 32:38have migrated into the college level.
- 32:41And this is the way,
- 32:42one of the ways that we're going
- 32:44to deal with core curriculum
- 32:46for interprofessional education.
- 32:48And now there's a major,
- 32:49major move to bring medical science
- 32:52curriculum into K12 schools in
- 32:55order to deal with.
- 32:56The issue of health literacy,
- 32:59now as this massive migration takes place,
- 33:02that's the time when we have to be very,
- 33:04very focused on grabbing the parts of the
- 33:07curriculum that could be within our domain.
- 33:11And I would argue telehealth gives
- 33:14us tremendous leverage in that area.
- 33:16We're currently putting together a report
- 33:19that's showing in a sketch to the right,
- 33:23and it's called Flexner 3.0.
- 33:26And Threxner 3.0 describes Flexnerian
- 33:29science moving first into graduate schools.
- 33:32That's Flexner 2.0,
- 33:34and then into college is Flexner 3.0.
- 33:37And the name of the report
- 33:39will be Reinvention of Medical
- 33:41Education in the United States.
- 33:43And hopefully it'll become a book as well.
- 33:46And we've got 11 out of the 20 chapters
- 33:48pretty pretty close to being finished
- 33:50and and this, this, this could be.
- 33:52We think it's going to be important.
- 33:54We'll see how it turns out.
- 33:56If you want to read more about it,
- 33:57just Google Flexor 3.0.
- 33:59A whole bunch of papers come up,
- 34:01but we think it's very important
- 34:03and we think it is a trend.
- 34:05And once again,
- 34:06I would urge people who are in the
- 34:09telemedicine telehealth arena to realize
- 34:11that they are actually center stage,
- 34:13whether they know it or not.
- 34:15And this is a real opportunity
- 34:17for medical schools to expand
- 34:19their educational franchise.
- 34:21Thank you.
- 34:25Thank you, Ron for that segue.
- 34:28The transitions nicely into a little
- 34:30bit of a discussion about the devices
- 34:32that are currently on the market and
- 34:34opportunities for integrating this type
- 34:37of devices and mobile health and apps
- 34:40into the virtual care delivery model.
- 34:42Seeing that you know,
- 34:43we think about M health and remote
- 34:45patient monitoring and virtual care
- 34:48delivery as sort of separate entities,
- 34:50but really in an ideal world they
- 34:52would be able to be integrated.
- 34:55Down the line.
- 34:56So one of the things that is important
- 34:58to think about going back to panel two,
- 35:01is the general competencies in
- 35:04performing histories and physical exams.
- 35:07You know,
- 35:08can you do a history and a physical
- 35:10exam and build completely if you don't
- 35:12have basic things such as vital signs,
- 35:14which are called that because they're vital.
- 35:17And so there are a number of
- 35:20devices including Fitbits,
- 35:21Apple Watches, pulse oximeters.
- 35:23Digital thermometers,
- 35:25which have been around for a while,
- 35:27and even digital blood pressure cuffs
- 35:29that can be used to ascertain this.
- 35:31But before I talk about
- 35:33each individual thing,
- 35:34I think one of the important things
- 35:36to talk about is what if a patient
- 35:38doesn't have these things or that
- 35:41idea of sort of the digital divide.
- 35:43If a patient can't afford it,
- 35:45or just doesn't have a CVS or a
- 35:47Walgreens nearby to access one of
- 35:48those things to objectively tell you
- 35:50their information from their home?
- 35:52So one of the tools that has been
- 35:54talked about is called the Roth score,
- 35:56which is actually not a device,
- 35:58It's a clinical measurement and
- 36:01it's particularly relevant in the
- 36:02age of COVID where oxygenation and
- 36:04dyspnea is important to ascertain.
- 36:06So it's used to assess a patient's
- 36:09ability to count and it uses their
- 36:12counting times to risk stratify
- 36:13their dyspnea and the severity of it
- 36:16as it correlates with their level
- 36:18of hypoxia and it has been shown to
- 36:20correlate with their dyspnea severity.
- 36:23And it works by having the patient
- 36:24count from 1 to 30 in a single breath,
- 36:27and as rapidly as possible.
- 36:29And the primary result of that Roth
- 36:31score is the duration of time they
- 36:32are able to count and the highest
- 36:34number they're able to reach.
- 36:36A maximal counting number less than 10,
- 36:38or a count time of less than 7
- 36:41seconds identifies patients with a
- 36:42room air pulse ox of less than 95%
- 36:45with a sensitivity of 91% and 83%,
- 36:48respectively.
- 36:48And if they can only count to
- 36:517 seconds or less,
- 36:53or their count time is less than 5 seconds,
- 36:56that can identify patients with the
- 36:58room air pulse ox of less than 90%
- 37:00with a sensitivity of 87% and 82% each.
- 37:03So this is a tool that not too
- 37:07many clinicians sort of anecdotally
- 37:10that are aware of and so.
- 37:13It would be ideal if these types of
- 37:15devices were measuring objective
- 37:17numbers to ascertain hypoxia were
- 37:19actually available and as ubiquitous
- 37:21as something like ATV remote control
- 37:23or cable box or a
- 37:25fire extinguisher that could be
- 37:27found in the average American home.
- 37:29And that'll segue nicely into the next
- 37:32panel about access equity and sort of
- 37:35the influence that we as physicians can
- 37:38have with policymakers and pairs to.
- 37:40Invest in this kind of technology
- 37:42as part of something that can be
- 37:45used in virtual care delivery.
- 37:46So for ascertaining things like heart rates,
- 37:50the Fitbit can provide that
- 37:52and the Apple Watch E KG,
- 37:54the Series 5 pictured here can
- 37:57also ascertain 3 lead EKG's.
- 37:58There are other devices on the market
- 38:01that can ascertain up to six lead
- 38:02EKG's with wireless remote technology.
- 38:06One of the benefits that could be
- 38:08seen here using evaluation for cardiac
- 38:10patients and routine follow up or if
- 38:13they're having an urgent care concern
- 38:15like they're feeling palpitations,
- 38:17you might be able to say you know this
- 38:19looks like sinus tachycardia or SVT.
- 38:20Maybe we could try some bagel maneuvers
- 38:23at home before sending you in,
- 38:25especially if the patient is in a
- 38:27high risk COVID area or is afraid
- 38:29of going in which tends to be much
- 38:31of the collateral damage that we're
- 38:32seeing during COVID where patients are
- 38:34having symptoms or they're concerned.
- 38:35But they're really afraid to go
- 38:37in because of COVID,
- 38:38and so they end up having adverse
- 38:40events from things that are not
- 38:42taken care of because of their fear.
- 38:46Other things such as the Pulse ox
- 38:48are pretty routinely available
- 38:49at most pharmacies,
- 38:50although during COVID periods
- 38:51much of that has sold out,
- 38:52including on things like Amazon.
- 38:55And then we also have the digital
- 38:58scales that can be synced to
- 39:00Bluetooth technology with.
- 39:02Apps and iPhones and can also be
- 39:04synced with electronic medical
- 39:06records so that a patient might
- 39:08tell you what their weight is,
- 39:09but might that might differ significantly
- 39:11than what is actually recorded and
- 39:14so it keeps people honest as well.
- 39:16Next slide.
- 39:22So these are more advanced devices that
- 39:25can be used to ascertain different
- 39:27aspects of the physical exam that
- 39:30might be subspecialist specific.
- 39:32So the butterfly IQ pictured in the
- 39:35bottom left is a remote ultrasound
- 39:37that can be used with an iPhone.
- 39:39Typically the applications for this might
- 39:41be used in the setting of paramedicine,
- 39:43where a patient might be able to be
- 39:46evaluated remotely with a paramedic
- 39:48who's been trained in how to apply
- 39:51the the device to the patient's
- 39:53chest or whichever body part they're
- 39:55looking to ultrasound.
- 39:57It can also be used for
- 39:59things like assessing.
- 40:00Remote fetal activity for pregnant
- 40:02mothers who are concerned,
- 40:04or if someone has abdominal pain,
- 40:05it's an easy way to assess the patient's
- 40:08gallbladder or kidneys if they're
- 40:11having back pain or urinary symptoms.
- 40:14Above that is the Eco Duo
- 40:18EKG and Digital stethoscope,
- 40:20which enables remote auscultation and
- 40:23can also be done while visualizing
- 40:25A realtime E kg.
- 40:27The devices to the right in green
- 40:32are sort of neurospecific devices
- 40:34that can be used.
- 40:36The Impatica biosensor was developed
- 40:38by Roslyn Picard at the MIT Media
- 40:40Lab and that can be used for
- 40:42evaluating and detecting elevated
- 40:44sympathetic nervous system activity
- 40:46and prodrimal seizure activity,
- 40:48and can prevent unnecessary
- 40:50deaths from unwitnessed seizures,
- 40:52especially in kids.
- 40:55The device in the top right
- 40:58is the Affectiva wearable
- 41:00biosensor from the MIT Media Lab,
- 41:02which I had done some research on
- 41:05during medical school with doctor
- 41:07Ed Boyer and we use that to detect.
- 41:11We use signal processing from that
- 41:13sensor to detect patients craving
- 41:15and actual use of cocaine and
- 41:17opioids and it used a combination
- 41:19of looking at patients heart rates.
- 41:21Their electrodermal activity and their
- 41:23peripheral body temperatures and
- 41:25how that might vary with times that
- 41:27they're experiencing craving and use.
- 41:29And it was very distinguishable from
- 41:31other types of elevated sympathetic
- 41:33nervous system activity,
- 41:34including if they were riding
- 41:35a roller coaster or going for a
- 41:37run and the signals were.
- 41:39Used to identify and and In many
- 41:42ways the goal was to try to prevent
- 41:44the relapse by triggering a signal
- 41:47to their support network in a,
- 41:49a or things like that to encourage
- 41:51the patient to seek alternative
- 41:53avenues to meet their cravings
- 41:58in the middle. In the blue on top
- 42:00we've got the neuro ophthalmology
- 42:01tools from the Volk ion view,
- 42:03which is something that can be used to look.
- 42:06Through the iPhone using a Fundus camera.
- 42:09And then there's also below the title care
- 42:12devices that can be used and are linked
- 42:15with on demand virtual care subscriptions.
- 42:18These are things that can be used
- 42:20to do throat exams and ear and eye
- 42:23exams and are good ways to sort of
- 42:28evaluate remotely orifices that might
- 42:30not be so easily evaluated otherwise.
- 42:33And then there's also not featured here
- 42:35something called the Mid, Mid Tygo,
- 42:37which is a subscription service where
- 42:40they provide these types of tools to be
- 42:42used in the home and they included in
- 42:44something that they call their life pack.
- 42:46And the idea is that it links them
- 42:49with a telehealth service and a
- 42:51physician access and tools that they
- 42:53can use remotely so that if they
- 42:55don't have access to them otherwise,
- 42:57they're provided with the
- 42:59toolkits from Mid Tygo.
- 43:01So one thing to think about just in
- 43:04going back to the sort of vital sign
- 43:07ascertainment one of the institutions
- 43:09that's been using these types of
- 43:11devices is Ochner Health in Louisiana.
- 43:13And they have,
- 43:14they represent a unique case
- 43:16study where they offer sort of
- 43:17prescribable devices and apps that
- 43:19are vetted by their doctors there.
- 43:21And they offer it in conjunction with
- 43:23what they use or partner with a retail
- 43:25O bar and it functions like an Apple
- 43:27Genius Bar providing tech devices
- 43:29and apps and training and teaching.
- 43:31At their various clinical sites
- 43:32and one of the programs they've
- 43:34used it for is with hypertension.
- 43:37So patients enrolled in their
- 43:39digital hypertension program,
- 43:40they need to have access to a smartphone
- 43:42and then the patient will pick up a
- 43:45wireless blood pressure cuff either
- 43:46at the O bar or via mail fulfillment.
- 43:48And then they take their
- 43:50blood pressure routinely.
- 43:51And then the readings are
- 43:53automatically integrated with the EHR.
- 43:56And this way the patient's care
- 43:57teams are able to see their data
- 43:59remotely and they can see it.
- 44:01As it changes over time and
- 44:03intervene when necessary.
- 44:04They published some of their outcomes from
- 44:07this study and they found that at 90 days,
- 44:1071% of patients in the hypertension
- 44:12digital medicine cohort achieved
- 44:14target blood pressure control,
- 44:15whereas only 31% of patients getting usual
- 44:18care achieved their blood pressure control.
- 44:21So there is some data to support
- 44:24efficacy and using this digital
- 44:26evaluation technique with devices.
- 44:29Thank you,
- 44:29Kelly. So we are going to move on
- 44:33with the with looking at our time.
- 44:35We want to make sure that we give time for
- 44:39our panelists to answer some questions.
- 44:42So as far as Neil,
- 44:45I wanted to ask you how you know
- 44:48you have some great simulations.
- 44:50I think these are perfect
- 44:52for physicians on you know,
- 44:53just basic simple techniques
- 44:56for website manner.
- 44:57How do you evaluate the effectiveness of
- 45:00these simulation models when teaching?
- 45:04That's an excellent question.
- 45:06So right now, we're doing it mostly
- 45:09based on feedback from our participants,
- 45:13all of the sessions that go
- 45:15into special specialty areas.
- 45:17So we've done this training
- 45:19with dermatologists,
- 45:20we've done it with psychiatrists.
- 45:21We have faculty members from their
- 45:23department actually join us for
- 45:25the simulations and the debriefs to
- 45:27give their personalized perspective.
- 45:29And we've actually modified the course
- 45:31over the course of the last two years.
- 45:34Based on all that feedback to the point
- 45:36where it is right now and tailored
- 45:38it specifically to to specialists,
- 45:40I think one of the things that we're
- 45:42going to be looking at is really do
- 45:44these simulations and do what do
- 45:46the improvements that we see in the
- 45:48simulations correlate to actual care.
- 45:49And I don't think we have an
- 45:52answer for that yet.
- 45:53I think that's something that
- 45:54we need to look into and really
- 45:56figure out how to evaluate.
- 45:58It could be a checklist kind
- 45:59of evaluation where.
- 46:00You know,
- 46:01we have tapes of these learners
- 46:04and so we can definitely utilize
- 46:06checklists and and do it that way.
- 46:08But until that checklist is,
- 46:10we have a validated checklist
- 46:11which I think was referred to by
- 46:13Doctor Joshi in the previous panel,
- 46:15it's hard to see whether or not you
- 46:17actually have that translation of skill.
- 46:19So I think that's the future.
- 46:20That's where we have to go with this
- 46:21and I think it's going to be very
- 46:23important as we continue to train people.
- 46:26Thank you, Neil. Laura,
- 46:27can you speak more on the differences
- 46:29for new versus established patients,
- 46:32particularly as trust me,
- 46:34I've already been developed for
- 46:36the established patients during
- 46:39prior in person encounters.
- 46:44Sorry, I have to hit on mute. Not being
- 46:46very technical today,
- 46:49I have to say that I don't think
- 46:51that we have gotten to that level of
- 46:54granularity with our telehealth education.
- 46:56I think, I think that there you'd
- 46:59probably want to take it on a case
- 47:02by case basis depending on how
- 47:04you've structured your curriculum
- 47:07and delivery as to whether you
- 47:11would actually need to distinguish
- 47:13between established versus new.
- 47:16But we have not taken that approach.
- 47:17We've taken more of a.
- 47:20A standard approach where we're
- 47:24emphasizing empathetic communication
- 47:25versus like distinguishing how how
- 47:28the communication may be different
- 47:30between established versus new patient.
- 47:34And you had also sparked the spoke on the
- 47:37role of of having Tele telehealth champions.
- 47:40We've developed at Indiana University
- 47:43a telehealth panel of champions from
- 47:46I think 20 to 30 different departments
- 47:49and it's it's intriguing how how you
- 47:52know their uptake or acceptance of the
- 47:56importance of the role of telehealth in
- 47:59their own department really affects how
- 48:01they communicate to their other providers.
- 48:05And the the effective
- 48:06dissemination of information.
- 48:07So how do you think you best engage
- 48:11champions, virtual champions,
- 48:16I I mean
- 48:17I guess we've just adopted kind
- 48:19of a we with our champions.
- 48:22I guess we just adopt A.
- 48:25Approach where we're just developing
- 48:27a close relationship with them and
- 48:29as we're developing the education
- 48:31and looking to implement it,
- 48:34we're just working.
- 48:35We're just giving them more support
- 48:37and time and interacting with them
- 48:39to make sure that they're successful
- 48:41and getting the education implemented
- 48:44and that we're responsive to their
- 48:46feedback and to make changes or
- 48:49or pivots based on on their input.
- 48:53And Ron, you had spoken on medical
- 48:56schools and that includes ours here in
- 49:00Indiana University being late to the game
- 49:03As far as advancements in innovation,
- 49:06how do we get our medical schools to
- 49:08see the importance of advancing in
- 49:10the innovations, particularly around
- 49:12peripheral devices in telemedicine
- 49:161 message is that there's there's
- 49:18just tons of money out there.
- 49:20For Pacori grants and NIH grants
- 49:23and in that book that I mentioned,
- 49:25we just published a chapter
- 49:26on the 1st 10 years of Pacori,
- 49:29you know 3rd 88 telehealth grants
- 49:31designated as such worth $381,000,000.
- 49:33And
- 49:36NIH has come to us and they and they've
- 49:38said for the projects we were doing,
- 49:40we'll multiply it by 5:00.
- 49:42So the amount of money that's going certainly
- 49:46into innovation grants, Ind grants.
- 49:49Or DNI grants you know in in NIH
- 49:52is over $1.5 billion this year.
- 49:54It's more than stem cell research.
- 49:57So the opportunities 11 way is to find
- 49:59faculty members who are interested
- 50:01in doing that and can make that
- 50:02central to what their agenda is And
- 50:05those individuals will certainly
- 50:06be aware of where that innovation
- 50:09interface is and and and often are
- 50:11interested in teaching about it.
- 50:13So I I think that's that that's one Ave.
- 50:16that's very interesting very appealing.
- 50:19And I'll give the mic back over to Lee.
- 50:22I know we are out of time.
- 50:25You did a wonderful job.
- 50:26In fact you left me two minutes
- 50:28to to make my own summary comment.
- 50:30So that was also terrific set
- 50:33of examples of really trying
- 50:35to think about this work from
- 50:36a variety of different lenses.
- 50:38One thing that struck me as I listened
- 50:40to really the wide-ranging scope of
- 50:42the presentations in this section
- 50:45was when we talked about evaluation.
- 50:48Or feedback.
- 50:49It's very different when we
- 50:52give feedback about social and
- 50:54emotional qualities like empathy,
- 50:56Then when we give, you know,
- 50:58feedback on execution of a of a procedure,
- 51:01you know,
- 51:01the proper execution of a procedure where
- 51:04there may be more easily quantified
- 51:06metrics and where individuals may
- 51:08have a different sense of a personal.
- 51:11Emotional injury.
- 51:12When you give them feedback
- 51:13about their performance,
- 51:15you know when I tell you you
- 51:16didn't tie that suture, right?
- 51:17I can learn to tie that suture better
- 51:19when you tell me that I didn't
- 51:21relate to that patient very well.
- 51:23It it can sometimes be perceived
- 51:24as a sort of personal attack
- 51:26or an emotional attack.
- 51:27And so it is a wide-ranging set of skills
- 51:30that we're talking about delivering.
- 51:32And I think it also reminds us that
- 51:36our profession has been one based
- 51:38on the concept of apprenticeship.
- 51:40Right.
- 51:41Most of our models of didactic
- 51:43learning are you come,
- 51:45you stay with me for several years,
- 51:47You watch what I do, You learn by my elbow.
- 51:50And when I think you're ready,
- 51:52I give you your diploma.
- 51:54And you can go hang your shingle
- 51:55up and open your shoe store or,
- 51:57you know, your, your forge,
- 51:59your blacksmithy forge next to mine or,
- 52:01you know, in the next town, right.
- 52:02It's a very much an apprenticeship model.
- 52:04And we're really talking about,
- 52:06in a lot of ways, shifting that.
- 52:08To more of a measurement and
- 52:10outcome based assessments of
- 52:13competency that that vary, right.
- 52:15So somebody may be ready in a year,
- 52:17someone else might not
- 52:18be ready for five years.
- 52:19Actually,
- 52:19it's interesting.
- 52:20I have colleagues in Germany and
- 52:22in Germany the residency program
- 52:23lasts as long as the chair of the
- 52:26department thinks it takes you to get ready.
- 52:28So some may graduate early and some
- 52:30may graduate several years later.
- 52:32They they don't have a fixed length
- 52:34of time and so it's an interesting.
- 52:37MA is a very different model,
- 52:38but I do think that it raises some
- 52:40really interesting questions well.