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GIR Member Viewpoint - October 2012

It is Time to Teach Technology: Thoughts on Digital Literacy in the Medical Curriculum

Warren Wiechmann, MD, MBA, Faculty Director of Instructional Technologies and Assistant Clinical Professor of Emergency Medicine at the University of California, Irvine, School of Medicine

When we began our foray into the advancement of mobile technology in medical education, our team was highly focused on the basic requirements for getting our program up and running. Before August 2010, the tablet computer/device was a relatively foreign concept and in medical education, it was unheard of. While we could envision its potential, the role of the tablet was yet to be fully realized. Our experience was not unique, however. Through collaborations with over 30 other US medical schools that have employed such devices, we discovered that the question of how best to implement tablets in medical education was a pervasive theme. 

As we shared our experiences of initiating these innovative programs in our respective institutions, we learned that many of us were hearing the same questions. Why are we doing this?  What does this do for us in the long term? Now, instead of hearing them from administrators or financiers looking for justification to fund these programs, we were also hearing them from our students. This led many to question: Had the appeal of the tablet diminished?  Had it lost its charm and "newness" as a marketing tool to recruit students?  Was it less useful then we had originally envisioned?

I argue that the answer to these questions is a conclusive “no”. From our three-year experience, it is evident that the students have moved beyond learning the basic uses of their iPad device and now desire and require guidance in fully understanding its more innovative role in patient care. With the completion of their first two years of medical school, most of our students clearly understand the utility of the iPad in the lecture setting. However, as they are transitioning to their clinical years, some admittedly do not have a good understanding of its potential though it is at this juncture that the iPad’s potential becomes more evident to them. It might be obvious as to how it would be useful to access and modify the electronic medical record (EMR), as well as application for reference materials. But when students were queried as to their knowledge or comfort on topics such as social media usage as physicians, data security and mobile devices, “e-patients,” telemedicine/tele-health, remote patient monitoring, or “virtual” visits, less than half of our students felt competent in these areas. From our discussions with other schools, it seems that student knowledge and comfort with these topics is universally deficient. 

This is concerning, as these topics represent the next step in the future of medicine and they will likely play a more substantial role in the practice and delivery of healthcare within the next five to ten years. Coincidentally, this is the time frame that many of our current students will be finishing their residency training and embarking on their own practice. It is our obligation as medical educators to do our best in preparing our students to not only be competent and skilled physicians, but also be modern practitioners of medicine. 

The evolution of modern or 21st Century medicine is sometimes referred to as Health 2.0 or Medicine 2.0 because of its reliance on technology and social networking to enable and facilitate collaboration between health care consumers, caregivers, patients, health professionals, and biomedical researchers1. The concept of Health 2.0 might seem foreign to many of us who were not born as digital natives and still remember technology milestones like the Commodore computer, 5.25” and 3.5” floppy disks, the first cell phones, and even the PDA. Some of us feel that these novel advances in the practice and delivery of healthcare are great in theory, but they might be too overwhelming and too ambitious to address in our current medical school curricula. I ask you to think about these questions posed by medical students over the past few years:

•       How do social media sites like Facebook, LinkedIn, and Google+ affect the patient-physician relationship?  Should I “friend” my patients?

•       A large number of physicians are creating content on the web through sites like Twitter, Tumblr, and WordPress - are there implications to posting teaching materials or de-identified cases on the web?

•       How do I know if my device (smartphone, laptop, tablet, USB drive) is HIPAA compliant?  Is it safe for me to keep a “to-do” or rounding list of my patients on my device? 

•       A consultant asked me to text them a photo of a patient’s clinical finding - i.e. rash, fracture, etc - as well as their identifying information. They are the resident/attending, so it must be OK, right?

•       A patient brought in a print-out from a website that describes a treatment that I had never heard of, from a website that I had not heard of.  How can I tell if this information is legitimate?  How can I best teach my patients what web content is good or bad?

•       What is the best medical calculator for my device?  When I go to the iTunes App Store and type in “medical calculator” there are over 100 results!  How do I know which ones of these are good, accurate, or up-to-date? 

•       Why am I taught to write an H&P with pen and paper when I will only be using an EMR to document my patient encounters in the future?

Do any of these questions sound familiar? Or perhaps have you asked the same ones yourself? These are the issues of technology and healthcare delivery that are core to the Medicine 2.0 discussion and I would suggest that it is not overly ambitious to broach these topics in medical school. These are issues that our students confront daily as they are trying to navigate clinical medicine, and therefore should be addressed in the safe and protected environment of medical school. 

By neglecting discussion of these topics, we do not adequately prepare our students to become “digitally literate” modern practitioners of medicine.

But is anybody teaching digital literacy?  In recent years, I have seen an increased focus on teaching beyond the traditional medical school curriculum with courses on the business of medicine, healthcare reform, humanities, and health maintenance. These topics are often presented as an elective or “opt-in” sessions because there is simply limited time in the already saturated medical school curriculum. This elective status is likely advantageous, however, since it necessitates that these courses must be creative in how the content is delivered to our busy medical students. Great examples of social media curricula for medicine include the Social Media University Global2, powered by a WordPress blog and managed by Lee Aase of the Mayo Clinic’s Center for Social Media and the Social MEDia course3, powered by Prezi and managed by Dr. Bertalan Mesko of Hungary’s University of Debrecen. Dr. Bryan Vartabedian of the Baylor College of Medicine is also putting together a similar curriculum for the residents of Texas Children’s Hospital4

These groundbreaking efforts to impart technology and digital literacy to our students and residents need to be applauded and supported. These courses take advantage of social networking tools and build upon principles of collaboration and teamwork across varied disciplines and backgrounds. Unlike anatomy or pathology, often times there are no “right” answers in technology, only best practices and collective experiences that can be shared openly. 

Taking inspiration from the examples above, this September we launched our Health 2.0 and Digital Literacy elective for our medical students at the University of California, Irvine, School of Medicine. In addition to social media, we are covering topics such as Information Design, App Development, Physician-Developer Relationships, Curating Web and App Content, E-Patients, HIPAA, Technology Etiquette, Telemedicine, Remote Patient Monitoring, and Consumer Health Technology5. We don’t expect our students to be “experts” at the conclusion of the course, but we want to expose them to these topics, build familiarity, show them what is possible, and let them apply the technology where it makes sense for them as they look to their future roles as physicians. Ambitious? Yes. Important? We believe so. 

In closing, think about how technology has changed the way you teach, learn, and practice medicine over the past several years and then think about what could be possible in the next five years. Think about how we are currently educating our medical students and ask yourself: “Are we adequately preparing them to be modern practitioners of 21st century medicine?” 


References

1.  Eysenbach G.  Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. J Med Internet Res 2008;10(3):e22
2.   Social Media University, Global.  (2008).  Retrieved September 1, 2012, from http://social-media-university-global.org
3.  The Social MEDia Course.  (2008). Retrieved September 1, 2012, from http://thecourse.webicina.com
4.   Digital Smarts Social Media Primer for Texas Children’s Interns.  (2012).  Retrieved September 15, 2012, from http://33charts.com/2012/06/digital-smarts-live.html
5.  Health 2.0 and Digital Literacy Syllabus.  (2012).  Retrieved September 25, 2012, from http://health2course.tumblr.com/syllabus

 

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