If you want to succeed, double your failure rate.
Thomas Watson, Founder–IBM
John Seely Brown, often referred to as JSB and former Chief Scientist at Xerox and Director of the Palo Alto Research Center (PARC), co-authored A New Culture of Learning: Cultivating the Imagination for a World of Constant Change. In the book, JSB and Douglas Thomas, associate professor at the Annenberg School for Communication at the University of Southern California, discuss the need for learning in this century and beyond to be collaborative, welcoming questions, and challenging what we “know” to be answers. From the book:
…in the new culture of learning the point is to embrace what we don’t know, come up with better questions about it, and continue asking those questions in order to learn more and more, both incrementally and exponentially. The goal is for each of us to take the world in and make it part of ourselves. In doing so, it turns out, we can re-create it.
The authors also talk about the need to embrace change, “looking forward to what comes next and viewing the future as a new set of possibilities, rather than something that forces us to adjust.” We don’t have to look very far to see the world changing much more quickly around us. The technology being developed is so intuitive, kids 5- and under can easily pick up an iPad or smart phone and navigate their way through the latest version of Angry Birds. JSB and Thomas provide examples of the 70 years it took from the discovery of a color TV signal in 1929 by Bell Labs to color TVs becoming ubiquitous in American homes, versus the exponentially faster adoption of internet technology (18% of households with internet access in 1997 to 73% in 2008). The tools we use in all business sectors, especially healthcare, are now more capable of harnessing large amounts of data that can drive solutions to questions that years ago may have seemed ridiculous, too “far out”, or even crazy.
So how does this all fit in medicine and medical education? The quote that led this post–“If you want to succeed, double your failure rate,” has no place at the bedside. But now, more than ever before, healthcare has a real need to solve the problems that are burying the industry with new thinking that comes from new learning. Simulation training and redesign of curriculum are two ways to address the needs not currently being met in medical education. But it goes deeper than that–as so many have said, the culture of medicine needs to shift. Medical students and residents have not only been bullied in their training by know-it-all mentors creating a learning environment that not only kills creativity, but the spirit as well. With all the discovery yet to be made in the sciences, how could one person think they “know” all the answers–wouldn’t it be best to view what is known as a starting place, and use it as a springboard to invite other intelligent, knowledgeable people into the conversation to take that baseline knowledge further?
In my maybe not-so-humble opinion, learning should embrace the not-knowing as well as the knowing. How we accomplish that in healthcare will take a shift–not only in thinking but in long-held beliefs as well. We don’t have the luxury of waiting for those afraid of change to leave medicine, and we don’t want to continue a stilted learning process that has proven to limit options. This change needs to be embraced today, and John Seely Brown’s book is both a lifeline and a roadmap. Please take a look at his keynote at Indiana University below, or pick up the book–I barely scratched the surface of the wealth of content contained within.
Intel suggests the following classroom environment for future 8th grade science students:
How far into the future until a classroom like this becomes reality? And how will technology like this advance medical education? These are questions the speed at which technology is evolving now more forcefully requires a thoughtful answer. The Wall Street Journal All Things D blog reported last week that the iPhone5 will most likely be unveiled the week of September 9th. Didn’t the iPhone4S just come out? Steve Jobs unveiled the first iPhone in 2007–only five years ago, in all its glory. Apple will now be on their 6th generation iPhone, and with each generation came additional capabilities, giving users the ability to do more–faster, better, stronger–than the previous generation, over a short five-year span. iPhone apps, iOS and iPhone compatible medical devices are fodder for an entirely different post, but in a nutshell, now make it possible for the Eric Topol’s of the world to diagnose an airline passenger having a heart attack mid-flight and get him to a hospital in time for treatment. Technology is increasingly available, but when will we be skilled enough to use it to its fullest capacity?
In an excellent post on the use of iPads for special needs students by Eric Nansteil, iPad, Therefore I Am, it would seem almost unethical NOT to prepare to provide educational interventions in the best interest of, in this case, the autistic learner, but for all learners. Technology not only augments what the average and exceptional student can do, but it provides alternatives for students who were once limited by current knowledge delivery platforms. What does this say about true intelligence, not only how it’s measured, but nurtured and given the tools to flourish? The ways in which technology will change education and affect every type of student are only beginning to be seen.
Medical education of the future has the potential to be an amazing thing. Simulation where patients once assumed the risk of student skill development is just one example. SiTel in Washington, DC is a simulation center led by Dr. Yuri Millo that is also part of the MedStar Health System. Together the two organizations are changing the way medical training is delivered. In a post on SiTel’s blog, AAMC Survey | Medical Simulation in Medical Education, author Todd Borghesani acknowledges the fact that simulation labs have been around for a while, but that the number of medical errors occurring throughout the US healthcare systems is raising the sense of urgency around safer and alternative skill acquisition training for medical trainees that does not put the patient at risk–and the healthcare community is starting to put resources behind the idea. He says:
..Events such as the creation of an academic society dedicated to simulation, the inauguration of a simulation journal, unprecedented Agency for Healthcare Research and Quality grant awards totaling $5 million, and the proliferation of simulation-based literature and research have all heralded the promise of simulation as a keystone of health profession education and patient safety…
…Simulation has the potential to revolutionize health care and address the patient safety issues if appropriately utilized and integrated into the educational and organizational improvement process.
And it is true–many medical centers across the country have, or are developing simulation centers, though they are still far from mainstream as they are expensive to start-up and maintain. But as the technology involved becomes more life-like, and the costs begin to fall inline with technological advances, the implementation of such medical training tools could significantly offset the cost of quality and safety misadventures as students and residents perfect their skills.
“Everyone is both a learner and a teacher,” states Peter Norvig, Director of Research at Google, and an expert on Artificial Intelligence (AI), during his February 2012 TED.com talk on the 100,000-student classroom. Norvig, and his partner, Sebastian Thrun, taught a 10-week course on AI to a virtual class of over 100,000 students from around the globe. Drawing on what others have already accomplished, such as Salman Khan at Kahn Academy, Norvig and Thrun knew that shorter videos work best, and that typical educational deadlines were also a necessity to move the learning forward. Through their experience, the pair has gathered billions of interactions and data points from students on the future of learning, which they plan to analyze and share, as well as use to reshape future offerings.
From flipping the classroom to creating a global classroom, what Khan, Norvig and Thrun have begun, others have picked up and expanded upon. Coursera, the group garnering current attention, is ready to roll with over 100 MOOCs, or Massive Open Online Courses, which include courses in medicine, biology and health, society & medical ethics. Original Coursera partners (University of Michigan, Princeton, Stanford and University of Pennsylvania) offered 43 courses and registered 680,000 students. This week the company announced that 12 major research universities (listed below) will now also offer courses. Both Forbes (“Is Coursera the Beginning of the End for Traditional Higher Education?“) and the New York Times (“Universities Reshaping Education on the Web“) picked up the story, as interest in the changing educational paradigm grows. Whether or not MOOCs will replace traditional education is yet to be seen, but the number of course offerings at Coursera has now more than doubled, as will the number of expected students from around the world. New Coursera partners include:
- California Institute of Technology
- Duke University
- Georgia Institute of Technology
- Johns Hopkins
- Rice University
- University of California at San Francisco
- University of Illinois – Champaign-Urbana
- University of Washington
- University of Virginia
- University of Edinburgh-Scotland
- University of Toronto
- EPF Lausanne (a technical college in Switzerland)
The inclusiveness and ability to reach less traditional students are just two impressive benefits of these MOOCs. All a learner needs is access to the internet, which they can get in any internet cafe or Starbucks around the world. Suddenly someone living on the south side of Chicago, or as Khan points out–in Kolkata, without the means for higher education, has one more option. Not to mention the collaboration that can occur across oceans. As knowledge spreads through these novel means with greater openness and transparency, think of the accelerated rate at which problems, medical or otherwise, can potentially be solved.
I just signed on for a course offered by University of Michigan Professor Eric Rabkin on Fantasy & Science Fiction: The Human Mind, Our World, which focuses on how we understand ourselves and our world through stories. As we look to better understand patients through narrative, what better way than to get grounded in the classics and character archetypes once again? And as a perpetual student, what an incredible opportunity to take a course of this caliber in the moments I can spare throughout a full work week! I will be sure to report back on the experience along the way. Please share your own experience with anything educationally innovative–as Norvig so astutely stated, “everyone is both a learner and a teacher.”