'A couple of weeks ago, I had the pleasure of reconnecting with a remarkable man -- a former attending, a mentor, a friend. As healthcare providers sometimes do, we started talking about interesting cases.
We had a patient who was a vibrant 15 year old girl, on the swim team, and suddenly couldn't walk, I told my friend. We feared the worst, as did her parents -- advanced spinal or brain tumor was a very real possibility. Every day, even every hour, is important. In addition to not wanting to delay any necessary treatment, we also didn't want a busy high schooler out of class for weeks on end. That said, four specialist opinions were needed, from different health centers, and all with visit waiting lists of months. We were lucky enough to have iClickCare available to us, and in seconds we had securely shared a video of the girl's issues and a brief request for consult with all of the specialists. Within hours, three physicians weighed in on their opinions and appropriateness of referral. Semi-emergent surgery was scheduled and a good outcome obtained. The entire workflow was accomplished without interruption (the specialists could respond as easily as posting to Facebook, and on their schedule) and without scheduling a video clinic visit. The system saved thousands of dollars. Everyone won -- the patient, the doctors, the system, the secretaries.
Our friend listened carefully, and as I finished describing the outcome, his eyes lit up and he exclaimed, “Great Case!”
There is a lot of satisfaction in hearing that. It means that you, the provider, did something a little unusual, made a good diagnosis, participated in an ideal outcome, shared worry and success with colleagues and peers, and even managed to appease the looming demands of cost containment.
Of course, as a busy provider, I didn't have time to do anything special with the case once it was resolved. But without needing to do anything special, the case was stored, the pictures, video, and data were all stored, and I've used it as a teaching case countless times in the years since. I'm able to reference it -- and the hundreds of other cases that have been stored in the course of regular care -- and students can learn from them. The student can learn about the pathophysiology, but maybe even more importantly he can learn by reviewing the discussion. It is there that judgement, approach, analysis can be saved and later revealed.
This type of real-world learning is more important now than ever because modern medical education has changed. The 80-hour work week provides rest (although this is not being shown as beneficial for patient safety as was once thought). Testing is more prevalent, participation is less. Current education does not allow for the absorption of the subtle discussion that constitutes continuity of care. It does not show or teach the interactions and give-and-take that are so important in healthcare collaboration and care management.
Indeed, it seems as if we have been thrust back to 1910 when Abraham Flexor reviewed the abysmal state of medical education and suggested a framework for improvement.
The combination of attitude, work hours, financial constraints and EHR/EMR conspire to give the student the same deficiencies as Flexor saw in 1910. Instruction is didactic and wholly textbook, memorization without innovation. Students don't touch the patient often. Much of clinic time is tied up in EMRs. At a few minutes per patient, there is little time to allow the student to think, to fail in the thinking, to be corrected and to think again. Working by shift amplifies these deficiencies. Research funds are shrinking. Continuity of care and care collaboration are not part of this process.
All of that said, we don't believe that fixing these issues need to be a matter of waiting for the whole system to change, or even overhauling all of medical education. In fact, we've found that using hybrid store-and-forward telemedicine, like iClickCare, can create opportunities for individual healthcare providers to change medical education, 5 minutes at a time. Since Hybrid Store-and-Forward® technology, all collaborations/consultations are stored, we can see how things unfold, and any case can become a "Great Case."
So, our proposal (and yes we recognize the magnitude of this -- it took decades for Flexor to see change) is that each medical student starts the first day with a way to record and participate in “Great Cases”. A note enriched with video, pictures and PDFs of data is made as a dissection progresses, an X-Ray is read, a lab finding is discussed. By collecting the information and by participating in the process, under supervision, lifelong learning and a love of same can be developed.
And that means that the satisfaction of sharing and learning, and the reward of providing truly good care all add up to more and more Great Cases.
You can try iClickCare for medical education for 2 weeks, absolutely free. Just click here for your trial:
Photo from wocintechchat on Flickr, used under Creative Commons rights.