Precision education and the future of medical education

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How is medical education changing? What is precision education? What does the AMA give grants for? What is an example of precision education in medicine?

Our guests are Sanjay Desai, MD MACP, chief academic officer, and Kim Lomis, MD, vice president of medical education innovations, with the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.

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Speakers

• Sanjay Desai, MD MACP, chief academic officer, American Medical Association
• Kim Lomis, MD, vice president of medical education innovations, American Medical Association

Dr. Desai: We do think this is the future. Personalization in medicine and medical education is so important, because the current model is very much a one-size-fits-all. 

Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about precision education, what it is, and how the AMA's new grant program will help incorporate it throughout medical education. 

With me in our studio today are two guests from the AMA. Dr. Sanjay Desai is our chief academic officer, and Dr. Kim Lomis is vice president of medical education innovations. 

I'm Todd Unger, AMA's chief experience officer. Welcome, Dr. Desai, Dr. Lomis. Glad to have you in the studio today. 

Dr. Desai: Thanks for having us. 

Dr. Lomis: Excited to be here. 

Unger: Well, let's talk about precision education. I'm going to say, I'm starting from scratch here. My frame of reference is Keanu Reeves in The Matrix. Download, I know Kung Fu. Is that what we're talking about here, or is this something entirely different? 

Dr. Desai: It's actually, a little bit different. But there are ways that you already experienced this, and I'll try to share. 

Precision education, put very simply, is leveraging data and technology to do three main things. One is to personalize our education, to make it more efficient and to give agency to the learner. And it could be to a person, it could be to a program, it can be to an institution. 

But the way to think about it, Todd, I think, is that this has happened in other industries. The easiest example would be Wayfair or Amazon, which has used these exact concepts, leveraging data and technology, to transform the retail industry. They've made it more personalized for you, they've made it super efficient for you and they've given you agency. You now have the right and the opportunity to go out and shop for anything you want, not dependent upon what a department store wants to share with you. 

Unger: So I love that example, and I totally understand that framing of it. Do you see this as the future of medicine and medical education? 

Dr. Desai: We do, because I think, again, the way—Again, using Amazon as an example—that becomes a system that adds value in so many ways. And we do think this is the future. 

Personalization in medicine, in medical education is so important because the current model is very much a one-size-fits-all, or a random approach. You go in as a student and independent of whether you came in with a biochemistry background or you come in with a humanities background, you get the same content fed to you. So we need personalization. 

We need more efficiency. It's a very high-resourced system right now, and there's many opportunities to make—to reduce friction in the learning process. And then agency just gives me the opportunity to direct my own learning. So these are really important. 

But the reason it's the future, I think the evidence that it's the future, is that it's already happening. So if you, Todd, were to visit virtually any medical school in this country, and you go to the lecture hall when they're giving their coursework, they're empty. And the reason they're empty is because the students are on themselves creating these precision education systems. 

They're actually looking online for content that is best for them to consume, and finding ways to drive their own education as they go through it. And again, make it more personal, efficient and taking ownership over it. So it's already happening, and what we want to do is build this ecosystem so that we can structure it and organize it and do it more effectively. 

Unger: Dr. Desai, why now, for precision education? 

Dr. Desai: Yeah, it's a great question, Todd. I think there are some challenges in medical education that we've been pursuing for decades, and have been so frustrating. And they're stubborn problems or wicked problems that some people describe them. We believe precision education may be that tool that helps us advance these. 

So I'll give you just three really quick examples. One is we want, in medical education, we aspire to have a competency-based model. And that's really hard because assessment is hard. And using these systems of precision education, we can get abundant, feasible assessment. With data that are already found in the system, we can use those to actually create assessments that are far more frequent and meaningful. 

The second is transitions. We have a model that you have these compartments of education, and you have to move between them. And those transitions are difficult for the learner. They're difficult for the program. 

One of the challenges, how do you get a representation, a true representation, of the learner as they move from one to the next so they can seamlessly develop, instead of being interrupted? In a precision education system where there are data that about a particular individual that could be shared with fidelity, that allows us to achieve those transitions much more friction-free. 

And the third is equity. We know that there are inequities in our system. And the opportunity with precision education is to get objective, holistic models for recruitment, for development, and for promotion of individuals as they enter and traverse this journey. And so these are, again, really hard for us to have done before, and we believe that precision education can help us pursue them much more effectively. 

Unger: Similar themes just keep popping up. Availability of data to do that assessment. Interoperability not just between systems, but between the stages of education. And finally, just making sure that the resources like this are not just in certain high resource places, that they are really available to everybody. So the future is now, I guess, is what you're saying. 

Dr. Lomis, I'm curious to hear more about how precision education is playing out in the present. 

Dr. Lomis: Well, we've been fortunate that AMA to already be experimenting in this space. Over the past few years, we've funded a variety of different projects. And I can give you an example across the entire continuum, because precision education applies to every stage of a physician's career. 

So if you think about a medical student, we typically have clinical rotations, put students in a setting for a given amount of time, hoping that they see the right mix of patients so that they're prepared for their future care of their population. But what we know is that that's somewhat haphazard. 

What they actually see could depend on the time of the year that they're on a given rotation, what team they're assigned to. And so we have, in the past, used logs, which are onerous and burdensome and not very comprehensive. 

So now, some of the teams that we're working with are tapping into the electronic health record, looking at when a student enters a note, giving them credit for multiple concepts within that note, and populating that to a dashboard. So now, you can see what the student has and importantly, has not seen, so that you can adjust their educational experience and put them with patients that will round out their experience more broadly and fill in gaps. So that's an important element, is using the data, but then also having an educational response that fills in that gap. 

You carry it on to the residency level, you have the opportunity to actually connect with patient outcomes, because you can start to mine the electronic record to determine which patients the resident really has influence over the course of care. And then provide that resident dashboards about the outcomes around things, like diabetes management or hypertension control. And now, the resident is more engaged because they truly believe these are my patients. And you can couple that with a coach that helps them advance and improve the outcomes that they have with their patients. 

And then finally, when we think about our practicing physicians, we know very well from other work at the AMA, that they are overwhelmed with clinical burdens and administrative burdens. The time for learning is really precious. 

So one project that we've developed here at the AMA is an opportunity to mine the electronic record in advance. Look at patients that are going to be coming to see that physician in the future, and put that in the context of the physician's practice, and elevate to them, learning resources before they see the patient that are likely to help them be better prepared and be more efficient in their clinic and more confident. 

Unger: It's so exciting because there are so many things in what you just said that are all coming together. And I'm thinking about the interface design, and the types of interfaces that students, physicians, residents would all be encountering in their normal day. You're really talking about AI, which is kind of a little—mining the future, essentially, to make sure that the education is there and presented in time for that interaction with the patient. 

There's got to be a lot to pull this off and to take it from where we are today. I'm assuming that is why the grant program exists, that you're developing right now. I'd like to hear a little bit more about the program itself and what it intends to do. 

Dr. Lomis: Yeah. We're proud that the AMA is going to invest significantly to support people to develop these programs. As you're hearing, it requires a multidisciplinary approach that we haven't had in the past to this degree. So you need experts in education, but you also need experts in technology, informatics, as well as artificial intelligence. 

And all of this has to occur in a culture that is supportive of learning, gives the learner agency, and is not threatening. And so we are pleased to announce the Transforming Lifelong Learning Through Precision Education grant program. We will be awarding 10 grants of $1.1 million each to support. So this is a significant investment because we know how challenging the work is. 

We have three main goals for this grant program. We hope to spur the development of new ways of measuring performance. Some of the things that we captured around using electronic health record or other data trails that are part of the daily work of a trainee or a physician, to understand their learning needs. So new ways to assess where people are and what they might need to learn. 

As I mentioned, it must be coupled with an action, and this is a challenge. The educational program has to be positioned with some agility to make adjustments to deliver what the individual needs. 

And then the third point is we're focusing all of this around pushing beyond just knowledge to competencies that we know are very important to the care of patients and to communities, but have been often difficult to capture or measure or give feedback on. Things that we've invested in previously, such as health systems science, systems thinking, teaming, communication, as well as the features of being a master adaptive learner throughout one's career. And so we hope by putting all of these things together and unleashing the creativity of our medical education community, we'll be able to see exciting ideas emerge across the entire continuum. 

This is open to medical student, residency or continuing professional development. So in addition to our traditional partners of medical schools and residency programs, we would love to hear from health systems, specialty societies. So we're very open to novel ideas across the board that might spur this forward. 

Unger: Now, that's really exciting. And obviously, a huge opportunity for transformation. 

When you think about programs like this, it's obviously going to be more than just the technology part of it. And you mentioned culture, and we know that kind of change is really hard to adapt to. Dr. Desai, when you think about obstacles to this, what do you think? What stands out in your mind? 

Dr. Desai: Yeah, this is a really—we've been thinking about this work for now, two years, and the barriers have become very evident, and ones that we are focused on trying to reduce. 

And so the way we think about this, Todd is—you mentioned the future is now. It's true, it's happening, but it's happening with an undue burden on medical students, in the example that I gave, because they have to go find these resources and drive this on their own. And it's happening in settings and institutions that are highly resourced, because it takes all of the resource that Dr. Lomis just described. 

And so the default future, if you play that out 10 years, is that these highly resourced settings will continue to develop this and have access to these systems. And therefore, only a subset of patients and communities in our country will actually benefit from the development of these innovations. 

So our goal is to promote democratization of this. And I think that's going to be challenging, but the way that we think about it is ensuring that this grants program and the work that we do enables that. One way to enable that is in the portfolio of work that we do, including in that portfolio, the deployment of these innovations and demonstration of these innovations in diverse settings, in under-resourced settings, in addition to the typical settings that we see it in now. 

The second, which is also really important, and this is a really national effort that we want to promote and help catalyze, is creating interoperability. So right now, if one institution creates an innovation, it is exceedingly difficult, more than I think we would imagine at the onset, to pick that up and then put it in and deploy it in a different institution. 

There are technical things, but there are cultural things, there are legal things. There are so many barriers. So one mechanism to ensure that we are able to do this better is to create standards and principles for this entire space. So we're working with partners to do that, so we can promote interoperability, and hopefully, create mechanisms for replication and for scaling of these innovations nationally, which is really important for us. 

Unger: That makes so much sense. And I was just thinking about that initial challenge you talked about up front, and how—we started talking about how some of these concepts come out of retail and technology, and the same problems exist there, and you would expect them to port themselves over into medical education, as well. Dr Lomis, if somebody is interested in applying for one of these grants, what should they do? 

Dr. Lomis: So we have a landing page that they can go to AMAPrecisionEd.org, which hopefully is showing on the screen, as well. So at that page we have a description of the grants program, a Frequently Asked Questions page. 

There are recorded previous webinars and people can sign up for an upcoming public webinar as well, in order to gather a lot more information about not only the grants program, but the background work that we've done around precision education, making sure that they fully understand the concepts that we're hoping to promote. 

The letter of intent process will be used. So we're making the barrier of entry relatively low, so that programs can pitch an idea with a relatively short application, a letter of intent. That will open in mid-March and extend until April. 

But we would actually encourage people to dive in right away if you're interested in this at all, because as you can hear, it takes some orchestration of relationships that might not already exist. And so if someone's interested, I would jump on it. 

And I would encourage our members to look at this, and take this to the organizations that they lean on for their own continuing professional development, because as we said, we'd like to reach sites that perhaps haven't partnered with us before. 

And so members could take the information pursue it with a provider of continuing professional development that they lean on, a health system that they work in, to encourage them to take a good look at this, as well. 

Unger: It definitely is a big opportunity. We'll make sure to get the word out starting with this particular discussion. 

Dr. Lomis: Absolutely. 

Unger: We'll definitely include a link to that landing page with more information about the program and the grant in the description of this particular episode. 

If you want to support the AMA's efforts to transform medical education, then become an AMA member at ama-assn.org/join. 

That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care. 

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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