Consider This from NPR - How The Pandemic Shaped Medical Education And, Ultimately, Your HealthCare

Episode Date: July 19, 2021

Medical education must always keep up with the times. But the pandemic forcing medical students to learn virtually revealed new fault lines and opportunities to rethink the way medical professionals should learn. The medical field is grappling with which of those changes should become permanent and which ones could jeopardize the quality of healthcare. To get a better understanding of how technology has enabled new ways of approaching medical education, NPR's Jonaki Mehta visits Kaiser Permanente's Bernard J. Tyson School of Medicine, a school that was uniquely positioned to adapt to the conditions imposed by the pandemic since it opened during quarantine. Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and a non-practicing physician, shares her concerns about the medical field leaning more heavily on telemedicine as a result of the pandemic. In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Mock patient visits are a normal part of medical school, a way for doctors in training to practice their clinical and conversational skills. We are practicing having kind of serious conversations with patients. What's not exactly normal is your patient disappearing right before your eyes. And my Wi-Fi kept going out and then so I just fully dropped out of the call and then I came back in and I was like, oh, so sorry about that. Like, I just think that... For Ashlyn Torres, walking a patient through technical difficulties

is actually a routine part of her training. Her med school, Kaiser Permanente's Bernard J. Tyson School of Medicine, opened its doors a year ago. It's just outside LA. And they opened during the pandemic. Students there haven't just been practicing bedside manner. They've been learning about website manner. Yeah, so we talked in class about if you're on a telehealth visit and then you can't really see them well

or how to kindly ask them to adjust their camera. And then sometimes, too, there's tech difficulties, like the patient's muted and they don't realize they're muted. Kaiser is one of many med schools that had to adapt during the worst of the pandemic. Teaching labs, lectures, and much else online. Now that shift has been hard, but it's also showed healthcare educators across the country that there are benefits to using remote technology in healthcare training. With moving online when COVID hit, it kind of helped us push the envelope as to what you can achieve with simulation.

Dr. Stephen Scheinman is president and dean of the Geisinger Commonwealth School of Medicine in Pennsylvania. I think that will move simulation farther forward as part of medical education. Consider this. Remote technology changed the way people work in all kinds of industries during the pandemic. But now the medical field is grappling with which of those changes should be permanent. We'll explain what that could look like for you and your doctor. From NPR, I'm Adi Cornish. It's Monday, July 19th. This message comes from WISE, the app for doing things in other currencies. It's Monday, July 19th. Support for this podcast and the following message come from Sejo. A mindful, sustainable home brand, Sejo creates bedding from performance materials to contribute to healthier and more restful sleep. Whether you prefer the soft texture of French flax linen or the breathability and heat dispersion of eucalyptus bedding, Sejo has something for every type of sleeper.

Sejo is offering a 30-night risk-free trial so you can try out their bedding. Visit CjoeHome.com slash consider for 20% off of your first order. There is no denying that there is a lot going on in the economy right now. So far in 2021, about 3,600 retail stores have closed. You know, China has banned Bitcoin many times before, but this time it's looking pretty serious. Understanding this stuff, it is kind of our thing here at The Indicator. It's how we like to spend our free time. Every day we explain something that is going on in the economy.

Listen and follow The Indicator from Planet Money on NPR. It's Consider This from NPR. Virtual lectures, simulated dissections. These aren't brand new technologies. Med schools have been experimenting with them for many years now. But when the pandemic forced most students home, Dr. Christopher Fries said new fault lines were exposed. I've had students attending class in their cars,

you know, pulled up to a restaurant where they can get good Wi-Fi because they don't have good Wi-Fi at home or they don't have an environment at home where they can be in a quiet space and participate. Dr. Fries teaches nursing and health management at the University of Michigan. He says inequities like these changed the way he and his colleagues thought about instruction. It made me think about meeting the student where they are. If they can't turn their camera on, that's okay. As long as we can find a way to connect and engage.

And so that's on me to create that environment where they can participate, they can be safe, and they can learn. It's not as easy as turning Zoom on. It's a lot more complicated. And that's just one way medical educators have been rethinking the way they teach. At Kaiser Permanente's new medical school, technology helps students learn anatomy virtually and through simulated means. Their state-of-the-art anatomy lab, it's like a trip to the future. Yes, there are real cadavers stored away in cabinets rolling around on wheels.

But in this lab, put on a pair of augmented reality goggles and a hologram of a cadaver appears before your eyes, one that students can collaboratively dissect. And then those students can continue anatomy practice at home with digital representations of specimens from class on their laptops. I think it's nice to be able to visualize multiple times kind of like what these structures are, what lies beneath them. Again, first year medical student Ashlyn Torres. Since it is a software, I mean, you can like hit the undo button and restore a muscle that you've just dissected.

And so you can really get a sense for what's in the body. And I just appreciate being able to, I think, take that at my own pace as a learner. NPR's Janaki Mehta visited the school to learn more about how med students learn, even if at times they can't be there in the flesh. What I'm doing is I'm just taking my iPhone and I direct the camera to this QR code. That is Dr. Jose Baral. He's professor and chair of biomedical science at Kaiser Permanente's new medical school. What's happening is it's reading the QR code. It's like going to a restaurant these days. It's exactly like getting a menu. But instead of getting a menu, you get a three-dimensional representation of this precise

specimen. We're in the anatomy lab where Baral teaches medical students. And that specimen in his hand is a real preserved human heart. Attached to it is that QR code he mentioned. The students can now get it on their iPhone, tablet, whatever they have. And it's not just a heart. Students can dissect 3D renderings of entire human bodies or put on augmented reality goggles and perform dissections on holograms. I come back to my control panel and I choose the virtual scalpel. The entire layer of human skin just disappeared with the click of that virtual scalpel. And this process would normally take hours, without much learning, really. It might save time, but I ask Baral if students are missing a learning opportunity

by not doing the real thing. I have had many years of doing traditional cadaveric dissections. I love dissecting cadavers, but I am convinced that this technology is equally effective at learning the anatomical relationships. Rural says it's okay if students wait to get their hands on actual bodies, because it's more helpful once they're preparing to do real surgeries anyway. Across town is UCLA's David Geffen School of Medicine. Now, they've been around for 70 years, but they're also shifting towards more virtual instruction.

Our experience with the pandemic helped us to realize the things that we could actually do remotely, but also to realize what was lost or could be lost. Dr. Clarence Braddock is the Vice Dean for Education at UCLA's Medical School. He says things like admission interviews and lectures may well stay online for the long run. And he agrees with Kaiser's Dr. Baral that simulated dissections can help first-years learn the fundamentals of human anatomy. But he does have reservations about losing the hands-on experience. He says it helps students to better appreciate the look and feel of live human tissue. The outcomes of simulated medical training are still being

researched. It's too early to tell how effective it is. And there's another thing Braddock says students could miss out on, a kind of relationship. The medical student who's in an anatomy lab, in some ways, that's their first patient. They come to develop a sense of respect for the person. And in fact, every year we hold a celebration and remembrance for all the patients who became the cadavers in the anatomy lab. Radek says these experiences are pivotal in helping students form their identities as physicians. But Dr. Jose Baral from Kaiser says no matter how an instructor or school feels about this new way of doing things, medical education has to become more efficient.

As we learn more and more about basic science, there is less and less time to teach it, right? So medical school is four years. Some schools are moving to shorter. So we really need to find efficient means to teach themselves. Which could look like students practicing surgery on a digital heart in their bedrooms. That's NPR's Janaki Mehta. While younger doctors may come up in a field where remote technology is the new normal, for a lot of practicing physicians, it still feels all really new and a lot to manage. Stephen Scheinman with the Geisinger Commonwealth School of Medicine, again in Pennsylvania, he says before the pandemic, his hospital system handled less than 100 virtual patients a week.

With COVID, within a few months, Geisinger went up to 20,000 telemedicine visits a week, half of which were video visits. Now that's leveled off to to 20,000 telemedicine visits a week, half of which were video visits. Now that's leveled off to about 6,000, but still a huge jump from the before times. And there are benefits. The no-show rate in a telemedicine visit is much lower than for actual visits when patients have to travel distances. There are certain things that you cannot do directly.

But telemedicine, particularly in large rural areas, we know is going to be an important part of care delivery in the future. And some doctors think that's an upside that's worth potential trade-offs, but not Elizabeth Rosenthal. I think we overestimate the value of convenience in medicine sometimes. And underestimate the value of being in an office. Rosenthal is a non-practicing physician and editor-in-chief of Kaiser Health News. That's not connected to Kaiser Medical School. Rosenthal wrote that COVID let telemedicine out of the bottle. And when the pandemic is over, she's worried it won't go back in. We spoke about why. I think it should be used as a screening tool in the sense of if your doctor schedules

a telemedicine visit and can solve your problem with that, great. That's wonderful. And a lot of things can be solved that way. But if the doctor says, you know, I can't tell if that's strep or COVID over the phone, I need you to come in, then maybe the cost of hybrid model where providers can use telemedicine and in-person medicine interchangeably as appropriate. And I just worry so much that for many people, it's going to be one or the other. What questions would you have for something like the Geisinger Commonwealth School of Medicine, right? Something that's trying to be a medical school with a big virtual kind of experience, or that is also trying to bring that kind of training to the field as well. I mean, I think you need to teach medical students that crucial like on-off switch. So they have to see enough patients in person so that they

know when they are in practice, is this something that benefits from a physical exam? Or is this something that I could do just as well over the screen? So what we get in the end, I hope will be determined by what's medically right, but it also will be heavily influenced by the competing financial interests at play in our healthcare system. It's funny, we've been focused on the medicine part of it, but you're also pointing out that this is doing something to the business model of medical care in the U.S. Sure. I mean, telemedicine can be very lucrative, right? You don't have to have exam rooms. You don't even have to have, if you take it to the extreme, you don't even have to have a hospital or an office. You can just have a phone bank somewhere.

And that's what really worries me that, you know, instead of being able to see an actual physician, if needed, you'll be talking to, be talking to a bunch of physicians in a room somewhere 3,000 miles away who have no capacity, if they see something that looks funky, to say anything other than, oh, go to the ER. And meanwhile, they'll be charging you for that useless advice of go to an ER. So I do worry about how it's going to be monetized, particularly in this era of high deductible health plans and big co-pays out of network care. Patients could be on the hook for a lot of money for care that isn't very effective. We started this with your quote about COVID-19 letting telemedicine out of the bottle. It's hard to get things saying, you know, we're not going to reimburse that as if it

was in person. So I expect a lot more negotiating battles between insurers and providers about what this new kind of service is worth. Now, you know, that being said, in some cases, it is, I'll give you an example of where it could be amazing. For example, home monitoring of cardiac rhythms, right? That could be a godsend for patients rather than lying in a hospital bed for two days. You can wear a home telemetry unit for two days and just transmit the rhythm strip into a cardiologist to read. Now, a hospital might want to say, oh, that should be worth the same as two days in a hospital,

meaning in the US, you know, $8,000. An insurer might want to say, the patient's doing all the work here. So yeah, there's a big gulp there. And I do not know how that decision is going to be made. Elizabeth Rosenthal, editor-in-chief of Kaiser Health News. It's Consider This from NPR. I'm Adi Cornish.