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The vision of transformation in medical education after the COVID-19 pandemic - 23rd ICHPE 2022 - Full Transcript of 'Live' Conference Presentation
Poh-Sun Goh (4 May 2022, 0441am, Singapore Time)
Thank you to the organisers of the 23rd ICHPE for inviting me to give this keynote presentation.
In my presentation, I would like to focus on the idea of Transformation in medical education to transform health’care’. My personal conviction, is that transformation, requires a major shift in our central point of view, from our ‘system’ of medical education, to ‘care’ of our patients. When we care (enough), about our patients, their needs, concerns, views, this will naturally provide the motivation for all of our stakeholders, our students, our faculty, our administrative leaders to learn everything that is required, the science, and art of medical practice, working in teams, designing and delivering cost effective and state of the art health’care’.
Let me share with you briefly my professional and personal journey, over the last 4 decades, in medical education, and healthcare. I have been both student and practitioner, teacher and scholar, whilst simultaneously a son of a patient (my mother) with stage 4 breast cancer whilst I was in medical school; having early stage cancer myself, and not only having the opportunity to ‘be’ a patient, in the same academic medical center where I work, and have continued to work; but share adjoining waiting room seats with a breast cancer patient, who two years earlier I had inserted a still functioning well porta-cath, providing me with personal feedback of her painless experience during the procedure and gratitude that the porta-cath was still functioning well; and more recently having two near-death experiences on the operating table during delicate skull base endoscopic surgery. Lying in recovery before having to return to the operating room with active bleeding whilst fully aware of what was going on, seeing the very familiar corridors I have been walking along over 30 years from the viewpoint of a hospital trolley, and wheelchair have continued to give a ‘patient’ perspective of health’care’, through the many human interactions throughout my professional and as patient journey. These experiences have brought home to me, and continue to bring home to me, a visceral appreciation, a deep emotional connection to importance of ‘both’ deep knowledge and insight into the Science, and Art of Medicine.
Simply put, when we care (enough), we will engage with the purpose of our professional practice, as educators, and practitioners - our patients. We will then put in the time, and effort to undertake personally, and organisationally the deep work to master the Science and Art of Medicine, and deliver Health’care’. Imagine listening to, and caring about, what each patient is really concerned about. Technology, assisted with omnipresent devices, systems and platforms can already give us current insights in real-time, not after the fact, of what each patient wants and needs. Technology can deliver just-in-time information, decision making support, augment and amplify our health’care’. How can we change and shift the time spent, and emphasis of medical education reducing time spent in lecture halls, classrooms and simulation centers to the bedside and where the patient sits, and lives their life? How can we apply learning and training science, and what we know from training for mastery and peak performance to create truly integrated, lifelong learning experiences? Training digital and learning literacy in our students, practitioners and faculty, and educating our patients and administrative managers? Does building the capacity to care, and serve require starting medical and healthcare training in classrooms for the first years of a medical or allied health program? Or should we begin, and continue to emphasise the art of medicine and healthcare, whilst building up the capacity of our practitioners to learn, and to innovate, and deep knowledge of the scientific foundation of medicine?
To transform medical education, and health’care’, let us consider a transformative shift in our emphasis and central focus as health’care’ practitioners. To embody the spirit and science of the lovely quote - “To cure sometimes, to relieve often, to comfort always.” - Edward Livingston Trudeau [
https://medicine.yale.edu/news-article/to-comfort-always/].
Where there is the will, there is (we will find) a way.
Let us 'Transform' Medical Education to transform health'care', by focusing first on 'care'. Caring.
Thank you.
I would like to now open the floor to engage you in an interactive discussion. I have requested that the conference organisers make the transcript of my presentation available to conference participants one week before the conference. We can engage in a more detailed discussion of additional topic content and themes (see below). Discuss what you 'care' about. Customised to the interests and needs of this audience.
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"The vision of transformation in medical education after the COVID-19 pandemic"
by Poh-Sun Goh
Keynote presentation for 23rd ICHPE 2022
Abstract
This presentation will invite participants to envision possibilities to transform medical education in the near future, seeing the ongoing COVID-19 pandemic as a challenge, and opportunity. Our mental models, lenses and thinking frame our worldview, shaping our interpretation of what we see, and can imagine. Examining medical education with a historical lens, using an anthropological, sociological, biological frames of reference, combined with technology and network thinking, can assist us in thinking about blending the very best of human capabilities, with technology, to augment human intelligence, augmented HI or AI (augmented intelligence). Translating a vision of medical education into practice, and transforming medical education will also require examining (near) future practice models, including telemedicine; as well as capacity and capability building, for life-long learning and professional development, as well as building adaptive dynamic learning and practice networks, education and healthcare systems. We will conclude a journey through the past, present and envisioning possible futures; from a macro to micro perspective; ending with a discussion on practical steps which could be taken in the here and now, informed by implementation science, design thinking and action research, to improve and transform healthcare, through envisioning and implementing a transformation in medical education, by focusing on supporting and developing our faculty. Augmenting our human intelligence through training and faculty development, and informed innovative use of technology.
abstract drafted on 8 February 2022, @ 0158am, Singapore Time
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Presentation: There are 6 'sections' to my formal presentation - with the full transcript of each section, and illustrations which I will use in my presentation below - sections A) through F). The initial 5 sections A, B, C, D and E are a more expansive and 'informal' introduction, and series of opening general comments and illustrative thinking of the topic. Followed by a traditional SlideDeck in section F. There is additional material after this section on the final part of this blog for illustration, exploration, and self-study.
A)
Thank you to the organisers of the 23rd ICHPE 2022 for inviting me to participate, and give this keynote presentation, which is titled "The vision of transformation in medical education after the COVID-19 pandemic"
The full transcript of my presentation, the illustrations and slides, cited resources, and additional material for further reading and exploration is available on a customised blogpost for this session, available at https://medicaleducationelearning.blogspot.com/2022/02/the-vision-of-transformation-in-medical.html
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The one takeaway I would like to share, at the beginning of my presentation is this - That 'transformation' can and will occur when 'time is taken' (by all stakeholders), and 'human care, compassion and consciousness is connected, concentrated and amplified by technology and our networks of connection', through consistent, cumulative effort. To 'care enough, and about' health'care', education and training - involving all stakeholders in the healthcare system - the practitioners, administrators-managers-resource owners, and especially our patients - having their concerns and needs front and center of our decision making, and as the centralising point, center and anchor of our efforts to transform medical education, which is fit for purpose, to care for the health of our populations and patients. Poh-Sun Goh, 24 April 2022, 0351pm, Singapore Time
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"Transforming Medical Education to Transform Health'care' - a personal story with Three Chapters.
Poh-Sun Goh, 26 April 2022, 1009am, Singapore Time
I would like to start the presentation by sharing three personal events, in my life journey. To touch your hearts. Share a point of view, to see and Think about Medical Education and Health'care'. With the aim to Transfer what you feel, and think into action and practice.
I have been a son, to my mother, with stage 4 breast cancer, whilst undergoing medical school and houseman training (age 15 to 23). I have been a cancer patient, being treated at the academic medical center where I work (as diagnostic and interventional radiologist) including experience of sitting next to my patient in the same waiting room area, waiting to see our oncologist [2 years after completing chemo-radiotherapy myself], a patient who I had inserted a porta-cath for breast cancer treatment (who happily recognised me, and fed back her experience of the procedure to me [painless], and her gratitude that the porta-cath was still functioning well 2 years after placement (age 43). And recently as patient for very delicate skull base endoscopic surgery to drain mucocoele where I had to return to the operating theatre during same day from recovery room back to operating theatre, thankfully with successful final outcome (age 57), in the same institution where I have been working for the last 33 years, with colleagues and former students and clinicians I have personally mentored clinically, and in health professions education whilst they undertook their Masters training (MHPE), including the two most senior anaesthetists on duty that day. I will share in general anonymised vignettes my observations and reflections of patients and families in similar situations to my mother, and myself over the last 30 years, as compare and contrast brief exercise around these three personal events. Reflecting on medical education, delivery of, and experience of, health'care', in four continents, over four decades (the 80's, 90's and 20's).
I hope starting with this intimate, personal take of health, illness, healthcare, and insight from the viewpoint of relative, student, practitioner, teacher, patient, educator, scholar, patient again, and now, fortunately speaking to you will resonate with your own experience (in the audience), and touch you heart, so that the next section of my presentation of ideas, thinking and approaches will start further conversations and discussions, for us to continue to collectively to act, and to transform medical education. To transform healthcare.
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Let me start by examining 5 core ideas (on slide below) - Future Forecasting - Human Technology Network Blends - Augmented Human Intelligence (AI)
B)
above first posted on
C)
This is more formally illustrated and elaborated on series of slides below
above first posted on
above first posted on
When and how provider competition can improve health care delivery - by Penelope Dash, MD; and David Meredith
Health Care Needs Real Competition - by Leemore S. Dafny and Thomas H. Lee
Is the healthcare market competitive? - by Mike Wokasch
Barros, P. P., Brouwer, W. B., Thomson, S., & Varkevisser, M. (2016). Competition among health care providers: helpful or harmful?. The European journal of health economics : HEPAC : health economics in prevention and care, 17(3), 229–233.
https://doi.org/10.1007/s10198-015-0736-3
Rivers, P. A., & Glover, S. H. (2008). Health care competition, strategic mission, and patient satisfaction: research model and propositions. Journal of health organization and management, 22(6), 627–641.
https://doi.org/10.1108/14777260810916597
We Need More Competition And Innovation To Bring Healthcare Costs Down - by Adam A. Millsap
above first posted on
D)
Ultimately our efforts to transform medical education are 'for' our patients (see series of illustrations below)
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Designing a Medical Education System for the Future, For Patients
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F)
I will conclude with a 'traditional SlideDeck' available below:
"Let's engage in a thought experiment [leaving aside for discussion later during the session a wide range of technical and social implementation, tradeoff, societal and personal acceptance, privacy, protection and governance issues]. Imagine a (near) future, with patients, empowered and assisted by wearable(s) and ambient (environmental) digital 'intelligent' monitors - continually and unobtrusively keeping an 'eye' on blood pressure, pulse rate, respiratory rate, blood oxygen, urine and bowel output, what is breathed out (air), including sputum and saliva, blood 'micro' sampling (invasive and non-invasive, including for sugar and electrolytes etc.; not to mention 'observing' our physical, mental and emotional 'performance' trends (within baseline thresholds, to progressively amplify and increase this through assisted training and educational efforts [to attain individual profesional and personal growth and development goals], and to trigger interventions when deterioration is observed for early intervention) combined with AI (artificial intelligence) locally and in the cloud, linked to a personal physician, personal educator/trainer/guide/coach and healthcare system. How will we train healthcare professionals to work 'with' patients, and in this (near) future, in partnership and collaboration?" - Poh-Sun Goh, 24 February 2022, 0828am, Singapore Time
"The vision of transformation in medical education after the COVID-19 pandemic" ➡ ➡ How will we train healthcare professionals to work 'with' patients, in this (near) future, in partnership and collaboration?" - Poh-Sun Goh, 2 March 2022, 0938am, Singapore Time
"What is the role of 'faculty development', 'digital literacy' for both healthcare professionals and patients, and an understanding and ownership of complementary roles and responsibilities as healthcare professionals working in partnership with patients; fully leveraging on ubiquitous and ambient technology, and AI to support and 'augment' human intelligence and insights?" - Poh-Sun Goh, 2 March 2022, 0945am, Singapore Time
1 + 1 + 1 = 5 or more ; HP + P + T = HC ✔ ; (healthcare professional[s] + patient + technology = (near future) healthcare (model outcomes ✔) ; T or technology = Tools, Platforms, Networks and Systems - Poh-Sun Goh, 2 March 2022, 0951am, Singapore Time
Further reading:
Goh, PS. (2021) The vision of transformation in medical education after the COVID-19 pandemic'. Korean J Med Educ. 33 (3):171-174. https://doi.org/10.3946/kjme.2021.197
Goh, PS. (2020) Medical Educator Roles of the Future. Med.Sci.Educ. 30:5–7. https://doi.org/10.1007/s40670-020-01086-w
Goh, PS, Sandars, J. (2020) 'A vision of the use of technology in medical education after the COVID-19 pandemic', MedEdPublish, 9, [1], 49, https://doi.org/10.15694/mep.2020.000049.1
Goh, PS. (2016). Technology enhanced learning in Medical Education: What’s new, what’s useful, and some important considerations. MedEdPublish 2016, 5:102. https://doi.org/10.15694/mep.2016.000102
Goh, PS. (2016) eLearning or technology enhanced learning in medical education—Hope, not hype, Medical Teacher, 38:9, 957-958, https://doi.org/10.3109/0142159X.2016.1147538
Goh P. S. (2016). Using a blog as an integrated eLearning tool and platform. Medical teacher, 38(6), 628–629. https://doi.org/10.3109/0142159X.2015.1105947
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Quotes and Reflections:
“The future is already here. It’s just not evenly distributed.” - William Gibson
https://www.nytimes.com/2012/01/15/books/review/distrust-that-particular-flavor-by-william-gibson-book-review.html
https://quoteinvestigator.com/2012/01/24/future-has-arrived/
“In this future world of dramatically amplified digital connectivity, anything that can be distributed will be distributed.” - IFTF Distinguished Fellow Bob Johansen
IFTF = Institute for the Future (in California’s Silicon Valley)
https://www.iftf.org/what-we-do/who-we-are/
“In this digitally transforming world, within the professional spaces we operate in, digital literacy, and digital productivity, creativity, and innovation ‘will’ be the defining and distinguishing characteristics for each and everyone of us in our personal and professional lives; as well as for groups and institutions. Open digital practice and Micro-Scholarship are paths to thrive in this future.” -Poh-Sun Goh, 21 February 2022, 0510am, Singapore time
“... be mindful and project the future.” - Steve Jobs
above quote advice given to Salesforce CEO Marc Benioff by Steve Jobs
Learning curves navigating transitions during disruption:
“See (one), Do (one), Teach (one) applied to learning curves navigating transitions during disruption = See (disruption), Do (self reflection exercises, apply model), Teach (progressively engage in iterative demonstrations through Micro-Scholarship of deepening and broader insights into both theory and practice, through Micro-Assets, publicly shared within community of practice CoP). Note, Teach also = Assess, or ‘Assess to learn’, ‘engage in Micro-Scholarship to learn’ and ‘to demonstrate learning.” Poh-Sun Goh, 20 February 2022, 1017am, Singapore time.
“Micro-learning involves micro-activities (micro-encounters, micro-exploration, micro-reflection, micro-conversations), recording down, capturing micro-assets and notes progressively, regularly and cumulatively. Engaging in Micro-Scholarship - the process and output.” Poh-Sun Goh, 20 February 2022, 0758am, Singapore time.
#OpenPedagogy #OER or #OpenEducationalResources
https://medicaleducationelearning.blogspot.com/2022/02/openpedagogy-oer-open-educational.html
https://www.downes.ca/presentations.htm
https://www.bbc.com/storyworks/future/tech4all-tech4education/home
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https://www.straitstimes.com/business/govts-must-drive-inclusive-sustainable-growth-in-face-of-global-uncertainties-lawrence-wong ⬅
#ProductDevelopment #BareBoardVersions #NonFunctionalPhysicalMockUps #Look #Feel #Function #Prototyping #EVT (#EngineeringValidationTesting) #DVT (#DesignValidationTesting) #PVT (#ProductionValidationTesting) #Apple (#CaseStudy)
https://telmeded.blogspot.com/2022/02/productdevelopment-bareboardversions.html
Sandars, J., & Goh, PS. (2020). Design Thinking in Medical Education: The Key Features and Practical Application. Journal of Medical Education and Curricular Development, 7, pp. 1-5. https://doi.org/10.1177/2382120520926518
Sandars J., Goh PS. (2020) 'How to make it work: a framework for rapid research to inform evidence-based decision –making about the implementation of online learning during the COVID-19 pandemic', MedEdPublish, 9, [1], 154, https://doi.org/10.15694/mep.2020.000154.1
"Implementation science is the scientific study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers. " - quoted from 'What is Implementation Science?' University of Washington [accessed 7 March 2022].
https://implementationscience.biomedcentral.com/
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Google search for 'precision medicine'
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https://www.idc.com/promo/arvr
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https://www.cnet.com/tech/computing/features/magic-leap-2-hands-on-ar-glasses-that-can-dim-the-real-world/
https://www.cnet.com/tech/computing/magic-leap-2-aims-to-bring-ar-to-business-customers-with-no-bs-this-time-around/
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https://health.google/
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/what-technology-trends-will-and-should-lead-business-agendas-in-2022
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https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/iot-value-set-to-accelerate-through-2030-where-and-how-to-capture-it
https://www.mckinsey.com/industries/technology-media-and-telecommunications/our-insights/connected-world-an-evolution-in-connectivity-beyond-the-5g-revolution
https://www.mckinsey.com/industries/technology-media-and-telecommunications/our-insights/breaking-through-the-hype-the-real-world-benefits-of-5g-connectivity
https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/patients-love-telehealth-physicians-are-not-so-sure
https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/irl-versus-url
https://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/six-problem-solving-mindsets-for-very-uncertain-times
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https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/what-technology-trends-will-and-should-lead-business-agendas-in-2022
https://www.mckinsey.com/about-us/new-at-mckinsey-blog/new-council-identifies-ten-tech-trends-to-watch
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/the-top-trends-in-tech
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/what-is-the-metaverse-and-what-does-it-mean-for-business
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/the-promise-and-peril-of-the-metaverse
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/innovative-and-practical-applications-of-the-metaverse ⬅
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights
https://www.mckinsey.com/business-functions/mckinsey-analytics/our-insights/global-survey-the-state-of-ai-in-2021
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https://www.economist.com/leaders/2022/05/05/wearable-technology-promises-to-revolutionise-health-care
https://www.economist.com/technology-quarterly/2022/05/01/data-from-wearable-devices-are-changing-disease-surveillance-and-medical-research
https://www.economist.com/technology-quarterly/2022/05/01/wearable-devices-are-connecting-health-care-to-daily-life
https://www.economist.com/technology-quarterly/2022/05/01/apps-interpreting-data-from-wearable-devices-are-helping-people-to-live-better
https://www.economist.com/technology-quarterly/2022/05/01/wearable-devices-measure-a-growing-array-of-health-indicators
https://www.economist.com/technology-quarterly/2022/05/01/some-health-apps-are-able-not-just-to-diagnose-diseases-but-also-to-treat-them
https://www.dbs.com.sg/treasures/templatedata/article/generic/data/en/CIO/122021/CIOInsights1Q22.xml
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https://www.businesstimes.com.sg/leadership-management/three-old-school-hiring-practices-that-are-no-longer-relevant-in-2022
https://www.businesstimes.com.sg/leadership-management/should-i-stay-or-should-i-go
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"In the last few decades, artificial intelligence (AI)–aided analysis of medical imaging data has been implemented reliably in many healthcare areas [5], including the diagnosis of acute ischemic or hemorrhagic stroke. Since these so-called computer-aided diagnosis (CAD) applications have been primarily introduced to provide radiologists with a second opinion, they have nowadays become an integral part of clinical routine [6]. " - from Introduction section - Schmitt, N., Mokli, Y., Weyland, C.S. et al. Automated detection and segmentation of intracranial hemorrhage suspect hyperdensities in non-contrast-enhanced CT scans of acute stroke patients. Eur Radiol 32, 2246–2254 (2022). https://doi.org/10.1007/s00330-021-08352-4
Artificial intelligence in healthcare: transforming the practice of medicine. Junaid Bajwa, Usman Munir, Aditya Nori, Bryan Williams. Future Healthc J Jul 2021, 8 (2) e188-e194; DOI: 10.7861/fhj.2021-0095 https://www.rcpjournals.org/content/futurehosp/8/2/e188/tab-article-info
"The Data We Made: Sensory and Biometric Data - The second deep seam of new AI data is coming from us, as humans, in the form of sensory, emotional and biometric data .... Walking gait, typing speed, tone and timbre of one's voice ..... early diagnosis of illnesses, improved access to healthcare .... better personalisation ...... ......... use of sensors in, or on the body, to .... gather personal data .... to improve human performance, ...." Mark Purdy, For the Straits Times, on topic of AI, accessed on 16 March 2022 from https://www.straitstimes.com/opinion/ai-data-bonanza-will-intensify-geo-strategic-competition
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Toonders SAJ, Poolman EY, Nieboer ME, Pisters MF, Veenhof C. Healthcare professionals' perspectives on a blended care program in primary care; A qualitative study. Internet Interv. 2021 Aug 4;26:100440. doi: 10.1016/j.invent.2021.100440. PMID: 34401397; PMCID: PMC8358151. https://pubmed.ncbi.nlm.nih.gov/34401397/
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https://www.moh.gov.sg/cos2022
https://www.straitstimes.com/singapore/politics/budget-debate-preventive-care-at-the-heart-of-healthcare-reform-to-keep-people-healthy-and-out-of-hospital
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NUS Medicine: Educating Healthcare Professionals of Tomorrow (NUS Medicine, YouTube)
0:16 / 1:17 Lifelong Learning in Healthcare | Head, CenMED, Dr Dujeepa Samarasekera (NUS Medicine, YouTube)
https://medicine.nus.edu.sg/
https://medicine.nus.edu.sg/cenmed/
https://nus.edu.sg/cdtl
https://www.nus.edu.sg/
About the Speaker:
Dr Goh Poh-Sun
吳 宝 山
Associate Professor, Department of Diagnostic Radiology, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore (NUS), Senior Consultant, Department of Diagnostic Radiology, National University Hospital and Associate Member, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Member, AMEE TEL (Technology Enhanced Learning) Committee (since 2011)
Poh-Sun (MBBS(Melb) 1987, FRCR 1993, FAMS 1998, MHPE(Maastricht) 2012 and FAMEE 2017) practices on the clinician educator tract (80/20 time allocation clinical/education) augmenting his education and training time allocation with technology, and regular cumulative early morning focused scholarly efforts, spent developing and evaluating the use of open access online digital repositories in clinical training, and medical education faculty development, under a mastery training and deliberate practice framework. He focuses his efforts on the challenge of transfer to practice, in the widest possible settings, through use of reusable comprehensive digital content, iterative low cost proof of concept implementation combined with collaborations and partnerships to scale, all anchored on a solid foundation of theory and evidence. Am a certified Newfield/YLLSOM Associate Coach, successfully completing The Coach Partnership/Newfield Coach Training Program for NUS YLL SOM (2021), after which further engaged in another 6 month cycle of Coach Training - representing 125 hours of coach specific training - Newfield's Coach Certification Program (2022).
Dr Poh-Sun Goh
吳 宝 山
Short Bio:
Am a Clinical Radiologist at NUHS/YLLSOM@NUS. Working at NUH since 1989.
Also Medical Educator, with Masters in Health Professions Education (MHPE) from Maastricht University (2012); with deep passion for both eLearning/Technology enhanced Learning and Faculty Development - locally and internationally.
Two recent publications below
Goh, PS. 'The vision of transformation in medical education after the COVID-19 pandemic'. Korean J Med Educ. 2021;33 (3): 171-174. Publication Date (Web): 2021 August 27
My signature achievement is to have a curry named after me, Poh-Sun's Chicken Curry.
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