Are Millennial Doctors well trained for the 21st century? That was the question posed in NPR's Millennial Doctors May Be More Tech-Savvy, But Is That Better? I believe how Millennials Doctors are educated may make them less adequately prepared than previous generations. This isn't a reflection of medical education, but of education in general.
Do the technological tools available prevent the engagement needed to develop deep learning and expertise of our future doctors?
Do residency hour work restrictions prevent this learning as well?
Dr. Amy Ho noted that "with modern technology, med school really wasn't too hard... If you want to do the whole thing by video stream, you can," she says. "I would wake up at 10 a.m., work out for an hour or so, get some lunch and then video stream for 6 hours and then go to happy hour. It actually was not that bad." Is learning experience and environment as good or better than generations ago?
A Different Time Means Different Ways of Learning
When I mentor first year medical students, I'm amazed on how different their medical school experience is. I marvel when they listen to professors' lectures at double speed via podcast. I'm envious that they retrieve information instantly via the internet. Laptop computers, smartphones, and tablets are the tools of school. No more large binders. No thick paperback reference manuals stuffed into short white coat pockets. The potential to learn more in a shorter period of time is possible.
However, this also means rapid access to distractions. There is the distraction of social media, email, texting, and the internet. Do they simply learn twice as fast or perhaps only half as much? My recollection of medical school was hours in lecture and then more hours studying, reviewing and revising notes, and a lot of quiet thinking. Free of today's distractions of smartphones, Facebook, and the world wide web. In the 1990s, most of us were only reachable by answering machines and land line phones. Email communication was just a novelty and not a reliable way of getting hold of someone.
Will the next generation of medical doctors have the deep knowledge and insight to solve problems?
This challenge faces all students at every level not just future doctors. Rapid access to information does not equate to wisdom or knowledge. For doctors, wisdom means medical judgment. This can only occur if the learning process is focused and not fragmented.
As Malcolm Gladwell highlighted in his book, Outliers: The Story of Success , it takes 10,000 hours of deliberate practice to be come expert at cognitive demanding tasks. Some areas like medicine fit in that category. The struggle of learning, grasping difficult concepts, making judgment calls is something that can't be done even with the best technology, simulators, and latest gadgets. Wikipedia for medical research? Only unless one is well trained can he or she tell the difference between what is accurate and what is not. After all just because it is printed doesn't mean it is true.
The concern of how individuals develop deep expertise and knowledge is occurring in aviation. In the past, many airline pilots were former military pilots, like Captain Chesley Sullenberger, who had significant training and hours in combat aircraft. They tested both themselves and their aircraft's abilities and performance. They learned intimately their strengths and limitations. They witnessed first-hand tragedy from others and learned from those experiences.
Today more airlines pilots trained at flight schools. The number of flight hours and learning experience is different. Coupled with the fact that automation and systems are making flight safer, pilots face fewer minor and critical flight situations than generations ago.
This is precisely at the time when the type of error and danger we are facing in flight is fundamentally different than generations ago. As the Vanity Fair piece "The Human Factor" notes regarding Air France flight 447 which killed 228 people:
"To put it briefly, automation has made it more and more unlikely that ordinary airline pilots will ever have to face a raw crisis in flight—but also more and more unlikely that they will be able to cope with such a crisis if one arises. Moreover, it is not clear that there is a way to resolve this paradox. That is why, to many observers, the loss of Air France 447 stands out as the most perplexing and significant airline accident of modern times."
and how the co-pilot had
"been trained nearly from scratch by Air France and placed directly into Airbuses at a time when he had only a few hundred flight hours under his belt. By now he had accumulated 2,936 hours, but they were of low quality, and his experience was minimal, because almost all of his flight time was in fly-by-wire Airbuses running on autopilot."
You Can't Google Future Unforeseen or Complex Problems
With residency hour work restrictions coupled with a different medical school educational experience, is it possible a similar issue will occur in medicine? Certainly straightforward problems are solvable. How to put in a central line. What are the criteria to determine a patient's morbidity or mortality from acute pancreatitis?
Will Millennial Doctors have the ability to solve, dissect, and think through more complicated and not easily answerable issues that a simple Google search can fix? As Dr. Rahul Parikh noted "In Practice: Dr. Google has mixed results - Using the search engine can be a boon for physicians — if they do it right.":
"In a 2006 study published in the British Medical Journal, researchers had physicians read the histories of 26 tricky cases published in the New England Journal of Medicine and enter search terms into Google to see if they could make the diagnosis. They nailed it 58% of the time. Not bad, but not much better than the flip of a coin, either.
I tried this experiment myself with a handful of those New England Journal cases — I didn't get a single one right. So my advice is: Unless you're Internet savvy enough and have time to scan pages and pages of websites, skip Googling for diagnoses and just call your nearest specialist for help."
Patients are living longer with illnesses that once killed them - cancer, heart disease, diabetes - and the complications of those illnesses and treatments. Childhood cancer survivors are now entering adulthood. The consequences of their treatments which saved their lives only now are becoming apparent. Solving these problems will require deep knowledge and expertise.
As health care increasingly becomes more fragmented and doctors steer away from specialties like primary care, which favor continuity, for more shift work like emergency medicine and hospital medicine, will there be the necessary feedback and accountability to learn how to do better and the outcomes of particular decisions and judgments? Will we have future doctors who can step back and see the whole picture of the patient?
It would be fascinating to follow these doctors in their next level of training - after residency and then after a few years in practice - and see if their perspective has changed.
Education is Engagement which Technology Should Not Replace
Interestingly parents who work at eBay, Apple, Google, Yahoo, and Hewlett-Packard send their children to the Waldorf School for education. This is a school where the core teaching tools are "anything but high-tech: pens and paper, knitting needles and, occasionally, mud. Not a computer to be found. No screens at all. They are not allowed in the classroom, and the school even frowns on their use at home."
“Teaching is a human experience,” [Paul Thomas, former teacher and an associate professor of education at Furman University, author of 12 books about public educational methods] said. “Technology is a distraction when we need literacy, numeracy and critical thinking.”
Even Apple CEO Steve Jobs wondered about technology and limited his children's use of technology. As his biographer Walter Issacson of Steve Jobs, noted:
“Every evening Steve made a point of having dinner at the big long table in their kitchen, discussing books and history and a variety of things,” he said. “No one ever pulled out an iPad or computer. The kids did not seem addicted at all to devices.”
Time will Tell
As I noted in a previous post, a Millennial physician and entrepreneur Dr. Jay Parkinson, felt that change in health care would only happen when Millennial doctors step into leadership roles. For a variety of reasons, I didn't think it was that easy.
Time will tell if that observation was correct.
As will this one.