Author Archives: hnt2

Apr 25 2014
Education, Health, Medicine

Has the Influence of Harry Potter Spread to Medical Education?

As the semester comes to a close, it’s not unusual to see clusters of seniors chatting eagerly about how they’re going to spend their last summer before starting medical school. According to a study done in 2006 by the Mayo clinic, students that enter medical school with mental health profiles similar to their college peers. Although they spend their next few years training and studying on how to improve the health of others, they tend to disregard their own in the process. Reports show decreased attention to getting adequate sleep, meals, recreation and show higher rates of mental distress as student’s progress through medical school.  Sadly, the same study has also shown that depressed students are less likely to reach out for help because of the stigma surrounding mental illness.

With the worrisome consequences of depression in medical students including possible burnout and increased rate of contemplated suicide, it is important to contemplate how a change in culture within the medical school environment can be brought about to tackle some of the stigma surrounding mental illness.

So, what can we do to bring about this change?

Lisolette Dyrbe, M.D., and the lead author of the Mayo study, has encouraged a lot of conversation about the issue.

“It’s certainly important for the student to learn the right coping strategies, time management skills, and stress reduction techniques. All of that is important, but it is not the entire answer. We also have to look at school-level initiatives. There needs to be organizational change.” 

So, how are institutions responding?

Including pass/fail options for courses, reducing volume of course material, and giving students more opportunities to work and teach outside the hospital are just some of the ways that universities are working to lessens the stressful burden on patients. Many programs also provide mandatory resilience and mindfulness courses that teach coping mechanisms and stress management techniques. In addition, other universities have incorporated confidential web sites and hot lines for counseling, hired mental health experts, and have developed elective courses in health and wellness.

But, is this really helping?

Recent studies have examined these changes and have identified an important problem: students aren’t participating. Despite the good intentions of the universities and resources provided to the students, only a few seem to be taking advantage of these opportunities and these, more than likely, aren’t the ones that are in real need of care.

One program, though, has been able to show some success.

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The Student Wellness Program at Vanderbilt medical school, which provides a variety of health and wellness activities, has been seen to improve the health of students by effectively partnering and empowering the medical students themselves into organizing and promoting their own health and interests. The program has allowed the students to be divided into four “colleges,” similar to the Hogwarts houses in Harry Potter, that allow the students to connect and organize activities that provide an outlet outside of the classroom. Dr. Scott Rodgers, the associate dean of medical student affairs describes the aim of the program perfectly and outlines the importance of health and happiness for these students.

“It’s a challenge for anyone to stay healthy and happy. But when doctors are able to stay healthy and happy, that means patients get physicians who are more compassionate and selfless. They end up with doctors who really have the energy to invest time in them.” 

As undergraduate students pursuing careers in medicine, this discussion brings up some interesting conversations. What can we do to better prepare ourselves for medical school going forward? Are there ways that we can contribute to not only helping ourselves and our peers reduce stigma surrounding mental illness but also to improve health within the medical community?

 

sources: https://www.aamc.org/newsroom/reporter/jan2013/325922/stress.html; http://well.blogs.nytimes.com/2011/12/22/a-medical-school-more-like-hogwarts/?_php=true&_type=blogs&_r=0

 

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Apr 24 2014
Design

Conspiracy Theories Come to Life

If I were to ask you to name someone in your life that is described by the word eccentric, who comes to mind? Everyone has someone in his or her life that blurs the line when it comes to sanity, and can be described, for a lack of better words, as a little bit “off their rocker.” For me, that person is my grandpa. A high spirited and extremely social old man, he is constantly calling me to talk to me about his garden, to rant about the latest University of Arkansas sporting event, or to remind me that I need to cover up the camera on my laptop because the government is using it to spy on me. While his slightly paranoid notions constantly amuse me, I’ve begun to see how some of today’s advances in science appear to be a bit out of this world. The constant innovation and development of new technology has provided tools for medicine that seem like they belong in a sci-fi book or the ranting’s of a conspiracy theorist.

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One such example is a technology that has the possibility to revolutionize the way we approach medicine. In many of the projects presented in class, students brought up issues of patient adherence to treatment plans as obstacles in designing a solution. Teams provided examples of having no way to check or confirm if patients were taking their medication and if so were patients doing so consistently, at the right time, etc. So, what if we could eliminate this problem of adherence to a medication plan all together?

A group of researchers at MIT are trying to do just that.

This team has designed a microchip, about the size of a scrabble piece, that can be preloaded with medication and implanted into the body with the option of being programmed to administer drugs at a given time, interval, and dose. This allows patients freedom from the burdensome medication schedules they usually adhere to, and gives doctors the ability to theoretically adjust or stop medication dosage remotely. Proven to be safe and effective in a study done in 2012, the company, microCHIPS, hopes to continue to improve the chip in order to be able to have it turn on and off remotely and improve structure of that hopefully it could remain in the body and deliver medication for up to sixteen years.

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What implications does this innovation have on the future of medicine? First and foremost it offers the possibility for major improvements in the treatment of chronic illness that require constant medication and treatment. Having a built in system that eliminates a lot of the human variable of adherence provides the opportunity for more consistent care and better health outcomes.

The microCHIPS also present a variety of possible resources in preventative medicine. For example, can implanting a chip in a person at a high risk for allergic reaction be beneficial and effective further down the line when an emergency ensues? The possibility of arming high-risk patients against future potential medical problems increases opportunities for improvements in preventative care.

As we move forward in our examination of this product we are left with a variety of questions:

What other implications or applications could microchip produce?

 Also, what possible complications, both medical and social, could arise from implanting a microCHIP with medication into the body?

 

Sources: http://www.cnn.com/interactive/2014/04/health/the-cnn-10-healing-the-future/?frame=1&hpt=he_c1

Apr 24 2014
Design, Education, Technology

Resurrecting PowerPoint in Medical Education

I recently visited one of my teachers from high school and was greatly amused to see her teaching class from an archaic overhead projector.  I did not understand why, in a world with so much innovative technology, she had opted to use such outdated equipment. The experience caused me to ponder the extent to which technology has become integrated in our culture, and how this has affected the increasing role of multimedia software in education.

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Tools like PowerPoint, podcasts, video tutorials, etc., offer new and innovative teaching methods and possibilities. As a result, these technologies are used so frequently that it has become almost more unusual for a professor NOT to use some sort of multimedia tool in conjunction with their lecture. PowerPoint, especially, has become a popular multimedia resource for professors because of its ease of access and ability to streamline information into bullet-pointed lists.

While the software offers a variety of options for presenting and configuring information in many different ways, most professors still opt for the classic bullet-point format. We have all had that professor who lectures quickly, flipping through plain slides overloaded with text, resulting in a mad rush to record the information. Ultimately, this leads to confusion and the propagating of washed-out expressions and bored students.  Sadly this detrimental practice is so common that researchers have named the phenomenon, “death by PowerPoint.”

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If this is the case, then how is the use of PowerPoint as an educational tool any better than my teacher’s antiquated, boring overhead projector?

Medical education provides an extremely high stress environment where students must learn enormous amounts of information in a limited amount of time. In such a high-stake atmosphere, improvements in the effectiveness of educational tools like PowerPoint could have a massive effect on the education of our country’s upcoming physicians.

So, are there ways to improve the use of PowerPoint and other multimedia tools to make them better resources for imparting information to students?

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Example of Adapted Powerpoint Slide

Research done by Richard E. Mayer has directly addressed many of these questions. Mayer has established a number of theories and principles regarding design and implementation strategies of multimedia educational materials through his work with evidence-based education materials. Both his and supporting research has shown that incorporation of Mayer’s multimedia design strategies involving college-level students showed increases in short-term retention of information. In addition, current research has shown that incorporation multimedia (similar to Mayer’s design) led to an increase in the short-term retention of information by medical students.

Preliminary evidence has shown that PowerPoint and its use can be redeemed, but still leaves many questions unanswered:

(1) Is there a possibility of improving multimedia presentation to improve long-term information retention?

(2) Do the use of multimedia tools improve student’s ability to incorporate information into a clinical setting?

 

Sources:

Mayer, R. Multimedia Learning, 2nd edn. Cambridge: Cambridge University Press 2009.

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Apr 22 2014
Communication, Electronic Medical Record, Medicine, Technology

EMR vs. EHR: What does it really mean?

One of the topics that we have discussed on varying occasions throughout the semester is electronic health records (EHR) and how they interact with and effect patient care. In my own groups work with our problem owner in the CV ICU, interaction with the EHR has been a large part of developing a solution. As I have continued to work with and research the present systems, I have noticed, both in the classroom and in the hospital environment, an inconsistency in terminology used to refer to the records. From what I observed, the terms electronic medical record (EMR) and electronic health record (EHR) are often used interchangeably. Curious, I looked to see if there was an actual difference between these two records and how they are involved in medicine.

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Google Trend Data Tabulating Searches for “EMR”and “EHR”

Though these terms are often used synonymously, there are marked differences between EHRs and EMRs and how they are used within the medical field. My research led me to discern that the term EMR refers to essentially a digital version of the paper charts that they replaced. These digitalized systems contain a patients medial and treatment history specific to a doctors practice and posses the ability to allow caretakers to track data over time, identify which patients are due for screenings or appointments, and monitor quality of care within the practice. The largest difficulty when using EMR is transfer of information out of a physicians practice, and in that sense does not improve significantly from a paper record.

So how do EHRs differ from what I have just described? The key difference between an EMR and EHR is the focus of use. As described by a variety of sources, an EHRs functional aim is to address the total health of the patient, going beyond the original health organization to encompass information from other health providers including laboratories, specialists, and most importantly the patients themselves. The ability to share information in a secureway throughout all aspects of patient care creates the possibility for interactive communication and the meaningful use of EHRs as a tool to improve patient care.

Overall, what I found is that while the terms EMR and EHR only differ by one word, that small change makes a world of difference. The engagement and commination opportunities that the EHR provides, makes a case for the use of these systems exclusively. A push for providers to engage patients through their access to the EHR system has occurred in recent years, but is this engagement really effectual and beneficial to patient care? With an estimated 77 million Americans that possess either basic or below basic health literacy, are EHR systems providing accessible and useable information to patients to improve their care or are many patients just getting lost in the process?

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To answer that question the Agency for Healthcare Research and Quality have examined health education materials delivered by EHRs and have determined that many do not often account for the poor health literacy possessed by a large amount of the population. So what can we do to make EHR systems more useable for patients and improve care outcomes?

A number of leaders of Health IT have begun address this disparity by suggesting a list of preliminary standards and key tools designed to be incorporated into the existing and new EHR systems. A number of simple changes to improve direct communication with patients include providing patients with the ability to identify their preferred language. Other functions including the ability of EHRs to filter quality measures by patient characteristics such as language, socioeconomic status, and education level, could work to reveal and address disparities in care, including those involving health literacy. In addition to providing better resources for patients, having EHRs include information such as disability status, sexual orientation, or gender identity can provide caregiver a greater context regarding a patient’s health recommendations and outcomes. While these changes serve as the initial push in addressing functional and health literacy changes to EHRs, there are still ways to improve the educational value of the interactive system.

What other innovations could be incorporated into EHR systems in improve health literacy?

Mar 08 2014
Communication, Electronic Medical Record, Medicine, Technology

Through the Looking Google Glass

As I was scanning my twitter feed this last week I came across an article discussing one of Google’s newest technology accessories, Google Glass.  Google glass is essentially a lightweight pair of eyeglasses that works like a headset equipped with camera, GPS, Bluetooth, microphone, and viewfinder. This technology allows the wearer to connect to smartphones, allowing them to search for and access information online and to use the camera, GPS, etc. all hands-free.

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Google Glass: What It Does

 

With all this information less than a click away and viewable without having to carry a physical device I wondered, what possibilities could this technology have in the world of medicine?

I decided to look at how Google Glass was currently being used in the medical field. I found that this technology provides a means to change the ways the doctors work and communicate both with each other and with patients.

In class we’ve discussed how the internet has come to change how information is spread throughout the medical community, from simple avenues like the increased access to information to more creative paths like the live tweeting of surgeries for the public to access. Technologies like Google Glass make these information sharing “innovations” of today look small in comparison.

A perfect example of this can be seen in an article that discusses a surgery performed by Dr. Pedro Guillen earlier this year. Dr. Guillen was able to perform a highly complex surgery while wearing Google Glass, allowing the surgery to be streamed around the world in real-time. This feature allowed him to serve as an interactive teaching tool to university students and physicians all over the world, opening non-traditional avenues to improve medical education around the globe. The technology, as reviewed by Guillen, also revolutionized the way he performed surgery. The split-screen display allowed him to maximize access to valuable information such as images of the knee, notes, or past surgery videos without having to lift his eyes from the table. While all of these features were impressive one that stood out the most was in the off chance that an error occurred, Dr. Guillen possessed the ability to rewind the tape to review the surgery while standing at the table. This feature can serve to drastically change the way we approach and view medical error in the future.

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Video of Dr. Guillen’s Surgery

I also found an account of how Google Glass is working to improve doctor-patient interaction. One company, IOS Health Systems, has developed a native EHR app that can be used with Google Glass. This means that doctors could access patient information such as medical history, vitals, etc. and display it into the heads-up display while talking to the patient. This opens the possibility for doctors to reduce reference to a stationary screen and engage in more direct conversation with the patient, working to improve the doctor-patient interaction.

As I reviewed the literature I marveled at the possible impacts that technology like Google Glass could have on the practice of medicine and considered the role that Google Glass could play in our design setting. In the cardiovascular ICU physicians are required to both consolidate and communicate vast quantities of data into a simple and informative patient narrative and plan of care. In the current system often hand copy detailed data from the patient EHR onto sheets of paper. This practice, while necessary within the system, has created a sort of presentation “crutch,” where fellows will focus and rely on the data that they have spent so much time collecting rather than giving a cohesive patient narrative. Technology like Google Glass can work to eliminate this crutch. By allowing for the information to be readily available and accessible, physicians can focus more on preparing a patient narrative and care plan for presentation during rounds.

While Google Glass offers many positive aspects for the world of medicine it also holds many cautionary aspects. With the adoption of any new technology there come many unanswered questions. How will the ability to stream in real-time at any moment change privacy?  Will the knowledge that your doctor is viewing information that you cant see change the way that doctors and patients interact? The positive impacts that utilizing revolutionary technology in medicine can have are great, but as always we must move carefully as we move towards the future.

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