By Matthew Carr, SKMC Class of 2019
Healthcare is amid an unprecedented paradigm shift. Rapid advances in technology, new legislation, and a myriad of other factors are constantly remodeling the healthcare landscape. However, for medicine to successfully transition into this new future it will require some restructuring of the fundamentals of its culture, a shift in mindset of both patients and healthcare professionals, and changes to medical education. To ensure the professional and emotional viability of the next generation of physicians, there must also be a resolution to the present system’s ineffectiveness in providing quality, affordable care to everyone. This will require disruption of the status quo of medical practice and improved allocation of our healthcare assets. Unfortunately, medical institutions and the government have well-earned reputations for conservative policies and a long history of resistance to change.
In contrast to this “Old Guard,” Silicon Valley has been synonymous with creativity and innovation for the past generation. Before this area became the technology hub that it is today, it was a sleepy agrarian community of scenic orchards on the outskirts of bustling San Francisco. The birth of the silicon semiconductor forever altered the face of this land. Massive companies such as Hewlett-Packard were created in the garages of suburbia, springing from brilliant minds which were powered by their spirit of invention, regardless of their shoestring budget. This burgeoning electronics industry became a powerful economic force and gave the area its famous moniker. The farmland and tract houses evolved into a mecca for modern technology and innovative business ventures. The capabilities of the computer chip and the software industry exploded and spawned the familiar behemoths we know today as Intel, Apple, and Google. These companies embrace the shared purpose cited by Timothy J. Sturgeon that "the strongest thread that runs through the Valley's past and present is the drive to 'play' with novel technology." In another contrasting intellectual discipline, northern California is also home to several of the most prestigious medical institutions in the country. This poses an interesting question regarding whether the proximity to a hotbed of innovation is intellectually contagious?
Healthcare has always taken a more cautious and measured approach to change. Any deviation from the norm usually requires a groundbreaking scientific discovery or the proven efficacy of a lengthy clinical trial. However, the outcome from the intermingling of the 'playful' tech culture and the conservative bastion of the healthcare institutions has yielded some interesting results. For example, medical students in proximity to the Silicon Valley, such as those attending Stanford or the University of California San Francisco, are diverging from the standard practice of clinical medicine. In 2011 only 68% of Stanford graduates sought medical residency positions. Many students are instead opting to found startup ventures, create new medical devices, or seek employment in financial or pharmaceutical companies. Many of the most qualified young physicians are being drawn from direct patient care to positions with greater financial, personal, and professional autonomy.
These graduates can be found as employees of newly founded companies, such as Vida Health, founded by UCSF graduate Connie Chen. Her business connects chronically ill persons with physicians, nurses, nutritionists, and therapists. This healthcare team assists each patient in meeting their individual medical needs. Another entrepreneur, Pelu Tran, chose not to pursue a residency tract after graduating from Stanford Medical School. He instead formed Augmedix, a company that markets the use of Google Glass which is an eyeglass mounted camera and display. This device enables a remote connection between a physician and a scribe that allows the completion of the EMR during the visit. This frees the doctor to devote uninterrupted time to focus on the care of the patient. To further capitalize on its location and history of collaboration, Stanford Medical School recently announced the creation of the Center for Digital Health. This entity aims to facilitate intellectual camaraderie and interface in a collaborative business relationship with their technology neighbors, both startups and corporate giants alike.
But the question remains: how can this type of thinking be cultivated from the start of medical school and make the greatest impact on the life of each student? The opportunity to embrace the spirit of innovation and change is of paramount importance, especially if the stature and desirability of pursuing clinical medicine is to continue. Medical schools should emulate the success reaped by those inhabiting the Silicon Valley who adopted the changes as they appeared on their doorsteps. In fact, some schools far from Silicon Valley have embraced the inevitability of this evolution and acted accordingly. At Jefferson University, Sidney Kimmel Medical College recently adopted a unique extracurricular JeffDESIGN program. This provides the opportunity for students to attend workshops and lectures to learn how design skills can be utilized within the arena of healthcare. Other medical institutions have also chosen to expand their traditional educational tenets. Students attending the Donald and Barbara Zucker School of Medicine at Hofstra-Northwell spend their first educational block training to become certified EMT's. Matriculants at the Duke University School of Medicine complete a compressed core curriculum in two years which allows almost one third of students to complete an additional advanced degree.
Although there has been a significant learning curve to adopt of these innovative ideas, it should be clear to all medical schools that the medical education and the practice of healthcare is in the midst of inexorable change. Institutions must accept and then contribute to the progress of this inevitable evolution. This will assist the current generation of students and future physicians to succeed in this competitive and innovative world. We must all be believers in Charles Kettering who wrote, "If you have always done it that way, it is probably wrong."
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