There aren’t many great resources for medical clerkship education. While programs such as UpToDate offer a wealth of details for practicing physicians, the sheer volume of articles can discourage students from understanding the fundamentals of clinical medicine.
Case-in-point: my education on “real-world” medicine began as a hodgepodge of cases I’d see in the clinic, reading about those cases at night, and practice questions on UWorld. Sure, this method scored me points on multiple-choice tests, but what was missing was a framework for how to think about common medical problems. As much as I’d never want to go back to those months of Step 1/Level 1 preparation, at least there was a gold standard of review material: the much glorified UWorld, First Aid, Pathoma combination. There had to be something better out there for clinical education.
OnlineMedEd, a video series for medical students and interns, aims to change all that by making learning “easier, faster, and more reliable”. And like any education good resource, OnlineMedEd has spread largely through the recommendation of its user base. It wasn’t until I grew tired of hearing my classmate rave about the platform that I gave the videos a try, and my only regret is not starting sooner.
The brainchild of Dr. Dustyn Williams, the Internal Medicine Clerkship Director for Tulane-Baton Rouge, OnlineMedEd has since become my go-to resource for learning the fundamentals for my rotations. In a sea of factoids and trivia-type medical knowledge, OnlineMedEd provides easy to remember frameworks for thinking about high-yield medical topics. And the best part? All of the videos are 100% free. Don’t believe me? Check out the video on coronary artery disease.
Dr. Williams has taken the time to answer questions about his platform, how medical education has (or hasn’t) changed since he was a student, and what’s in store for the future of OnlineMedEd. This is a great read on the theory behind why his platform has been successful so far and why students are raving about it.
1. How has medical education, specifically 3rd/4th year clerkship education, changed from when you were a medical student?
Honestly, it hasn’t. People are trying to make changes, and that’s awesome. But the changes keep showing “just as good as it was.” People call that a non-inferiority study.
Here’s the thing, though. Medical students are smart. Resources exist for their success. Students succeed in spite of new curricular changes, not because of them. A non-inferiority study just means the new curriculum was just as bad as the old one, and students went outside their school to get what they needed.
Most importantly, from a top-down perspective, there have been changes in the LCME that reflect the changes in the ACGME core competencies. Medical knowledge is not stressed as heavily as the things that make an effective person: communication, teamwork, leadership, professionalism. The idea is to get students away from memorizing everything about everything, and coaching them to be more effective players. That means students need to learn frameworks, foundations, methods. While that is all great, there hasn’t been (until now) a method for teaching that: people keep giving lectures and students keep complaining.
Yeah…schools keep talking about technology. Apps come out, iPads are distributed, even hand-held sonograms. But no one addresses the common core problem: the quality of education. Technology alone cannot succeed. We need technology and quality education.
I think you’re going to see a lot more small group sessions, problem-based learning, and team-based learning in the future. There is a really big push to “flip the classroom.” That, we think, is how we’ll satisfy the LCME mandates to build better people, not just more knowledgeable doctors. That’s what we at OnlineMedEd want as well. We’ll talk more about that later.
2. What are the biggest differences between designing an online platform versus an official medical school curriculum?
We move faster. Academia moves like a slug uphill backwards covered in molasses and lit on fire. Any change that’s made at a school level is in the magnitude of years, not days. We just don’t have the burden of committees and approval processes. We just do. There also isn’t a bureaucracy demanding items a, b, and c on the list are checked off. That lets us focus on what’s actually needed from the student perspective. That means the users are actually crowd sourcing us ideas from hundreds of medical schools. Freedom also means we don’t have to be politically correct or proper; we can develop in an informal style with the sole focus of improving retention and making the student a more efficient and better doctor. It might seem insignificant, but that allows ufs to do things an official curriculum can’t. Understanding is more important than truth; making the right choice, whether it be for a virtual patient on a test or a real patient in real life, is actually all that matters. We get that.
The other difference is scope. The trouble with education is that it doesn’t pay. Faculty are paid, promoted, and evaluated based on research and clinical work. While some universities are trying to come up with schema to promote education, it’s always the first thing to go. And so you are left with hit or miss education. Sometimes you get that awesome lecture that stands out amongst all the others, but they are too few and far between. Worse, the person at school A teaches only school A, they literally cannot teach more than the students they have. But with online content? Immediately scalable to everyone everywhere, instantly. We have no limits on the number of students who can benefit. The scope even extends beyond the target audience; anyone can come, anyone can benefit. It’s not just MD students who come to OnlineMedEd… we’ve got PA, NP, MD, and DO students alike.
3. What role do you see online video-based platforms such as OnlineMedEd or Pathoma playing into the future of medical education?
It is the key to the flipped clerkship, the flipped classroom. Pre-work teaches the content you need to know. Deliberate practice in the classroom gets you to the next level. And that’s the magic. Instead of catching up, you next-level it.
But I wouldn’t say video-based platforms, but rather comprehensive platforms in whole. Videos themselves are essential for the curriculum to work, but they are not sufficient. Too many people learn too many different ways for that to be effective. As the demands of the medical system continue to increase time management becomes more essential than ever. This platform alleviates demand on students and faculty alike. It allows a student to learn on their own schedule, at their own pace, and in the method best for him or her.
We provide the online, virtual training environment to set the student up for success. Then, by realizing the flipped education model, the faculty can spend their time adding on the next levels of learning. That’s really where their interest is, isn’t it? The end result is schools/hospitals run more efficiently, faculty are happier, and students learn more by actually putting into practice what they’ve learned.
And here’s the best part. By freeing the student up from the burden of medical knowledge, faculty can focus their attention on developing the other skills crucial to being an effective physician. Those are the other core competencies laid out by LCME: teamwork, leadership, communication, and professionalism. Unburden the students, free them from the fear and anxiety of medical knowledge and testing, and watch them grow as people.
4. Is there data/literature to suggest this style of education is more effective than traditional classroom-based methods?
In the publish or perish world there’s always research. I could point you to a few publications, but honestly I don’t like to. MedEd research is inherently difficult. The student population changes annually (and is often not representative year to year), resources shift, educators move, and it’s a challenge to get the power you need to empirically make statements of yes or no.
That said, we’re developing partnerships and programs to see if we can help make the case. However, that process takes years and the results may never be telling for the reasons listed above.
So while there “is evidence” this stuff works, I don’t like citing it. I use people instead. People who aced their Step 1 exam (they beat the game by playing well) and walk onto wards and get crushed. Then they find OnlineMedEd and are back on top. The people who get Junior AOA because they us the site. The people who were failing or just barely passing their shelves, then jump up to High Pass and Honors.
And then there’s the 15,000 unique visitors that come to the site. Yeah, it’s free, so it’s easy to show up. But people wouldn’t show up, they wouldn’t keep coming back if it didn’t work.
And if that’s not enough, you go to an Academic Academy or a medical education fellowship, you’ll hear all the same principles. They’ve been worked on by some pretty potent educators. I won’t name drop, but suffice to say I didn’t make this stuff up on my own. Stanford, UCSF, and Hopkins (you may recognize the names) have been promoting this style of education for a long time. I took their teachings, their know-how, their abilities, and made it to scale. Sure you lose a little by not being in person. But the number of people who benefit easily outweighs that.
No one yet has been able to scale it like we have.
5. What’s in store for the future of OnlineMedEd?
We started off as a dude with a camera in his bedroom. We’ve gone far from there. We have further yet to go. And we’re going in multiple directions.
We’ve started with the students and that’s where our primary focus is. We’re improving our methodology and bringing on new content in July to even better promote retention and understanding. No matter what type of learner you are, there will be something for you. Integrating these resources with clear study plans will make learning what you need to even easier.
We’re also forming partnerships to bring on additional content creators for intern and residency years to help develop the student into an eventual powerhouse attending. It won’t just be medicine, we’re talking every specialty at every level. That’s the end-game: education from start to finish.
Finally, we’re forming partnerships with medical schools to get research done. How can these materials be used? We’ve got one school using it as a remediation tool for failing students. We’ve another actually flipping the classroom at the clerkship level. Every day, as the word continues to spread, it’s easier for faculty to see the symbiotic relationship we can have to help them differentiate themselves and improve the education experience.
The future is open. We won’t stop.. We are educators. We are academics. And we are pioneers. It’s an exciting time in medical education and I’m in it for the long haul. As an academic lifer it’s something I’m committed to and excited to be taking on.