A few months ago, CBS Moneywatch published an article entitled “$1 million mistake: Becoming a doctor.” Aside from the possibility that devoting one’s life to helping others might be considered a mistake, I was struck by the “$1 million” figure.
Was it actually that much? I mean, $1 million is a lot of money. When I was younger, millionaires seemed a rarefied breed. They drove expensive cars and had houses with names like “Le Troquet” or “Brandywine Vale.” The figure was supposedly calculated using the following factors:
- The cost of school, inclusive of tuition, fees and insurance
- The interest on the loans incurred to pay for the above items
- The income lost by not working full-time for 10 years, assuming an average income of $50,000 per year
Before coming to medical school, I worked in the pharmaceutical industry. I even turned down a hefty promotion to start my education as soon as possible, rather than defer for a year or two.
Thus, my back-of-the-envelope calculations made it fairly obvious that, including benefits, bonuses, and potential promotions, my medical decision was not a $1 million mistake, but was more like a $1.3 million dollar disaster.
Of course, people tell me that I’ll be profitable and that I’m a good credit risk, but what I really am is one of a rarefied breed that drive economy cars and have houses with names like “Apt. #203.” What I really am is an anti-millionaire.
Continue reading “Medical Students: The Anti-Millionaires”
Filed Under: Physicians, THCB
Tagged: Daniel Coleman, FutureMed, Medical Education, medical student debt
Feb 13, 2014
America might never agree on how much doctors deserve to earn. But there ought to be much less debate on the immense debt today’s medical students incur on the way to becoming doctors.
Few people are more aware of the stress of medical student debt than med students themselves, and there’s evidence that it affects our specialty and practice decisions later on down the line.
Enter this tweetchat. What began as a typical med student complaint about their debt load evolved into a provocative discussion about the underlying factors and potential solutions to the debt problem.
We’ve incorporated some notes explaining perhaps unfamiliar concepts, but otherwise this is the unvarnished product of a few med students procrastinating on a Sunday night.
Allan Joseph (AJ): The easiest way to tell if med-student debt is becoming an acute problem is if the demand for medical-school spots (easily measured by the number of applicants) is declining relative to the supply. That’s just not happening. In fact, the opposite is.
Continue reading “The Real Problem With Med Student Debt”
Filed Under: THCB
Tagged: Allan Joseph, FutureMed, Josh Herigon, Karan Chhabra, Medical Education, medical student debt, Physicians
Jan 28, 2014
Over the last month, journal headlines have been heralding the death of massive online open courses (MOOCs). You could almost hear the sigh of relief from the academy. With Sebastian Thrun himself acknowledging the “lousy” quality of the MOOC product, told-you-so skeptics have been giddily pointing out that Udacity, in its failure to disrupt higher education, is now moving on to vocational training.
Sadly, what audiences are missing is that Thrun’s shift to workforce training is precisely what has the potential to disrupt and severely impact traditional postsecondary education. We at the Christensen Institute have already written extensively about how MOOCs were not displaying the right markers for disruption (see here, here, here, and here), but we became more hopeful as they started to offer clusters of courses. Coursera announced Foundations of Business with Wharton, while edX and MITX introduced the Xseries in Computer Science as well as Supply Chain & Logistics.
These moves appeared to map better to employer needs and what we describe as areas of nonconsumption. In their turn away from career-oriented training, colleges and universities have unwittingly left unattended a niche of nonconsumers—people over-served by traditional forms of higher education, underprepared for the workforce, and seeking lifelong learning pathways.
What most people forget when they bandy about the term “disruptive innovation” is that disruptive innovations must find their footholds in nonconsumption. McKinsey analysts estimate that the number of skillsets needed in the workforce has increased rapidly from 178 in September 2009 to 924 in June 2012. Unfortunately, most traditional institutions have not adapted to this surge in demand of skillsets, and as a result, the gap has widened between degree-holders and the jobs available today.
Continue reading “MOOCs Ain’t Over. Till They’re Over …”
Filed Under: The Business of Health Care
Tagged: Clayton Christensen Institute, Khan Academy, Medical Education, Michelle R. Weise, MITX, MOOCs, Sebastian Thrun, Wharton
Jan 24, 2014
Whether having meals with physician-relatives, attending a professional society meeting, or walking the halls of a hospital, I find that a common issue on physicians’ minds during our discussions is the American Board of Medical Specialties’ (ABMS) Board Certification process – and particularly our program for maintaining certification known as Maintenance of Certification (MOC).
Questions range from “I know you’re old enough to have grandmother status – do YOU do MOC?” (Yes) to “How can I fit this into my already insanely busy life?” Comments range from appreciation for some aspect of the program to frustration with one of the program components.
As the relatively new leader of ABMS, I welcome the opportunity to discuss issues pertaining to Board Certification and MOC. I hope this post will generate thoughtful dialogue that will result in continuing improvements to the certification process developed by ABMS and our 24 Member Boards. That, in turn, will help us render MOC more relevant and meaningful to participating physicians and will assist them in their efforts to provide quality patient care and improve our health care system.
For many years there were few, if any, requirements for maintaining ABMS Board Certification. Physicians took an exam after graduating from their residencies and thereafter had no further obligations for testing or evaluation. However, over time the error of this approach became obvious. Medical science continuously changes, and the pace of that change has accelerated.
Continue reading “Why Maintenance of Certification Will Make You a Better Doctor”
Filed Under: Physicians, THCB
Tagged: American Board of Medical Specialties (ABMS), Maintenance of Certification (MOC), Medical Education, Physicians
Jan 20, 2014
Coursera, the popular massive open online course (MOOC) platform, intrigues. With over 5 million students served and $85 million raised—both numbers are first among the “MOOC platforms”—it’s the type of company that captures the imagination of people in Silicon Valley who dream of transforming sectors.
Its reach and emerging focus on K–12 professional development were prime reasons that we at the Clayton Christensen Institute, along with the Silicon Schools Fund and the New Teacher Center, recently offered a MOOC on blended learning through Coursera.
But Coursera has always given me reason to pause as well. It’s never felt to me like its initial incarnation could possibly disrupt higher education. Why? As I’ve told its team, offering courses from the top universities online and claiming that at last, anyone anywhere can access the best learning in the world isn’t correct.
The reason is that the top universities do not offer the best teaching and learning experiences. Instead, their faculty members are incentivized heavily to focus on research at the expense of teaching. If a professor seeking tenure at one of these institutions receives a teaching award, it is often said that that professor has just received the kiss of death for her tenure hopes. If students learn at these institutions, it’s often not because the teaching is so good, but because the students are so talented that they can absorb anything thrown at them (and it’s worth noting that just because a professor is entertaining, does not mean it’s a good learning experience).
Putting these courses online often makes them worse. Not only do professors not know how to teach well in person, but also their lack of understanding of the basic principles of sound learning design causes them to exacerbate these problems as they put these experiences online, which can become more problematic as students from all walks of life with many different learning needs are now theoretically able to take these courses.
Continue reading “An Epic Fail for Massive Open Online Courses?”
Filed Under: Uncategorized
Tagged: business models, Clayton Christensen Institute, Coursera, Disruption, Education, Medical Education, MOOCs
Jan 1, 2014
The educational world is becoming flat.
A quiet revolution is underway in the way teachers and students interact using recorded lectures, YouTube, and the internet. In 2004, financial analyst turned online educator Sal Khan began tutoring his niece in math using an online drawing program. As he uploaded these lectures to YouTube, their popularity grew into a social phenomenon.
Today, Khan Academy has provided over 240 million online lessons around the world in over 4000 topics. Stanford, MIT, and other universities now offer massive open online courses (MOOCs) by top professors to all comers. In fact, Harvard Business School no longer offers an introductory accounting class due to the availability of an exceptional online course from Brigham Young University. With high-quality content readily available online, the student-teacher dynamic is changing. Students are expecting excellent instruction and teachers are expecting students to be increasingly knowledgeable about subjects from online viewing. These reciprocal heightened expectations have the potential to create a more dynamic and interactive classroom experience.
These innovations can also transform patient education by bringing patients into the circle of learning. Patients already leverage YouTube and other online sources for health purposes. For example, PatientsLikeMe was started in 2004 by the family and friends of Stephen Heywood who had been diagnosed with amyotrophic lateral sclerosis. This online community helps connect patients with other similarly affected patients and aims to educate patients about the illness experience and potential treatment options. This encourages patients to think synergistically about complex problems such as outcomes, decision-making and ethics. Today, PatientsLikeMe covers more than 1200 health conditions with over 100,000 members.
Given these broad ranging developments, we need to rethink the patient–doctor encounter. The typical encounter follows the traditional pedagogic paradigm of “banking” – in which the teacher, who has the power and the knowledge, seeks to deposit knowledge assets into the learner’s bank (1). Unfortunately, though this approach induces passivity and disempowerment it is the dominant mode of patient education. Instead, imagine encounters where patients are prepared to engage in shared decision-making, allowing the office visit to center on activities that promote patient-centeredness and engagement such as confirming patient comprehension, ascertaining values, and establishing goals.
Continue reading “The New Tools: What 21st Century Education Can Teach Us”
Filed Under: Tech, THCB
Tagged: FutureMed, HJDSI, Khan Academy, Medical Education, MOOCs, YouTube
Dec 11, 2013
You’re a loyal THCB reader. You have a symptom. You Google it. One of the first three hits will be an entry about the symptom or an associated condition on Wikipedia.
As an informed lay person, you wonder, “How accurate is Wikipedia for medical information?”
You’ve always been a little skeptical of Wikipedia, but over the years you’ve found it more and more reliable for celebrity tidbits (e.g. “How old is Jane Lynch?” or “What was the name of that guy in “Crash?”) and sports trivia (“How many Super Bowls have the Minnesota Vikings lost?”).
In fact, it’s become quite useful for understanding geopolitics, ancient and recent history, and helping explain science topics (Higgs Boson, anyone?).
So why not medicine?
We in academic medicine look down our noses at Wikipedia. “Show us original texts,” we harrumph. “Where does the original data come from?” we ask our residents and students.
Just like high schoolers and college kids are warned NOT to use Wikipedia as a research tool, medical professors hold the site lowly in regard to seriousness of purpose.
Well, it’s time to accept reality.
We all use it, whether we admit it or not. Some of us a lot. The good news is, Wikipedia’s going to get even better in the medical realm.
Continue reading “UCSF’s Wikipedia Experiment: Should Med Students Get Credit For Curating Medical Information Online?”
Filed Under: Tech, THCB
Tagged: FutureMed, John Schumann, Medical Education, UCSF, Wikipedia
Nov 8, 2013
Since its Sundance premiere in 2012, ESCAPE FIRE has screened for national leaders, medical experts, thousands of students, and the general public. The film opened in theatres last October, and had its broadcast premiere on CNN March 10th. From the Pentagon to local communities, ESCAPE FIRE has reached an incredibly diverse audience.
Last year, ESCAPE FIRE: The Fight to Rescue American Healthcare screened on college campuses nation-wide two weeks before opening in theaters. Almost 6,000 students came together to watch the award-winning documentary, and to host discussions about the current state of the American healthcare system. The sentiments from these discussions became calls to action: service projects, course work, and blogs for undergraduates and medical students across the nation.
This year we’re doing it all again. On September 17th, ESCAPE FIRE will play at more than 60 college and university campuses across the country, followed by panel discussions and Q&As. We’ve partnered with the Institute for Healthcare Improvement (IHI), one of the widest-reaching non-profit health organizations in the US, to make sure as many students are aware of the opportunity as possible.
We’re taking the event a step further this year by donating an Educational copy of ESCAPE FIRE to each participating campus, allowing the event to incite change for years to come. Our hope is that students, after attending an entertaining event and participating in thoughtful conversations about their communities, will take on an active role in transforming healthcare.
In order to make sure this discussion doesn’t stop after school or with student groups, we have accredited ESCAPE FIRE for both Continuing Medical Education units and Continuing Nursing Education contact hours. Now, anyone who views the film, can get educational credit. And for the week of September 17th through 30th, the film will be available on iTunes for $0.99.
This is a unique and unprecedented chance for healthcare providers to utilise the film to elevate and deepen the national dialogue about our healthcare system and our role in leading it out of crisis.
Spread the word about this event on Facebook and Twitter. And find a screening near you.
Filed Under: THCB
Tagged: ESCAPE FIRE, Health Care Reform, Institute for Healthcare Improvement, Medical Education
Sep 7, 2013
A fashion faux pas almost prevented me from getting into my dream medical school. Midway through the interview there, the interviewer pointed to my left earlobe and said, “Do you really think we accept men who wear … those things?”
I had no idea what he was talking about at first, but then remembered the gold post I’d forgotten to remove. In a disdainful southern drawl the interviewer let me know how dark a shadow this stylistic error cast on my otherwise favorable application.
I left his office fairly sure I would not be admitted. I also doubted whether I wanted to be admitted to a school that selected physicians on the basis of their jewelry. Really?
Twenty years later, medical schools around the country still struggle to find the right way to decide who should be the physicians of the future, and who should not. Most have evolved past caring about male earrings, but what are the right criteria for admission – what makes a good proto-doctor?
Over forty thousand students apply to medical school each year. Each applicant spends thousand of dollars in fees and plane tickets, and institutions spend still more to screen, host, interview and pick among the hordes of black-suited applicants. Increasingly, medical schools are considering innovative and creative ways to distinguish the most promising applicants from the rest.
New approaches include:
1. Using a more holistic review rubric that de-emphasizes grades and MCAT scores, such as at Boston University;
2. Suspending traditional pre-med requirements for humanities students, such as at the Icahn School of Medicine at Mt Sinai; and,
3. Creative admissions interviews that include problem solving, multiple mini-interviews and even observed standardized patient interactions.
Each of these innovative methods sounds great. Used in combination I suspect they will identify applicants with the necessary academic chops plus a great bedside manner.
Continue reading “A Modest Proposal: Replace the Med School Interview With fMRI”
Filed Under: Physicians, THCB
Tagged: FutureMed, Malcolm Gladwell, Medical Education, Nalini Ambady, practice of medicine, Tim Lahey
Aug 12, 2013
Consider the doctor’s office: the sanctum of care in American medicine, where a patient enters with a need — a question or an ailment or a concern — and leaves with an answer, a diagnosis or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It’s where health care happens.
But in a less sentimental light, the doctor’s office doesn’t seem so exalted. Yes, it remains the essential hub for clinical care. But what occurs in that room isn’t exactly ideal, nor state-of-the-art. The doctor-patient encounter is fraught with tension, asymmetrical information, and flat-out incomprehension. It is a high-cost, high-resource encounter with surprisingly limited value and limited returns. It is too cursory to be exhaustive (the infamous fifteen-minute median office visit), too infrequent to create an honest relationship (one or two times a year visits at best), and too anonymous to be personal (the average primary care doc has more than 2,300 patients).
At best, it offers a rare personal connection between doctor and patient. At worst, it is theater. The doctor pretends she remembers the patient, and that she has actually had the time to read the patient’s chart in full; the patient pretends that he hasn’t spent hours on the Internet trying to diagnosis himsef, half-admitting what he’s really doing day to day, and pretending he won’t second- guess the doctor’s orders the moment he gets back to a computer.
As woeful as that sounds, we know that there’s real value here. This encounter can be meaningful; it should and must be meaningful. The doctor is a necessary interface to medicine, and his office is a source of care, expertise, and trust. The patient is eager and receptive to learning, primed for guidance and direction. Pragmatically, the doctor’s visit is a powerful part of modern medicine. The problem is that we, collectively, are not optimizing this resource; we have not reconsidered and re-evaluated how we might exploit the visit to its full advantage.
So how can we improve this situation? How can we fix this thing?
Continue reading “Flipping the Doctor’s Office”
Filed Under: Tech, THCB
Tagged: Betty Irene Moore School of Nursing, Camden Coalition of Healthcare Providers, clinicians, FutureMed, Khan Academy, Medical Education, Patient-centered care, Patients, practice of medicine, RWJF, Thomas Goetz, UC Davis
Jul 17, 2013