From SFO, I carefully followed my Droid Navigator’s directions off Highway 101 into a warren of non-descript low-slung office buildings—non-descript except for the telltale proliferation of Google signs and young adults riding colorful Google bikes. I drove around to the back of several of those complexes and finally found the correct numbered grouping. It really could have been any office or doctors’ office complex in the U.S. The Khan suite is on the second floor. There’s a simple brass plate saying “Khan Academy” on what looked like oak double doors. I let myself in and immediately encountered a large, central open space—with long dining tables, food, an ample sitting area with couches conducive for group discussions—and a friendly greeting by programmers and staff. Oh, and computers—there were lots of computers. As far as I could tell, nobody had their own office—though maybe Sal does. Everyone was also open, friendly and passionate about the great work happening there.
After some trial and error, Rishi and I found an unused office and huddled around his Mac for a Google Hangout interview with a Bay Area reporter about the Khan/RWJF health care education project. Later, I met with Shantanu, the Khan COO and former “math jock” high school friend of Sal, as well as Charlotte, external relations, and Matt, software engineer. They’re all long termers at Khan—that means they’ve been there for about two years. Overall, the energy was pretty electric. One other small thing—do not be fooled—these incredible people are, how should I put it—ferociously—intense and focused.
Pioneers in flipping the med school classroom
The next morning, Rishi and I met at Stanford Medical School—in the Li Ka Shing Center for Learning and Knowledge—an enormous and beautiful building off Campus Drive near the hospital that did not exist back in my days as an earnest Stanford law student. We were there to observe some pioneers in medical education attempt to use Khan-like videos to flip the medical school classroom. This work at Stanford is part of the current Khan Academy and RWJF collaboration. We’re trying to understand what happens when a medical school attempts to use the Khan-style videos to change the classroom interaction.
The class we observed was an ECG Cardiology course. The professor, Dr. Paul Wang, was everything you’d want from a teacher—smart, informed, compassionate, patient—and popular with his students. The students were great—also smart—and empowered. Several noted that they liked viewing the video before class. In fact, at one point, a number of female students grouped around Rishi—once they discovered he was the man behind the Khan medical school curriculum videos—and gushed. I momentarily flashed to black and white footage of Beatle-mania.
This Stanford class-flipping experience is new—in fact, it’s just a week old—so I got to see it at its beginning. In the first hour, Dr. Wang essentially gave the video lecture again. In the subsequent two- hour small group sessions, the students worked with teachers on ECG problem-solving and games. They engaged well with the teachers and each other—and seemed to be using new vocabulary and identifying ECG patterns pretty adeptly by the end.
The dean, Dr. Charles Prober—a Stanford Medical School champion of moving medical education content into YouTube format and onto the Khan platform— was there. Another local champion of this work, Dr. Drew Patterson, associate professor of anesthesiology, was there as well. These leaders, Drs. Prober, Patterson and Wang, are creative and brave people. They are trying to bring the first ripples of widening care transformation to fortress academia, and no doubt the status quo will not adjust quietly. Both Drs. Prober and Patterson spoke passionately about the enormous potential of this technology along with changing attitudes about medical education. They are trying hard to get their medical school to embrace that change and help lead it.
Facing massive changes and challenges
This new work is not without problems, of course. In fact, it’s pretty challenging. Rishi and I witnessed early baby steps. Drs. Prober and Patterson readily admit that they would like to rely more on videos, better empower students to teach themselves based on those videos and more quickly change the role of teachers to be more like coaches. Rishi and I also, though, wondered about waves of transformation hitting health care now—around, for example, patient empowerment and professional accountability for results and decreased cost. Those massive changes include efforts to alter the dynamic both between the professional and the patients and among various health care professionals. Those challenges are enormous and could swamp fledgling incremental efforts to help a few medical students learn well and efficiently. Right now—in this interesting experiment—these teachers are not yet training for that new day. I say, though, give them time.
Rishi and I also talked about an even more worrisome point. What if in the near future much of this learning becomes anachronistically analog? Imagine the coming proliferation of Watson-like artificial intelligence in health care. On our visit we observed bright minds learning how to “read ECGs.” That’s what medical students have done since ECGs came to medicine—that’s part of what medical students must learn. What about when things change, though? It’s not too much of a leap to imagine that a device will simply inform teams—including the patient, by the way—of the definitive ECG reading. All this learning about how to read ECGs would then be superfluous—an “FYI.” What then? My guess is that we’ll need professionals who are very adept at taking that knowledge and working together with patients do the actual healing—you know like Bones on Star Trek.
We have a lot of work to do.