Another Step toward Open Health Education

Osmosis Screen

Earlier this month Shiv and Ryan published a piece in the Annals of Internal Medicine, entitled What Can Medical Education Learn from Facebook and Netflix? We chose the title because, as medical students, we realized the tools our classmates are using to socialize and watch TV use more sophisticated algorithms than the tools we use to learn medicine.

What if the same mechanisms that Facebook and Netflix use—such as machine learning-based recommender systems, crowdsourcing, and intuitive interfaces—could transform how we educate our health care professionals?

For example, just as Amazon recommends products based on other items that customers have bought, we believe that supplementary resources such as questions, videos, images, mnemonics, references, and even real-life patient cases could be automatically recommended based on what students and professionals are learning in the classroom or seeing in the clinic.

That is one of the premises behind Osmosis, the flagship educational platform of Knowledge Diffusion, Shiv’s and Ryan’s startup. Osmosis uses data analytics and machine learning to deliver the best medical content to those trying to learn it, as efficiently as possible for the learner.

Since its launch in August, Osmosis has delivered over two million questions to more than 10,000 medical students around the world using a novel push notification system that syncs to student curricular schedules.

Osmosis is aggregating medical school curricula and extracurricular resources as well as generating a tremendous amount of data on student performance. The program uses adaptive algorithms and an intuitive interface to provide the best, most useful customized content to those trying to learn.

However, as Ryan and Shiv conclude in their Annals article, data can only take us so far. Anyone who has received a baffling Netflix or Amazon recommendation can likely relate to that problem. Ultimately Osmosis will need an even larger database of curated and validated open educational resources (OER) to create a truly useful health education platform, for both clinicians and patients.

To help take this work to the next level, Robert Wood Johnson Foundation (RWJF) recently extended a $150,000 grant to help Osmosis make its platform accessible to all clinical students and, eventually, patients and other public users.

This project will build on RWJF’s ongoing investment in reimagining medical education. As Michael says, this kind of smart online platform that enables customized, just-in-time learning could be another piece in our search for that giant leap to “free, ubiquitous and utterly fantastic health care education.”

The Osmosis content will be openly licensed under Creative Commons so that students and faculty can continuously improve upon it through the Osmosis crowdsourcing platform. Combined with our recommendation engine, this high-yield content will be made publicly available on www.osmosis.org.

Members of the medical community, we need your help. We need clinicians, experts and educators like you to help contribute and review content. We’re counting on the medical community as we develop and curate practice questions, images, videos, mnemonics, and other resources in ten specific areas, from anesthesiology to surgery.

If you’re interested in helping us build this unique and potentially powerful learning tool for all, learn more at https://www.osmosis.org/oer/apply.

Shiv Gaglani (@ShivGaglani) is a co-founder of Osmosis.  An editor of Medgadget, he is currently an MD/MBA candidate atthe  Johns Hopkins School of Medicine and Harvard Business School.

Ryan Haynes, PhD is a co-founder of Osmosis.  He is also an MD candidate at the Johns Hopkins School of Medicine.

Michael W. Painter, JD, MD (@paintmd) is a senior program officer at the Robert Wood Johnson Foundation.

17 replies »

  1. Ryan, the Bahn brothers now run Medivo…they started Ozmosis and may sell you the name if you care…

    You are sharp, young, hardworking and intelligent. I am none of those but my only differentiating factor is that I am old, have a semi-decent memory and like to throw the odd rock.

    No harm meant & good luck with the project!

  2. Hi Matthew,

    Thanks for the opportunity to explain the name “Osmosis”. I came up with the name Osmosis when I was writing the first few lines of code for it while in my first year of med school in 2011. Osmosis had two meanings: the crowd sourcing and targeted recommending of questions allowed knowledge to diffuse among med school classmates instead of a simple top down educational model. The push notifications of the mobile app would allow passive learning (the 2nd definition of “osmosis” in Webster’s dictionary) that did not require a student to create a schedule to return to her cardiology text 3 months after the exam on it in order to keep the facts fresh in her head.

    I’ll admit I was a bit surprised by your comment, especially considering that not a single one of following google searches: ‘osmosis’, ‘osmosis med’, ‘osmosis healthcare’, ‘osmosis online health’, ‘osmosis education’, ‘osmosis doctors’, ‘osmosis physicians’, ‘osmosis social network’ produces ‘ozmosis’ in the search results (4 of the 8 do produce our site osmosis.org however). The only thing that finds ozmosis is ‘osmosis online physician community’ and the only way you’d be able to do that search is if you already knew it existed and what it was (we didn’t we we started Osmosis and it’s not surprising considering that we were students, not MDs, and ozmosis doesn’t seem to even be active anymore).

    I also wanted to clarify that osmosis.org targets students and the delivery of didactics to enhance long term retention of knowledge. Again, both Shiv and I are medical students (not young MDs) and started developing Osmosis as a tool to help us and our colleagues more efficiently absorb and retain the lecture-based components of medical training so we could spend more time learning from patient interactions. Although medicine is our area of domain expertise, Osmosis already has been used (in private beta) to deliver content all the way from graduate school down to high school. Thus, it aims to be a generic educational tool that enhances learning and promotes retention. “ozmosis” seems to have been a professional social network specifically for practicing physicians (more like an online forum + medical news aggregator… something a bit closer to LinkedIn or ReasearchGate I think). That’s not the purpose of Osmosis, but I could understand how based on only this blog post that the distinction might not be clear.

  3. But Osmosis isn’t just about question and answer learning; that’s just a very small part. It’s also about all the resources available to students such as videos, mnemonics, diagrams, and just about anything else that can be imagined and getting them to the student at the point of learning. After, Osmosis tests the students before everything is forgotten in the deluge of information that is medical school. This allows more focused study on new concepts as old concepts are strengthened not only with questions and resources but also time in clinic which helps students and doctors recall information when they need it most.

    Osmosis isn’t about not bothering to study. It’s about studying smarter.

    Osmosis’s website does focus on boards and exams because that’s what worries med students, but it’s also about solving the problem of retention and information overload in a system of education that has barely developed in 100 years for a subject that has developed exponentially.

  4. The real scandal here is not the question about whether young MDs are practicing medicine or older ones are bullying them, it’s shocking re-use of the name!

    Ozmosis was a not too unsuccessful online physician community started by the Bhan brothers also young MDs who now run Medivo. You can see it right here https://ozmosis.org/home

    Now a new batch of young MDs are running an online community for other MDs and they decide to call it Osmosis. It’s also a dot org

    You notice the massive difference? Ozmosis vs Osmosis

    Guys, was that the best name you could come up with and did you do a Google search to see if anyone had used anything like it in online health before?

  5. A thread which was intended to discuss an open health education resource has now turned into one regarding physician bullying…

    Sighing indeed.

    Any chance we can get back to the point here?

  6. First of all, thank you to Shiv, Ryan, and Mike for your tremendous work. This is an exciting development and one that I hope will help many health care professionals and their patients.

    Second, I would argue that you reconsider inviting Dr. Sibert to work with you. I was shocked by her rude comment questioning your motivations, which you handled with grace despite it being totally uncalled for and not even remotely related to the article you wrote. Sibert is a well-recognized bully in the field of medicine, and I knew her name sounded familiar so I did a google search. She was the author behind this NYT article (http://www.nytimes.com/2011/06/12/opinion/12sibert.html?pagewanted=all&_r=0) basically arguing that doctors neither deserve nor should expect having a semblance of work-life balance. Here are a few representative comments (many from physicians) in response to her viewpoints (http://onpoint.wbur.org/2011/06/16/should-doctors-work-more) that will give you insight into the fact that she bullies doctors and not just medical students:


    I am deeply insulted by Dr. Sibert’s suggestion that I have a “moral obligation” to work full-time- that this isn’t a choice.  After dedicating 14 years of my life to “training” (8 MD/PhD, 3 residency, 3 fellowship), during most of which I worked 80+ hours per week while being paid below minimum wage, I feel the least I deserve is the ability to now choose how to balance my work and my home-life in a way that makes sense for me and my family. Dr. Sibert should take a little time away from the OR and be referred to Sheryl Sandberg’s beautiful Barnard commencement address…. her children, her colleagues, her trainees, and her patients will thank her for it.

    Dr. Sibert needs to examine her own motivations for writing that Op-Ed in the NY Times.  Perhaps she’s motivated by annoyance or jealousy, that she put in “full time” hours and those around her have better, more balanced lives?  Perhaps she just wants to point out to the world that, hey, look how tough she is – everyone should try to be as tough as her, raising 4 kids and nevertheless having a full-time career as an anesthesiologist.

    What Dr. Sibert has failed to realize is that the system is broken not the people trained in the system…Since Dr. Sibert is concerned about the primary care physician shortage, wouldn’t it be great if she re-trained to take up the clarion call to become a primary care doctor who works full time?

    I am offended, insulted, and enraged at this op-ed.  Offended and insulted because it is NOT up to her to tell ANYONE what they should with their education.  Use it, don’t use it, work part-time, work full time, throw it all over your shoulder & go weave baskets in Bali–the last time I looked this is NOT a communist society, where your occupation is ASSIGNED TO YOU, and where the parameters of that  occupation are decided by SOMEBODY ELSE. But I am enraged because she has twisted facts, used inflammatory language, relied on illogic, and outright lied.  And 90% of the people reading her article will not look beyond their noses to see if what she is saying is true.

    I very early on came to terms with the fact that this field is permeated with the egotistical madness that drives people to write essays filled with the pomp and unjustified indignation as Mrs. Silbert has done here. I’m not saying that everyone is like this, but if you really went to medical school you cannot say that you’re surprised to find that there is a physician with marbles loose enough to honestly believe she’s better than everyone around her and that she would scream as loudly as possible from atop her cyber podium in order to make sure that you all knew.

    Are you feeling guilty about having neglected your children Dr Sibert? I am an emergency medicine physician who recently cut back dramatically on my hours to raise my children. I am a better mother with a happier family. I am also a much better doctor since I am no longer exhausted, have more time for continuing medical education, and I am excited to see my patients. My patients are better served with my new situation. The growing doctor shortage is due to physicians’ dissatifaction with a broken system, as opposed to some of us scaling back temporarily.

    Firstly, Cry me a river, Dr Sibert!  If you really cared so much about helping the poor, sick masses, you would have chosen to practice internal medicine in Appalachia, not anesthesiology in L.A. That being said, I am a female pediatric subspecialist and I work 85% time.  I wish I could work even less, but I cannot afford to due to being a fairly equal breadwinner with my husband.  I do not think doctors have any moral obligation to pay back the government for their investment.  We are human beings, like everyone else.  We have biological drives, we love our children, and it is in our genes to want to nurture them.


    Please don’t be discouraged by what I hope are becoming increasingly rare, albeit vocal, physician bullies. Their pens, if not their diplomas, should be taken away.

  7. Oh dear, no. Getting an MD degree would never contribute financially to a business plan; you’re absolutely correct. However, it can provide a credential that opens doors. That’s why MD/MBA programs are proliferating. Everyone wants to be a thought leader, whatever that is. The only problem is that no one wants to take care of the patients.

    I’m relieved at least to hear that you’re taking time off from medical school to do all this. Medical school ought to be a full commitment of intellectual as well as physical energy.

    I suppose what depresses me about the Osmosis logo is the concept that medical education is only about “acing” classes and board exams. Medical care isn’t a simulation or a game; it’s about learning all you can learn so that you don’t hurt people who are in your care. It’s not even necessarily what you know; it’s what you can think of in time. There isn’t always leisure to open your iPad.

    What I see today is an excessive focus on question-and-answer learning rather than sitting down and reading about one topic or one disease in a comprehensive way. If you know the subject, the tests will take care of themselves. I’d rather see students shadow physicians on rounds or in the ER if they want to pick up information by osmosis. Then when you go back and read about the disease of the patient you just saw, it all makes sense.

    Writing is a hobby, pursued late at night and in odd moments. That is why I am just now getting to my personal emails, after getting home from my usual full day in the operating room. I didn’t begin writing opinion columns until my last child left for college, at a time when I had been board-certified for quite some years and actually had something to say. I wish more people would show similar restraint.

    Your comment about the profession of anesthesiology being sought after for its income potential is amusing, or would be if I didn’t think you were serious. The unhappiest people I know are those who pick their field for the wrong reasons. For whatever reason, I enjoy taking care of very sick patients, knowing how to ventilate them on one lung for their cancer operations, knowing how to get someone with an EF of 20% through major surgery. I hope some day you have a comparable sense of your own hard-earned expertise.

    In the meantime, go to medical school for real, or don’t. But please don’t do it halfway. And please don’t contribute to the prevailing myth that you can learn medicine by osmosis, without actually bothering to study.

  8. Thank you for giving us the opportunity to clarify our career paths with you, Dr. Silbert. Both Ryan and I are very interested in practicing medicine. As is the case with your journalistic endeavors, we also have passions that we intend to combine with medicine to contribute to the field. I’m sure you can relate given your excellent articles that raise awareness to important issues. The time spent on those articles may also have been spent on patient care, but I believe your choice to write them was wise since they contribute to a necessary dialogue that may influence policy and thus have a broader effect.

    I’ll speak to my own career goals here. My two passions are medicine and education, which I’ve found to be highly complementary given that both fields involve teaching and behavior change (e.g. motivational interviewing). My goal is to use technology and journalism to contribute to these fields, which I’ve had the good fortune of being able to do as a medical student through creating Osmosis (which is being used by over 10,000 colleagues and helping many of them retain information that can eventually be used to help patients) and editor of Medgadget (which raises awareness of cutting-edge technologies that also may affect not just hundreds of patients but tens of thousands). What I’m getting at here is the ability to have a broad impact, informed by personal interactions. That has been my motivation to write articles and books or start companies, and I believe I am not alone in this.

    Both Ryan and I have worked with patients at the Johns Hopkins School of Medicine and I would argue that our most meaningful interactions were in the clinic of our mentor, the neurosurgeon Dr. Daniele Rigamonti. It was there that we comforted and examined patients with idiopathic normal pressure hydrocephalus (iNPH). These patients are often not diagnosed early on and present with severe mental or physical symptoms, such as dementia, incontinence, and impaired gait. We could each spend the rest of our professional lives seeing 10 iNPH patients a day and still only reach a fraction of the total number or people who suffer from this condition. Or we could spend a few days each week seeing these patients, which in turn would inform the rest of our time; time spent devoted to research to find a way to detect iNPH earlier (which incidentally we’ve been working on) or developing an app or other tool that helps patients track their symptoms over time. If these latter efforts are successful we could help hundreds of thousands of patients, well beyond our retirement. Ultimately this is how progress is made.

    We are excited about curating and creating freely accessible health education resources with the support of the Robert Wood Johnson Foundation and similarly feel that through this endeavor we can help thousands of future health professionals access and learn important information that in turn will affect hundreds of thousands of patients. We did not begin medical school with this intent, but our experiences in the classroom and clinic have shown us that there is a need for such resources and technology, which is why we’ve decided to take time off to contribute to the field of medical education.

    Regarding your last comment, pursuing an MD degree as “part of the business plan” would be highly imprudent because the financial and opportunity cost would be untenable. I am sure you are familiar with the current state of medical education in terms of graduating debt as well as declining reimbursements, which for better or for worse drives many of our classmates to pursue fields such as the one you are in (anesthesiology).

    Ultimately the solvency of our health care system, and the health of our society, will depend on innovations in public health, policy, and – yes – business. I am happy to discuss further if you would like to email me at sgaglani [at] jhmi [dot] edu.

  9. Thanks for the interesting comments and discussion.

    Shiv and Ryan, to the extent it’s necessary or appropriate, can comment on their personal career plans. We at RWJF though are interested in innovative, entrepreneurial ways to help make learning about health faster, better, cheaper.

    To do that we like to encourage energetic, smart, creative individuals impatient with the marginal status quo. The fact that Shiv and Ryan are high performing medical students is, if anything, potentially a plus. For instance, these two have already created a medical education question resource, Osmosis, that’s pretty popular with their medical student peers. Currently, about 7500 medical students use the Osmosis crowd-sourced question bank globally. In fact their medical student perspective no doubt helped them create a learning resource that’s valuable to that medical student audience.

    But Shiv and Ryan think they can do more–we do too.

    There seems to be a bit of a misunderstanding in this discussion string about the learning engine piece of that next step for Osmosis. The Internet is obviously a vast place with an enormous number of resources for learning–mixed in of course with even more items that are not so helpful. We all need engines and tools–like a Google search engine or curated sites like Wikipedia–to help us find the best resources on the Internet wild west precisely when we need them. Without those engines and tools the Internet would be an enormous but essentially useless repository of stuff.

    But the search engines and tools we generally use are not customized to find the optimal content to learn about health–say medical education–efficiently. The Osmosis team will use machine learning to identify the content that users find most compelling and helpful–learn from those users to find better and better content and then with that information point the out that content for others. The idea is to decrease the hunting time for great education content–to make learning faster, better, cheaper.

    We think that’s potentially pretty important. With our support, if their work goes as we hope, we also think that everyone interested in learning about health can benefit from that resource as well.

  10. Happy to provide more detail, Rockville and m25. If you can access it too, our piece in the Annals of Internal Medicine does this as well. We’d be happy to share if you email us.

    One example of Amazon/Netflix-style recommendations as applied on Osmosis is as follows: based on what a medical student is looking at, e.g. a course document, we have developed a system that will automatically recommend related content that other medical students look at, e.g. a YouTube video or mnemonic. That’s similar to Amazon’s “customer who bought this also bought that” or Netflix “if you liked this TV show, you may also like…” We are happy to go into more detail with you about how this is accomplished if you email us (hi [at] osmosis [dot] org).

    If you download the free Osmosis Med app on Android or Apple devices you will also see that we recommend content based on curricular schedules, such as exam dates. That’s another intelligent recommendation feature that you may find interesting.

  11. @BobbyGvegas, thank you for your question. We are creating open educational resources (OER) for medicine with the generous support of the Robert Wood Johnson Foundation. In terms of sustaining the platform, we have a few potential options: follow-up grant funding, approved and helpful advertising, and providing users more analytics or features beyond access to the OER. Please feel free to touch base should you have any additional questions.

  12. Seconding Rockville’s inquiry. Shiv and Ryan, perhaps tapping into your own experiences in medical school and providing us an example of where Osmosis might have been been beneficial would help us have a better picture of how this would work…

  13. Ouch, Karen. Since when did taking advantage of opportunities to open up access to med ed resources turn into a master plan for world domination?

  14. Why is using an learning engine better than traditional learning? Tell us more about your algorithm. You’re going to have to do better than it “works like Facebook” and “Netflix” you’re going to get a lot of the skepticism you’re hearing here. Med students already have the internet, a pretty decent “learning engine.”

  15. My question is this: Did Gaglani or Haynes ever have any real intention of practicing medicine, in the sense of taking care of actual patients? (As opposed to avatars.) Or were their quests for MD degrees simply part of the business plan?