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Shifting the Paradigm: Moving from rote memorization to training in and using information tools


Middle school kids can use calculators when they take a test, so why can't medical students use open books or computers? Art Papier, M.D., is a dermatologist and medical informaticist who says medical education is flawed. It's time, he says, to shift from memory based, to memory assisted learning. 

Albo: How is technology helping us move beyond diagnostic errors? I'm Amy Albo with the Algorithms for Innovation team in Baltimore at the AAMC meeting and I'm talking to Art Papier who's a dermatologist, a medical informaticist, and the CEO of Visual DX, a company dedicated to improving medical diagnostics.

Announcer: Asking questions, seeking solutions. Algorithms for Innovation, live from Baltimore at the AAMC 2015.

Albo: So Art, you're a physician who started a company 16 years ago. Tell me what was the need you saw that prompted you to leave medicine and go into business?

Papier: Well, I haven't left medicine entirely. I still see patients, though what prompted this was I met Dr. Larry Weed in 1984. Larry Weed is the physician that invented the idea of the problem-oriented record and SOAP notes, and Larry, as early as the 1960s, was saying that we cannot memorize it all.

And so now, living through this transition from a memory-based paradigm in health care to a memory-assisted paradigm, where our young physicians, students and residents, it's second nature to be using their apps and information from their computers, yet we haven't seen this shift fully with some of the educators that are here at this meeting.

Albo: So what exactly does Visual DX do?

Papier: Visual DX allows the user to search by patient factors, and this is a key difference. Patients present with problems. It's the job of the clinician to figure out what they have, how to most appropriately test, the test things needed, and how to treat, and every patient's unique. What Visual DX does, it allows you to search by the patient's symptoms and to add other clues so that you can have a differential diagnosis in seconds at the point of care, which is very different from reading an online book and trying to load it all to the brain.

Albo: So what is it that we have to shift, do you think, in order to move into the future?

Papier: Well, we have to shift right here with medical educators. This idea that we're going to do multiple choice testing and board scores where we're testing what people can do just out of their brain is a flawed premise. Our children could take a calculator into their exam in middle school, and they're tested on their ability to solve the problem with the calculator. Yet we take medical students, and the idea is we're forcing them to memorize and take these boards instead of doing open book tests.

I mean, we should have open book tests because in real life we want the physicians in practice to be looking up information while they practice. So we really need to shift medical education so that we're rewarding looking up information. We also need to understand that we need to invest in tools to help doctors think rather than load information to the brain.

Albo: So if you could describe in just a few words how you feel about the future?

Papier: I'm optimistic about this young generation because there's no student or resident that doesn't know how to use these tools, and so we're living through this shift from a memory-based educational paradigm to an information intensive, information access problem-solving paradigm.

Albo: Are we moving fast enough?

Papier: Well, for me, not fast enough, but I think that it's accelerating and it's really pleasing to see the transition now underway which was not the case when we started our company 16 years ago. So 16 years ago doctors looked at us cross-eyed about this idea, and they were really just using computers for scheduling and billing their patients. That's all the use of computers back then.

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