Howard Bauchner on the speed of knowledge


All of the medical schools that I visited have clearly increased the amount of education that they're doing, particularly in the field of genetics. The struggle would be whatever anyone learns today may be largely irrelevant in five years. In such a rapidly changing field, how do you keep people up to date? And I'm not certain people need to be kept up to date, but ultimately when they're in a clinical environment to have enough knowledge so that when they're provided with additional information, they know how to use that information.

JAMA has a med issue once a year, we just had our one in December. We have it every fall. And two years ago we had a piece by Victor Fuchs, and Zeke Emanuel who talked about training being unchanged essentially for 30 years. They certainly argue that it needs to be changed, and shifted, largely shortened, but also the content needs to be changed, and shortened. I think there's attention, people have really struggled with, so medical schools, residencies and fellowships have all developed core competencies. Six, they're very similar across all of those training areas, and that's occurred at the same time with the explosion of medical knowledge.

And I think we really need to sort through approaches to some of the core competencies that can be delivered at a different time, perhaps not in residency, but in fellowship, or perhaps not in medical school, but in residency, so that it doesn't have to be emphasized equally throughout. There are some interesting experiments on going. Interestingly enough the AMA has been generous, and has funded a medical education innovation program. There are 12 programs that have received substantial resources from the AMA to try to understand if we can do education better, and differently. Obviously with information technology being so much in the forefront the goal is to understand how we can utilize that effectively.

I think big data personalized medicine is fraternal twins and we have to figure out as a provider of care particularly in academic medical centers who do much of this, not to silo this information. And how to make it usable at the interface between the doctor, and patient encounter. Not every physician is going to be well educated in genomics, so that information will need to be interpreted for the clinician, but how the information from the emergency department move to the inpatient facility move to the outpatient facility, we still have yet to do a good job in.

I grew up in a paper record period of time, I don't regret leaving them behind. I struggle with my EHR, but on the other hand I really recognize the opportunity that it presents. I think one of the first goals in healthcare reform was to electronify us, digitalize us, and I think now that 75% of encounters are through an EHR, and that's a start. How we utilize those data will be answered over the next decade.