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The Pandemic Changed Medical Education In Potentially Lasting Ways

Jul 13, 2021
Originally published on July 13, 2021 3:50 pm
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AUDIE CORNISH, HOST:

Awkward moments during mock patient visits are a normal part of medical school.

ASHLYNN TORRES: We were practicing having kind of serious conversations with patients.

CORNISH: But your patient disappearing unexpectedly, maybe less so.

TORRES: And my Wi-Fi kept going out. And then, so I just fully dropped out of the call. And then I came back in, and I was like, oh, so sorry about that. Like, I just think that...

CORNISH: Ashlynn Torres started at Kaiser Permanente's Bernard J. Tyson School of Medicine, that's just outside of L.A., last July. In fact, all of her peers did because the school opened its doors during the pandemic, which made learning this kind of webside manner - that's right, webside - particularly relevant. Kaiser is one of the many med schools that had to adapt in the past year. Teaching labs, lectures and much else - they all went online. NPR's Jonaki Mehta visited their campus to get a look at one innovation that's probably sticking around - an anatomy lab where students perform virtual dissections.

JOSE BARRAL: What I'm doing is I'm just taking my iPhone, and I direct the camera to this QR code.

JONAKI MEHTA, BYLINE: That is Dr. Jose Barral. He's professor and chair of biomedical science at Kaiser Permanente's new medical school.

BARRAL: What's happening is it's reading the QR code.

MEHTA: It's like going to a restaurant these days.

BARRAL: It's exactly like getting a menu, yeah. But instead of getting a menu, you get a three-dimensional representation of this precise specimen.

MEHTA: We're in the anatomy lab where Barral teaches medical students. And that specimen in his hand is a real preserved human heart. Attached to it is that QR code he mentioned.

BARRAL: The students can now get it on their iPhone, tablet, whatever they have.

MEHTA: And it's not just a heart. Students can dissect 3D renderings of entire human bodies or put on augmented reality goggles and perform dissections on holograms.

BARRAL: I come back to my control panel, and I choose the virtual scalpel.

MEHTA: The entire layer of human skin just disappeared with the click of that virtual scalpel.

BARRAL: And this process would normally take hours, without much learning really.

MEHTA: It might save time, but I ask Barral if students are missing a learning opportunity by not doing the real thing.

BARRAL: I love dissecting cadavers, but I am convinced that this technology is equally effective at learning anatomical relationships.

MEHTA: Barral says it's OK if students wait to get their hands on actual bodies because it's more helpful once they're preparing to do real surgeries anyway. Across town is UCLA's David Geffen School of Medicine. Now, they've been around for 70 years, but they're also shifting towards more virtual instruction.

CLARENCE BRADDOCK: Our experience with the pandemic helped us to realize the things that we could actually do remotely, but also to realize what was lost or could be lost.

MEHTA: Dr. Clarence Braddock is a vice dean for education at UCLA's medical school. He says things like admission interviews and lectures may well stay online for the long run. And he agrees with Kaiser's Dr. Barral that simulated dissections can help first-years learn the fundamentals of human anatomy. But he does have reservations about losing the hands-on experience. He says it helps students...

BRADDOCK: ...To better appreciate the look and feel of live human tissue.

MEHTA: The outcomes of simulated medical training are still being researched. It's too early to tell how effective it is. And there's another thing Braddock says students could miss out on - a kind of relationship.

BRADDOCK: The medical student who's in an anatomy lab - in some ways, that's their first patient. They come to develop a sense of respect for the person. And in fact, every year, we hold a celebration and remembrance for all the patients who became the cadavers in the anatomy lab.

MEHTA: Braddock says these experiences are pivotal in helping students form their identities as physicians. But Dr. Jose Barral from Kaiser says no matter how an instructor or school feels about this new way of doing things, medical education has to become more efficient.

BARRAL: As we learn more and more about basic science, there is less and less time to teach it, right? So medical school is four years. Some schools are moving to shorter. So we really need to find efficient means to teach themselves.

MEHTA: Which could look like students practicing surgery on a digital heart in their bedrooms.

CORNISH: NPR's Jonaki Mehta. The logical conclusion of an evolving medical education - evolving medical treatment.

STEVEN SCHEINMAN: With COVID, within a few months, Geisinger went up to 20,000 telemedicine visits a week.

CORNISH: Dr. Steven Scheinman is president and dean of the Geisinger Commonwealth School of Medicine in Pennsylvania. He says that before the pandemic, Geisinger's 12 hospitals were doing fewer than a hundred telemedicine visits per week. It's now leveled off to around 6,000, but it's still significantly higher than before. And Scheinman says there's good reason to keep it that way.

SCHEINMAN: The no-show rate in a telemedicine visit is much lower than for actual visits when patients have to travel distances to get there.

CORNISH: But the fact that telemedicine is expanding raises concerns for Dr. Elisabeth Rosenthal.

ELISABETH ROSENTHAL: We overestimate the value of convenience in medicine some times and underestimate the value of being in an office.

CORNISH: Now, Rosenthal is a non-practicing physician, but she's the editor-in-chief of Kaiser Health News - that's not connected to Kaiser medical school. She wrote that COVID let telemedicine out of the bottle. And when the pandemic is over, she's worried it won't go back in. We spoke about what she sees as the right way to work with patients remotely.

ROSENTHAL: I think it should be used as a screening tool in the sense of if your doctor schedules a telemedicine visit and can solve your problem with that, great. But if the doctor says, ah, you know, I can't tell if that's strep or COVID over the phone, I need you to come in, then maybe the cost of that first visit should be folded into the eventual in-person visit. So I think to me, the ideal is a kind of hybrid model where providers can use telemedicine and in-person medicine interchangeably as appropriate. And I just worry so much that for many people, it's going to be one or the other.

CORNISH: What questions would you have for something like the Geisinger, you know, Commonwealth School of Medicine - right? - something that's trying to be a medical school with a big virtual kind of experience?

ROSENTHAL: I think you need to teach medical students that crucial, like, on-off switch. So they have to see enough patients in person so that they know when they are in practice, is this something that benefits from a physical exam or is this something that I could do just as well over the screen? So what we get in the end I hope will be determined by what's medically right, but it also will be heavily influenced by the competing financial interests at play in our health care system.

CORNISH: We started this with your quote about COVID-19 letting telemedicine out of the bottle. It's hard to get things back in the bottle, as we know.

ROSENTHAL: Yup.

CORNISH: So how do you think about this going forward? What do you think that balance should be between traditional and in-person?

ROSENTHAL: I'll give you an example of where it could be amazing. For example, home monitoring of cardiac rhythms. Rather than lying in a hospital bed for two days, you can wear a home telemetry unit for two days and just transmit the rhythm strip in to a cardiologist to read. Now, a hospital might want to say, oh, that's - that should be worth the same as two days in a hospital, meaning, in the U.S., you know, $8,000. An insurer might want to say the patient's doing all the work here. So yeah, there's a big gulf there. And I do not know how that decision is going to be made.

CORNISH: Elisabeth Rosenthal, editor-in-chief of Kaiser Health News.

Thanks for being with us.

ROSENTHAL: Thanks for having me.

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