1 00:00:06,453 --> 00:00:07,588 >> ALL RIGHT, EVERYBODY, LET'S 2 00:00:07,588 --> 00:00:09,223 GO AHEAD AND GET STARTED. 3 00:00:09,223 --> 00:00:10,858 THANKS FOR YOUR ATTENDANCE TODAY 4 00:00:10,858 --> 00:00:13,160 IN PERSON AND ON VIDEOCAST FOR 5 00:00:13,160 --> 00:00:15,329 OUR LATEST GME GRAND ROUNDS 6 00:00:15,329 --> 00:00:19,500 SESSION FOR JULY. 7 00:00:19,500 --> 00:00:22,036 SO TODAY IS OUR CLINICAL CENTER 8 00:00:22,036 --> 00:00:23,470 GME GRAND ROUNDS, OF COURSE, AND 9 00:00:23,470 --> 00:00:28,475 FOR CME PURPOSES THE CODE FOR 10 00:00:28,475 --> 00:00:34,081 TODAY'S GRAND ROUNDS IS 50566. 11 00:00:34,081 --> 00:00:36,050 SO PLEASE TEXT THIS CODE TO THE 12 00:00:36,050 --> 00:00:38,552 HOPKINS CME PHONE NUMBER ON THE 13 00:00:38,552 --> 00:00:44,558 SLIDE TO RECEIVE CME CREDIT. 14 00:00:44,558 --> 00:00:45,993 WE KINDLY INVITE YOU ALSO TO 15 00:00:45,993 --> 00:00:47,861 PROVIDE FEEDBACK ON TODAY'S 16 00:00:47,861 --> 00:00:50,464 LECTURE BY SCANNING THE QR CODE 17 00:00:50,464 --> 00:00:53,434 SHOWN ON THE CME SLIDE, AND FOR 18 00:00:53,434 --> 00:00:55,836 THOSE APPLYING FOR CME, YOU WILL 19 00:00:55,836 --> 00:00:57,938 RECEIVE THE FEEDBACK SURVEY LINK 20 00:00:57,938 --> 00:00:58,906 VIA EMAIL. 21 00:00:58,906 --> 00:01:00,274 THE SURVEY WILL BE USED, OF 22 00:01:00,274 --> 00:01:02,409 COURSE, TO PROVIDE US WITH 23 00:01:02,409 --> 00:01:04,278 IMPORTANT FEEDBACK ABOUT THIS 24 00:01:04,278 --> 00:01:05,479 PRESENTATION AND ALLOWS YOU TO 25 00:01:05,479 --> 00:01:07,448 SUBMIT ANY SUGGESTIONS FOR 26 00:01:07,448 --> 00:01:08,315 FUTURE GRAND ROUNDS TOPICS, 27 00:01:08,315 --> 00:01:09,616 WHICH WE ALWAYS APPRECIATE. 28 00:01:09,616 --> 00:01:11,585 SO FOLLOWING THE PRESENTATION 29 00:01:11,585 --> 00:01:13,020 TODAY, WE'LL HAVE THE 30 00:01:13,020 --> 00:01:14,655 OPPORTUNITY FOR QUESTIONS FOR 31 00:01:14,655 --> 00:01:15,189 THE SPEAKER. 32 00:01:15,189 --> 00:01:18,392 I'LL BE TAKING IN-PERSON FOR THE 33 00:01:18,392 --> 00:01:19,126 MICROPHONES IN THE AISLES. 34 00:01:19,126 --> 00:01:20,894 ALSO THE VIDEOCAST VIEWERS MAY 35 00:01:20,894 --> 00:01:21,929 SUBMIT QUESTIONS AT ANY TIME 36 00:01:21,929 --> 00:01:25,466 DURING THE LECTURE BY SCROLLING 37 00:01:25,466 --> 00:01:27,134 DOWN AND CLICKING THE LIVE 38 00:01:27,134 --> 00:01:30,070 FEEDBACK BUTTON LOCATED ON THE 39 00:01:30,070 --> 00:01:32,906 VIDEOCAST WEBSITE. 40 00:01:32,906 --> 00:01:34,341 SO QUESTIONS WILL BE TAKEN AS 41 00:01:34,341 --> 00:01:36,443 TIME PERMIT AT THE CONCLUSION OF 42 00:01:36,443 --> 00:01:38,078 THE PRESENTATION AND DR. CHUNG 43 00:01:38,078 --> 00:01:38,612 WILL FACILITATE THAT. 44 00:01:38,612 --> 00:01:41,548 SO I'M REALLY EXCITED TODAY TO 45 00:01:41,548 --> 00:01:45,285 INTRODUCE OUR SPEAKER TODAY, DR. 46 00:01:45,285 --> 00:01:46,620 DR. DESAI IS AN ACCOMPLISHED 47 00:01:46,620 --> 00:01:48,122 CLINICIAN RESEARCHER, EDUCATOR 48 00:01:48,122 --> 00:01:51,191 AND ADMINISTRATOR, AND A FRIEND 49 00:01:51,191 --> 00:01:53,827 OF MINE. 50 00:01:53,827 --> 00:01:56,096 HE HAS APPOINTMENTS IN 51 00:01:56,096 --> 00:01:57,197 PULMONARY, CRITICAL CAR AND 52 00:01:57,197 --> 00:01:58,298 GENERAL INTERNAL MEDICINE. 53 00:01:58,298 --> 00:02:02,469 HE'S WIDELY RECOGNIZED FOR HIS 54 00:02:02,469 --> 00:02:05,272 ACCOMPLISHMENTS IN HEALTH 55 00:02:05,272 --> 00:02:05,806 SYSTEMS ADMINISTRATION. 56 00:02:05,806 --> 00:02:07,941 HIS RESEARCH EFFORTS FOCUS ON 57 00:02:07,941 --> 00:02:09,209 GENERATING HIGH QUALITY DATA TO 58 00:02:09,209 --> 00:02:10,544 INFORM POLICY AND PRACTICE IN 59 00:02:10,544 --> 00:02:13,046 MEDICAL EDUCATION. 60 00:02:13,046 --> 00:02:15,582 HE HAS AUTHORED OVER 50 PEER 61 00:02:15,582 --> 00:02:17,217 REVIEWED MANUSCRIPTS INCLUDING A 62 00:02:17,217 --> 00:02:18,519 SERIES OF ARTICLES IN THE NEW 63 00:02:18,519 --> 00:02:21,488 ENGLAND JOURNAL OF MEDICINE. 64 00:02:21,488 --> 00:02:25,626 DR. DESAI GRADUATED CUM LAUDE 65 00:02:25,626 --> 00:02:27,828 FROM THE UNIVERSITY OF 66 00:02:27,828 --> 00:02:29,296 PENNSYLVANIA AND EARNED A 67 00:02:29,296 --> 00:02:30,998 BACHELOR OF SCIENCE IN 68 00:02:30,998 --> 00:02:32,900 BIOENGINEERING AND A BACHELOR OF 69 00:02:32,900 --> 00:02:34,635 ECONOMICS FROM THE WHARTON 70 00:02:34,635 --> 00:02:35,636 SCHOOL OF BUSINESS IN HEALTHCARE 71 00:02:35,636 --> 00:02:35,936 MANAGEMENT. 72 00:02:35,936 --> 00:02:38,038 HE EARNED HIS MEDICAL DEGREE 73 00:02:38,038 --> 00:02:39,439 FROM THE HARVARD MEDICAL SCHOOL 74 00:02:39,439 --> 00:02:41,275 AND COMPLETED HIS RESIDENCY AS 75 00:02:41,275 --> 00:02:43,510 WELL AS CHIEF RESIDENCY AT THE 76 00:02:43,510 --> 00:02:45,879 JOHNS HOPKINS HOSPITAL, AS WELL 77 00:02:45,879 --> 00:02:49,550 AS A FELLOWSHIP IN PULMONARY AND 78 00:02:49,550 --> 00:02:50,584 CRITICAL CARE MEDICINE. 79 00:02:50,584 --> 00:02:52,553 HE SERVED AS DIRECTOR OF THE 80 00:02:52,553 --> 00:02:58,125 MEDICAL ICU AT MEDSTAR 81 00:02:58,125 --> 00:02:59,226 WASHINGTON HOSPITAL, THEN 82 00:02:59,226 --> 00:03:02,496 RECRUITED BACK TO HOPKINS AS THE 83 00:03:02,496 --> 00:03:05,566 MEYER PROFESSOR OF MEDICINE, THE 84 00:03:05,566 --> 00:03:07,768 DIRECTOR OF THE OCER MEDICAL 85 00:03:07,768 --> 00:03:09,670 RESIDENCY AND VICE CHAIR IN THE 86 00:03:09,670 --> 00:03:10,704 DEPARTMENT OF MEDICINE. 87 00:03:10,704 --> 00:03:13,307 DURING HIS TIME ON UNIVERSITY 88 00:03:13,307 --> 00:03:15,409 FACULTY, DR. DESAI WAS AWARDED 89 00:03:15,409 --> 00:03:16,843 THE PRESTIGIOUS PROFESSOR'S 90 00:03:16,843 --> 00:03:18,178 AWARD FOR EXCELLENCE IN TEACHING 91 00:03:18,178 --> 00:03:20,013 FROM THE JOHNS HOPKINS 92 00:03:20,013 --> 00:03:23,283 UNIVERSITY SCHOOL OF MEDICINE. 93 00:03:23,283 --> 00:03:27,654 IN 2021, DR. DESAI JOINED THE 94 00:03:27,654 --> 00:03:29,523 AMERICAN MEDICAL ASSOCIATION AS 95 00:03:29,523 --> 00:03:30,624 CHIEF ACADEMIC OFFICER. 96 00:03:30,624 --> 00:03:32,492 AND NOW HE OVERSEES MEDICAL 97 00:03:32,492 --> 00:03:34,394 EDUCATION ACTIVITIES FOR THE 98 00:03:34,394 --> 00:03:34,795 ORGANIZATION. 99 00:03:34,795 --> 00:03:36,997 THAT SAME YEAR HE ALSO JOINED 100 00:03:36,997 --> 00:03:38,599 MCKENZIE AS COMPANY AS SENIOR 101 00:03:38,599 --> 00:03:39,733 ADVISOR WHERE HE HAS CONSULTED 102 00:03:39,733 --> 00:03:41,101 FOR A VARIETY OF INDUSTRIES BOTH 103 00:03:41,101 --> 00:03:42,569 IN THE U.S. AND IN SOUTHEAST 104 00:03:42,569 --> 00:03:44,838 ASIA. 105 00:03:44,838 --> 00:03:47,341 AND IN JUNE, DR. DESAI CONCLUDED 106 00:03:47,341 --> 00:03:50,611 A FIVE-YEAR, $1.8 MILLION 107 00:03:50,611 --> 00:03:52,579 RESEARCH EFFORT FOR THE AMA IN 108 00:03:52,579 --> 00:03:54,548 PARTNERSHIP WITH STANFORD 109 00:03:54,548 --> 00:03:56,550 UNIVERSITY AND THE UNIVERSITY OF 110 00:03:56,550 --> 00:03:58,385 ALABAMA BIRMINGHAM ENTITLED 111 00:03:58,385 --> 00:04:01,888 REIMAGINING RESIDENCY TRAINING, 112 00:04:01,888 --> 00:04:05,058 OVERSEEING GRADUATE MEDICAL 113 00:04:05,058 --> 00:04:07,160 LABORATORY TO MEASURE RELEVANT 114 00:04:07,160 --> 00:04:08,195 VARIABLES IN RESIDENCY AND 115 00:04:08,195 --> 00:04:09,429 ASSOCIATE THEM WITH IMPORTANT 116 00:04:09,429 --> 00:04:10,764 DOMAINS SUCH AS BURNOUT, 117 00:04:10,764 --> 00:04:11,965 CLINICAL SKILLS AND OTHER KEY 118 00:04:11,965 --> 00:04:13,033 OUTCOMES. 119 00:04:13,033 --> 00:04:14,701 SO REALLY EXCITED TO HAVE 120 00:04:14,701 --> 00:04:15,335 SANJAY. 121 00:04:15,335 --> 00:04:17,638 HIS TALK TODAY IS PRECISION 122 00:04:17,638 --> 00:04:19,172 EDUCATION, THE FUTURE OF 123 00:04:19,172 --> 00:04:19,840 LIFELONG LEARNING. 124 00:04:19,840 --> 00:04:21,808 PLEASE JOIN ME IN WELCOMING 125 00:04:21,808 --> 00:04:22,342 DR. SANJAY DESAI. 126 00:04:22,342 --> 00:04:27,714 [APPLAUSE] 127 00:04:27,714 --> 00:04:28,582 >> THANKS. 128 00:04:28,582 --> 00:04:30,651 I WANT TO THANK EVERYONE THAT 129 00:04:30,651 --> 00:04:31,685 PARTICIPATED IN INVITING ME. 130 00:04:31,685 --> 00:04:33,053 IT'S AN HONOR TO BE HERE. 131 00:04:33,053 --> 00:04:34,354 I'VE COME HERE A COUPLE OF TIMES 132 00:04:34,354 --> 00:04:38,325 FOR THE CRITICAL CARE TEAM AND 133 00:04:38,325 --> 00:04:39,526 IT'S REALLY NICE TO BE PART OF 134 00:04:39,526 --> 00:04:40,594 THIS WIDER GROUP AS WELL. 135 00:04:40,594 --> 00:04:42,596 WHAT I'M HOPING TO DO IS TALK 136 00:04:42,596 --> 00:04:45,232 MAYBE FOR 30, 35 MINUTES JUST ON 137 00:04:45,232 --> 00:04:46,967 THE CONTENT THAT I HAVE BUT 138 00:04:46,967 --> 00:04:47,534 HOPEFULLY STIMULATE SOME 139 00:04:47,534 --> 00:04:49,469 DISCUSSION WITH ALL OF YOU HERE 140 00:04:49,469 --> 00:04:51,672 IN THE AUDITORIUM AS WELL AS 141 00:04:51,672 --> 00:04:52,706 ANYBODY ONLINE THAT'S INTERESTED 142 00:04:52,706 --> 00:04:55,709 IN THIS, AND THE GOAL HOPEFULLY 143 00:04:55,709 --> 00:04:57,444 IS TO SHARE WORK THAT WE'VE BEEN 144 00:04:57,444 --> 00:04:59,846 THINKING ABOUT, WORK THAT WE'RE 145 00:04:59,846 --> 00:05:02,049 STARTING TO DEPLOY GRANTS IN AS 146 00:05:02,049 --> 00:05:03,016 WELL BUT REALLY THE OPPORTUNITY 147 00:05:03,016 --> 00:05:04,785 THAT WE'RE TRYING TO SHAPE IS 148 00:05:04,785 --> 00:05:06,753 THINKING ABOUT THE FUTURE OF 149 00:05:06,753 --> 00:05:10,023 MEDICAL EDUCATION AND FOR US, 150 00:05:10,023 --> 00:05:11,892 WE'RE TITLING THIS PRECISION 151 00:05:11,892 --> 00:05:12,225 EDUCATION. 152 00:05:12,225 --> 00:05:13,860 SO I'LL GIVE A DEFINITION OF 153 00:05:13,860 --> 00:05:15,595 THAT AS WELL AS THE CONCEPTUAL 154 00:05:15,595 --> 00:05:16,496 MODEL THAT WE'VE THOUGHT 155 00:05:16,496 --> 00:05:18,231 THROUGH. 156 00:05:18,231 --> 00:05:19,666 MY DISCLOSURES ARE ONLY THAT 157 00:05:19,666 --> 00:05:21,435 THESE OPINIONS ARE MY OWN, THE 158 00:05:21,435 --> 00:05:22,502 ONES THAT I'LL SHARE, AND WE 159 00:05:22,502 --> 00:05:24,805 HAVE MANY, MANY ACKNOWLEDGMENTS. 160 00:05:24,805 --> 00:05:26,106 THIS WORK HAS BEEN DONE BY A 161 00:05:26,106 --> 00:05:27,341 LARGE TEAM ACROSS THE KUN TRU 162 00:05:27,341 --> 00:05:29,376 AND I'LL TRY AND BRING IN THEIR 163 00:05:29,376 --> 00:05:30,277 NAMES AS I GO THROUGH THE 164 00:05:30,277 --> 00:05:30,811 EXAMPLES WE HAVE. 165 00:05:30,811 --> 00:05:41,221 THE OBJECTIVES ARE TO IDENTIFY 166 00:05:41,221 --> 00:05:42,723 THE BARRIERS OF LIFELONG 167 00:05:42,723 --> 00:05:42,989 LEARNING. 168 00:05:42,989 --> 00:05:45,992 I THINK FOR ALL THE PHYSICIANS 169 00:05:45,992 --> 00:05:47,661 IN THE AUDITORIUM AS WELL AS 170 00:05:47,661 --> 00:05:48,962 ONLINE, I THINK THESE WILL NOT 171 00:05:48,962 --> 00:05:50,597 BE SURPRISING TO YOU AND 172 00:05:50,597 --> 00:05:52,132 HOPEFULLY WON'T CAUSE ANY PTSD 173 00:05:52,132 --> 00:05:53,033 FOR YOU EITHER. 174 00:05:53,033 --> 00:05:55,102 WE'LL SHARE THE CONCEPTUAL MODEL 175 00:05:55,102 --> 00:05:56,370 WE'VE DEVELOPED IN PRECISION 176 00:05:56,370 --> 00:05:57,304 EDUCATION AND I THINK THE MORE 177 00:05:57,304 --> 00:05:58,372 IMPORTANT PART AND REALLY THE 178 00:05:58,372 --> 00:05:59,573 SECTION I THINK THAT BRINGS THIS 179 00:05:59,573 --> 00:06:00,674 TO LIFE ARE THE EXAMPLES. 180 00:06:00,674 --> 00:06:04,511 SO REALLY DESCRIBING HOW THIS IS 181 00:06:04,511 --> 00:06:05,912 ALREADY BEING USED ACROSS THE 182 00:06:05,912 --> 00:06:07,547 COUNTRY, WHICH HOPEFULLY WILL 183 00:06:07,547 --> 00:06:08,882 ILLUSTRATE THE POWER OF 184 00:06:08,882 --> 00:06:12,919 PRECISION EDUCATION IN MEDICINE. 185 00:06:12,919 --> 00:06:14,688 SO THIS IS THE MODEL FOR MEDICAL 186 00:06:14,688 --> 00:06:15,889 EDUCATION IN THIS COUNTRY. 187 00:06:15,889 --> 00:06:17,958 SO JUST AS BACKDROP, WHY DO WE 188 00:06:17,958 --> 00:06:19,059 HAVE MEDICAL EDUCATION IN THE 189 00:06:19,059 --> 00:06:20,494 COUNTRY, AND I THINK WE FORGET 190 00:06:20,494 --> 00:06:21,528 THIS SOMETIMES OR AT LEAST WE 191 00:06:21,528 --> 00:06:24,464 DON'T THINK ABOUT IT EVERY DAY 192 00:06:24,464 --> 00:06:25,732 AS IS NOT SURPRISING BUT THE 193 00:06:25,732 --> 00:06:27,167 REASON WE EVEN HAVE A MEDICAL 194 00:06:27,167 --> 00:06:29,136 EDUCATION SYSTEM IS PRODUCE A 195 00:06:29,136 --> 00:06:29,603 PHYSICIAN WORKFORCE. 196 00:06:29,603 --> 00:06:31,304 THE GOAL IS TO PRODUCE A 197 00:06:31,304 --> 00:06:32,205 PHYSICIAN WORKFORCE THAT CAN 198 00:06:32,205 --> 00:06:33,440 CARE FOR OUR PATIENTS, FAMILIES 199 00:06:33,440 --> 00:06:35,175 AND COMMUNITIES IN THIS COUNTRY. 200 00:06:35,175 --> 00:06:36,543 THE WAY THAT WE DO THAT IN THIS 201 00:06:36,543 --> 00:06:37,744 COUNTRY, AND IT'S NOT -- THIS IS 202 00:06:37,744 --> 00:06:39,179 ACTUALLY IN SOME WAYS UNIQUE TO 203 00:06:39,179 --> 00:06:40,380 THIS COUNTRY, IS THE MODEL HERE. 204 00:06:40,380 --> 00:06:41,448 I WON'T GO THROUGH ALL THE 205 00:06:41,448 --> 00:06:42,883 DETAIL WITH YOU, BUT THE GOAL 206 00:06:42,883 --> 00:06:44,518 IDEALLY IS TO HAVE THESE 207 00:06:44,518 --> 00:06:46,153 COMPARTMENTS OF EDUCATION THAT 208 00:06:46,153 --> 00:06:48,355 WE TRAVERSE AND AS WE TRAVERSE 209 00:06:48,355 --> 00:06:50,657 THEM, THERE ARE GATES OBVIOUSLY 210 00:06:50,657 --> 00:06:53,059 BETWEEN ONE STAGE OF LEARNING TO 211 00:06:53,059 --> 00:06:54,294 THE NEXT STAGE OF LEARNING. 212 00:06:54,294 --> 00:06:55,695 THOSE GATES ARE HOPEFULLY MEANT 213 00:06:55,695 --> 00:06:56,663 TO AND DESIGNED TO BRING IN 214 00:06:56,663 --> 00:06:58,532 PEOPLE TO RECRUIT PEOPLE TO 215 00:06:58,532 --> 00:07:01,835 DEVELOP PEOPLE AND TO PROMOTE 216 00:07:01,835 --> 00:07:02,803 PEOPLE EQUITABLY THROUGH THIS 217 00:07:02,803 --> 00:07:03,236 PROCESS. 218 00:07:03,236 --> 00:07:04,871 IF WE'RE ABLE TO DO THAT AND 219 00:07:04,871 --> 00:07:06,006 BRING THEM INTO LEARNING 220 00:07:06,006 --> 00:07:07,507 ENVIRONMENTS THAT ARE ABLE TO 221 00:07:07,507 --> 00:07:09,042 CONTINUE TO DEVELOP THEM AS THEY 222 00:07:09,042 --> 00:07:10,710 GO FORWARD THEN THIS WOULD BE 223 00:07:10,710 --> 00:07:11,344 THE OUTCOME. 224 00:07:11,344 --> 00:07:14,281 THE OUTCOME IS THAT WE HAVE A 225 00:07:14,281 --> 00:07:16,249 CONTINUOUS INCREASE IN THE 226 00:07:16,249 --> 00:07:17,350 COMPETENCY OF THE PHYSICIANS 227 00:07:17,350 --> 00:07:20,720 THAT ARE TRAVERSING THIS AND THE 228 00:07:20,720 --> 00:07:22,789 CPD STANDS FOR CONTINUOUS 229 00:07:22,789 --> 00:07:25,325 PROFESSIONAL DEVELOPMENT SO THIS 230 00:07:25,325 --> 00:07:26,993 IS -- THAT'S THE LONG ARC OF 231 00:07:26,993 --> 00:07:28,061 WHERE WE ARE, AND THE GOAL IS 232 00:07:28,061 --> 00:07:29,696 THAT WE HAVE LIFELONG LEARNING 233 00:07:29,696 --> 00:07:31,264 IN WHICH WE CONTINUE TO DEVELOP 234 00:07:31,264 --> 00:07:31,765 COMPETENCY. 235 00:07:31,765 --> 00:07:34,734 WE RECOGNIZE, HOWEVER, THIS 236 00:07:34,734 --> 00:07:36,002 IDEALIZED MODEL IS NOT WHAT WE 237 00:07:36,002 --> 00:07:37,237 EXPERIENCE IN THE COUNTRY AND SO 238 00:07:37,237 --> 00:07:39,439 THERE'S LOTS OF DEVIATIONS FROM 239 00:07:39,439 --> 00:07:40,540 THAT IDEALIZED MODEL. 240 00:07:40,540 --> 00:07:42,375 THE FIRST IS THAT WE HAVE AN 241 00:07:42,375 --> 00:07:43,043 INEFFICIENT PROCESS. 242 00:07:43,043 --> 00:07:45,545 SO WE DON'T FOLLOW THIS LINEAR 243 00:07:45,545 --> 00:07:46,213 TRAJECTORY. 244 00:07:46,213 --> 00:07:48,315 INSTEAD WE HAVE THIS UNDULATING 245 00:07:48,315 --> 00:07:48,849 TRAJECTORY. 246 00:07:48,849 --> 00:07:51,151 THERE ARE MOMENTS WHERE WE 247 00:07:51,151 --> 00:07:51,818 ACCELERATE, THERE ARE MOMENT 248 00:07:51,818 --> 00:07:54,855 THAT WE DECELERATE OR STALL IN 249 00:07:54,855 --> 00:07:55,755 COMPETENCY DEVELOPMENT. 250 00:07:55,755 --> 00:07:56,823 IT'S EASY TO THINK THROUGH SOME 251 00:07:56,823 --> 00:07:57,924 EXAMPLES OF THAT AND THAT'S 252 00:07:57,924 --> 00:08:02,395 BECAUSE WE ARE ALL TAUGHT IN A 253 00:08:02,395 --> 00:08:03,964 ONE -- GENERALLY SPEAKING IN A 254 00:08:03,964 --> 00:08:05,265 ONE SIZE FITS ALL MODEL. 255 00:08:05,265 --> 00:08:07,634 SO YOU GO TO MEDICAL SCHOOL, ONE 256 00:08:07,634 --> 00:08:10,837 PERSON HAS A DEGREE IN 257 00:08:10,837 --> 00:08:13,673 BIOCHEMISTRY, ANOTHER PERSON 258 00:08:13,673 --> 00:08:15,642 GOES TO SCHOOL -- IT'S PRETTY 259 00:08:15,642 --> 00:08:17,377 EASY TO UNDERSTAND ONE PERSON 260 00:08:17,377 --> 00:08:18,578 WILL GET MORE OUT OF THAT COURSE 261 00:08:18,578 --> 00:08:19,679 WORK THAN THE OTHER PERSON SO 262 00:08:19,679 --> 00:08:21,214 AGAIN WE'RE NOT DEVELOPING THEM 263 00:08:21,214 --> 00:08:22,315 EVERY DAY THAT WE'RE THERE, 264 00:08:22,315 --> 00:08:22,983 WHICH IS A PROBLEM. 265 00:08:22,983 --> 00:08:25,051 THE OTHER IS THE RANDOMNESS THAT 266 00:08:25,051 --> 00:08:25,418 OCCURS. 267 00:08:25,418 --> 00:08:28,054 THIS IS EASIEST TO EXPLAIN IN 268 00:08:28,054 --> 00:08:29,523 RESIDENCY OR FELLOWSHIP PROGRAMS 269 00:08:29,523 --> 00:08:31,057 WHICH MANY OF YOU ARE EITHER 270 00:08:31,057 --> 00:08:32,058 LEADING OR PARTICIPATING IN, 271 00:08:32,058 --> 00:08:34,027 WHERE YOU HAVE ROTATIONS BASED 272 00:08:34,027 --> 00:08:35,428 ON CONVENIENCE OR WHEN WE HAVE 273 00:08:35,428 --> 00:08:36,997 VACATION PREFERENCE, NOT BASED 274 00:08:36,997 --> 00:08:38,164 ON WHAT IS BEST FOR YOU TO LEARN 275 00:08:38,164 --> 00:08:39,866 TOMORROW. 276 00:08:39,866 --> 00:08:41,801 SO THERE'S INEFFICIENCY AS PART 277 00:08:41,801 --> 00:08:43,103 OF THE CYST TE. THE SECOND THING 278 00:08:43,103 --> 00:08:45,305 THAT HAPPENS ARE THERE ARE THESE 279 00:08:45,305 --> 00:08:47,908 PLATEAUS THAT OCCUR THAT 280 00:08:47,908 --> 00:08:49,009 PREDOMINATE AT THE TRANSITIONS 281 00:08:49,009 --> 00:08:49,776 BETWEEN ONE COMPARTMENT OF 282 00:08:49,776 --> 00:08:50,544 LEARNING TO THE NEXT. 283 00:08:50,544 --> 00:08:53,179 THAT'S BECAUSE WE DO NOT SHARE 284 00:08:53,179 --> 00:08:56,316 INFORMATION ABOUT SOMEONE FROM 285 00:08:56,316 --> 00:08:57,551 ONE COMPARTMENT TO THE NEXT IN A 286 00:08:57,551 --> 00:08:59,819 WAY THAT IS MOST INFORMATIVE. 287 00:08:59,819 --> 00:09:01,288 WHEN THAT ENTERS YOU ENTER 288 00:09:01,288 --> 00:09:02,556 WITHOUT KNOWING WHAT IS BEST FOR 289 00:09:02,556 --> 00:09:04,124 THIS PERSON TO LEARN AND THAT 290 00:09:04,124 --> 00:09:05,959 LEADS TO A PLATEAU IN THEIR 291 00:09:05,959 --> 00:09:09,029 DEVELOPMENT AS THEY GO FORWARD. 292 00:09:09,029 --> 00:09:10,430 THE BIGGER PROBLEM THAT WE 293 00:09:10,430 --> 00:09:11,865 OBSERVE, HOWEVER, IS NOT JUST 294 00:09:11,865 --> 00:09:14,367 THE INEFFICIENCY AND THE 295 00:09:14,367 --> 00:09:15,702 PLATEAUS THAT OCCUR BUT THE 296 00:09:15,702 --> 00:09:16,870 VARIABILITY AND JOURNEYS THAT WE 297 00:09:16,870 --> 00:09:17,337 EACH HAVE. 298 00:09:17,337 --> 00:09:19,639 SO I'M GOING TO SHARE JUST A FEW 299 00:09:19,639 --> 00:09:20,640 ARCHETYPES OF JOURNEYS THAT 300 00:09:20,640 --> 00:09:21,474 PEOPLE HAVE TRAVERSED. 301 00:09:21,474 --> 00:09:22,709 I THINK MANY OF THESE WILL BE 302 00:09:22,709 --> 00:09:23,343 FAMILIAR FOR YOU. 303 00:09:23,343 --> 00:09:24,411 SO THIS IS THE COMMON ONE. 304 00:09:24,411 --> 00:09:25,845 THIS IS WHAT WE CALL THE 305 00:09:25,845 --> 00:09:26,313 PREDOMINANT PATH. 306 00:09:26,313 --> 00:09:27,814 THIS IS THE UNDULATION AS YOU 307 00:09:27,814 --> 00:09:29,349 SEE, THE PLATEAUS THAT OCCUR, 308 00:09:29,349 --> 00:09:31,651 BUT THANKFULLY, AT THE END OF 309 00:09:31,651 --> 00:09:33,620 THIS JOURNEY, THIS PERSON HAS 310 00:09:33,620 --> 00:09:35,322 REACHED THE LEVEL OF COMPETENCY 311 00:09:35,322 --> 00:09:38,224 THAT'S EXPECTED OF THEM FROM THE 312 00:09:38,224 --> 00:09:38,892 COUNTRY. 313 00:09:38,892 --> 00:09:40,293 SO AGAIN THE PATH MAY NOT BE 314 00:09:40,293 --> 00:09:41,962 IDEAL BUT THEY REACH A LEVEL OF 315 00:09:41,962 --> 00:09:43,029 COMPETENCY TO DELIVER CARE IN A 316 00:09:43,029 --> 00:09:44,464 WAY WE WOULD EXPECT THEM TO 317 00:09:44,464 --> 00:09:47,467 DELIVER BUT THIS IS NOT EVE 318 00:09:47,467 --> 00:09:48,301 EVERYONE. 319 00:09:48,301 --> 00:09:49,836 ANOTHER PATH IS WHAT WE CALL THE 320 00:09:49,836 --> 00:09:50,804 CLASSROOM ACHIEVER. 321 00:09:50,804 --> 00:09:53,106 THIS IS THE PERSON THAT EXCELS 322 00:09:53,106 --> 00:09:54,774 IN STRUCTURED LEARNING 323 00:09:54,774 --> 00:09:55,942 ENVIRONMENTS ON THE STANDARDIZED 324 00:09:55,942 --> 00:09:57,911 OR THE TYPICAL WAYS THAT WE DO 325 00:09:57,911 --> 00:09:59,479 ASSESSMENTS IN THIS COUNTRY, 326 00:09:59,479 --> 00:10:01,414 EXCELS IN ALL OF THOSE. 327 00:10:01,414 --> 00:10:03,283 THEY HOWEVER GET TO THE CLINICAL 328 00:10:03,283 --> 00:10:04,684 ENVIRONMENT AND THEY'RE NOT 329 00:10:04,684 --> 00:10:05,685 EXCELLING AT THE SAME PACE. 330 00:10:05,685 --> 00:10:07,220 AND THEY CONTINUE TO EXCEL BUT, 331 00:10:07,220 --> 00:10:08,722 AGAIN, NOT AT THE SAME PACE, AND 332 00:10:08,722 --> 00:10:10,390 PROBABLY NOT PREDICTABLE BASED 333 00:10:10,390 --> 00:10:12,025 ON THE PERFORMANCE THAT THEY HAD 334 00:10:12,025 --> 00:10:13,326 PREVIOUSLY AND THE INVERSE OF 335 00:10:13,326 --> 00:10:15,095 THIS ALSO OCCURS, WHICH WE'VE 336 00:10:15,095 --> 00:10:15,629 CALLED THE LATE BLOOMER. 337 00:10:15,629 --> 00:10:19,566 THIS IS THE PERSON THAT DOESN'T 338 00:10:19,566 --> 00:10:21,768 EXCEL IN THE STANDARDIZED 339 00:10:21,768 --> 00:10:23,003 TRADITIONAL WAYS OF ASSESSMENT 340 00:10:23,003 --> 00:10:24,537 HOWEVER THEY HIT THE BEDSIDE AND 341 00:10:24,537 --> 00:10:25,238 IT IS MAGICAL. 342 00:10:25,238 --> 00:10:26,573 I WOULD SAY JUST MYSELF HAVING 343 00:10:26,573 --> 00:10:28,742 BEEN A M PRA DIRECTOR FOR OVER 344 00:10:28,742 --> 00:10:30,076 10 YEAST, THIS IS THE MORE 345 00:10:30,076 --> 00:10:31,478 COMMON ARCHETYPE THAT I'VE SEEN 346 00:10:31,478 --> 00:10:33,613 AND THE ONE THAT WE ARE AGAIN 347 00:10:33,613 --> 00:10:34,214 OVERJOYED TO SEE. 348 00:10:34,214 --> 00:10:35,982 BUT REALLY IT BRINGS TO LIFE THE 349 00:10:35,982 --> 00:10:37,183 PROBLEM THAT WE HAVE, THAT WE 350 00:10:37,183 --> 00:10:39,052 HAVEN'T BEEN ABLE TO PREDICT WHO 351 00:10:39,052 --> 00:10:42,222 THIS PERSON IS. 352 00:10:42,222 --> 00:10:44,391 THERE'S ALSO THE PERSON THAT 353 00:10:44,391 --> 00:10:45,592 CONTINUES TO GET PUSHED THROUGH, 354 00:10:45,592 --> 00:10:47,260 THE STAGNATING LEARNER, THE 355 00:10:47,260 --> 00:10:48,428 PERSON THAT HASN'T QUITE MET THE 356 00:10:48,428 --> 00:10:49,829 LEVEL OF EXPECTED COMPETENCY 357 00:10:49,829 --> 00:10:51,998 THAT WE WOULD WANT THEM TO HAVE, 358 00:10:51,998 --> 00:10:53,933 HOWEVER, IT'S A LOT OF WORK TO 359 00:10:53,933 --> 00:10:55,335 CONTINUE TO DEVELOP THEM. 360 00:10:55,335 --> 00:10:57,637 AND OUR STRUCTURED ENVIRONMENTS 361 00:10:57,637 --> 00:10:58,838 ARE NOT OFTEN DESIGNED OR 362 00:10:58,838 --> 00:11:00,373 RESOURCED TO BE ABLE TO BRING 363 00:11:00,373 --> 00:11:02,342 EVERYBODY UP TO THAT LEVEL OF 364 00:11:02,342 --> 00:11:03,643 EXPECTATION THAT WE WOULD HAVE. 365 00:11:03,643 --> 00:11:05,378 AND THE EASIER PATH IS TO PUSH 366 00:11:05,378 --> 00:11:06,379 THEM FORWARD. 367 00:11:06,379 --> 00:11:09,983 THIS IS VERY COMMON IN K THROUGH 368 00:11:09,983 --> 00:11:11,084 12, CONTINUE TO PUSH PEOPLE 369 00:11:11,084 --> 00:11:12,819 THROUGH BECAUSE IT'S THE PATH OF 370 00:11:12,819 --> 00:11:13,720 LEAST RESISTANCE. 371 00:11:13,720 --> 00:11:15,355 THE PROBLEM IS AGAIN AS YOU GET 372 00:11:15,355 --> 00:11:17,490 FURTHER AND FURTHER ALONG, THE 373 00:11:17,490 --> 00:11:18,425 MORE DISTANT YOU BECOME FROM THE 374 00:11:18,425 --> 00:11:20,160 LEVEL OF EXPECTATION THAT'S BEEN 375 00:11:20,160 --> 00:11:21,494 DESIGNED. 376 00:11:21,494 --> 00:11:23,897 THEN OF COURSE THERE'S THE 377 00:11:23,897 --> 00:11:25,398 PERSON THAT WE CALL UNSUPPORTED 378 00:11:25,398 --> 00:11:26,399 IN THE LEARNING ENVIRONMENT. 379 00:11:26,399 --> 00:11:28,134 THESE ARE THE INDIVIDUALS THAT 380 00:11:28,134 --> 00:11:30,437 FIND THEMSELVES IN AN 381 00:11:30,437 --> 00:11:31,805 ENVIRONMENT THAT UNFORTUNATELY 382 00:11:31,805 --> 00:11:33,940 IS NOT DESIGNED TO SUPPORT THEM. 383 00:11:33,940 --> 00:11:35,575 NOT DESIGNED TO DEVELOP THEM. 384 00:11:35,575 --> 00:11:37,343 NOT DESIGNED TO PROMOTE THEM AS 385 00:11:37,343 --> 00:11:38,211 THEY MOVE FORWARD. 386 00:11:38,211 --> 00:11:39,946 IF IT HAPPENS, CERTAINLY THEY 387 00:11:39,946 --> 00:11:42,582 STAGNATE, THEY PLATEAU, BUT IN 388 00:11:42,582 --> 00:11:43,583 THE WORST-CASE SCENARIO AS SHOWN 389 00:11:43,583 --> 00:11:44,651 HERE, THEY DROP OUT OF THE 390 00:11:44,651 --> 00:11:45,752 SYSTEM ALL TOGETHER AND THAT CAN 391 00:11:45,752 --> 00:11:47,087 HAPPEN AT ANY STAGE, IT CAN 392 00:11:47,087 --> 00:11:48,588 HAPPEN IN MEDICAL SCHOOL, IT CAN 393 00:11:48,588 --> 00:11:50,457 HAPPEN IN RESIDENCY, AND WE KNOW 394 00:11:50,457 --> 00:11:51,691 THIS HITS MINORITIES MORE THAN 395 00:11:51,691 --> 00:11:55,128 IT HAPPENS TO OTHER INDIVIDUALS 396 00:11:55,128 --> 00:11:56,362 AS THEY TRAVERSE THIS JOURNEY. 397 00:11:56,362 --> 00:11:57,897 AND FINALLY, THE LAST ONE THAT 398 00:11:57,897 --> 00:11:58,932 I'LL DESCRIBE IS THE PERSON THAT 399 00:11:58,932 --> 00:12:01,501 GOES THROUGH IT AND ACTUALLY 400 00:12:01,501 --> 00:12:04,471 FOLLOWS THE PATH THAT IS THE 401 00:12:04,471 --> 00:12:06,439 PREDOMINANT PATH BUT THEN FINDS 402 00:12:06,439 --> 00:12:08,842 THEMSELVES AFTER LEAVING THESE 403 00:12:08,842 --> 00:12:09,576 STRUCTURED ENVIRONMENTS OF 404 00:12:09,576 --> 00:12:10,243 LEARNING IN A PRACTICE 405 00:12:10,243 --> 00:12:12,545 ENVIRONMENT THAT NO LONGER 406 00:12:12,545 --> 00:12:14,614 FACILITATES LIFELON LEARNING. 407 00:12:14,614 --> 00:12:16,616 THAT IS, I THINK, ONE OF THE 408 00:12:16,616 --> 00:12:19,753 MOST DANGEROUS EXAMPLES OF ARC 409 00:12:19,753 --> 00:12:21,087 TYPES THAT WE HAVE BECAUSE NOW 410 00:12:21,087 --> 00:12:23,323 THEY'RE NOT UNDER SUPERVISION, 411 00:12:23,323 --> 00:12:24,624 AND YOU GET FURTHER AND FURTHER 412 00:12:24,624 --> 00:12:25,692 AWAY FROM THE LEVEL OF 413 00:12:25,692 --> 00:12:28,094 COMPETENCY THAT'S EXPECTED 414 00:12:28,094 --> 00:12:30,964 BECAUSE THE FIELD OBVIOUSLY 415 00:12:30,964 --> 00:12:32,398 CONTINUES TO EVOLVE AND DEVELOP. 416 00:12:32,398 --> 00:12:34,367 SO THESE ARE JUST A FEW 417 00:12:34,367 --> 00:12:35,502 ARCHETYPES, I THINK IF WE GIVE 418 00:12:35,502 --> 00:12:36,903 YOU A FEW MINUTES YOU COULD COME 419 00:12:36,903 --> 00:12:38,404 UP WITH A HUNDRED MORE 420 00:12:38,404 --> 00:12:39,372 ARCHETYPES THAT YOU COULD 421 00:12:39,372 --> 00:12:40,540 PROBABLY THINK THROUGH OF HOW WE 422 00:12:40,540 --> 00:12:41,875 ARE DIFFERENT THAN THE IDEALIZED 423 00:12:41,875 --> 00:12:42,575 STATE. 424 00:12:42,575 --> 00:12:43,877 THE PROBLEM ISN'T JUST THE 425 00:12:43,877 --> 00:12:45,245 VARIABILITY OF JOURNEY. 426 00:12:45,245 --> 00:12:46,346 THE PROBLEM IS THE VARIABILITY 427 00:12:46,346 --> 00:12:47,046 IN OUTCOMES. 428 00:12:47,046 --> 00:12:50,550 SO WE LAND WITH -- WE END WITH A 429 00:12:50,550 --> 00:12:51,417 PHYSICIAN WORKFORCE IN WHICH 430 00:12:51,417 --> 00:12:53,052 THERE ARE A SUBSET OF PHYSICIANS 431 00:12:53,052 --> 00:12:55,488 THAT HAVE NOT MET THE LEVEL OF 432 00:12:55,488 --> 00:12:56,656 COMPETENCY THAT AGAIN WE HAVE 433 00:12:56,656 --> 00:12:58,258 EXPECTED AND THE SYSTEM IS 434 00:12:58,258 --> 00:13:00,994 DESIGNED TO ACHIEVE. 435 00:13:00,994 --> 00:13:02,962 JUST TO BE VERY CLEAR ABOUT IT, 436 00:13:02,962 --> 00:13:03,963 WE WANT VARIABILITY IN 437 00:13:03,963 --> 00:13:05,765 COMPETENCY IN TERMS OF WHAT 438 00:13:05,765 --> 00:13:07,667 PEOPLE MASTER, WHAT PEOPLE DO, 439 00:13:07,667 --> 00:13:10,069 BUT WE WANT A MINIMUM LEVEL OF 440 00:13:10,069 --> 00:13:11,037 COMPETENCY IN TERMS OF 441 00:13:11,037 --> 00:13:12,705 DELIVERING CARE FOR OUR PATIENTS 442 00:13:12,705 --> 00:13:13,773 AND OUR COMMUNITIES, AND THAT'S 443 00:13:13,773 --> 00:13:14,541 THE VARIABILITY THAT WE'RE 444 00:13:14,541 --> 00:13:16,509 TRYING TO AVOID. 445 00:13:16,509 --> 00:13:18,044 SO THIS NOISE IN THE SYSTEM AND 446 00:13:18,044 --> 00:13:20,680 BIAS IN THE SYSTEM HAS TO BE 447 00:13:20,680 --> 00:13:21,214 ADDRESSED. 448 00:13:21,214 --> 00:13:25,251 THERE ARE FOUR WAYS THAT WE'VE 449 00:13:25,251 --> 00:13:27,253 PRIORITIZED THINKING ABOUT IN 450 00:13:27,253 --> 00:13:29,322 TERMS OF ADDRESSING THIS AND 451 00:13:29,322 --> 00:13:30,723 MAKING THIS A BETTER SYSTEM THAT 452 00:13:30,723 --> 00:13:32,592 CAN ACHIEVE THESE OUTCOMES. 453 00:13:32,592 --> 00:13:34,027 THE FIRST IS EXPANSION OF 454 00:13:34,027 --> 00:13:35,328 COMPETENCY BASED MEDICAL 455 00:13:35,328 --> 00:13:35,862 EDUCATION. 456 00:13:35,862 --> 00:13:39,933 THIS HAS BEEN A GOAL, AN 457 00:13:39,933 --> 00:13:41,801 ASPIRATION FOR MEDICAL EDUCATION 458 00:13:41,801 --> 00:13:42,869 AND EDUCATION IN GENERAL 459 00:13:42,869 --> 00:13:43,970 GLOBALLY FOR DECADES. 460 00:13:43,970 --> 00:13:45,171 AND IN FACT, OTHER COUNTRIES ARE 461 00:13:45,171 --> 00:13:46,806 FURTHER AHEAD THAN US IN TRYING 462 00:13:46,806 --> 00:13:49,676 TO PURSUE COMPETENCY-BASED 463 00:13:49,676 --> 00:13:51,845 MEDICAL EDUCATION. WE HAVE A 464 00:13:51,845 --> 00:13:53,947 TIME-BASED NOT A 465 00:13:53,947 --> 00:13:54,681 COMPETENCY-BASED MODEL AND I 466 00:13:54,681 --> 00:13:55,481 THINK IF YOU ASK ANYBODY THAT 467 00:13:55,481 --> 00:13:56,883 YOU CARE FOR WHAT'S MORE 468 00:13:56,883 --> 00:13:58,284 IMPORTANT, THE NUMBER OF YEARS 469 00:13:58,284 --> 00:13:59,819 YOU GO TO SCHOOL OR THE ABILITY 470 00:13:59,819 --> 00:14:01,788 TO CARE FOR SOMEBODY CAPABLY, I 471 00:14:01,788 --> 00:14:03,156 THINK THAT ANSWER IS OBVIOUS, WE 472 00:14:03,156 --> 00:14:04,324 DO NOT HAVE A SYSTEM THAT 473 00:14:04,324 --> 00:14:04,991 DEPENDS ON THIS. 474 00:14:04,991 --> 00:14:07,827 BUT IF WE CAN EXPAND COMPETENCY 475 00:14:07,827 --> 00:14:09,128 BASED MEDICAL EDUCATION SYSTEMS 476 00:14:09,128 --> 00:14:10,430 THEN WE CAN START TO MOVE THESE 477 00:14:10,430 --> 00:14:11,331 GRAPHS IN THE WAY THAT'S 478 00:14:11,331 --> 00:14:11,764 DESCRIBED HERE. 479 00:14:11,764 --> 00:14:13,499 WE CAN ELEVATE THE SLOPES OF 480 00:14:13,499 --> 00:14:15,568 THESE CURVES SO EACH LEVEL, EACH 481 00:14:15,568 --> 00:14:17,136 STAGE OF LEARNING AND WITHIN 482 00:14:17,136 --> 00:14:18,271 EACH COMPARTMENT OF LEARNING, 483 00:14:18,271 --> 00:14:20,173 WE'RE ABLE TO ENSURE SOMEBODY 484 00:14:20,173 --> 00:14:21,241 REACHES THE COMPETENCY LEVEL 485 00:14:21,241 --> 00:14:23,142 BEFORE THEY MOVE FORWARD AND WE 486 00:14:23,142 --> 00:14:24,110 CAN REDUCE VARIABILITY THAT WAY. 487 00:14:24,110 --> 00:14:25,044 THE SECOND IS IMPROVING 488 00:14:25,044 --> 00:14:25,345 TRANSITION. 489 00:14:25,345 --> 00:14:26,746 SO WE HAVE THESE TRANSITIONS 490 00:14:26,746 --> 00:14:28,882 BETWEEN EACH COMPARTMENT, THE 491 00:14:28,882 --> 00:14:30,884 ONE WE DESCRIBE MOST OFTEN IS 492 00:14:30,884 --> 00:14:33,219 BETWEEN MEDICAL SCHOOL AND TO 493 00:14:33,219 --> 00:14:34,721 RESIDENCY. 494 00:14:34,721 --> 00:14:36,489 AND INFORMATION IS NOT SHARED. 495 00:14:36,489 --> 00:14:38,224 AGAIN, WHEN INFORMATION ISN'T 496 00:14:38,224 --> 00:14:39,259 SHARED BECAUSE THERE'S MISTRUST 497 00:14:39,259 --> 00:14:40,727 AND WE DON'T HAVE SYSTEMS THAT 498 00:14:40,727 --> 00:14:42,395 PROVIDE INFORMATION WITH 499 00:14:42,395 --> 00:14:43,496 FIDELITY, THEN LEARNING IS LOST 500 00:14:43,496 --> 00:14:46,165 AND DEVELOPMENT IS LOST AND THIS 501 00:14:46,165 --> 00:14:47,400 PLATEAUS OCCUR, SO IF WE CAN 502 00:14:47,400 --> 00:14:49,936 IMPROVE THE FIDELITY OF 503 00:14:49,936 --> 00:14:53,006 INFORMATION TRANSFER AND MAKE 504 00:14:53,006 --> 00:14:54,440 THAT INFORMATION REPRESENTATIVE 505 00:14:54,440 --> 00:14:55,608 OF THE PERSON FOR THE 506 00:14:55,608 --> 00:14:58,578 COMPETENCIES THAT MATTER, THEN 507 00:14:58,578 --> 00:14:59,879 WE CAN START TO, AGAIN, INCREASE 508 00:14:59,879 --> 00:15:01,314 THE SLOPES OF THESE CURVES AND 509 00:15:01,314 --> 00:15:04,484 REDUCE VARIABILITY. 510 00:15:04,484 --> 00:15:05,184 EMBEDDING EQUITY IN THE LEARNING 511 00:15:05,184 --> 00:15:06,219 ENVIRONMENT IS INCREDIBLY 512 00:15:06,219 --> 00:15:07,220 IMPORTANT SO WE DON'T FIND 513 00:15:07,220 --> 00:15:08,421 PEOPLE IN ENVIRONMENTS THAT ARE 514 00:15:08,421 --> 00:15:12,692 NOT DESIGNED TO SUPPORT THEM, TO 515 00:15:12,692 --> 00:15:13,893 DEVELOP THEM AND TO PROMOTE 516 00:15:13,893 --> 00:15:14,761 THEM. 517 00:15:14,761 --> 00:15:16,095 AND IF WE'RE ABLE TO DO THAT, WE 518 00:15:16,095 --> 00:15:17,830 CAN STOP THE PLATEAUS, BUT 519 00:15:17,830 --> 00:15:18,932 IDEALLY IN THE WORST CASE, WE 520 00:15:18,932 --> 00:15:20,099 STOP THESE DROPOFFS THAT ARE 521 00:15:20,099 --> 00:15:21,567 CRITICAL FOR US DEVELOPING THE 522 00:15:21,567 --> 00:15:23,202 WORKFORCE THAT WE NEED IN THE 523 00:15:23,202 --> 00:15:24,370 COUNTRY. 524 00:15:24,370 --> 00:15:26,139 WE ALREADY FIXED THE PIPES HERE, 525 00:15:26,139 --> 00:15:27,440 THE IDEA WITH WATER IN THE 526 00:15:27,440 --> 00:15:28,441 HOUSE, IF YOU HAVE A LEAK IN 527 00:15:28,441 --> 00:15:30,310 YOUR HOUSE IN THE PIPES, IT'S A 528 00:15:30,310 --> 00:15:32,045 PROBLEM WITH THE -- THE 529 00:15:32,045 --> 00:15:33,279 INCORRECT THING TO DO IS TRY TO 530 00:15:33,279 --> 00:15:34,714 ADDRESS THE WATER, IT'S NOT THE 531 00:15:34,714 --> 00:15:36,416 PROBLEM THAT'S THE PROBLEM, IT'S 532 00:15:36,416 --> 00:15:37,951 THE PIPES THROUGH WHICH THE 533 00:15:37,951 --> 00:15:39,319 WATER FLOWS, THAT'S THE PROBLEM, 534 00:15:39,319 --> 00:15:40,620 THE DURABLE SOLUTION WE HAVE TO 535 00:15:40,620 --> 00:15:42,188 ALL BE THINKING ABOUT. 536 00:15:42,188 --> 00:15:43,523 FINALLY, BUILDING SYSTEMS OF 537 00:15:43,523 --> 00:15:44,190 PRECISION EDUCATION WILL BE THE 538 00:15:44,190 --> 00:15:46,759 TALK THAT I GIVE TODAY, AND THE 539 00:15:46,759 --> 00:15:48,328 IDEA OF PRECISION EDUCATION IS 540 00:15:48,328 --> 00:15:49,963 THE RIGHT LEARNING FOR THE RIGHT 541 00:15:49,963 --> 00:15:51,164 PERSON AT THE RIGHT TIME AND 542 00:15:51,164 --> 00:15:52,131 LEVERAGING DATA AND TECHNOLOGY 543 00:15:52,131 --> 00:15:53,032 TO DO THIS. 544 00:15:53,032 --> 00:15:55,001 OF IF WE'RE ABLE TO 545 00:15:55,001 --> 00:15:55,835 INDIVIDUALIZE LEARNING, 546 00:15:55,835 --> 00:15:57,303 ELIMINATE THE RANDOMNESS, 547 00:15:57,303 --> 00:15:58,938 ELIMINATE THE ONE SIZE FITS ALL 548 00:15:58,938 --> 00:16:00,239 PARADIGM THAT WE'D HAVE, REALLY 549 00:16:00,239 --> 00:16:01,474 GENERALLY THROUGHOUT ALL OF OUR 550 00:16:01,474 --> 00:16:03,209 COMPARTMENTS OF LEARNING, THEN 551 00:16:03,209 --> 00:16:04,811 WE CAN REDUCE THESE UNDULATIONS 552 00:16:04,811 --> 00:16:05,378 THAT OCCUR. 553 00:16:05,378 --> 00:16:06,479 AND TO BE, AGAIN, VERY CLEAR 554 00:16:06,479 --> 00:16:07,814 ABOUT IT, WE KNOW THAT LEARNING 555 00:16:07,814 --> 00:16:09,449 IS FRICTION, THERE'S FRICTION IN 556 00:16:09,449 --> 00:16:09,782 LEARNING. 557 00:16:09,782 --> 00:16:11,417 THAT'S HOW YOU LEARN, BUT 558 00:16:11,417 --> 00:16:12,618 THERE'S UNNECESSARY FRICTION. 559 00:16:12,618 --> 00:16:15,021 THERE'S THIS PLATEAU, THERE'S 560 00:16:15,021 --> 00:16:15,355 DECELERATIONS. 561 00:16:15,355 --> 00:16:16,556 THOSE ARE THE MOMENTS THAT WE 562 00:16:16,556 --> 00:16:18,291 CAN ELIMINATE IF WE'RE ABLE TO 563 00:16:18,291 --> 00:16:19,292 PERSONALIZE LEARNING WITH 564 00:16:19,292 --> 00:16:19,926 PRECISION EDUCATION. 565 00:16:19,926 --> 00:16:23,029 AND THAT WOULD AGAIN ELEVATE 566 00:16:23,029 --> 00:16:23,896 THE -- AND SMOOTH THE PATH. 567 00:16:23,896 --> 00:16:25,732 SO IF WE'RE ABLE TO DO THIS 568 00:16:25,732 --> 00:16:26,933 EFFECTIVELY, THEN WE CAN TAKE 569 00:16:26,933 --> 00:16:29,369 THIS OUTCOME WE HAVE NOW WITH 570 00:16:29,369 --> 00:16:30,136 VARIABILITY IN THE PHYSICIAN 571 00:16:30,136 --> 00:16:33,506 WORKFORCE THAT WE PRODUCE AND 572 00:16:33,506 --> 00:16:34,974 IDEALLY PRODUCE A PHYSICIAN 573 00:16:34,974 --> 00:16:37,777 WORKFORCE WITH LESS VARIABILITY 574 00:16:37,777 --> 00:16:39,178 AND OUTCOMES RELATED TO 575 00:16:39,178 --> 00:16:40,279 COMPETENCY AND ONE THAT'S 576 00:16:40,279 --> 00:16:41,748 RELIABLE AND ENABLES BETTER 577 00:16:41,748 --> 00:16:42,148 PATIENT CARE. 578 00:16:42,148 --> 00:16:43,449 SO THAT'S THE GOAL THAT WE HAVE, 579 00:16:43,449 --> 00:16:45,551 AND THE FOCUS AGAIN FOR US WITH 580 00:16:45,551 --> 00:16:47,620 THE WAY THAT WE BELIEVE THE 581 00:16:47,620 --> 00:16:50,356 FUTURE SHOULD BE DESIGNED TO 582 00:16:50,356 --> 00:16:52,325 PROMOTE THIS AND TO ESTABLISH IT 583 00:16:52,325 --> 00:16:53,626 IS THROUGH PRECISION EDUCATION. 584 00:16:53,626 --> 00:16:55,361 SO WHY PRECISION EDUCATION? 585 00:16:55,361 --> 00:16:56,929 WE'LL GET INTO THE CONCEPTUAL 586 00:16:56,929 --> 00:16:58,364 MODEL IN JUST A MOMENT, BUT WE 587 00:16:58,364 --> 00:17:01,067 WOULD PROPOSE TO EVERYBODY THAT 588 00:17:01,067 --> 00:17:04,137 PRECISION EDUCATION ELEVATES ALL 589 00:17:04,137 --> 00:17:05,238 OF THESE DIFFERENT INTERVENTIONS 590 00:17:05,238 --> 00:17:06,873 THAT LEAD TO THIS REDUCED 591 00:17:06,873 --> 00:17:07,974 VARIABILITY IN OUTCOME. 592 00:17:07,974 --> 00:17:09,609 SO PRECISION EDUCATION, IF 593 00:17:09,609 --> 00:17:13,312 YOU'RE ABLE TO UNDERSTAND THE 594 00:17:13,312 --> 00:17:17,517 PROFILE OF COMPETENCY, OF 595 00:17:17,517 --> 00:17:19,886 LEARNING, THE GAPS, THE NEEDS OF 596 00:17:19,886 --> 00:17:22,522 THE INDIVIDUAL THEN YOU CAN 597 00:17:22,522 --> 00:17:23,823 EXPAND -- YOU CAN'T DO THAT 598 00:17:23,823 --> 00:17:25,258 WITHOUT ASSESSMENT, WITHOUT 599 00:17:25,258 --> 00:17:26,225 UNDERSTANDING PRECISELY WHAT 600 00:17:26,225 --> 00:17:27,093 THIS INDIVIDUAL NEEDS. 601 00:17:27,093 --> 00:17:29,295 IF YOU UNDERSTAND PRECISION -- 602 00:17:29,295 --> 00:17:31,597 IF YOU EXPAND AND INVEST IN 603 00:17:31,597 --> 00:17:33,232 PRECISION EDUCATION, THEN YOU 604 00:17:33,232 --> 00:17:35,435 GET DATA THAT THEN CAN BE 605 00:17:35,435 --> 00:17:35,868 SHARED. 606 00:17:35,868 --> 00:17:36,936 THOSE DATA THAT WHEN THEY'RE 607 00:17:36,936 --> 00:17:38,237 SHARED CAN HELP ELIMINATE THE 608 00:17:38,237 --> 00:17:39,572 PROBLEMS THAT WE HAVE WITH 609 00:17:39,572 --> 00:17:40,239 TRANSITIONS. 610 00:17:40,239 --> 00:17:43,943 IF WE UNDERSTAND THE ACTUAL 611 00:17:43,943 --> 00:17:45,311 OBJECTIVE OBJECTIVELY, MAKE 612 00:17:45,311 --> 00:17:47,313 THESE ASSESSMENTS EQUITABLE, 613 00:17:47,313 --> 00:17:49,182 MAKE THEM OBJECTIVE, ELIMINATE 614 00:17:49,182 --> 00:17:50,850 BIAS, AND UNDERSTAND EACH 615 00:17:50,850 --> 00:17:51,918 INDIVIDUAL IN TERMS OF WHAT 616 00:17:51,918 --> 00:17:53,086 THEY'RE ABLE TO CONTRIBUTE AND 617 00:17:53,086 --> 00:17:54,787 AS WELL AS WHAT THEY'RE ABLE TO 618 00:17:54,787 --> 00:17:55,988 DEVELOP, AND CREATE A MODEL 619 00:17:55,988 --> 00:17:58,057 WHERE WE'RE THERE TO SUPPORT 620 00:17:58,057 --> 00:17:59,158 EVERYONE RATHER THAN A DEFICIT 621 00:17:59,158 --> 00:18:00,460 MODEL WHERE WE'RE TRYING TO SAY 622 00:18:00,460 --> 00:18:02,762 YOU'RE NOT GOOD ENOUGH, THEN WE 623 00:18:02,762 --> 00:18:04,497 CAN CHANGE THE CULTURE AND THE 624 00:18:04,497 --> 00:18:05,832 ENVIRONMENT OF ASSESSMENT, OF 625 00:18:05,832 --> 00:18:07,567 PROCESS AND OF DEVELOPMENT SUCH 626 00:18:07,567 --> 00:18:09,635 THAT EQUITY IS LIFTED AND AGAIN 627 00:18:09,635 --> 00:18:12,705 LIFTING EQUITY, EMBEDDING EQUITY 628 00:18:12,705 --> 00:18:13,606 LIFTS ALL THOSE. 629 00:18:13,606 --> 00:18:15,875 SO WE SEE PRECISION EDUCATION AS 630 00:18:15,875 --> 00:18:17,743 A TOOL, THESE SYSTEMS AS A TOOL 631 00:18:17,743 --> 00:18:19,378 THAT ENABLES US TO ACHIEVE 632 00:18:19,378 --> 00:18:24,083 BETTER COMPETENCY-BASED MEDICAL 633 00:18:24,083 --> 00:18:26,385 EDUCATION, A TOOL THAT CAN HELP 634 00:18:26,385 --> 00:18:28,754 US EMBED EQUITY MORE EQUITABLY 635 00:18:28,754 --> 00:18:30,189 INTO THE MEDICAL EDUCATION 636 00:18:30,189 --> 00:18:30,990 STRUCTURES THROUGHOUT THE 637 00:18:30,990 --> 00:18:31,958 CONTINUUM. 638 00:18:31,958 --> 00:18:34,527 SO WHAT IS IT? 639 00:18:34,527 --> 00:18:36,562 WE TALKED ABOUT IT BEING THE 640 00:18:36,562 --> 00:18:37,630 RIGHT LEARNING FOR THE RIGHT 641 00:18:37,630 --> 00:18:40,066 PERSON AT THE RIGHT TIME USING 642 00:18:40,066 --> 00:18:40,900 TECHNOLOGY. 643 00:18:40,900 --> 00:18:42,001 PRECISION EDUCATION HAD BEEN 644 00:18:42,001 --> 00:18:43,002 DEVELOPED OR AT LEAST THOUGHT 645 00:18:43,002 --> 00:18:47,073 ABOUT AND DISCUSSED IN OTHER 646 00:18:47,073 --> 00:18:48,574 DISCIPLINES IN EDUCATION, NOT 647 00:18:48,574 --> 00:18:49,675 MEDICINE, BEFORE IT CAME TO 648 00:18:49,675 --> 00:18:50,009 MEDICINE. 649 00:18:50,009 --> 00:18:54,380 AND SO WE TOOK TIME TO TALK TO A 650 00:18:54,380 --> 00:18:55,548 LOT OF DIFFERENT TYPES OF 651 00:18:55,548 --> 00:18:55,781 PEOPLE. 652 00:18:55,781 --> 00:18:57,250 WE STARTED OUR JOURNEY IN 653 00:18:57,250 --> 00:18:58,417 PRECISION EDUCATION BACK IN 654 00:18:58,417 --> 00:19:00,820 2022, WHEN WE HAD ALL THE SUMMIT 655 00:19:00,820 --> 00:19:04,557 ASKING ABOUT THIS. 656 00:19:04,557 --> 00:19:06,425 THIS ENERGY THAT WE HAD FOR 657 00:19:06,425 --> 00:19:08,594 PRECISION EDUCATION WAS TIMED 658 00:19:08,594 --> 00:19:09,795 REALLY CONVENIENTLY BECAUSE AS 659 00:19:09,795 --> 00:19:12,431 ALL OF YOU KNOW, THE BOOM IN 660 00:19:12,431 --> 00:19:16,035 A.I. AND IN GENERATIVE A.I. IN 661 00:19:16,035 --> 00:19:17,470 PARTICULAR HAS REALLY COINCIDED, 662 00:19:17,470 --> 00:19:18,871 WE WERE ABLE TO SORT OF CAPTURE 663 00:19:18,871 --> 00:19:20,506 SOME OF THE WAVE THAT CAME WITH 664 00:19:20,506 --> 00:19:22,975 THAT, BUT WE TOOK TIME TO -- AND 665 00:19:22,975 --> 00:19:25,645 I THINK THIS IS A LITTLE BIT 666 00:19:25,645 --> 00:19:26,979 AUTOMATED, BUT WE TOOK TIME TO 667 00:19:26,979 --> 00:19:28,514 TALK NOT ONLY TO MEDICAL 668 00:19:28,514 --> 00:19:29,615 EDUCATION EXPERTS BUT TO TALK TO 669 00:19:29,615 --> 00:19:30,917 INDUSTRY EXPERTS, TO TALK TO 670 00:19:30,917 --> 00:19:32,018 TECHNOLOGY EXPERTS AND TALK TO 671 00:19:32,018 --> 00:19:33,986 EDUCATION EXPERT OUTSIDE OF 672 00:19:33,986 --> 00:19:36,822 MEDICINE AS WELL AND THIS IS US 673 00:19:36,822 --> 00:19:39,225 SPEAKING WITH SAL KHAN, WHO I 674 00:19:39,225 --> 00:19:40,993 HOPE MANY OF YOU KNOW SOME OF 675 00:19:40,993 --> 00:19:42,628 HIS WORK, HE'S RECENTLY WRITTEN 676 00:19:42,628 --> 00:19:44,263 A NEW BOOK ON A.I. AND 677 00:19:44,263 --> 00:19:45,565 REVOLUTION OF A.I. RELATED TO 678 00:19:45,565 --> 00:19:47,433 EDUCATION GENERALLY. 679 00:19:47,433 --> 00:19:49,502 HE IS, IN MY VIEW, PROBABLY THE 680 00:19:49,502 --> 00:19:51,270 FURTHEST AHEAD IN TERMS OF 681 00:19:51,270 --> 00:19:54,006 INNOVATION AND THINKING 682 00:19:54,006 --> 00:19:54,974 CREATIVELY BL PRECISION 683 00:19:54,974 --> 00:19:56,609 EDUCATION AND HE'S APPLIED THAT 684 00:19:56,609 --> 00:19:58,377 CERTAINLY TO K THROUGH 12 IN 685 00:19:58,377 --> 00:20:00,112 EFFECTIVE MODELS THAT HAVE BEEN 686 00:20:00,112 --> 00:20:00,546 SCALED GLOBALLY. 687 00:20:00,546 --> 00:20:01,647 SO THIS IS THE DEFINITION THAT 688 00:20:01,647 --> 00:20:03,616 WE DEVELOPED WITH PRECISION 689 00:20:03,616 --> 00:20:04,016 EDUCATION. 690 00:20:04,016 --> 00:20:05,318 THESE ARE SYSTEMS IN MEDICINE 691 00:20:05,318 --> 00:20:07,119 THAT USE DATA AND TECHNOLOGY TO 692 00:20:07,119 --> 00:20:08,654 TRANSFORM LIFELONG LEARNING. 693 00:20:08,654 --> 00:20:10,623 THEY DO THREE THINGS, IMPROVE 694 00:20:10,623 --> 00:20:11,490 PERSONALIZATION OF LEARNING, 695 00:20:11,490 --> 00:20:13,593 THEY IMPROVE THE EFFICIENCY, WE 696 00:20:13,593 --> 00:20:14,894 DESCRIBED HOW THE CURRENT MODELS 697 00:20:14,894 --> 00:20:16,529 ARE INEFFICIENT, AND REALLY 698 00:20:16,529 --> 00:20:17,697 IMPORTANTLY, THEY TRANSFER 699 00:20:17,697 --> 00:20:20,132 AGENCY OF LEARNING TO THE 700 00:20:20,132 --> 00:20:21,234 LEARNER. 701 00:20:21,234 --> 00:20:22,635 SO THE IDEA HERE AS THE QUICK 702 00:20:22,635 --> 00:20:23,970 EXAMPLE WOULD BE A DASHBOARD, SO 703 00:20:23,970 --> 00:20:25,938 THAT YOU AS THE LEARNER 704 00:20:25,938 --> 00:20:27,139 UNDERSTAND AND CAN DRIVE THE 705 00:20:27,139 --> 00:20:28,975 LEARNING THAT YOU HAVE, YOU HAVE 706 00:20:28,975 --> 00:20:29,976 OWNERSHIP OVER IT THAT YOU DON'T 707 00:20:29,976 --> 00:20:31,510 HAVE TODAY. 708 00:20:31,510 --> 00:20:33,045 BECAUSE TODAY, LARGELY IT'S 709 00:20:33,045 --> 00:20:34,347 DETERMINED BY THE DIRECTORS OF 710 00:20:34,347 --> 00:20:35,448 THAT EDUCATIONAL PROGRAM OR 711 00:20:35,448 --> 00:20:36,983 CURRICULUM. 712 00:20:36,983 --> 00:20:39,919 WE ALSO IMPORTANTLY DESCRIBE 713 00:20:39,919 --> 00:20:45,625 THIS IN TERMS OF INDIVIDUALS, 714 00:20:45,625 --> 00:20:46,292 PROGRAMS AND ORGANIZATIONS. 715 00:20:46,292 --> 00:20:47,593 SO THIS CAN HAPPEN AT DIFFERENT 716 00:20:47,593 --> 00:20:48,661 LEVELS THROUGHOUT THE 717 00:20:48,661 --> 00:20:49,328 EDUCATIONAL STRUCTURES. 718 00:20:49,328 --> 00:20:51,097 IF WE DO THIS WELL, WE CAN 719 00:20:51,097 --> 00:20:51,764 IMPROVE PATIENT OUTCOMES. 720 00:20:51,764 --> 00:20:55,901 SO THIS IS THE CONCEPTUAL MODEL 721 00:20:55,901 --> 00:20:57,203 GRAPHICALLY, SO THIS CIRCLE WILL 722 00:20:57,203 --> 00:21:00,339 LOOK FAMILIAR TO PROBABLY ALL OF 723 00:21:00,339 --> 00:21:00,806 YOU. 724 00:21:00,806 --> 00:21:04,744 IT'S BUILT OFF OF A PDA CYCLE, 725 00:21:04,744 --> 00:21:06,178 MASTER ADAPTIVE LEARNER CYCLE. 726 00:21:06,178 --> 00:21:07,380 IT'S ADAPTED IN A COUPLE OF 727 00:21:07,380 --> 00:21:08,581 DIFFERENT WAYS. 728 00:21:08,581 --> 00:21:13,419 THE FIRST I IS THE TOP ARROW, 729 00:21:13,419 --> 00:21:14,620 ANALYTICS. 730 00:21:14,620 --> 00:21:15,688 WE GATHER DATA ABOUT 731 00:21:15,688 --> 00:21:16,589 INDIVIDUALS, PROGRAMS OR 732 00:21:16,589 --> 00:21:18,124 ORGANIZATIONS AND ANALYTICS ARE 733 00:21:18,124 --> 00:21:19,525 PERFORMED ON THOSE DATA. 734 00:21:19,525 --> 00:21:21,827 THOSE ANALYTICS REVEAL INSIGHTS. 735 00:21:21,827 --> 00:21:23,362 UPON THOSE INSIGHTS WE DEVELOP 736 00:21:23,362 --> 00:21:24,664 INTERVENTIONS THROUGH A PLANNING 737 00:21:24,664 --> 00:21:26,198 PROCESS, INTERVENTIONS ARE 738 00:21:26,198 --> 00:21:28,601 IMPLEMENTED, LEARNING OCCURS, WE 739 00:21:28,601 --> 00:21:30,236 ASSESS BASED ON THOSE THINGS. 740 00:21:30,236 --> 00:21:31,871 OUTCOMES ARE GENERATED AND THEN 741 00:21:31,871 --> 00:21:34,173 YOU ADJUST AND YOU CONTINUE. 742 00:21:34,173 --> 00:21:35,274 THE CORE OF THIS IS THE MIDDLE, 743 00:21:35,274 --> 00:21:36,475 WHICH IS THE DATA. 744 00:21:36,475 --> 00:21:42,248 THE DATA ARE THE ENGINE FOR 745 00:21:42,248 --> 00:21:43,482 PRECISION EDUCATION SYSTEMS. 746 00:21:43,482 --> 00:21:45,451 WE DESCRIBE DATA REALLY AS ALL 747 00:21:45,451 --> 00:21:47,420 TYPES OF DATA THAT COULD BE 748 00:21:47,420 --> 00:21:48,788 POSSIBLY COLLECTED ABOUT AN 749 00:21:48,788 --> 00:21:49,188 INDIVIDUAL. 750 00:21:49,188 --> 00:21:51,123 AS YOU PROBABLY ARE AWARE, THERE 751 00:21:51,123 --> 00:21:52,124 ARE DATA COLLECTED ABOUT YOU 752 00:21:52,124 --> 00:21:53,959 EVERY DAY. 753 00:21:53,959 --> 00:21:55,061 CONTINUOUSLY REALLY. 754 00:21:55,061 --> 00:21:56,262 THROUGH THE PHONES THAT YOU USE, 755 00:21:56,262 --> 00:21:59,131 THROUGH THE EMR THAT YOU USE, 756 00:21:59,131 --> 00:21:59,999 THROUGH LEARNING MANAGEMENT 757 00:21:59,999 --> 00:22:01,300 SYSTEM, THROUGH THE FORMS AND 758 00:22:01,300 --> 00:22:02,601 INFORMATION THAT YOU SUBMIT TO 759 00:22:02,601 --> 00:22:04,370 THE GOVERNMENT OR TO PAYORS. 760 00:22:04,370 --> 00:22:07,306 SO THERE ARE ABUNDANT AMOUNT OF 761 00:22:07,306 --> 00:22:08,441 DATA THAT ARE COLLECTED. 762 00:22:08,441 --> 00:22:09,508 THE GOAL HERE WOULD BE TO 763 00:22:09,508 --> 00:22:11,477 LEVERAGE THAT DATA IN A USEFUL 764 00:22:11,477 --> 00:22:13,245 WAY TO DO ASSESSMENT AS WELL AS 765 00:22:13,245 --> 00:22:15,081 DEVELOPMENT. 766 00:22:15,081 --> 00:22:16,716 WE PUT AROUND THAT DATA, AND 767 00:22:16,716 --> 00:22:18,684 AGAIN, THE REASON -- THE 768 00:22:18,684 --> 00:22:20,686 INDIVIDUAL, THE PROGRAM AND THE 769 00:22:20,686 --> 00:22:21,854 ORGANIZATION, THERE'S A YELLOW 770 00:22:21,854 --> 00:22:25,524 CIRCLE IN HERE THAT WE DESCRIBE 771 00:22:25,524 --> 00:22:26,992 WE ARE ENTITIES AND PRODUCTS, 772 00:22:26,992 --> 00:22:29,195 AND THE GOAL OF THIS LAYER, THE 773 00:22:29,195 --> 00:22:30,496 REASON THAT LAYER IS THERE, IS 774 00:22:30,496 --> 00:22:33,532 THIS IS THE LAYER THROUGH WHICH 775 00:22:33,532 --> 00:22:34,433 DATA ARE CONSUMED. 776 00:22:34,433 --> 00:22:36,402 SO THE DATA ARE COLLECTED IN A 777 00:22:36,402 --> 00:22:38,337 VARIETY OF DIFFERENT AREAS, 778 00:22:38,337 --> 00:22:39,472 REALLY FRAGMENTED IN THIS 779 00:22:39,472 --> 00:22:40,473 COUNTRY, THE DIFFERENT PLACES 780 00:22:40,473 --> 00:22:42,341 THAT DATA ARE COLLECTED AND 781 00:22:42,341 --> 00:22:43,442 HELD, BUT THEY'RE CONSUMED 782 00:22:43,442 --> 00:22:44,810 THROUGH ENTITIES AND PRODUCTS. 783 00:22:44,810 --> 00:22:46,712 SO ENTITIES WOULD BE THE NIH 784 00:22:46,712 --> 00:22:48,447 CLINICAL CENTER AS AN EXAMPLE. 785 00:22:48,447 --> 00:22:51,083 A PRODUCT WOULD BE THE LEARNING 786 00:22:51,083 --> 00:22:52,151 MANAGEMENT SYSTEM OR THE 787 00:22:52,151 --> 00:22:53,352 ELECTRONIC MEDICAL RECORD THAT 788 00:22:53,352 --> 00:22:54,153 YOU HAVE. 789 00:22:54,153 --> 00:22:55,988 THAT'S HOW DATA ARE ACTUALLY 790 00:22:55,988 --> 00:22:56,889 COLLECTED, CONSUMED AND SHARED 791 00:22:56,889 --> 00:22:59,392 WITH OTHERS. 792 00:22:59,392 --> 00:23:02,228 SO THE ENTIRE PRECISION 793 00:23:02,228 --> 00:23:03,329 EDUCATION SYSTEM RELIES ON ALL 794 00:23:03,329 --> 00:23:03,863 OF THIS. 795 00:23:03,863 --> 00:23:04,730 THE GOAL WOULD BE TO LEVERAGE 796 00:23:04,730 --> 00:23:09,335 ALL OF THIS, AGAIN, DEPLOY TO 797 00:23:09,335 --> 00:23:11,003 DEVELOPMENT AND ASSESSMENT OF 798 00:23:11,003 --> 00:23:11,537 LEARNERS. 799 00:23:11,537 --> 00:23:12,938 THERE'S A LOT OF PRINCIPLES AND 800 00:23:12,938 --> 00:23:13,773 STANDARDS WE NEED TO ESTABLISH 801 00:23:13,773 --> 00:23:15,040 IN THIS WORK TO ENSURE EQUITY, 802 00:23:15,040 --> 00:23:18,310 TO ENSURE THAT LEARNERS DO HAVE 803 00:23:18,310 --> 00:23:19,278 AGENCY AND STANDARDS TO MAKE 804 00:23:19,278 --> 00:23:20,713 SURE THAT IT'S SAFE FOR 805 00:23:20,713 --> 00:23:22,548 EVERYBODY TO USE, AND YOU'VE ALL 806 00:23:22,548 --> 00:23:23,883 I'M SURE READ ABOUT THIS IN 807 00:23:23,883 --> 00:23:25,351 RELATION TO A.I. 808 00:23:25,351 --> 00:23:26,519 IT'S SIMILAR IN TERMS OF THE 809 00:23:26,519 --> 00:23:28,053 THINGS THAT WE THINK ABOUT IN 810 00:23:28,053 --> 00:23:30,689 PRECISION EDUCATION. 811 00:23:30,689 --> 00:23:34,160 IF YOU TURN THAT ON ITS SLIDE, 812 00:23:34,160 --> 00:23:37,229 THE LAST SLIDE BEFORE I GIVE YOU 813 00:23:37,229 --> 00:23:37,897 EXAMPLES, ONE IMPORTANT CONCEPT 814 00:23:37,897 --> 00:23:39,265 WE THINK ABOUT WITH PRECISION 815 00:23:39,265 --> 00:23:40,299 EDUCATION IS IT'S NOT STATIC, 816 00:23:40,299 --> 00:23:41,734 IT'S NOT ONE POINT IN TIME, BUT 817 00:23:41,734 --> 00:23:45,337 REALLY FOR US TO ACHIEVE 818 00:23:45,337 --> 00:23:46,405 EFFECTIVE LIFELONG LEARNING, 819 00:23:46,405 --> 00:23:48,841 THIS IS ACTUALLY A LONGITUDAL 820 00:23:48,841 --> 00:23:49,708 CONTINUOUS PROCESS. 821 00:23:49,708 --> 00:23:51,343 THE IDEA HERE IS THAT YOU 822 00:23:51,343 --> 00:23:53,412 TRAVERSE FROM UME TO GME TO 823 00:23:53,412 --> 00:23:56,248 CONTINUOUS PRACTICE AND DATA ARE 824 00:23:56,248 --> 00:23:58,818 SHARED BIDIRECTIONALLY SO THE 825 00:23:58,818 --> 00:24:00,186 MEDICAL SCHOOL FROM WHICH YOU'VE 826 00:24:00,186 --> 00:24:02,154 GRADUATED WILL LEARN ABOUT THE 827 00:24:02,154 --> 00:24:05,658 OUTCOMES THAT YOU GENERATE AS A 828 00:24:05,658 --> 00:24:06,325 PRACTICING PHYSICIAN. 829 00:24:06,325 --> 00:24:07,426 OR THE RESIDENCY PROGRAM THAT 830 00:24:07,426 --> 00:24:08,194 YOU JOIN. 831 00:24:08,194 --> 00:24:10,262 THOSE DATA THEN CAN HELP DRIVE 832 00:24:10,262 --> 00:24:11,163 CONTINUOUS PROCESS IMPROVEMENT 833 00:24:11,163 --> 00:24:14,200 AND CHANGE THE WAY THAT THEY 834 00:24:14,200 --> 00:24:15,067 DELIVER EDUCATION FOR THE 835 00:24:15,067 --> 00:24:16,602 STUDENTS THAT CONTINUE TO COME 836 00:24:16,602 --> 00:24:17,036 THROUGH. 837 00:24:17,036 --> 00:24:19,438 AND EVEN MORE IMPORTANTLY, MOVE 838 00:24:19,438 --> 00:24:20,773 UPSTREAM FROM THERE, SO THEY CAN 839 00:24:20,773 --> 00:24:21,974 GENERATE INFORMATION ABOUT HOW 840 00:24:21,974 --> 00:24:23,275 TO SELECT FOR PEOPLE IN A WAY 841 00:24:23,275 --> 00:24:24,376 THAT YOU THINK ARE MORE 842 00:24:24,376 --> 00:24:26,879 EFFECTIVE FOR THEIR MISSION OR 843 00:24:26,879 --> 00:24:27,847 FOR THE PHYSICIAN WORKFORCE THAT 844 00:24:27,847 --> 00:24:28,848 THEY WANT TO HELP DEVELOP. 845 00:24:28,848 --> 00:24:31,484 SO AGAIN THIS BIDIRECTIONAL 846 00:24:31,484 --> 00:24:32,685 LONGITUDAL ASPECT OF PRECISION 847 00:24:32,685 --> 00:24:34,987 EDUCATION, WE FEEL IS VERY 848 00:24:34,987 --> 00:24:37,389 IMPORTANT. 849 00:24:37,389 --> 00:24:38,924 SO NOW I'M GOING TO TALK A 850 00:24:38,924 --> 00:24:40,025 LITTLE BIT ABOUT HOW. 851 00:24:40,025 --> 00:24:42,528 THIS HAS REALLY TAKEN OFF, I 852 00:24:42,528 --> 00:24:44,163 WOULD SAY, THERE ARE SILOS, THIS 853 00:24:44,163 --> 00:24:45,798 IS A HANDFUL, I KNOW THESE 854 00:24:45,798 --> 00:24:47,466 ACRONYMS WON'T MAKE SENSE TO 855 00:24:47,466 --> 00:24:49,201 YOU, BUT THE GOAL OF PUTTING 856 00:24:49,201 --> 00:24:50,936 THIS ON THE SLIDE AND SHARING IT 857 00:24:50,936 --> 00:24:52,471 IS TO SHOW YOU THAT THERE IS 858 00:24:52,471 --> 00:24:53,806 ACTIVITY IN THIS SPACE. 859 00:24:53,806 --> 00:24:57,409 SO ACROSS THE TOP IS THE 860 00:24:57,409 --> 00:24:59,912 COMPARTMENTS OF EDUCATION, UME, 861 00:24:59,912 --> 00:25:01,447 GME AND CONTINUOUS PRACTICE, 862 00:25:01,447 --> 00:25:02,248 ORGANIZATIONS, PROGRAMS AND 863 00:25:02,248 --> 00:25:02,982 INDIVIDUALS AT THE BOTTOM. 864 00:25:02,982 --> 00:25:05,084 YOU CAN SEE EACH OF THESE BULLET 865 00:25:05,084 --> 00:25:06,919 POINTS ARE INITIATIVES IN 866 00:25:06,919 --> 00:25:08,120 PRECISION EDUCATION THAT WE ARE 867 00:25:08,120 --> 00:25:08,888 HELPING SUPPORT. 868 00:25:08,888 --> 00:25:09,989 I'M GOING TO HIGHLIGHT THE ONES 869 00:25:09,989 --> 00:25:11,524 THAT ARE IN GREY, AND THIS IS A 870 00:25:11,524 --> 00:25:13,492 SUBSET OF WHAT'S OCCURING IN THE 871 00:25:13,492 --> 00:25:13,792 COUNTRY. 872 00:25:13,792 --> 00:25:14,960 ONE THING I WANT TO HIGHLIGHT 873 00:25:14,960 --> 00:25:18,130 HERE IS YOU CAN SEE THERE'S A 874 00:25:18,130 --> 00:25:19,398 LOT OF ACTIVITY BUT THESE 875 00:25:19,398 --> 00:25:20,799 ACTIVITY ARE OCCURRING AND BEING 876 00:25:20,799 --> 00:25:24,870 DEVELOPED IN, NOT SU SURPRISING, 877 00:25:24,870 --> 00:25:26,305 HIGH RESOURCED INSTITUTION IN 878 00:25:26,305 --> 00:25:27,139 THE COUNTRY. 879 00:25:27,139 --> 00:25:30,075 SO ONE OF THE GOALS WE HAVE AT 880 00:25:30,075 --> 00:25:33,178 THE AMA IN HELPING TO NURTURE 881 00:25:33,178 --> 00:25:34,713 THIS IS TO ENSURE AT THE OUTSET 882 00:25:34,713 --> 00:25:36,382 THAT WE DEVELOP PRINCIPLES AND 883 00:25:36,382 --> 00:25:37,283 STANDARDS FOR THIS WORK SO THAT 884 00:25:37,283 --> 00:25:39,652 WHAT IS CREATED CAN BE A PUBLIC 885 00:25:39,652 --> 00:25:40,386 GOOD. 886 00:25:40,386 --> 00:25:42,354 THAT THERE'S INTEROPERABILITY, 887 00:25:42,354 --> 00:25:44,123 THAT WHATEVER IS CREATED AS AN 888 00:25:44,123 --> 00:25:45,124 INSTITUTION THAT HAS A LOT OF 889 00:25:45,124 --> 00:25:47,159 RESOURCE CAN BE REPLICATED AND 890 00:25:47,159 --> 00:25:48,494 SCALED IN INSTITUTIONS THAT HAVE 891 00:25:48,494 --> 00:25:49,395 LESS RESOURCE. 892 00:25:49,395 --> 00:25:50,996 ULTIMATELY THIS IS TO DEVELOP A 893 00:25:50,996 --> 00:25:51,764 PHYSICIAN WORKFORCE SO IT'S 894 00:25:51,764 --> 00:25:53,432 IMPORTANT THAT WE DO THAT. 895 00:25:53,432 --> 00:25:55,301 SO I'M GOING TO SHARE WITH YOU, 896 00:25:55,301 --> 00:25:57,369 AGAIN, BECAUSE THIS IS 897 00:25:57,369 --> 00:25:58,404 GME-RELATED AUDIENCE PRIMARILY, 898 00:25:58,404 --> 00:25:59,972 I'M GOING TO FOCUS ON GME. 899 00:25:59,972 --> 00:26:01,674 YOU CAN SEE A LOT OF THE GREY IN 900 00:26:01,674 --> 00:26:03,142 THE GME AND ONE EXAMPLE IN 901 00:26:03,142 --> 00:26:04,476 CONTINUING PRACTICE AS WELL, AND 902 00:26:04,476 --> 00:26:07,313 THEN HOPEFULLY THESE WILL 903 00:26:07,313 --> 00:26:08,747 GENERATE SOME IMAGINATION IN 904 00:26:08,747 --> 00:26:10,583 TERMS OF WHAT'S POSSIBLE WITH 905 00:26:10,583 --> 00:26:11,150 PRECISION EDUCATION. 906 00:26:11,150 --> 00:26:12,918 SO I'VE STATED EACH OF THESE 907 00:26:12,918 --> 00:26:14,219 EXAMPLES AS A PROBLEM THAT THAT 908 00:26:14,219 --> 00:26:18,591 IB OVATINNOVATION IS TRYING TO . 909 00:26:18,591 --> 00:26:19,892 SO THE FIRST IS FIVE, I'M GOING 910 00:26:19,892 --> 00:26:21,226 TO SHARE FIVE WITH YOU, IS 911 00:26:21,226 --> 00:26:22,094 SELECTION INTO RESIDENCY 912 00:26:22,094 --> 00:26:22,661 PROGRAMS. 913 00:26:22,661 --> 00:26:24,063 YOU CAN OBVIOUSLY IMAGINE THAT 914 00:26:24,063 --> 00:26:25,164 SELECTION INTO FELLOWSHIP 915 00:26:25,164 --> 00:26:26,131 PROGRAMS AS WELL. 916 00:26:26,131 --> 00:26:27,666 HOW DO YOU POSSIBLY SCREEN 917 00:26:27,666 --> 00:26:29,301 THOUSANDS OF APPLICATIONS? 918 00:26:29,301 --> 00:26:31,403 THESE NUMBERS ARE JUST 919 00:26:31,403 --> 00:26:32,271 INCREASING EACH AND EVERY YEAR 920 00:26:32,271 --> 00:26:33,472 THAT WE GO THROUGH THIS. 921 00:26:33,472 --> 00:26:35,341 AND THE OPPORTUNITY HERE IS 922 00:26:35,341 --> 00:26:37,509 THROUGH NYU USING A.I. TO 923 00:26:37,509 --> 00:26:39,478 AUGMENT RECRUITMENT, AND I'VE 924 00:26:39,478 --> 00:26:42,114 HIGHLIGHTED HERE DR. JESSI RAFEL 925 00:26:42,114 --> 00:26:44,083 WHO HAS LED THIS WORK. 926 00:26:44,083 --> 00:26:46,485 IDEA HERE, THIS WAS DONE AT THE 927 00:26:46,485 --> 00:26:48,787 NYU INTERNAL RESIDENCY PROGRAM. 928 00:26:48,787 --> 00:26:49,855 THE RES DEN SEEP PROGRAM 929 00:26:49,855 --> 00:26:52,057 RECEIVES THOUSANDS OF 930 00:26:52,057 --> 00:26:53,592 APPLICATIONS AND THERE'S A 931 00:26:53,592 --> 00:26:54,893 PROGRAM DIRECTOR REVIEW, THE 932 00:26:54,893 --> 00:26:56,629 GOAL IS TRYING TO BE HOLISTIC 933 00:26:56,629 --> 00:27:00,633 AND THEY RECOGNIZE AND 934 00:27:00,633 --> 00:27:01,500 UNDERSTOOD THAT THEY WERE 935 00:27:01,500 --> 00:27:02,067 MISSING PEOPLE. 936 00:27:02,067 --> 00:27:03,802 SO HOW MIGHT THEY USE A.I. NOT 937 00:27:03,802 --> 00:27:06,839 TO RELAYS THEM, THEMSELVES, BUT 938 00:27:06,839 --> 00:27:08,574 TO ENHANCE THEIR SYSTEM AND 939 00:27:08,574 --> 00:27:10,109 THEIR PROCESS SUCH THAT THEY 940 00:27:10,109 --> 00:27:13,379 DON'T MISS PEOPLE BECAUSE OF 941 00:27:13,379 --> 00:27:14,146 THEIR MANUAL REVIEW. 942 00:27:14,146 --> 00:27:18,283 SO WHAT THEY DO IS THIS IS AN 943 00:27:18,283 --> 00:27:20,819 IDEA THAT THERE'S A DIAMOND IN 944 00:27:20,819 --> 00:27:25,457 THE RUFF, SO WHAT THEY DID IS 945 00:27:25,457 --> 00:27:27,159 THEY TOOK HISTORICAL DATA ON WHO 946 00:27:27,159 --> 00:27:28,594 THEY SELECTED, SO THIS IS NOT 947 00:27:28,594 --> 00:27:30,229 THE RIGHT APPLICANT OR THE WRONG 948 00:27:30,229 --> 00:27:31,764 APPLICANT, IT'S JUST BASED ON 949 00:27:31,764 --> 00:27:32,865 WHO THEY SELECTED IN THE PATION. 950 00:27:32,865 --> 00:27:34,933 SO THEY USED THAT INFORMATION, 951 00:27:34,933 --> 00:27:36,568 THEY FED THAT INTO AN A.I. 952 00:27:36,568 --> 00:27:40,939 ENGINE AND THEN THEY TOOK THEIR 953 00:27:40,939 --> 00:27:42,775 UPCOMING YEARS OF APPLICANTS AND 954 00:27:42,775 --> 00:27:44,843 THEY FED IT INTO THE A.I. ENGINE 955 00:27:44,843 --> 00:27:46,845 AND THIS IS THE TYPE OF GRAPH 956 00:27:46,845 --> 00:27:48,147 THAT'S DISTRIBUTED. 957 00:27:48,147 --> 00:27:51,216 WHAT THE AI ENGINE PUTS OUT HERE 958 00:27:51,216 --> 00:27:53,585 ARE BASED ON HISTORICAL 959 00:27:53,585 --> 00:27:56,455 INFORMATION AND THE ALGORITHM 960 00:27:56,455 --> 00:27:57,122 IT'S CREATED. 961 00:27:57,122 --> 00:27:59,291 ON THE LEFT ARE THE PEOPLE THE 962 00:27:59,291 --> 00:28:00,159 ALGORITHM WOULD SAY WE SHOULD 963 00:28:00,159 --> 00:28:03,562 NOT INVITE FOR INTERVIEW AND INN 964 00:28:03,562 --> 00:28:05,397 THE RIGHT IN ORANGE ARE THE ONES 965 00:28:05,397 --> 00:28:06,965 THE ALGORITHM SAYS WE SHOULD 966 00:28:06,965 --> 00:28:08,033 INVITE TO INTERVIEW. 967 00:28:08,033 --> 00:28:09,802 ON THE WHITE, IF YOU GUYS CAN 968 00:28:09,802 --> 00:28:10,869 SEE THE WHITE LITTLE BAR IN THE 969 00:28:10,869 --> 00:28:12,638 ORANGE, THOSE ARE AM KANGTS THAT 970 00:28:12,638 --> 00:28:14,373 THE COMMITTEE HAS NOT EXTENDED 971 00:28:14,373 --> 00:28:16,909 AN INTERVIEW TO. 972 00:28:16,909 --> 00:28:18,811 SO THE IDEA IS TO HIGHLIGHT 973 00:28:18,811 --> 00:28:19,845 PEOPLE THAT THE ALGORITHM WOULD 974 00:28:19,845 --> 00:28:22,047 SAY BASED ON HE HAVE BEEN YOU 975 00:28:22,047 --> 00:28:22,915 TYPICALLY INTERVIEW, YOU WOULD 976 00:28:22,915 --> 00:28:24,016 HAVE SELECTED THIS PERSON, BUT 977 00:28:24,016 --> 00:28:24,616 YOU DEPARTMENT. 978 00:28:24,616 --> 00:28:26,552 SO DO YOU WANT TO TAKE A LOOK AT 979 00:28:26,552 --> 00:28:27,319 THAT PERSON? 980 00:28:27,319 --> 00:28:28,587 SO THEN CAN YOU ACTUALLY DOUBLE 981 00:28:28,587 --> 00:28:30,155 CLICK, YOU CAN SEE EXACTLY WHO 982 00:28:30,155 --> 00:28:31,890 THOSE PEOPLE ARE. 983 00:28:31,890 --> 00:28:33,225 THIS PERSON WAS NOT INVITED 984 00:28:33,225 --> 00:28:34,960 ALTHOUGH THE ALGORITHM SAYS THEY 985 00:28:34,960 --> 00:28:37,162 SHOULD HAVE BEEN INVITED BASED 986 00:28:37,162 --> 00:28:39,465 ON HISTORICAL INFORMATION. 987 00:28:39,465 --> 00:28:41,400 THEY'LL TELL YOU WHY THEY SAID 988 00:28:41,400 --> 00:28:42,735 THIS PERSON WOULD HAVE BEEN 989 00:28:42,735 --> 00:28:44,069 INVITED BASED ON HISTORICAL 990 00:28:44,069 --> 00:28:44,503 DATA. 991 00:28:44,503 --> 00:28:46,338 YOU CAN STILL MAKE YOUR OWN 992 00:28:46,338 --> 00:28:47,639 DECISION, MAYBE THERE'S 993 00:28:47,639 --> 00:28:50,509 SOMETHING UNIQUE THAT WAS NOT 994 00:28:50,509 --> 00:28:51,376 CAPTURED, THIS IS SOMEBODY YOU 995 00:28:51,376 --> 00:28:52,811 MAY HAVE MISSED. 996 00:28:52,811 --> 00:28:55,447 THEY THEN ADDED THIS TO -- THEY 997 00:28:55,447 --> 00:28:57,950 ADDED INTO THIS NATURAL LANGUAGE 998 00:28:57,950 --> 00:28:58,717 PROCESSING OF THE PERSONAL 999 00:28:58,717 --> 00:28:59,785 STATEMENTS IN THE APPLICATION. 1000 00:28:59,785 --> 00:29:01,887 AND THEY CAN LOOK FOR KEYWORDS 1001 00:29:01,887 --> 00:29:03,722 THAT ARE MISSION-FOCUSED OR 1002 00:29:03,722 --> 00:29:05,057 MISSION-ALIGNED FOR NYU. 1003 00:29:05,057 --> 00:29:07,059 WHEN THEY DO THAT, THEY INCREASE 1004 00:29:07,059 --> 00:29:12,064 THE PERFORMANCE OF THIS ENGINE. 1005 00:29:12,064 --> 00:29:13,165 SO AGAIN THE IDEA IS YOU CAN 1006 00:29:13,165 --> 00:29:15,801 START TO HOPEFULLY IMPROVE 1007 00:29:15,801 --> 00:29:17,202 HOLISTIC REVIEW, WHEN IT'S 1008 00:29:17,202 --> 00:29:18,403 MECHANICALLY ALMOST IMPOSSIBLE, 1009 00:29:18,403 --> 00:29:19,338 AGAIN HAVING GONE THROUGH THIS 1010 00:29:19,338 --> 00:29:21,306 FOR A DECADE MYSELF, IT IS 1011 00:29:21,306 --> 00:29:22,241 IMPOSSIBLE TO BE ABLE TO DO 1012 00:29:22,241 --> 00:29:22,574 THIS. 1013 00:29:22,574 --> 00:29:23,776 EVERY YEAR THAT I WAS PROGRAM 1014 00:29:23,776 --> 00:29:25,477 DIRECTOR, WE WOULD GET AN EMAIL 1015 00:29:25,477 --> 00:29:26,645 FROM AN APPLICANT SAYING CAN YOU 1016 00:29:26,645 --> 00:29:28,614 TAKE A LOOK, I'D REALLY LIKE TO 1017 00:29:28,614 --> 00:29:29,815 BE CONSIDERED, AND YOU TAKE A 1018 00:29:29,815 --> 00:29:32,885 LOOK AND YOU HAVE NO EXPLANATION 1019 00:29:32,885 --> 00:29:34,620 FOR WHY THEY WEREN'T 1020 00:29:34,620 --> 00:29:35,587 INTERVIEWED, NONE. 1021 00:29:35,587 --> 00:29:36,588 SOMETIMES THAT PERSON GOES ON 1022 00:29:36,588 --> 00:29:38,557 AND BECOMES THE CHIEF RESIDENT. 1023 00:29:38,557 --> 00:29:40,425 SO YOU REALIZE YOU HAVE AN 1024 00:29:40,425 --> 00:29:43,796 IMPERFECT FEBT SYSTEM. 1025 00:29:43,796 --> 00:29:45,764 SYSTEM SO HOPEFULLY 1026 00:29:45,764 --> 00:29:48,200 THAT WILL START TO BOOST THAT 1027 00:29:48,200 --> 00:29:49,301 PROCESS. 1028 00:29:49,301 --> 00:29:50,502 NUMBER TWO, THE RESIDENCY 1029 00:29:50,502 --> 00:29:51,470 PROGRAMS OR THE FELLOWSHIP 1030 00:29:51,470 --> 00:29:52,704 PROGRAMS ARE MEANT TO IMPROVE 1031 00:29:52,704 --> 00:29:54,039 CLINICAL SKILLS AND IMPROVE 1032 00:29:54,039 --> 00:29:55,774 WELL-BEING AS YOU DO IT BUT WE 1033 00:29:55,774 --> 00:29:57,042 DON'T KNOW ON THE ACTIVITIES 1034 00:29:57,042 --> 00:29:58,277 THAT YOU HAVE IF THEY CORRELATE 1035 00:29:58,277 --> 00:29:59,378 TO THAT OR NOT. 1036 00:29:59,378 --> 00:30:00,913 WE DESIGN ACTIVITIES BASED ON A 1037 00:30:00,913 --> 00:30:02,447 LOT OF DIFFERENT CLINICAL KNEE, 1038 00:30:02,447 --> 00:30:03,649 BASED ON SCHEDULES, BASED ON 1039 00:30:03,649 --> 00:30:05,384 NEEDS THAT ARE NOT RELATED TO 1040 00:30:05,384 --> 00:30:08,020 DEVELOPMENT OF THE PERSON. 1041 00:30:08,020 --> 00:30:10,422 AND HOPE THAT THEY DO ACHIEVE 1042 00:30:10,422 --> 00:30:12,391 CLINICAL SKILL AND WELL-BEING 1043 00:30:12,391 --> 00:30:13,058 IMPROVEMENT BUT WE'RE NOT SURE 1044 00:30:13,058 --> 00:30:13,592 ABOUT THAT. 1045 00:30:13,592 --> 00:30:15,460 ONE WAY TO DO THAT IS TO DO 1046 00:30:15,460 --> 00:30:16,428 REALTIME DATA COLLECTION. 1047 00:30:16,428 --> 00:30:18,063 SO THE IDEA HERE IS TO SEE WHERE 1048 00:30:18,063 --> 00:30:19,298 PEOPLE ARE IN THE HOSPITAL. 1049 00:30:19,298 --> 00:30:20,532 THIS IS A HOSPITAL-BASED 1050 00:30:20,532 --> 00:30:20,933 INTERVENTION. 1051 00:30:20,933 --> 00:30:22,234 AND BASED ON THEIR LOCATION, YOU 1052 00:30:22,234 --> 00:30:23,335 CAN MAKE HYPOTHESES. 1053 00:30:23,335 --> 00:30:25,003 FOR EXAMPLE, YOU CAN MAKE THE 1054 00:30:25,003 --> 00:30:26,705 HYPOTHESIS THAT IF SOMEBODY IS 1055 00:30:26,705 --> 00:30:28,040 WITH PATIENTS MORE OFTEN, THEN 1056 00:30:28,040 --> 00:30:29,241 THAT WOULD IMPROVE THEIR 1057 00:30:29,241 --> 00:30:29,808 CLINICAL SKILLS. 1058 00:30:29,808 --> 00:30:31,643 THAT COULD BE A HYPOTHESIS THAT 1059 00:30:31,643 --> 00:30:33,178 SOMEBODY COULD REASONABLY MAKE. 1060 00:30:33,178 --> 00:30:34,713 OR IF THEY'RE WITH PATIENTS MORE 1061 00:30:34,713 --> 00:30:36,348 OFTEN, THAT MIGHT IMPROVE THEIR 1062 00:30:36,348 --> 00:30:39,618 EELK AS OPPOSED TO BEING IN FROT 1063 00:30:39,618 --> 00:30:42,487 OF A COMPUTER. 1064 00:30:42,487 --> 00:30:43,755 -- YOU HIRE MEDICAL STUDENTS 1065 00:30:43,755 --> 00:30:45,023 AND SEND THEM AROUND, WE 1066 00:30:45,023 --> 00:30:47,159 ACTUALLY RAN THE LARGEST ONE 1067 00:30:47,159 --> 00:30:48,193 THAT'S BEEN PUBLISHED IN THE 1068 00:30:48,193 --> 00:30:49,728 COUNTRY, AND THAT HAD 2,000 1069 00:30:49,728 --> 00:30:51,063 HOURS OF OBSERVATION, BECAUSE 1070 00:30:51,063 --> 00:30:52,364 IT'S REALLY HARD TO TRAIN 1071 00:30:52,364 --> 00:30:53,665 MEDICAL STUDENTS AND HAVE THEM 1072 00:30:53,665 --> 00:30:54,566 FOLLOW PEOPLE AROUND. 1073 00:30:54,566 --> 00:30:56,201 BUT IF YOU DO THIS WITH REALTIME 1074 00:30:56,201 --> 00:30:57,603 DATA COLLECTION, THIS WAS DONE 1075 00:30:57,603 --> 00:31:01,673 WHICH THEBY THE WAY AT HOPKINS,D 1076 00:31:01,673 --> 00:31:03,775 AND UAB, YOU CAN COLLECT 1077 00:31:03,775 --> 00:31:06,912 HUNDREDS OF THOUSANDS OF HOURS, 1078 00:31:06,912 --> 00:31:07,379 CONTINUOUSLY. 1079 00:31:07,379 --> 00:31:09,248 AND SO THIS WAS DONE WITH THE 1080 00:31:09,248 --> 00:31:11,783 BADGE THAT PEOPLE WOULD WEAR IN 1081 00:31:11,783 --> 00:31:13,185 THE HOSPITAL, THERE ARE THESE 1082 00:31:13,185 --> 00:31:14,620 SENSORS THAT MONITOR THESE 1083 00:31:14,620 --> 00:31:15,053 BADGES. 1084 00:31:15,053 --> 00:31:16,788 THEY'RE DESIGNED FOR HIGH 1085 00:31:16,788 --> 00:31:18,090 CAPITAL COST EQUIPMENT OR FOR 1086 00:31:18,090 --> 00:31:21,593 ULTRASOUND MACHINES OR FOR OTHER 1087 00:31:21,593 --> 00:31:23,028 PEOPLE THAT ARE BEING MONITORED. 1088 00:31:23,028 --> 00:31:24,763 THEY DID THIS FOR INTERNS IN 1089 00:31:24,763 --> 00:31:26,865 THEIR RESIDENCY PROGRAM. 1090 00:31:26,865 --> 00:31:30,302 YOU CAN SEE 43 INTERNS, HUNDREDS 1091 00:31:30,302 --> 00:31:31,904 OF THOUSANDS OF HOURS BY NOW, 1092 00:31:31,904 --> 00:31:33,105 AND IT PRODUCES GRAPHS LIKE 1093 00:31:33,105 --> 00:31:33,438 THIS. 1094 00:31:33,438 --> 00:31:37,376 THE IDEA IS, AGAIN, CREATE DATA 1095 00:31:37,376 --> 00:31:39,878 THAT IS ABUNDANT, HIGH VOLUME 1096 00:31:39,878 --> 00:31:41,013 AND PRECISE THAT CAN BE 1097 00:31:41,013 --> 00:31:41,446 ACTIONABLE. 1098 00:31:41,446 --> 00:31:43,615 SO I'LL TRY TO DESCRIBE HOW THIS 1099 00:31:43,615 --> 00:31:44,716 COULD BE ACTIONABLE. 1100 00:31:44,716 --> 00:31:46,885 SO THESE ARE HOW INTERNS SPEND 1101 00:31:46,885 --> 00:31:48,086 THEIR TIME. 1102 00:31:48,086 --> 00:31:49,755 ACTUALLY 13% WAS AT BEDSIDE. 1103 00:31:49,755 --> 00:31:52,157 IF YOU LOOK AT THE TOP ROW ONLY, 1104 00:31:52,157 --> 00:31:53,692 YELLOW IS PATIENT ROOM, THAT'S 1105 00:31:53,692 --> 00:31:55,227 13% OF THEIR TIME THAT'S SPENT 1106 00:31:55,227 --> 00:31:56,428 AT THE BEDSIDE. 1107 00:31:56,428 --> 00:31:57,429 AGAIN, MANY PEOPLE WOULD ARGUE 1108 00:31:57,429 --> 00:31:58,864 THAT THAT IS SAD, THAT THAT'S 1109 00:31:58,864 --> 00:32:00,265 HOW MUCH TIME WE SPEND AT THE 1110 00:32:00,265 --> 00:32:00,732 BEDSIDE. 1111 00:32:00,732 --> 00:32:02,601 THIS ACTUALLY CORRELATES TO THE 1112 00:32:02,601 --> 00:32:03,769 TIME MOTION STUDIES THAT HAVE 1113 00:32:03,769 --> 00:32:07,406 BEEN DONE HISTORICALLY BUT THIS 1114 00:32:07,406 --> 00:32:08,507 IS NOT NECESSARILY ACTIONABLE. 1115 00:32:08,507 --> 00:32:10,575 HOW DO YOU INTERVENE UPON THIS 1116 00:32:10,575 --> 00:32:12,444 AND SEE IF IT'S WORKING OR NOT. 1117 00:32:12,444 --> 00:32:13,645 SO ONE NEXT LEVEL OF DATA 1118 00:32:13,645 --> 00:32:14,446 BECAUSE YOU COLLECT THIS 1119 00:32:14,446 --> 00:32:16,315 CONTINUOUSLY IS YOU CAN SEE IF 1120 00:32:16,315 --> 00:32:17,516 THERE'S VARIATION IN THIS DATA 1121 00:32:17,516 --> 00:32:18,150 AND IN FACT THERE ARE. 1122 00:32:18,150 --> 00:32:19,818 EACH OF THESE BARS IS ONE 1123 00:32:19,818 --> 00:32:20,052 INTERN. 1124 00:32:20,052 --> 00:32:21,253 YOU CAN SEE THAT THERE'S 1125 00:32:21,253 --> 00:32:21,920 VARIATION FROM THE PERSON THAT 1126 00:32:21,920 --> 00:32:22,955 SPENDS THE LEAST AMOUNT OF TIME 1127 00:32:22,955 --> 00:32:29,127 AT THE BEDSIDE, # #%, 9%, TO THE 1128 00:32:29,127 --> 00:32:31,096 PERSON THAT SPENDS 18%, DOUBLE. 1129 00:32:31,096 --> 00:32:32,864 SO THERE IS OPPORTUNITY WITHIN 1130 00:32:32,864 --> 00:32:33,999 THAT STRUCTURE FOR DIFFERENT 1131 00:32:33,999 --> 00:32:35,600 AMOUNTS OF TIME AT THE BEDSIDE. 1132 00:32:35,600 --> 00:32:38,236 IF EVERYBODY GOES TO 18%, THAT'S 1133 00:32:38,236 --> 00:32:40,072 ALMOST 400 HOURS MORE OF TIME AT 1134 00:32:40,072 --> 00:32:43,375 THE BEDSIDE THROUGH THE YEAR. 1135 00:32:43,375 --> 00:32:44,576 AGAIN -- YOU CAN GET A LITTLE 1136 00:32:44,576 --> 00:32:46,111 BIT FURTHER DETAIL, YOU CAN 1137 00:32:46,111 --> 00:32:47,212 BREAK IT DOWN BY SERVICE AS 1138 00:32:47,212 --> 00:32:47,612 WELL. 1139 00:32:47,612 --> 00:32:49,614 SO THIS IS THE GENERAL MEDICINE 1140 00:32:49,614 --> 00:32:49,815 WARDS. 1141 00:32:49,815 --> 00:32:51,350 CAN YOU SEE HERE THE 13% WHICH 1142 00:32:51,350 --> 00:32:53,118 IS THE PATIENT ROOM, THEY SPENT 1143 00:32:53,118 --> 00:32:54,553 THIS MUCH TIME IN THE HALLWAY, 1144 00:32:54,553 --> 00:32:58,490 THIS YOU MUCH TIME IN THE WORK 1145 00:32:58,490 --> 00:32:59,524 ROOM, COMPARE THAT TO THE 1146 00:32:59,524 --> 00:33:00,792 SPECIALTY SERVICE WHERE IT MUCH 1147 00:33:00,792 --> 00:33:03,662 MORE CONCENTRATED, A LOT LESS 1148 00:33:03,662 --> 00:33:04,396 VARIABILITY IN THE SPECIALTY 1149 00:33:04,396 --> 00:33:05,397 SERVICES IN TERMS OF WHERE THEY 1150 00:33:05,397 --> 00:33:06,164 SPEND THEIR TIME. 1151 00:33:06,164 --> 00:33:09,234 AGAIN INTERESTING, THEN THE 1152 00:33:09,234 --> 00:33:10,535 HYPOTHESIS OR IDEA HERE WAS HOW 1153 00:33:10,535 --> 00:33:11,670 DO WE CHANGE THIS? 1154 00:33:11,670 --> 00:33:12,537 WE CAN CHANGE THIS BECAUSE 1155 00:33:12,537 --> 00:33:13,839 THERE'S A TIME AND A DAY WHERE 1156 00:33:13,839 --> 00:33:15,173 WE CONTROL WHERE PEOPLE ARE, AND 1157 00:33:15,173 --> 00:33:15,607 THAT'S ROUNDS. 1158 00:33:15,607 --> 00:33:16,508 SO LET'S LOOK AT ROUNDS. 1159 00:33:16,508 --> 00:33:17,909 YOU CAN DO THAT BECAUSE YOU CAN 1160 00:33:17,909 --> 00:33:19,444 BREAK THESE DATA DOWN ANY WAY 1161 00:33:19,444 --> 00:33:21,646 YOU WISH TO, AND THIS IS WHAT 1162 00:33:21,646 --> 00:33:22,180 HAPPENS ON ROUNDS. 1163 00:33:22,180 --> 00:33:23,749 YOU CAN SEE THAT ON THE GENERAL 1164 00:33:23,749 --> 00:33:26,018 MEDICINE WARDS, THERE'S THIS 1165 00:33:26,018 --> 00:33:27,486 AMOUNT OF TIME AT THE BEDSIDE, A 1166 00:33:27,486 --> 00:33:29,421 LOT OF VARIABILITY AGAIN, SOME 1167 00:33:29,421 --> 00:33:32,057 PEOPLE IN THE WARD HALL, SOME 1168 00:33:32,057 --> 00:33:33,358 PEOPLE IN THE WORK ROOM. 1169 00:33:33,358 --> 00:33:34,359 SPECIALTY SERVICE, THEY'RE 1170 00:33:34,359 --> 00:33:35,694 ROUNDING IN THE WORK ROOM 1171 00:33:35,694 --> 00:33:35,961 PRIMARILY. 1172 00:33:35,961 --> 00:33:37,129 THIS IS AN OPPORTUNITY FOR 1173 00:33:37,129 --> 00:33:38,030 INTERVENTION. 1174 00:33:38,030 --> 00:33:39,131 SO YOU CAN INTERVENE, YOU CAN 1175 00:33:39,131 --> 00:33:41,166 MAKE A DECISION THAT I BELIEVE 1176 00:33:41,166 --> 00:33:43,902 ROUNDING AT THE BEDSIDE IS 1177 00:33:43,902 --> 00:33:44,836 BETTER, IT'S A BELIEF THAT YOU 1178 00:33:44,836 --> 00:33:46,238 CAN HAVE, BUT NOW BECAUSE WE 1179 00:33:46,238 --> 00:33:48,407 HAVE CONTINUOUS PRECISION 1180 00:33:48,407 --> 00:33:49,274 EDUCATION SYSTEM, CAN YOU 1181 00:33:49,274 --> 00:33:50,709 ACTUALLY DO THAT AND A TWO WEEKS 1182 00:33:50,709 --> 00:33:51,576 LATER WOULD YOU KNOW IF IT'S 1183 00:33:51,576 --> 00:33:52,778 ACTUALLY WORKING OR NOT, ARE 1184 00:33:52,778 --> 00:33:54,546 THEY SPENDING MORE TIME AT THE 1185 00:33:54,546 --> 00:33:56,314 PATIENT ROOM OR NOT. 1186 00:33:56,314 --> 00:33:57,616 THAT WOULD GIVE YOU LOAK, AND 1187 00:33:57,616 --> 00:33:59,584 THE GOAL THEN IS TO CORRELATE 1188 00:33:59,584 --> 00:34:00,352 THAT TO WELL-BEING. 1189 00:34:00,352 --> 00:34:01,787 SO THEY MONITOR -- THIS IS EARLY 1190 00:34:01,787 --> 00:34:03,889 SO WE DON'T HAVE THESE DATA YET, 1191 00:34:03,889 --> 00:34:06,391 BUT THEY ALSO ARE NOW COLLECTING 1192 00:34:06,391 --> 00:34:09,027 CORRELATIONS OF LOCATION TO 1193 00:34:09,027 --> 00:34:10,896 CLINICAL SKILL AND CORRELATIONS 1194 00:34:10,896 --> 00:34:12,697 OF DATA TO WELL-BEING INDICES, 1195 00:34:12,697 --> 00:34:13,899 WHICH THEY MEASURE EVERY TWO 1196 00:34:13,899 --> 00:34:14,099 WEEKS. 1197 00:34:14,099 --> 00:34:15,867 SO THEN YOU CAN NOW HAVE -- IT'S 1198 00:34:15,867 --> 00:34:17,969 REALLY HARD TO TELL HOSPITALS 1199 00:34:17,969 --> 00:34:19,771 AND THE HOSPITAL ADMINISTRATION 1200 00:34:19,771 --> 00:34:23,842 THAT WE ARE GOING TO SPEND THIS 1201 00:34:23,842 --> 00:34:26,278 MUCH TIME ROUNDING OR THIS MUCH 1202 00:34:26,278 --> 00:34:27,312 RESOURCE ON ROUNDS DURING THE 1203 00:34:27,312 --> 00:34:28,580 MORNING BECAUSE OF THE FORCES TO 1204 00:34:28,580 --> 00:34:29,681 TRY TO GET PEOPLE OUT OF THE 1205 00:34:29,681 --> 00:34:30,882 HOSPITAL, BUT IF YOU HAVE DATA 1206 00:34:30,882 --> 00:34:32,751 TO SHOW THAT IT IMPROVES 1207 00:34:32,751 --> 00:34:34,086 CLINICAL CARE OR DATA THAT 1208 00:34:34,086 --> 00:34:36,054 IMPROVES WELL-BEING, THOSE ARE 1209 00:34:36,054 --> 00:34:37,155 THE TYPE OF INFORMATION I THINK 1210 00:34:37,155 --> 00:34:38,557 ARE IMPORTANT TO HAVE IN THOSE 1211 00:34:38,557 --> 00:34:39,257 CONVERSATIONS. 1212 00:34:39,257 --> 00:34:40,992 AND THE TRANSFERRING AGENCY TO 1213 00:34:40,992 --> 00:34:42,727 LEARNERS, SO EACH INTERN GETS 1214 00:34:42,727 --> 00:34:44,396 THIS KIND OF REPORT. 1215 00:34:44,396 --> 00:34:45,297 WE DON'T KNOW WHAT THE RIGHT 1216 00:34:45,297 --> 00:34:46,832 AMOUNT OF TIME IS AT THE BEDSIDE 1217 00:34:46,832 --> 00:34:47,999 BECAUSE YOU COULD ARGUE IF I 1218 00:34:47,999 --> 00:34:49,201 SPEND TWICE AS MUCH TIME AS 1219 00:34:49,201 --> 00:34:52,104 ANYBODY ELSE, MAYBE I'M NOT AS 1220 00:34:52,104 --> 00:34:53,405 EFFICIENT, MAYBE I DON'T KNOW 1221 00:34:53,405 --> 00:34:54,272 HOW DO THAT WELL. 1222 00:34:54,272 --> 00:34:56,274 BUT IT'S PROBABLY IMPORTANT YOU 1223 00:34:56,274 --> 00:34:57,476 KNOW YOU SPEND TWO TIMES THE 1224 00:34:57,476 --> 00:34:59,144 AMOUNT OF TIME AT THE BEDSIDE 1225 00:34:59,144 --> 00:34:59,978 THAN YOUR PEERS DO. 1226 00:34:59,978 --> 00:35:01,780 SO THAT'S THE TYPE OF REPORT 1227 00:35:01,780 --> 00:35:03,348 THAT THEY GET, THAT SAYS HOW 1228 00:35:03,348 --> 00:35:04,816 MUCH TIME THEY SPEND COMPARED TO 1229 00:35:04,816 --> 00:35:06,051 THE REST OF THE PROGRAM. 1230 00:35:06,051 --> 00:35:08,120 AND YOU CAN USE THAT TO MAKE 1231 00:35:08,120 --> 00:35:08,987 INTERVENTIONS. 1232 00:35:08,987 --> 00:35:11,957 YOU'D USE A COACH AND PROCESS 1233 00:35:11,957 --> 00:35:12,624 THIS INFORMATION. 1234 00:35:12,624 --> 00:35:13,725 THE PRELIMINARY DATA WHICH 1235 00:35:13,725 --> 00:35:15,794 HASN'T BEEN PUBLISHED YET IS 1236 00:35:15,794 --> 00:35:17,863 PERCEIVED TIME AT BEDSIDE DOES 1237 00:35:17,863 --> 00:35:18,563 CORRELATE TO WELL-BEING. 1238 00:35:18,563 --> 00:35:19,865 SO WE KNOW THERE IS SOME SIGNAL 1239 00:35:19,865 --> 00:35:20,232 HERE. 1240 00:35:20,232 --> 00:35:22,534 WE NEED TO UNDERSTAND IT BETTER. 1241 00:35:22,534 --> 00:35:23,502 AGAIN, FOLLOWING PEOPLE AROUND 1242 00:35:23,502 --> 00:35:24,936 IS NOT GOING TO HELP US 1243 00:35:24,936 --> 00:35:25,937 UNDERSTAND THIS BETTER. 1244 00:35:25,937 --> 00:35:27,606 WELL-BEING IS ONE OF THOSE 1245 00:35:27,606 --> 00:35:29,107 REALLY STUBBORN PROBLEMS THAT WE 1246 00:35:29,107 --> 00:35:31,209 NEED TO UNDERSTAND THE ROOT 1247 00:35:31,209 --> 00:35:33,612 CAUSES FOR AND IF WE CAN FIND 1248 00:35:33,612 --> 00:35:34,479 INTERVENTIONS THAT GIVE US 1249 00:35:34,479 --> 00:35:35,747 MEANING THEN WE CAN INVEST IN 1250 00:35:35,747 --> 00:35:36,348 THEM. 1251 00:35:36,348 --> 00:35:38,350 THE THIRD ONE I WILL DESCRIBE IS 1252 00:35:38,350 --> 00:35:39,985 CLINICAL COMPETENCY IN A 1253 00:35:39,985 --> 00:35:40,385 TEAM-BASED MODEL. 1254 00:35:40,385 --> 00:35:42,387 SO ALL OF US WORK IN TEAMS. 1255 00:35:42,387 --> 00:35:46,558 IT'S REALLY HARD, PROBABLY ALL 1256 00:35:46,558 --> 00:35:49,628 OF YOU SUPERVISE RESIDENTS AND 1257 00:35:49,628 --> 00:35:50,529 FELLOWS IN TEAMS AS WELL. 1258 00:35:50,529 --> 00:35:52,397 IT'S HARD TO UNDERSTAND THE 1259 00:35:52,397 --> 00:35:53,498 COMPETENCY OF AN INDIVIDUAL THE 1260 00:35:53,498 --> 00:35:55,133 NEXT DAY WHEN YOU SEE WHAT'S 1261 00:35:55,133 --> 00:35:56,601 BEEN HAPPENING WITH THE PATIENTS 1262 00:35:56,601 --> 00:35:58,203 THAT THEY'VE CARED FOR BECAUSE 1263 00:35:58,203 --> 00:35:59,304 YOU RECOGNIZE THAT THERE ARE 1264 00:35:59,304 --> 00:36:00,939 TEAMS THAT HAVE BEEN WORKING ON 1265 00:36:00,939 --> 00:36:01,406 THAT CARE. 1266 00:36:01,406 --> 00:36:03,041 SO HOW DO YOU CREATE 1267 00:36:03,041 --> 00:36:03,375 ATTRIBUTION? 1268 00:36:03,375 --> 00:36:04,910 SO THIS IS A PROBLEM AGAIN FOR 1269 00:36:04,910 --> 00:36:05,677 DECADES PEOPLE HAVE BEEN 1270 00:36:05,677 --> 00:36:06,244 THINKING ABOUT. 1271 00:36:06,244 --> 00:36:07,546 AND IT VERY DIFFICULT TO DO. 1272 00:36:07,546 --> 00:36:09,414 HOW DO I CREATE ATTRIBUTION FOR 1273 00:36:09,414 --> 00:36:11,183 THE CARE THAT'S BEEN PROVIDED 1274 00:36:11,183 --> 00:36:12,083 AND ATTRIBUTE THAT TO ONE 1275 00:36:12,083 --> 00:36:12,617 PERSON. 1276 00:36:12,617 --> 00:36:14,619 SO NOW AGAIN WITH TECHNOLOGY AND 1277 00:36:14,619 --> 00:36:15,954 DATA IN PRECISION EDUCATION 1278 00:36:15,954 --> 00:36:16,922 SYSTEMS WE CAN START TO DO IS 1279 00:36:16,922 --> 00:36:18,223 THAT USING INFORMATICS. 1280 00:36:18,223 --> 00:36:20,625 THIS WORK HAS BEEN DONE AT 1281 00:36:20,625 --> 00:36:22,627 CINCINNATI, AT NYU AND AT 1282 00:36:22,627 --> 00:36:23,395 STANFORD AND THESE ARE SOME OF 1283 00:36:23,395 --> 00:36:24,596 THE PRINCIPLE INVESTIGATORS 1284 00:36:24,596 --> 00:36:26,031 WORKING ON THIS PROJECT. 1285 00:36:26,031 --> 00:36:28,233 AND THIS WORK WAS DONE LOOKING 1286 00:36:28,233 --> 00:36:29,634 AT PATIENTS WHO WERE ADMITTED TO 1287 00:36:29,634 --> 00:36:31,503 THE HOSPITAL WITH COMPLICATIONS 1288 00:36:31,503 --> 00:36:32,037 OF DIABETES. 1289 00:36:32,037 --> 00:36:33,805 AND THE IDEA WAS TO TRY TO 1290 00:36:33,805 --> 00:36:36,007 UNDERSTAND THE COMPETENCY OF AN 1291 00:36:36,007 --> 00:36:36,775 INDIVIDUAL IN THE MANAGEMENT OF 1292 00:36:36,775 --> 00:36:38,944 A PATIENT WHO COMES IN WITH A 1293 00:36:38,944 --> 00:36:39,945 COMPLICATION OF DIABETES THAT 1294 00:36:39,945 --> 00:36:40,645 REQUIRES HOSPITALIZATION. 1295 00:36:40,645 --> 00:36:43,882 SO THESE ARE THE TYPES OF 1296 00:36:43,882 --> 00:36:44,649 PATIENTS, JUST GRAPHICALLY 1297 00:36:44,649 --> 00:36:46,418 THERE'S PATIENTS THAT COME IN 1298 00:36:46,418 --> 00:36:50,255 DWIRDIFFERENT VERITIES OF 1299 00:36:50,255 --> 00:36:51,022 DECOMPENSATED DIABETES. 1300 00:36:51,022 --> 00:36:52,524 THEY GET ADMITTED TO MEDICINE 1301 00:36:52,524 --> 00:36:54,125 AND THE WAY THAT THEY SET THIS 1302 00:36:54,125 --> 00:36:55,460 UP IS THAT THEY UNDERSTAND THIS 1303 00:36:55,460 --> 00:36:56,761 WAS SET UP IN ONE HOSPITAL, THIS 1304 00:36:56,761 --> 00:36:57,963 WAS ACTUALLY AT UNIVERSITY OF 1305 00:36:57,963 --> 00:36:58,296 CINCINNATI. 1306 00:36:58,296 --> 00:36:59,764 AND THEY UNDERSTAND AT 1307 00:36:59,764 --> 00:37:00,599 UNIVERSITY OF CINCINNATI WHAT 1308 00:37:00,599 --> 00:37:04,336 THE TEAM STRUCTURE IS AND WHAT 1309 00:37:04,336 --> 00:37:05,770 THE BEHAVIORS ARE ON THAT TEAM. 1310 00:37:05,770 --> 00:37:07,105 WHEN SOMEBODY COMES IN ADMITTED 1311 00:37:07,105 --> 00:37:08,607 TO MEDICINE, THEY KNOW WHOEVER 1312 00:37:08,607 --> 00:37:11,343 PUTS IN THE ORDERS FOR THE FIRST 1313 00:37:11,343 --> 00:37:12,344 12 HOURS OF THAT PERSON'S STAY 1314 00:37:12,344 --> 00:37:13,912 IS THE PERSON THAT'S MAKING THE 1315 00:37:13,912 --> 00:37:15,413 DECISIONS FOR THAT PARTICULAR 1316 00:37:15,413 --> 00:37:15,914 PATIENT. 1317 00:37:15,914 --> 00:37:17,549 THAT PERSON IS -- SO THAT'S NOT 1318 00:37:17,549 --> 00:37:19,517 TRUE IN EVERY CIRCUMSTANCE. 1319 00:37:19,517 --> 00:37:20,285 SOMETIMES SOMEBODY ELSE IS 1320 00:37:20,285 --> 00:37:22,153 PUTTING IN ORDERS AND SENIOR 1321 00:37:22,153 --> 00:37:23,488 RESIDENT IS MAKING DECISIONS, 1322 00:37:23,488 --> 00:37:24,789 BUT THEY KNOW THIS TEAM AND THAT 1323 00:37:24,789 --> 00:37:26,224 PERSON THAT'S PUTTING IN THE 1324 00:37:26,224 --> 00:37:27,325 ADMISSION ORDERS IS MAKING THE 1325 00:37:27,325 --> 00:37:27,592 DECISION. 1326 00:37:27,592 --> 00:37:29,094 SO WHEN THIS PERSON COMES IN, 1327 00:37:29,094 --> 00:37:30,629 THERE'S AN ADMISSION ORDER 1328 00:37:30,629 --> 00:37:31,730 THAT'S CREATED. 1329 00:37:31,730 --> 00:37:33,698 WHEN THAT ADMISSION ORDER IS 1330 00:37:33,698 --> 00:37:36,234 CREATED THERE'S A TRAINEE THAT'S 1331 00:37:36,234 --> 00:37:38,203 ATTRIBUTED TO HAVING MADE 1332 00:37:38,203 --> 00:37:39,437 DECISIONS RELATED TO THE CARE. 1333 00:37:39,437 --> 00:37:41,306 AND THEY LOOK AT THE FIRST 12 1334 00:37:41,306 --> 00:37:43,375 HOURS, THEY SEE WHO'S MADE THE 1335 00:37:43,375 --> 00:37:44,276 PLURALITY OF ORDERS AND THAT 1336 00:37:44,276 --> 00:37:45,610 PERSON IS NOW ATTRIBUTED AS 1337 00:37:45,610 --> 00:37:46,711 MAKING DECISIONS FOR THIS 1338 00:37:46,711 --> 00:37:47,812 PATIENT. 1339 00:37:47,812 --> 00:37:49,247 THEY THEN COLLECT ALL THE 1340 00:37:49,247 --> 00:37:50,348 CLINICAL DATA FOR THE CARE OF 1341 00:37:50,348 --> 00:37:52,584 THE PATIENT THAT COMES THROUGH, 1342 00:37:52,584 --> 00:37:55,487 THAT'S SENT TO AN INFORMATICS 1343 00:37:55,487 --> 00:37:58,156 ENGINE AND BEHIND THAT, THEY 1344 00:37:58,156 --> 00:38:00,225 HAVE PROGRAMMED INTO THIS 1345 00:38:00,225 --> 00:38:02,827 INFORMATICS ENGINE WHAT IS 1346 00:38:02,827 --> 00:38:05,130 EXPECTED FOR THE MANAGEMENT OF A 1347 00:38:05,130 --> 00:38:08,667 PATIENT WITH DIABETES, FOR A 1348 00:38:08,667 --> 00:38:12,070 PGY1, A PGY2 AND A PGY3. 1349 00:38:12,070 --> 00:38:13,271 SO NOW YOU HAVE THE CLINICAL 1350 00:38:13,271 --> 00:38:14,739 DATA COME IN, YOU HAVE WHAT'S 1351 00:38:14,739 --> 00:38:18,910 EXPECTED, YOU KNOW WHAT LEVEL 1352 00:38:18,910 --> 00:38:20,445 YEAR THE ATTRIBUTED TRAINEE IS 1353 00:38:20,445 --> 00:38:21,780 AND YOU CROSS THAT AND IDENTIFY 1354 00:38:21,780 --> 00:38:22,314 GAPS. 1355 00:38:22,314 --> 00:38:24,716 SO FINALLY, YOU SEE EXACTLY 1356 00:38:24,716 --> 00:38:26,017 WHERE THEY'VE MET EXPECTATION 1357 00:38:26,017 --> 00:38:27,352 AND WHEN THEY FALL AWAY FROM 1358 00:38:27,352 --> 00:38:27,686 EXPECTATION. 1359 00:38:27,686 --> 00:38:29,387 I THINK IT'S EASY TO SAY, BUT I 1360 00:38:29,387 --> 00:38:32,557 THINK FOR ALL OF US WHO HAVE 1361 00:38:32,557 --> 00:38:36,361 SEEN AND HELPED COACH AND 1362 00:38:36,361 --> 00:38:40,765 DEVELOP TRAINEES, IT'S REALLY 1363 00:38:40,765 --> 00:38:42,000 HARD FOR YOU TO COLLECT THAT 1364 00:38:42,000 --> 00:38:43,835 TYPE OF INFORMATION AT A 1365 00:38:43,835 --> 00:38:44,936 GRANULAR LEVEL, PARTICULARLY ON 1366 00:38:44,936 --> 00:38:46,237 A CONTINUOUS LEVEL THAT'S 1367 00:38:46,237 --> 00:38:48,473 STANDARDIZED IN ANY PARTICULAR 1368 00:38:48,473 --> 00:38:49,574 WAY. 1369 00:38:49,574 --> 00:38:51,109 IT'S COMPLETELY RANDOM WHEN THEY 1370 00:38:51,109 --> 00:38:51,876 ADMIT SOMEBODY WITH ONE 1371 00:38:51,876 --> 00:38:53,645 CONDITION AND WHO WAS GOING TO 1372 00:38:53,645 --> 00:38:54,746 BE OBSERVING THEM AND WHAT KIND 1373 00:38:54,746 --> 00:38:55,513 OF INFORMATION YOU GET ABOUT 1374 00:38:55,513 --> 00:38:55,814 THEM. 1375 00:38:55,814 --> 00:38:57,048 SO THAT'S THE POWER. 1376 00:38:57,048 --> 00:39:00,485 THE POE WE ARE SYSTEM IS DONE 1377 00:39:00,485 --> 00:39:02,854 PASSIVELY, WE CALL THESE 1378 00:39:02,854 --> 00:39:03,621 NO-TOUCH ASSESSMENTS. 1379 00:39:03,621 --> 00:39:04,723 THIS IS JUST THROUGH THE 1380 00:39:04,723 --> 00:39:06,191 CLINICAL CARE THAT THEY DELIVER 1381 00:39:06,191 --> 00:39:08,693 FROM A NO-TOUCH ASSESSMENT, YOU 1382 00:39:08,693 --> 00:39:09,761 COLLECT THE DATA IN THE 1383 00:39:09,761 --> 00:39:11,329 BACKGROUND AND YOU'RE ABLE TO DO 1384 00:39:11,329 --> 00:39:13,231 ASSESSMENTS THAT ARE FAR MORE 1385 00:39:13,231 --> 00:39:14,632 FREMONT AND INFORMATIVE THAN WE 1386 00:39:14,632 --> 00:39:18,136 CAN DO WITH US AS SUPERVISORS. 1387 00:39:18,136 --> 00:39:20,672 SO THAT DATA, THE GAPS GO TO A 1388 00:39:20,672 --> 00:39:21,439 PERFORMANCE DASHBOARD AND THAT 1389 00:39:21,439 --> 00:39:22,440 GOES TO A COACH. 1390 00:39:22,440 --> 00:39:23,475 AGAIN THE PRECISION EDUCATION 1391 00:39:23,475 --> 00:39:24,509 MODEL WE HAVE RELIES ON 1392 00:39:24,509 --> 00:39:24,976 COACHING. 1393 00:39:24,976 --> 00:39:26,945 WE BELIEVE THAT YOU HAVE TO HAVE 1394 00:39:26,945 --> 00:39:28,279 COACHES TO BE ABLE TO INTERPRET 1395 00:39:28,279 --> 00:39:30,181 THESE DATA AND TO USE TO DEVELOP 1396 00:39:30,181 --> 00:39:31,249 SOMEBODY EVEN MORE EFFECTIVELY. 1397 00:39:31,249 --> 00:39:32,584 SO THIS WORKS AT -- THIS HAS 1398 00:39:32,584 --> 00:39:33,985 BEEN DEPLOYED AT THE UNIVERSITY 1399 00:39:33,985 --> 00:39:37,822 OF CINCINNATI, I SHOULD SAY. 1400 00:39:37,822 --> 00:39:38,923 I DON'T MEAN TO SUGGEST ALL OF 1401 00:39:38,923 --> 00:39:40,592 THESE THINGS ARE EASY TO DO. 1402 00:39:40,592 --> 00:39:41,793 THIS IS REALLY HARD TO DO. 1403 00:39:41,793 --> 00:39:43,561 IN FACT THE THREE UNIVERSITIES 1404 00:39:43,561 --> 00:39:44,863 THAT PUT THIS TOGETHER, THEY 1405 00:39:44,863 --> 00:39:46,030 COULDN'T REPLICATE IT AT THE 1406 00:39:46,030 --> 00:39:46,531 NEXT UNIVERSITY. 1407 00:39:46,531 --> 00:39:47,732 THAT'S HOW HARD IT IS TO 1408 00:39:47,732 --> 00:39:49,501 ACTUALLY DEVELOP THESE TYPES OF 1409 00:39:49,501 --> 00:39:51,035 ALGORITHMS AND DEPLOY THEM IN A 1410 00:39:51,035 --> 00:39:51,503 CLINICAL ENVIRONMENT. 1411 00:39:51,503 --> 00:39:53,104 THAT WILL GET BETTER, IT'S GOING 1412 00:39:53,104 --> 00:39:54,539 TO TAKE ALL OF US TO START TO 1413 00:39:54,539 --> 00:39:55,907 INVEST IN THIS EVEN MORE, BUT 1414 00:39:55,907 --> 00:39:57,308 THIS WORK NEEDS TO GET STARTED. 1415 00:39:57,308 --> 00:39:59,177 BUT THE POWER, AGAIN, IS THE 1416 00:39:59,177 --> 00:40:01,780 IDENTIFICATION AND CREATION OF 1417 00:40:01,780 --> 00:40:05,884 AGENCY IN A LEARNER, IN A TEAM, 1418 00:40:05,884 --> 00:40:06,651 THROUGHOUT THE YEAR. 1419 00:40:06,651 --> 00:40:09,421 AND I THINK, AGAIN, LOOKING 1420 00:40:09,421 --> 00:40:10,555 BACK, THIS TYPE OF DASHBOARD 1421 00:40:10,555 --> 00:40:12,056 WOULD HAVE BEEN INCREDIBLY 1422 00:40:12,056 --> 00:40:13,391 USEFUL FOR ME AS I WENT THROUGH 1423 00:40:13,391 --> 00:40:14,492 TRAINING. 1424 00:40:14,492 --> 00:40:15,059 PROCEDURAL TRAINING. 1425 00:40:15,059 --> 00:40:16,895 SO THIS IS ANOTHER REALLY 1426 00:40:16,895 --> 00:40:17,796 COMPLICATED PROBLEM. 1427 00:40:17,796 --> 00:40:20,765 HOW DO WE GIVE FEEDBACK FOR 1428 00:40:20,765 --> 00:40:25,103 SOMEONE THAT'S DOING A PROCED 1429 00:40:25,103 --> 00:40:26,571 PROCEDURE? 1430 00:40:26,571 --> 00:40:28,740 I WROTE HERE WHAT WE USED TO SAY 1431 00:40:28,740 --> 00:40:30,508 WHEN I TRAINED, SEE ONE, DO ONE, 1432 00:40:30,508 --> 00:40:33,812 TEACH ONE, I THINK MANY OF YOU 1433 00:40:33,812 --> 00:40:34,512 PROBABLY HAVE HEARD THAT. 1434 00:40:34,512 --> 00:40:35,947 I THINK MANY PLACES STILL HAVE 1435 00:40:35,947 --> 00:40:37,682 THAT CRITERIA THAT IF YOU 1436 00:40:37,682 --> 00:40:38,750 PERFORM FIVE CENTRAL VENOUS 1437 00:40:38,750 --> 00:40:39,884 CATHETER INSERTIONS, THEN CAN 1438 00:40:39,884 --> 00:40:41,419 YOU DO THEM. 1439 00:40:41,419 --> 00:40:42,520 MAGICALLY, IF YOU'VE DONE FIVE, 1440 00:40:42,520 --> 00:40:44,722 YOU ARE COMPETENT. 1441 00:40:44,722 --> 00:40:45,857 WE KNOW THAT'S NOT TRUE. 1442 00:40:45,857 --> 00:40:50,094 SO HOW DO WE START TO IMPROVE 1443 00:40:50,094 --> 00:40:51,196 USING OUR ASSESSMENT OF 1444 00:40:51,196 --> 00:40:51,496 PROCEDURES. 1445 00:40:51,496 --> 00:40:57,135 CAN YYO.YOU CAN DO THIS IN A SCE 1446 00:40:57,135 --> 00:40:57,602 WAY. 1447 00:40:57,602 --> 00:41:01,906 THIS WAS WORK DONE BY DR. PEW, 1448 00:41:01,906 --> 00:41:05,076 AND HER IDEA WAS TO TRACK MOTION 1449 00:41:05,076 --> 00:41:05,844 USING WEARABLES. 1450 00:41:05,844 --> 00:41:08,513 SO WEARABLES, AGAIN, ARE 1451 00:41:08,513 --> 00:41:09,814 BECOMING OBVIOUSLY MORE AND MORE 1452 00:41:09,814 --> 00:41:15,220 COMMONLY USED IN ASSEM ASSESSMED 1453 00:41:15,220 --> 00:41:16,955 IN SIMULATION. 1454 00:41:16,955 --> 00:41:19,657 YOU CAN SEE ON THE WHITE COAT 1455 00:41:19,657 --> 00:41:20,658 THE INDIVIDUAL IS WEARING AS 1456 00:41:20,658 --> 00:41:22,293 WELL AS IN THE GLOVE YOU CAN SEE 1457 00:41:22,293 --> 00:41:23,895 THE TRACKING DEVICES AND IT 1458 00:41:23,895 --> 00:41:25,363 CREATES THESE TYPES OF GRAPHICS 1459 00:41:25,363 --> 00:41:26,731 THAT YOU CAN -- THESE ARE THE 1460 00:41:26,731 --> 00:41:29,067 DATA THAT COME OUT OF A MOTION 1461 00:41:29,067 --> 00:41:29,601 TRACKING SYSTEM. 1462 00:41:29,601 --> 00:41:31,703 SO YOU CAN SEE THE LEFT HAND ON 1463 00:41:31,703 --> 00:41:33,805 THE LEFT SIDE, THIS IS CARDIAC 1464 00:41:33,805 --> 00:41:35,006 SURGERY THAT'S OCCURRING AND YOU 1465 00:41:35,006 --> 00:41:36,541 CAN SEE IN THREE DIMENSIONS 1466 00:41:36,541 --> 00:41:37,742 WHERE PEOPLE'S HANDS ARE MOVING. 1467 00:41:37,742 --> 00:41:42,280 SO YOU CAN USE THIS TO DO 1468 00:41:42,280 --> 00:41:43,715 ASSESSMENT FOR AND COACHING AND 1469 00:41:43,715 --> 00:41:44,682 DEVELOPMENT FOR PROCEDURAL 1470 00:41:44,682 --> 00:41:44,949 TRAINING. 1471 00:41:44,949 --> 00:41:48,019 SO THIS IS AN EXAMPLE THAT -- 1472 00:41:48,019 --> 00:41:49,387 OUTPUT THAT CAN OCCUR THAT WOULD 1473 00:41:49,387 --> 00:41:50,622 HELP INFORM THE TRAINING OF AN 1474 00:41:50,622 --> 00:41:50,922 INDIVIDUAL. 1475 00:41:50,922 --> 00:41:53,424 SO THIS, AGAIN, A CARDIAC 1476 00:41:53,424 --> 00:41:55,393 SURGERY CASE, ON THE TOP IS THE 1477 00:41:55,393 --> 00:41:57,161 FELLOW, ON THE BOTTOM IS THE 1478 00:41:57,161 --> 00:41:58,263 FACULTY MEMBER, ON THE LEFT IS 1479 00:41:58,263 --> 00:41:59,998 THE LEFT HAPPENED, ON THE RIGHT 1480 00:41:59,998 --> 00:42:00,765 IS THE RIGHT HAND. 1481 00:42:00,765 --> 00:42:02,033 YOU'LL SEE LOTS OF LINES MOVING 1482 00:42:02,033 --> 00:42:02,433 AROUND. 1483 00:42:02,433 --> 00:42:04,302 SO I'LL POINT OUT TWO THINGS FOR 1484 00:42:04,302 --> 00:42:04,736 YOU. 1485 00:42:04,736 --> 00:42:05,503 THE FIRST IS THE LINES HAVE 1486 00:42:05,503 --> 00:42:08,706 DIFFERENT COLORS. 1487 00:42:08,706 --> 00:42:19,250 SO THE COLORS REPRESENT VERY R 1488 00:42:19,250 --> 00:42:19,517 VELOCITY. 1489 00:42:19,517 --> 00:42:20,652 SO IF YOU LOOK ON THE RIGHT 1490 00:42:20,652 --> 00:42:22,620 SIDE, YOU'LL SEE A LOT MORE 1491 00:42:22,620 --> 00:42:25,924 GREEN IN THE FELLOW AND THERE 1492 00:42:25,924 --> 00:42:27,058 ARE MOMENTS OF BLUE IN THE 1493 00:42:27,058 --> 00:42:28,693 FACULTY. 1494 00:42:28,693 --> 00:42:30,995 DR. PEW WILL DESCRIBE THIS AS 1495 00:42:30,995 --> 00:42:33,698 THE FACULTY MEMBER SLOWING DOWN 1496 00:42:33,698 --> 00:42:36,067 AT THE MOST CRITICAL PORTIONS OF 1497 00:42:36,067 --> 00:42:41,873 THIS PARTICULAR PROCEDURE. 1498 00:42:41,873 --> 00:42:46,177 SHOOL FURSHE'LL FURTHER SAY THET 1499 00:42:46,177 --> 00:42:48,279 THE FELLOW'S HAND DOES NOT SLOW 1500 00:42:48,279 --> 00:42:59,991 DOWN IS IMPERFECT SEPTEMBERI IM. 1501 00:43:03,661 --> 00:43:04,295 AGAIN, IMPERFECT ACCEPT TIBL 1502 00:43:04,295 --> 00:43:05,296 WHEN YOU'RE WATCHING THEM, BUT 1503 00:43:05,296 --> 00:43:06,164 SOMETHING THAT THEY CAN BE 1504 00:43:06,164 --> 00:43:07,865 COACHED ON AND TO DEVELOP TO BE 1505 00:43:07,865 --> 00:43:10,134 MORE EFFICIENT WITH THEIR HAND. 1506 00:43:10,134 --> 00:43:11,035 FINALLY, ON THE LEFT HAND, 1507 00:43:11,035 --> 00:43:13,004 YOU'LL SEE THAT THE FACULTY 1508 00:43:13,004 --> 00:43:15,974 MEMBER HAS MORE SPLAY IN THEIR 1509 00:43:15,974 --> 00:43:18,276 HAND THAN THE FELLOW. 1510 00:43:18,276 --> 00:43:19,944 AND HER INTERPRETATION OF THIS 1511 00:43:19,944 --> 00:43:22,647 IS THE FACULTY MEMBER IS USING 1512 00:43:22,647 --> 00:43:23,915 THEIR LEFT HAND WITH MORE 1513 00:43:23,915 --> 00:43:25,883 AGILITY TO SUPPORT THEIR RIGHT 1514 00:43:25,883 --> 00:43:27,852 HAND THAN THE FELLOW IS. 1515 00:43:27,852 --> 00:43:31,456 AGAIN, SOMETHING THAT IS 1516 00:43:31,456 --> 00:43:38,596 IMPERFSOMETHING YOU CAN HOPEFULE 1517 00:43:38,596 --> 00:43:41,232 THEM FEEDBACK ON. 1518 00:43:41,232 --> 00:43:42,634 CREATING HIGHLY INDIVIDUALIZED 1519 00:43:42,634 --> 00:43:44,535 FEEDBACK FOR SOMEBODY IN A 1520 00:43:44,535 --> 00:43:46,070 PRECISION EDUCATION SYSTEM IN 1521 00:43:46,070 --> 00:43:46,404 SURGERY. 1522 00:43:46,404 --> 00:43:50,108 AS SHE SCALED THIS TO -- SHE 1523 00:43:50,108 --> 00:43:51,476 GOES TO SURGICAL CONFERENCES AND 1524 00:43:51,476 --> 00:43:53,978 DOES HUNDREDS OF SIMULATED 1525 00:43:53,978 --> 00:43:55,179 SURGICAL SCENARIOS FOR HUNDREDS 1526 00:43:55,179 --> 00:43:56,381 OF PEOPLE AT A TIME. 1527 00:43:56,381 --> 00:44:00,718 WITH THAT, YOU'RE ABLE TO 1528 00:44:00,718 --> 00:44:02,553 ESTABLISH FOUNDATIONAL DATA THAT 1529 00:44:02,553 --> 00:44:05,189 CAN SET UP A BASE FOR CRITERIA 1530 00:44:05,189 --> 00:44:06,991 FOR WHAT ARE THRESHOLDS THAT WE 1531 00:44:06,991 --> 00:44:08,960 WANT TO ACHIEVE AS A SYSTEM IN 1532 00:44:08,960 --> 00:44:10,261 PARTICULAR PROCEDURES. 1533 00:44:10,261 --> 00:44:11,729 BECAUSE IT'S HARD TO DO THAT AS 1534 00:44:11,729 --> 00:44:12,497 INDIVIDUALS. 1535 00:44:12,497 --> 00:44:13,498 INDIVIDUALLY YOU CAN HELP THEM 1536 00:44:13,498 --> 00:44:14,799 GET A LITTLE BETTER BUT HERE YOU 1537 00:44:14,799 --> 00:44:16,200 CAN ACTUALLY SET UP STANDARDS 1538 00:44:16,200 --> 00:44:18,236 FOR SURGICAL TRAINING AND 1539 00:44:18,236 --> 00:44:19,871 CRITERIA FOR WHAT WE THINK IS 1540 00:44:19,871 --> 00:44:23,074 ACCEPTABLE FOR A THRESHOLD FOR 1541 00:44:23,074 --> 00:44:24,042 COMPETENCY. 1542 00:44:24,042 --> 00:44:25,943 NOW SHE'S USING THIS NOT JUST IN 1543 00:44:25,943 --> 00:44:28,680 THESE SETTINGS BUT FOR INTERNAL 1544 00:44:28,680 --> 00:44:29,781 MEDICINE PROCEDURES, ALSO NOW 1545 00:44:29,781 --> 00:44:32,784 WITH A.I. AND WITH SIMULATION 1546 00:44:32,784 --> 00:44:37,455 AND ABOUT B.R., STARTING TO IK 1547 00:44:37,455 --> 00:44:38,356 INCORPORATE THAT WHICH WILL MAKE 1548 00:44:38,356 --> 00:44:41,125 IT EVEN MORE POWERFUL. 1549 00:44:41,125 --> 00:44:42,860 FINALLY, THE WILD, WILD WEST OF 1550 00:44:42,860 --> 00:44:44,328 CLINICAL PRACTICE, UNSTRUCTURED 1551 00:44:44,328 --> 00:44:45,463 ENVIRONMENT WHERE THE RISKS I 1552 00:44:45,463 --> 00:44:47,265 THINK ARE THE GREATEST FOR US. 1553 00:44:47,265 --> 00:44:50,835 WE HAVE CME OBLIGATIONS, MOC 1554 00:44:50,835 --> 00:44:52,036 OBLIGATIONS, BUT MY EXPERIENCE 1555 00:44:52,036 --> 00:44:54,872 IN MOC IS THAT IT'S NOT 1556 00:44:54,872 --> 00:44:55,306 PATIENT-RELEVANT. 1557 00:44:55,306 --> 00:44:57,108 I TYPICALLY -- AND I'M HAPPY TO 1558 00:44:57,108 --> 00:44:59,343 REVEAL AND I DON'T THINK I'M 1559 00:44:59,343 --> 00:45:01,145 ALONE THAT WHEN I LOOK FOR MOC, 1560 00:45:01,145 --> 00:45:04,816 I LOOK FOR THE EASIEST THING FOR 1561 00:45:04,816 --> 00:45:06,017 ME TO COMPLETE BECAUSE I JUST 1562 00:45:06,017 --> 00:45:06,984 WANT TO GET IT DONE. 1563 00:45:06,984 --> 00:45:08,686 IT IS NOT DESIGNED IN ANY WAY 1564 00:45:08,686 --> 00:45:10,955 FOR ME TO ACTUALLY LEARN ABOUT 1565 00:45:10,955 --> 00:45:12,824 THE PATIENT I'M GOING TO SEE 1566 00:45:12,824 --> 00:45:13,291 TOMORROW. 1567 00:45:13,291 --> 00:45:15,259 AGAIN THIS IS A.I.-BASED 1568 00:45:15,259 --> 00:45:16,494 LEARNING PORTFOLIOS, WORK WE'VE 1569 00:45:16,494 --> 00:45:17,695 ACTUALLY GENERATED AT THE AMA. 1570 00:45:17,695 --> 00:45:20,164 THIS IS AN EXAMPLE OF HOW YOU 1571 00:45:20,164 --> 00:45:21,466 MIGHT THINK ABOUT LEARNING 1572 00:45:21,466 --> 00:45:23,301 STRATEGIES FOR CONTINUING 1573 00:45:23,301 --> 00:45:23,968 PRACTICE. 1574 00:45:23,968 --> 00:45:25,069 THESE ARE DIFFERENT -- YOU CAN 1575 00:45:25,069 --> 00:45:29,273 SEE MOC, WHICH IS THE Y AXIS 1576 00:45:29,273 --> 00:45:30,141 TIME-CONSUMING TO QUICK, 1577 00:45:30,141 --> 00:45:31,609 RELEVANT TO THE FIELD, AND 1578 00:45:31,609 --> 00:45:32,510 RELEVANT TO THE PATIENT 1579 00:45:32,510 --> 00:45:34,345 THEMSELVES THAT YOU'RE GOING TO 1580 00:45:34,345 --> 00:45:35,346 BE SEEING. 1581 00:45:35,346 --> 00:45:38,282 SO MOC IS QUITE TIME-CONSUMING, 1582 00:45:38,282 --> 00:45:40,084 NOT NECESSARILY THAT 1583 00:45:40,084 --> 00:45:40,485 PATIENT-RELEVANT. 1584 00:45:40,485 --> 00:45:41,819 YOU CAN SEE RE-CERTIFICATION 1585 00:45:41,819 --> 00:45:44,856 EXAMS OVER HERE, IT'S A VERY 1586 00:45:44,856 --> 00:45:46,157 TIME-CONSUMING FIELD BUT NOT 1587 00:45:46,157 --> 00:45:46,691 NECESSARILY FOR US. 1588 00:45:46,691 --> 00:45:48,226 WE USUALLY USE THESE PUSH AND 1589 00:45:48,226 --> 00:45:50,895 PULLS WHERE YOU GET EMAIL 1590 00:45:50,895 --> 00:45:53,197 ARTICLES OR YOU GO AND LOOK FOR 1591 00:45:53,197 --> 00:45:54,499 THEM YOURSELVES WHERE YOU'RE 1592 00:45:54,499 --> 00:45:54,832 POOLING THEM. 1593 00:45:54,832 --> 00:45:57,101 SO THIS IS THE TYPICAL SCENARIO, 1594 00:45:57,101 --> 00:46:00,138 NONE OF THESE ARE PARTICULARLY 1595 00:46:00,138 --> 00:46:00,872 PATIENT-RELEVANT. 1596 00:46:00,872 --> 00:46:02,140 THIS LEADS TO THIS IDEA OF MORAL 1597 00:46:02,140 --> 00:46:02,406 DISTRESS. 1598 00:46:02,406 --> 00:46:03,341 THIS IS ACTUALLY A MEASUREMENT 1599 00:46:03,341 --> 00:46:05,209 WE HAVE. 1600 00:46:05,209 --> 00:46:06,778 WHAT I'LL DESCRIBE, WE PILOTED 1601 00:46:06,778 --> 00:46:08,112 IN THE WORK LEADING UP TO THAT 1602 00:46:08,112 --> 00:46:09,080 PILOT WE ASKED PEOPLE ABOUT 1603 00:46:09,080 --> 00:46:12,517 THEIR CONTINUING ME MEDICAL 1604 00:46:12,517 --> 00:46:12,784 EDUCATION. 1605 00:46:12,784 --> 00:46:13,918 THERE IS MORAL DISTRESS AROUND 1606 00:46:13,918 --> 00:46:15,119 THE NOTION THAT YOU'RE UNABLE TO 1607 00:46:15,119 --> 00:46:18,089 LEARN IN A WAY THAT HELPS YOU 1608 00:46:18,089 --> 00:46:19,023 TREAT THE PATIENTS YOU'RE GOING 1609 00:46:19,023 --> 00:46:20,324 TO SEE TOMORROW EFFECTIVELY. 1610 00:46:20,324 --> 00:46:24,328 SO THAT CREATES DISSONANCE FOR 1611 00:46:24,328 --> 00:46:25,863 ALL OF US. 1612 00:46:25,863 --> 00:46:28,132 THE RECONNECT PILOT, THE ONE WE 1613 00:46:28,132 --> 00:46:33,504 GENERATED, IS DESIGNED TO 1614 00:46:33,504 --> 00:46:36,040 PROVIDE EDUCATE FOR YOU RELATED 1615 00:46:36,040 --> 00:46:37,608 TO THE PATIENTS YOU'RE GOING TO 1616 00:46:37,608 --> 00:46:38,009 SEE. 1617 00:46:38,009 --> 00:46:40,144 QUICKLY HOW IT WORKS, IT IS AN 1618 00:46:40,144 --> 00:46:41,813 A.I. ENGINE LINKED TO THE EMR. 1619 00:46:41,813 --> 00:46:45,983 THIS IS AN OUTPATIENT SCENARIO. 1620 00:46:45,983 --> 00:46:47,084 IT IS AWARE OF WHAT PATIENTS 1621 00:46:47,084 --> 00:46:48,386 YOU'RE GOING TO BE SEEING NEXT 1622 00:46:48,386 --> 00:46:50,288 WEEK, SO FOR ONE WEEK -- IT 1623 00:46:50,288 --> 00:46:52,156 DIGESTS ALL THAT INFORMATION. 1624 00:46:52,156 --> 00:46:57,562 PROBLEM I LIST, MEDICATION LIST, 1625 00:46:57,562 --> 00:47:00,731 HISTORY OF PATIENTS YOU'VE SEEN 1626 00:47:00,731 --> 00:47:01,265 BEFORE. 1627 00:47:01,265 --> 00:47:02,600 IT TAKES THAT INFORMATION AND 1628 00:47:02,600 --> 00:47:04,268 POINTS TO PUBMED, RIGHT NOW JUST 1629 00:47:04,268 --> 00:47:06,370 TO PUBMED BUT YOU CAN IMAGINE IT 1630 00:47:06,370 --> 00:47:07,672 CAN POINT TO A VARIETY OF 1631 00:47:07,672 --> 00:47:09,040 DIFFERENT DATABASES AND IT 1632 00:47:09,040 --> 00:47:11,976 CURATES FROM PUB MET ARTICLES 1633 00:47:11,976 --> 00:47:15,613 THAT IT THINK FOR YOU TO BE 1634 00:47:15,613 --> 00:47:18,649 USEFUL BEFORE THIS WEEK'S 1635 00:47:18,649 --> 00:47:20,451 PATIENTS YOU'RE GOING TO SEE. 1636 00:47:20,451 --> 00:47:21,786 IF IT'S A CONDITION YOU HAVEN'T 1637 00:47:21,786 --> 00:47:24,922 SEEN AT ALL OR VERY INFREESHTLY, 1638 00:47:24,922 --> 00:47:28,092 IT MIGHT POOL JUST GUIDELINES OR 1639 00:47:28,092 --> 00:47:29,260 ARTICLES FOR YOU. 1640 00:47:29,260 --> 00:47:31,996 IT SHARES IT WITH YOU IN A 1641 00:47:31,996 --> 00:47:34,432 CONSUMABLE WAY, YOU'LL DECIDE 1642 00:47:34,432 --> 00:47:35,299 WHETHER YOU WILL READ THEM OR 1643 00:47:35,299 --> 00:47:35,733 NOT. 1644 00:47:35,733 --> 00:47:37,068 THE IDEA HERE IS THAT IT PUSHES 1645 00:47:37,068 --> 00:47:40,071 THIS TO PATIENT RE RELEVANCE. 1646 00:47:40,071 --> 00:47:41,806 AND THE GOAL WOULD BE -- SO WE 1647 00:47:41,806 --> 00:47:43,074 PILOTED THIS AT ONE HEALTH 1648 00:47:43,074 --> 00:47:43,341 SYSTEM. 1649 00:47:43,341 --> 00:47:45,142 IN THAT ONE HEALTH SYSTEM, WE 1650 00:47:45,142 --> 00:47:50,948 LEARNED THAT PHYSICIANS ONLY 1651 00:47:50,948 --> 00:47:52,116 LOOKED AT THIS FOR 10 MINUTES, 1652 00:47:52,116 --> 00:47:53,985 BUT IN THOSE 10 MINUTES, THEY 1653 00:47:53,985 --> 00:47:55,353 THEN REPORTED THAT ON AVERAGE, 1654 00:47:55,353 --> 00:47:57,755 IT INFLUENCED 1 1/2 DECISIONS 1655 00:47:57,755 --> 00:47:59,190 THAT THEY MADE FOR THEIR 1656 00:47:59,190 --> 00:48:01,893 PATIENTS IN THE UPCOMING WEEK. 1657 00:48:01,893 --> 00:48:03,527 SO IT HAS INFLUENCE, AND THIS 1658 00:48:03,527 --> 00:48:05,930 WAS A REALLY RAW SYSTEM, VERY 1659 00:48:05,930 --> 00:48:08,532 POOR USER INTERFACE, BUT THE 1660 00:48:08,532 --> 00:48:09,834 IDEA IS YOU'RE ABLE TO DO THIS, 1661 00:48:09,834 --> 00:48:11,168 THEN YOU POINT IT NOT JUST TO 1662 00:48:11,168 --> 00:48:14,805 PUBMED WI BUT YOU POINT TO ACP F 1663 00:48:14,805 --> 00:48:16,340 YOU'RE INTERNAL MEDICINE, TO 1664 00:48:16,340 --> 00:48:19,076 OTHER DATABASES, AND FINALLY THE 1665 00:48:19,076 --> 00:48:19,610 AMERICAN BOARD OF MEDICAL 1666 00:48:19,610 --> 00:48:20,278 SPECIALTIES IS PARTNERING WITH 1667 00:48:20,278 --> 00:48:21,178 US AS WELL. 1668 00:48:21,178 --> 00:48:22,847 THE IDEA WOULD BE THAT YOU WOULD 1669 00:48:22,847 --> 00:48:24,849 GET MOC FOR THIS IF YOU CONSUME 1670 00:48:24,849 --> 00:48:26,384 THIS INFORMATION. 1671 00:48:26,384 --> 00:48:27,685 BECAUSE THAT IS WHAT MAINTENANCE 1672 00:48:27,685 --> 00:48:30,721 IS MEANT TO BE, CONTINUING 1673 00:48:30,721 --> 00:48:32,690 MEDICAL EDUCATION IS MEANT TO BE 1674 00:48:32,690 --> 00:48:33,357 RELEVANT INFORMATION AND IF YOU 1675 00:48:33,357 --> 00:48:34,825 DO IT YOU SHOULD PASSIVELY 1676 00:48:34,825 --> 00:48:37,828 RECEIVE CREDIT FOR DOING THIS SO 1677 00:48:37,828 --> 00:48:39,063 HOPEFULLY THESE PRECISION 1678 00:48:39,063 --> 00:48:40,898 EDUCATION SI TEMS CAN REPLACE 1679 00:48:40,898 --> 00:48:45,870 THE MOC NOW TO ONE THAT IS IN 1680 00:48:45,870 --> 00:48:47,405 THE SPIRIT OF LIFELONG LEARNING. 1681 00:48:47,405 --> 00:48:49,040 THAT WOULD BE THE GOAL. 1682 00:48:49,040 --> 00:48:50,408 SO AGAIN I'LL CONCLUDE THAT WE 1683 00:48:50,408 --> 00:48:51,976 HAVE A SYSTEM THAT WE THIN IS 1684 00:48:51,976 --> 00:48:57,615 TOO I INEFFICIENT, TOO VARIABLE, 1685 00:48:57,615 --> 00:49:00,685 OUR GOAL IS TO REDUCE THIS WITH 1686 00:49:00,685 --> 00:49:01,552 PRECISION EDUCATION SYSTEMS TO 1687 00:49:01,552 --> 00:49:03,587 MAKE IT EFFECTIVE FOR US TO 1688 00:49:03,587 --> 00:49:04,822 ACHIEVE LIFELONG LEARNING WITH 1689 00:49:04,822 --> 00:49:06,324 THE IDEA OF PRODUCING A 1690 00:49:06,324 --> 00:49:07,625 PHYSICIAN WORKFORCE THAT CAN 1691 00:49:07,625 --> 00:49:08,726 CAPABLY CARE FOR OUR PATIENTS, 1692 00:49:08,726 --> 00:49:10,127 OUR FAMILIES AND OUR 1693 00:49:10,127 --> 00:49:10,695 COMMUNITIES. 1694 00:49:10,695 --> 00:49:12,763 I'LL JUST CONCLUDE WITH WHAT 1695 00:49:12,763 --> 00:49:15,032 WE'VE DESCRIBED AS IMMEDIATE 1696 00:49:15,032 --> 00:49:15,366 NEEDS. 1697 00:49:15,366 --> 00:49:17,668 WE NEED TO CULTIVATE THIS MORE, 1698 00:49:17,668 --> 00:49:19,203 WE NEED TO THINK MORE ABOUT THE 1699 00:49:19,203 --> 00:49:21,138 THEORY AND DEVELOP 1700 00:49:21,138 --> 00:49:21,505 SCHOLARSHIPNESS. 1701 00:49:21,505 --> 00:49:23,874 WE'VE STARTED TO DO THIS, BUT 1702 00:49:23,874 --> 00:49:25,276 MORE IS DEFINITELY NEEDED, IT'S 1703 00:49:25,276 --> 00:49:27,144 A NASCENT FIELD. 1704 00:49:27,144 --> 00:49:28,446 AS I MENTIONED WE NEED 1705 00:49:28,446 --> 00:49:29,847 PRINCIPLES AND STANDARDS BECAUSE 1706 00:49:29,847 --> 00:49:30,982 OTHERWISE THE DEFAULT FUTURE 1707 00:49:30,982 --> 00:49:32,450 WILL BE THAT THOSE THAT HAVE 1708 00:49:32,450 --> 00:49:35,920 RESOURCE WILL HAVE DISRESOURCE 1709 00:49:35,920 --> 00:49:37,588 AND WE DON'T WANT THAT TO BE THE 1710 00:49:37,588 --> 00:49:38,255 FUTURE. 1711 00:49:38,255 --> 00:49:39,623 THE FUTURE NEEDS FOR THIS TO BE 1712 00:49:39,623 --> 00:49:40,825 A PUBLIC GOOD. 1713 00:49:40,825 --> 00:49:42,159 FINALLY WE WANT TO BUILD, SHARE 1714 00:49:42,159 --> 00:49:44,462 AND SCALE SYSTEMS TO ADDRESS 1715 00:49:44,462 --> 00:49:45,830 URGENT PROBLEMS AND OUR GOAL IS 1716 00:49:45,830 --> 00:49:47,164 TO START INITIATIVES TO DO THAT 1717 00:49:47,164 --> 00:49:47,498 AS WELL. 1718 00:49:47,498 --> 00:49:49,133 SO I THANK YOU FOR YOUR TIME. 1719 00:49:49,133 --> 00:49:50,301 I'M GOING TO PAUSE THERE AND I'M 1720 00:49:50,301 --> 00:49:51,302 HAPPY TO TAKE ANY QUESTIONS. 1721 00:49:51,302 --> 00:50:01,479 [APPLAUSE] 1722 00:50:08,753 --> 00:50:09,220 >> HI. 1723 00:50:09,220 --> 00:50:11,622 THANK YOU VERY MUCH FOR YOUR 1724 00:50:11,622 --> 00:50:12,490 TALK. 1725 00:50:12,490 --> 00:50:13,958 I THOUGHT THAT THE CONCEPT OF 1726 00:50:13,958 --> 00:50:16,293 USING DATA TO DRIVE EDUCATION IS 1727 00:50:16,293 --> 00:50:18,662 BOTH COMFORTING AS A SCIENTIST 1728 00:50:18,662 --> 00:50:20,064 AND IT ALSO BROUGHT UP A 1729 00:50:20,064 --> 00:50:21,599 QUESTION FOR ME, BECAUSE I 1730 00:50:21,599 --> 00:50:23,868 NOTICED IN YOUR INTRODUCTION, 1731 00:50:23,868 --> 00:50:26,871 WHEN YOU'RE TALKING ABOUT THE 1732 00:50:26,871 --> 00:50:27,905 ARCHETYPES, A LOT OF THE SOURCES 1733 00:50:27,905 --> 00:50:30,941 OF THE PLATEAUS OR THE STOPPAGE 1734 00:50:30,941 --> 00:50:32,243 POINTS WERE BECAUSE OF A LACK OF 1735 00:50:32,243 --> 00:50:33,511 SUPPORT, A LACK OF COMMUNITY, 1736 00:50:33,511 --> 00:50:34,945 AND I'M ALSO LIKE VERY AWARE 1737 00:50:34,945 --> 00:50:37,248 THAT MY SHIRT SAYS "IN THIS 1738 00:50:37,248 --> 00:50:39,050 TOGETHER," SO IT'S LIKE KIND OF 1739 00:50:39,050 --> 00:50:39,517 COINCIDENTAL. 1740 00:50:39,517 --> 00:50:42,353 BUT I'M CURIOUS WHAT THE AMA 1741 00:50:42,353 --> 00:50:43,654 RECOMMENDS IN ADDITION TO ALL OF 1742 00:50:43,654 --> 00:50:48,192 THESE LIKE INCREDIBLE -- THIS 1743 00:50:48,192 --> 00:50:49,627 INCREDIBLE PROGRESS IN PRECISION 1744 00:50:49,627 --> 00:50:51,028 EDUCATION, WHICH I CAN IMAGINE 1745 00:50:51,028 --> 00:50:52,596 CAN BECOME QUITE ISOLATING. 1746 00:50:52,596 --> 00:50:54,932 HOW CAN WE PROVIDE A COMMUNITY 1747 00:50:54,932 --> 00:50:57,768 OF SUPPORT TO PHYSICIANS BOTH IN 1748 00:50:57,768 --> 00:50:59,070 PRACTICE THROUGHOUT BUT ALSO 1749 00:50:59,070 --> 00:51:01,038 HERE AT NIH FOR OUR FELLOWS? 1750 00:51:01,038 --> 00:51:01,705 >> TERRIFIC. 1751 00:51:01,705 --> 00:51:08,045 THANK YOU FOR THAT QUESTION. 1752 00:51:08,045 --> 00:51:10,014 HOPEFULLY I'VE CONVEYED THAT 1753 00:51:10,014 --> 00:51:11,816 THIS IS A TOOL, PRECISION 1754 00:51:11,816 --> 00:51:13,150 EDUCATION SYSTEMS ARE TOOLS THAT 1755 00:51:13,150 --> 00:51:14,285 HELP US ENHANCE THE LEARNING 1756 00:51:14,285 --> 00:51:16,087 THAT WE PROVIDE. 1757 00:51:16,087 --> 00:51:17,588 IT IS NEVER, AT LEAST IN MY 1758 00:51:17,588 --> 00:51:18,889 VIEW, MEANT TO REPLACE THE 1759 00:51:18,889 --> 00:51:19,757 LEARNING THAT WE HAVE. 1760 00:51:19,757 --> 00:51:21,392 SO WHAT I BELIEVE IT DOES, IT 1761 00:51:21,392 --> 00:51:26,497 FILLS IN GAPS SO AGAIN IF WE 1762 00:51:26,497 --> 00:51:27,298 JUST REFLECT ON THE TRAINING 1763 00:51:27,298 --> 00:51:28,566 THAT PROBABLY EACH OF US HAVE 1764 00:51:28,566 --> 00:51:30,301 GONE THROUGH, I DESCRIBED PERSON 1765 00:51:30,301 --> 00:51:31,702 LEARNING ABOUT THEIR GAPS IN 1766 00:51:31,702 --> 00:51:32,670 MANAGING A PERSON WITH DIABETES. 1767 00:51:32,670 --> 00:51:34,004 SO THAT DOESN'T CHANGE WHAT YOU 1768 00:51:34,004 --> 00:51:35,706 WILL DO CLINICALLY, BUT IT 1769 00:51:35,706 --> 00:51:36,907 ENHANCES TREMENDOUSLY THE 1770 00:51:36,907 --> 00:51:37,908 INFORMATION YOU GET ABOUT HOW 1771 00:51:37,908 --> 00:51:39,577 YOU MIGHT IMPROVE. 1772 00:51:39,577 --> 00:51:41,212 THE OTHER WAY THAT I THINK IT 1773 00:51:41,212 --> 00:51:42,546 HELPS BUILD COMMUNITY IS BY 1774 00:51:42,546 --> 00:51:44,415 RELIANCE ON COACHING. 1775 00:51:44,415 --> 00:51:46,016 SO WE BELIEVE THAT YOU NEED TO 1776 00:51:46,016 --> 00:51:47,985 HAVE INTERACTION WITH OTHERS. 1777 00:51:47,985 --> 00:51:49,086 THIS IS NOT DONE IN ISOLATION 1778 00:51:49,086 --> 00:51:50,654 FOR YOU TO IMPROVE. 1779 00:51:50,654 --> 00:51:52,189 THE THIRD THING I WOULD MENTION 1780 00:51:52,189 --> 00:51:53,724 IS THAT USING DATA AND 1781 00:51:53,724 --> 00:51:55,392 PARTICULARLY USING TECHNOLOGY, I 1782 00:51:55,392 --> 00:51:58,395 THINK GENERATES COMMUNITY THAT 1783 00:51:58,395 --> 00:51:59,697 WE'RE UNABLE TO GENERATE TODAY. 1784 00:51:59,697 --> 00:52:01,565 WE KNOW THIS POST PANDEMIC, 1785 00:52:01,565 --> 00:52:03,134 WHERE WE'VE BEEN ISOLATED, WHERE 1786 00:52:03,134 --> 00:52:04,034 WE'RE NOT GATHERING. 1787 00:52:04,034 --> 00:52:05,669 I DON'T KNOW WHAT THE TYPICAL 1788 00:52:05,669 --> 00:52:06,770 AUDIENCE IS HERE, THIS IS 1789 00:52:06,770 --> 00:52:07,872 ACTUALLY QUITE A NICE AUDIENCE 1790 00:52:07,872 --> 00:52:09,773 IN THE PLACES I'VE GONE WHERE 1791 00:52:09,773 --> 00:52:11,075 THERE'S USUALLY JUST A HANDFUL 1792 00:52:11,075 --> 00:52:12,409 OF PEOPLE POST PANDEMIC. 1793 00:52:12,409 --> 00:52:15,312 SO TECHNOLOGY HAS HOPEFULLY IN 1794 00:52:15,312 --> 00:52:18,048 THIS NEW WORLD WILL BRING PEOPLE 1795 00:52:18,048 --> 00:52:19,917 TOGETHER THAT COULD BE DISTANT 1796 00:52:19,917 --> 00:52:21,018 PHYSICALLY, AND HELP GENERATE 1797 00:52:21,018 --> 00:52:21,552 COMMUNITY FURTHER. 1798 00:52:21,552 --> 00:52:24,488 THE LAST THING I'LL SAY IS, I 1799 00:52:24,488 --> 00:52:30,127 THINK THAT THERE'S MOWER POWER A 1800 00:52:30,127 --> 00:52:31,662 AND IF WE CAN LEVERAGE THAT DATA 1801 00:52:31,662 --> 00:52:33,731 AND THAT POWER TO CHANGE 1802 00:52:33,731 --> 00:52:34,999 CULTURE, AN FOR ME, THIS COMES 1803 00:52:34,999 --> 00:52:37,735 DOWN TO PRECISION EDUCATION 1804 00:52:37,735 --> 00:52:40,237 SYSTEMS, THE REAL CORE OF IT IS 1805 00:52:40,237 --> 00:52:41,105 AROUND ASSESSMENT. 1806 00:52:41,105 --> 00:52:43,374 SO IF WE CAN CHANGE THE CULTURE 1807 00:52:43,374 --> 00:52:45,209 OF ASSESSMENT, BECAUSE WE NOW 1808 00:52:45,209 --> 00:52:47,311 HAVE A SYSTEM WHERE WE 1809 00:52:47,311 --> 00:52:49,446 UNDERSTAND HOW TO TREAT YOU AS 1810 00:52:49,446 --> 00:52:53,050 AN INDIVIDUAL AND HOW WE FRAME 1811 00:52:53,050 --> 00:52:54,919 EDUCATION AS AN OPPORTUNITY TO 1812 00:52:54,919 --> 00:52:56,120 DEVELOP SOMEBODY, NOT AS AN 1813 00:52:56,120 --> 00:52:57,154 OPPORTUNITY TO SAY YOU'RE NOT 1814 00:52:57,154 --> 00:52:57,922 GOOD ENOUGH. 1815 00:52:57,922 --> 00:53:00,457 AND WE NEED DATA AND WE NEED 1816 00:53:00,457 --> 00:53:01,325 EQUITABLE ASSESSMENT FOR US TO 1817 00:53:01,325 --> 00:53:01,959 DO THAT WELL. 1818 00:53:01,959 --> 00:53:04,161 AND I THINK THAT WILL GENERATE 1819 00:53:04,161 --> 00:53:05,663 CULTURE CHANGE WHICH HOPEFULLY, 1820 00:53:05,663 --> 00:53:07,264 AGAIN, ENHANCES THE COMMUNITY 1821 00:53:07,264 --> 00:53:07,932 THAT YOU'RE DESCRIBING. 1822 00:53:07,932 --> 00:53:09,567 BUT FOR ME, AGAIN, IF WE BOIL 1823 00:53:09,567 --> 00:53:11,969 THIS DOWN TO ONE FUNDAMENTAL 1824 00:53:11,969 --> 00:53:13,771 CONCEPT, IT'S EQUITABLE 1825 00:53:13,771 --> 00:53:14,872 ASSESSMENT, WHICH WE DON'T HAVE 1826 00:53:14,872 --> 00:53:16,740 RIGHT NOW. 1827 00:53:16,740 --> 00:53:18,342 AND IT'S NECESSARY FOR US TO 1828 00:53:18,342 --> 00:53:19,210 ACHIEVE ANY OF THESE GOALS THAT 1829 00:53:19,210 --> 00:53:23,480 WE HAVE. 1830 00:53:23,480 --> 00:53:25,549 >> THANK YOU, SANJAY. 1831 00:53:25,549 --> 00:53:26,016 FANTASTIC TALK. 1832 00:53:26,016 --> 00:53:28,352 KIND OF BUILD ON THAT A BIT, IN 1833 00:53:28,352 --> 00:53:29,887 TERMS OF GETTING THAT EQUITABLE 1834 00:53:29,887 --> 00:53:31,222 DATA, I THINK THERE'S A TENSION 1835 00:53:31,222 --> 00:53:33,691 WHEN, FOR EXAMPLE, IN THOSE 1836 00:53:33,691 --> 00:53:35,092 TRANSITIONS, THOSE VULNERABLE 1837 00:53:35,092 --> 00:53:36,327 TIMES BEING ABLE TO 1838 00:53:36,327 --> 00:53:36,961 INDIVIDUALIZE KIND OF SOME OF 1839 00:53:36,961 --> 00:53:38,896 THE FEEDBACK AS THEY TRANSITION, 1840 00:53:38,896 --> 00:53:40,297 BUT HOW HAVE YOU OVERCOME I 1841 00:53:40,297 --> 00:53:41,632 THINK THE CONCERN THAT PEOPLE 1842 00:53:41,632 --> 00:53:46,203 WILL HAVE IS THAT YOU'RE GIVING 1843 00:53:46,203 --> 00:53:47,705 CANDID FEEDBACK, MEDICAL SCHOOL, 1844 00:53:47,705 --> 00:53:48,772 SOMEONE IS GROWING, YOU DON'T 1845 00:53:48,772 --> 00:53:49,974 WANT THAT TO BE SHARED, THAT 1846 00:53:49,974 --> 00:53:51,242 SHOULD BE CONFIDENTIAL AS THEY 1847 00:53:51,242 --> 00:53:53,244 GO TO RESIDENCY, THAT TENSION 1848 00:53:53,244 --> 00:53:55,079 ABOUT THAT BE USED NEGATIVELY AS 1849 00:53:55,079 --> 00:53:56,413 OPPOSED TO SUPPORTING THAT 1850 00:53:56,413 --> 00:53:56,714 TRANSITION? 1851 00:53:56,714 --> 00:53:59,650 >> YEAH, WE'VE SPENT THE LAST 1852 00:53:59,650 --> 00:54:00,618 SIX MONTHS CONVENING GROUPS 1853 00:54:00,618 --> 00:54:01,852 AROUND THIS TRANSITION FROM 1854 00:54:01,852 --> 00:54:03,487 MEDICAL SCHOOL TO RESIDENCY, AND 1855 00:54:03,487 --> 00:54:04,855 ONE OF THE FEEMS THEEMS THAT 1856 00:54:04,855 --> 00:54:08,459 COMES OUT VERY STRONGLY IS THIS 1857 00:54:08,459 --> 00:54:13,597 MISTRUST, BIDIRECTIONAL MISTR 1858 00:54:13,597 --> 00:54:15,966 MISTRUST, FROM LEARNS ABOUT HOW 1859 00:54:15,966 --> 00:54:17,735 THAT DATA IS GOING TO BE USED. 1860 00:54:17,735 --> 00:54:18,702 IT GETS BACK TO THE COMMENT I 1861 00:54:18,702 --> 00:54:20,304 WAS MAKING EARLIER WHERE IT 1862 00:54:20,304 --> 00:54:21,538 REVEALS THIS SYSTEM THAT WE HAVE 1863 00:54:21,538 --> 00:54:25,976 THAT IS SO CORRUPTED IN TERMS OF 1864 00:54:25,976 --> 00:54:27,511 CULTURE BUT THERE'S THIS 1865 00:54:27,511 --> 00:54:28,712 INCREDIBLE HIGH STAKES 1866 00:54:28,712 --> 00:54:30,648 ENVIRONMENT THAT CREATES A LOT 1867 00:54:30,648 --> 00:54:36,253 OF FALSE OR DISINGENUOUS 1868 00:54:36,253 --> 00:54:38,589 BEHAVIORS WHI BY MANY DIFFERENT 1869 00:54:38,589 --> 00:54:38,856 PEOPLE. 1870 00:54:38,856 --> 00:54:41,125 TO GET AWAY FROM THAT, I THINK 1871 00:54:41,125 --> 00:54:42,860 DATA IS ONE LEVER THAT WE CAN 1872 00:54:42,860 --> 00:54:45,829 OUUSE TO GET AWAY FROM THAT. 1873 00:54:45,829 --> 00:54:50,100 I THINK THE YO CULTURE CHANGE WL 1874 00:54:50,100 --> 00:54:52,603 LAG BECAUSE THAT MISTRUST IS SO 1875 00:54:52,603 --> 00:54:57,408 DEEPLY EMBEDDED IN OU OUR SYSTEM 1876 00:54:57,408 --> 00:54:57,808 RIGHT NOW. 1877 00:54:57,808 --> 00:54:59,343 THE WAY TO START IN OUR VIEW IS 1878 00:54:59,343 --> 00:55:00,311 TO START POST MATCH. 1879 00:55:00,311 --> 00:55:02,379 SO CAN WE CREATE INFORMATION 1880 00:55:02,379 --> 00:55:04,315 ABOUT AN INDIVIDUAL THAT IS 1881 00:55:04,315 --> 00:55:07,051 AUTHENTIC, THAT IS INFORMATIVE, 1882 00:55:07,051 --> 00:55:10,321 THAT IS THIS MIND OF -- OR AT 1883 00:55:10,321 --> 00:55:12,723 LEAST THE ATTITUDE OF ABUNDANCE 1884 00:55:12,723 --> 00:55:15,426 THAT THIS IS WHERE SOMEBODY CAN 1885 00:55:15,426 --> 00:55:16,627 STRETCH, AND CAN WE CREATE THAT 1886 00:55:16,627 --> 00:55:19,463 IN A WAY THAT'S STANDARDIZED AND 1887 00:55:19,463 --> 00:55:20,631 OBJECTIVE TO SHARE THE MOMENT 1888 00:55:20,631 --> 00:55:22,066 SOMEBODY MATCHES WITH THEIR 1889 00:55:22,066 --> 00:55:23,133 RESIDENCY PROGRAM. 1890 00:55:23,133 --> 00:55:24,368 WHERE HOPEFULLY THE STAKES ARE 1891 00:55:24,368 --> 00:55:26,003 NOW LOWER, BECAUSE THEY'RE 1892 00:55:26,003 --> 00:55:27,604 COMING FOR SURE, AND I KNOW AND 1893 00:55:27,604 --> 00:55:29,006 I THINK HERE TOO, YOU DON'T 1894 00:55:29,006 --> 00:55:30,341 REALLY LEARN ANYTHING ABOUT 1895 00:55:30,341 --> 00:55:31,542 SOMEBODY UNTIL THEY ARRIVE. 1896 00:55:31,542 --> 00:55:33,911 YOU MIGHT GET DEMOGRAPHIC 1897 00:55:33,911 --> 00:55:37,748 INFORMATION, BUT YOU DON'T LEARN 1898 00:55:37,748 --> 00:55:38,849 IMPORTANT THINGS ABOUT THEIR 1899 00:55:38,849 --> 00:55:39,483 DEVELOPMENT, IMPORTANT THINGS 1900 00:55:39,483 --> 00:55:40,784 ABOUT THEIR BACKGROUND, 1901 00:55:40,784 --> 00:55:41,852 IMPORTANT THINGS ABOUT THEIR 1902 00:55:41,852 --> 00:55:43,520 EMOTIONAL STATE, THEIR FINANCIAL 1903 00:55:43,520 --> 00:55:43,854 STATE. 1904 00:55:43,854 --> 00:55:47,758 THERE'S SO MANY THINGS THAT I 1905 00:55:47,758 --> 00:55:49,226 THINK COULD INFLUENCE HOW YOU 1906 00:55:49,226 --> 00:55:50,494 SUPPORT SOMEBODY AND TRANSITION 1907 00:55:50,494 --> 00:55:51,929 THEM INTO YOUR PROGRAM THAT WE 1908 00:55:51,929 --> 00:55:52,696 DO NOT COLLECT TODAY. 1909 00:55:52,696 --> 00:55:55,065 SO THAT'S AN OPPORTUNITY FOR US 1910 00:55:55,065 --> 00:55:58,669 TO SHARE MORE FREELY ACROSS THE 1911 00:55:58,669 --> 00:55:59,103 TRANSITION. 1912 00:55:59,103 --> 00:56:00,304 EVEN THAT IS HARD, THOUGH, 1913 00:56:00,304 --> 00:56:02,339 BECAUSE HOW DO YOU CREATE THOSE 1914 00:56:02,339 --> 00:56:03,640 ASSESSMENTS, BUT I THINK THAT'S 1915 00:56:03,640 --> 00:56:04,575 SOMETHING THAT WE'RE ACTUALLY 1916 00:56:04,575 --> 00:56:06,276 QUITE INTERESTED IN AND FOCUSING 1917 00:56:06,276 --> 00:56:09,580 ON, HOW MIGHT WE -- THEN HOW DO 1918 00:56:09,580 --> 00:56:11,148 YOU DO THAT FOR INTERNATIONAL 1919 00:56:11,148 --> 00:56:12,916 MEDICAL GRADUATES, FOR EXAMPLE? 1920 00:56:12,916 --> 00:56:18,255 HOW MIGHT WE USE THESE 1921 00:56:18,255 --> 00:56:19,990 TECH-ENABLED ASSESSMENTS TO 1922 00:56:19,990 --> 00:56:23,394 CREATE INTERPRETABLE DATA FOR 1923 00:56:23,394 --> 00:56:25,829 KEY COMPETENCIES TO SHARE FROM 1924 00:56:25,829 --> 00:56:28,399 THE POINT OF MATCH TO RESIDENCY 1925 00:56:28,399 --> 00:56:28,632 PROGRAM? 1926 00:56:28,632 --> 00:56:30,367 AND IF WE DO THAT, HOPEFULLY YOU 1927 00:56:30,367 --> 00:56:31,635 START TO GENERATE TRUST. 1928 00:56:31,635 --> 00:56:35,672 AND THEN YOU CAN WORK ON 1929 00:56:35,672 --> 00:56:39,743 UPSTREAM FROM THERE, BUT 1930 00:56:39,743 --> 00:56:42,646 STARTING UPSTREAM IS PROHIBITIVE 1931 00:56:42,646 --> 00:56:43,247 TO ME. 1932 00:56:43,247 --> 00:56:45,816 >> THIS SPEAKS TO SORT OF 1933 00:56:45,816 --> 00:56:46,383 EVIDENCE-BASED EDUCATION. 1934 00:56:46,383 --> 00:56:48,085 WE DO TRIALS AND ALL SORTS OF 1935 00:56:48,085 --> 00:56:49,086 RESEARCH HERE AT THE NIH AND 1936 00:56:49,086 --> 00:56:50,287 JUST THINKING ABOUT REALLY 1937 00:56:50,287 --> 00:56:51,455 APPLYING THOSE PRINCIPLES TO 1938 00:56:51,455 --> 00:56:53,090 EDUCATION IS REALLY KIND OF -- I 1939 00:56:53,090 --> 00:56:54,525 MEAN, MAKES A LOT OF SENSE. 1940 00:56:54,525 --> 00:56:56,026 I WAS WONDERING IF YOU COULD 1941 00:56:56,026 --> 00:56:57,594 SPEAK A LITTLE BIT MORE THAN 1942 00:56:57,594 --> 00:57:00,531 JUST NAMING THE PIs ON THESE 1943 00:57:00,531 --> 00:57:02,399 INITIATIVES ABOUT THE ACTUAL 1944 00:57:02,399 --> 00:57:04,201 TECHNOLOGY AND WHAT'S REQUIRED 1945 00:57:04,201 --> 00:57:05,536 TO IMPLEMENT THESE SORTS OF 1946 00:57:05,536 --> 00:57:06,303 THINGS. 1947 00:57:06,303 --> 00:57:08,272 I MEAN RANGING FROM THE EHR, 1948 00:57:08,272 --> 00:57:09,306 CLOUD SYSTEMS. 1949 00:57:09,306 --> 00:57:11,608 CAN YOU SPEAK THROUGH AN EXAMPLE 1950 00:57:11,608 --> 00:57:13,577 AND GIVE ALL THE STEPS THAT ARE 1951 00:57:13,577 --> 00:57:14,745 NEEDED TO IMPLEMENT SOMETHING 1952 00:57:14,745 --> 00:57:16,280 LIKE THIS? 1953 00:57:16,280 --> 00:57:26,323 >> SO I'LL DESCRIBE SORT OF THE 1954 00:57:26,323 --> 00:57:29,293 THE -- PROBABLY THE INSTITUTION 1955 00:57:29,293 --> 00:57:30,727 THAT'S FARTHEST AHEAD IN MY VIEW 1956 00:57:30,727 --> 00:57:31,562 IS NYU. 1957 00:57:31,562 --> 00:57:34,832 THEY HAVE DEVOTED MILLIONS OF 1958 00:57:34,832 --> 00:57:35,466 DOLLARS FOR THIS. 1959 00:57:35,466 --> 00:57:37,768 THIS IS A HIGH RESEARCH 1960 00:57:37,768 --> 00:57:38,836 INITIATIVE. 1961 00:57:38,836 --> 00:57:40,404 THEY HAVE SET UP -- THEY HAVE 20 1962 00:57:40,404 --> 00:57:43,373 PEOPLE IN THAT TEAM THAT ARE 1963 00:57:43,373 --> 00:57:45,075 THERE TO DESIGN PRECISION 1964 00:57:45,075 --> 00:57:45,843 EDUCATION SYSTEMS. 1965 00:57:45,843 --> 00:57:47,311 THEY CREATED A DATA WAREHOUSE 1966 00:57:47,311 --> 00:57:48,579 FOR ALL OF THEIR MEDICAL 1967 00:57:48,579 --> 00:57:49,179 STUDENTS. 1968 00:57:49,179 --> 00:57:51,415 THEY HAVE THE FORTUNATE 1969 00:57:51,415 --> 00:57:53,050 CIRCUMSTANCE OF 40% OF THEIR 1970 00:57:53,050 --> 00:57:54,985 MEDICAL STUDENTS STAY AT NYU FOR 1971 00:57:54,985 --> 00:57:55,552 RESIDENCY. 1972 00:57:55,552 --> 00:57:57,054 SO THEY HAVE AN OPPORTUNITY TO 1973 00:57:57,054 --> 00:57:59,790 SCALE ACROSS UME TO GME THAT'S 1974 00:57:59,790 --> 00:58:00,991 DIFFERENT THAN MOST PLACES BUT 1975 00:58:00,991 --> 00:58:02,025 THEY HAVE INFRASTRUCTURE. 1976 00:58:02,025 --> 00:58:04,294 THEY HAVE PARTNERED WITH OPEN AI 1977 00:58:04,294 --> 00:58:06,597 TO ACTUALLY GET GENERATIVE AI 1978 00:58:06,597 --> 00:58:08,065 INTO THEIR EMR. 1979 00:58:08,065 --> 00:58:09,366 THEY'VE DEVELOPED TOOLS SO THAT 1980 00:58:09,366 --> 00:58:11,468 WHEN A MEDICAL STUDENT ADMITS A 1981 00:58:11,468 --> 00:58:13,837 PATIENT ON A CLERKSHIP, THEN 1982 00:58:13,837 --> 00:58:16,807 THEY WOULD SEE THE DIAGNOSIS AND 1983 00:58:16,807 --> 00:58:18,876 THEN SEND JUST IN TIME TO THAT 1984 00:58:18,876 --> 00:58:22,312 MEDICAL STUDENT MODULES FOR THAT 1985 00:58:22,312 --> 00:58:23,480 DIAGNOSIS SO THEY CAN CONSUME 1986 00:58:23,480 --> 00:58:24,748 THAT BEFORE ROUNDS THE NEXT 1987 00:58:24,748 --> 00:58:25,082 MORNING. 1988 00:58:25,082 --> 00:58:26,583 SO THERE ARE A LOT OF STEPS, BUT 1989 00:58:26,583 --> 00:58:28,986 I THINK THERE IS A TECHNOLOGY 1990 00:58:28,986 --> 00:58:30,387 PIECE TO THAT IS PROBABLY THE 1991 00:58:30,387 --> 00:58:32,689 HARDEST OR AT LEAST THE HIGHEST 1992 00:58:32,689 --> 00:58:34,758 RESOURCE, BUT THEN THERE'S ALSO 1993 00:58:34,758 --> 00:58:36,493 THE PHYSICIAN LOADER SHIP FOR 1994 00:58:36,493 --> 00:58:38,262 THAT. 1995 00:58:38,262 --> 00:58:43,867 WHAT I'VE LEARNED IS THE BIGGEST 1996 00:58:43,867 --> 00:58:44,968 NEED IS FOR THE PHYSICIAN 1997 00:58:44,968 --> 00:58:47,204 EXECUTIVES TO BE CHAMPIONS FOR 1998 00:58:47,204 --> 00:58:47,638 THIS. 1999 00:58:47,638 --> 00:58:51,275 BECAUSE IT'S REALLY DIFFICULT TO 2000 00:58:51,275 --> 00:58:52,309 IMPLEMENT THIS WITHOUT A 2001 00:58:52,309 --> 00:58:54,077 PHYSICIAN CHAMPION THAT'S READY 2002 00:58:54,077 --> 00:58:57,047 TO SEE THIS AS THE FUTURE. 2003 00:58:57,047 --> 00:58:58,482 AND I THINK THE OBLIGATION IS ON 2004 00:58:58,482 --> 00:59:00,484 A LOT OF US IN EDUCATION TO MAKE 2005 00:59:00,484 --> 00:59:02,686 THE CASE TO THOSE PHYSICIAN 2006 00:59:02,686 --> 00:59:04,755 EXECUTIVES THAT THIS IS -- YES, 2007 00:59:04,755 --> 00:59:07,357 THIS IS EDUCATION, BUT THE 2008 00:59:07,357 --> 00:59:09,226 DOWNSTREAM BENEFIT OF THIS 2009 00:59:09,226 --> 00:59:11,428 EDUCATION IS OUR PATIENT 2010 00:59:11,428 --> 00:59:11,828 OUTCOMES. 2011 00:59:11,828 --> 00:59:14,331 THAT'S THE LINK THAT WE NEED TO 2012 00:59:14,331 --> 00:59:15,632 DO, WE NEED TO MAKE THAT 2013 00:59:15,632 --> 00:59:17,601 CONNECTION MORE EFFECTIVELY IN 2014 00:59:17,601 --> 00:59:22,506 MY VIEW FOR US TO GENERATE THE 2015 00:59:22,506 --> 00:59:23,607 ENTHUSIASM AND THE SUPPORT 2016 00:59:23,607 --> 00:59:24,908 BECAUSE THAT WILL COME DOWN TO 2017 00:59:24,908 --> 00:59:25,909 FINANCIAL SUPPORT ULTIMATELY. 2018 00:59:25,909 --> 00:59:27,177 BUT JUST BACKING OFF OF ALL OF 2019 00:59:27,177 --> 00:59:28,912 THAT, THAT'S WHY IT SITS IN HIGH 2020 00:59:28,912 --> 00:59:30,013 RESOURCE INSTITUTIONS TODAY. 2021 00:59:30,013 --> 00:59:31,548 OUR GOAL -- AND I THINK JUST 2022 00:59:31,548 --> 00:59:32,749 LIKE EVERYTHING ELSE THAT 2023 00:59:32,749 --> 00:59:34,585 STARTS, THE COST WILL COME DOWN. 2024 00:59:34,585 --> 00:59:39,623 SO THAT'S WHY ONE OF THE 2025 00:59:39,623 --> 00:59:41,124 URGENCIES WE FEEL IS TO CREATE 2026 00:59:41,124 --> 00:59:42,759 PRINCIPLES AND STANDARDS DONE IN 2027 00:59:42,759 --> 00:59:44,628 A WAY THAT'S INTEROPERABLE 2028 00:59:44,628 --> 00:59:45,696 BECAUSE THE COST WILL COME DOWN. 2029 00:59:45,696 --> 00:59:47,798 WHEN THEY COME DOWN, IF THERE'S 2030 00:59:47,798 --> 00:59:48,832 A THOUSAND DIFFERENT MECHANISMS 2031 00:59:48,832 --> 00:59:50,233 TO DO THIS, THEN THEY CAN'T BE 2032 00:59:50,233 --> 00:59:50,701 SHARED. 2033 00:59:50,701 --> 00:59:52,436 BUT IF WE'RE ABLE TO CREATE A 2034 00:59:52,436 --> 00:59:53,971 LANGUAGE NOW FOR HOW TO DO THIS, 2035 00:59:53,971 --> 00:59:58,976 WHEN COSTS DO COME DOWN, THEN WE 2036 00:59:58,976 --> 01:00:00,177 CAN REPLICATE AND SCALE THEM FOR 2037 01:00:00,177 --> 01:00:00,644 THE COUNTRY. 2038 01:00:00,644 --> 01:00:02,679 OUR GOAL, ACTUALLY INITIATIVES 2039 01:00:02,679 --> 01:00:04,214 WE'RE GOING TO INVEST IN, WE'RE 2040 01:00:04,214 --> 01:00:05,549 GOING TO DELIBERATELY SCALE THEM 2041 01:00:05,549 --> 01:00:07,818 IN LOWER RESOURCED INSTITUTIONS, 2042 01:00:07,818 --> 01:00:08,785 BECAUSE WE WANT TO PROVE THEY 2043 01:00:08,785 --> 01:00:09,686 CAN BE EFFECTIVE THERE. 2044 01:00:09,686 --> 01:00:13,790 >> WILL THIS BE EHR-AGNOSTIC 2045 01:00:13,790 --> 01:00:13,991 OR -- 2046 01:00:13,991 --> 01:00:16,326 >> THESE ARE ALL EHR-AGNOSTIC. 2047 01:00:16,326 --> 01:00:17,928 >> EPIC RESEARCH OR SOMETHING 2048 01:00:17,928 --> 01:00:18,328 LIKE THAT. 2049 01:00:18,328 --> 01:00:20,130 >> THEY ALL SIT ON TOP, THEY'VE 2050 01:00:20,130 --> 01:00:23,834 WORKED WITH SERNER, EPIC, EVEN 2051 01:00:23,834 --> 01:00:25,702 SMALLER EHRs THAN THAT. 2052 01:00:25,702 --> 01:00:31,274 BUT IT TAKES AN INFO MA TISH -- 2053 01:00:31,274 --> 01:00:33,110 IT DOES TAKE EXPERTISE LIKE THAT 2054 01:00:33,110 --> 01:00:34,745 TO DO THIS EFFECTIVELY. 2055 01:00:34,745 --> 01:00:37,814 >> I THINK THIS IS A GREAT TALK. 2056 01:00:37,814 --> 01:00:38,782 QUICK QUESTION ABOUT SORT OF THE 2057 01:00:38,782 --> 01:00:39,216 BIAS. 2058 01:00:39,216 --> 01:00:40,617 YOU MENTIONED FOR EXAMPLE DATA 2059 01:00:40,617 --> 01:00:43,820 AT NYU WHEN THEY'RE LOOKING AT 2060 01:00:43,820 --> 01:00:44,655 RESIDENCY APPLICATIONS SO 2061 01:00:44,655 --> 01:00:45,756 THEY'VE LOOKED AT WHAT THEY'VE 2062 01:00:45,756 --> 01:00:46,723 ALREADY ACCEPTED INTO THEIR 2063 01:00:46,723 --> 01:00:47,024 PROGRAM. 2064 01:00:47,024 --> 01:00:48,592 AS THE MODEL FOR WHICH THEY CAN 2065 01:00:48,592 --> 01:00:53,130 GO BACK AND THEN RE-SCREEN 2066 01:00:53,130 --> 01:00:54,765 CURRENT APPLICATIONS TO GET THE 2067 01:00:54,765 --> 01:00:57,067 PREVIOUS OUTCOMES IN A SENSE. 2068 01:00:57,067 --> 01:00:59,202 HOW DO YOU -- I MEAN, I THINK 2069 01:00:59,202 --> 01:01:01,438 ALL OF US, THAT'S SORT OF A 2070 01:01:01,438 --> 01:01:03,273 REPLICATION OF BIAS IN THE 2071 01:01:03,273 --> 01:01:04,074 ALGORITHM ITSELF. 2072 01:01:04,074 --> 01:01:06,343 SO YOU'RE USING YOUR PREVIOUS 2073 01:01:06,343 --> 01:01:08,745 DECISIONS TO JUSTIFY FUTURE ONES 2074 01:01:08,745 --> 01:01:10,280 IN A SYSTEM THAT YOU ALREADY 2075 01:01:10,280 --> 01:01:12,916 ADMIT IS IMPERFECT AND HAS 2076 01:01:12,916 --> 01:01:14,284 MISSED MANY POTENTIAL CANDIDATES 2077 01:01:14,284 --> 01:01:14,718 PREVIOUSLY. 2078 01:01:14,718 --> 01:01:17,954 THIS IS NOT AN ISSUE FOR THE AMA 2079 01:01:17,954 --> 01:01:18,855 NECESSARILY TO SOLVE BUT THERE 2080 01:01:18,855 --> 01:01:22,459 HAS TO BE SORT OF A LOT OF WORK 2081 01:01:22,459 --> 01:01:27,264 THOUGHT AROUND THE BIAS THAT HAS 2082 01:01:27,264 --> 01:01:29,399 ECK -- EXISTS AND HAS EXISTED IN 2083 01:01:29,399 --> 01:01:30,434 THE PATCH. 2084 01:01:30,434 --> 01:01:32,102 A.I. WILL GIVE YOU WHAT YOU'VE 2085 01:01:32,102 --> 01:01:32,402 PUT IN. 2086 01:01:32,402 --> 01:01:33,804 BUT THE QUESTION IS HOW DO WE 2087 01:01:33,804 --> 01:01:35,572 THINK DEEPER ABOUT CREATING NEW 2088 01:01:35,572 --> 01:01:37,407 VISIONS FOR WHAT WE WANT A.I. TO 2089 01:01:37,407 --> 01:01:38,308 HELP US ACHIEVE. 2090 01:01:38,308 --> 01:01:41,178 AND I DON'T KNOW SORT OF HOW TO 2091 01:01:41,178 --> 01:01:41,578 DO THAT. 2092 01:01:41,578 --> 01:01:42,979 I MEAN, OTHER THAN, OF COURSE, 2093 01:01:42,979 --> 01:01:44,848 USING PREVIOUS DATA, BUT I 2094 01:01:44,848 --> 01:01:47,350 THINK -- I DON'T KNOW IF NYU 2095 01:01:47,350 --> 01:01:48,552 TUNED THIS A LITTLE BIT TO SEE 2096 01:01:48,552 --> 01:01:50,187 IF THEY COULD GET AN OUTCOME 2097 01:01:50,187 --> 01:01:51,822 THAT THEY WANT AND OF COURSE THE 2098 01:01:51,822 --> 01:01:53,557 OUTCOME THEY WANT IS GOING TO BE 2099 01:01:53,557 --> 01:01:55,192 CLEARLY BIASED BY WHATEVER YOUR 2100 01:01:55,192 --> 01:01:56,393 INSTITUTION VALUES, BUT I THINK 2101 01:01:56,393 --> 01:01:57,027 THAT DEFINITELY IS SOMETHING 2102 01:01:57,027 --> 01:01:58,995 THAT I'M SURE EVERY PLACE THINKS 2103 01:01:58,995 --> 01:02:00,230 ABOUT AS THEY TRY TO IMPLEMENT 2104 01:02:00,230 --> 01:02:02,399 THESE SYSTEMS, I JUST DON'T KNOW 2105 01:02:02,399 --> 01:02:03,800 HOW THAT'S BEING SORTED OUT NOW. 2106 01:02:03,800 --> 01:02:04,901 >> THANK YOU FOR HIGHLIGHTING 2107 01:02:04,901 --> 01:02:05,202 THAT. 2108 01:02:05,202 --> 01:02:06,970 IF THEY WERE HERE, I THINK 2109 01:02:06,970 --> 01:02:08,171 THEY'D BE THE FIRST TO AFFIRM 2110 01:02:08,171 --> 01:02:09,706 WHAT YOU JUST DESCRIBED AND 2111 01:02:09,706 --> 01:02:12,342 RECOGNIZE THAT THAT BIAS -- THAT 2112 01:02:12,342 --> 01:02:13,677 WHAT I SHARED WAS A PROOF OF 2113 01:02:13,677 --> 01:02:15,045 CONCEPT TO SHOW THE MODEL COULD 2114 01:02:15,045 --> 01:02:16,813 WORK BUT THEY ABSOLUTELY 2115 01:02:16,813 --> 01:02:18,014 RECOGNIZE THAT THEY JUST -- 2116 01:02:18,014 --> 01:02:19,649 AGAIN, PROOF OF CONCEPTS, THEY 2117 01:02:19,649 --> 01:02:20,684 RECOGNIZE WHATEVER THEY CREATED 2118 01:02:20,684 --> 01:02:22,085 IS GOING TO PROPAGATE THE BIAS 2119 01:02:22,085 --> 01:02:23,620 THAT WAS ALREADY INSTILLED 2120 01:02:23,620 --> 01:02:23,854 EARLIER. 2121 01:02:23,854 --> 01:02:24,988 SO THEY ARE AWARE OF THAT AND 2122 01:02:24,988 --> 01:02:26,456 ARE THINKING ABOUT HOW TO 2123 01:02:26,456 --> 01:02:27,557 DE-BIAS THE SYSTEM AS WELL. 2124 01:02:27,557 --> 01:02:29,126 BUT I THINK THE EQUITY ISSUE AND 2125 01:02:29,126 --> 01:02:31,728 THE BIAS ISSUE IS TOP OF MIND 2126 01:02:31,728 --> 01:02:32,929 FOR -- AT LEAST I'VE SEEN IN THE 2127 01:02:32,929 --> 01:02:34,231 PEOPLE THAT WE'VE WORKED WITH 2128 01:02:34,231 --> 01:02:36,399 TOP OF MIND FOR THOSE THAT ARE 2129 01:02:36,399 --> 01:02:37,501 INNOVATING IN THIS SPACE. 2130 01:02:37,501 --> 01:02:38,702 SO I DON'T HAVE THE SOLUTION FOR 2131 01:02:38,702 --> 01:02:42,105 YOU, BUT I THINK IT IS A 2132 01:02:42,105 --> 01:02:43,507 SENSITIVITY THAT EVERYONE SEEMS 2133 01:02:43,507 --> 01:02:45,375 TO SAY IS A HIGH PRIORITY. 2134 01:02:45,375 --> 01:02:47,444 BUT THANK YOU FOR HIGHLIGHTING 2135 01:02:47,444 --> 01:02:48,245 IT. 2136 01:02:48,245 --> 01:02:52,249 >> YEAH, THAT WAS I THINK REALLY 2137 01:02:52,249 --> 01:02:53,450 SO BEAUTIFULLY SAID AND 2138 01:02:53,450 --> 01:02:54,451 HIGHLIGHTED A LOT OF MY CONCERNS 2139 01:02:54,451 --> 01:02:57,020 SO JUST SORT OF A SIMILAR 2140 01:02:57,020 --> 01:03:00,090 FOLLOW-UP IS TO WHAT EXTENT DO 2141 01:03:00,090 --> 01:03:01,191 YOU ACTUALLY THINK -- COULD 2142 01:03:01,191 --> 01:03:04,995 THERE BE A RISK OF MINIMIZING 2143 01:03:04,995 --> 01:03:06,096 VARIABILITY ESPECIALLY WHEN THE 2144 01:03:06,096 --> 01:03:07,631 FUTURE ROLE OF US AS DOCTORS IS 2145 01:03:07,631 --> 01:03:09,099 SO UNCERTAIN IN THE HEALTHCARES 2146 01:03:09,099 --> 01:03:12,869 ISHEALTHCARESYSTEM, COULD YOU AY 2147 01:03:12,869 --> 01:03:15,272 SCRUB OUT A TYPE OF ARCHETYPE 2148 01:03:15,272 --> 01:03:16,706 THAT ACTUALLY TURNS OUT TO BE 2149 01:03:16,706 --> 01:03:18,775 REALLY, REALLY VALUABLE IN 15 2150 01:03:18,775 --> 01:03:18,975 YEARS? 2151 01:03:18,975 --> 01:03:23,680 >> I THINK ALL OF THAT TO BE 2152 01:03:23,680 --> 01:03:23,980 DETERMINED. 2153 01:03:23,980 --> 01:03:26,082 I HOPE PERSONALLY HOPE NOT. 2154 01:03:26,082 --> 01:03:27,951 I THINK THE POWER OF THIS, TO 2155 01:03:27,951 --> 01:03:32,422 ME, IS TO ACTUALLY STEP AWAY 2156 01:03:32,422 --> 01:03:35,358 FROM WHAT WE'VE EMPHASIZED 2157 01:03:35,358 --> 01:03:35,592 TODAY. 2158 01:03:35,592 --> 01:03:36,893 TODAY WE EMPHASIZE MEDICAL 2159 01:03:36,893 --> 01:03:37,160 KNOWLEDGE. 2160 01:03:37,160 --> 01:03:39,729 IF YOU LOOK AT WHAT DO YOU USE 2161 01:03:39,729 --> 01:03:44,568 TO GET IN RE RESIDENCY, CME SCO, 2162 01:03:44,568 --> 01:03:45,769 ONE OF THE REASONS IT'S 2163 01:03:45,769 --> 01:03:47,170 PASS/FAIL IS BECAUSE OF THE BIAS 2164 01:03:47,170 --> 01:03:48,271 IT INTRODUCES INTO THE SYSTEM. 2165 01:03:48,271 --> 01:03:49,472 IT'S NOT MEANT FOR THAT UM IN 2166 01:03:49,472 --> 01:03:51,007 BER ONE AND IT'S NOT 2167 01:03:51,007 --> 01:03:51,975 PREDECORATIVE FOR WHO IS GOING 2168 01:03:51,975 --> 01:03:53,310 TO SUCCEED IN RESIDENCY BUT 2169 01:03:53,310 --> 01:03:55,145 THOSE THINGS ARE GOING AWAY AND 2170 01:03:55,145 --> 01:03:56,346 IT'S LEFT BEHIND A VACUUM, SO 2171 01:03:56,346 --> 01:03:57,747 HOW DO WE LEARN ABOUT PEOPLE? 2172 01:03:57,747 --> 01:03:59,716 NOW I THINK WE ARE LEARNING THAT 2173 01:03:59,716 --> 01:04:01,251 COMMUNICATION, EMPATHY, 2174 01:04:01,251 --> 01:04:02,452 PROFESSIONALISM, UNDERSTANDING 2175 01:04:02,452 --> 01:04:03,486 SOCIAL DRIVERS, THERE ARE ALL OF 2176 01:04:03,486 --> 01:04:04,521 THESE OTHER COMPETENCIES THAT 2177 01:04:04,521 --> 01:04:05,856 WE'RE STARTING TO UNDERSTAND 2178 01:04:05,856 --> 01:04:08,024 MATTER FOR A PHYSICIAN TO 2179 01:04:08,024 --> 01:04:08,458 THRIVE. 2180 01:04:08,458 --> 01:04:09,759 SO MY HOPE IS THAT WE ARE ABLE 2181 01:04:09,759 --> 01:04:13,897 TO ACTUALLY CREATE OR USE THESE 2182 01:04:13,897 --> 01:04:17,534 TOOLS TO ASSESS AGAINST THOSE, 2183 01:04:17,534 --> 01:04:18,401 IDEALLY DEVELOP AGAINST THOSE 2184 01:04:18,401 --> 01:04:20,470 AND BRING PEOPLE IN LOOKING AT 2185 01:04:20,470 --> 01:04:23,306 THOSE OBJECTIVELY WHEREAS TODAY, 2186 01:04:23,306 --> 01:04:24,708 WITHOUT THOSE DATA, AGAIN, WITH 2187 01:04:24,708 --> 01:04:26,776 THE VACUUM AROUND ASSESSMENT FOR 2188 01:04:26,776 --> 01:04:29,112 THOSE PARTICULAR ATTRIBUTES, 2189 01:04:29,112 --> 01:04:30,614 IT'S IMPOSSIBLE TO DO THAT, AT 2190 01:04:30,614 --> 01:04:31,548 LEAST EFFECTIVELY. 2191 01:04:31,548 --> 01:04:33,049 WE TALKED ABOUT HOLISTIC REVIEW, 2192 01:04:33,049 --> 01:04:35,785 BUT MY VIEW IS THAT WE'RE NOT 2193 01:04:35,785 --> 01:04:38,088 ACHIEVING THAT EFFECTIVELY YET. 2194 01:04:38,088 --> 01:04:39,823 SO I THINK IT'S A REALLY 2195 01:04:39,823 --> 01:04:40,190 IMPORTANT POINT. 2196 01:04:40,190 --> 01:04:42,659 AND I THINK AS WE EVOLVE 2197 01:04:42,659 --> 01:04:45,595 FURTHER, WE'LL SEE HOW THIS GOES 2198 01:04:45,595 --> 01:04:47,264 BUT MY -- I'M OPTIMISTIC THAT 2199 01:04:47,264 --> 01:04:49,232 THIS WILL ELEVATE ATTRIBUTES 2200 01:04:49,232 --> 01:04:51,401 THAT WERE NOT -- THAT ARE BEING 2201 01:04:51,401 --> 01:04:52,469 NEGLECTED AND THAT WE THINK DO 2202 01:04:52,469 --> 01:04:54,671 MATTER. 2203 01:04:54,671 --> 01:04:55,772 BECAUSE WE'RE UNABLE TO MEASURE 2204 01:04:55,772 --> 01:05:00,377 THEM. 2205 01:05:00,377 --> 01:05:01,311 THANK YOU GUYS VERY MUCH. 2206 01:05:01,311 --> 01:05:11,488 [APPLAUSE]