Physicians are tinkerers. We dissect, probe, palpate, and auscultate in an attempt to understand how the body works and ultimately use that knowledge to help our patients. Throughout history, physicians developed medical devices to meet the dynamic needs of their patients. For instance, Dr. Rene Laennec wanted to hear lung sounds more clearly so he carved the first stethoscope out of wood by hand. These tools, fundamental to the practice of medicine, were born out of the necessity to improve care; however, modern medical making has been largely outsourced to the medical technology industry. We want to redesign medical education by enabling medical students to become tinkerers, who prototype and create solutions to problems in healthcare at the earliest stages of their training. Preclinical medical education does a wonderful job building the academic foundations of medicine, but provides minimal exposure to the tools, devices, and patient experiences that encompass the practice of medicine. We learn about a wide variety of organ systems, diseases, and procedures – say, the process and clinical relevance of balloon-inflated valvuloplasty in mitral stenosis – without the opportunity to touch, feel, and deconstruct the tools that are being used. Furthermore, disease is taught from every perspective (anatomic, biochemical, pathological, etc.) except from that of the patient, whose experiences cannot be summed up in a textbook blurb.
Designing and making with patients would flip the current dynamic of medical education, making us feel empowered to solve problems in healthcare even at this early stage in our career. Quoting Mark Hatch, who has written about the Maker Movement, making allows us to “create and express ourselves to feel whole...things we make are like little pieces of us and seem to embody portions of our soul.” Making at the bedside with patients would enable us to reconnect with the human aspect of medicine - the reason why most of us chose this demanding profession. Co-creating with patients would build empathy, problem-solving abilities, and communication skills that will extend into clinical practice. Furthermore, the exercise would serve as an extracurricular outlet in a field struggling with epidemic levels of burnout. Fueled by patient engagement and creativity, medical making could produce many dividends for the future of high-quality, patient-centered care.
As we explore the social determinants of health, engaging patients through making could serve as the fulcrum to revolutionize patient care and improve outcom es. Doctors, nurses, and pharmacists may be experts in the clinical aspects of a disease, but only the patient knows how that condition directly impacts their daily lives. What if,rather than prescribing medications for rheumatoid arthritis, doctors worked with patients to identify and solve the problems that go along with that condition - like designing a pill container with wider wells to help someone with limited dexterity? In tailoring solutions to patients, the physician can work together with the patient to guide them in improving their health rather than dictating a prescribed list of medications. With patient satisfaction now tied to reimbursements, teaching hospitals would be wise to educate their future physician workforce in the use of techniques that personalize and customize care to meet each patient’s needs. The key is to expose young physicians to this human-centered problem solving early in training before they are exposed to, and become entrenched in, algorithm-based medicine.
We want to introduce the concept of the daily “hacking” of medical devices to improve healthcare. Modern medicine is outfitted with many tools, but there is no real mechanism to incorporate improvements spurred by innovative users. An ICU nurse may rig a fragile catheter neck with surgical tape to prevent breaks, but how can they communicate this change to a wider community or have a say in redesigning the tool? Valuable clinical insights are useless unless the people who experience them are empowered to be part of the change. In Thursky and Mahemoff (2007), they described an ICU where key users (residents and pharmacists) were identified for rapid design of an antibiotic decision support system. When physicians and pharmacists were able to apply their experiences to redesign their own workspace, the resulting solution was better able to meet the needs of their colleagues and patients. Susannah Fox, the Chief Technology Officer for the U.S. Department of Health and Human Services, characterized these types of solutions as "hack(ing) the system in a way that you never would expect…(to) see the future of health care." We agree.
Aspiring physicians have backgrounds in the humanities, business, engineering, arts, and many other areas that could bring fresh perspectives to unsolved problems in healthcare. If medical school could foster a collaborative network to explore, iterate, and prototype new ideas, these experiences could be harnessed productively. This summer, Jefferson medical students in the co-curricular Design Track worked with patients in the emergency department to make their own blister pill packs at the bedside, explored the use of low cost bicycle pump-powered nebulizers with asthmatic patients in Panama, and prototyped a drone that delivers health kits to hikers. Imagine the impact that could be made if this diversity of interests was being leveraged at medical schools across the country. We want to help young doctors give voice to their passions using the methodology of the Maker Movement, which empowers everyday people to express themselves through making.
Since many academic medical centers are affiliated with, or located in close proximity to, undergraduate institutions, pre-existing resources could be utilized to educate medical students in aspects of engineering, design, business, and other disciplines. We believe that three core technical skill areas should be focused upon: Computer Science and Small Electronics (CSSE), Textiles and Medical Materials (TMM), and Rapid Prototyping Technologies (RPT). CSSE would expose students to coding principles that would enable them to use microcontroller platforms such as Arduino and Raspberry Pi and create mobile/web-based applications. TMM would introduce skills for working and prototyping with fabric, foam, Legos, or any material that brings an idea to life. RPT focuses on Computer Animated Design (CAD) and 3D printing, which could be bolstered by open-access biomedical printing resources such as the NIH 3D Print Exchange.
Design thinking and fabrication could also be directly incorporated into the medical school curriculum through rotating “clinical immersion” modules during organ-system teaching blocks. Using the Cardiology block as an example, sections of the class would begin with a three-part “design orientation” on design thinking, ethnographic research, and empathy. They would then form small teams to tackle a problem in that field - such as reducing readmissions to the hospital in patients with heart failure. During a 4-week teaching block, students would supplement their educational experience by collaborating with providers and other students, interviewing patients, and, most importantly, making something. The experience would culminate with “innovation rounds” pitching sessions in front of their classmates. The experience could be easily adapted to promote interdisciplinary collaboration with students of other health professions - thereby approximating the care teams that will form in actual practice. The clinical immersion would allow students to gain deeper insight into different departments and, hopefully, introduce them to problems that they will pursue throughout medical school and beyond.
We are confident that today’s medical student will embrace the tinkering legacy in medicine and develop tools that will revolutionize healthcare delivery. A “Medical Maker” curriculum will foster deep empathy, clarity of purpose, and interprofessional collaboration - core competencies for a 21st century physician.
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About The Authors
This article was written by Mark Mallozzi, Ludwig Koeneke, Lorenzo Albala, and Tim Bober.