Does technology improve medicine?   7 comments

When we were in the “control center” of the simulations section at the Med School on Tuesday, I deliberately asked the question that had stuck with me as soon as I saw the lifeless, $25,000 dollar mannequin lying on the table–is there any evidence to suggest that all this expensive technology produces better doctors? Nadine answered the question as honestly as possible, namely that there is no evidence but that they’re working off of the assumption that it does make better doctors. I wasn’t surprised by her answer, but I have to admit that I was a little disheartened.

That technology always makes thing better is an assumption that I believe is particularly prevalent in our society. That to solve any problem all I need to do is throw the latest gadgets and gizmos at it seems to be an unconscious philosophy that drives much of our thinking. And why shouldn’t it be? Technology has reshaped human existence from the beginning, and in the last century, these changes have come at such a dizzying pace that technological change has become the norm rather than the rare occasion. Moreover, our society views everything in terms of “trajectory.” Moving up equals getting better, and in this social formula–an underlying assumption that generally remains unquestioned–technology is always an additive. For instance, if I can control the temperature in my house with an AC unit, that’s good; however, if I can control the temperature in my house remotely with an “app” on my iPhone, that’s great! The more technology I pile onto the problem (a hot house), the better the solution becomes.

Through my studies in T&T, I’ve become more aware of this societal assumption and, increasingly so, begun to question it. I think of my students in Freshman Composition. They all have access to word processors; they all have access to the internet; they all have access to online writing tools (writing aids, electronic thesaurus, research tools, etc., etc.), but do any of these technologies make them better writers? I think anyone who teaches Freshman Comp would agree with me that the answer to that is an exuberant “Hell No!

I can’t help but think of medicine in the same vein. Sure, technology makes the process easier. Just as it’s easier and potentially faster for my students to use word processors (and perhaps they’ll have fewer spelling errors), I imagine that it might be easier and potentially faster for a doctor with an iPad and internet access to retrieve medical/patient information. But in the same way that technology doesn’t make my students better Writers (their prose is still unorganized and unfocused; they still have grammatical problems; they still don’t understand the difference between summary and analysis, etc.), I don’t think technology by itself is going to make better Doctors.

Take the advanced simulator mannequins at UCF (or even the patient avatars that are being developed), for example. From an embodiment perspective, these tools are limited at best. The students don’t receive any embodied information from the patient because the patient doesn’t move. Sure, someone in a separate room can speak through the mannequin and say, “My right side hurts,” but that’s no where near the same kind of experience as seeing a patient actually react to a pain. In the real world, verbal cues and bodily cues can compliment each other and reinforce each other when one or the other is lacking. Also, it’s very possible in real situations for the verbal and bodily cues to contradict each other, forcing the medical practitioner to have to wade through the information in order to come to a correct diagnosis. In either case, the simulators that the students are working on are missing a significant part of the equation.

Don’t get me wrong; I’m not advocating that we ignore technology except when we can conclusively prove that it will benefit the situation. My point is that we need to think about what kinds of problems technology can and can’t solve before we invest lots of time and money into a “technological solution.” Unfortunately, I think all too often we’re guided by the unconscious assumption that technology (any technology) can make a situation better, so we take a shotgun approach–throw as many gizmos at the problem as possible and see what sticks.

 

-John L.

Advertisements

Posted October 25, 2010 by lamothej in Uncategorized

7 responses to “Does technology improve medicine?

Subscribe to comments with RSS.

  1. Well said, John. In fact, I think it might have been you who asked the question regarding old equipment I mentioned in my post a few moments ago.

    I agree that technologies don’t automatically improve anything, along with the cultural ideal of progress. I think they can provide a supplement, but never a replacement. Like you said, “the simulators that the students are working on are missing a significant part of the equation.” No matter how much programming or AI gets put into a dummy patient, it’s not going to be the same experience that a real person provides.

  2. I have the same concerns about online education. Our society has become so programmed to accept and encourage technological change that any new feature gets lauded as an essential necessity for learning. And then we get things like the “blog” mode in Webcourses. ‘Nuf said.

    I know you know this, but I feel compelled to point it out: Harvey is the beginning of their training, not the end. They’ll move from a mic in a mannequin to a real human soon enough, and there, they’ll talk to real people who have had real heart attacks. If we view technology as a tool to make the steps involved in learning more incremental, I think it’s undoubtedly valuable.

    Take calculators in a math class, for example. We all hated when our teachers made us work a problem by hand, all the while knowing the magic button existed on the calculator that could do it all for us. But we also knew that we would have to understand the principle before relying on the tool to do the work for us.

    Students writing essays with a spell check and online thesaurus still need to have a command of the language. Med students with an iPad and instant access to DynaMed still need to understand what the drugs they prescribe will do. In every case, the technology can support the knowledge, but it doesn’t replace the learning.

    John, you’re absolutely right in your concerns, your hesitations, and your misgivings. The skeptical part of me is reassured, though, when I think that these students are learning *with* the technology. That means the tech is here (gesture to my left), but the learning still happens in addition to the tech (gesture to my right). One can only hope that DynaMed will be like that little red squiggly: a gentle reminder to use one’s brain, and a catch for the ‘little things’ that we might not always think about.

  3. Hi Chris,

    I certainly understand that Harvey is the beginning of their training. However, as Nadine reiterated numerous times, these are very expensive machines. I believe she quoted somewhere around $25,000 per machine, and that’s not including the money to train someone to maintain/operate it and what it takes to upkeep it. And I think she mentioned how the Florida State med school has a dozen or so of these simulators. That’s an awful lot of money at any stage of education to invest in a technology where there is no evidence whatsoever that it has any impact on a students’ ability to work with real patients with real illness.

    Again, my point is that they are operating off of an assumption that technology–any increase in the amount of technology–improves things, in this instance improving med school education. Perhaps they’re right. I’m not saying that the assumption is faulty in this particular instance, but it’s still a lot of “faith” in technology.

    This is my fear: that instead of focusing on a way to solve a particular problem and looking toward technology as one possible way to solve it, they see technology (in this case a simulator) and try and fit it into an educational plan. It’s like saying, “Hmmm…avatars are pretty cool; they’re being used in everything else, why not see what happens when we combine avatars and medicine.” Clearly, there’s a pedagogical problem here, namely that there is no real pedagogical forethought. I’d like to think that this isn’t the case for UCF’s Harvey, but Nadine admits that they’re putting their faith in technology instead of attempting to solve a particular problem with that technology.

    -John

  4. I think this critique of the effectiveness of these specific technological enhancements to medical training has strayed into T&T theorizing without reflecting on the context. Nadine told us there has not been a great deal of empirical evidence to prove that Harvey or the high-tech examination rooms makes better doctors. However, how would such evidence be generated right now? Not at UCF. The UCF medical college has not graduated anyone yet. It may take a T&T student’s dissertation to even design a suitable study, based on the considerations we have developed in this course.

    I was impressed by the technological tools at the medical college that we were allowed to see. I don’t think they represent a shotgun approach to deploying technology, but rather careful planning for providing technological interventions at critical points in a med student’s career. Nadine expressed how important the Harvey manikin is for preparing students for more intense exercises when they are involved with standardized patients, not to mention when they are learning in the field as more advanced students dealing with real, live, suffering people. The fact that Harvey can generate a host of heart and breathing sounds that students would otherwise have to imagine from textbook and lecture descriptions is a huge advantage.

    The surveillance technology of the exam rooms, combined with their near-perfect simulation (and are they really simulacra, virtual realities, or bone-fide exam rooms?), presents what I think is another huge advantage to what previous states of the art offered for training doctors. Compare it to sports teams that study films of their game play. To have a real physician monitoring your actions, commenting on your body movements while performing actions on another human being, all the while recording the encounter so that you can review it later–what would be the previous state of the art? The observer’s handwritten notes? A debriefing of the standardized patient? My only concern with the exam rooms was that they may be too modern and well designed, creating an unrealistic environment such that proto-doctors may be uncomfortable when they have to work in a real hospital. However, Nadine stated that med students have become very choosy about where they do their residencies, having been exposed to these new technologies. Yes, let’s remember that the ergonomics of the room, the type of exam table, where the computer is located, all constitute technological design considerations. Therefore, another aspect of the new UCF med school’s technology choices is that they may influence the design of future care facilities when the graduates begin to have an impact in the workplace.

  5. Great post John. I too have these concerns, and reading the responses I think such concerns might be more prevalent than one might think. Technophobia itself is a growing corrollary to our waxing technological dependence and addictions. Yet, in defense of technology-based training platforms we saw in the medical school, though much of this medical technology is too new to really know if it makes better doctors, I think we can look at other areas where technology clearly has benefited training processes. As John B. mentions, even in football, having the ability to review films of previous games/plays gives players the opportunity to see themselves in action and self-evaluate their own errors or opportunities for improvement. This, actually, is the first thing I thought of when we entered the control room. But, I did wonder if it might evoke an element of self-consciousness in the student. That said, it did seem like much of the training relies not on $25,000 Harvey mannequins that can simulate any number of medical emergencies from a biological system processes perspective, but on the standardized patients — real human beings who can potentially represent outward behavioral cues. This would seem to me to fill just about any gap left by the use of technologically-based simulated patients, and ensures a broader coverage of potential experience inside or out. I am the first to advocate a return to a simpler time as a means of improving every aspect of life, but I think there is room for both (tradition and technology). I do realize that technology is incredibly seductive, and I for one doubt I could willingly live without it. In our world, simulation has become ubiquitous as a means of training in just about any practical discipline. However, because medical practice is still the most human of practical arts, I tend to think it should stay that way.

  6. Well you go with your bad selves and this discussion!

    John’s response and the ensuing replies reminded me of Elle’s post last week about the NPR interview where Dr. Verghese laments the loss of the physical exam. He claims that the increase in technology makes doctors less reliant on what they see and feel on patients (a la Elle’s example about the patient in the ER with the amputated fingers). It seems as we become more dependent on technology, we become less trustful of “good ol’ fashioned” methods that have been proven effective over the years. This is my biggest concern with the increase of techonlogy in medical training and practice. Technology is certainly important but is there less time to train in traditional methods such as the physical exam when so much time is spent on simulated and computer-based training? Though, as John B. points out, much of their training also involves real people and patients.

    This relates to Will’s concern about students interning in hospitals/offices with less sophisticated technology. I was confounded by Nadine’s response to his question, since there must be more medical students than residencies at cutting edge hospitals. Won’t some of them inevitably end up in less technologically advanced sites?

  7. “That technology always makes thing better is an assumption that I believe is particularly prevalent in our society. That to solve any problem all I need to do is throw the latest gadgets and gizmos at it seems to be an unconscious philosophy that drives much of our thinking.”

    I am not sure that we use technology and add technology to so many aspects of life because we believe it will be automatically better–rather, we are simply creatures who are willing to try new things. We see the ROI that some gadgets and gizmos have provided, and we decide another risk may yield another return. Sometimes we are wrong or too quick to implement, but often we are right.

    Elle

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: