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From the June 2018 issue of DOTmed HealthCare Business News magazine

HCB News: Can you detail some of the challenges that may be unique for a research and clinical institute?
MR: Our commitment, and funding of research and education, means we may have less funds for competition in a constantly changing healthcare landscape. We may decide to support potentially transformative research while centers focused mainly on their clinical mission may use funds from their margin to develop new relationships, construct new buildings, and promote themselves. For research-intensive institutions, we must continue to innovate in value-based healthcare. That is how we will compete, although it is a constant challenge as the growth of healthcare systems continues at a rapid pace.

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Physicians in an academic medical center often also have more competing interests and more administrative requirements. They do teaching, and the best are often called to serve on very important committees and other administrative roles. But they’re partly here for those opportunities of course.

HCB News: The public’s active involvement in being responsible for its care seems to be evolving quickly today, especially with access through personal devices. Has that impacted the education opportunities you offer?
MR: Definitely. Technological advances are here to stay. So is the immediacy with which everyone expects answers. This can create a time-crunch for all involved in healthcare. And there is a generational component. I’m a senior physician and I’m simply not as facile with all these devices as younger health care providers who have lived with them their whole lives. We are working to blend the new technological advances with the very human part of medicine – the patient interaction. There are many studies on human interactions as an important part of the healing process. It’s an interesting challenge for us to make sure our trainees can make the best use of the technology while maintaining that level of human touch.

About five years ago, we were one of eleven medical schools to receive a grant from the American Medical Association to do major curriculum reform. Part of our major reform was redoing our curriculum to ensure that med students get engaged with patients early in training, really from their first day. Traditionally in medical school, you take two years’ worth of classroom basic sciences and then start seeing patients. Now they’re seeing patients in their first week. Of course, their background in diagnosis and treatment of human disease is quite limited at this point in their training. Ironically, this allows them to maximally benefit from observing the human component of high-tech medicine. They meet with families, and they listen to families telling them about their experiences with healthcare. And they do go to the clinic where they observe how some of our best clinicians interact with patients. What they’re learning isn’t how to diagnose and treat disease but rather how physicians interact with patients, in a setting where they do not have to worry about having the right answer to a clinical question. I think it’s an interesting and excellent way to get them introduced.

Another important issue is how we all can best use technology to accelerate learning. When I went to medical school, you could learn pretty much everything about medicine if you studied really hard. But today, with the explosion of knowledge every year, you can’t possibly learn everything about medicine, there’s just too much. So we want to help our students build the tools that will allow them to continue lifelong learning. This has resulted in a move from traditional lectures to small group formats for learning. Medicine is very team-based today and our patients benefit from all of their health care providers working together. We also just opened a new simulation center within the last six months. It allows students and nurses, residents, trainees in other areas, to have practically a real-life experience with medical procedures, giving them the opportunity to practice a procedure over and over.

HCB News: What are you most excited about in healthcare today?
MR: I’m really excited to see how we will leverage current and emerging technology and research to improve health. To give you one example, precision medicine offers the potential for directing care based on individual characteristics. This is truly a “big data” problem and has led to new collaborations between non-medical and scientists in other areas to try to pull together the full picture of the patient to treat the individual.

I’m also excited about the idea of using machine learning and Artificial Intelligence (AI) to help physicians. For now, we’re not close to having AI make a diagnosis. An example of where AI may be useful in the relatively near future is in radiology. A physician evaluating a CT or MRI scan must review a large number of complicated images. If AI could identify those images that contain abnormalities and those that do not, that would allow radiologists to focus on the most critical parts of the exam. I am less convinced that AI will be able to replace clinical judgment. This is complex, with all the variables and the nuances of interpretation of clinical presentations, where the possible diagnoses are many. Maybe it’ll get there someday, maybe it won’t.

HCB News: Can you offer a prediction as to where you think our healthcare system will be in 10 years?
MR: If you think back about advances in medicine, each has come along with bits of technology. The stethoscope was developed 200 years ago, electrocardiograms in the 1930s. The speed of innovation has continually increased since the 1980s and 1990s. I think what we can expect today is that the rate of discovery is accelerating incredibly in the next decade. A major challenge for all of us in healthcare will be understanding which technologies are truly transformative and those which are either incremental or mainly hype. All said, though, the next decade promises exciting advancement in medical care and health.

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