Are face-to-face medical meetings a thing of the past?

Everything, from exercise classes to pub quizzes, went online last year – and medical education was no exception. In their droves, congresses, conferences, and masterclasses went virtual in a bid to ensure healthcare professionals were supported, up to date, and socially distanced.

But is this change here to stay? Are the days of queuing for coffee, rushing to symposiums, and the glitzy conference dinner a thing of the past? We asked those in the know.

International reach

Online learning makes medical education more accessible but presents challenges in terms of networking opportunities and sponsor exposure.

That is according to Jamie McGregor, head of policy, intelligence and operations at the Neurology Academy, which provides education programmes and masterclasses across a range of neurological specialisms.

“We have gone worldwide,” he says. “We have had people from Indonesia, West Africa – places where people usually find it very hard to access medical education. A recent international masterclass in MS had 53 delegates from 11 countries.”

Geography is not the only accessibility consideration, as healthcare professionals have less time than ever. For most, study leave is a distant memory, and many are juggling long working hours with childcare and other family commitments.

“People can dip in and out of online content, rather than block three days out of their calendar to attend a course. They also avoid all the travel time and the expense.

“But in terms of disadvantages, we are always at the mercy of the IT gods, and from a delivery standpoint, there’s a lot more to organise. You’ve got potentially hundreds of people you need to make sure can log on and take part.”

Online can also be more difficult for speakers because they are unable to gauge their audience’s reaction, and the loss of networking opportunities has also been noted.

“We have really tried to drive engagement and give delegates the opportunity to get involved – we have had question and answer functions, Twitter feeds and dedicated inboxes. For the smaller events, we have set up WhatsApp groups so they can talk amongst themselves,” says McGregor.

“We want to try to make them feel as though they are in the room.”

Sponsor engagement was also a concern for the academy, and McGregor admits this is something they are still working on.

“We want to give sponsors as much exposure as possible, and make sure delegates understand that without the sponsorship, the events either would not be happening at all, or would certainly not be free.

“So far, we have tried virtual networking cafes, where pharma reps can sit and chat to people, and we are doing online sponsored symposiums. There is more that we want to do, and we will work with our sponsors on that, but it’s definitely a learning curve.”

Re-creating face-to-face

The pivot from “in real life” to virtual wasn’t an easy one for the team at the British Society of Echocardiography, but they were determined that the “vital educational event” would go ahead.

“A virtual conference is a completely different beast to a face-to-face event – the project plan needs turning on its head,” says Jo Sopala, executive director at the society, adding that she was “immensely grateful” to work with a trusted platform supplier who could provide expertise and support.

“I think digital will always have a part to play. I suspect for the next year we will remain predominantly virtual, but once we can socialise again, there will be a call for face-to-face events. People, and particularly the medical fraternity, will need the personal connection”

“There was a huge amount of work to do. We had a full programme and had already invited speakers. To facilitate a virtual event, we had to go right back to the drawing board: revising the programme, the structure and pretty much everything.”

The hard work paid off, and the virtual conference was deemed a success with a 50% increase in audience and wider international reach when compared to the previous year.

“We received overwhelmingly positive feedback about the content, platform, engagement and accessibility, and were very proud of the result,” Sopala says.

They worked hard to recreate the social element of conference, opting for a platform with inbuilt networking abilities and even throwing a virtual “conference disco”.

“You cannot underestimate the value of networking and informal clinical supervision/support that people get at conferences – something which is probably needed now more than ever,” Sopala says, adding that this had been difficult to recreate in the digital setting.

“The other slight downside was that our sponsors did not receive the level of engagement they would usually expect, but we will work with them and providers to improve on that.”

Asked if virtual medical meetings were the future, Sopala says she envisions a hybrid model, post-2021.

“I think digital will always have a part to play. I suspect for the next year we will remain predominantly virtual, but once we can socialise again, there will be a call for face-to-face events.

“People, and particularly the medical fraternity, will need the personal connection,” she says.

Industry adaptations

While educational content lends itself to the virtual model, translating sponsor exposure into the online space has posed something of a challenge.

Fiona Robinson, director of exhibition design company Discovery Events, says: “We have looked into various virtual platforms for clients for exhibition stands, including virtual tours, downloaded videos, brochures and information.

“But it is a really different way of disseminating information.”

Many clients have diverted spend from conferences to online content generation and are “taking the opportunity to profile themselves in different ways”.

“Websites are playing an even more important role than ever before, certainly as a sales tool. It is every company’s shop window to the world, and promoting expertise has never been more critical,” says Robinson.

The pandemic-driven shift to digital communications has demonstrated it is possible to maintain contacts while working from home, and people have adapted quickly. But, Robinson says, that will not spell the end of face-to-face conferences in the future.

“What I’m continually hearing is that people are sick of Zoom meetings and that it’s just not the same as in-person comms,” she says.

“Many a deal has been made in a bar after congress and this kind of social interaction plays a huge part of the business world. People like a good conference giveaway, and even the most seasoned travellers do still get a buzz from visiting a foreign country.

“Can we really imagine a world without face-to-face congresses? Without that personal networking touch? I, for one, hope they will not be lost to a virtual world.”

About the author

Amanda Barrell is a health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities and agencies, and has written extensively for patients, healthcare professionals and the general public.

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Virtual Engagement During COVID Pushes Paradigm Shift for Physician Training and Patient Care

Virtual engagement during COVID pushes paradigm shift for physician training and patient care
Shalini Shah, MD is Vice-Chair and Associate Professor, Department of Anesthesiology & Perioperative Care, and Enterprise Director of Pain Services, UC Irvine Health

The dominant presence of COVID-19 has not meant the absence of cancer, ear infections, heart attacks, chronic pain, or other illnesses that need attention and care. Physicians have continued treatment for all types of maladies, and physician training has continued as well. But this treatment and this training look much different these days. Despite the challenges that came with major COVID shutdowns and changing requirements, the healthcare system and patients have been both creative and resilient in finding robust “temporary” solutions to these challenges. It is now looking like some of these COVID-era transitional steps will be preserved and play a lasting role in the future of medical education and telemedicine. What must be sacrificed to reap the benefits of these new protocols?

The rapid adoption of technology and virtual engagement tools has been both impressive and interesting to watch – Zoom meetings between medical association boards of directors, FaceTime calls between isolated patients and their family members at home, telehealth phone appointments with family practice physicians, or virtual medical conferences through Webex – the increasing reliance on these tools has pushed boundaries and exposed both opportunities and challenges with technology use for the future of healthcare.

As COVID-19 has significantly accelerated the feasibility and acceptance of telehealth care by physicians, patients, and payors, we now see healthcare systems navigating in real-time the complex issues with cybersecurity and patient privacy. Due to waivers, everyday technologies can be utilized right now, including FaceTime, Skype, Facebook Messenger video chat, Google Hangouts, and Zoom, but new regulatory guidance may be needed to develop safe, secure, and patient-friendly telehealth applications for the future. Cyber-security, already an important priority in the healthcare information space, is going to become that much more essential as doctor’s offices and clinics implement even more telehealth protocols faster than they ever would have normally planned or budgeted for.

These changes in practice and patient care have also impacted how controlled substances are prescribed. The Drug Enforcement Agency has modified policies to allow for the remote prescribing of controlled substances during the pandemic. Online counseling, informed consent, and follow-up with patients can be done in a virtual setting. Pill counts can be done in a video call and patients can still have their questions answered regarding their pain therapy, although it is likely that after the crisis, prescribing certain controlled substances may return to in-person visits.   It is important that the regulatory climate continues to evolve at the pace needed to address the changing needs and realities of telehealth in the time of COVID.

While we have all become more comfortable on telehealth platforms, there continues to be an important role for in-person visits. Patients may appreciate the convenience of telemedicine; however, they must understand that it can limit a physician’s ability to perform a thorough examination and possibly reduce the chances of a physician detecting an unexpected complication or condition. 

Moving forward, I expect there will be much greater reliance on telehealth strategies even post-COVID, but it will always have to be balanced with old-fashioned office visits.

Residency training has also experienced a profound shift this year. Conventional teaching approaches have either been cut back or have been canceled due to COVID risks, and reduced access to personal protective equipment (PPE) has limited the amount of time spent with patients being cared for during residency and fellowship programs. But we can’t stop training for the next generation of physicians or providing quality Continuing Medical Education (CME) for practicing physicians. E-learning techniques, such as webinars and online skills training, certainly play a role – and these may offer ways to actually enhance cross-departmental or multidisciplinary collaborative educational sessions. E-learning may be more cost-effective and easier to participate in than traveling to conferences or symposia, but the hands-on learning and deep discussions that can occur in breakout sessions or clinical training modules will need to be replaced somehow. And there must be careful vetting of online content in order to avoid a proliferation of commercially biased information, plagiarized materials, or simply false information. As we all adjust to new settings and styles for learning, there must be purposeful strategies to ensure online lectures are still supported with opportunities for learning from direct patient contact and collegial support.

Despite these concerns and challenges, new models for CME activities actually pose a great opportunity for increased access, cost-effectiveness, and practicality for busy clinicians.

Even before the first case of COVID-19 was diagnosed, technological innovation had already begun to change education, healthcare, and even social relationships. The COVID-19 crisis has simply accelerated the drive and interest in these new tools. But while the technological tools and platforms to a large extent existed years before COVID-19, they have never been used as purposefully, as rapidly, or with such intentionality as they are being used now.

I am sure the shift toward technology and virtual engagement in medicine will not go away when we finally get past the COVID-19 crisis. There will likely be lasting changes with the reliance on distance-medicine techniques for both patient care and physician training. But we must keep a close eye on regulatory frameworks that need to be updated, and make extra efforts to build and maintain patient-physician relationships.

About Shalini Shah, MD

Shalini Shah, MD is Vice-Chair and Associate Professor, Department of Anesthesiology & Perioperative Care, and Enterprise Director of Pain Services, UC Irvine Health.  Dr. Shah completed her residency in Anesthesiology from NYP-Cornell University and a combined fellowship in Adult and Pediatric Chronic Pain at Brigham and Women’s Hospital, Beth Israel Deaconess and Children’s Hospital of Boston, Harvard Medical School. 

Lo que los doctores no aprenden: a detectar el racismo en la atención médica

Betial Asmerom, estudiante de medicina de cuarto año en la Universidad de California-San Diego (UCSD), nunca había demostrado interés en ser doctora.

En su adolescencia, ayudó a sus padres, inmigrantes de Eritrea que hablaban poco inglés, a navegar el sistema de atención de salud en Oakland. Veía a médicos que eran irrespetuosos con su familia y que no se preocupaban por el tratamiento de la cirrosis, la hipertensión y la diabetes de su madre.

“Todas esas experiencias hicieron que no me gustaran los médicos”, dijo Asmerom.

“En mi comunidad siempre se decía: ‘Sólo ve al médico si estás a punto de morir’”.

Pero eso cambió cuando tomó un curso en la universidad sobre disparidades en salud. Se dio cuenta que otras comunidades de color sufrían lo mismo que su familia y amigos eritreos. Asmerom pensó que, como médica, podía ayudar a cambiar las cosas.

Hace tiempo que profesores y activistas estudiantiles de todo el país les piden a las escuelas de medicina que aumenten el número de estudiantes e instructores de comunidades poco representadas, para mejorar el tratamiento y fomentar la inclusión.

Pero para identificar las raíces del racismo y sus efectos en el sistema de salud, dicen, se deben hacer cambios fundamentales en los planes de estudio.

Asmerom es una de las muchas voces que piden una sólida educación antirracista. Exigen que las escuelas eliminen el uso de la raza como herramienta de diagnóstico, que reconozcan cómo el racismo sistémico perjudica a los pacientes, y que tengan en cuenta parte de la historia racista de la medicina.

Este activismo no es algo nuevo. White Coats for Black Lives (WC4BL), una organización dirigida por estudiantes que lucha contra el racismo en la medicina surgió a raíz de las protestas de Black Lives Matter en 2014.

Pero después del asesinato de George Floyd en Minneapolis, en mayo, las escuelas de medicina y las organizaciones médicas están bajo más presión para tomar medidas concretas.

Dejar de usar la raza como herramienta de diagnóstico

Durante muchos años, se ha enseñado a los estudiantes de medicina que las diferencias genéticas entre las razas tenían un efecto en la salud. Pero en los últimos años, estudios han encontrado que la raza no refleja eso de manera confiable.

El Instituto Nacional de Investigación del Genoma Humano observa muy poca variación genética entre las razas, y más diferencias entre las personas dentro de cada raza. Por eso, más médicos aceptan que la raza no es una diferencia biológica intrínseca, sino una construcción social.

Pero la doctora Brooke Cunningham, médica y socióloga en la Escuela de Medicina de la Universidad de Minnesota, señaló que en una idea difícil de abandonar. Forma parte de la manera en que los médicos diagnostican y miden las enfermedades, explicó.

Algunos médicos afirman que es útil tener en cuenta la raza cuando se trata a los pacientes; otros sostienen que conduce a prejuicios y a una atención deficiente.

Esas opiniones han llevado a una variedad de creencias falsas, como que los negros tienen la piel más gruesa, que su sangre se coagula más rápido que la de los blancos o que sienten menos dolor.

Cuando la raza interviene en los cálculos médicos, puede conducir a tratamientos menos eficaces y perpetuar las desigualdades basadas en la raza.

Uno de estos cálculos estima la función renal (eGFR, o la tasa estimada de filtración glomerular). El eGFR puede limitar el acceso de los pacientes negros a la atención médica porque el número utilizado para denotar la raza negra en la fórmula proporciona un resultado que sugiere que los riñones funcionan mejor de lo que lo hacen, según informaron recientemente los investigadores en el New England Journal of Medicine.

Entre otra docena de ejemplos que citan está una fórmula que los obstetras usan para determinar la probabilidad de un parto vaginal exitoso después de una cesárea, lo cual pone en desventaja a las pacientes negras no hispanas e hispanas, y un ajuste para medir la capacidad pulmonar usando un espirómetro, lo cual puede causar estimaciones inexactas de la función pulmonar para pacientes con asma o enfermedad pulmonar obstructiva crónica.

A la luz de estas investigaciones, los estudiantes de medicina piden a las escuelas que se replanteen los planes de estudio que tratan la raza como un factor de riesgo de enfermedad.

Briana Christophers, estudiante de segundo año en el Weill Cornell Medical College de Nueva York, dijo que no tiene sentido que la raza haga a alguien más propenso a las enfermedades, aunque los factores económicos y sociales jueguen un papel importante.

Naomi Nkinsi, estudiante de tercer año de la Escuela de Medicina de la Universidad de Washington en Seattle (UW Medicine), recordó haber asistido a una conferencia —junto a otras cuatro estudiantes negras en la sala— y haber oído que los negros son más propensos a enfermedades.

“Lo sentí muy personal”, expresó Nkinsi. “Ese es mi cuerpo, esos son mis padres, esos son mis hermanos. Ahora, cada vez que vaya a un consultorio, sentiré que no sólo no me consideran una persona completa, sino que soy físicamente diferente a todos los demás pacientes sólo porque tengo más melanina en la piel”.

Nkinsi ayudó en una exitosa campaña para excluir la raza del cálculo del eGFR en la UW Medicine, uniéndose a un pequeño número de otros sistemas de salud. Ella dijo que el logro, anunciado oficialmente a finales de mayo, se debió en gran parte a los incansables esfuerzos de los estudiantes negros.

Reconocer los efectos adversos del racismo en la salud

El Liaison Committee on Medical Education (LCME), órgano oficial de acreditación de las facultades de medicina de los Estados Unidos y Canadá, dice que se debe enseñar a los estudiantes a reconocer los prejuicios “en ellos mismos, en los demás y en el proceso de prestación de servicios de atención de la salud”.

Pero el LCME no exige explícitamente a las instituciones acreditadas que enseñen sobre el racismo sistémico en la medicina.

Esto es lo que los estudiantes y algunos profesores quieren cambiar.

El doctor David Acosta, jefe de diversidad e inclusión de la Asociación Americana de Escuelas de Medicina (AAMC, en inglés), reportó que cerca del 80% de las facultades ofrecen un curso obligatorio o electivo sobre disparidades en salud. Pero explicó que hay pocos datos sobre cuántas escuelas enseñan a los estudiantes a reconocer y combatir el racismo.

Un plan de estudios antirracista debería explorar formas de mitigar o eliminar el daño del racismo, indicó Rachel Hardeman, profesora de políticas de salud de la Universidad de Minnesota.

“Hay que pensar en cómo penetra esto en el aprendizaje de la educación médica”, dijo. Los cursos que profundizan en el racismo sistémico deben ser obligatorios, añadió Hardeman.

Edwin Lindo, profesor en la Escuela de Medicina de la Universidad de Washington, dijo que se debería adoptar un modelo interdisciplinario, permitiendo a sociólogos o historiadores dar conferencias sobre cómo el racismo perjudica la salud.

Acosta dijo que la AAMC ha organizado un comité de expertos para desarrollar un plan de estudios contra el racismo para cada nivel de la educación médica. Esperan hacer público su trabajo este mes y hablar con el LCME sobre el desarrollo e implementación de estándares.

“Nuestra próxima tarea es cómo persuadir e influenciar al LCME para que piense en añadir cursos de capacitación antirracista”, dijo Acosta.

Reconocer el racismo en el pasado y el presente de la educación médica

Los activistas quieren que sus instituciones reconozcan sus propios pasos en falso, así como el racismo que ha acompañado a los logros médicos del pasado.

Dereck Paul, estudiante de medicina en la Universidad de California-San Francisco, dijo que quiere que en todas las facultades se incluyan conferencias sobre personas como Henrietta Lacks, la mujer negra que se estaba muriendo de cáncer cuando le extrajeron células sin su consentimiento, que se utilizaron para desarrollar líneas celulares que han sido fundamentales en la investigación médica.

Asmerom puntualizó que quiere que la facultad reconozca el pasado racista de la medicina en las clases. Citó un curso introductorio de anatomía en su escuela que no señaló que en el pasado, cuando los científicos trataban de estudiar el cuerpo humano, los negros y otros grupos habían sido maltratados. “Es como, OK, ¿pero no vas a contar que sacaron de sus tumbas cuerpos de negros para usarlos en el laboratorio de anatomía?” preguntó.

Aunque a Asmerom le alegra ver que su facultad escucha las reivindicaciones estudiantiles, siente que los administradores deben reconocer sus errores del pasado reciente.

“Alguien tiene que admitir cómo se perpetuó el racismo anti-negro en esta institución”, dijo Asmerom.

Asmerom, una de las líderes de la Coalición Antirracista de la UCSD, aseguró que la administración ha respondido favorablemente hasta ahora a las demandas de la coalición de invertir tiempo y dinero en iniciativas antirracistas. Y se siente cautelosamente esperanzada.

“No me atrevo a aguantar la respiración hasta que vea cambios reales”, concluyó.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


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What Doctors Aren’t Always Taught: How to Spot Racism in Health Care

Betial Asmerom, a fourth-year medical student at the University of California-San Diego, didn’t have the slightest interest in becoming a doctor when she was growing up.

As an adolescent, she helped her parents — immigrants from Eritrea who spoke little English — navigate the health care system in Oakland, California. She saw physicians who were disrespectful to her family and uncaring about treatment for her mother’s cirrhosis, hypertension and diabetes.

“All of those experiences actually made me really dislike physicians,” Asmerom said. “Particularly in my community, the saying is, ‘You only go to the doctor if you’re about to die.’”

But that changed when she took a course in college about health disparities. It shocked her and made her realize that what her Eritrean family and friends saw was happening to other communities of color, too. Asmerom came to believe that as a doctor she could help turn things around.

Faculty members and student activists around the country have long called for medical schools to increase the number of students and instructors from underrepresented backgrounds to improve treatment and build inclusivity. But to identify racism’s roots and its effects in the health system, they say, fundamental changes must be made in medical school curriculums.

Asmerom is one of many crusaders seeking robust anti-racist education. They are demanding that the schools eliminate the use of race as a diagnostic tool, recognize how systemic racism harms patients and reckon with some of medicine’s racist history.

This activism has been ongoing — White Coats for Black Lives (WC4BL), a student-run organization fighting racism in medicine, grew out of the 2014 Black Lives Matter protests. But now, as with countless other U.S. institutions since the killing of George Floyd in Minneapolis in May, medical schools and national medical organizations are under even greater pressure to take concrete action.

Debunking Race as a Diagnostic Tool

For many years, medical students were taught that genetic differences among the races had an effect on health. But in recent years, studies have found race does not reliably reflect that. The National Human Genome Research Institute notes very little genetic variation among races, and more differences among people within each race. Because of this, more physicians are embracing the idea that race is not an intrinsic biological difference but instead a social construct.

Dr. Brooke Cunningham, a physician and sociologist at the University of Minnesota Medical School, said the medical community is conflicted about abandoning the idea of race as biological. It’s baked into the way doctors diagnose and measure illness, she said. Some physicians claim it is useful to take race into account when treating patients; others argue it leads to bias and poor care.

Those views have led to a variety of false beliefs, including that Black people have thicker skin, their blood coagulates more quickly than white people’s or they feel less pain.

When race is factored into medical calculations, it can lead to less effective treatments and perpetuate race-based inequities. One such calculation estimates kidney function (eGFR, or the estimated glomerular filtration rate). The eGFR can limit Black patients’ access to care because the number used to denote Black race in the formula provides a result suggesting kidneys are functioning better than they are, researchers recently reported in the New England Journal of Medicine. Among another dozen examples they cite is a formula that obstetricians use to determine the probability of a successful vaginal birth after a cesarean section, which disadvantages Black and Hispanic patients, and an adjustment for measuring lung capacity using a spirometer, which can cause inaccurate estimates of lung function for patients with asthma or chronic obstructive pulmonary disease.

In the face of this research, medical students are urging schools to rethink curricula that treat race as a risk factor for disease. Briana Christophers, a second-year student at Weill Cornell Medical College in New York, said it makes no sense that race would make someone more susceptible to disease, although economic and social factors play a significant role.

Naomi Nkinsi, a third-year student at the University of Washington School of Medicine in Seattle, recalled sitting in a lecture — one of five Black students in the room — and hearing that Black people are inherently more prone to disease.

“It was very personal,” Nkinsi said. “That’s my body, that’s my parents, that’s my siblings. Every time I go into a doctor’s office now, I’ll be reminded that they’re not just considering me as a whole person but as somehow physically different than all other patients just because I have more melanin in my skin.”

Nkinsi helped in a successful campaign to exclude race from the calculation of eGFR at UW Medicine, joining a small number of other health systems. She said the achievement — announced officially in late May — was largely due to Black students’ tireless efforts.

Acknowledging Racism’s Adverse Effects on Health

The Liaison Committee on Medical Education, the official accrediting body for medical schools in the U.S. and Canada, said faculty must teach students to recognize bias “in themselves, in others, and in the health care delivery process.” But the LCME does not explicitly require accredited institutions to teach about systemic racism in medicine.

This is what students and some faculty want to change. Dr. David Acosta, the chief diversity and inclusion officer of the American Association of Medical Colleges, said about 80% of medical schools offer either a mandatory or elective course on health disparities. But little data exists on how many schools teach students how to recognize and fight racism, he said.

An anti-racist curriculum should explore ways to mitigate or eliminate racism’s harm, said Rachel Hardeman, a health policy professor at the University of Minnesota.

“It’s thinking about how do you infuse this across all of the learning in medical education, so that it’s not this sort of drop in the bucket, like, one-time thing,” she said. Above all, the courses that delve into systemic racism need to be required, Hardeman said.

Edwin Lindo, a lecturer at the University of Washington School of Medicine, said medicine should embrace an interdisciplinary model, allowing sociologists or historians to lecture on how racism harms health.

Acosta said the AAMC has organized a committee of experts to develop an anti-racism curriculum for every step of medical education. They hope to share their work publicly this month and talk to the LCME about developing and implementing these standards.

“Our next work is how do we persuade and influence the LCME to think about adding anti-racist training in there,” Acosta said.

Recognizing Racism in Medical Education’s Past and Present

Activists especially want to see their institutions recognize their own missteps, as well as the racism that has accompanied past medical achievements. Dereck Paul, a student at the University of California-San Francisco School of Medicine, said he wants every medical school to include lectures on people like Henrietta Lacks, the Black woman who was dying of cancer when cells were taken without her consent and used to develop cell lines that have been instrumental in medical research.

Asmerom said she wants to see faculty acknowledge medicine’s racist past in lessons. She cited an introductory course on anatomy at her school that failed to note that in the past, as scientists sought to study the body, Blacks and other minorities were mistreated. “It’s like, OK, but you’re not going to talk about the fact that Black bodies were taken out of graves in order to have bodies to use for anatomy lab?” she said.

While Asmerom is glad to see her medical school actively listening to students, she feels administrators need to own up to their mistakes in the recent past. “There needs to be an admission of how you perpetuated anti-Black racism at this institution,” Asmerom said.

Asmerom, who is one of the leaders of the UCSD Anti-Racism Coalition, said the administration has responded favorably so far to the coalition’s demands to pour time and money into anti-racist initiatives. She’s cautiously hopeful.

“But I’m not going to hold my breath until I see actual changes,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


This story can be republished for free (details).

WebMD buys German health information company coliquio

WebMD Health Corp. is acquiring coliquio, a digital medical information company for German-speaking health professionals. 

Coliquio is used by doctors to share educational content and will be added to WebMD’s flagship brand, Medscape.

WebMD Health Corp is one of the largest providers of online health information services, with Medscape and its affiliate network of platforms currently reaching over 5 million physicians worldwide. Over 4 million of these physicians are based outside the US.

The COVID-19 pandemic has caused an increased consumption of online medical content, with companies like coliquio experiencing a rise in membership.

coliquio said its telemedicine and doctor-patient offering medflex is not part of the acquisition and will remain independent, operated by Germany-based medflex GmbH.

The deal is expected to close by the end of the year, subject to regulatory approval. Financial terms were not disclosed.

Jeremy Schneider, senior vice president at WebMD Global said coliquio’s platform was an “excellent” addition to its global presence. “Together, we can leverage our combined strengths to extend our reach and engagement to healthcare professionals in Europe and increase our value to customers through our best-in-class digital channels.”

Earlier this year, WebMD bought employee wellbeing firm, The StayWell Company, a subsidiary of US-based Merck & Co. The company’s products include its core StayWell employee wellbeing platform and the Krames clinical patient education platform.

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KHN on the Air This Week

California Healthline correspondent Angela Hart discussed how the coronavirus pandemic has derailed California’s efforts to deal with homelessness on KPBS “Midday Edition” on Oct. 8.

KHN Midwest correspondent Lauren Weber discussed the difference between D.O.s and M.D.s with Newsy’s “Morning Rush” on Tuesday.

KHN correspondent Anna Almendrala discussed how L.A. County’s enforcement of workplace coronavirus protocols has cut COVID-19 deaths with KPCC’s “Take Two” on Tuesday.

KHN senior correspondent Sarah Jane Tribble discussed rural hospitals and KHN’s “Where It Hurts” podcast with Illinois Public Media’s “The 21st” on Oct. 5 and “Tradeoffs” on Oct. 8.

KHN chief Washington correspondent Julie Rovner joined C-SPAN’s “Washington Journal” on Tuesday to discuss the Affordable Care Act case before the Supreme Court next month and what else to expect in the realm of health care after the election.

KHN freelancer Priscilla Blossom discussed Halloween safety tips with KUNC’s “Colorado Edition” on Tuesday.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


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Stigma Against D.O.s Had Been Dissipating Until Trump’s Doctor Took the Spotlight

Dr. Katherine Pannel was initially thrilled to see President Donald Trump’s physician is a doctor of osteopathic medicine. A practicing D.O. herself, she loved seeing another glass ceiling broken for the type of doctor representing 11% of practicing physicians in the U.S. and now 1 in 4 medical students in the country.

But then, as Dr. Sean Conley issued public updates on his treatment of Trump’s COVID-19, the questions and the insults about his qualifications rolled in.

“How many times will Trump’s doctor, who is actually not an MD, have to change his statements?” MSNBC’s Lawrence O’Donnell tweeted.

“It all came falling down when we had people questioning why the president was being seen by someone that wasn’t even a doctor,” Pannel said.

The osteopathic medical field has had high-profile doctors before, good and bad. Dr. Murray Goldstein was the first D.O. to serve as a director of an institute at the National Institutes of Health, and Dr. Ronald R. Blanck was the surgeon general of the U.S. Army. Former Vice President Joe Biden, challenging Trump for the presidency, also sees a doctor who is a D.O. But another now former D.O., Larry Nassar, who was the doctor for USA Gymnastics, was convicted of serial sexual assault.

Still, with this latest example, Dr. Kevin Klauer, CEO of the American Osteopathic Association, said he’s heard from many fellow osteopathic physicians outraged that Conley — and by extension, they, too — are not considered real doctors.

“You may or may not like that physician, but you don’t have the right to completely disqualify an entire profession,” Klauer said.

For years, doctors of osteopathic medicine have been growing in number alongside the better-known doctors of medicine, who are sometimes called allopathic doctors and use the M.D. after their names.

According to the American Osteopathic Association, the number of osteopathic doctors grew 63% in the past decade and nearly 300% over the past three decades. Still, many Americans don’t know much about osteopathic doctors, if they know the term at all.

“There are probably a lot of people who have D.O.s as their primary [care doctor] and never realized it,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, a philanthropic group focused on community health.

So What Is the Difference?

Both types of physicians can prescribe medicine and treat patients in similar ways.

Although osteopathic doctors take a different licensing exam, the curriculum for their medical training — four years of osteopathic medical school — is converging with M.D. training as holistic and preventive medicine becomes more mainstream. And starting this year, both M.D.s and D.O.s were placed into one accreditation pool to compete for the same residency training slots.

But two major principles guiding osteopathic medical curriculum distinguish it from the more well-known medical school route: the 200-plus hours of training on the musculoskeletal system and the holistic look at medicine as a discipline that serves the mind, body and spirit.

The roots of the profession date to the 19th century and musculoskeletal manipulation. Pannel was quick to point out the common misconception that their manipulation of the musculoskeletal system makes them chiropractors. It’s much more involved than that, she said. Dr. Ryan Seals, who has a D.O. degree and serves as a senior associate dean at the University of North Texas Health Science Center in Fort Worth, said that osteopathic physicians have a deeper understanding than allopathic doctors of the range of motion and what a muscle and bone feel like through touch.

That said, many osteopathic doctors don’t use that part of their training at all: A 2003 Ohio study said approximately 75% of them did not or rarely practiced osteopathic manipulative treatments.

The osteopathic focus on preventive medicine also means such physicians were considering a patient’s whole life and how social factors affect health outcomes long before the pandemic began, Klauer said. This may explain why 57% of osteopathic doctors pursue primary care fields, as opposed to nearly a third of those with doctorates of medicine, according to the American Medical Association.

Pannel pointed out that she’s proud that 42% of actively practicing osteopathic doctors are women, as opposed to 36% of doctors overall. She chose the profession as she felt it better embraced the whole person, and emphasized the importance of care for the underserved, including rural areas. She and her husband, also a doctor of osteopathic medicine, treat rural Mississippi patients in general and child psychiatry.

Given osteopathic doctors’ likelihood of practicing in rural communities and of pursuing careers in primary care, Health Affairs reported in 2017, they are on track to play an increasingly important role in ensuring access to care nationwide, including for the most vulnerable populations.

Stigma Remains

To be sure, even though the physicians end up with similar training and compete for the same residencies, some residency programs have often preferred M.D.s, Seals said.

Traditional medical schools have held more esteem than schools of osteopathic medicine because of their longevity and name recognition. Most D.O. schools have been around for only decades and often are in Midwestern and rural areas.

While admission to the nation’s 37 osteopathic medical schools is competitive amid a surge of applicants, the grade-point average and Medical College Admission Test scores are slightly higher for the 155 U.S. allopathic medical schools: The average MCAT was 506.1 out of 528 for allopathic medical school applicants over a three-year period, compared with 503.8 for osteopathic applicants for 2018.

Seals said prospective medical students ask the most questions about which path is better, worrying they may be at a disadvantage if they choose the D.O. route.

“I’ve never felt that my career has been hindered in any way by the degree,” Seals said, noting that he had the opportunity to attend either type of medical school, and osteopathic medicine aligned better with the philosophy, beliefs and type of doctor he wanted to be.

Many medical doctors came to the defense of Conley and their osteopathic colleagues, including Dr. John Morrison, an M.D. practicing primary care outside of Seattle. He was disturbed by the elitism on display on social media, citing the skills of the many doctors of osteopathic medicine he’d worked with over the years.

“There are plenty of things you can criticize him for, but being a D.O. isn’t one of them,” Morrison said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


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Medical Education Must Adapt to Support the Broadening Role of Physicians


As a physician and writer on the topic medical careers, I’ve noticed extensive interest in nonclinical career options for physicians. These include jobs in health care administration, management consulting, pharmaceuticals, health care financing, and medical writing, to name a few. This anecdotal evidence is supported by survey data. Of over 17,000 physicians surveyed in the 2016 Survey of America’s Physicians: Practice Patterns and Perspectives, 13.5% indicated that they planned to seek a nonclinical job within the subsequent one to three years, which was an increase from less than 10% in a similar survey fielded in 2012.

The causes of this mounting interest in nonclinical work have not been adequately investigated. Speculated reasons tend to be related to burnout, such as increasing demands placed on physicians in clinical practice, loss of autonomy, barriers created by insurance companies, and administrative burdens. However, attributing interest in nonclinical careers to burnout is misguided and unjustified.

Physicians are needed now – more than ever – to take on nonclinical roles in a variety of industries, sectors, and organizational types. By assuming that physicians interested in such roles are simply burned out and by focusing efforts on trying to retain them in clinical practice, we miss an opportunity promote the medical profession and improve the public’s health.

Supporting medical students and physicians in learning about and pursuing nonclinical career options can assist them in being prepared for their job responsibilities and more effectively using their medical training and experience to assist various types of organizations in carrying out missions as they relate to health and health care.   

A shifting locus of control from physicians to patients

A major reason for the expanding need for medical doctors outside of patient care settings is a shift in health- and disease-related locus of control from providers to patients. Medical information is increasingly available, comprehensive, accurate, and free of charge. Individuals wishing to learn about their own health can do so, often without the help of a doctor. Similarly, large data sets, new technologies, and analytical techniques are taking on a progressively significant part of patient care and consumer health.

Domains of patient care that were historically the responsibility of doctors are now in the hands of not just patients themselves, but also corporations, regulators, policymakers, and others whose efforts will ultimately impact patient actions and outcomes.

Physicians in nonclinical roles ensure that the most appropriate decisions are made from a clinical and scientific perspective, despite that fact that these decisions are being made outside of a traditional patient encounter. Physicians can, for example, provide clinical expertise in the development of a device, confirm that scientific data are interpreted accurately, and effectively communicate medical information to stakeholders.

Medicine is becoming less of an art and more of a science

In addition to technologies changing the way that individuals maintain their health, they are altering the way that clinicians deliver care. Electronic health records, health care analytics platforms, and artificial intelligence algorithms play a role in guiding physicians’ medical decision-making in every type of care setting.

As the role of technologies in clinical care becomes more widespread, involvement by physicians throughout the full lifecycle of these tools to ensure that they are scientifically accurate, medically sound, usable, reliable, and valuable. Medical professionals, more so than others, can ensure alignment with the needs of both clinicians and patients as a product or service is being developed.

Nonclinical work addresses a need for systems-thinking in the medical profession

There is little emphasis within medical education on building proficiency on an organizational and system-wide level – and even less on a societal level. While it is vital that doctors are competent in handling medical situations involving individual patients, they should further be able to contribute their knowledge and skills outside of a clinical setting.

The medical profession is not lacking in medical expertise. What is lacking is education on how to use this expertise in a broader capacity, including in the type of work that is the focus of many nonclinical roles.

Medical students and residents who are interested in using their medical expertise outside of patient care are quite limited in their training options to be prepared for this. Some may have the opportunity to do a rotation in an area such as quality improvement or clinical informatics. A few may take time off from their program to pursue an internship with a consulting firm or federal government agency, though are likely to be challenged by logistics, funding, and scheduling issues.

The options available to practicing physicians to participate in continuing medical education on nonclinical topics have been increasing, with courses on topics such as leadership skills, health care financing, and addressing burnout. Nonetheless, there is a need for additional education, especially programs that teach physicians how to use their skills and expertise in settings where their training didn’t take them: outside of the hospital and clinic.

Currently, burnout leaves doctors thinking that they want to “leave medicine” when, if fact, they would be fulfilled in a career that utilizes their medical and clinical knowledge to a great extent, just in a different way than they’re used to. Though a career pivot might mean that they stop directly treating patients, it is far from “leaving medicine.” This misconception leaves too many physicians feeling stuck, not realizing that they have viable options to explore. Many don’t realize the extent to which their experience and knowledge will come into play in other types of work settings.

Moving toward improvements in medical education and protecting the medical workforce

The issues described above can be addressed from multiple angles and on different levels, in light of the fact that opportunities for physicians outside of clinical care are growing in number, breadth, and interest to doctors.

Undergraduate medical education must foster and invest in learning environments that prepare physicians to be both clinicians and medical experts. Medical schools and residency programs, where possible, should support and encourage trainees to rotate in nonclinical settings and capacities. Continuing medical education providers should make an effort to include topics in their content that enable physicians to utilize their medical knowledge outside of clinical setting.

If they are trained sufficiently, physicians who experience burnout or frustrations in patient care can transition smoothly to a rewarding nonclinical role. Once there, they can make just as much (or more) of a positive impact on our population’s health than they did while directly treating patients.

Sylvie Stacy, MD, MPH is a preventive medicine specialist and blogs about career fulfillment for medical professionals at Look for Zebras. She recently published the book 50 Nonclinical Careers for Physicians.

Mayo Clinic Performs First Shoulder Arthroplasty Procedure Using Mixed Reality

Mayo Clinic Performs First Shoulder Arthroplasty Procedure Using Mixed Reality

What You Should Know:

– Mayo Clinic in Rochester, MN performed the first-ever shoulder arthroplasty procedure using Wright Medical’s groundbreaking BLUPRINT Mixed Reality Technology, which provides surgeons a 3-D holographic view of the patient’s pre-operative plan.

– The Mixed Reality Application is the
latest addition to Wright’s BLUEPRINT ecosystem and enables a surgeon to
maintain a direct view of the surgical site and simultaneously visualize and
manipulate a holographic representation of the patient’s native anatomy and
pre-operative plan.

 Wright Medical Group N.V. (NASDAQ: WMGI) announced
that the first shoulder arthroplasty procedure was performed using
groundbreaking BLUEPRINT Mixed Reality Technology at
Mayo Clinic’s campus in Rochester, Minnesota.  Joaquin Sanchez-Sotelo,
M.D., Ph.D, performed the procedure utilizing BLUEPRINT OR Visualization Mixed Reality software,
which provides a 3-D holographic view of the patient’s pre-operative

Mixed Reality Application Overview

The Mixed Reality Application is the latest
addition to Wright’s BLUEPRINT ecosystem and enables a surgeon to maintain a
direct view of the surgical site and simultaneously visualize and manipulate a
holographic representation of the patient’s native anatomy and pre-operative
plan. By using hand gestures and voice commands, the surgeon can interact with
a more robust data set to optimize the position of the 3-D holographic models
displayed by the Mixed Reality application. This can allow the
surgeon to replicate the pre-operative plan as closely as possible given the
availability of information while operating.

Why It Matters

“This procedure is an important milestone for shoulder arthroplasty and marks a major step in the evolution of BLUEPRINT mixed reality technology in shoulder surgery. For the first time in shoulder arthroplasty, surgeons will be able to interact with their 3-D pre-op plan in real-time to more precisely tailor shoulder joint replacement procedures to the unique needs and anatomy of their patients. By integrating other solutions in the future, such as artificial intelligence, case planning optimization and mixed reality modules for medical education, the BLUEPRINT ecosystem offers an opportunity to significantly reduce variability in the way shoulder arthroplasties are performed, potentially reducing complications and improving overall patient outcomes,” said Robert Palmisano, president, and chief executive officer of Wright .

Palmisano continued, “In addition to Dr. Sanchez-Sotelo, we
would like to recognize and thank the entire surgeon team who have been
integral to the development of this groundbreaking platform: George Athwal –
London, ON, CA; Julien Berhouet – Tours, FR; Philippe Collin – Rennes, FR;
Ashish Gupta – Brisbane, AU; Gilles Walch – Lyon, FR; and Jon J.P. Warner –
Boston, USA.”

Dr. Sanchez-Sotelo, stated, “I was able to visualize,
rotate, and tilt three-dimensional holographic objects right in front of the
surgical field. As mixed reality continues to develop, it will
provide a very unique, cost-effective tool for execution of our surgical plan.”

Dr. Sanchez-Sotelo and Mayo Clinic have financial interest
in Wright Medical Group N.V.  Mayo Clinic will use any revenue it receives
to support its not-for-profit mission in patient care, education and research.