Published 9/1/2012
David Robinson, MD

Graduate Medical Education in the 21st Century

“New technology is frequently met with skepticism and resistance. It can be complicated, disruptive, and initially not any better than what is currently available. For example, originally, address books were physical books with names, telephone numbers, and addresses penciled onto their pages. The advent of the electronic address book provided the same information, only it needed batteries, was slow to search, and was much more expensive.

Many people thought, “Why would I use that?” And they were right.

It was only when the electronic address book stopped trying to be an address book that it became an essential tool of the modern world. Today, contact lists now auto-populate from phone calls, texts, and emails—so there’s no need to enter the data individually. They can place calls without a misdial, identify callers with photos and unique ringtones, and are immediately searchable, sortable, and infinitely editable. They are shareable and can be backed up to protect against loss or theft. They talk to “the cloud” (third-party data storage accessible by multiple devices over the Internet) so that contacts are no longer just in a pocket device, but also on phones, tablets, and desktops.

As a result, the old address book now seems quaint, inefficient, insufficient, and archaic. The contact list is so vastly superior in its applications that it is hard to imagine a time when things were done differently.

What does this have to do with GME?
Graduate medical education (GME) is undergoing a similar paradigm shift right now. With the advent of work hour restrictions and new guidelines from the Accreditation Council on GME, many programs have been forced to examine how they do things and look for creative solutions. GME has the potential to grow by leaps and bounds if programs can stop trying to do things “the way we have always done it” and leverage the array of powerful tools at their disposal.

When I was an intern, we printed out journal articles and stored them in 3-ring binders and tall metal filling cabinets. We managed patient lists on a spreadsheet on a single computer. We held conferences in a single room, and both presenters and audience had to travel to physically attend.

In just 2 years, the system has become so different that it is hardly recognizable. Atlanta Medical Center has implemented the Electronic Residency Access (ERA) initiative and begun using tablets to remain connected to information, each other, and our patients.

I now carry more than 300 journal articles with me at all times, a feat that was previously impossible. These articles are organized by specialty (pediatrics, trauma, tumor, etc.) and topic (carpal tunnel syndrome, clubfoot, femur fractures, etc.) and are searchable by title or content. I can highlight and annotate them for emphasis and review. I can share them with perfect fidelity among junior residents, faculty, or patients simply by touching the screen.

Conferences are now webconferences, allowing speakers and audience to view presentations and participate remotely. Residents on away rotations can “attend” home conferences. Faculty no longer have to battle traffic and schedules to give presentations to residents, but can do them from the comfort of their homes, offices, or from anywhere in the world.

We store patient lists online in a HIPAA-compliant database that allows for residency-wide simultaneous access and real-time editing. This level of granularity in patient tracking minimizes errors attributed to intermittent hand-offs. Now “hand-offs” are occurring among all team members, all the time, throughout the day. The tablet has greatly improved both resident education and patient care.

This is the tip of the iceberg. What is being done today is still just a reflection of former educational and patient care practices. Imagine what GME will be like when it stops trying to be an address book and becomes a contact list.

David Robinson, MD, is an orthopaedic surgery resident (PGY-4) at the Atlanta Medical Center. He can be reached at drobin911@gmail.com