Can med students learn better with Osmosis?

With more physicians taking advantage of the efficiency and accuracy promised by mobile health devices, another flourishing sector in health tech developments aims to improve knowledge and tech adaptability earlier in the health care cycle: mobile tech for med students.

An Osmosis screen shot.
An Osmosis screen shot.

Osmosis is a recently approved iOS app and web platform for med students and schools founded by Ryan Haynes, a Johns Hopkins med student with a PhD in neuroscience from Cambridge, and Shiv Gaglani, also a Johns Hopkins med student, who developed the Smartphone Physical at TEDMED 2013.

The free, quiz-based app, available now, aims to help students learn and retain the voluminous information needed to pass those tricky medical boards. It combines three education concepts: quick, periodic reviews; improved absorption of material through practice questions; and social network-enabled, peer-to-peer learning. Many of its quiz questions were developed in conjunction with content providers such as the American College of Physicians.

The app tracks students’ confidence, accuracy, and elapsed time on each question and will soon publish anonymized leaderboards that allow students to see how they stack up in terms of answering questions. Some 240 invited alpha users, all medical students, contributed more than 1,500 images and videos, crowd-sourced over 5,000 practice questions, and answered those more than half-a-million times.

“Now that we have 6,000 medical students from more than 250 institutions signed up, we anticipate delivering millions of practice questions to our future doctors, keeping them up-to-date on their medical knowledge. This is something I feel strongly about as a medical student who experienced significant cram-forget cycles that don’t lead to long-term retention,” says Gaglani, who is also a Harvard MBA candidate and an editor at Medgadget.com. “That’s why we designed Osmosis: to flatten the forgetting curve and help medical students learn fundamental medical knowledge to help improve patient outcomes.”

“We’ve received an overwhelmingly positive response to the mobile app. Within one week we became one of the top 100 free educational apps on the iTunes store. Around 1,500 medical students have already downloaded it and collectively answered close to 30,000 questions,” he says.

The web platform, currently in beta and with a public launch planned this fall, has been live since 2012 both at the Johns Hopkins School of Medicine and the Perdana University Graduate School of Medicine in Malaysia, Haynes says. The web platform has added gamification features, including contributor leaderboards. Osmosis will offer institutional subscribers a tiered fee schedule, from free to $2 per user, per month, which includes features like open-lecture videos, resources to take and store notes and course documents, and usage analytics.

TEDMED 2013 Day 3: From Scuba Diving Wheelchair to Death Over Dinner

By Medgadget Editors

Day three of TEDMED 2013 kicked off with “Session X,” which was a special session focusing on innovation and entrepreneurship, and consisted of a spirited panel discussion of two hot topics. During the first half of the session, Marleece Barber, Jennifer Kurkoski, Rick Valencia, Geeta Nayyar and Jeff DeGraff participated in a discussion titled “Every Company is a Healthcare Company: Innovating From the Outside In,” which offered insights into integrating good healthcare practices at a basic level.

Photo: Jarod Harris/TEDMED

From Barber’s observation, “If we can put a man on the moon, why can’t we put rocket scientists’ butts on bicycles?” to Kurkoski’s thoughts on creating work environments that help employees make good choices, there was consensus that meaningful changes can be made without burdensome mandates on employees. As an example, Kurkoski pointed to Google’s efforts of making it easy to subconsciously choose fruit as a snack over candy at the company’s cafeterias. The second half of the session had Grant Verstandig, Giovanni Colella, Nina Nashif, Michael Weintraub and Juan Enriquez tackling the topic of “Shifting the Curve from Start to Scale to Exit: Lessons from the Trajectory of Innovation,” which offered observations of investors and experienced entrepreneurs on starting and maintaining companies from innovation to maturity.

The next session, “Going Farther while Staying Closer,” opened with an innovative musical program by the Washington Conservatory. Susan Desmond-Hellmann, Chancellor of the University of California, San Francisco discussed her vision of patient centered healthcare. Roni Zeiger former Chief Health Strategist for Google and now CEO of Smart Patients, talked of creating systems that allow patients to collaborate in a more equal footing with physicians and the health care system. Ramesh Raskar of the MIT Media Lab demonstrated two of his projects that use capabilities of smartphones to measure vision and prescribe corrective lenses, as well as demonstrating fundoscopic examinations using a brand new approach (look more on that from Medgadget in the coming days). Christopher J.L. Murray, Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, shared his work collecting and providing data analysis tools for evaluating the global burden of disease. Larry Brilliant rounded off the session with a presentation on dealing with pandemics and the possibility of eliminating them altogether.

Photo: Jarod Harris/TEDMED

The third session, “Thinking Outside the (Check) Box,” included Sue Austin showing off her work as an artist performing underwater in her scuba wheelchair. She claimed to be, though she’s paralyzed in the legs, the most mobile person at TEDMED. Considering what she does underwater, that claim is not as outlandish as one might suspect. Jessica Richman presented uBiome, the world’s largest successful citizen science project and her vision that citizen science can be performed at the Nobel Prize level. As she stated, “We can put those anecdotes together in a structured way and create data, and that’s science!”

Elazer Edelman discussed the perils of the explosion of knowledge and how this can actually limit the integration of disparate fields of work together. Following him, Ryan Panchadsaram shared his ideas for the uses of data visualization in public policy. Salvatore Iaconesi followed by describing how his community, both in person and online, helped him deal with his brain cancer diagnosis and say “Hey Cancer! You’re not all there is to me!” Finally, Andrew Solomon offered his ideas on the merging of illness, identity, and relationships, and his view that relationships of all types help us deal with illness. Take away: “I don’t subscribe to a subtractive model of love. I subscribe to an additive model of love.”

The final session of the day, an amazing and challenging session, “Welcoming Death Into Life,” dealt with end of life issues. From Charity Tillemann-Dick’s experience with pulmonary hypertension and lung transplants, including sharing her beautiful soprano voice coming from her third set of lungs, to John Kheir describing how the death of a child spurred him to create medical innovation, this session invited us to think about mortality with curiosity and even a bit of humorAmanda Bennett discussed how the medical system does a poor job helping patients avoid denial and the reality of death, and Kelli Swazey described how the practices of other cultures can help us find new ways of dealing with death. The centerpiece of the session was Michael Hebb’s “Death over Dinner” and how he thought of and created a new ritual that allows family and friends to discuss death in a new, innovative and non-threatening way.

This post originally appeared on Medgadget.com.

TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular Interactions

By Medgadget Editors

The second day of TEDMED 2013 began with the curator, Jay Walker, providing a recap of the first day, which set the stage for the first session of the day: “How Can Big Data Become Real Wisdom?” This session was the most technologically focused of the day.

Larry Smarr at TEDMED 2013 TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsThis session started with computer scientist Larry Smarr, an advocate of personalized medicine, who noted that applying changes to the data we already collect can give us a new vision. For example, by applying data visualization techniques we can make the data “organ centric” in ways that clinicians traditionally do not expect.

As he pointed out, “stool is information rich media” that the typical clinician will usually not think of using to help diagnose or treat a condition. Smarr had amazing computer resources at his disposal, and when he combined this information with a detailed description of data and symptoms, he obtained very specific answers. As he worked on his own medical condition, an inflammatory bowel disease, it occurred to him that medicine can and should be this individualized for all.

Deborah Estrin 2 TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsDeborah Estrin discussed the use of the large amounts of data we generate to create a “Digital Social Pulse” that can be used by individuals to get feedback about their health, as well as by health care providers to assist in the care of patients. This realization came to her painfully, realizing after her father’s death that his patterns of phone calling and emailing changed drastically before anyone knew there was a deep fundamental problem.

She noted that we analyze data but do not bring it back to the person who generated that data and there is a lot that we can learn from our digital data, just like bread crumbs that lead to their source. She sees real potential for enhancing healthcare with personalized data insights so that “we don’t have to just rely on our subjective memory.”

Elizabeth Marincola, publisher of Science News, discussed the concept that public dissemination of knowledge can be profitable even in an open access environment, which is essential because in her view open access publishing goes to the heart of science. Then, Max Little, applied mathematician, spoke on the “The Unreasonable Effectiveness of Math” and how we can build this into our approaches to data.

Amy Abernethy TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsThe final speaker for the session was Amy Abernathy, oncologist and palliative medicine physician. She shared the story of a patient, who had a “special treasure” to share…her data. Abernathy noted that our ability to personalize medicine is within our grasp, but the irony is that at the bedside we have trouble applying all this information to an individual, we need big data, but we also need the ability to use it. From her patient, she learned some key “pearls” about data: First, the patient needs to own their data, then patients should be able to control how their data is shared and used (to include the ability to rescind access if needed). Finally the data needs to be portable, and to be able to be used across a variety of settings and uses. She closed with the observation that “data is a non-depletable resource” and we need to find ways to use it in many different ways.

The second session of the day was focused on “Translating the Untranslatable” and featured speakers like the Mayor of Oklahoma City, KC Mick Cornett, about transforming his community from one of the “fattest cities” in the country to one that’s relatively healthy. David Agus, author of “The End of Illness,” who spoke about his vision of cancer as a disease. Sue Austin shared an amazing video of her scuba diving in her wheelchair that was turned into a miniature submarine. For many, a highlight of the session was a talk by Sally Okun, the first nurse to speak at TEDMED. She promoted the power of patient stories and how we need to capture them from the patient’s point of view, as well as the physician’s. Finally, the session closed with Richard Simmons who got the entire TEDMED audience moving with song, dance, and his message of “counting your blessings every day.”

The next session focused on “Shifting the Patterns of Power” and featured speakers like entrepreneur Jonathan Bush, urban farming advocate Ashley Atkinson, medical researcher H. Shaw Warren, mathematician Max Little, and closed with an amazing talk by Peter Attia, a physician who shared an amazing story of his growth as a person and as a physician.

The final session of the day addressed “What Happens When You Mix Up The Models” and began with the announcement of a new TEDMED initiative, Lab TV, by Jay Walker and Francis Collins, Director of the National Institutes of Health. This project will enable researchers to share in real time their work, and perhaps even assist in the research.

Lab TV will try to get curious and scientifically minded people to interview researchers, go into labs, and provide a first person point of view of the latest scientific advancements, with the final goal of getting the public educated about what’s under development and to give a chance to researchers to profile their work to a wider audience.

Next in the session, Mike Pazin of the National Human Genome Research Institute spoke about his project to take the raw human genome data and build a disease encyclopedia to make the data useful. He made the observation that this type of research is possible only because new devices have allowed individual genomes to be analyzed cheaper than ever before. Then Gary Slutkin, epidemiologist, discussed his work in using epidemiology to look at violence as a public health problem.

David Odde and Black Label Movement TEDMED 2013 Day 2 – Information Density of Stool and a Dance to Study Cellular InteractionsDavid Odde of the University of Minnesota in particular had a very interesting approach to the use of art, and dance in particular, to study how cells move and interact. As he was studying cellular activity, he talked to a dancer and demonstrated how the activity or body storming of the dancers can be used as a method of rapid prototyping of various types of cellular activity, including the migration of tumor cells, microtubule activity, and other cellular behaviors.

After this initial effort, the concept of “body storming” became more developed, with the addition of boundaries, groups, and permitted moves by dancers to more closely model actual cellular activity under various conditions. This effort directly led to better computer models and observations of cellular activity.

After performances by the The Manzari Brothers and David Odde & Black Label Movement, Zubin Damania, of ZDoggMD fame, addressed his plans to create new models of primary health care.

Reporting by Medgadget guest blogger Mike Moore and editor Gene Ostrovsky. This post originally appeared on Medgadget.com. Photos by Jerod Harris.

TEDMED 2013 Day 1 – The Paradox of Design in Medicine and Inspiration from Seventy-Two Thousand Nadis

By Mike Moore, Medgadget

We’re here at TEDMED 2013, excited to be part of a unique group of people passionate about the future of medicine and curious to walk the path that will take us there. We’ll be reporting through the rest of the week on the talks, demos, and people that make TEDMED the world’s premier medical conference.

The first session of TEDMED 2013 opened with performing artist Kishi Bashi setting the stage with music. That led the audience to, in the words of TEDMED curator Jay Walker, “being present” in the moment and ready to engage for the next few days with the presenters, delegates, and the ideas that permeate the Kennedy Center in Washington, D.C. this week.

John Maeda

As the first presenter of the session, designer John Maeda began with a discussion of the intersection of leadership and design by stating that “leadership isn’t about going up the mountain, it’s about jumping off the mountain.” He continued with his observations about the ubiquitous need for design, and then focused on the ways that having an eye for design can help us understand effective systems and structures; in other words, his “5 Things About Design.” He then discussed how good design can help the healthcare industry. For Maeda, answer is art, which he admitted, based on his recent experience with surgery, is a bit paradoxical.

As he stated, when you are a surgeon doing a procedure, “I don’t want you to be creative,” but instead to do the procedure in a standardized way. However, looking at the challenges that health care providers face today in terms of their barriers to successful practice, the primary questions we face are not just can we survive, but can we thrive? In Maeda’s words: “Art and design can help us thrive.”

After John Maeda’s talk, Jay Walker acknowledged the Boston Marathon bombings, stating that citizens were a critical part of the response. For example, runners donated blood right after finishing the marathon, running an extra mile to the donation location to do their share. TEDMEDLive was recognized, and Jay went on to describe his vision of TEDMED as a community. He also introduced the TEDMED editorial team and remarked on its diversity, and reiterated the value of a diverse community, including those from healthcare, education, business and other areas.

The next presenter, Danny Hillis, professor of research medicine at USC Keck School of Medicine and co-founder of Applied Minds, stated “I dreamed of becoming a physician,” and recounted vivid memories of the streets of Calcutta, and his memories of people dealing with chronic disease without healthcare. In this struggle, the hospital was not the main event.

Ayurvedic medicine, the traditional medicine of India, was the primary way that the ordinary person dealt with that struggle. As he examined this traditional model of medicine with its focus on balance of humors, especially in contrast with Western medicine that focuses on a being in a state of either sickness or health. Though the Western medicine model of vaccination, sanitation, and antibiotics that served us so well in dealing with infectious disease was certainly effective, Hillis noted an aesthetic preference for the complex balanced view of seventy-two thousand nadis in intricate diagrams.

As he started his studies in modern neuroscience, he realized that the state of knowledge about the brain and nervous system was not really much better than seventy-two thousand nadis.

In his search for ways of understanding neuroscience, he was pulled into the artificial intelligence community where one could design intelligence and learn from it that way. There Hillis discovered not just the technology, but the data and models that he could use to study neural systems, and then finally the technology started to catch up to be able to look at the body. And as we look at the body, what we see is that the body is in a constant struggle against disease. He noted that when you can see what is going on with the patients, you can be preemptive, and that you can see the struggle before the body loses the battle, changing the way we look at the traditional “sickness and health.”

TEDMED’s Clinical Editor, Pritpal S. Tamber followed up Hillis’ talk with the observation that “good ideas not getting traction happens all too often in healthcare,” and refocused the audience on that mission.

America Bracho

America Bracho then gave a stirring presentation on access to health care by underserved populations based on her work with Latino populations in her native Venezuela. She also discussed these ideas with Harvey Fineberg of the Institute of Medicine.

Rafael Yuste, originator of the Brain Activity Map (BAM) project, then gave an inspiring talk about the challenges and rewards of science. He compared his two passions: science and mountaineering. They are similar in that you need big goals, a passionate and committed team, and you must analyze the problem and plan a route, break your plan into small steps, and perhaps most importantly, always keep your eye on the ultimate goal.

Rafael Yuste

As he looked at scientific mountains to climb, mapping the brain seemed like the “Everest” standing before science. He noted that we still know very little about how the brain works, we treat brain symptoms only because we do not understand the causes of problems in the brain. This gave him the idea of the Brain Activity Map (BAM) project as the grand challenge of science of 21st century.

In his view, these grand challenges show the role of science in our society, the role of moving knowledge forward, improving science as a business, building creativity. In Yuste’s view “Science has so many problems to solve, we can’t afford to dream small dreams.”

The remainder of the session was devoted to a short inspirational talk by the Surgeon General Regina Benjamin, and a vocal performance by acapella group Afro Blue.

This has been reprinted with permission from Medgadget.com, where Mike Moore is a guest blogger.

The Smartphone Physical: The evolution of the checkup

Imagine a comprehensive, clinically relevant well-patient checkup using only smartphone-based devices. The data is immediately readable and fully uploadable to an electronic health record. The patient understands – and even participates – in the interaction far beyond faking a cough and gulping a deep breath.

For real?

Johns Hopkins medical student and Medgadget editor Shiv Gaglani says it is not only possible, but may in fact be the checkup of the future. Gaglani and a team of current and future physicians will do a first-of-its kind large-scale demo of a “smartphone physical” for hundreds of attendees at TEDMED 2013.

The checkup, which uses a unique combination of smartphone-powered devices, will capture quantitative and qualitative data, ranging from simple readings of weight and blood pressure to more complex readings such as heart rhythm strips and optic discs. Measurements and instruments will include:

Body analysis using an iHealth Scale.

• Blood pressure reading using a Withings BP Monitor.

• Oxygen saturation/pulse measured simultaneously with blood pressure, using an Masimo iSpO2 placed on the left ring finger.

• Visual acuity via an EyeNetra phone case.

• Optic disc visualization using a Welch Allyn iExaminer case attached to a PanOptic Ophthalmoscope.

• Ear drum visualization with a CellScope phone case.

• Lung function using a SpiroSmart Spirometer app to conduct a respirometer test.

•Heart electrophysiology using the AliveCor Heart Monitor.

•Body sounds: A digital stethoscope from ThinkLabs auscultates and amplifies the sounds of a patients lungs and heart.

• Carotid artery visualization using a Mobisante probe.

Image of an optic disc taken through an undilated eye with an iPhone 4 and Welch Allyn iExaminer. Around the optic disc you can see the out-of-focus iris. Photo Credit: Shiv Gaglani

While it all sounds very slick and tech-y, Gaglani says the smartphone-enabled checkup will actually improve doctor-patient relationships. For one thing, the related medical devices are generally smaller and less invasive than their predecessors.

“For example, thanks to the AliveCor Heart Monitor, it has never been easier to get a one-lead ECG reading. Similarly, the Withings and iHealth blood pressure cuffs are plug-and-play so a clinician doesn’t have to fumble around with both a stethoscope and sphygmomanometer to assess whether her patient is hypertensive,” Gaglani says.

Second, smartphone-based devices usually provide a visual or auditory output that patients can actually see and hear, hopefully increasing their understanding of their bodies and engagement during the checkup. For example, the Welch Allyn iExaminer captures an image of the retina that is displayed on the phone screen, and digital stethoscopes like ThinkLabs’ record heart and lung sounds that can be replayed through the microphone.

Third, the patient can participate in data gathering. As Gaglani says,

“These devices can abstract away the mundane and standardize the unreliable aspects of the physical exam. Measurements such as weight and blood pressure are so variable day-to-day, or even hour-to-hour, that an annual exam doesn’t provide much insight into an individual patient’s health status. Some of the smartphone devices are already being used by patients to collect and store their data so when they see their clinicians they can have productive and informed conversations, rather than relying on fragmented and unreliable metrics.”

Hypothetically, once the data is uploaded to an electronic medical record, back-end clinical decision support software can help both patients and clinicians come up with treatment plans.

The technology may of course be particularly helpful for mobile physicians, particularly in emergency health care settings, and for global health workers, as even untrained staffers can carry the tools to low-resource settings to collect data and then, via telemedicine, receive instructions for how to treat patients. Some of these tools are already being combined into a versatile clinical data-gathering device, called a Tricorder, Gaglani says.

How long will it be before we’re all having our own smartphone physicals every one or two years?  Devices such as the body analysis scale, blood pressure cuff, pulse oximeter, and ECG are already in use as teaching devices in med schools and by some patients, and some early adopting clinicians are using them in daily life. TEDMED speaker Eric Topol has been integrating smartphone-based devices into his practice over the last few years and most recently used his AliveCor to diagnose a passenger-in-distress on an airplane as well as the CellScope Oto to visualize Stephen Colbert’s ear drum on the “Colbert Report.”

While there will be an inevitable learning curve and hopefully constant assessments of cost-effectiveness and value to patients, Gaglani says some of these devices, or at least second and third generation versions, will successfully make their way into the clinic.

“Whatever form these devices are applied, chances are high that more than one person’s life will be improved as a result,” he says.

Visit www.smartphonephysical.org for more information.

The Smartphone Physical at TEDMED will take place in an “exam room of the future,” developed by Nurture.  Click here for more information.

The Patient Promise: Healers pledge to lead by example

“Physician, heal thyself. And also, get at least 30 minutes of moderate exercise per day, eat nutritious whole foods, and ease some of your stress.”

That’s not quite how the biblical quote reads.  But Johns Hopkins medical students Shiv Gaglani and David Gatz are hoping doctors and nurses will heed those words nevertheless. They’ve begun an initiative called The Patient Promise that urges current and future healthcare professionals to pledge that they’ll adopt “healthy lifestyle behaviors” – physical activity, balanced nutrition, and stress management — to benefit themselves and, by extension, their patients.

Shiv Gaglani and David Gatz

The two came up with the idea after watching, with dismay, their own health decline due to the stress and long working hours of their first year of medical school. They also noted studies showing that some 63 percent of male physicians and 55 percent of female nurses are overweight or obese, what the health industry calls “tight white coat syndrome.”

That could spell trouble for patients; a study in the January issue of the journal Obesity showed that overweight or obese physicians talked to obese patients about weight management for only 18 percent of available opportunities; in doctors with a healthy BMI, that number rose to 30 percent — still plenty of room for improvement, though. Conversely, other studies show that doctors with healthier habits are more likely to counsel their patients to adopt preventive lifestyle behaviors.

Another Patient Promise goal is to combat weight bias discrimination. “Research suggests that medical students are more likely to view the obese and smokers as lazy or apathetic, which can show up in how they care for such patients down the road,” says Gaglani, who adds that he has witnessed such behavior in clinical settings.

Those pledging the Promise agree to, instead, “…identify and guard myself from potential prejudices against my patient based on unhealthy behaviors, recognizing the often complex origins of these habits.”

Since the program launched in June, 642 medical professionals and students from 50 institutions around the country have made the pledge. Participants monitor themselves, but Gaglani says he’s received a great deal of positive feedback, and that a number of students who’ve signed the promise have since lost weight or quit smoking — including himself.

“Personally, it affects my daily habits as well as my interactions with patients,” he says. “I had gained about 10 pounds during my first year of med school and have since lost those after committing to the Promise. I also have tried learning more about nutrition – something not emphasized at most medical schools – so that I can optimize my own, and my patients’, diet.

“It’s kept me honest with my own lifestyle,” he says.

 

Ivan Oransky talks to Medgadget: Are we over-medicalized?

Ivan Oransky, M.D. and Executive Editor of Reuters Health, made waves with his TEDMED 2012 talk on the vast amounts of time and money spent on “pre-conditions” — pre-cancer, pre-diabetes, even pre-acne.  Today, Medgadget continues the discussion with Ivan, in which he fields questions about post-talk coverage, the importance of casting a critical eye on research evidence, and whether consumer-based health monitoring devices actually work.

Watch Ivan’s talk at TEDMED 2012: