Techno-philic

As technology assumes an ever growing importance in health care, Douglas Olson and James L Scott discuss its impact on undergraduate medical education

The years spent in medical school are intended to produce doctors who are altruistic, knowledgeable, skilful, and adaptable life long learners¹ who make the needs of their patients their paramount objective. While this has been a constant goal of medical schools since their inception, medicine has changed with both the availability of new technology and the needs of patients and society. Doctors must constantly integrate new technology and information into standard diagnoses and treatments. They must work as members of a healthcare team that is often being asked to do more, produce more, learn more, and integrate more - in shorter periods of time - while remaining ethical, compassionate, and empathetic.

Integrating new technology into medicine is not a novel concept. Computed tomography and magnetic resonance imaging are two examples of relatively recent technological advances that have been integrated into medical practice and have had profound effects. What is changing, however, is that new technology is not being limited to clinical care. It is being integrated ever earlier into medicine and is making great headway in both the preclinical and clinical years of undergraduate medical education worldwide.


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Your grandmother may have stories to tell you about living in an age of cutting edge technology

Increasing integration
The internet has been effectively integrated into the everyday lives of many people, and very much so into undergraduate medical education.² Such integration has focused mainly on medical database searches and evaluation, as well as the use of the internet in patient care. Medical schools have responded quickly to alter their programmes and include this as part of a standard curriculum. As computer use continues to escalate in medical information management, students will use their undergraduate computer skills to ensure compliance with patient privacy rights in an electronic and potentially non-secure electronic environment, which is becoming an increasingly common topic in clinical care.³

Impact on preclinical education
The use of technology for basic science teaching has also become more popular. For example, technology that will revolutionise the way histology is taught to medical students is being introduced-computers which work as virtual microscopes will soon replace standard microscopes sitting on a laboratory bench. Students have uniformly welcomed this computer based introduction, and several reports have shown improved student satisfaction and improved laboratory attendance when the change was made from microscope to computer.⁴

Impact on hospital medicine
In many hospitals, medical records are going from written to wireless; the use of computers is quickly going from desktop to wireless; and the integration of handheld computer devices, known as personal digital assistants (PDAs), is becoming common for many practising clinicians. Indeed, in the United States only 15% of physicians used handheld computers in 1999, but this number nearly doubled to 26% in just three years.⁵ PDAs have even been described as being critical to patient care, as it is predicted that "most clinicians will carry a PDA for all clinical encounters just as they do with their stethoscopes."⁶ For many years, the stethoscope was the clinical tool that defined physicians. It is possible that we will soon be defining doctors by two clinical instruments-one designed in 1826 and the other in the late 20th century-providing another clear example of how technology continues to shape clinical medicine. Handheld devices have been shown to improve medical students' evidence based decision making,⁷ further demonstrating the likelihood that such technology will soon be commonly used by all medical students.

The stethoscope, the "badge" of clinicians for many years, may soon have a much less important role in clinical patient encounters. Handheld echocardiographic devices-which allow not only cardiac auscultation but also visualisationare being introduced into more routine clinical care. These devices have a positive impact on patient triage and uncover otherwise undetected cardiac disease,^{8 9} which improves not only the quality of patient care but also the economics of patient treatment. It has been predicted that they will soon be used in everyday clinical care by general internists, with an introduction into undergraduate medical education following shortly thereafter.^{8 10}. However, with the increasingly advanced features offered in traditional stethoscopessuch as noise amplification and filtration, as well as the ability to record and playback heart sounds"-the stethoscope may simply function as an improved piece of diagnostic equipment, leaving echocardiography as a second tier diagnostic evaluation.

An effective clinical teaching tool
While many medical schools commit the first two years of medical school to basic science education, the deluge of technological machinery that third and fourth year medical students must quickly learn and comprehend is enormous. The use of medical mannequins and simulator medicine allows students to practise medicine without risk and removes some of the stress associated with the torrent of new technology. Patient simulators are already being implemented with great success at many teaching hospitals throughout the United States. This type of hands-on simulated patient contact is enjoyable for all students, regardless of their year in school, and is increasingly being requested. ¹² Simulated patient encounters, when used in a broad and comprehensive fashion, are not only an effective teaching tool but also a reliable method to assess a student's acute care skills.¹³

Potential negative implications
The teaching and integration of advancing technology will affect academic medical centres, private practice, free clinics, and other clinical care environments. In essence, new technology will affect the patients who receive treatment in all of these diverse care settings as well. In this regard, it would be inappropriate not to mention the potential negative aspects of new technology. The most obvious pitfall would be that new technology has the ability to supplant clinical examination skills, making them secondary to a test or machine reading. Secondly, cost is an issue, especially as the world continues to deal with the ever increasing medical costs of acute and chronic diseases.

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clinicians will carry a PDA for all clinical encounters just as they do with their stethoscopes
Finally, as with all new advances, it is typically the "haves" who benefit before the "have nots," regardless of where in the world this chasm exists. Ideally, new technology should be able to improve and complement clinical examination skills, reduce ultimate cost as a result of earlier diagnosis and treatment of disease, and ensure improved health for all people. If these ideals remain paramount, advancing technology will ensure that medical schools continue to produce doctors who are ready to practise medicine in the rapidly changing environment called the present.

Douglas P Olson medical student,
James L Scott professor and dean,
George Washington University School of Medicine
olsondp@gwu.edu
studentBMJ 2005;13:353-396 October ISSN 0966-6494

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