Dr. Monica Lypson, Vice-Dean of Education, Columbia University Medical School
Medical training needs to change to adapt to the future. How will technology affect that? Dr. Monica Lypson, Vice-Dean of Education at Columbia’s medical school, shares the opportunities we have to diversify and evolve medical education. She explores artificial intelligence, and ways to develop communication and collaboration skills that support an equitable healthcare system.
Monica L. Lypson MD, MHPE is the Vice-Dean of Education at Columbia’s medical school. She also is a member of the practice plans board of trustees. As Vice-Chair, she is committed to creating and supporting the academic careers of all faculty members in the department.
After graduating from Saint Ignatius, Monica graduated from Brown University and received her medical degree from Case Western Reserve University School of Medicine. She completed her graduate medical training at the Brigham and Women's Hospital in Internal Medicine - Primary Care. Subsequently, Monica went on to complete a Robert Wood Johnson Clinical Scholars program at the University of Chicago and a master’s in Health Professions Education at the University of Illinois at Chicago. She has also trained to be an executive coach; and is currently participating as an Aspen Health Innovator, as well as the Seeding Disruption Fellowship in the District of Columbia.
Show Notes
Dr. Monica Lypson shares her professional medical background. [02:56]
How will medical training need to shift now in order to change the healthcare system in 2049? [03:57]
The role of the clinician as a communicator. [06:21]
What will the interaction between the patient and physician look like in the future? [09:32]
We will need to build patient trust into the healthcare system. [11:23]
What will the role of specialists vs. primary care physicians be in the future? [13:29]
Will some medical specialties become non-existent? [15:34]
Will the health care consumer prefer an artificial intelligence solution in 2049? [17:30]
What needs to change now in medical training to adapt to the future? [19:12]
Will the length of medical school training shorten and become less expensive with virtual learning? [22:11]
Will those entering the medical profession be more diverse? [25:50]
How will this vision of changing medical training improve the healthcare system? [28:27]
Transcript
Jason Helgerson: I'm Jason Helgerson and you're listening to Health 2049.
Dr. Monica Lypson: I think what we recognize now as typical disciplines in medicine will fundamentally change because one can even argue, do you need physician anymore? So I think getting to 2049 in terms of specialty turf wars, in terms of identity crisis, it's going to be tough. But I do have great hope that a lot of that will have been worked out because primacy will be put on a patient's health, and we will create a healthcare team that is able to focus on that outcome.
Jason Helgerson: [01:59] As the Vice Dean for Education at Columbia University's Medical School, today's guest clearly brings an academic perspective to health in 2049. That said her experiences within the system go far beyond the academic world to include years of experience working within the Veterans Administration and as a practicing general internist. She believes that in order to prepare doctors for success in 2049, we will need to start reassessing how we train physicians today. It's clear that today's training and teaching methods won't satisfy the demands of the future, and today she will share her vision for what medical education can and should be like in the year 2049.
I'm Jason Helgerson, and you're listening to Health 2049. And it's my pleasure to welcome Dr. Monica Lypson to our program. Monica, welcome.
Dr. Monica Lypson: [02:48] Thank you. It's a pleasure to be with you today.
Jason Helgerson: [02:51] Well, first, Monica, can we start off by telling our audience a bit more about your interesting background?
Dr. Monica Lypson: [02:56] Yes, I am a general internist or an adult primary care doctor. That's how I define myself clinically, but probably my more important role is really as an educator, administrator, and leader. I spent most of my career not only developing and honing my clinical skills, but actually really thinking about how do we best educate the next generation of physicians and, quite frankly, all members of the healthcare team. And so I really kind of focused on medical education and health professions education as a goal. And I think a lot of that comes from the background that both my parents were elementary school teachers.
Jason Helgerson: [03:48] So we always start with our guests with this very first standard question, which is, what does health care look like in the year 2049?
Dr. Monica Lypson: [03:57] It's a great question, because believe it or not, the learners that are entering our medical schools today will actually be thriving in their mid careers in 2049. So it's something that we need to think a lot about. And I hope that the healthcare system looks like a system that focuses on health. I think one of the things that will not only ideally save us money, but also really impact our citizenry is to move from really a disease-based model to a health-based model. So that's what I hope for.
And one of the ways that can be executed would be to focus on how do we train the next generation? And I'm going to specifically talk about physicians. But I hope these principles actually apply to the entire healthcare team in the future. We need to train people who are able to not only be master clinicians or focus on the art of medicine, i.e. that healing touch, but also folks that are actually quite nimble in a highly technical, highly innovative healthcare system that might be actually pushing the boundaries of science.
So I think our goals in the future will be really to focus on training. In the past, we focused on how do we actually get people to know a lot? And I think in the future we're going to have to think about systems and training paradigms that really focus on how do we help people manage vast amounts of information and deliver it in a timely and equitable way to our patients?
Jason Helgerson: [05:54] So it sounds like the future you describe and the role of physician in that future is really going to be with a heavy emphasis on communicator, because technology will provide the physician of the future with access at the tip of her fingers. Can you talk a little bit more, maybe dive a little bit more deeply into the role of the clinician as a communicator interface between that technology and the patient?
Dr. Monica Lypson: [06:21] Sure. So I would like to spend a lot of time talking about communication, but I do want to sort of also emphasize what the clinician actually will need to communicate about.
So the communication the person will need to not only be able to digest vast amount of information that are gathered through algorithms, be able to deal with the concurrence or the incongruence of an artificial intelligence diagnosis potentially, and how they might deliver that to a patient. And they need to have a vast sense of understanding, really probability and epidemiologic phenomenon if we really are going to focus on health. They're going to have to really understand and have a facile view of numeracy and probability and understand, more importantly, how to communicate those incredibly technical details to the patient.
And that communication style actually might be different. So the communication style might be how do you actually best send out personalized electronic information? How do you make sure that a patient feels touched and the information is personalized when you're actually doing it at the population based level? So that's one level of communication. And that's a skill we don't actually teach people if you think about it, how to write an email, how to write a letter to a population. How might you communicate? We see currently, we don't do such a hot job. If we look at our current situation about how do we communicate to a population about a health related issue.
And so that's a skill set that I think other disciplines actually have. Might we need to bring marketing experts into the medical school classroom? Might we need to bring communication experts into the medical school classroom to really help the physician of the future, really hone that skill at talking to populations and groups of people. And we still need to focus on I think that healing practice. I don't think that that's going to go away, that patients in need and patients with questions are going to come down and you're going to have to be able to be facile with that one-on-one conversation and really understanding how to deliver news in a way that it is heard, but also in a way that people feel empowered to act on.
Jason Helgerson: [09:09] So maybe we could sort of help our audience sort of wrap their heads around this future state in terms of the relationship, say, between the clinician and the patient, can you describe for us what that future interaction will be like, what the role is, what will it feel like, particularly from the patient's perspective and how it'll be different than it is today.
Dr. Monica Lypson: [09:32] So I would imagine that actually the actual hands on, day to day interaction between patients won't actually be between patient and physician. That hands on in-person interaction, actually, in many ways might be between patient and community health worker, patient and nurse patient and extender at the actual level. I think many and we're seeing this, even some evidence now the physician conversation, because I envision that potentially physicians will take care of vast many more patients because we have technology to be able to do that. And then the best mode of individual communication might be virtual, in some sort of virtual format where I might be following patients at some distance and really need to have a healing touch across a hologram, across a screen, across some sort of virtual reality. I think we are moving to that direction.
Jason Helgerson: [10:41] Interesting. So one of the interesting things about some of the surveys that have come out around COVID-19 has been around, who do people really trust when it comes to information about whether they should get the vaccine or not? And generally speaking, at the top of the list of who people trust is their doctor. And so what you've described is a world in which a lot of the communication isn't so much directly with the physician, but with others. Are you worried at all about patients of the future in 2049, not necessarily trusting these other voices, these other people and still longing to have that direct relationship with the physician? Or do you think things will have fundamentally changed in that regard by 30 years in the future?
Dr. Monica Lypson: [11:23] I actually think you pose an interesting question that I'm torn with. So my very DNA says I hope to have that bedside, that classic bedside interaction with patients, and my ego tells me only a physician can deliver that. But in reality, I think that's why we really have to work on that communication skills at the population and marketing level to really embolden that trust in whoever that extender might be. I think one of the interesting things in the scenario with COVID is it's the physician plus my neighbor. It's actually the two of them together that might promote adoption of a value or adoption of a therapeutic engagement.
So I do think the community health worker, I wouldn't rush her out of the system. I actually think that that's a valuable, if not more valuable member of the healthcare team. But those partnerships patients will need to trust that partnership in an important way.
Jason Helgerson: [12:36] Interesting. So maybe we could dive a little bit into the role of specialists versus the role of primary care physicians. So imagine that, and you're obviously a primary care physician first and foremost, as you identified upfront. One of the things at least I think about is that as more of this technology, artificial intelligence, machine learning, things like complex diagnoses and development of treatment options and even treatments themselves will become things that, frankly, primary care physicians with the right training and access to that technology could do on their own without needing to refer to specialty care.
And so I'm just wondering if you agree with that potential outcome. And do you see that the role of specialists being fundamentally different in 2049?
Dr. Monica Lypson: [13:29] Yeah. I'm going to define the middle road. So I think that the middle road is, you're right, what we know as primary care and specialty care actually will fundamentally change. I actually totally agree with you. I've done some exercises, and one of those terms we came up with was a comprehensivist, that in many ways has that function of what we see now as a primary care doctor and is using the algorithm-based medical approaches to take care of a patient with cancer, per se. And then there might be people who are an immunologist and geneticist.
I think how we have defined the current world of what specialties exist, how those specialties divvy up the landscape will, in fact, fundamentally change. And we will need people that might look like old time primary care or general docs. But I do think that their level of training and baseline and that's why I like comprehensivist, will be much more advanced and will need to take into account a lot of knowledge. And yes, I think I would recognize that person and embody what we think in many ways should be the quarterback and the primary care doctors of days of past.
Jason Helgerson: [15:01] So what you're in essence suggesting is almost a skilling up of primary care physicians, expanding their skill set, empowering them with new tools and additional training. But I still go back to this question is, let's take radiology, we already have supercomputers who are proving as effective today in 2021 as human beings at reading images and scans. Do you see that at least some of the specialties that exist today, I'm not saying totally disappear.
Dr. Monica Lypson: [15:34] I totally agree. Radiology, dermatology pathology, things that are visually recognizable, that a computer could probably do better, we won't need it. I agree with you. Will we need informationist, will we need logarithmist, and that's what I mean. I think what we recognize now as typical disciplines in medicine will fundamentally change because one can even argue, do you need a physician anymore?
Many things could be delivered by other professionals that we already have access to. So I think getting to 2049 in terms of specialty turf wars, in terms of identity crisis is actually going to be tough. But I do have great hope that in 2049, that a lot of that will have been worked out because primacy will be put on a patient's health, and we will create a healthcare team that is able to focus on that outcome.
Jason Helgerson: [16:48] Are you at all worried that the healthcare consumer in 2049 will prefer and in essence, choose, but vote with their feet for not an actual human being physician, but for a bot, artificial intelligence solution that they can access 24 hours a day, 365 days a year, that's powered by the latest greatest technology and is super inexpensive, always there at their fingertips. Do you fear that at all that medicine and the medical industry is potentially a threat from competition from machines?
Dr. Monica Lypson: [17:30] Yes. And we call it now, Doctor Google. This is not that far off. Doctor Google can answer a lot of questions that I don't actually see in my office, but I also know how many times people will bring in the phone or will print out, here I read this, Doc, can you help me figure this out? This is what I think, and they still come for, to get help with which information is better? How do I make a determination that what I've been told by an algorithm is correct.
I think there will still be a need for a human, but I think the human skill and really that's the healer skill, will fundamentally change in the ways of needing to be able to help navigate that information. But in the fundamental ways of working with the suffering that won't change.
Jason Helgerson: [18:34] So in terms of the future state, as you said that the clinicians currently in medical school are clinicians to be currently in medical school today in training will hopefully still be practicing medicine in the year 2049. And as we've been discussing significant changes on the near horizon, what needs to be done now to change medical education, to ensure that those clinicians and training are really ready and able to adapt to the new technology, the new challenges as well as the new opportunities presented by these new advances?
Dr. Monica Lypson: [19:12] I think we have to also change how we teach. So I think if there's any silver lining in a global pandemic was actually the rapid need to innovate in this current environment. So medical students and other health professional students were actually ripped out of the clinical environment over the course of the year and placed into a virtual learning environment. I think that virtual learning environment is not going away, and what we need to do as educators is make the most of that virtual learning environment. So are we doing multiple simulations and gamification of our learning scenarios?
There's other professions that are doing this. The airline pilot is expected to go into the flight simulator several hours every couple of months to enhance their skills. We should expect that of our clinicians as well. There should be simulations, virtual reality that you are expected to participate in, in terms of keeping up your skills. I think that as we move to this idea of algorithms, I think we are not teaching our learners how those algorithms are created. We are not teaching our learners how to spot bias in those AI creations.
That's how the curriculum needs to change so that we have clinicians ready and able to manage the artificial intelligence and mean learning. We don't want the machine managing us. We want to be able to manage the machines. And I think that that really is a change in paradigm of how we currently educate. How do we change people to really think probabilistically and in Bayesian theorems. We spend a lot of time specifically in academic medicine, focused on these rules, but I don't think that the average practitioner, when they're seeing patients on their day-to-day basis, are utilizing that knowledge that could be brought to bear to improve patient outcome.
Jason Helgerson: [21:27] Do you think that the current approach to medical education in terms of the timeline, the four years of medical school, after four years of undergraduate and then another four, potentially two to four years of residency, people coming out in their early 30s, oftentimes with hundreds of thousands of dollars in school debt. Do you think that model of education is what we'll continue to see in 2049? Or do you think this virtual learning and things like that will allow us to potentially shorten the amount of time that people need to get the adequate training and knowledge to be practitioners in this new world? And do you think we can find a way to train doctors in a way that's cheaper?
Dr. Monica Lypson: [22:11] I'm pausing because the answer is, of course, I don't think that this model is not economically sustainable. At some point, we won't be able to sustain this investment. Really, or we chalk it up to that this is a career of the elite, because otherwise we can't do it. So I think you asked a question that is right on, that in fact, we have to think about that. We have currently models about a three year curriculum. There are several schools that have done this. If we can actually look back to World War II, we've done that before. So a three year medical school curriculum is not unheard of.
I think on the residency training side, the feather in the US healthcare system's cap, is really its graduate medical education system and enterprise, and the way that they train physicians, everybody looks to us globally as a model. But that, too, needs to change. There's a lot of training that's done that is time-based and I have spent a lot of my research and a lot of my efforts focused on competency based education, where you get to move forward as soon as you show that you can handle the work for many of that might be early for others, we might have to delay.
And we learned that technique from K through twelve that have been doing competency based education since the 60s. So we actually have many of those fundamental principles, we just haven't put them together in a real way. I think we're going to have to ask a real financial question of, is the federal government, right now Centers for Medicaid and Medicare going to continue to support graduate medical education. I think that's a policy question. And if it does, we're going to have to show the public that it's worth their money.
So the public is interested in the outcomes of the learners. What are those learners doing to improve their health and the healthcare system? So I think that that is coming much sooner than we think.
Jason Helgerson: [24:30] All right. So my next question is actually, I think the best question I have for you today and the reason it's the best is it because it came from you, this suggestion for what you wanted me to get to, which I think it's a great question which really gets at the heart of as medicine, the practice of it, and the way in which physicians are trained and other allied professionals are trained is changing, as we talked about with this new state of health care, that is going to be upon us very near future.
What kinds of individuals will actually choose to enter the health professions? Why will they choose it? Especially given the fact that it's going to be much more algorithmic. And do you think that that future state will allow for a more diverse healthcare workforce than we have today? Clear evidence that when you are able to find particularly for people of color, they can find a provider who they recognize, whose opinion that is of the same race that they are, that there can be much better health outcomes as a result of that.
And yet we have really an inability overall to attract people of color or not attract but actually help them actually get into and then succeed in medical school. Do you think that who we see in the medical profession will be different and perhaps even more diverse than it is today?
Dr. Monica Lypson: [25:50] I hope so. I spent a lot of my time making it. So I think your point is, well, passion. I think if we start to focus on health as the optimal outcome, that we will continue to have a massive amount of learners who are more than capable to do the job as clinicians.
I think we've been talking lately about medical school enrollment in the Fauci effect. So you would think in the mast of a global pandemic where potentially as a healthcare worker, your health is at risk, and we're having vast amount of applicants to medical schools and other health professions. So the call for the altruistic meaning of being a healer, I think, is not going to go away. I think what we need to do is start to think about who is best to deliver that news. And I'm back to the communication skills of I don't think we really have tapped into who are the best people to fulfill the future of medicine. What is their mindset? How do they best work in teams? Are they reflective and can bring a population health lens to what they do?
I think if we focus on those outcomes and look for people who bring that skill set, we will by nature, diversify those who we think are eligible to participate in this guild, that I have such an honor to participate in. If we continue to focus on it's, just the test score and it's just who's had more access as a kid to certain opportunities, and that's what gets you into medicine, then we will continue to look like we do. But I think if we're going to create a system that focuses on the patient and the population by nature, we will have to diversify that workforce.
Jason Helgerson: [27:57] All right. So we come to the end of our session, and we always like to end with a question which is now that we've had a chance to wrap our arms around your vision for not only health and healthcare, but also for medical education in the year 2049, we always like to ask our guests to take a step back in terms of looking at your vision. If your vision for what the system could and should be is actually accomplished, how will it make the world a better place?
Dr. Monica Lypson: [28:27] So my bias is that health is a right and what we know is that people can't fulfill their full opportunity unless they are healthy. And so building a better health system that focuses on health will actually improve our citizenry, improve their economic opportunities, improve their ability to be the best person that they can, and people will still have acute disease that we need to intervene on. And that's why we still will have a healthcare system as well. But I think improving health overall is the best thing that we can do to really uplift and improve all of the outcomes of all of our citizens and get them to the point where they can take advantage of any opportunity that comes their way.
Jason Helgerson: [29:22] Fantastic perfect point to end on. Thank you, Monica. And that was Dr. Monica Lypson and her vision for healthcare in the year 2049 as always, thank you for listening to Health 2049. If you enjoyed what you heard, please subscribe to us and share this podcast with a friend. Thank you and see you next time.
