The Changing Role of the Otolaryngologist
Embedded in nearly every question that comes to the Academy these days is a sense of a more “global” uncertainty — a concern about how our roles as physicians, surgeons, teachers, learners, and professionals are changing. Familiarity is a powerful influence, and all of us know how difficult it can be to leave our “comfort zones” and adapt to necessary change; or more importantly, how hard it is to effectively drive and implement needed change. There is much that we cannot predict with certainty today. How will we provide better access to affordable healthcare to 46 million underserved and previously uninsured people? How will we avert a financial meltdown of Medicare as healthcare costs rise? Or how can we systematically eliminate preventable errors in healthcare, such as “Wrong Site/Wrong Side” surgery; or “Wrong Drug/Wrong Dose/Wrong Patient” errors? With restrictions on resident duty hours, how can the next generation of physicians master the ever-expanding knowledge base, and gain the clinical experience needed to be better than the previous generation? With all the changes implied and explicitly outlined in the elements of legislation and regulation in healthcare reform, it is helpful to stop for a moment and discuss what will NOT change. And within that discussion we can find some reassurance. What will NOT change is our role as professionals, our altruism, putting public health and patients’ needs ahead of personal gain; voluntary self-regulation; and transparency, disclosing competing interests. What will NOT change is our united voice in ensuring that true clinical improvement, more effective medical and surgical care, and a healthier population must be the target metrics of quality measures, not just reducing costs or improving administrative efficiency. What will NOT change is the leadership role that otolaryngologists will play in advancing the basic science, clinical applications, and health services improvements that are essential to improve care. Scenario planning is one tool that is used by organizations to strategically plan for the future. There are some likely scenarios for which we must be prepared, that we may not currently be ready for. Rather than striking fear in our hearts, or evoking uncertainty in our minds, these considerations can be exhilarating and challenging in exactly the positive way that medical training and practice can be. What are some of the roles, changes, and challenges that we will continue to address? What will our future look like? Changes in graduate medical training • Large amphitheaters of students are replaced with learner-centered educational systems with screens, keyboards, interactivity, and individually paced simulation. • With advanced training tools, both cognitive and procedural, we train to mastery and proficiency, not just competency. • Systems learning adapts the new generation to methods of life-long learning that change physician behavior in ways that are feasible, measurable, continuous, and documented. Changes in continuing medical education • While didactic learning will still have its place, much of it is replaced with mobile learning tools, shared systems, multidisciplinary access to broader and more specific content. • Clinically useful educational content is accessed in real time at the point of care. • Content includes decision support with systems approaches, evidence-based clinical practice guidelines, perform- ance measures and reference links. • Interactivity expands with cloud computing, actively shared knowledge, and community. • Higher levels of integration of all content will link enduring and printed materials, live content, published academic journals with clinical action and EMR/registry documentation and benchmarking for continuous improvement. Changes in practice • Simulation is more than a teaching or training tool. Practice and preparation for patient care, with both cognitive and procedural skills sets, will become a regular part of clinical work. • Simulated “warm-ups,” rehearsals, and virtual escapes are linked to the specific anatomy of individual patients through integration of imaging, haptics, and clinical information. • Simulation “boot camps” expand and offer continuous opportunity to upgrade skills, and apply new technology and techniques. • Augmented reality allows sharing of surgical experience and perspectives on a global scale. • Robotics expand, link with imaging data, improve approaches, reduce invasiveness, and heighten accuracy. As we contemplate the expected rapid changes in the next generation, focusing on enduring principles, ensuring patient-centered care, and engaging in solution-based conversations will assure us that we need not fear the future, but embrace it with enthusiasm and courage. There has never been a better time to be a physician!
Embedded in nearly every question that comes to the Academy these days is a sense of a more “global” uncertainty — a concern about how our roles as physicians, surgeons, teachers, learners, and professionals are changing. Familiarity is a powerful influence, and all of us know how difficult it can be to leave our “comfort zones” and adapt to necessary change; or more importantly, how hard it is to effectively drive and implement needed change.
There is much that we cannot predict with certainty today. How will we provide better access to affordable healthcare to 46 million underserved and previously uninsured people? How will we avert a financial meltdown of Medicare as healthcare costs rise? Or how can we systematically eliminate preventable errors in healthcare, such as “Wrong Site/Wrong Side” surgery; or “Wrong Drug/Wrong Dose/Wrong Patient” errors? With restrictions on resident duty hours, how can the next generation of physicians master the ever-expanding knowledge base, and gain the clinical experience needed to be better than the previous generation?
With all the changes implied and explicitly outlined in the elements of legislation and regulation in healthcare reform, it is helpful to stop for a moment and discuss what will NOT change. And within that discussion we can find some reassurance. What will NOT change is our role as professionals, our altruism, putting public health and patients’ needs ahead of personal gain; voluntary self-regulation; and transparency, disclosing competing interests. What will NOT change is our united voice in ensuring that true clinical improvement, more effective medical and surgical care, and a healthier population must be the target metrics of quality measures, not just reducing costs or improving administrative efficiency. What will NOT change is the leadership role that otolaryngologists will play in advancing the basic science, clinical applications, and health services improvements that are essential to improve care.
Scenario planning is one tool that is used by organizations to strategically plan for the future. There are some likely scenarios for which we must be prepared, that we may not currently be ready for. Rather than striking fear in our hearts, or evoking uncertainty in our minds, these considerations can be exhilarating and challenging in exactly the positive way that medical training and practice can be.
What are some of the roles, changes, and challenges that we will continue to address? What will our future look like?
Changes in graduate medical training
• | Large amphitheaters of students are replaced with learner-centered educational systems with screens, keyboards, interactivity, and individually paced simulation. |
• | With advanced training tools, both cognitive and procedural, we train to mastery and proficiency, not just competency. |
• | Systems learning adapts the new generation to methods of life-long learning that change physician behavior in ways that are feasible, measurable, continuous, and documented. |
Changes in continuing medical education
• | While didactic learning will still have its place, much of it is replaced with mobile learning tools, shared systems, multidisciplinary access to broader and more specific content. |
• | Clinically useful educational content is accessed in real time at the point of care. |
• | Content includes decision support with systems approaches, evidence-based clinical practice guidelines, perform- ance measures and reference links. |
• | Interactivity expands with cloud computing, actively shared knowledge, and community. |
• | Higher levels of integration of all content will link enduring and printed materials, live content, published academic journals with clinical action and EMR/registry documentation and benchmarking for continuous improvement. |
Changes in practice
• | Simulation is more than a teaching or training tool. Practice and preparation for patient care, with both cognitive and procedural skills sets, will become a regular part of clinical work. |
• | Simulated “warm-ups,” rehearsals, and virtual escapes are linked to the specific anatomy of individual patients through integration of imaging, haptics, and clinical information. |
• | Simulation “boot camps” expand and offer continuous opportunity to upgrade skills, and apply new technology and techniques. |
• | Augmented reality allows sharing of surgical experience and perspectives on a global scale. |
• | Robotics expand, link with imaging data, improve approaches, reduce invasiveness, and heighten accuracy. |
As we contemplate the expected rapid changes in the next generation, focusing on enduring principles, ensuring patient-centered care, and engaging in solution-based conversations will assure us that we need not fear the future, but embrace it with enthusiasm and courage. There has never been a better time to be a physician!