Using Design Principles to Reshape Medical Education
Using Design Principles to Reshape Medical Education
Educators at Thomas Jefferson University leverage cross-disciplinary practices to drive cutting-edge thinking
By M. Diane McCormick
The members of Owl Medical Team cherished their idea for a mattress to reduce the scourge of bedsores. For two weeks, they labored over a prototype equipped with gels and inflatable bladders.
Then they showed it to doctors and nurses. No good, the medical professionals said. The mattress would increase pressure in some areas and interfere with medical equipment. Although the team would later succeed by refocusing on the human element when it comes to care, that initial rejection was hard to hear.
“We had gotten excited about this, but we knew that the design process is about being able to pivot and to move when something isn’t working, and to not get too in love with one idea,” said Mark Keroles, a second-year medical student at Thomas Jefferson University.
The tale behind a medical student embracing design principles is a Philadelphia story. In this city steeped in political, industrial and technological revolutions, Thomas Jefferson University is reshaping medical education with an infusion of design thinking. Students in medicine, design, and engineering collaborate across disciplines to build the skills for creating solutions in the health care landscape of the future. Their product prototypes emerge from a maker space in a bank vault that once guarded money but now guards the currency of the 21st century – ideas.
Medicine is changing. At the 193-year-old Thomas Jefferson University, medical education is changing with it, under the disruptive vision of President and CEO Stephen Klasko, M.D., MBA, one of Modern Healthcare’s 100 Most Influential People in Healthcare in 2017.
“It used to be, if I knew 19 reasons someone had a disease and you only knew 15, I’d be considered the better doctor,” Klasko said before introducing his medical training reboot. “But now we have all that information on our iPhones, so it’s meaningless. We’ll focus on the art of attending, sharpening the observational skills of health care students by looking at art and listening to music in order to help understand what patients are telling us — not just memorizing the 19 reasons behind a disease. We’re calling it changing the DNA of health care, one student at a time.”
Klasko instituted a sweeping, four-pillar model universitywide that releases academic, clinical, innovative, and institutional advancement from their silos and encourages collaboration. At the core, Jefferson administrators and educators are leveraging new operational methods and cross-disciplinary practices to drive cutting-edge thinking.
Within the pillar model, Dr. Mark L. Tykocinski, provost and executive vice president for academic affairs and dean of Jefferson’s Sidney Kimmel Medical College, devised and trademarked Medicine+. The concept emboldens medical education through infusions of co- and extracurricular pursuits akin to college minors, as in Medicine + Humanities, + Creativity, + Entrepreneurship, + Computational Thinking.
And Medicine + Design.
As computational and data sciences, informatics, and robotics transform medicine, it’s time to reintroduce art, Tykocinski said. Within 20 years, diagnoses will be done efficiently, without physician intervention, by nurse practitioners, physician assistants, and even IBM Watson.
So if the future physician is not “this brilliant, House-type diagnostician,” he said, referring to the TV show physician, what will that M.D. be doing? At least one answer involves “rehumanizing medicine” and training future doctors to handle ambiguity by cross-cutting through knowledge domains, Tykocinski said. In this world, each patient reviews treatment options with a physician who knits together the medical, human, and social factors involved. “It’s an optimistic view of the physician of the future, but it’s a radically different one. It’s going back to the 19th-century model – the physician who makes a house visit and deals with it and does it.”
Dr. Bon Ku shepherds Jefferson’s design efforts. He is associate professor in the emergency medicine department and assistant dean for health and design. Early in his career as an emergency department physician, he hit the burnout point, just like 59 percent of his fellow emergency department practitioners. He was being judged on patient engagement and improving department efficiencies, but medical training hadn’t provided a playbook “for addressing these real problems.”
“I felt physicians needed more tools and a toolkit to tackle these problems,” he said. “No student enters into medical training thinking, ‘I’m going to get burned out,’ or ‘I’m going to be maximizing my RVUs.’ They enter into medicine to help people, but the demands are changing so much.”
Lorenzo Albala, one of Jefferson’s first design-oriented students, sees the problem in his own ED residency. Patients churn in and out without getting better. Physicians complain about the workflow but can’t craft solutions.
“That hopelessness builds up and leads to burnout, but with design thinking, you have different routes you can approach to these problems and try to do something about them,” Albala said.
“We're... changing the DNA of health care, one student at a time.” Dr. Stephen Klasko, Thomas Jefferson University president and CEO
Under Klasko, Jefferson’s drive to “blow the doors off of innovation” stands on a foundation of enhanced capacity, said Dr. Donna Gentile O’Donnell, special assistant to the president and CEO, and senior vice president, innovation partnerships and programs. Jefferson delivers impact by strengthening its engineering capacity and ties to researchers in engineering, defining innovation and fabrication as goals and outcomes, and building and strengthening relationships with engineering schools.
Klasko’s vision also emphasizes building a student corps ready to empathize and think outside the medical box even before entering Jefferson. Agreements with Princeton University and other undergraduate schools grant automatic admission to select students steeped in nonmedical disciplines, including engineering. “Bringing together people with different intellectual bents and educational content bents and mixing them together builds this creative infrastructure,” Tykocinski said.
On July 2, 2017, Jefferson exponentially enhanced capacity and creative diversity by finalizing what Tykocinski called “a first-of-its-kind-on-planet-Earth merger.” Jefferson, founded in 1824, joined forces with Philadelphia University, founded in 1884 and renowned for such programs as architecture, fashion, and graphic design. Philadelphia University’s verdant campus was renamed Jefferson East Falls, and its students were absorbed into Jefferson’s vision of high-impact education in medicine, science, architecture, design, fashion, textiles, health, business, and engineering.
“Although the world is changing rapidly, higher education is stuck using old models to teach students how things used to be done,” Klasko said in a merger announcement. “We need to help students lead change, not react to it.”
Even before that medical-creative mashup, there came the creation of JeffDESIGN, the College within a College Design Track in Jefferson’s Sidney Kimmel Medical College. Under creator and director Ku, JeffDESIGN engages select students in interactive workshops co-facilitated by designers, architects, and device-makers. There, they encounter “principles of design thinking and create projects that leverage design to do some very real kinds of things,” Tykocinski said.
Jefferson can point to 22 companies that have raised more than $22 million in venture capital as testament to its support of spinoffs spawned by federally funded research. But government agencies doling out funding “get to define who’s a leader,” said Dr. Rose Ritts, executive vice president and chief innovation officer. Cutting-edge ideas can come from anywhere, so Jefferson is “creating an ecosystem” that nurtures the contributions of students.
“The ability to envision the possible of what could be in designing for patients, and being given tools that bring the sort of logical, rigorous thinking that everybody associates with medical school, and adding to it imagination and the sort of systematic thinking that is design-level thinking, intuition, imagination — those things that are part of a doctor’s life but not commonly taught in medical school — are so empowering for the students,” said Ritts, whose office works under the JeffInnovation tag. “They love it.”
Which brings us to The Vault, officially the Health Design Lab of JeffInnovation and home of JeffDESIGN within the Sidney Kimmel Medical College.
The Vault is the versatile maker space for several Jefferson tracks and communities. JeffDESIGN students conduct workshops here. Students in the Medicine + Design co-curriculum perform hands-on labwork. Others selected for JeffSolves, Jefferson’s rapid medical device program, turn concepts into reality. Research teams and students in design internships explore new ideas.
In short, “it’s a place for people who have wild ideas and want to iterate a prototype,” Ku said.
The Vault originated from the need for space as JeffDESIGN grew. Jefferson already housed its administration in Philadelphia’s former Federal Reserve Bank building, a Beaux Arts shrine to Gilded Age lucre. In the basement, a vault with 3-foot-thick walls once housed gold and money but was now storage for departments universitywide. O’Donnell engaged those departments in clearing out their stuff, knowing that this vault should become the home of JeffDESIGN.
In the meantime, the Innovation Pillar won two $25,000 grants for needs assessment and planning from the Pennsylvania Department of Community and Economic Development. Ku and his team embarked on visits to such maker spaces as IDEO in Palo Alto, California, and Stanford University’s d.school, learning that space arrangement can cramp or promote creativity.
“We designed every square inch of that space,” Ku said. “We bought all the furniture. We bought all the chairs. Even the height of the tables is 39 inches, so someone could stand or someone could sit on a stool. They’re small tables, and it leads to collaboration. It’s hard to collaborate in a group if you’re in a traditional classroom.”
The Vault’s focal point is a massive steel door, permanently propped open between two rooms — one furnished with uncluttered tables and whiteboards, and the other a maker space of organized chaos.
Inside the maker space, plants grow in a Miracle-Gro AeroGarden. Post-it notes and 3-D-printed mandibles tacked to a bulletin board outline the groupthink behind pre-bending titanium plates for jaw surgery. A red couch and gray upholstered chairs snug in an alcove. A sewing station holds a Brother sewing machine, serger, and cones of thread in a rainbow of Skittles colors.
A cage along the wall houses the stars of the space — a Formlabs resin printer and several 3-D printers, including a new Ultimaker 3, capable of two-color printing. Within this cage, on a piece of paper in a vintage but functioning Underwood typewriter, one student typed, “im so glad I didn’t have to write my thesis on this. thanks technology.”
“We’re in this second industrial age, this digital revolution,” Ku said. “We can’t train physicians the way we’ve always been training, because health care is moving so rapidly in this present moment of time. We have to look at what health care is going to look like 20 years from now and try to predict that, almost, and try to give students the skills to be able to practice medicine in that future state.”
A bin cart worthy of an elementary school art room is stocked with glue sticks, clothespins, foil, and duct tape. It’s the supply line for students “building up their design muscles,” Ku said.
“Those little things help you get these ideas out of our head and into a physical form quickly,” he said. “Once we form a low-fidelity prototype and that works, we’ll form a higher-fidelity prototype by using 3-D printing. That allows us to work with our hands and give physical form to our ideas, which we don’t do in medicine.”
Failure, he added, is an option. “We only succeed because we fail. Medical school and medical training does not allow you to fail. This is a safe space where we encourage people to fail. That’s not a comfortable space for most of us in medicine.”
Among Vault users are student teams selected for JeffSolves, the rapid medical device program created by Ku and inspired by Tykocinski’s vision to jump-start invention through crowdsourcing. At each JeffSolves session, students and faculty assemble into teams and present ideas for problems to be tackled. The audience selects those ideas worthy of funding, and teams begin prototyping.
In addition to descending into The Vault, teams spend time in New York with JeffSolves partner 10XBeta, learning product development, business plans, and other real-world business fundamentals. At another Jefferson collaborative workspace called JAZ Tank (for Jefferson Accelerator Zone), teams hone their pitches in a competition for $10,000 in startup funds.
“Before the rise of the medtech industry, doctors were tinkerers,” Ku said. “Everything from pacemakers to machines used for open-heart surgery were built at Jefferson by doctors working with engineers.”
It’s time to reinject doctors into the maker arena, finding problems to solve instead of “solutions” that don’t account for care providers’ workflows or the needs of patients, Ku added.
Two JeffSolves teams demonstrate what Tykocinski called “creativity unleashed” when medical and design students partner to tackle real-world health care dilemmas.
Owl Medical Turn Timer: Pressure ulcers, also known as bedsores, cause about 60,000 deaths and cost the health care system $9.1 billion to $11.6 billion annually. But the solution is known — moving patients every two hours or as needed — and the issue was “something we as students could deal with,” second-year medical student Mark Keroles said.
After doctors nixed the mattress concept, the team honed the question it had heard in interviews with time-constrained providers — “What prevents a nurse or doctor from being able to see to the patient’s pressure relief in a timely manner?” The resulting Owl Medical Turn Timer counts down to the next turn for individual patients and collects floor-level data.
The team of second-year medical students Keroles, Daniel Choi, and Vinu Rajendran, plus Jefferson East Falls industrial design major Adam Hecht, mirrored the makeup and resources of a larger medical device company’s structure, “but our in was that we had access to the hospital” to witness daily workflow, Choi said.
ALAFLEX: The ALAFLEX team comprises Haru Jang, a Jefferson East Falls student trained in metalsmithing and fine jewelry-making, plus second-year medical students Leena Ramani, who has an artistic background; Victor Hsue, with a computer science and biology background; and Abhi Umashankar, who sees JeffDESIGN as “an interesting way to make an impact right away.”
Interviews with wound care doctors introduced the team to hidradenitis suppurativa, HS, a socially debilitating condition that causes pain, drainage and odor in the armpits and groin. It quietly affects an estimated 1 percent to 4 percent of the U.S. population, and when Jang learned that her brother had been enduring HS in silence, the team found its project.
Discovering a Facebook HS support group unleashed a torrent of comments – and patients willing to be interviewed. Suddenly, “the numbers became people,” Jang said. The problem: Conventional, 2-D bandages don’t fit the 3-D underarm area where HS thrives.
The team found inspiration in patients’ modifications devised from altered T-shirts, tape, and drugstore absorbent products. The Vault’s 3-D scanning and printing capabilities allowed them to model the tricky negative spaces of the human armpit, using Jang as a model. A major maker of diapers and menstrual pads taught them the fundamentals of layering. The resulting ergonomically designed bandaging system discreetly holsters a Pringles-shaped, layered pad. Doctors often have great ideas but can’t follow through, Ramani said. “We’re coming in with a fresh perspective, and we’re constantly looking at the way things can be improved.”
Ritts’ office supports students at all phases, from aha moment to product licensing, because “we never know what idea somebody’s going to come up with.”
“Technology transfer is such a misnomer,” she said. “It assumes that something happens and at some point it gets baked in and handed off. This office isn’t passive. We don’t wait for people to innovate and come tell us about it and then there’s a business transaction. We’re constantly in dialogue with researchers, faculty, and students across the whole enterprise.”
Creative things happen when people cross disciplinary boundaries, Tykocinski said. “That’s not new, but instead of talking about it, we’re actually giving life to it and doing it with some interesting angles.”
Albala, the Jefferson student now in residency, belongs to a JeffSolves team that created Circalux, a sensor-activated pod that creates light for care providers without disrupting patients’ circadian rhythms, for more restful, healing sleep. Connections made through JeffDESIGN helped the project win grants to finalize the design, join a rapid hardware accelerator program, and hire an intern. As a JAZ Tank Challenge winner, the team used its $10,000 prize to help cover patenting costs. Another grant is funding the product’s path to a Philadelphia manufacturer. After that come crowdfunding and the drive to “get it into the hands of consumers,” Albala said.
“Knowing that you have these principles of design thinking, you can work toward bettering yourself, and that goes hand in hand with medicine,” he said. “It’s a field where you’re constantly improving on your practice. How you talk with patients. How you provide medical solutions based on peer-reviewed literature. Incorporating those principles of design thinking makes for better, more mindful physicians, and I think I definitely have the tools to incorporate design thinking into my practice.”
The Philadelphia story
Jefferson’s focus on design thinking and innovation adds “real value” to Philadelphia’s thriving arts and technology scenes, O’Donnell said. “The creative economy is alive and well in Philadelphia. The gig economy is very much a part of that. There is an appetite more and more in the generations now moving to the fore to drive a different kind of creative agenda in the city, and that’s going to find expression.”
Jang, the ALAFLEX team member, has lived in cities worldwide but keeps returning to Philadelphia “because the opportunities are here,” in a city always on “a trajectory of progression. Philadelphia has its own ecosystem that’s happening at a very fast-paced scale. You never know what you’re going to get out of it.”
In this atmosphere, Ritts sees a bright future for health care.
“We can provide better care for a broader swath of humanity in a fair and equitable way than we do now and still provide quality care, and I think innovation is a way to do that,” she said. “We can be smarter about getting the right resources to the right people at the right time.”
AT A GLANCE
The technological disruption in medicine is forcing medical education to undergo a transformation that requires students to consider design principles to provide better experiences for patients and medical staff.
Thomas Jefferson University President and CEO Stephen Klasko instituted several sweeping changes, including the creation of the Health Design Lab of JeffInnovation, or The Vault, to create a design-level thinking ecosystem.
Jefferson’s support has helped 22 companies raise more than $22 million in venture capital. The JAZ Tank competition has teams compete for $10,000 in startup funds, and winners have included a smarter nightlight for hospitals and a device to prevent stairway falls by elderly and disabled people.