By Nicole Fauteux
About 200 people attending the 2014 ADEA Annual Session & Exhibition in San Antonio in March arrived a day early to catch the 2014 ADEA Signature Series. Coordinated by the ADEA Leadership Institute Alumni Association, the program, titled Leading Change—Disruptive Innovation in Health Care Education, drew three times as many participants as in previous years. The presentations provided hands-on, bird’s eye and historical perspectives on the topic, lessons learned and other observations from educational innovators in the health professions.
John Da Silva, D.M.D., M.P.H., Sc.M., Vice Dean at the Harvard School of Dental Medicine (HSDM), started off the morning by explaining the concept of “disruptive innovation,” first described by Harvard Business School Professor Clayton Christensen. The term refers to changes that transform a product or service that can only be delivered by someone with a high level of expertise or expensive equipment into a product or service that is widely available at an affordable price. Dr. Da Silva cited one well-known example from health care: retail clinics through which nurse practitioners provide immunizations, physicals and the diagnosis and treatment of common ailments at less cost than a traditional physician’s office.
In Dr. Da Silva’s view, dentists have focused too much attention on innovating at the high end of the market when opportunities for disruption lie in managing the burden of disease and in self-care. He noted that the standard of care is not absolute. Rather, it is the standard accepted by the profession at any point in time. As the growing popularity of retail clinics shows, that standard can change.
“Ultimately, it’s the consumer who decides the standard,” he concluded.
Stephen Shannon, D.O., M.P.H., President of the American Association of Colleges of Osteopathic Medicine, discussed the evolution of his profession since its emergence as a frontier model of holistic medicine in the wake of the American Civil War. In the last decade, osteopathic medicine has experienced unprecedented growth. With twice as many schools and twice as many students enrolled in them, the profession is having a rising impact, especially in its traditional strongholds: rural communities and primary care.
Yet, according to Dr. Shannon, the forces that are disrupting the health professions generally are also disrupting osteopathic culture. He asked whether, given these changes, it made sense to continue training physicians the way they are currently trained in the United States.
“It doesn’t take 11 to 18 years to train a physician in other countries,” he pointed out.
Lawmakers, concerned about dire predictions of physician shortages, have also taken note of this discrepancy, and at their behest, an Institute of Medicine panel will soon issue a report on issues related to accreditation, reimbursement and medical residency programs that could help reshape the medical education landscape, he reported.
In the meantime, the merger of medicine’s three residency accrediting bodies—“an innovation whose time is past coming,” in Dr. Shannon’s view—is already changing the lay of the land. Experiments underway to shorten the length of medical education and blur the boundaries between medical school and residency training may also prove transformative.
Attendees also heard from two dental educators who have first-hand experience with disruptive innovation: R. Todd Watkins, Jr., D.D.S., Assistant Dean for Education and Informatics at East Carolina University School of Dental Medicine (ECU SDM); and Theresa Mayfield, D.M.D., Associate Dean for Clinical Affairs at the University of Louisville School of Dentistry (ULSD).
Dr. Mayfield began her talk with a question posed by Christensen and his co-authors in The Innovator’s Prescription: A Disruptive Solution for Healthcare. “Are we educating health care professionals who can provide high-quality health care that is affordable and accessible?” the book asks.
Dr. Mayfield and her colleagues at ULSD asked this question about their local community and identified a gap in care delivery: oral health care was not integrated into primary care, especially for underserved individuals. A ULSD collaboration with the University of Louisville School of Nursing aims to bridge this gap by preparing dental and nurse practitioner students for interprofessional collaborative practice that recognizes the oral–systemic connection.
The Louisville curriculum uses four resources to educate students for interprofessional communication and collaboration in the identification and management of oral–systemic diseases: the Interprofessional Education Collaborative’s Interprofessional Core Competencies, Smiles for Life: A National Oral Health Curriculum delivered via the Web, an advanced course in physical assessment skills and standardized patients. The curriculum also has a community-based component during which graduate nursing students and general practice dental residents provide collaborative care to children through a charitable clinic and to employees at a local racetrack.
Louisville’s interprofessional collaboration is funded by the Health Resources and Services Administration with a goal of disrupting traditional patterns of care to improve health outcomes for the underserved. The hope is that over time, nurse practitioners will incorporate oral health assessment into their overall assessment routine and that dentists will evaluate their patients’ oral health within its systemic context.
A fourth perspective on disruptive innovation came from a dental educator/entrepreneur who shook up education and the textbook industry with the development of the first XML-based electronic book platform. Dr. Watkins shared his personal innovation journey and reflected on his experience with curriculum reform at one institution (the University of Texas Health Science Center at San Antonio Dental School) and curriculum creation at another (ECU SDM).
Inspired by Dental Education at the Crossroads and empowered by his then Dean Ken Kalkwarf, now retired, Dr. Watkins began developing a better electronic resource to support case-based learning in the late 1980s. Twenty-five years later, he says he has achieved his goal of creating a platform for case-based learning that supports research, discussion, collaboration and assessment. What has he learned in the process?
“All things are possible with money, software and time,” he says.
He also derived three additional lessons from his experience with educational reform:
- The status quo is self-justifying.
- The devil has plenty of advocates.
- Getting started will help you learn.
He hammered home this last point, urging participants not to let good ideas die in committee or pilot them to perfection. Instead, he argued, reformers would do well to get started and make iterative changes along the way.
To learn more about the 2014 ADEA Signature Series presentations, members can access PowerPoint slides through the ADEA website.