Keeping Pace with the Knowledge Explosion

By Sanjeev Arora, MD

Knowledge and expertise are at the center of medical care — without them, we are working in the dark. Fortunately, there is plenty of knowledge to be had: More medical knowledge has been created in the past one hundred years than in the previous five thousand, and more knowledge will be created in the next 50 years than ever before. Yet we have a serious shortage of expertise, in the form of access to clinicians with the latest knowledge and best practices, especially for the care of underserved populations.

Why?  This explosion in medical knowledge has not yet been accompanied by a similar transformation in our approach to medical education.   In short, we’re not able to keep up.

Given the challenges that our health care system faces – lack of access, uneven quality, workforce shortages, and rising costs – we can’t afford to lag behind the knowledge explosion or expertise translation.  We need to expand our capacity to synthesize new knowledge and get it into the practice setting.  We need to expand our capacity to save lives and alleviate suffering.

Staying up late reading the latest medical journal articles is not the answer.  For one thing, it’s inefficient.  For another, it’s not how we learn.  We learn by treating patients.

Learning by doing and working across disciplines: Case- and team-based learning.  The changes in medical school education are not enough.  We need  a platform for continuous, lifelong learning.

Project ECHO provides this platform. A new model for medical education and care delivery that dramatically expands our capacity to treat patients, it takes advantage of basic communications technology to conduct weekly virtual grand rounds, bringing specialized knowledge and best practices from academic medical centers to primary care clinicians in local communities. Together, they manage patients with highly complex chronic diseases such as hepatitis C and rheumatologic disorders.

In the process, the dynamic for sharing medical knowledge, improving expertise and providing care changes.  The traditional practice silos are replaced by learning networks of expertise where specialists, primary care clinicians, residents, students, nurses, community health workers and others are all interconnected, working as a team.  They form a community of practice whose capacity to provide care is many times greater than what existed previously and is based on the best available medical knowledge.

For those of us in the academic medical world, continuous case and team-based learning offers a tremendous opportunity to expand our reach to people in rural and underserved areas who need it most.   In turn, we gain important new knowledge by receiving real-time feedback from care teams who are discovering new best practices on the ground in community practice settings.

The knowledge explosion is not going to let up – and that’s a good thing.  Now is the time to re-design academic medical centers as the central nervous system of our health system: transmitting knowledge and expertise to clinicians across the spectrum while improving the health of our nation.

—Sanjeev Arora, MD is the developer of Project ECHO and a liver disease specialist at the University of New Mexico Health Sciences Center in Albuquerque.

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