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Join Ruchi Thanawala, a cardiothoracic surgeon, as we explore the transformative power of technology in surgical training. Discover how innovation is reshaping the way we educate future surgeons, improve feedback, and address critical issues of equity in health care. From web-based accelerated learning platforms to AI and virtual reality, Ruchi provides valuable insights into the future of surgical education and its global implications.

Ruchi Thanawala is a cardiothoracic surgeon.

She discusses the KevinMD article, “How accelerated learning platforms are pushing surgical education forward.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Ruchi Thanawala. She’s a cardiothoracic surgeon. Her KevinMD article is titled “How accelerated learning platforms are pushing surgical education forward.” Ruchi, welcome to the show.

Ruchi Thanawala: Thank you so much for having me. I’m very excited to be here.

Kevin Pho: So we’ll talk about your article in a little bit, but first off, just briefly share your story and journey.

Ruchi Thanawala: I’m a cardiothoracic surgeon, and some of the other unique things about me are that I’m a clinical informaticist, a data scientist and a surgical educator. I’m very passionate about this, and a lot of my research and work is centered on how we can use data science and informatics to improve how we learn. For hundreds of years, in this country and beyond, we’ve been training people to become physicians, even longer than that. We’re in an era where data drives our lives, so how can we actually apply that within our health care environment, where the stakes are so high and people trust us with their lives? I think if there’s a greater place to apply all the data and analytics, it’s in that space, and that’s what I’m committed to.

Kevin Pho: I can imagine how busy you are as a cardiothoracic surgeon and how rigorous that training would be. How did you get interested in this additional facet of surgical education and training?

Ruchi Thanawala: It actually came from my very own experience. As a PGY-3 general surgery resident, I realized that information is just really not integrated. It all exists in these separate little silos. We have to maintain a record of the procedures we do, and we have to get assessments so we can continually improve, and all of this lived in these really disparate systems. It felt incredibly inefficient. Additionally, a lot of our education is driven by our faculty’s assessments of us, and this is not centralized. So at that point I was inspired. I was just starting my informatics master’s, and I set out to actually build a platform to change the way we do this. All of this was born from my own experience, and my experience was common to all the other trainees I knew and was training with, and then across the country.

Kevin Pho: All right, so let’s talk more about that in your KevinMD article. It’s titled “How accelerated learning platforms are pushing surgical education forward.” How did your article come about?

Ruchi Thanawala: It came from all of these data sources living in these really different areas that are not connected together, because, let’s be honest, there is not a lot of funding that drives data analytics within the training of physicians. It’s very different when you’re an attending physician, an independent practicing surgeon or physician, because you are doing these independent procedures and taking care of patients. But when you’re training, it all just lives in its own little places. So this article is about the power of bringing it all together, and then leveraging all these technologies, like artificial intelligence, machine learning as a branch of artificial intelligence, standard data analytics and advanced data analytics, to understand how we learn. Because once we understand how we learn, we can then accelerate learning, and those two things are not far removed from each other. That’s what the article is about, and that’s what I center a lot of my work on.

Kevin Pho: So talk about some of the challenges the traditional surgical education model faces, and how it could be disrupted or innovated, from your standpoint.

Ruchi Thanawala: I’ll tell you that there’s a lot of low-hanging fruit. We have been using the same model, if we want to talk about surgery, the whole Halstedian model, which has existed for over 100 years. So the easiest way to disrupt this is actually to make it easy to gather information, and that’s actually where we are in competency-based medical education currently. Historically, most trainees, and I’ll speak within surgery, though this actually spans other procedural specialties, would get maybe 10-plus assessments a year. We graduate from general surgery often having done over a thousand operations, so there are a tremendous number of missed opportunities.

So probably one of the greatest disruptions is using a really well-integrated, workflow-driven platform that can gather so many more assessments. Then, when we have more assessments and more understanding of learning, there’s a lot more actionable data. I think that’s the greatest disruption we’ve been working on, and that I specifically have been working on. We have found that when we have so many more data points, we understand learning better. We’re actually uncovering knowledge we didn’t even know we had. The information existed, and now we are seeing it; it’s in front of us.

Kevin Pho: So give us a hypothetical, real-life scenario where we could see some of these learning platforms in action.

Ruchi Thanawala: Take a real-life resident entering general surgery training, which she’s going to be doing for five years. She comes in and is assigned to her rotation, and she’s going to be doing all these different operations. From day one, she’s getting directed feedback on every single operation she does. She sees her learning curves build out on a daily basis, and she can understand where she is in her learning relative to her local peers and national peers.

Fast-forward to PGY-4. She’s in her fourth year of training, and she knows she wants to be a thoracic surgeon, so now she’s really focused on how she is learning these thoracic surgery operations. And right there, in front of her and in front of her educators, is where she is in her learning, so her learning can be tailored specifically to her on a regular basis. We talk a lot about personalized medicine; this is the era of personalized education, and that’s what competency-based education is. That’s an example of how we can use learning platforms to really drive personalized learning, which is so important for individual learner growth. This PGY-4, soon to be a cardiothoracic surgery fellow and then an attending, is going to be taking care of patients not too far off. So if there’s a place we need personalized learning, it’s there.

Kevin Pho: So are there any programs right now that use some of these personalized learning platforms? What kind of penetration do we have now?

Ruchi Thanawala: We’re in 15 different training programs across 10 different specialties, and the breadth of the specialties reflects the fact that almost all the training paradigms have the exact same problem. Our penetration spans from large academic institutions, like the University of Iowa, OHSU and some of the UMass programs, to very important community-based hospitals, because they too have the exact same challenges.

Kevin Pho: Talk about some of the obstacles preventing further spread of these platforms.

Ruchi Thanawala: Some of the obstacles are, first, recognition and acceptance that we can do this better. I think there is something to our attachment to how we’ve trained and learned, and to recognizing that we have many ways to improve. That’s probably one of the behavioral barriers. Some of the other barriers are technological, because EHR systems, a lot of these case-logging platforms and a lot of these other systems haven’t inherently built interfaces. There has been no technology for this; we are kind of leading the way in building it. So there are the tech barriers of building your own API interface connectors, but we’re overcoming those. When you’re driving the space and you’re the first to it, you encounter a lot of barriers on different sides. So one is a behavioral example, and the other is a tech example.

But once we get in there, what we are finding, which I think demonstrates that this is a space that has been ripe for change and innovation, is that it sticks, and there is sustained use. I think that shows we have solved a pain point that we as a medical community have been experiencing for a long time.

Kevin Pho: So when you talk about the pushback from people who are perhaps not familiar with the technology, or who simply say, “We’ve been doing this for decades. Why do we need to change?”, what are some examples of that pushback?

Ruchi Thanawala: One example of the pushback is the comment, “Why do I need to write down the feedback? I give it to them verbally at the end of the case.” That verbal feedback is really important and relevant, but there is something of high value in reading feedback, because you can reference it and look at it again, the way you review your notes. That’s one example. Others are “I don’t have time. Things are really busy. I need to keep going with these cases. I need to see more patients, because we’re paid based on our RVUs.” That is a very valid point, but in health care, if we’re in a training environment, we have a responsibility to that. And as we develop these platforms, we’re trying to make them as usable and as focused on user experience as possible, because we recognize that we need to make it easy for people to do it.

Kevin Pho: One of the other things you mentioned in your article was the emergence of AI and virtual reality tools to help with surgical education. What are some innovations in those areas?

Ruchi Thanawala: They’re multifold. Probably one of the most common examples is the use of computer vision to help someone who is, say, doing a laparoscopic cholecystectomy, removing someone’s gallbladder: “Do you have the anatomy exposed correctly? Are you aware that this structure is here or not?” You can see the value in that. If someone is learning to identify the anatomy and to get their hands to do the operation at the same time, that’s valuable feedback they can use on a regular basis. Previously, we’ve been dependent only on human educators for that information, but having these computer vision models allows you to have another, AI-driven educator, if we’d like to think of it that way, in the operating room with us, along with the attending surgeon who’s helping us learn. Then you can take that to the sim lab and practice it in a high-fidelity, low-risk setting.

Another place where artificial intelligence, in the realm of machine learning, is helping in surgical education and medical education is in starting to predict where someone is going to be two to three years from now in their learning, using neural networks and deep learning for that. So there are many ways artificial intelligence can help drive education. Another example is one of the projects I’m working on, using natural language processing to understand what the residents understand about their operations as we look at their op notes. What is their cognitive understanding of what they’re doing when they write it down in a narrative format? That’s really important, and we can see it evolve. So there are a lot of applications of artificial intelligence in surgical and medical education that are really changing our understanding of where we are, and, importantly, helping to shorten the time it takes to get from where we are to where we want to be.

Kevin Pho: So you mentioned neural networks. They can actually predict what a surgeon will be like two to three years out, based on patterns they’re observing?

Ruchi Thanawala: Absolutely. That’s actually one of my areas of research. When we have large data sets, we’re able to put them into these models and understand, within a band of probability, where learners are likely to be. Imagine an early learner who may be struggling in different ways. If you can understand where they may start to stratify out a couple of years from now, we could potentially change their trajectory. Or a practicing physician who wants to gain a new skill with a very protracted learning curve: If you can understand where you’re going to be, then you can target interventions. We’re already working on that, and we have proven models that are able to do this.

Kevin Pho: We’re talking to Ruchi Thanawala. She’s a cardiothoracic surgeon. Her KevinMD article is titled “How accelerated learning platforms are pushing surgical education forward.” So what can we expect in the next one to two years when it comes to these innovations in surgical education?

Ruchi Thanawala: I think we can anticipate that all of a sudden things are going to really start to come together, all these different data systems, and there are going to be more and more of these platforms out there. Residents, and the educators as well, are really going to be used to personalized education. Our expectation will be, “I will have a learning profile that is specific to where I am right now and to where I want to be five to seven years from now, in the specialty I want to be in.” That is a very reasonable expectation, and we are essentially there right now. It’s going to be further penetration, and then the next step is going to be understanding how revolutionary this work really is, and how it’s changing the rate at which we’re learning and driving competency-based education.

Kevin Pho: And my final question, Ruchi: Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Ruchi Thanawala: My take-home message is that when we see a challenge we’re personally experiencing, like I did as a surgery resident, we should take it on and build actual innovations and solutions. If you’re able to, try them and test them. They’re going to fail, and then eventually something will succeed. I think probably one of the greatest values of working in the space of medical and surgical education is the direct impact it has on us and on all of our patients.

Kevin Pho: Ruchi, thank you so much for sharing your perspective, time, and insight, and thanks again for coming on the show.

Ruchi Thanawala: Thank you very much.