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Pediatrician Daniel Johnson discusses his article, “From isolation to innovation: the power of learning communities in health care.” He reflects on the collaborative, case-based learning that makes medical training exciting and contrasts it with the professional isolation many physicians experience after graduation. To combat this, Daniel champions Project ECHO, a global telementoring model that creates virtual learning communities. He describes ECHO as “hospital rounds on Zoom,” where an “all teach, all learn, all support” environment connects community practitioners with specialists to solve real-world patient cases, from the early days of AIDS to modern challenges like pediatric obesity. The conversation serves as a powerful call to action to formally integrate this model into the entire medical education system, ensuring clinicians remain part of a supportive, collaborative community throughout their careers.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Daniel Johnson. He’s a pediatrician. Today’s KevinMD article is “From isolation to innovation: The power of learning communities in health care.” Daniel, welcome to the show.

Daniel Johnson: Thanks a lot, Kevin. I appreciate being here.

Kevin Pho: All right, so tell us a little bit about your story and what led you to write this article in KevinMD.

Daniel Johnson: I’m a professor of pediatrics at the University of Chicago. I was a general pediatrician very early in my career, but for nearly all of my career, I have been a pediatric infectious disease specialist and, very importantly, a program builder. My program’s focus is on capacity building and workforce development with the goal of increasing services for underserved and under-resourced communities. First, this was focused on HIV; then I focused on communities on the south and west side of Chicago, and now my work has moved beyond those geographies as well.

I think the most important thing about me is that I’m a native Chicagoan. I grew up on the southeast side of Chicago. I was raised in a Jewish household and the Hebrew term—are you familiar with it? Tikkun olam?

Kevin Pho: I am not.

Daniel Johnson: Have you ever heard of that?

Kevin Pho: No.

Daniel Johnson: So, it means “healing the world” or “repairing the world.” It’s really about social action and the pursuit of social justice. The goal is that we will all work together through ethical behavior and positive change to make the world a better place. That was really heavily emphasized during my youth and my years of entering into my career, and that’s really what has led me to the place I am at.

I started as an engineering student and thought I wanted to do automotive design. But then I took a class on transplant materials, got interested in biomedical engineering, and was advised to go to medical school. There I discovered the joys of medicine and direct care of children and families. Taking care of kids is fun. You can really goof around with them, but you get to see the joy of children and their recovery. My background led me to ask a lot of questions, and that’s really what led me to develop what is now ECHO-Chicago, or a Project ECHO program. I’d be happy to tell you more about that if you’d like.

Kevin Pho: Absolutely. Tell us about Project ECHO and your KevinMD article for those who get a chance to read it.

Daniel Johnson: Back in 2009, I first learned about this Project ECHO program. In fact, it’s kind of funny. A friend of mine went to Truth or Consequences, New Mexico—I just love that name. In Truth or Consequences, she was talking to a friend and was telling her all about this program called Project ECHO. When that friend of mine got back to Chicago, she told me about it. I contacted Dr. Sanjeev Arora, who was leading the program, and he said, “Come on down to New Mexico, and I’ll teach you what I’m doing.” He was focused on rural New Mexico, and what I could see was that this could be applied to urban America and, in particular, Chicago.

So, what is ECHO? ECHO is recurring sessions. They’re roughly an hour long, so it’s a small amount of learning that occurs frequently. In our case, we do them weekly. It’s also what learning theory says you should do to learn. It’s done in a group setting with some didactics, but it’s heavily focused on case-based learning. The success of ECHO led me to focus on why it has been proven to be one of the strongest tools for medical learning.

It’s really about sharing data-driven information, sharing experience through case-based learning, and coupling it with active listening and participation. That should sound familiar to anybody who is a doctor because that’s basically what rounding is. Anybody who has watched a doctor show gets to see rounding, but of course, we live through it. We know that people can’t learn everything from a book. Think about how we learned to drive. I taught my kids how to drive. Would I have been happy with my kids just reading a book about how to drive and then just going out there and driving? Of course not. They needed to learn under the tutelage of someone who could give them direction and ideas. Well, that’s what rounding really is: the opportunity to do that.

But driving is a static process. Once you learn to drive, you really know how to drive. But not so with being a medical provider. Medicine is constantly evolving, and so we need to constantly be learning. What ECHO is, is an all-teach, all-learn, all-support system for knowledge transfer. It’s good throughout a person’s career, not just during their training. I wanted to share that thought, and that’s what led me to write the article. It’s important that we not stop that process of rounding and learning when we finish our training. The way most medical providers’ careers evolve is they go out into practice and they don’t get that opportunity to participate. That’s what we’ve done with ECHO: we’ve brought that opportunity to them.

And it makes a difference. ECHO has been proven to reduce cost, increase quality of care, improve provider and patient satisfaction, and even help to build communities by keeping patients local. It helps to strengthen communities. By keeping providers happy with their job, they stay in those communities, so it strengthens both rural and urban neighborhoods. It needs to be part of the ongoing process of people’s careers, and the medical education system needs to recognize that and support it.

Kevin Pho: So tell us what a typical session would look like for a practicing clinician.

Daniel Johnson: Usually there are somewhere between 20 and 30 people who are willing learners, and the sessions are led by facilitators and subject matter experts. They last about an hour. We do them weekly. We pick a time that works well for the group. In truth, most of the time that’s eight o’clock in the morning because that’s when providers have some control over their day.

The beauty of it is that you get on a videoconference setting just like this one, so all the time is spent learning rather than on travel or coming together. Because you can do it frequently—and again, learning theory has taught us that people learn best when they learn small amounts frequently—that’s what we’re doing with that session.

The first 20 minutes are usually didactic, helping to build foundational knowledge. The remainder of the time is case-based and HIPAA-protected, so no personal health information is shared. Providers bring their cases, so it’s real-world learning. They share them just like on rounding, and then there’s a conversation. You probably remember from rounding that it wasn’t just the attending, the most senior person in the room, who was sharing knowledge; it was everybody. That knowledge comes together to produce a plan for the care of patients.

In this way, it builds capacity, expands the workforce, and increases the availability of services at the community level. We did it in our training in a hospital setting. This is being done in an outpatient setting, almost exclusively. The goal then is to strengthen outpatient care so that patients can stay in their medical home, don’t have to leave their community for care, and are able to get high-quality service at their place close to home.

Kevin Pho: Now, what kind of topics or specialties are typically offered?

Daniel Johnson: You name it; we may have done it. We’ve done over 50 different topical areas. When we first started, we started with resistant hypertension in adults. But, you know, I’m a pediatrician, so I then said to my partners in this—because we use the cues from the primary care providers out in the community to tell us what they need—I said to them, “What about pediatrics?” So we then did obesity and ADHD, and then we’ve expanded. We’ve done a focus on just patient type, so adolescent medicine, geriatrics, and women’s health. We do very specific diseases like the ones I’ve already mentioned, but add to it hepatitis C and diabetes. There are so many different topical areas, but what’s critical to the topic selection is that it needs to be of a major concern to the provider and to the patient population that they’re taking care of.

It should have public health consequences, and it should be teachable through an algorithm or some type of protocol so that those primary care providers can follow and learn a protocol and algorithm that will help them deliver the care their patients need. It also builds community because now these providers, who are often isolated in their own practices, come together and meet each other remotely. They develop relationships. They also develop relationships with the subspecialists, the subject matter experts who lead the sessions. Now you’ve got this community that grows, helps to combat professional isolation, and builds a team that can provide the care that patients need.

Kevin Pho: It almost sounds like virtual grand rounds, so to speak.

Daniel Johnson: You could really say that, but it’s much more heavily focused on the interaction between the learners and the subject matter experts.

Kevin Pho: Is there CME offered for these sessions?

Daniel Johnson: CME is offered, but what’s interesting is that only about half the providers actually access the availability of the CME, which I’ve always thought was kind of interesting. It just shows how satisfied they are with the opportunity and how that is driving them to the table over and over again to want to do this.

Kevin Pho: What is the cost, if any?

Daniel Johnson: We don’t charge. We’ve made that a rule of thumb. So how do we underwrite it? That’s always been the challenge. Our ECHO program started in 2010, so we’ve been funding this for 15 years. We did it originally through some internal funding at the University of Chicago. We then found foundations who felt this was a great way to support it, then federal money, and city and state money. That’s how we have done this year after year.

But it’s part of the reason why I feel we need to incorporate this into the medical education system so that the medical education system will support this. It’s the reason why the article, in part, focuses on introducing the concept of ECHO during people’s education so that they will come to expect, want, and demand it after they finish their training because of the strength that ECHO will bring to their practice.

Kevin Pho: If I’m a physician listening to you for the first time and am interested in taking the first steps and participating in an ECHO session, what are some initial steps that they can take?

Daniel Johnson: Well, you need to identify an ECHO program. There are over 1,500 ECHO programs around the world now, and most of them are in the U.S. Almost every state now has ECHO programming. Part of the reason why it’s best to join an ECHO program in your own state is because there are unique aspects of care that relate to how care is delivered in your locality, in your geography. Although our program, for example, does nationwide ECHOs on occasion, most of our ECHO programming is directed at people in Illinois because of some of the unique aspects of care delivery in Illinois having to do with reimbursement—rules of the road, so to speak—that need to be appreciated and followed.

But of course, there are aspects that are applicable no matter where you’re at. First, you have to find that ECHO program. Then look at the list of what they’re offering or even contact them and say, “Can you develop an ECHO program in a particular area?” When I first started, I wanted to focus on hepatitis C; I’m an infectious disease specialist. But my providers in the area said, “No, no, no, we’re not interested in that.” Three years later, they came back to me and said, “Please develop a program in Hepatitis C because we now recognize the pandemic around hepatitis C, and we need help.” We went to the CDC; they provided funding. We did a five-year project that trained over 350 primary care providers and made a huge difference in the availability, diagnosis, and treatment of Hepatitis C in the Chicagoland area—something that we proved and published after doing that project.

Kevin Pho: We’re talking to Daniel Johnson. He’s a pediatrician. Today’s KevinMD article is, “From isolation to innovation: The power of learning communities in health care.” Daniel, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Daniel Johnson: Thank you for that. I would say that my biggest lesson learned is first, never give up. One person can do a lot, and so it’s worth working hard to do that. But one of the big lessons I’ve learned is that a team can do even more. I’ve built a team around this ECHO concept, and we believe in the all-teach, all-learn, all-support model. That really has proven to me over and over again that teams make a difference. Bringing people together for learning is critical.

The other is that we need to be committed to repairing the world through our actions. It’s, in essence, making the world a better place for ourselves and others. Finally, what I want to say is that we have to all work now to rebuild the system that our government, unfortunately, has worked recently to dismantle. We have to rebuild the faith of people in science, in medicine, and in the medical community. I believe that the sharing of knowledge, the democratizing of knowledge, the movement of knowledge, is key to making sure that we’re able to do that.

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

Daniel Johnson: Thanks a lot, Kevin. I appreciate it.