Training a Doctor in Today's Digital Health Era

It may appear paradoxical that a clinician trained in the BC era has the cheek to write on this topic. Digital health is not a subspecialty. It is just the sum total of all components used to deliver every type of healthcare to anyone, anywhere, anytime, and cost-effectively, efficiently, and effectively in a user-friendly way using ICT.

No doubt like basic digital literacy, deployment of digital health tools may be considered intuitive, with the provider and the beneficiary picking up user-friendly skills “on the go”. However recent publications indicate that residents formally exposed to the basics of digital health and its myriad applications do better. Interestingly their additional clinical inputs result in the betterment of the end product.

Re-registration of Clinicians?

In November 2022, the Ministry of Road Transport & Highways (MoRTH) proposed mandatory non-renewal of all vehicles older than 15 years. Personal vehicles that pass a fitness test could be re-registered for five more years – otherwise, it will be scrapped.

Considering that I registered with the Tamilnadu Medical Council in Jan 1975, am I not a menace to society? Attempts at re-registration of RMPs have been futile. Attempts to evaluate their continuing competency even more so. The medical doctor in India catering to the entire population of 1.4 billion is presumed to be omnipotent once he/she qualifies.

In the West, continuing recertification in some form is mandatory. Attending formal refresher courses, CME programs, seminars, conferences, workshops, etc to obtain the minimum “credit hours” is not just compulsory but actually implemented. Most countries have a formal re-examination.

Technology-based remote continuing health education for RMPs is today eminently doable. Thanks to the phenomenal growth of the internet the “have nots” can access information on a real-time basis.

Samuel Boswell Johnson defined an educated person as one who knows how to use the library. Accessing authenticated reliable information online is relatively straightforward. Online assessment and evaluation of doctors, responding to simulated real-life, clinical conditions, is possible.

Today an internet-enabled smartphone can provide more information in a digital format than all the printed books in all the libraries of the world.

Teaching Guidelines Adhering to Digital Health Suitability

Producing 92,000 medical graduates and 80,000 postgraduates every year, from 720 medical colleges and DNB-recognized institutions is not enough. They must be periodically re-evaluated and taught to deploy tomorrow’s tools of trade yesterday! A formal introduction to all components which together constitute the umbrella term digital health is mandatory. While teaching subjects such as neuroimaging, immunology, or pediatric surgery can be confined to selected groups every single member of the healthcare ecosystem must be exposed to what constitutes digital health.

Expert systems (computer programs simulating the behaviour of a human super specialist) with wide applications, will be increasingly available. AI has more reliable data to fall back upon, than the most competent experienced doctor. Even intuitive judgement, giving weightage to socio-economic, cultural, and less easy-to-define variables can now be incorporated into these programs.

Tomorrow’s surgeon will sit before a giant colour high-resolution monitor with a mouse, light pen, etc. After reviewing all clinical and lab information the area to be operated upon the next day will be visualized in 3D. Following the skin incision, he/she proceeds with all the surgical steps. Audio and visual displays of changes in pulse rate, blood pressure, arterial oxygen saturation, exact blood loss, fall in hemoglobin, etc, are updated every 15 seconds. Angiograms (studies showing blood vessels) are superimposed on MRI images using this “dry run” the surgeon, can for that particular patient, plan out the best possible approach to understanding intraoperative complications.

The computer can even be programmed to say “Ouch, that hurts,” if, after the injection of local anesthetic, the surgeon did not wait long enough.

Sophisticated life-size electronic mannequins with detachable parts train the medical student. A rectal and vaginal examination can be taught and the gloved finger can in 30 minutes, palpate several different abnormalities normally encountered in a year. The simulation is remarkably precise. Cardio-pulmonary resuscitation, starting drips, giving enemas, and various day-to-day procedures can also be learned with these incredible models which even say “thank you” after an injection.

Saving Time, Enhancing Experience

Digital simulation reduces the time for “experience” from years to days. It allows you to make all mistakes again and again without harming the patient in any way

We, in India, have the greatest resource for medical education, our infinite variety of patients. If only we are willing to learn from every single patient, each doctor has the potential to develop into an “Expert System” capable of constant and instantaneous upgradation.

However occasionally, inadvertently this is at the cost of the patient. Imagine if we also have digital learning tools. The inherent untapped dormant expert in each of us would transform exponentially.