The way we train doctors is backward – and CyberPatient has the treatmentAlex Kinsella - January 15, 2020
“It was mayhem.”
That’s how Dr. Karim Qayumi describes his first time on-call in a hospital inside the former U.S.S.R. Patient after patient appeared before him, but his training wasn’t helping.
That’s because, according to Dr. Qayumi, most medical training teaches future doctors to diagnose by first identifying the etiology (the cause of the medical issue), then the pathogenesis (the manner of development of the disease or injury), and finally to recognize the signs and symptoms.
Reflecting on this during his time in his medical clerkship, Dr. Qayumi came to the realization that the process was backward. He needed the practical knowledge of identifying signs and symptoms in order to properly move on to a diagnosis.
And that problem isn’t limited to doctors. Electricians, developers, teachers – almost every career shares a similar path of learning. Whichever field you happen to work in now, your training most likely included some in-class study of theory and real-world application of those lessons.
These paths of learning also share a similar missing component: there’s a lack of opportunity to practice those learnings between the classroom and the field.
As a professor of surgery at the University of British Columbia and founder of the university’s Centre of Excellence for Simulation Education and Innovation, Dr. Qayumi witnessed this missing component in practice as a major issue in clinical decision-making.
Seeing an opportunity to put his experience to work, Dr. Qayumi started to develop a solution to not only help health-care providers, but also to improve the quality of health-care for patients too.
This solution evolved into CyberPatient, a learning platform that uses interactive lessons to help medical students practice a variety of medical cases on virtual patients – and the service is now available to physicians around the world.
Where training fails and experience reigns
Think back to that classic childhood board game, Operation. Who among us hasn’t spent hours trying to remove that funny bone without touching the metal sides of Cavity Sam?
Games such as Operation and the late 1980’s video game Life and Death focused solely on the resolution of a medical issue. You went into the virtual operating theatre already knowing the diagnosis. There was no patient history section of the game. No chance to ask questions. You were given a scalpel and off you went.
Thankfully, real-life medicine isn’t like this. Physicians follow a set of steps to make a clinical diagnosis. When they meet with a patient, the first thing they do is take a history of the illness. When were the first symptoms noticed? Has the patient been outside of the country recently? Is there a history of illness or similar symptoms within other family members? These questions help to shape the next steps as the physician begins to form a diagnosis. From here, a physical examination is usually performed.
“We’re trying to make sure a medical student will have 100 clinical encounters before they see a real patient.”
– Dr. Karim Qayumi, founder of CyberPatient
The combination of the patient history and physical exam narrows down the potential problems to two or three hypotheses. “It’s here where the physician decides between lab tests, sending you home, keeps your for observation or sends you to an emergency room,” Dr. Qayumi says. “It’s a major clinical decision.”
The clinical diagnosis process is where Dr. Qayumi and CyberPatient are focused. While the theory of clinical diagnosis is part of medical training, Dr. Qayumi believes that the gap of real-life experience can lead to problems in the field. “When you perform the actual duty, you encounter a lot of problems. You build knowledge. We’re trying to make sure a medical student will have 100 clinical encounters before they see a real patient.”
How did this gap develop? Dr. Qayumi sees it as a scaling problem that has developed over a long period of time. “Medicine as a whole is a scale-based trade,” Dr. Qayumi says. “For the past 1,000 years, we have emphasized how disease and illness happen and progress. The evidence behind it – the theories.”
While honing a deep understanding of theory is important, Dr. Qayumi thinks that professors of medicine are starting to understand that theory doesn’t translate into practical skills and knowledge. “The bottom line is, we have emphasized theory rather than practical aspects,” Dr. Qayumi adds.
“For the past 1,000 years, we have emphasized how disease and illness happen and progress.”
– Dr. Karim Qayumi
The gap itself isn’t just a theory. Dr. Qayumi has seen it first-hand when a friend who returned to town from an overseas trip found himself very tired and feeling ill. His friend’s wife brought him to their family physician the next day. The doctor checked his friend out, said he was fine and sent him home.
Over the next day, his friend’s condition worsened and he continued to get weaker. “At this time, no one where we were had seen malaria before,” Dr. Qayumi says. That’s when he brought his friend into an emergency room and had them check for malaria. Only then were the hospital staff able to begin the proper treatment.
Beyond the experience gap
Beyond the gap in theory and practice, there is another objective Dr. Qayumi and his team are hoping to address with CyberPatient: “We never teach how much medicine costs,” Dr. Qayumi says. “In a busy office or emergency room, there is a lot that is happening and staff make mistakes. There’s costs to these mistakes when an incorrect lab test is ordered or the wrong examination is performed.”
From his experience, medical students are not taught to be cost-aware. Dr. Qayumi looks to this as another gap in medical training.
“As a physician, you need to have the knowledge, the speed to be able to quickly and accurately make a diagnosis, and to know how much will that cost to the medical system,” Dr. Qayumi adds. “CyberPatient is the first and only medical education tool that provides the cost.”
“You need to have the knowledge, the speed to be able to quickly and accurately make a diagnosis, and to know how much will that cost.”
– Dr. Karim Qayumi
Then there’s the misdiagnosis of medical issues with women. It’s one of the most alarming issues caused by a lack of real-world practical experience, says Dr. Qayumi. The majority of clinical studies and cases that medical students learn from are focused on the treatment of caucasian men.
This has created a one-size-fits-all approach for diagnosis, which has led to women suffering heart attacks or other illnesses after being misdiagnosed.
“There are small differences that doctors might not know,” Dr. Qayumi said. “Physicians ignore the symptoms because the differences are not in textbooks. They need practical knowledge and we can build that with CyberPatient.”
Creating the Duolingo of medicine
The journey of Dr. Qayumi and CyberPatient began in Dr. Qayumi’s native Afghanistan during the time of Soviet occupation. Honing his medical skills during the occupation and war, he started to create what would become CyberPatient. “I was the head of a department in Afghanistan and I would have done that forever,” he remembers.
But it wasn’t until he and his family left for Canada that things came together to make CyberPatient a reality. After arriving in Canada, he found opportunities to grow as a physician, educator and entrepreneur. “As an Afghan physician, not knowing English – it was a difficult job,” he says.
CyberPatient launched late last year and they already have contracts with four major medical schools. “It’s been overwhelming. We keep hearing ‘Yes, I want this now,’”
Think of it as Duolingo for medicine. Medical students work through interactive lessons similar to a choose-your-own-adventure story. After students complete a lesson, CyberPatient calculates the decisions – correct ones and mistakes – across the sections of the simulation.
“What are the patterns across the world? What don’t [physicians and medical students] pay attention to?”
– Dr. Karim Qayumi
Each section has its own score. “Why is the score low, the system will give them the answer,” Dr. Qayumi said. “CyberPatient points to the specific problem – wrong drugs, etc.”
CyberPatient’s simulations can also help physicians who work in small, dispersed communities. Doctors working in these communities can use CyberPatient to help keep their competencies up while serving in areas with limited patient diversity.
“We’re working on machine learning now, too,” Dr. Qayumi adds. “What are the patterns across the world? What don’t [physicians and medical students] pay attention to?”
Success for Dr. Qayumi and the CyberPatient team means many things. They currently have a research project underway that Dr. Qayumi is excited about. “When the project is complete, I will say we’ve been successful. Three to five years from now, we hope to go public. It will be a major turning point for the business of CyberPatient.”
And he believes strongly that he would not have flourished the same way without being in Canada.
“It gave me the opportunity to expand myself, express myself. Canada made me what I am today.”
- Name: CyberPatient
- Solution: An interactive study tool that lets medical students get real experience via simulations
- Owners: Dr. Karim Qayumi
- Headquarters: Vancouver, BC
- Contact: [email protected]