Leaders in Medical Education

Dr. Jonathan Sherbino, Clinician Educator at the Royal College of Physicians & Surgeons of Canada

Osmosis Team
Sep 15, 2014

Dr. Jonathan Sherbino is an Associate Professor at McMaster University where his also an Emergency Medicine Physician. His research focuses on education and cognitive reasoning. Dr. Sherbino has dedicated his career to improving the quality of both medicine and medical education. We were delighted to speak with Dr. Sherbino about his expertise into both medical education and technology.

How did you decide on a career in medicine?

I had a transformative experience leading into my final year of high school. I worked for an NGO in Brazil and realized that I wanted to change the path of my life. I came home and decided that in college, to take all of the prerequisites I needed for medical school. The experience of working with a charitable organization and seeing the inequities within cultures made me want to dedicate and devote my life to something in which I could help people every day. I saw medicine as an incredible, rich opportunity for me to do that. To have a job where you are engaged but also where you can help people seems cliché, but when you live it out day by day, it is incredibly rewarding. From a living in the rain forest in the Amazon to living in an urban intercity academic hospital seems like a stark contrast, but the two are infinitely connected.

What made you specialize in Emergency Medicine?

I think that I probably have the attention span of three year old child hyped up on sugar, so the opportunity to have the breadth of exposure of the human condition, from the newborn to the geriatric patient, is of particular interest for me. I find the opportunity to be able to use my abilities as a physician to help people that are critically ill particularly rewarding. I like to be the physician when the chips are down and there is the opportunity to work with my team to have a truly impactful influence and help the patient. Whether it is a patient who has suffered significant injuries from a car accident or who is has a heart attack and has gone into cardiac arrest, I want to intervene and provide care. I think that Emergency Medicine is for people who are creative in terms of finding solutions. It seems to attract people who can use those same type of skills elsewhere in academic medicine. I have been fortunate that my Emergency Medicine career has allowed me to do other things simultaneously without having to compromise one for the other. Emergency Medicine allows me to have flexibility in my schedule so I can pursue my research and education portfolio.

What do you believe are the biggest challenges medical students face?

I think that it is twofold. First is student debt which can be overwhelming and students lack perspective on how that debt gets paid off as your career advances. I think that lack of perspective causes you to make decisions based on that debt, not based on interests. I think that people end up choosing specialties without paying attention to the other elements like employability. I think that people end up being disuaged from going into medicine because when they see the upfront cost of that opportunity, it is too great of a risk.

The second big challenge is how competitive medicine is, and I do hope it always will be competitive because it is a highly desirable profession. The way that the science is progressing is such that the specialization of medicine is leading to competition and an increase desire to show that you have insight if you want to move into a speciality early in your training. I think medical students are being forced to choose the speciality so early in their training that they don’t have a good understanding as to what that speciality may look like, nor do they have the opportunity to explore the vast breadth of what medicine has to offer. In my experience, what I expected and what I have actually experienced have rarely been the same. In order to decide what kind of physician you will for the next thirty years, you need to see all of the options.

In the same way that debt can be overwhelming, I would reassure medical students that they debt will be dealt with; in the same way that imagining who you want to be and understanding that right from the beginning of medicine training,  is not necessarily who you need to be or who you will be,There is always an evolution in your practice and there is always new opportunities that come up that allow you to move into directions and into a practice that you could have never imagined.

What changes do you think need to be made in order for bridge the gap between technology and medical education?

I think the changes that need to be made are not ones that will ever be made from a top-down hierarchy. I see the use of social media in how it can transform the delivery of education, perhaps even at a grassroots level. It is happening in such an explosive way that educational organizations that are not prepared to embrace and/or address changes in technology. I think what we are talking about could be considered a generational difference. Describing it that way is a little blunt, but I know many people because of their age, are not accepting of new technologies. Educational organizations are often slow to make radical changes. That is one of the negatives of an organization, but it can also be its strength because of its consistency. We do not want organizations to make radical changes all of the time because you risk having no one understanding where that organization is going. When I look at things like free open access medical education movements which has really been influential in Emergency medicine, I look at the way that my residents are looking at study references and are sharing it with each other. It is a radically different approach to learning that I ever experienced as a trainee. Now, for many of the programs that I do, I do a reverse classroom model. I realized that I can use technology to increase the efficiency of my time and at the same time increase the quality of the educational experience. I am going from a very linear process of learning to a much more integrated and bidirectional process through the use of technology.

How do you think technology has impacted Emergency Medicine?

There is culture in Emergency Medicine to be early adopters. I think that the culture of Emergency Medicine is pioneering, but also has the need to be creative and adaptive. When technology make itself available, physicians within Emergency Medicine want to use it because it will solve problems that are immediately present. There is a practical and creative culture that says let’s adopt and let’s use technology. A good example in terms of clinical technology is point of care ultrasound. In the last ten years, I have seen point of care ultrasound go from unusable to now, when I do not think that one of my residents can see someone with an upper respiratory infection without ultra-sounding their entire organ system. With the free open access medical education movement, which was really developed by an emergency physician and an international Emergency Medicine conference, the idea of democratizing information, sharing, and the subsequent refining of the information has emerged. I think that this speaks to a community that faces a lot of challenges. Most physicians at some point in their training are trained in Emergency Medicine, whether it is as a medical student or a resident. There is a large cohort of learners that need to be taught from all specialties. I think the need to have resources to meet this challenge, in a clinical context, needs a large cohort of trainees with the creative and early-adoptive spirit. The discipline of Emergency Medicine is regarded as high quality bedside teachers and innovators within education and I think that technology is a tool which can improve the process of medicine.

Cover Photo Credits: Royal College of Physicians and Surgeons of Canada (https://www.youtube.com/watch?v=l-CYjv_rFvo)