Dr. Roger Seheult: Co-Founder of MedCram (Raise the Line)
Hi, I'm Doctor Ishida. And today on raise the line, I'm happy to be joined by Dr Roger S Welt co-founder of Med cram, popular and fast growing source of online medical education with uh over 50 million video views and a quarter million subscribers.
In addition to running med, Doctor SLT is a professor at the University of California Riverside and Loma Linda University and is a practicing pulmonologist and sleep physician.
Thanks so much for being here today. One other thing I got to plug is that we have a family friend and that we've done one of these, uh pre COVID.
So it's really nice to get caught up with you. Doctor Schultz.
So, so glad you're here with us today. Yes.
Yes. And I'll say hi to doctor Furan for you.
That's awesome. Yeah, that's my, that's my wife's auntie.
So, uh, it always helps to have uh, uh connections through the in laws. Um Yes.
So, I guess let's just jump right in. Why don't you start by telling us about your background and the path that led you to starting Med Gram.
Yeah. So, I'm a pulmonary and critical care specialist also in sleep and uh as part of my connection with Loma Linda, we used to have pa students that came out to our um our clinic.
And in doing that, I met the cofounder of Med cram.com to be Kyle Allred. And he was actually one of my students and uh he was involved with medical education before because his dad was also involved with uh medical education.
And he, he told me, he said, look, uh doctor s swelt students don't go to the library anymore. They don't check out journals, they don't photocopy them and, and need a library card.
They just go to youtube and they go to Google and they Google these things and that fit well with me because every single month I was having to give a lecture to uh the medical students and the, and the pa students about topics in, in pulmonary.
And I was doing the same lectures over and over and that's when he introduced me to flipping the classroom where we would actually have them watch the video and then come to clinic the next day and then discuss it.
And so it really worked well for me and, and that's how it started as a little channel on, on youtube almost there just for my students.
And uh more and more people came in the rest is history. What, what year was this?
Just to get some confirmation? Around 2012, got it.
And so around 2012 is when you started getting into this, uh what percentage of your time did it take up then? And then what percentage of your time does it take up?
Now? It's grown proportionately.
Um I would maybe produce a video maybe once a week. Uh Or, or, and then after I had done a, a cadre of them and we had a, a rotation, I really didn't have to do much, but as it started to grow and people wanted more and there was more questions then.
Uh We take the weekends off um and it's really taken up a large amount of my time, but it's helped me because I would have to learn about this virus anyway.
So if I know that I have to teach somebody something, I better know it well enough to be able to teach it. And it's really helped me to, to be on the cutting edge of, of COVID-19.
What do you see as Meds mission? And uh how does COVID-19 fit into that mission?
Yeah. So the uh the, the motto that we have is explaining medical topics clearly or demystifying.
One of the great um things that I get in life is looking at someone's face just light up when I can explain to them something that's been perplexing or, or a mystery to them.
And that, that is really something that is in medicine, you know, medicine has its own language, it has its own. We kinda, we kinda do this as doctors, right?
As healthcare professionals, we try to keep it away from everybody by co having, you know, these funny terms like hypothermia, right?
Uh w what's that? That just means, you know, your temperature is low but you use these Latin terms anyway, so we take these things and we demystify them because we can, we can actually do this, we can actually take complicated topics, we can boil them down to their essence and we explain why things are happening.
And um as I've noticed this is not only helpful for medical students, for pa students, for MP students, but for people who are not in the medical field, but may be very interested in a diagnosis because they have it or because they know somebody who does have it and, and, and that kind of goes into your, your next part of your question, which is what about COVID-19?
Everybody of course wants to know about COVID-19. I mean, I can remember back in late December, early January where I would go to a, a news uh report or a newspaper and maybe there was 20% of the news items that was on the Coronavirus.
Now you go there and every single news story is about Coronavirus if it's in the sports sections because they can't play sports if it's in the business sections because the stock market is going up or down if you know every single story right now is revolving around COVID-19.
And so it is the hottest story on the planet and everyone wants to know about every single newest thing and, and what's funny is a lot of people are looking at this now and they're finally beginning to understand that medicine is not 100% science.
Well, what are, what are all those things if you can boil it down to its essence, people really wanna know and they wanna know what they can do to make sure that they're not the next victim of COVID-19.
One thing that I really admire about the videos you make is that you um beautifully blend in things like you just said angiotensin two receptors with you'll cut away to a sa screen of a blackboard chalk talk style.
Um Do you mind just talking about the evolution of that and, and how your learners uh like it or if they've given you feedback on that?
Yeah. So the, the term that Kyle likes to use is learning at the speed of explanation.
Sometimes you can get way overloaded by so much information and words uh put up on the screen. This is exactly what happens.
Uh Nowadays, we want more medical providers, we want more uh pa s and so what we do is we make more schools, more classrooms and people are not maybe educated enough to teach.
So they put together a slide powerpoint presentation. They go through, they whip through 60 slides in an hour and it's basically Niagara falls into a styrofoam cup.
Um What people want to know is let's slow it down. Let's figure out exactly what's happening.
And what a chalk talk does is it innately has to allow you to describe something and draw it at the same time. Now, for some people that actually can be a little slow.
And so you may notice in some of our chalk talks, we speed it up sometimes because um let's face it. People are going to pick videos on youtube based on which is the shortest way to explain something.
But it's gotta be, it's gotta be described, it's gotta be talked through. And if someone needs to go back, that's the beauty of youtube is, you could stop it and you can go back and you can replay it again and if it's too slow for some people, well, that's the beauty as well.
You can click on 1.5 or 2.0 speed and, and get the essence of it. But I think chalk talks allows you to go through, through things in a linear fashion rather than boom, everything pops up on the screen and it's just boom, boom, boom and, and it's, it's just too fast.
W what are in your opinion, like, what would you say are the main uh learners that come to med prem? Are they health professionals students?
Um the general public? And, and I imagine it's changed quite a bit through COVID-19.
Yeah, it has. So prior to COVID-19, I would say the majority of our viewers were healthcare providers.
And when I say healthcare providers, it would, could be anything from a physician to a nurse practitioner to a uh pa pa student, respiratory therapists, even EMT S were watching some of the videos to get more education.
So in that sense, that's primarily what we had. That's primarily who we were playing to.
Obviously, after COVID-19 came, there was a lot more laypeople that were watching and uh we had to realize that and uh maybe take some time to explain some of the terms that we were using.
Um In fact, what we're about to do now on the channel is we're gonna go through a little bit more because it, to me, I believe that this disease is starting to look more and more like an endothelial disease.
Um with all the ace two receptors on the endothelium. And the reason why we're having problems there is with oxidative stress.
So how do you now talk about oxidative stress to people without using terms like super oxide dismutase and super oxide and catalase.
We're going to have to go back to medical school and we're going to have to educate people on what these terms mean. So now we can have a rational discussion.
No, I was going to say and for our listeners that may not understand what you mean by endothelial disease, do you mind just spelling that out for us now?
Yeah, thank you. Exactly.
So, an endothelial disease is this, these are the cells that line your blood vessels and they are very rich in ace two, which of course, we all know now is the, is the, um, is the target for uh the SARS virus.
So, you know, so just in that sense right there, when you're talking about this virus and you want to explain what's going on, people wanna know, people don't wanna be dumbed down.
I don't wanna, ii don't want to rain on the nightly news because they have a different job. They have to explain everything that's happened in the world in half an hour and you don't have time to do that and those kind of shows.
And so I used to be like, really upset at these uh medical correspondence for these uh evening news. It's like, wow, you could have gone to a lot more detail.
Well, they only got 10 seconds to give a little bit of something. No, they, they really don't have time to do that.
Well, that's what we could do. We don't have a half an hour slot.
You and I Rishi, we can talk and we can explain things. And um, what I found is this the bottom line to your question is this what I found is if you can explain something, well, then you should be able to explain it at just about any level.
Given uh the vocabulary, if you can get through the vocabulary and people can understand cause words just, you know, they have meanings and you got to explain what those are.
But every concept I think anybody could learn a and understand and that's really what we're attempting to do. Now post COVID is we realize that we've got a bigger audience that we have to satisfy and we have got to satisfy a lot of people at the same time with that.
It's also a very empowering message. This idea that you can really teach something that's so complex to every level of learner and not have to dumb it down.
But that just sometimes takes a little bit more time to work through the vocab because I think once you get it to vocab, everyone understands that learning a new language is a little tricky at first.
But you know, we all speak some language So we've all figured that out. Yeah.
The, the nice thing about this is that people are motivated, there are a lot of people now that, you know, whereas before they wouldn't be, they could care less now, people are motivated because they see the consequences of this in real life.
What is your sense on that motivation piece for learning online? Do you feel like it takes a certain type of motivated learning to do that or are we maybe seeing, I've heard, you know, a digital divide between motivated learners and non motivated learners where, where platforms online are really just helping those that may not need the help as much.
Yeah, I think that that's probably a little bit of truth. There maybe, maybe more than a little bit of truth.
Um There are a lot of people that just will get their information from the evening news and I think that's ok. Um, there are those people just like we know there are those people who come into the hospital who come into the clinic that are very involved in their health care and they wanna know why you're prescribing this medication and what are the side effects?
And there's other people that it's like, you know, just tell me what I need to do and uh I'll just do it, you know, and sometimes they won't even do it when you tell them.
Um, so there's all sorts of people and I think the people that come to the internet that come to osmosis that come to med cram.
These are people that want to know more. These are people that have a internal locus of control.
They, they have control over their um environment, they want to have more control of their environment because they see the consequences and um so long as we can give them good rational, peer reviewed information and not over promise but try to deliver.
I think that's, that's the goal of, of organization like yours and mine. You know, one thing I have also thought about, you've brought up news organizations a couple of times.
So I'll go into this is that there sometimes feels like a leading edge or bleeding edge of information. And, you know, maybe med cram is that bleeding edge.
And this idea you just posed here about endothelial damage being the main reason behind why we're seeing, you know, maybe strokes in younger folks that may not hit the news cycle for two or three more weeks.
I'm curious, do you sometimes or have you had experience with news media reaching out to you to say, hey, what are the things that we should be focused on that we're not focused on at the moment?
Yeah, they have um sometimes they don't wanna hear all of those things because they have to, they have a different job that they have to do.
They have to, they have a, they have a narrative that they want to have, uh, but at the same time they use the, the, the daily news cycle of what's topical and they have to put that narrative with what is topical.
Uh, we don't have to do that. We just can report on what medically we think is going on because that's hard enough.
It, it seems to morph and change. But actually, uh, it's our understanding that's just uh maturing and I think we're getting a better understanding of that.
Um, you know, we've talked about all sorts of things on our channel. We've talked about the hard science.
We've talked about Coronavirus, how it infects the receptors. One of the things that had bothered me from the very beginning in terms of our management, uh, generally speaking, and it's not anyone's fault.
It's just that we have concentrated a lot of our resources at the end stage of the disease. And, and the reason is, is because that's the least amount of people in the whole epidemic.
How are you going to get millions and millions of people the treatment that they need before they get and before they need to go to the hospital.
Well, that's different. We've talked about things that might, some people might think are a little bit soft or, or squishy in terms of scientific evidence.
But when you really look at it. Um, everything that we're doing right now for this virus is soft and squishy and we don't have a lot of evidence.
So, what are some of those things that we've talked about? We've talked about, you know, is Tylenol good to do for people who have fever and therefore, uh, uh, is heating up the, the body good for the immune system.
Has this helped the innate immune system. Everything that we talked about is circumstantial and we don't have any direct evidence that it works in COVID-19.
But at this point, what else are we gonna do? Wait for, for those studies to come out?
The the epidemic may be over at that point. Uh So the bottom line is, I think is when you start to bring up these, these topics, um some of them are sometimes people, people's brains aren't ready to be wrapped around some of these ideas.
That's, that's how I would say it. One other uh thing that I wanted to specifically get your input on is how you like to thread the needle with things where you might have a personal view.
And then there's also the documenting of what's actually happening. So for example, digital surveillance technology, we know it exists, we know certain countries are deploying it in different ways that's quite different than maybe your personal take on where that lands in terms of public health versus civil liberties.
I'm just curious how do you thread that needle for yourself and for the channel in terms of injecting your opinion into the issue.
Yeah, and this has been something that people are just really, really looking for. Uh I see it in the comments all the time.
They say thank you so much for not giving us your opinion. What we actually do, give our opinion, but we make it very clear, this is what the evidence shows and here's, here's be what my opinion would be.
So, uh we'll, we'll say this is what this is complete evidence based medicine and we try to do both sides of it. We try to be the prosecutor and the defense attorney at the same time.
Here are the pros, here are the cons. Uh, we did this, um, it was kind of as an example, you know, probably no other medication is as political as hydroxychloroquine.
And so, um what we did was we reviewed all of the data on hydroxychloroquine and it was interesting, there was a comment that came up and they said, OK, I'm gonna comment here.
It sounds as though doctor SLT is taking uh this side of this side of it, but I'm gonna watch it and I'll come back and I'll edit my comment.
So he, he came back and edited. He's like, you know, I was wrong.
He actually presented both sides of this and, and he's not actually taking the line that I thought and what you need to do is be able to do what we, you and I, Richie, we're all taught in medical school and residency and I know, you know how to do it as well.
It's, it's when you take a journal to journal club, you know, you're gonna get ripped apart at Journal Club. It's like here, here's what this says and here's what this says, like, well, first of all, they're gonna attack everything on you from the, the impact number on the journal that you're holding in your hand to uh the, the, the, the way it was.
And so we've had to do that as physicians. We've always had to look at stuff and say, yeah, this looks good.
But what could be all of the, the fallbacks on this. And so that's exactly what we did with those studies on, on hydroxychloroquine.
And I can't tell you right now whether or not hydroxychloroquine works or not. Um I'd certainly like to be able to have a discussion with somebody in the medical field like you and I about it without being pinned down as, as, you know, the devil or, or God, you know what I'm saying?
It's, it's uh a and so that's really what we have to do. And that's one of the things that, that really, I wanna make sure that med Cram and osmosis and all of these uh people, all of these uh companies that educate is to make sure that we have the trust of the population of, of humanity that we are going to present the data as we see it.
And then we'll tell you what our opinion is if we think what it is and we'll label that very clearly. But I think this is what it is, but I don't have any evidence uh of this or the other.
I can't, I think remdesivir may work in vitro. I mean, it's something that may work, but I've got no evidence right now that it does.
The other thing that I think is also helpful is educating uh the population on what these words mean. So when someone comes out and says, I have no evidence that sometimes people will mean thing to say, well, that means there's, there's no way that this is true.
That's not the case. Something could be very true.
We just don't have evidence cause no one's done a study like I can tell you right now, I have no evidence that putting a roof on a hospital keeps people's heads dry.
I have no evidence of that. No one has ever done a study to build a hospital without a roof this and actually check to see if people's heads get wet, you know what I'm saying?
So, I mean, you, you, when people say they, when, when the wh O comes out and says we have no evidence that getting antibodies is going to uh confer um immunity to this disease they're right.
We don't have any evidence, but there's a good chance that there's probably gonna be some evidence at some point that shows that because this is a virus, like any other virus in people have antibodies.
So we have to be careful with what we do and what we say. Um I hope that's a, that's a, a long answer to your question.
It's a great answer to my question. II, like the analogy of uh a roof and keeping my head wet.
It's very concrete and I can wrap my head around that very easily. Um I'm curious, you know, you, you've talked about online medical education a few times and right now we're going through a very clear shortage of healthcare workers and this was before COVID-19 and I don't necessarily mean physicians, I mean across the spectrum PA S NPS uh and nine of the top 15 fastest growing fields uh are in healthcare and that's accelerated.
Now, I'm curious, what is your thought in terms of what online medicine or online medical education will play in the coming years to help address that shortage of trainees?
Yeah, I think that our demand for health care workers is outstripping our supply of good medical education professors. But I think that's just the, the fact and it's not, II don't want to disparage our colleagues, but I've heard it from students saying, yeah, they, they came in here, they gave us a powerpoint presentation.
They left and we really didn't know what was going on and, and right now it's hard to get people in there. It, first of all, it doesn't pay much to be a, a professor or a teacher.
Um, you do this as a part time thing usually you, you're, you're busy in clinic and you say, hey, could you do a lecture on Friday?
Oh, what is it on? Oh, ok.
I'll put some slides together. So, yeah.
So while at the same time, we're trying to get a lot of people educated, we don't, we're not really investing in our education.
Um There are some bright spots though, I think uh what you've done uh RHI over at uh K academy and uh the flipping of the classroom really spearheaded.
I mean, a lot of us into uh getting into this field and doing online education. I think one of the areas that's concrete in COVID-19 is there was this thought and it was rightly so that we were getting into a lot of ventilators.
These, these are machines that people haven't seen in years. Some of them.
So these are surgeons that hadn't managed the ventilator, even ophthalmologists that hadn't been uh managed the ventilator and they thought they might have to do it well, we offered a uh a basic, basic ventilator course on our site.
And uh we, whereas before we had charged for it, we made it free, we advertised for it and, and people were taking this course uh in large numbers.
And I think that's one way of potentially educating a number of people in one field who have to be upgraded uh in another field.
Um So I'm sure that my colleagues in ophthalmology, if we had a virus that made everybody blind, for some reason, we would all be uh taking these online courses in, in uh ophthalmology.
I hope one day. Uh hopefully that never happens.
But yeah, no, that, that's a great example. And I think increasingly we're going to see that not just in health care but in other fields where people have to add a necessity, continue learning new things.
Well, after they finish college or med school or whatever, that it's not just like you learn in the first half of your life and then you work in the second half of your life, but that learning has to continue through.
Um I, I really appreciate these uh chances to talk to you and get caught up with you. Uh any final thoughts or advice you have for our audience of future, you know, health clinicians as well as public health professionals.
Yeah, I mean, basically the two things, COVID-19 and just in general. So just in general, always remember in terms of your education that never look at how long something is going to take to go into something you're gonna be, if it takes five years to do something, you're guess what five years is gonna come and go, get involved, educate yourself.
Um There's many opportunities that you can do online and then I would say specifically about COVID-19, we are about to enter into a period, I believe here in the next few months where a number of the fruits that we have that we have sown here in the last couple of months in terms of research are gonna start to come out and we're gonna get a lot of information and we're gonna start to understand a lot more about, about this disease in the next couple of months.
So it's gonna be exciting and hopefully med cram and osmosis and a number of other uh sites out there will be the um the vehicle for you to learn about what's going on with COVID-19 and, and the things that are gonna happen in the future.
Well, thank you so much for, for your parting advice. I really enjoyed talking to you today.
Thank you Rishi. Well, thank you so much uh Doctor Schw for being with us here today.
I'm Doctor Yez. Thanks for checking out today's show.
Remember to do your part to flatten the curve and raise the line. We're all in this together.
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