A Global Look at Online Postgraduate Medical Education and the Future of Healthcare – Dr. Tom O’Callaghan, CEO of iHeed (Cambridge Education Group)

Dr. Rishi Desai: Hi, I'm Rishi Desai. Today on Raise the Line, I'm happy to welcome Dr. Tom O'Callaghan, a leading global advocate for online medical education. As founder and CEO of iHeed, his mission is to use innovative approaches to educate and support healthcare providers, and he believes the accessibility of online education modules can help address the global shortage in the healthcare workforce.

Dr. O'Callaghan is also a practicing family doctor, a leading digital healthcare entrepreneur, and a regular contributor at events sponsored by the UN and WHO. Thank you so much for joining us today.

Dr. Tom O'Callaghan: It's great to talk to you again, Rishi.

Dr. Rishi Desai: Absolutely. We chatted a number of years ago, but at that time, and even since then, I've never really gotten the full story on what I'm about to ask you: What got you interested in medicine in the first place, particularly primary care?

Dr. Tom O’Callaghan: Thanks, Rishi. My background is that my dad was a family doctor in a small rural community in Cork in Ireland of about three or four thousand people. I suppose I grew up watching him as an old-style community physician looking after a community over generations of people, from young people up to their grandparents. Over many years, I got to see the value that was placed on that by his community, and by the individuals and the friendships he built up, and the difference he was able to make in the world as a doctor.

That inspired me to follow his tracks into medicine, and then subsequently into family medicine. I then joined him in practice. I had the good fortune to be in practice with him for many years, and then became part of what you call in the U.S. a wider physician group, where we came together in a much more structured primary care center with on-site diagnostics and outreach services, teaching medical students, researching and providing that multidisciplinary kind of care team that now exists quite extensively in many parts of the world.

Dr. Rishi Desai: Am I getting this right? In the early days, was it a practice of you and your father at one point?

Dr. Tom O’Callaghan: Yeah. The funny story I always tell is that I'd go out to the waiting room and there'd be a big queue of patients waiting to see my dad. The patient would go in to see him and they'd be laughing and joking and be there for half an hour. I could hear them in the next room. I'd be there looking at the big waiting room for the patients trying to empty the waiting room, see the next patient and sort their problem. He'd still be inside swapping jokes with the patients for forty-five minutes or an hour.

But that was, I suppose, of the time, and the way medicine was practiced and that's the way people build up trust and relationships with their family physicians. For many years, I had patients who would come to me and say, "Well, your father helped my daughter get a job in nursing. Or I remember him coming out to my house at 4 o'clock in the morning in his dressing gown when my child was sick. I suppose that was the medicine of the time.

When I travel as part of my work with iHeed, I get to meet family doctors and physicians all around the world, and it's very interesting to see the evolution of the care system in different parts of the world, and how that exists in many other countries.

Dr. Rishi Desai: This is a striking juxtaposition, because on the one hand, you have this man who's laughing it up in a patient room for thirty minutes with a lot of people obviously waiting to see him, and that's how a lot of people imagine medicine was done in yesteryear. And then today, I just in the intro talked about how you're a digital entrepreneur, using online platforms and doing all this other stuff. What would your father say about these activities? What was his take on this kind of approach?

Dr. Tom O’Callaghan: I think he was quite progressive. He was a bit of a medical leader in his way. He was quite involved in the development of postgraduate education in Ireland for family physicians and CME. I think he always felt that coming together and cooperating and working together as a professional group was the way forward, and that multidisciplinary teams and working with other professionals made a huge difference.

I think he'd be very proud of what has happened in Ireland, and what's happened in the work we've done internationally. But I think he would have always felt that the future was going to change in family medicine. I suppose the bit that heartens me is when I travel around the world and I see in many countries that primary care, particularly family medicine, is evolving quite rapidly.

We're involved in the forefront of a lot of that change, in developing residency programs in countries like Malaysia where we're running the National Family Medicine and Residency Program with the Irish College General Practitioners. And in Saudi Arabia where we've helped them scale by 800%, to Family Medicine and Residency training in the Kingdom of Saudi Arabia. Ultimately, looking after patients close to home at a lower cost by people whom they know and trust is the solution.

Technology now has obviously further enabled that with all of the wearables and trackables and the telemedicine approaches which are very exciting in terms of the opportunity they provide to both scale our care delivery, but also to reduce costs and to make it more affordable.

Dr. Rishi Desai: Walk me through what first got you interested in medical education, specifically? Was it meeting someone? Was it interacting with a group? What sparked that for you?

Dr. Tom O’Callaghan:  I know you from we met at Stanford many years ago and you were on that journey yourself with Osmosis. But I think I probably came to it a little bit later in life. I suppose it was teaching undergraduate medical students who used to come out and do a placement in primary care and family medicine, and it was often the placement they valued most. It was the experience where they got out into the community, got to meet people, understand the interaction between the psychological, the physical, the emotional, the social -- things that all go to make up someone's life and how they all interact.

Meeting those medical students and being involved with them inspired me to do more. I always felt that this is something that we do know, that very many of the countries in which we operate family medicine and primary care hasn't really scaled the way hospital medicine has. The opportunity to do that in a digital way, and to support countries to build that capacity I think was a very exciting opportunity, and I suppose that's what we've spent the last five or six years doing in different ways.

Dr. Rishi Desai: That brings me to iHeed, and this project that is grown in so many interesting and different ways. You mentioned Saudi Arabia and Malaysia. For those that may not be familiar, how do you describe what iHeed does and how has it evolved over the years? 

Dr. Tom O’Callaghan: iHeed is an online medical education organization, and in truth it's a bit of a social enterprise. It started as a social enterprise. It really is around designing, developing, and delivering postgraduate education programs and residency programs for doctors, nurses, and other healthcare professionals in about sixty-five different countries around the world in partnership with leading medical universities.

I suppose you'd call us an online program management company. That is the technical term. What we do is we design, develop, and deliver the program in partnership with the university. The person gets the value or the qualification from a world-leading university at a cost that's affordable in a way that's accessible to them without having to leave the workplace. Many of these physicians and nurses are female, and often don't want to travel abroad and the healthcare system in which they're operating is under-resourced, so they can't afford to have them leaving the healthcare system.

So, they get to build their skills and their competencies through us. They get to interact with the global community of passionate medical educators who can share their experiences, and other fellow students who are going through our program, and they get to use that as a way of improving their ability to deliver care to their patients. Also, to perhaps get a promotion or change direction in their career, and we're finding more and more people now post-COVID who want to go into different areas of practice in leadership and public health, medical education, or research, etcetera, and change the trajectory of their career.

And then often, it's around global mobility for people…giving them an opportunity, perhaps, to move to another country and take up a position. Obviously, having a postgraduate qualification helps them to do that.

Dr. Rishi Desai: You kind of alluded to this, but I'd like to just learn a bit more. Are there certain subgroups or folks that this particularly appeals to? You mentioned many may not be able to leave for various reasons, and the fact that you can do this maybe with a more flexible schedule. What have you found in terms of creating a bit more equity in terms of who ends up in healthcare?

Dr. Tom O’Callaghan: I suppose in truth, Rishi, we're in the postgraduate space, so we're not dealing with undergraduate people who are entering medical school. We're dealing with people who've already been through a graduate education program, and then they're looking at where they're going next with their careers. We're focused on helping them on their postgraduate journey, or the residency journey. 

It tends to be predominantly a mixture of students, right? About a third of our students are from Europe, which more and more students are studying online, closer to home, as you know. About a third of our students are in the Middle East, and about a third of our students are in Asia and the rest of the world, across about sixty-five countries. I would say about 80% of our students are doctors right now and then the rest is made up of pharmacists, nurses, and other ancillary healthcare professionals who may want to take, for example, a master's program in diabetes care, or a professional diploma in Women's Health or Pediatrics.

There are specialist qualifications in their area of expertise, or there are more broad kind of masters qualifications which allow them to transition their career into areas like public health, medical education, research, healthcare leadership, etcetera.

Dr. Rishi Desai: Given this experience, what have you noticed are some ways in which this ed-tech has improved medical education? What have you cited as bullet points or highlights along the way?

Dr. Tom O’Callaghan: I suppose the first one would be that your online experience can be just as good, and often better, than your face-to-face experience. One of the secret ingredients is the international perspective. You and I are medical colleagues. You are in the U.S. and I'm in Ireland sharing this experience. But if you add fifty people to the conversation or thirty people in an online class who are spread across sixty-five different countries, people can share their experiences and knowledge of what works in their environment. That is, I think really the secret sauce.

The other thing is the ability nowadays to develop skills online, and to build competencies online, is something that we've focused on and being able to track those competencies in a real-time way is important. We've been able to measure that and improve people's clinical skills and competencies online. That allows you to really upskill people in a way perhaps that wasn't done in the past. That's one thing. 

I think the second thing is that medical regulators all around the world have changed their perception of online education. For example, we would have found when we went to the Middle East, particularly, that they would have said most of any program would have to be delivered face-to-face, and only ten or twenty percent online. They went from that, to becoming the most global advocates for online education and wanting to move all their programs online. During the pandemic that accelerated for everybody because everything moved online.

It's really now the accepted gold standard, and in terms of educational outcomes, one of the things we've focused on is supporting our students in every level of the journey with us. Our net promoter scores are up in the eighties and nineties for all our programs, and our student satisfaction rates are in the high nineties.

We're doing something right in terms of the student experience. I think that's the critical thing. Then, the flexibility and being able to suit the flexibility of people's lives, and cost is a huge issue. All of those things. 

The last thing is the flexibility in terms of the start date for a program. I suppose traditional university programs would start at the beginning of a semester, whereas we have rolling intakes quarterly or even more frequently -- six or eight times a year -- to allow students to take a program when it suits them, rather than particularly turning it on its head and saying this is what we offer as a university at a time that suits us. It suits the student at all times if at all possible.

Dr. Rishi Desai: What about patient outcomes? Have you seen compelling data that shows that doing this online approach actually leads to not just more happy students, and students that can access the education, but all the way down to patients getting better care?

Dr. Tom O’Callaghan: Yeah, and I know this is something that we've advocated in iHeed for a long time: bringing together that research data. I know it's something you're quite passionate about as well. I think, through the lens of COVID, we've seen a rapid acceleration in the amount of research done in this space, and the data that's coming true to back that up.

Without getting into individual studies, there's been a significant increase in the amount of research data that shows that online medical education can have a direct impact on patient care, on building competencies, and building skills within the health workforce. I think what we focus on a lot in terms of our education programs is real-life improvement of your organization.

To give you an example: If somebody is doing a master's program with us in diabetes care, what we would ask them is to focus on a quality improvement initiative within their clinic, within their practice, within their organization, and measure that over a six month period as part of their education in the master's program. At the end of it, they would have a real measurable clinical improvement outcome to their practice. I think people really value that and their organization values it, and clearly, it's what we're all about. We have to be about improving patients' lives and communities' lives, because that's what motivated all of us to do this work.

Dr. Rishi Desai: Totally. And right now, one of the big issues is the global shortage in health workers. Do you mind extending that thought to how this can help effectively raise the line, which is what this entire podcast was founded on: The idea of increasing healthcare capacity? Walk me through how that's working through iHeed.

Dr. Tom O’Callaghan: If you think about it, it's a big global challenge. We're trying to fill a bucket of a 7.5 million global health worker shortage, which is going to accelerate to 12.5 million in the next ten or fifteen years. I was looking at your recent published data from Elsevier on future-proofing the health system, and we're seeing the same thing. We're seeing 30% to 50% of health workers looking to change their career, to leave the health workforce, so we're in a real crisis.

People are obviously stressed. There's burnout. We're hearing it from all the primary care and organizations were working with. People feel undervalued, and are looking for other options. I think we have a mammoth task on our hands. The good news is there are a lot of really good people and good organizations, like yourselves and ourselves, focused on this and we now have the tools and the technologies and the adoption of them -- and the acceptance by medical regulators -- that they can make a real difference. I think the softer end of it is in areas like postgraduate medical education and residency education. I think it's more challenging when you get into undergraduate medical education, where you're asking, I suppose, regulators to have a huge mind shift.

I know many of the people we would both have interacted with would have a vision of moving the whole undergraduate curriculum online and shortening the duration of the medical undergraduate program. I think some of that change will come slowly. There will be a big move to task-shifting to broader health workers, increasing healthcare assistants, and increasing the number of nurses -- which equally is a challenge -- and accelerating the paths to careers for nurses and other healthcare professionals. I think we have to welcome that. In my experience over the years, nurses are fantastic and can do ten times the amount of work a doctor can do at a fraction of the cost and often in a much more empathic and human way. I think if we can support all of those initiatives, I'd be quite optimistic that over the next ten, fifteen, or twenty years we're going to make a big impact on that number.

Dr. Rishi Desai: I'd be remiss if I didn't ask about how COVID has affected both iHeed and what you've seen overall in this model of online education. What has changed in your mind?

Dr. Tom O’Callaghan: The big thing, Rishi, is what I said earlier. It's just becoming the accepted norm, and in fact been advocated by everybody. There's no going back, which is a great thing. I think the evolution of the technologies and the tools has accelerated even further, which is fantastic. We're doing things now that we probably wouldn't have thought we were able to do twelve months or two years ago, which is very exciting. The funding is there to drive on and have the impact we all want to have. 

When you look at the countries that have very poor infrastructure in the developing world, that is a real challenge. I had the good fortune many times to be down in Africa and to meet the various health care ministries and governments. They have a real challenge around primary care and community-based care. Obviously, technologies offer the opportunity to accelerate that, but I also think we need more medical education programs specifically developed to help build the skills in medical education in these countries. That's one of the areas I'm quite passionate about. 

We have built a really exciting Medical Education Master's program with the University of Warwick. I'm excited that we're putting a large number of very young, enthusiastic, and driven people through that program who really want to go out and have an impact, and they're across very many countries. I think that they're going to drive that innovation, which is really exciting.

Dr. Rishi Desai: That's awesome. Yeah, the idea of medical education being taught more informally makes a lot of sense, especially given the instrumental role it plays in the global economy. 

Do you mind teaching us something? I know that at Osmosis we love to fill knowledge gaps and bust any myths that may be out there. In your experience, what are some areas where you feel like folks may not know something that they ought to know or should know? It could be on any range of topics. Feel free to choose what you like.

Dr. Tom O’Callaghan: Thanks, Rishi. I'll bring it back to primary care again, and to family medicine. Go to North America or the U.S., where perhaps the healthcare system is more hospital-centric and more care is delivered on a hospital level rather than as community care, and say a country like Ireland, where 95% of illness is dealt with in the community by a family physician. Only one of every ten consultations is a referral. 

Then you go to other countries -- India is an example that springs to mind -- which had a very good, evolved, and developed primary care system. But, because of rapid privatization, it's now moving towards a very hospital-centric care system where people end up getting unnecessary procedures and unnecessary investigations because of it being driven by a private consumer model.

I think we need to get back to basics. Thinking about really looking at the patient holistically and in the community and saying what can we do that makes a difference in preventative care in the community at a low cost that makes a real difference in patients' lives over the lifetime of this individual? I think that's where I believe the future for medicine is, and I believe the technology is really going to transform that. Telemedicine already has. Trackables and wearables and remote monitoring has. Also patient empowerment, and patients taking responsibility for their own care.

If I was to say where you'd love to see it go, that's where you'd love to see it go. I think you worry that economic forces often drive it in the other direction, particularly private corporatization. The experience I've had in my life has been to understand the value of really good community-based care. Often people ask me at a personal level, what's important for my healthcare? And I say probably the most important thing in your life is to have a good family doctor -- somebody who you know, trust, respect -- and go to them when you need good counsel.  I think if you have one of them, you're far more likely to have a better healthcare outcome to every illness you have in your life.

Dr. Rishi Desai: I couldn't agree more and nowadays, that also spans mental health and wellness in general as well…just making sure that someone's on your side. So, I appreciate that advice. Now, I know you have a lot of mentees in your life that you advise and help out in various ways. In our audience, we have a lot of students and a lot of early-career health professionals. What advice could you offer them in terms of meeting the challenges of this moment? They're coming out at a very unique time with COVID-19 and they may be looking at your career and just inquiring as to how they may be able to do something analogous in some way to what you've been able to do. What would you tell them?

Dr. Tom O’Callaghan: I'm really inspired by the young medical students and particularly the young doctors I meet and young nurses and other healthcare professionals I meet around the world. Their passion and their motivation to make a real difference in the world I think is really important and critical right now at this really challenging time for the world, both with climate change and sustainability, and economically.

What I would say to a lot of young people is really believe in yourself and believe in what you want to do with your life. And be brave. Don't be afraid to make mistakes. When my dad died, I found his old doctor’s bag, and in the bottom of it, underneath all his stuff, he had a little note. that said, “When we are old enough to know that we know nothing, it's then that we know something.”

It always stuck with me that he had this in his own bag obviously for very many years. But I would say to young people, don't be afraid to make mistakes. Know that ultimately, it's in making mistakes that you get to learn and know about life. Also, follow your heart. If you can make a difference in other people's lives, and if you can touch other people's lives, that will reward you more than anything else financially or otherwise.

Dr. Rishi Desai: He sounds like a very humble man, a very wise man. That's a wonderful piece of advice and a great way to end. Thank you so much for being with us today.

Dr. Tom O’Callaghan: Great to talk to you, and keep up the good work.

Dr. Rishi Desai: I appreciate that. I'm Rishi Desai, 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.