Necessity is the mother of invention. Crises spur innovation. This time-honored concept is playing out once again. COVID-19 generated an urgency to innovate so that hospitals could care for the sick, so that people could continue to work, and so that children could continue to learn. Innovation blasted from every crevice and crept into everyday life. Medicine is no exception.
Andrea Wolf.Advances that were on the cusp of adoption vaulted to center stage. Before COVID, remote monitoring and telemedicine were slogging along, fighting against traditional ways of practice. They became mainstream overnight.
A recent study showed a 63-fold increase in telemedicine appointments for Medicare patients since the pandemic began.1 Overall telehealth usage has stabilized at about a 38-times increase from prepandemic levels.2
Patient and provider openness to new ideas for optimizing clinical workflows paved a path to new ways of solving problems and accelerated solutions that had been percolating but fell short of adoption. In 2020, 20% of hospitals across the country had adopted remote patient monitoring (RPM) systems and 23% more said they had plans to do so in the following 12 months.3 These innovations extend well beyond COVID-19 prevention and care.
Innovations in education and training
Radiology, especially breast imaging, needs to rise to the top of this innovation turning point. COVID has made it harder for radiologists to keep up. Burnout is at the top of every administrator's concerns. Clinical workloads for radiologists have skyrocketed. As a result, training and professional development have been set aside. But radiologists still want, and need, to stay abreast of their rapidly changing profession.
The confluence of COVID and an accelerating on-demand culture have laid the foundation for radiology education to transform. Companies like Peloton, Uber, and Netflix paved the way for on-demand radiology education that melds seamlessly into radiologists' lives.
In addition to the on-demand trend, COVID impacted traditional opportunities for clinicians to develop and learn new skills. CME training facilities closed. Fellowship opportunities were put on hold. Lecture series and in-person conferences were canceled and then forced to adopt suboptimal virtual models.
Learning models need to innovate beyond the "let's just do the same thing but in Zoom" mentality. And clinicians no longer have the luxury to take several days out of their work and family life to travel to conferences and training programs. Clinicians need training platforms that are available to them on-demand.
Breast imaging case in point
This rings particularly true in breast imaging. Breast imaging is a great example of a field that is on the cusp of massive acceleration into new ways of practice. Radiologists reading breast cases need to stay up to date on the latest imaging modalities, guidelines for screening, and AI and other new technologies. Access to leaders in breast imaging through microlearning will give radiologists at all stages of their careers the confidence they need to tackle cases that seemed daunting before, even as breast imaging changes and grows.
Over the past four decades, breast imaging has evolved slowly. In 1976, the American Cancer Society recommended mammograms as the standard of care for average-risk women starting at age 50.4 But conventional mammography has significant limitations in specificity and sensitivity, especially in women with dense breasts.5 Mammograms have been the standard of care for all women for over 40 years. This is changing.
Now, the American College of Radiology recommends that higher-risk women use a range of modalities to screen properly for breast cancer.6 These include MRI7 and ultrasound.8 New forms of mammography, such as multimodal, grating-based, phase-contrast mammography, and absorption-contrast breast CT are being used more often.9
In 2011, the U.S. Food and Drug Administration (FDA) approved digital breast tomosynthesis as a recommended imaging modality for breast screening and diagnosis. It is increasingly used nationwide.10 In 2015, the FDA included dedicated breast CT as a diagnostic tool in breast imaging.11
Imaging modalities and techniques are increasingly vast. But changes in breast screening and diagnostics extend beyond imaging modalities. Artificial intelligence (AI) in breast imaging is quickly being recognized as a valuable tool for better and earlier detection in AI computer-aided detection software (AI-CAD) as well as for reductions in workflow (AI-triage). AI adoption will lead to increased efficiency, improved quality, and cost-effectiveness. Specifically, AI-CAD's application will lead to better identification; segmentation; and classification of lesions, breast density assessment, and breast cancer risk assessment.12
Changes to imaging modalities and interpretation are coupled with a controversial world of screening guidelines. Unlike most radiology subspecialties, breast imaging is often performed on asymptomatic, healthy women. Despite compelling data, medical societies still do not agree on screening guidelines or the use of screening modalities beyond mammograms for higher risk women.13 This can make it harder for radiologists to understand patient risk profiles and guide patients about personalized breast imaging options.
The solution: On-demand microlearning
But there is a solution. Radiologists reading breast cases need a new paradigm for staying up to date without taking big chunks of time that they do not have. Microlearning, such as the options put forth by MRI Online in radiology, Osmosis for medical students, BioDigital for patients and providers, and GibLib in Surgery, will be the antidote for providers racing to catch up with breast imaging's rapidly changing and, often, confusing landscape.
"Microlearning is a holistic approach for skill-based learning and education which deals with relatively small learning units."14 Microlearning is used to improve skills and increase facility with a particular field or area of expertise. Historically, medical education has been transmitted through longer lectures and multiday courses. Medical conference agendas are packed with 45-minute to multihour lectures.
Today's mobile, fast-paced world is demanding that people, especially physicians, have access to on-demand content when and where they need it, in increments that work for busy people. Brands like Peloton, Netflix, MasterClass, Coursera, and Uber arose because people want workouts, entertainment, education, and rides on demand. It is time for medicine to keep pace.
Opportunities for radiologists to have on-demand, case-based, and bite-sized learning at their fingertips will improve efficiency, accuracy, and, ultimately, patient outcomes. Breast imagers, and all radiologists, can learn and grow when they are relaxed and open to new information. One radiologist mentioned that he took courses during football game commercials. This is how people function and consume information in 2022. In addition, if widely adopted, microlearning holds the potential to reduce radiologist burnout, increase work satisfaction, and increase overall retention of radiologists. Radiologists will be happier if they can learn and grow on their own schedules.
In addition to transforming the way radiologists learn about breast imaging and giving them the ability to acquire new skills on-demand, microlearning for radiologists will reignite their passion for radiology. We rarely hear the words "passion" and "radiology" together anymore. If and when microlearning in radiology is widely adopted, it is not an exaggeration to say that radiologists will feel more confident, patient-focused, and satisfied.
Medical microlearning environments and technologies will lead to a world where more radiologists find satisfaction and, dare I say, passion, in their practice. COVID-19 paved the path for an explosion of healthcare innovation for patients. It is high time for the same openness to innovation for providers to gain traction and adoption. On-demand, accessible learning is the first, critical step in this direction.
Andrea Wolf is the CEO of the Brem Foundation to Defeat Breast Cancer. In this role, she works to maximize every woman's chances of catching early, curable breast cancer through education, access programs for women in need, and physician education. Andrea started the country's first and only ride-sharing program exclusively dedicated to transportation for breast care. Prior to her current role, Andrea served as the director of public policy for Girls Inc., a national education nonprofit for low-income girls, and, before that, Andrea was an attorney in Litigation and Public Policy at Patton Boggs.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
References
- https://www.hhs.gov/about/news/2021/12/03/new-hhs-study-shows-63-fold-increase-in-medicare-telehealth-utilization-during-pandemic.html
- https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
- https://insights.samsung.com/2021/07/26/6-remote-patient-monitoring-lessons-learned-from-covid-19/
- https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/overview/chronological-history-of-acs-recommendations.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957539/#:~:text=Breast%20Tomosynthesis%20was%20US%20FDA,and%20is%20now%20widely%20used.
- https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Breast-Cancer-Screening-in-Women-at-Higher-Than-Average-Risk
- Id.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872003/
- https://www.sciencedirect.com/science/article/pii/S1120179720302684
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957539/#:~:text=Breast%20Tomosynthesis%20was%20US%20FDA,and%20is%20now%20widely%20used.
- Id.
- https://www.frontiersin.org/articles/10.3389/fonc.2021.600557/full#:~:text=Early%20screening%20for%20breast%20cancer,studied%20in%20breast%20cancer%20screening.
- https://medicine.yale.edu/news-article/searching-for-clarity-among-conflicting-breast-cancer-screening-guidelines/
- https://en.wikipedia.org/wiki/Microlearning
