Leadership in Medical Education: Design Thinking

By Alexei Wagner (@docwagzand Michael Gisondi (@MikeGisondi)

Technology has improved most activities of our daily life, but at times don’t you question whether the tech gods forgot about teaching hospitals and medical schools?

Sure, we have some gadgets that you plug into the wall to make teaching more interesting (hat tip to you, simulationists), but we can do better for our students than PowerPoint and clickers.

Enter the era of Design Thinking in medical education.

Design Thinking is defined as a human-centered approach to problem-solving. Examples of problems that can be tackled include product development, process improvement, and experience design. Prototypes are iteratively created and tested with end users to gather meaningful feedback. Testing prototypes early and often minimizes the risk of launching a solution that does not optimally solve user needs.

Among the first — and best — introductions to design thinking was the ABC News Nightline episode, “The Deep Dive: The Shopping Cart,” which featured the company, IDEO, on July 13, 1999. [This is a must-watch and debrief with your medical education faculty and fellows.]

Design Thinking has 5 classic steps:

  1. Empathize: the upfront work that is required of designers to deeply understand the needs of the customers they serve
  2. Define: the clear articulation of the specific problem or challenge that designers need to address
  3. Ideate: the stage in which designers move from identifying problems to creating solutions; ideas that are generated provide the source material for prototypes
  4. Prototype: the creation of experiences and artifacts to elicit feedback from consumers
  5. Test: the solicitation of user feedback to prototypes and the iteration of additional solutions based on that feedback

Design thinking is a tool to understand user needs and then design solutions to meet those needs. Starting a design with an understanding of the end user requires the designer to be open-minded and not limited by predefined constraints. Designers uncover the needs of their users through research methods that employ interviews and observations. Problems are redefined from the user’s perspective in order to design authentic solutions for prototyping.

Design thinking can reimagine learning environments. Design for a new generation of students who are digital natives, defined by how they experience the world (and Dopamine) through their use of smartphones and computers. Design for modern learners who expect the bedside application of knowledge that was published online just yesterday.  Design for health care systems that must make complex resource allocation decisions about transformative, new technology.

Designing: EducationMany lectures, courses, and curricula result from merely considering the intersection of the left two circles above – is what I plan to teach feasible, and does it meet the educational mission/goal of the instructors/institution?

Design thinking fundamentally alters the conversation. Instead – does this new curriculum or lesson solve a latent student need? Is this innovation something students will want to use as a learning tool? Are the instructional sessions appropriately designed for my students and their unique learning environments?

When curricular or educational tools address all three considerations in the above graphic — Viability (educational mission), Feasibility (technology), and Usability (student values) — the result is better content, quicker adoption, and happier learners. “This curriculum ‘gets’ me and my needs.”

We see this model played out time and again in medical education. Here’s an example. An emergency medicine residency program decides that suturing is a core skill that interns need to learn; the faculty members develop a suture lab and PowerPoint slide deck, schedule dates for classes, and then mandate that residents attend workshops and lectures.

In the simplest form, design-driven education would flip this sequence upside down. Instead, the residency program would seek to understand the educational needs of the residents. Knowing educational milestones is not enough; curriculum designers also need to understand the latent needs of their students.  Not just the ‘what’ the resident needs to know but also the ‘why.’ In the suturing example, the resident does not just need to learn to suture. The resident also needs to learn to tie knots well enough that their supervising physician builds trust in their skills, then including the resident on more complex cases in the future. Understanding this latent need allows the program to design a suturing curriculum that targets specific, high-value suturing techniques or experiences that simulate the varying preferences of their supervising physicians.

Find an Instructional Designer and Get Started!

You may not know your local, neighborhood, educational designer, but you likely have one at your institution — if not an office full of them. An Academic Medicine Last Page described the recent spike in demand for instructional designers at US medical schools. These design experts offer valuable skills and potentially exciting new partnerships for your medical education faculty.

“Future hard trends in medical education” may require that our faculty members demonstrate expertise in design and tech, according to a 2018 JGME editorial. Want to explore your creative side and become a designer yourself? The Stanford d.school trains students and professionals from any discipline in the principles of design thinking.

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About the Authors:

Alexei Wagner MD, MBA is a healthcare designer and Clinical Assistant Professor of Emergency Medicine at Stanford University. He is a visiting lecturer in the Stanford d.school.

Michael Gisondi, MD is Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford University. He is an ICE Blog Editor.

Featured Image: Inside the d.school at Stanford University, Credit: Alexei Wagner