Author Archives: Jeffrey Levy

Werkema Interview Front PageThe Gynecology and Obstetrics experience offered by the four communities affiliated with Michigan State University provide residents with exceptional diverse rotations in all sub-specialties. As part of this affiliation, the Grand Rapids Medical Education Partners program, consisting of 32 residents, covers two different institutions by itself – a smaller Catholic hospital with about 2,500 deliveries each year, and a larger tertiary hospital with 8,000 deliveries each year. As Program Director, Dr. Michael Werkema oversees this very big, very busy program.

In this backdrop of a program with high clinical volume, Dr. Werkema shares his experience integrating CoreCases into his curriculum and his comments on this generation of learners.

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What was your motivation in bringing CoreCases into your program?

Our residency program is highlighted as a distinguished program, and one of our strengths is our clinical volume. However, based on resident evaluations, one of the areas we were looking to strengthen was the didactic portion of our program. We wanted something we could add in to augment our didactic curriculum and make it stronger.

We have an excellent clinical faculty, but that doesn’t always translate to providing the best lecturers. And even if we were to put together more lecturers, we would still need some help with the basics, because residents are just not going to get it all from a lecture. Also, lectures have been shown to yield low retention – you get the most in the first 15 minutes and after that retention really slips. We wanted something that the residents could use, on their own time, which would be effective in improving their retention of medical knowledge.

How are you using CoreCases in your program?

I assign the cases based on what is pertinent to our current academic rotations. I assign one to three cases per rotation and make them a curricular component of each rotation. Upon completion of that rotation, those CoreCases have to be done. I also involve the faculty on those rotations, so they know what the residents will be doing.

There are 48 cases in the complete curriculum, so you should be able to cover a quarter of them each year, starting as an intern through their chief year. Since we started in June, some of our third and fourth years wouldn’t be exposed to all of the cases. But I also opened the door, so that if anybody wants to move ahead or move backward, I can assign additional cases. When I do that, I’ll give them cases from their upcoming rotation so they can get ahead. Then, if they are a third or fourth year and get those done, I’ll pull some of the first and second year cases for them. I’ve had a couple of residents that have done probably 20 additional cases as they have gone through certain rotations

What has been the participation and feedback from the residents?

Compliance and participation is good. It’s interesting to note that probably one-third of residents access the cases every week and about one-third log on every other week. So I’m happy with something that can engage two-thirds of our residents and keep them involved.

The residents really like them and find the cases really user friendly. From my own experience with several of the cases and the comments from the residents, the overall feedback is that this is a very succinct and interesting way to teach this generation of learners, those who are more familiar using technology.

I really like it because it does augment what we’re doing in a way that’s less boring than lecturing at them for 45 minutes. The key points of each case are highlighted, and I think they’ve been spot on and accurate.

The residents also like the ability to go back through the case and look at all the answers so they can see some of the reasoning as to why some answers are incorrect and why other answers might be better choices. I think that’s part of the strength of the program, because sometimes you learn a lot more from getting something wrong than from getting it right.

We are now working with the reporting features of the program. It’s able to collect a lot of data in terms of evaluation and finding areas of deficiency. We want to use them for our clinical competency committees (CCCs), but still need to work out the best way.

Have the resident’s overall exam scores improved?

I’m currently doing an assessment that will correlate our inservice exam in January, resident CREOG scores, and Boards in June with the performance and use of the patient cases in the CoreCases curriculum. We want to see how it equates with the different scores and whether there is any relationship.

I plan on running a full statistical report on all residents the week before the exams. This will include things like time stamps for when they completed the case, their scores, the number of cases they’ve completed, the amount of time they’ve spent in the cases, the milestone levels they’ve achieved as reported in the cases, etc. I would expect that some of these parameters would reflect an increase in scores.

Has CoreCases met your expectations, and where do you see it going?

I think it’s been a very good asset to our current strategies. I think it is an excellent tool to use to expand what we are already providing to highlight important points within a rotation. For example, we are currently using point-of contact evaluations, end-of-rotation evaluations, in-service examinations, and question-bank software.

It also provides a platform that our modern day learner is much more comfortable with as opposed to the in-room didactic-type curriculum. That’s a huge point.

The other place I see CoreCases fitting in is for use in faculty lectures. When you have an institution that’s very clinically based as opposed to academically based, getting faculty to present lectures on a regular basis is a lot of work. With the CoreCases curriculum, we now have appropriate patient cases the faculty can use to supplement or use outright as a basis for their didactic lectures. This way, our faculty can add their professional opinion in addition to the discussion that’s coming from the case itself. It can make prepping for their lectures a lot easier.

Michael S. Werkema, MD is Program Director, Obstetrics and Gynecology at Michigan State University, Grand Rapids Medical Education Partners, Grand Rapids, MI 2015 Interview with CaseNetwork LLC.

CaseNetwork Medical Hall of Fame: Leonardo da Vinci

Leonardo da Vinci, 1452-1519, The Original Renaissance Man.

A multi-faceted genius, da Vinci exemplified the true Renaissance Man. Painter, musician, philosopher, scientist, architect and inventor, he sought to discover all he could about nature, including the human body. Leonardo used his anatomical knowledge and prowess to create a robot that, in his opinion, was a machine in structure and could imitate the human body by the use of mechanical parts and levers.

BACKGROUND

Presumed self-portrait by Leonardo da Vinci

Presumed self-portrait by da Vinci

Leonardo da Vinci was born in Vinci, Italy in 1452 of humble origins. Born out of wedlock, son of a notary and a peasant girl, he is thought to be the world’s most illustrious painter. His paintings of the Mona Lisa and The Last Supper are perhaps two of the world’s most famous paintings.

The Last Supper (Leonardo da Vinci)

The Last Supper by Leonardo da Vinci

Mona Lisa

Mona Lisa

Living with his father’s family, he was apprenticed at age 14 to an Italian sculptor and painter, Andrea del Verrocchio. At age 20, he earned a place as a master artist in the painter’s Guild, and by the time he was 26, he was an expert painter, owning his own studio. While at del Verrocchio’s, Da Vinci learned the art of painting, including anatomy and perspective and he also studied sculpture, the mechanical arts and engineering. This apprenticeship brought a wide breadth of knowledge and an appreciation for the laws of science and nature.

RENAISSANCE MAN

A multi-faceted genius, da Vinci exemplified the true Renaissance Man. Painter, musician, philosopher, scientist, architect and inventor, he sought to discover all he could about nature, including the human body. He began his quest by dissecting cadavers in greater detail than even the physicians did and became a master of topographic anatomy. His sketches of the human body changed the way anatomy was studied. By attaching strings to muscles, da Vinci learned how the human body was articulated, in minute detail. The extremely detailed drawings da Vinci made of human anatomy are deemed comparable to what modern technology can produce today.

Human anatomy sketch by Leonardo da Vinci

Human anatomy sketch by Leonardo da Vinci

Human anatomy sketch by Leonardo da Vinci

Human anatomy sketch by Leonardo da Vinci

LEONARDO’S ROBOTS

Leonardo da Vinci was a prolific inventor who created designs for cars, helicopters and bicycles as well as war machines and weapons.

Helicopter designed by Leonardo da Vinci

Helicopter designed by da Vinci

Glider designed by da Vinci

Glider designed by da Vinci

Spring Catapult by da Vinci

Spring Catapult designed by da Vinci

Watermills designed by Leonardo da Vinci

Watermills designed by Leonardo da Vinci

He created several types of robots including a walking mechanical lion and a spring powered car, thought to be the first programmable computer. When Leonardo created his robot in human form, it was of a knight whose appearance was one in the tradition of the time, Italian-German armor. He created his Robot-Knight to prove to himself that a human’s body could be imitated and also, in part, to show it off at parties on behalf of his patron at the time. Leonardo used his anatomical knowledge and prowess to create a robot that in his opinion, was a machine in structure and could imitate the human body by the use of mechanical parts and levers.

Robot built by Leonardo da Vinci

Robot built by Leonardo da Vinci

When the robot was completed in 1495, it was said to have the capability to walk, sit and stand, open and close its mouth, move its head and lift its arms. The robot’s jaw had been noted to have been anatomically correct.

His robot had two working structures. The first was a system controlling the use of the hands, wrists, shoulders and the elbows, with the chest containing the means of power to move the arms. The second was a system controlling the ankles, knees and hips. This was powered by a crank to a cable which was connected to all the leg components.

USE OF DA VINCI ROBOTICS FOR SPACE EXPLORATION

Leonardo’s robots and designs have been used by NASA for a robot to man a space station and eventually aid in colonizing Mars. An expert on robotics, Mark Rosheim, spent 5 years bringing da Vinci’s robot to life and making adaptations to it for NASA. It was he who coined the name Anthrobot, a combination of the word anthropology (a study of human origins and development), and robot (a mechanical automation). NASA’s robots are called Anthrobots, which include articulating joints and actuators that can perform tasks where dexterous manipulation or telemanipulation are required.

LEONARDO DA VINCI AND CASENETWORK

As CaseNetwork continues its development of education and training programs to teach the fundamentals of robotic surgery, it is appropriate that Leonardo da Vinci be added to CaseNetwork’s Medical Hall of Fame.

For da Vinci, some 500 plus years before his time, through his drawings, exquisite understanding of human anatomy and creation of the first robots, accomplished things that scientists and the medical community had yet to conceive. It wasn’t until the latter part of the 20th century that the true measure of his genius was realized by the world today.

Leonardo da Vinci, 1452-1519, Creator of Masterpieces – art, drawings, anatomy, science, medicine, engineering and robotics. The original Renaissance Man.

Mona Lisa in the Louvre

Mona Lisa in the Louvre

All the best!

Jeffrey S. Levy, MD
CEO, CaseNetwork

(With special thanks to researcher and historian, Patricia L. Stellwagon)
 

Depression’s Impact on Hospital Readmission for CHF

In a recent study [i] from the Henry Ford Health System focusing on identifying predictors for early readmission in Medicare and Medicaid patients with heart failure, researchers found that “a psychiatric history of depression, anxiety and other mood disorders as well as impairments in a patient’s ability to think, remember and reason, may well be such predictors.” The possible implications are that early screening for depression, anxiety and other mood disorders among CHF patients can offer a means to identify risk of early readmissions and provide effective behavioral and educational interventions.

The Henry Ford study’s lead investigator, Mark W. Ketterer, Ph.D., indicated that “factors in 30-day readmission rates included immediate memory problems and a history of psychiatric treatment and/or the use of an antidepressant. The severity of congestive heart failure, however, was not a factor in either admission or readmission rates.”  While the study size was relatively small (84 patients who were admitted to Henry Ford Hospital for treatment of acute congestive heart failure) its results seem to reinforce earlier research from 2001 in the European Journal of Heart Failure that “depression is relatively common in this population, with a reported prevalence between 24 and >40% in patients with stable heart failure.”[ii]

The European study reported that:

“Our findings emphasise the importance of depression, along with clinically relevant prognostic indicators of severity of myocardial disease and comorbidity, as risk factors for mortality and hospital readmission in patients with dilated cardiomyopathy. The findings also support published data showing that psychosocial intervention deserve consideration as a potentially important component of prevention programmes…”

Dr. Mark Moore, Director of Psychological Services, Abramson Cancer Center at Pennsylvania Hospital, wrote that the Henry Ford study’s findings;

“(The findings) are intriguing and noteworthy, and it lends support to clinical observations that early readmissions in CHF patients are often related more to psychosocial factors than the presenting medical problem. Tellingly, the severity of CHF was not a factor in readmission, while memory problems, history of psychiatric treatment and use of an antidepressant were. If this finding can be replicated by others it would open up how we think about reducing readmissions and shift the focus onto a wider range of factors that are often ignored at great cost to the system.”

As health systems struggle to comply with Medicare’s readmission requirements, the use of psycho-social evaluations as part of a “high risk assessment” to identify patients with the greatest risk for readmission can be a cost-effective strategy. Considering that for 2013 Medicare has penalized 2,225 hospitals $227 million for “excessive readmission rates” and that these penalties will rise over time and include additional diagnoses, these results, while preliminary, should be viewed as an opportunity for the significant integration of a psycho-social ‘toolbox’ into discharge planning and post-acute care.
 


[i] Behavioral Factors and Hospital Admissions/Readmissions in Patients With CHF.
Mark W. Ketterer, Cathy Draus, James McCord, Usamah Mossallam, Michael Hudson
Psychosomatics – 09 September 2013 (10.1016/j.psym.2013.06.019)

[ii]Clinical Depression is Common and Significantly Associated with Reduced Survival in Patients with Non-Ischaemic Heart Failure.
R. Farisa,  H. Purcella,  M.Y. Heneina and A.J.S. Coats
European Journal of Heart Failure, Volume 4, Issue 4, Pp. 541-551

CaseNetwork Medical Hall of Fame: Elizabeth Blackwell, MD

Elizabeth Blackwell, MD, First Woman to Receive Medical Degree (1821-1910)

Elizabeth Blackwell was born in Bristol, England in 1821, daughter of Hannah and Samuel Blackwell and the 3rd daughter of 9 surviving children. Her father, Samuel, was very progressive and a social activist. He believed in women’s rights, temperance and abolitionism and had private tutors teach his children subjects such as mathematics, Latin and Greek. The family immigrated to the U.S. in 1832.

Several of his children followed in his reform principles. Elizabeth became the first woman to receive a U.S. medical degree, her sister Emily was the 3rd woman to be awarded a U.S. medical degree, son Samuel married Antoinette Brown Blackwell, the first ordained woman minister, son Henry Browne Blackwell married Lucy Stone, a prominent women’s rights activist and their daughter, Alice Stone Blackwell, a suffrage and temperance leader, was the head writer of the Woman’s Journal, Boston, The family was strongly opposed to slavery and after meeting with William Lloyd Garrison, became involved in abolitionist activities as well.

The Blackwell family suffered serious financial losses which culminated with the Panic of 1837. They relocated to Cincinnati, Ohio in 1838 and in that same year Samuel Blackwell died. Elizabeth helped support the family by teaching in a small private school that she and her sisters Anna and Marion established in Cincinnati. She also later taught in Kentucky and North Carolina, all the while pursuing her studies and interests in medicine and the reform movements. She studied privately with John Dickson in Asheville, N.C. and then his brother Samuel in Charleston, S.C. and in 1847 moved to Philadelphia PA with the intent of gaining admission to a medical school while still studying privately.

Blackwell was turned down by 29 medical schools to which she had applied when finally the administration of Geneva College, hesitating to admit her themselves, asked their students to make the final decision. The students laughingly said yes and so she entered their medical school as the first woman to be admitted. There, however, she was ostracized by both male students and teachers and she was not permitted to attend medical demonstrations. Yet when she graduated in 1849, she ranked first in her class and when she received her degree as the first woman to qualify as a doctor in the U.S., more than 20, 000 people came to watch her receive that degree . When the Dean, Dr. Charles Lee conferred it, he stood up and bowed to her.

Elizabeth felt that women might prefer consulting with and being treated by a woman rather than a man and, after graduation, moved to Europe where she studied midwifery at La Maternite in Paris as a student midwife. She gained a great deal of training and experience from the mentorship of Dr. Hippolyte Blot and by the end of the year, Paul Dubois, the foremost obstetrician in his time, gave his opinion that Elizabeth would make the best obstetrician in the U.S., male or female. While there, however, she contracted purulent ophthalmia and lost the sight in one eye. This forced her to give up her idea of becoming a surgeon.

In 1850, she moved to England and worked under Dr. James Poaget at St. Bartholomew’s Hospital in London where she met Florence Nightingale and Elizabeth Garrett Anderson. Both of these women were inspired by Blackwell and became pioneers for women in medicine in Britain. Returning to New York City in 1851, Blackwell was barred from city clinics and dispensaries because she was a woman and was unable to find appropriate quarters to rent. Finally, in 1853, she opened a clinic in an impoverished part of New York City where she treated women and children.

After a few years her sister Emily, now a physician, joined her in the practice along with Dr. Marie Zakrzewska (later the founder of New England Hospital for Women and Children). In 1857, the women expanded the clinic into a hospital, the New York Infirmary for Women and Children. During this time she adopted an orphan, Katherine Barry, who stayed with Blackwell the rest of her life.

Blackwell had ties to the women’s rights movement from its earliest days and was proudly proclaimed a pioneer for women in medicine as early as the Adjourned Convention in Rochester, NY (1848).

She once again returned to England and some years later became the became the first woman to have her name added to the General Medical Council’s Medical Register.

In 1851, Blackwell went back to the United States, which was on the brink of the Civil War. After the outbreak, she helped establish the Woman’s Central Relief Association in New York City. This group was instrumental in the establishment of the United States Sanitary Commission (1861). The organization, largely made up of women, aided the Union army by giving them food, medical supplies, clothing and other services.

After the war was over, she followed her long-held dream of founding a medical college for women. This was finally realized in 1868 with the opening of Women’s Medical College of the New York Infirmary in New York City where Blackwell’ s innovative ideas about a four year training period with a much greater clinical training were incorporated. Elizabeth became the Hospital’s first Chair of Hygiene.

She stayed but for a short time and returned to England in 1869 where she would remain for the rest of her life. In 1871, she helped establish the National Health Service and in that same year, Blackwell accepted a chair in gynecology at the New Hospital and London School of Medicine for Women. A year later she resigned that position and spent the rest of her life lecturing and writing. In 1880, Great Britain’s Fortnightly Journal listed six hundred names of prominent women for suffrage and Blackwell’s name appeared there among medical practitioners lending their name to the cause.

Over the next 30 years she published a number of books, essays and pamphlets in which she espoused her belief that many medical diseases could be prevented by proper hygiene and sanitation. She wrote that medical issues were often caused by societal problems such as poverty and lack of education. Blackwell was a strong proponent of moral reform, believing that men and women should be held to the same standard of behavior. In 1895, she published her auto-biography, “Pioneer Work in Opening the Medical Profession to Women.” After publishing her book, she gave up public reform work and spent much of her time traveling. In 1906, she visited the U.S., taking her first and only automobile ride.

In 1907, she had a serious fall and became almost entirely disabled. Blackwell died on May 10, 1910 in Hastings, England, leaving behind her an amazing legacy for women in medicine,

In March, 2013, the U.S. Department of Education celebrated Women’s History Month – Women’s Education, Women’s Empowerment – reflecting on amazing women who have left their mark throughout history. As part of their month-long commemoration of inspirational women, Elizabeth Blackwell, M.D, was highlighted as one of two women chosen because of their incredible ability to break glass ceilings through their dedication to education. She opened the door for women in medicine forevermore.

As Elizabeth Blackwell stated, “For what is done or learned by one class of women, becomes by virtue of their common womanhood — the property of all women.” Following decades of her pursuit of excellence, improvements in healthcare and an extraordinary commitment to women’s rights, I think that Dr. Blackwell would be very proud of the fact that today approximately 50% of all medical students are women.

CaseNetwork wanted to honor Elizabeth Blackwell’s pioneering work in medicine and especially her leadership in the field of women’s health as we roll out our Obstetrics and Gynecology resident curriculum. This product is called CoreCases and is a competency-based resident curriculum in the form of simulated patient encounters. It utilized the most advanced technologies to couple it with private social networks (peer-to-peer learning) and deliver it conveniently on mobile devices. As a result of this innovative education methodology, residents are able to learn faster, with greater efficiency and convenience. In addition, educators are able to track learners’ progress, measure achievement, and objectively and consistently demonstrate proficiency at specific milestones in training.

As CaseNetwork continues its pursuit to become the new standard in medical education, I can personally relate to another quote by Dr. Blackwell, “It is not easy to be a pioneer- but oh, it is fascinating! I would not trade one moment, even the worst moment, for all the riches in the world.”

All the best!

Jeffrey S. Levy, MD
CEO, CaseNetwork

(With special thanks to researcher and historian, Patricia L. Stellwagon)
 

CaseNetwork Medical Hall of Fame: Sir William Osler

SIR WILLIAM OSLER, MDCM, “FATHER OF AMERICAN MEDICINE” (1849-1919)

Few in history have impacted the field of medicine to the degree that Osler did from the latter part of the 1800’s through the early 1900’s. Notably, many of those same principles and practices are still being followed in present day medicine.
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Sir William Osler is known by most of the medical community as the “Father of American Medicine”, famous for so many of his outstanding contributions to the advancement of medicine in the 20th century and thereafter. His name is used in connection with diseases, syndromes and buildings. He is renowned for the books and articles he wrote and the teaching practices he instituted that educated generations of students during medical school along with physicians during their years of practice. Osler is remembered as a preeminent educator, innovator, internist, pathologist, historian, author, public speaker, bibliophile, humanitarian and practical joker.

Born in Canada, receiving his medical degree from McGill University in Montreal and taking his first professorship there, he continued his medical career first at the University of Pennsylvania, then Johns Hopkins University of Medicine and finally, Oxford University, England. His accomplishments at these prestigious institutions have had a profound impact on the field of medicine and have filled literally hundreds of books and thousands of periodicals and journal articles.

Surely deserving the title “Father of American Medicine”, many of Osler’s contributions have endured for over a century and are still are in place today. He was most proud of his ideas for establishing the first bedside teaching program, pioneered at Johns Hopkins, to take students out of the lecture hall and bring them to the patients’ bedside where they would experience clinical training firsthand.

Some of his other accomplishments include:

  • Created the first formalized journal club at McGill University for the study of medical publications at a group level.
  • Served as Chair of Clinical Medicine at University of Pennsylvania.
  • Co-founded the Association of American Physicians whose purpose was the advancement of scientific and practical medicine.
  • Co-founded Johns Hopkins University School of Medicine where he became the first Professor of Medicine and Founder of Medical Services.
  • Created Johns Hopkins School of Medicine’s first Residency program for specialty training and clinical clerkship.
  • Wrote what is said to perhaps be the most influential general medical textbook ever published, “Principles and Practices of Medicine, Designed for the Use of Practitioners and Students of Medicine”, Appleton, New York, 1892 (See excerpts from my personal copy of a first edition book).
  • Founded the Medical Library Association in the United States serving as its second president, and in Britain, was the first(and only) President of the Medical Library Association of Great Britain and Ireland
  • Appointed to the Regius Chair, Oxford University, England in 1905 and held that until his death. In 1911, he started the Postgraduate Medical Association there, becoming its first president.
  • Honored with a “baronet” in the 1911 Coronation Honors List for his many outstanding contributions to the field of medicine.
  • Created, established or instituted so many other firsts not being listed or given credit here.

CaseNetwork has based many of its educational philosophies on the past innovations of the “Father of Medicine”in our passionate pursuit to improve the future of medical education. The most important result is CaseNetwork’s case-based training and interactive, decision-oriented learning, which offers students and clinicians “simulated bedside experiences” in the same spirit as Osler’s groundbreaking approach. CaseNetwork also uses a collaborative peer-to-peer learning method with its educational social networks similar to Osler’s original formalized journal clubs.

One of Osler’s most famous essays entitled “Aequanimitas”, delivered at the University of Pennsylvania School of Medicine in 1889, exemplifies the insights and wisdom he passed on to the physicians and students of his time and for every generation since. He expounded the virtue of imperturbability or the outward expression of calmness, coolness and self-assurance even under the most difficult medical challenges. He also elucidated the virtue of aequanimitas, which is the personal quality of patience, tranquility, equanimity and goodwill. In his essay Aequanimitas he shared the following words:

Whatever way my days decline,
I felt and feel, tho’ left alone,
His being working in mine own,
The footsteps of his life in mine.

I strongly believe that innovations from the past, like those from Sir William Osler, help establish the foundation of the present and shape our responsibilities for the future.

All the best!

Jeffrey S. Levy, MD
CEO, CaseNetwork

(With special thanks to researcher and historian, Patricia L. Stellwagon)
 

Why CaseNetwork?

I am extremely excited on several levels about creating this new company, CaseNetwork that will help shape a brighter future for medical education.

AS A PHYSICIAN, I understand that most physicians are too busy and it is difficult for them to leave their practices to go to live educational programs. But I also understand that physicians have a need and desire to stay as current as possible in their field, so they can provide the best possible care for their patients. CaseNetwork will be smarter about education and help physicians learn faster, with greater efficiency and convenience.

AS AN EDUCATOR, I understand how physicians want to learn. I understand that they want to be engaged, challenged, and have interactions with their peers. Over the last 20 years, I have taught hundreds of thousands of physicians and have found that case-based education, a decision-oriented form of learning where physicians make active decisions throughout the educational experience is their preferred method of learning. In addition, if physicians have the opportunity to interact with their peers during the educational process, they are much more likely to take the newly learned information and apply it to their clinical practice. CaseNetwork is making social networking, or social learning, an integral part of our educational programs.

AS AN INNOVATOR, I understand that if technology is used correctly, it can be a tool that enhances the educational experience. I also understand that physicians are learning differently than in the past. They learn on the run, so they want anytime/anywhere learning and “just-in-time” learning. Through new mobile technologies, CaseNetwork will deliver the right kind of education to physicians when they want it and where they want it.

AS A COLLABORATOR, I understand that big ideas and big ambitions cannot be accomplished alone. CaseNetwork must partner with expert physicians around the world, with top academic centers, and with medical societies from every medical specialty. I believe that with strong collaborations, we can co-create a new standard of medical education that will have a positive impact on physicians, with the ultimate goal to improve patient care.

If you are interested in collaborating with CaseNetwork, please e-mail us at info@casenetwork.com

Here is to a brighter future!

Jeffrey Levy, MD
Founder and CEO, CaseNetwork

Education Philosophy

What is intelligence? How do people best learn? How do people process and apply knowledge? Can technology enhance education?

Over the last 20 years in my roles as a physician, educator, researcher and CEO, I have tried to answer these questions and apply innovative techniques and solutions to improve medical education. In the process, I have had the privilege to educate over 400,000 physicians and conduct hundreds of medical education programs. Below, I will describe some of the intelligence and learning theories that have influenced my thinking.

In the beginning of my academic career, I struggled to effectively teach medical students and residents about anatomical structures, diagnostic skills, clinical nuances, and surgical techniques. I decided I needed to acquire greater knowledge about the educational process to become a better teacher.

I started with the intelligence theories of Howard Gardner, a Harvard psychologist. After decades of research, he demonstrated that there are Multiple Intelligences that include:

  • Verbal/Linguistic Intelligence: ability to use words and language
  • Logical/Mathematical Intelligence : ability to use reason, logic and numbers
  • Visual/Spatial Intelligence: ability to perceive the visual and spatial relationships
  • Bodily/Kinesthetic Intelligence: ability to control body movements and handle objects skillfully
  • Musical/Rhythmic Intelligence: ability to produce and appreciate music
  • Interpersonal Intelligence: ability to communicate with and understand others
  • Intrapersonal Intelligence: ability to self-reflect and be aware of one’s inner state of being

These powerful concepts changed the face of K-12 education for the last 30 years. I agreed with Gardner’s belief that everyone possesses their own set of intelligence strengths, so I began to teach the medical community how to maximize their educational experiences utilizing Multiple Intelligences.

Later, I began to explore many learning theories that led me to define learning as processes that lead to lasting improvements in the capacity of cognition, motor and behavioral skills acquisition, and the development of social character. There are many learning theories that address one or more of these processes. I will briefly describe a few that have influenced how I deliver my educational programs:

  • Behaviorism: Focus on external responses elicited by stimuli
  • Cognitivism: Focus on models of memory (Sensory memory, short-term memory, long-term memory)
    • Schema theories: Knowledge is arranged in a hierarchical network of constructs called “schemas” (Richard Anderson in 1977)
    • Subsumption theory: Learning involves linking of new information to relevant points in the learner’s existing cognitive structure (David Ausubel in 1978)
    • Elaboration theory: Instruction should be organized in increasing order of complexity (Charles Reigeluth in 1983)
    • Surgical intuition theory: Experts form a repertoire of “scripts”, or the mental organization of compiled knowledge that is relevant to the situation at hand that allows for the rapid and accurate assessment of the situation and the formulation of an action plan (Hamm and Abernathy in 1995)
  • Constructivism: People learn by constructing their own knowledge on the basis of their experiences. Everyone’s framework of prior knowledge is unique, thus they have their own needs, goals and contexts.
    • Andragogy: Adult learners are self-directed and like to exercise more control, bring experience to learning environment, ready to learn to perform role in society, problem oriented, motivated by internal factors (Malcolm Knowles from 1970 to 1980)
    • Situated learning theory: Focus on social, practice-based approach to learning where learners participate in communities of practitioners and communicate with peers and experts (Jean Lave and Etienne Wenger in 1990)
    • Skills acquisition theory: A learner-centered theory describing a progression of skills acquisition from novice to expert (Hubert and Stuart Dreyfus in 1986)
  • Connectivism: Exploit technology to extend your knowledge beyond your own brain and build a network of knowledge sources which can be accessed as the need arises (George Siemens in 2005)

I have found that the ideal educational method combines all of these learning theories into a comprehensive framework that allows students to:

  • Take responsibility for their own learning
  • Be taught according to their best learning style(s)
  • Be placed in a program commensurate with their learning skill
  • Be able to progress at their own pace
  • Have instruction organized in increasing order of complexity
  • Receive contextual learning (form schema or scripts – mental organization of compiled knowledge that is relevant to the situation)
  • Get immediate feedback with a discussion about measured milestones
  • Build a network of knowledge sources that can be accessed as the need arises
  • Build a network of knowledge sources that can be accessed as the need arises

By coupling this comprehensive learning framework with advanced technologies, I believe we can create a new standard in medical education. In collaboration with top medical educators across the world, I hope that CaseNetwork can play a significant role in advancing the future of medical education. But we can’t do it alone. In the words of Henry Ford, “Coming together is a beginning; keeping together is progress; working together is success.”

If you are interested in collaborating with CaseNetwork, please e-mail us at info@casenetwork.com

Here is to a brighter future!

Jeffrey Levy, MD
Founder and CEO, CaseNetwork