Students use design thinking to fix broken care processes

Sara Berg
Senior Staff Writer
AMA Wire
Third-year medical student Yao Liu

Third-year Warren Alpert Medical School of Brown University student Yao Liu.

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Health system failures contribute to physician burnout, but medical education often does a poor job of giving students the tools they will need to make meaningful changes as physicians. However, a joint effort between Warren Alpert Medical School of Brown University and Rhode Island School of Design (RISD) students aims to train future physicians in design thinking to help identify and repair system issues.

This kind of thinking is taught in a course, “Design+Health,” an educational collaboration for medical and design students to tackle health care challenges. The course is designed to reduce burnout by supporting students in designing projects that improve health systems.

“Brown is teaching medical education students about the American health care system and the challenges we face,” said Yao Liu, a third-year medical student at Brown. “Training future physicians in design thinking is a way to help them diagnose and treat system issues.”

Medical education courses often focus more on problems rather than solutions, but Design+Health looks to change that. By pairing medical students at Brown with design students at RISD, this program strives to encourage critical thinking, creativity and innovative solutions for the promotion of individual and community health. Liu presented on design thinking at the AMA ChangeMedEd™ 2017 National Conference.

Identify problem from user perspective

Design+Health began in fall 2013, as an attempt to draw upon the unique strengths of medical and design students. The course allowed students to follow a physician or other “users” in the health care system to determine a health care problem from their perspective, rather than just making assumptions.

“We don’t start with preconceived notions of what the problem is,” he said.

After defining the problem, students brainstorm innovative ideas that may provide a solution to the system issue. This process draws upon the same skills students are already learning in medical school, beginning with a thorough interview and examination with the patient followed by empathizing with the patient’s situation and understanding the problems they are solving before jumping to any treatment. Students then prototype their ideas and refine them based on user feedback, embarking on an iterative process of testing and refining.

“With each iteration, your ideas become honed down. Your understanding of the problem gets deeper and your solutions get better,” Liu said.

“Design thinking adds another layer to the physician’s mindset that problems, even systems issues, can be addressed if we’re bold enough to understand the causes of these failures and attempt solutions to them,” he added.  

Students will participate in these pre-clinical electives over the course of a semester, with teams responsible for meeting on their own time to complete shadowing and other necessary work. In 2016, the pre-clinical elective had its largest enrollment yet—40 total students—split between medical and design students. The program will remain at this size until full-time faculty can become more involved.

Design thinking helps physicians expand their conceptions of what they can accomplish. In doing so, the hope is that when they encounter system failures in the future, they won’t feel hopeless.

Through interdisciplinary, team-based project work, students gain a hands-on experience applying design in clinical settings. Students choose one of four project tracks from emergency medicine, surgery, the neonatal intensive care unit (NICU) and primary care. Once in these tracks, students focus on an issue of their own choosing. This allows students to take project ownership from start to finish of the design process, with mentor support.

Relieving the physician’s load—literally

By observing and shadowing health care providers or patients in real clinical settings, students will focus on a single user, such as the physician, to define a problem.

“Projects have tackled issues like patient wait times in clinics, operating room ergonomics and NICU phlebotomy safety,” Liu said.

One team began with the goal of reducing surgeon back pain and developed an assistive device to help support surgeons after standing long hours in the operating room (OR). The team of students conducted interviews with surgeons, watched their interactions in the OR and looked at other products already on the market to develop the deepest understanding of the problems faced by surgeons.

“They realized that few solutions had been developed with surgeons’ comfort at the forefront,” said Liu. “Therefore, they made surgeons’ comfort their top priority in designing their solutions.”

To find a solution, the students went into design workshops, came up with different assistive devices and went back to the surgeons to get feedback to come up with their final version. 

“Projects like this, if successful, can do things like save surgeons’ backs,” Liu said. “They can make patients more satisfied with their clinic visits.”

“However, even if projects like this don’t make it past the prototyping stage—which many did not—they teach students and future physicians that the challenges nagging our health care system are not impossible to change,” he added.

The course culminates in a pitch or critique session that lays the foundation for long-term research and implementation. With health care rapidly evolving, Liu states that medical education must train future physicians to shape it, which can be completed through design thinking.

“Physician burnout and system failures do not have to be things we accept,” he said. “They cannot be things we accept.”

Design thinking is a “crucial first step toward empowering tomorrow’s physicians to change health care systems,” said Liu.

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Dec 06, 2017
Health information technology had a significant impact on medical education—at both the graduate and undergraduate levels—in 2017.