But at The Ohio State University College of Medicine, Doug Danforth, PhD, has emerged as a leader for implementing new technology and creating smart classrooms.

When the LeadServeInspire curriculum rolls out this year, Danforth will be the leader for Part I of the new curriculum. “With the new curriculum, we’re trying to reduce our emphasis on traditional lectures to deliver content. That type of learning doesn’t always promote long-term retention or significant learning with students,” explains Danforth. “Students typically remember 10 to 20 percent of what’s in those lectures. Retention rates are much higher when material is presented in an interactive way.”

Danforth began instructing at The Ohio State University College of Medicine in the fall of 1992, teaching the reproduction content for the main college curriculum. A year later, he took over the reproduction module for the Independent Study Program (ISP). When the lecture curriculum was revised in 2004, Danforth oversaw the reproduction and development block. In 2008, Danforth became academic program director for the ISP.

Interested in emerging technologies and how they can be applied in the classroom, one of the first and most significant technological implementations for Danforth was the podcast. He was one of the first to utilize podcast technology in the classroom. The popularity of the podcasts has since exploded among students.

In 2006, Danforth began exploring Second Life, a virtual environment in which a user can create an avatar and interact in virtual-world environments. In it, Danforth and his team built a virtual model of a hospital and an ovary and testis. Students could explore the world as Danforth narrated key aspects and functions of the reproductive structures.

Implementing the new Second Life software came with its share of complications. More than half of students thought it was a great way to learn, but a significant part of the student population found the technology to be cumbersome, and were uncomfortable having an avatar represent them, feeling it didn’t portray them or their profession accurately.

“We make the mistake of assuming everyone in this generation of students is very technologically savvy, simply because they use technology so much.” explains Danforth. “In fact, students  expect technology  to be simple and transparent—to be able to turn it on and make it work. Technology now has to be intuitive from the very beginning, and we think that’s the key.”

Also in 2006, Danforth and his team started the virtual patient project. The goal was to create a virtual patient that students could interview, take a history from and give a diagnosis to. The patients were programmed with artificial intelligence, allowing students to interact through a chat function designed in Second Life.

This initial virtual patient project was a springboard to a grant the team received to build high-fidelity avatars via the gaming platform Unity. Unity is more realistic and more user-friendly than Second Life. The avatars are more realistic looking, allowing Danforth and his team to give them unique facial expressions and advanced artificial intelligence for interaction with students.

The program will be able to generate a score for the students and provides informative feedback. It will also give students and instructors a sense of their clinical decision-making ability. It is one of the first of its kind and is designed to teach students medical interviewing skills.

The grant has also funded the creation of a student version of electronic medical records software. The Ohio State University Medical Center uses the software EPIC for its electronic medical records (EMR). The student version of EPIC is being used to add fidelity to the standardized patient encounter, and will be deployed soon with the virtual patient system to provide students with valuable experience learning and using EMR software.

Danforth and his team are outfitting an area in the new Clinical Skills Center for the virtual patient project. A high fidelity  projection of life-sized virtual patients will  allow students to carry on a conversation in a more natural manner.

“Students will embrace a new technology as long as there’s enough value added,” says Danforth. “That’s one of the things we have to constantly ask ourselves—is there enough value in this for the students? It’s a constant challenge, but we know we’re heading in the right direction.”

1. Timing-wise, when do you foresee healthcare reform happening and how do you see it affecting the University?
I think it’s happening right now, maybe not from all the provisions of the healthcare reform law going into affect on items like exchanges, but I think a lot of the factors and forces that are not going to go away are already affecting us. Issues like the continuing emphasis on quality, bringing readmissions down, population management, those things are all happening now. So I think the impact of reform is here sooner than I think a lot of people have realized.

2. What do you think healthcare reform means for academic medical centers?
I think there are challenges and there are opportunities. I think academic medical centers are really well positioned. I think OSU is well positioned for a number of reasons: our electronic medical record implementation, our own health plan, and our Faculty Group Practice is integrated into the University and our scores are ranked nationally in the Quality and Safety outcomes by the University Health System Consortium. I think the challenge for academic medical centers is how do you fund the research and teaching missions under healthcare reform, and that will be a challenge for us.

3. Do you have solutions? Or is it kind of a wait-and-see process?
I think the best solution in all of this, and the one thing that isn’t going to go away, is the flight to quality. The focus on quality is going to be everything in the future of health care. That is, how you are going to get paid or not paid, and I think again, we are in great shape and we’ll be able to thrive under that and support teaching and research.

4. What changes do you anticipate seeing, specifically at Ohio State?
I think you are going to see a couple changes, in the College, obviously the change in the curriculum; it has really made it one of the most cutting-edge curriculums in the United States. I think on the clinical side, you are going to see much closer integration of the hospitals and the physicians’ group in terms of managing the clinical operations. In other words, instead of just having hospital leaders, there will be hospital and physician leaders, and we will probably manage less by hospital and more by service line. So managing cancer, heart, neurosurgery, transplant across all of our in-patient and out-patient sites. And in the research area, it’s going to be much greater joint collaboration in colleges across the University in order to compete for large grants. But again, in all of these I feel as though we are pretty well-positioned.

5. What about changes in the state of Ohio? Can you talk about changes with how people perceive their care or how reform will affect the insurance companies and the average person in the state of Ohio?
I think for the consumer there are going to be some wholesale changes. One, the whole system is going to shift toward paying you as an individual for staying out of the hospital. In other words, for wellness, fitness, all the programs are going to be designed to keep people out of the hospital and keep them well, whether it’s diet, exercise or smoking cessation. And then for the chronic, the twenty percent of people with chronic illness, there will be much more intense management of their illness, I think in the future, if someone gets admitted into the hospital, it will be viewed as a failure because we didn’t keep them out of the hospital and keep them well.

6. What is OSU doing to prepare for reform?
A lot of it is still going on. I think a number of things have been done to help us prepare for this; first was the conversion to electronic medical records. You get certification at certain levels, and soon we will be a level seven, which is the highest level you can get in terms of certification, so we will be in the top-five percent nationally. Bringing all the physicians in to have them employed by the Faculty Group Practice and having the OSU Health Plan as part of the Medical Center, that is what we are going to use and turn ourselves into our own accountable care organization. Some of the estimates to set an accountable care organization have been between two and twenty million dollars and we basically already have that, so we don’t have to go into that expense. So I think we are in pretty good shape, but you know it’s a weird time, it’s going to be schizophrenic for a while.

7. What about timing? When do you really see the final product being put into place?
I would peg that at about 2014 for us, and plus 2014 is also when, according to the healthcare reform act, when healthcare exchanges go active. In other words, people can go out and actively pick their health care, so that will be a game-changer.

2011 has truly been a great year, from the addition of our new dean, Dr. Charles Lockwood to the rollout of our new Lead. Serve. Inspire Curriculum, we have made great progress in reaching our goals of improving people’s lives through innovation in research, education and patient care. We will continue to work towards our goals and we know that 2012 will be even better!

• Meet Our New Dean, Dr. Charles Lockwood!
• Lead. Serve. Inspire, Curriculum for Tomorrow’s Medicine
• The Johanna and Ralph DeStefano Personalized Health Care Conference
• Schlesinger Named Chair of Microbial Infection and Immunity
• OSU Students Forge Careers in Biomedical Science Research
• OSU Medical Programs Ranked Among Nation’s Best
• Graduation Celebration Marks “New Beginnings” for College Diversity Efforts
• NIH Funds OSU Medical Scientist Training Program
• OSU Researchers Receive R01 Grants
• Alumni Reunion – More Than 350 Buckeyes Return to Campus for Medical

The feature article focuses on how his leadership and research has improved the care of patients with diabetes, particularly pregnant women.

In his four decades as a scientist and physician, Gabbe has helped countless diabetic women—who otherwise might have delivered stillborn or disabled children—to have healthy babies. One of his basic science findings, in 1972, had important clinical implications: while doctors previously believed that the placenta was not affected by a pregnant woman’s insulin levels, Gabbe showed that insulin could, in fact, alter its ability to provide energy to a growing fetus. The finding suggested that artfully controlling an expectant mother’s diabetes— whether she already had the disease or developed it during pregnancy— could prevent its associated malformations, stillbirths, and obesity. In two large trials, he proved it.

Read the full article here.

The Cancer Drug Development Roundtable ended Wednesday afternoon, and I left it feeling we’d achieved what we set out to accomplish. As we’d hoped, the event – organized and sponsored by the OSUCCC – James and the Friends of Cancer Research – was a good next step toward solving the problems that currently make it impossible to conduct clinical trials that evaluate two or more experimental drugs simultaneously in patients.

The Roundtable was the first time that the key players have come together with the goal of addressing this challenge to cancer drug development. The fact that they made the time to attend the Roundtable shows that these representatives from the cancer-research and patient-advocacy communities, the pharmaceutical industry, and the FDA and NCI recognize the importance of solving the problem.

The group mapped out specific areas on which to focus and agreed to continue working together until a plan is hammered out. Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, and Dr. James Doroshow, director of NCI’s Division of Cancer Treatment and Diagnosis, both agreed to return to continue the conversation.

Here are a few key points that emerged:

• This problem is not new, but participants agreed that no one has stepped up to address it the way that the OSUCCC – James and Friends of Cancer Research have done.
• Participants pinpointed specific barriers that need resolving. They include scientific and logistics issues, competitive and business obstacles, needed regulatory clarifications and a model mechanism that allows different stakeholders to work together.
• Participants were enthusiastic about solving these problems and agreed that, while scientists’ discoveries and companies’ investments are critical considerations, it is most important to focus on the patient.

We are committed to seeing this through and have offered to host the group’s next gathering. We will keep you informed.

Check out ONN’s “Ohio Means Business” starting May 11, 2011 at 7:30pm to learn more about the business barriers of cancer drug development and how they’re affecting cancer researchers at The Ohio State University.

Click the picture to learn more about Dr. Caligiuri

By: Michael Caligiuri, MD
Chief Executive Officer, The James Cancer Hospital & Solove Research Institute
Vice President for Health Sciences, Cancer Programs
Director, The OSU Comprehensive Cancer Center

Want to frustrate a cutting-edge clinical cancer researcher? Suggest that he or she organize a clinical trial that combines two experimental targeted agents that together could paralyze cancer cells in multiple ways. No matter how convincing or brilliant the evidence that the combination could benefit patients, such trials are off-limits. Frustration is an understatement.

Currently, two compounds can be tested together in clinical trials only after both agents are approved by the U.S. Food and Drug Administration (FDA). Additionally, if the two agents are owned by different pharmaceutical companies, it raises business, legal, liability and intellectual property issues that are so thorny no one has wanted to touch them.

Recognizing the seriousness of the problem, the FDA last December released a draft guidance document that provides recommendations for addressing certain scientific and regulatory issues that arise during co-development of two or more experimental drugs. The business world, however, has yet to figure out how to move quickly and successfully to co-develop drugs that are owned by different companies. Solving that problem is the goal of this roundtable.

The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute and Friends of Cancer Research have organized this Cancer Drug Development Roundtable to address the industry hurdles and make co-development of two or more experimental drugs a reality. The recommendations will be announced later this year.

There are tremendous rewards in store if we can overcome these obstacles. I applaud the FDA for issuing its Guidance Document and setting up the scientific framework to co-develop two investigational drugs. If we can now solve the legal and business side of the problem, we can achieve our ultimate goal—to speed life-saving treatments to our patients and create a cancer-free world.

Tomorrow’s Roundtable brings together leaders in cancer research, the pharmaceutical industry, the FDA and cancer advocacy. We will begin with an open session that will enable researchers, advocates, patients and media to learn more about the issue and ask questions of a panel. That will be followed by a closed working session lasting the remainder of the day. The open-session panel participants include:

• Michael Caligiuri, M.D. – Director of The Ohio State Comprehensive Cancer Center and CEO of the James Cancer Hospital and Solove Research Institute
• Jim Doroshow, M.D. – Director of the Division of Cancer Treatment and Diagnosis at the National Cancer Institute
• Eric Rubin, M.D. – Vice President, Oncology Clinical Research, Merck
• Ellen Sigal, Ph.D. – Chair and Founder, Friends of Cancer Research
• Janet Woodcock, M.D. – Director, Center for Drug Evaluation and Research, FDA

For more about co-development of experimental agents, we recommend the following:
“Development of Rational Drug Combinations with Investigational Targeted Agents” Friends of Cancer Research document

“When it takes two to tango, FDA suggests a new regulatory dance” article from Nature, March 2011, summarizes the early work on this topic

“Utilizing targeted cancer therapeutic agents in combination: novel approaches and urgent requirements” article from Nature Reviews, Nov. 2010

Do you agree with the premise that these principles are essential?  Are there other core principles?
Would you share “best in class” examples of organizations employing these (and potentially other) principles?

Dr. Powell asked that we reflect on what Flexner would think  and what Osler would do.  Intergration was a key theme — integrating studens into interprofessional teams for education and care and intergrating UGME, GME and CME in a competency based curriculum.

Darrell Kirch reminded us that we are facing challenging times and that we cannot be passive observers.  He laid out a five point action agenda:

1. Initiate a new approach to leadership development.
2. Consider resources in a new way.
3. Create the continuum of medical education in a unified, competency based way.
4. Extend research beyond “bench to bedside” to directly serve the community.
5. “Heal thyself” by developing systems that encourage wellness and lower healthcare costs among physicians.

Malcolm Gladwell, reminded us about the nuances of  ”expert failure” and encouraged us to lead with humility.

In these challenging times, we cannot merely stay the course — we must  inspire and lead.

What is the first step for you in this new leadership paradigm?

Medical education in Ohio is at the forefront of the Patient Centered Medical Home (PCMH) movement.  House Bill 198 passed the Ohio General Assembly in spring 2010 and established the PCMH education pilot project to select 40 physician practices to train medical students and residents in the PCMH care delivery model.

Ohio Academy of Family Physicians (OAFP) supported the bill because primary care physicians are integral to the success of a PCMH.  The OAFP believes in the fundamental principles of the PCMH including encouraging coordinated care delivery which focuses on wellness and prevention, as well as whole person care.

PCMH initiatives are expanding in Ohio.  There are four new initiatives being developed in conjunction with University of Toledo, Wright State, NEOUCOM and Ohio University.  Existing initiatives are also expanding: 

• Access Health Columbus helps central Ohio primary care practices through process of NCQA certification and providing learning collaboratives for practices that are already certified or in the process of becoming certified. 
• Better Health Greater Cleveland is working  with federally qualified health centers and building collaboration among Cleveland-based health systems. 
• CareSource in Dayton is a Medicaid managed care health plan while Aligning Forces for Quality in Cincinnati was funded through Robert Wood Johnson Foundation.

How do you see medical education changing in light of  the PCMH movement?

1. Each patient should have a personal physician
2. Physicians direct and lead the medical practice
3. Whole person integrated care
4. Enhanced access to care (including same day)
5. Payment reform to support the framework needed to provide PCMH care.

Clear evidence exists which has shown that the PCMH model of care improves outcomes, reduces cost, and improves patient and physician satisfaction. As such, the Department of Family Medicine, with the backing and support of leadership at the Ohio State University Medical Center, has embarked on practice transformation to create PCMH’s across the Ohio State University Ambulatory Network.  

CarePoint Gahanna is the first ambulatory location to embark on this endeavor. The family medicine physicians at this location have been preparing for National Committee for Quality Assurance (NCQA) certification as a level 3 PCMH for the past three months with a target of achieving certification by January 2011.

The family physicians at CarePoint Gahanna have committed to increasing access by implementing a same day “sick call” plan to decrease urgent care and emergency room utilization. Population health for improving chronic disease will be improved by leveraging the capabilities of the Electronic Health Record to provide family physicians the ability to better coordinate and facilitate care. Inter-Departmental collaboration has lead to pharmacy, nutritional, and social work services being established within the family practice itself, along with other speciality care services offered at CarePoint Gahanna. This allows the family practice physicians at CarePoint Gahanna to provide patients a PCMH within a neighborhood of a medical community. The goal is to provide patients the care they need, when they need it, and all at one location.

What is your opinion of the PCMH model of health care?