As a third year medical student, I’m just starting my placement years, and I’m slowly learning what it means to be a healthcare professional in today’s national health service. As part of my studies, I’m undertaking a project that allows me to explore a branch of medicine that’s new and particularly interesting to me.
Having recently finished my surgical placement, I got to watch patients consent for various procedures and was surprised by many patients’ approach to consent. With a ‘doctor knows best’ approach, many didn’t appear to take much interest in alternative options, or take the opportunity to weigh up these options themselves. They appeared to take the doctor’s recommendation and were happy to accept the associated risks or side effects. I found myself surprised at the seeming lack of control of their own healthcare. I was interested in the reasons for this, and whether there was more lying under the surface that I was seeing in a 10 minute snapshot. So I’ve chosen to focus my project on the current consent process, and explore how it could be improved.
My project is based with Concentric, a medical technology startup in Cardiff, created by clinicians who saw an opportunity to improve the consent process, and decision making in healthcare more broadly, for both clinicians and patients. The idea is to make a digital platform that helps empower patients to make their own decisions regarding their healthcare, and to aid clinicians in supporting this. Patients are provided with evidence based information to show risks, benefits, alternatives and more, in an understandable way to allow them to make an informed decision. I’ve been welcomed into the team, a so-called ‘startup’, and have been able to see an innovative and technological side of medicine I’d had no previous exposure to.
The Concentric platform aims to provide a patient-centred approach, facilitating shared decision making in practice. In addition, it fits in with the digitising of medical services, for example digitising patient notes and implementation of SNOMED-CT, a digital, structured, clinical terms database. I’m realising that digital healthcare is an area that is expanding rapidly, and I hope it will have a bigger footprint in medical school curricula before the end of my studies. The ball has already started rolling, for example the BartsXMedicine programme running in London, getting medical students involved with technological innovation.
Assessing health technologies
Upon entering this new area, a big question for me had been - how do you take a great idea and apply it to today’s healthcare system. Who thinks of them, how is it created, who decides if it’s good enough to be used and then how is it nationally implemented into everyday practice? In my first week I was able to attend a workshop that answered these questions exactly. Run by Health Technology Wales at the Life Sciences Hub, the workshop was keen to promote innovation and development in healthcare. Health Technology Wales is a national body with the aim to improve the quality of healthcare offered in Wales. They identify upcoming technologies, support their development, assess them and then help to implement them into practice. Overall optimising the use of technologies within everyday care to increase efficiency.
The workshop was led by Dr Susan Peirce from Cedar, an NHS academic evaluation centre, and was based on health technology assessment and economics. She explained the journey a health technology must take, from the initial preclinical design, to the implementation in the healthcare service, and all the evaluations and decision making that happens in between. She went into detail about each of the steps: - what questions had to be addressed, who would be asking them, and most importantly, what evidence could be used to aid the decisions that had to be made.
We spent a large part of the workshop focussing on what makes good evidence – how to critically appraise a paper. To then see ourselves if it supports the proposed idea of a change in practice. Within this, we discussed how a study design should be analysed and what this means for its appraisal. We compared randomised control trials to observational studies looking at the advantages and disadvantages of each. We looked into how to use the method to judge credibility. We talked through the different types of bias and how to spot them in different designs. As well as looking at confounding variables and the difference between funding and sponsorship and how this may impact on results and conclusions of research.
My future practice
The knowledge I gained as part of this workshop is useful for me, and is very relevant to my future practice. As a doctor, to keep up with developments in science and technology, it’s important to stay up to date with the research being published. This ensures you’re offering the best care to your patients with strong published and peer-reviewed evidence supporting your practice. To help me accomplish this I can use the skills I learned in this workshop to critically appraise the research, and to decide for myself if I think the evidence is strong enough to support a clinical decision in practice as well as decisions about future health technologies.
The workshop provided me with knowledge in areas not usually covered in a medical degree and I gained a much deeper appreciation for what goes on behind the scenes to allow medical practice to keep developing. Most importantly, I will take forward a new analytical approach to practice alongside an open minded one, to allow new, innovative ideas to come through and change the way I think about medicine. As a medical student this increased knowledge and new outlook, will assist in my current studies and I can use and take this forward in my career, helping me understand what shapes the healthcare system I’ll graduate into in a couple of years.
However, in the meantime, for the rest of my project time with Concentric, I’ll be using this new approach in my research into the consent journey. Applying it to explore ideas for improving the patient experience as well as ways to empower patients to take control of their own decision making.