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X Gonna Give It To Ya

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A gentle street poet named Earl Simmons once penned the words, “X Gonna Give It To Ya”. I can’t remember the next line of the stanza, but I think it may have been, “If You Let it”. He may very well have been talking about Stanford Medicine X, because you kind of have to be open to what it has to offer. But if you are, it will deliver quite an experience.

As usual, #MedX started well before the conference proper with the pre-conference which generated an outpouring of tweets and other activities leading up to its kickoff this year and throughout the conference. If there is any doubt, the fine folks at Symplur have put that question to bed.

From the pre-conference, there was a high-utility tweetstream for anyone interested in clinical trial design, particularly those seeking ways to integrate the patient. From afar, it appeared the workshop was very effective in introducing epatients to the complexities and headaches of clinical trial design and execution AND in introducing researchers to what epatients really care and think about with clinical trials.

UMQ (Uncomfortable Moment Quotient)
UMQ = number of total conference sessions/number of instances in which a question or comment makes speaker or audience (in-room + virtual) visibly uncomfortable. One of the things that separates Medicine X from most other conferences I attend is that it has a remarkably high number of instances in which people become visibly uncomfortable as a result of a presentation or (more likely) a Q&A. I had many conversations about this observation in 2014. To be clear, this is a good thing. The truth can be uncomfortable. Health is messy. Health care may even be messier. So kudos to Dr. Larry Chu (@larrychu) and everyone involved for the way Med X is structured to almost cultivate the UMQ as a mechanism for addressing the tough problems we face in health care. Last year the UMQ was high as well, but at times there was an edge to it that was…not helpful. Through planning and design, it seemed this year had another remarkable UMQ, minus the sometimes-nasty edge.

How Quickly the Uninitiated Become The Learned
It is a-maz-ing to me to reflect back on just a few years ago when I saw the first inclusion of epatients, then epatient scholars, then epatient advisors at Medicine X. The same people who blew me away with their bravery in sharing their struggles with their health, were also as vulnerable as an exposed nerve at times. To see what has really been a transformation of some of them over the years has been part of the joy of being a part of this conference experience. (By intent, Stanford Medicine X is a conference experience). I still remember the first time I heard Sarah Kucharski (@AfternoonNapper) speak and was blown away by her voice (her ‘capital V’ voice, although her ‘lower case v’ voice is quite nice as well). To see her grow in her role and  (sometimes quiet, sometimes not-at-all quiet) self-assuredness has been pretty cool. Similarly, seeing others like Britt Johnson (@HurtBlogger) evolve from leader-as-blogger to also taking on the mantle of IRL leader has been encouraging to watch. One other neophyte-to-leader journey has really struck me as well, that of Chris Snider (@iam_spartacus). This is a guy who I thought of as a podcaster who talked about gaming, diabetes, and various tech geekery. I feel like he has really developed this Voice as a curator/narrator hybrid for #MedX and for the broader conversation. Almost like an human-version of Storify. Oh, and he also wields surprising power. I saw firsthand how the power of his tweets could motivate people to walk up to physicians and ask them about their socks. #truestory

400% Increase in Pharmacist Participation
I don’t have the access or authority to release the actual attendance figures for pharmacists at Med X, so I thought I would guesstimate. I mean, if only 10-35% of ACTUAL MEDICAL CARE is based on level 1A evidence (per @drnigam and various other sources, although technically not Cochrane), I can get away with this guesstimation, right?

Whatever the actual figures may be, there was definitely a stronger presence for pharmacy this year. From mentions of the role of the clinical pharmacist at Stanford Coordinated Care by its Co-director Ann Lindsay to multiple panel, plenary, student leadership, and first-time attendee roles by pharmacists and pharmacy students (@kellygrindrod, @rnovak_pharmd, @nicholasvu, @asapola_pharmd), it was encouraging to see and hopefully a sign of things to come. [h/t @nickdawson] Pharmacy has a lot to offer and (unfortunately) is the second best-kept secret in health care.

Poolside Backchannel of the Backchannel
I read a book a few years ago titled, The Backchannel: How Audiences are Using Twitter and Social Media and Changing Presentations Forever. I also use Twitter quite a bit and actually consider it to be my most useful social media tool for professional development and connections. So I thought I had a fair grasp of the use of it as a “Backchannel”. However, one  evening a group of Med X student leaders and epatients taught me that there is such a thing as the Backchannel of a Backchannel. That’s part of the beauty of being in academia. There is no shortage of the steady stream of new ideas and youthful enthusiasm that come in from new students and learners.

Science-y Stuff 
I love the plenary sessions, but I am always going to look forward to the parallel, research-track sessions. I had it narrowed down to my top two favorites for 2014, but couldn’t decide so I am going to mention both. The first is the eHealth and Personal Health Records Panel with Nigam Shah [abstract], Perry Gee [abstract], Anne Townsend [abstract], and Floor Sieverink [abstract]. {by the way, all abstracts also have the Twitter accounts at end} Shah made a compelling case for mining EHRs for practice-based recommendations, and the others had really interesting takes on PHRs and the patient experience.

The Health and Human Behavior session was my other favorite as I believe their theme of health behavior change + technology is at the core of so much of what we are trying to do to improve outcomes. The presenters were John Hixson [abstract], Shiyi Zan [abstract], Sean Young [abstract], and Ken Yale [abstract]. Hixson used  PatientsLikeMe in a population you wouldn’t necessarily expect: 50 year old (average age) US veterans with epilepsy. Zan explored the use of social media for healthcare in adolescents and young adults. Young started with 550 million tweets and ended with a more manageable 2.1 million tweets to evaluate for HIV-related risk communications. And Yale looked at 5 years worth of data on the impact of incentives in promoting health behaviors. You owe it to yourself to check out their abstracts.

Best Poster
The fact that I had followed Paul Grant for years and even have a screenshot of one of his tweets from a 2009 mHealth Dubai conference in a slidedeck legit has nothing to do with this selection. Although I can’t imagine it hurts. More info on his fascinating work here. h/t @engagmentstrat

Visceral Reactions aka The Good Kind of Stomach Punch
There were a couple of jaw-dropping and dusty room plenary presentations I want to share. The first was the E-NABLE system. Basically it’s: 3D printing + goodwill + community = affordable prosthetic hands for kids.

The other was the introduction to the current version of Jerry The Bear. Great cause. Great motivation. Fingers crossed they keep plugging away and have success on Indiegogo. They are trying to “Reinvent diabetes education through PLAY”.

Back to the airport
Today I leave for CTIA Super Mobility Week. I’ve never been to it. It is at the other end of the conference spectrum from Medicine X in that is massive and industry focused. I am uncertain exactly what to expect. I am certain that no other conference has what MedX is gonna give to ya.



Other Perspectives on Stanford Medicine X 2014 (Click on title for link)

(I maintained a list  of these last year, so I will try to do so again as able)

From a medical student and fellow Gunner (@TheBiopsy)

From co-host of #hcldr chat (@Colin_Hung)

From symplur – hashtag analytics (@symplur)

From a family physician (@drmikesevilla) [h/t @GilmerHealthLaw]

From a communications professional (@MichelleLBrandt)

From a medical educator & pediatrician (@MedsPedDoctor) [h/t @wingofzock]

From the artist-formerly-known-as-Pew [Storify] (@SusannahFox)
From the artist-formerly-known-as-Pew on sharing the glow (@SusannahFox)

From a mother of child with Cystic Fibrosis [Storify] (@ekeeleymoore)

From a PhD candidate with MedX bike tips [@jsperber]

From an epatient & paramedic (@prostheticmedic)

From an epatient/podcaster & a Gaggle of Google voices (@iam_spartacus)

From an epatient with T1DM (@txtngmypancreas)

From an epatient with Crohn’s (@CarlyRM)

Stanford Medicine X YouTube Channel (h/t @JBBC)

What do pharmacy students think about #socialmedia for education?

TLM2013Dr. John Sandars has been looking at the roles of technology in medical education for many years. So when we decided to look at use of social media by pharmacy students (and their thoughts in particular on its use in education and engagement) I sought him out. As with any good collaboration, everybody brings a little bit to the table, and this one was no exception. Our articleSocial media use and educational preferences among first-year pharmacy students” was recently published in the journal Teaching and Learning in Medicine.


Trends in Technology, Mobile, and Education

Mary Meeker from KPCB recently delivered her gallery of “2013 Internet Trends” at the All Things D conference (#D11). I was originally directed to this data marathon from the mobile perspective via Brian Dolan (@mobilehealth). However, Meeker’s presentation is much more than that. It is a sprawling look at the Internet of Things, Traditional Industries Being Re-Imagined, and Sharing Everything. Fortunately, her mammoth 117-slide deck (that was delivered quickly in just 20 minutes; video here) has been placed on @Slideshare.

It is a lot to process, but here are just a few points that jumped out at me from Meeker’s presentation:

  • The average smartphone user reaches for his/her device 150 times a day (what does this hint at for wearables?)
  • Percentage of residents who ‘share everything’ or ‘most everything’ online: USA (15%) compared to Saudi Arabia (60%)
  • offers same day package delivery with real-time map tracking…often by bike…in China
  • Amazon was the third largest provider of tablets in 2012 (behind Apple & Samsung); overall tablet growth has outpaced smartphone growth
  • 77% of academic leaders at 2,800 colleges perceive online education as the same or superior versus face-to-face education
  • Top “Learning Tools” from “learning professionals” worldwide included: 1. Twitter 2. YouTube 3. Google Docs…7. Skype 8. PowerPoint…12. Evernote 13. Slideshare 14. Prezi
  • Mary Meeker is funny, who knew?

Again, there is a lot of information here and some require a deeper dive, but this is a great resource to answer some questions and stimulate more.


ASHP Guide to Residency Prep

Get_the_Residency_COV-PNGCnvtSince the demand for pharmacy residency spots far outstrips the supply – only about 60% of students match nationally – my colleagues Josh Caballero, PharmD, BCPP and Sandra Benavides, PharmD created a course to better prepare students at our College of Pharmacy to pursue a residency. Over the next couple of years, students completing that course went on to match 80% of the time. That success eventually turned into the recently published bookGet The Residency:  ASHP’s Guide to Residency Interviews and Preparation edited by Drs. Caballero, Benavides, and I. The book was written in collaboration with faculty, clinicians, and residency program directors from across the country. I am pleased that it has been well received by students and reviewers alike and has entered its second printing. Currently, Dr. Caballero directs a neurocognitive fellowship and I serve as a director of a fellowship in consumer health informatics.


Stanford Medicine X: To inform and inspire

Skinny jeans are a surrogate marker, Nick Gross was not who I expected, and the e-patients are even braver than I thought. Listening to the Club Med X play list (selections at bottom), I found myself reflecting on the things I learned, who I spoke with, and what inspired me at Stanford Medicine X.

The Things I Learned
Bringing the science/citizen science
Scientist and wine aficionado Ian Eslick (@ieslick) was the first winner of my daily ‘Bringing the Science’ (BtS) award at Med X. He explained how his own condition of psoriasis informed and affected his approach in creating the first MIT-run authoring experiment. The purpose of the experiment is to study “how patients think about self-experimentation and figuring out how making changes impacts them” at He also opened the door to the n-of-1 vs epi debate and the idea of future sampling.

The next day CEO of Asthmapolis David Van Sickle (@dvansickle) claimed the coveted (albeit fictitious) BtS award with his fantastic marriage of humanizing the process of research with almost zealous inquisitiveness. He shared the origin of his obsession of “stalking asthma” from Navajo villages to Alaska and then to the CDC where the limitations of public health data and the role of technology were crystallized for him. Van Sickle went on to describe his excitement about the role of mHealth in preventing diseases in populations. Acknowledging that I may have sipped the Kool-Aid when it moved into mHealth for prevention, you must watch his 15 minute talk. “The hardest cause to identify is the one that is universally distributed.” Indeed.

Rhiju Das was the very next speaker discussing EteRNA, which necessitated creation of the ‘Bringing the Citizen Science’ faux-ward. His Das Group at Stanford in conjunction with Carnegie Mellon challenges citizen scientists and gamers to create RNA sequences that fold into target shapes via the interface they’ve developed. Interestingly, in part due to Das’ involvement as part of the team that created Foldit, EteRNA is seen as its successor by some.

Role of design and UX
So, it turns out design isn’t just for architects and frogs anymore. I had some feel for the roles of human-computer interaction and behavioral health design from working with researchers and others like Tonic. However, I was blown away by the roles of design and UX ranging from the seemingly mundane (e.g., hospital equipment) to the ambitiousness of the IDEO Design Challenge Workshop to its potential in transforming children’s fears about nebulizer treatments into nurturing moments.

Self-trackers and Quantified Self
Before the Med X Self-Tracking Day, I was peripherally aware that people like @FredTrotter were hacking away at things and tweeting their weight and that Ernesto Ramirez (@e_ramirez) was causing waves in something called Quantified Self. But I definitely did not realize how widespread self-tracking is until @SusannahFox debuted her new Pew data (re-defining it for much of the crowd), nor did I appreciate how creative (@nancyhd; Winner: Best smile-powered LED headdress) or dedicated (@bettslacroix) some of those involved are. This is an area worth exploring for future research and I’ll be curious to see what comes of some of the specific efforts such as MyMee.

Who I Spoke With
Surprises and plans
Just because it seems cliché to say that the best part about conferences are often the hallway conversations doesn’t make it any less true. In this case, the Medicine X First Look video archive of the entire conference goes a long way for those who couldn’t make it…but being surrounded by the attendees of this conference conferred an entirely separate set of benefits and opportunities. I had a series of eye-opening impromptu meetings and promising conversations. One was with Nate Gross (he of the minimalist Twitter handle @NG; co-founder of Rock Health and Doximity) at a group dinner. As I have zero feet in the business world and most of my business savvy comes from having watched the movie Wall Street in 1987, I was sort of resigned to sitting next to a brusque, bottom-line type. Instead, I found him to outwardly be a more contemplative sort who spent more time observing than speaking…or maybe he was just happy to be seated next to someone who didn’t have something to pitch.

Most of my other notable conversations portended more specific possibilities. I found myself in one sitdown listening to opportunities described on the fly between AMIA Fellow and researcher Qing Zeng-Treitler, Medify’s Derek Streat, and Alliance Health’s David Goldsmith (@dsgold). Later I enjoyed an intial exploration with Sarah Kucharski (@AfternoonNapper) about extending the role of the patient in research design. That was a conversation I suspect will continue.

What Inspired Me
Two people and an object
Unsurprisingly, it was the people and their stories at Medicine X that I found most inspiring. Many of the Ignite talks by the e-patient scholars were personal and touching, but I found two people particularly so. Sean Ahrens has taken his own story about Crohn’s and literally built a community for others suffering with the same struggles in Crohnology. It’s amazing to me that someone with a potentially debilitating condition refuses to cave to its daily demands and instead sources it to create a virtual bridge to connect and benefit others.

The other person is @DanaMLewis. Personal bias aside (see panel slide deck), to have a person at her age & stage create another type of virtual community in #hcsm that has such far reaching effects that it even inspires Alicia (@stales) Staley (herself quite the wow-inducer) to create #bcsm is immensely encouraging to me.

Youth. Creation. Connection. Wow.

A different kind of enchanted object
Watching David Rose of Vitality present at the mHealth Summit introduced me to the concept of the ‘enchanted object’. At Med X, I saw a more literal version of this implemented in the form of the Magic Mask. The Magic Mask used augmented reality tech and lessons from IDEO to transform what can be a frightening experience of nebulizer treatments to a parent-involved storybook time for these children with asthma. Trust me, you’ll want to read the full description of this work by @RoujaPakiman and @LucieRichter here.

Our Panel and Fin
An e-patient, an entrepreneur, and an academician collaborate to conduct research. In our panel, @DanaMLewis, @BorisGlants, and I tried to share our lessons in adopting the participatory design model for research. Hopefully we were able to inform a bit about misteps and successes and provide a dash of inspiration so that more patients and researchers will partner to capitalize on the strengths of each other.

I have been to a lot of conferences, and no one puts the level of thought and care into each detail of a conference like @LarryChu. This was a stellar experience that I look forward to next year!


Club MedX Playlist (selected songs)

Harvest Moon – Poolside
Night Falls – Booka Shade
Pharaohs – SBTRKT
4 years – Kid Savant
Rocket No. 3 – A Rocket in Dub
Skylight – Gramatik
Save the World – Swedish House Mafia
Shuffle a Dream – Little Dragon
Somebody That I Used to Know (feat. Kimbra) – Gotye [h/t @iam_spartacus who told me who the artist was, as I am old and thought the chorus was Sting]

TC (Theft Citation i.e., where I stole this post title from): I read @SusannahFox’s post on Stanford Medicine X. As with many of her posts (and I think she would agree), some of the best value is in the comments. In this case, it was the contribution by David Goldsmith who pointed out that Med X is the rarest of birds in that it managed to both inform AND inspire.

Development of a residency interviewing preparatory seminar

As the profession of pharmacy continues to evolve in response to society’s health-related needs, one of the most pressing developments is the demand for more residency training opportunities. The demand currently far outstrips the supply of residency positions, and 2010 saw nearly 1 in 3 applicants fail to secure one through the Match. The onus on us as pharmacy educators is two-fold. Nationally, we need to scale up existing slots and help create new programs. Locally, we need to prepare our students as intensively as possible to help them compete for residencies that will help transform them into agents of change for the profession.

To that end, a couple of my colleagues developed an elective, Residency Interviewing Preparatory Seminar (RIPS), the details of which were recently published in the American Journal of Health-System Pharmacy. I was fortunate to be involved in this course aimed at developing our students’ core skills in the process including: improving their interviewing and presentation skills, professionalism, and developing their curriculum vitae (CV) and personal statement. As the course was targeted to P4s (i.e., completing the final, clinical phase of their education) who were at their rotation site all day, the class was held weekly for two hours in the evening and timed to be completed directly before the Midyear Clinical Meeting.

Completion of the RIPS course demonstrably improved the confidence of the enrolled students and 78% of RIPS students that cycle secured a residency. Nationally, the success rate is only around 62%, although these numbers cannot be directly compared. We have continued the course since publication and the most recent iteration saw a further increase in the percentage of RIPS students able to secure a residency position. Plans are to continue an iterative approach to course development.


Using clickers to engage pharmacy students across multiple campuses

Click to access free full-text

When you teach at a University with multiple campuses (in our case, Fort Lauderdale and Palm Beach in Florida and Ponce in Puerto Rico) even with live, interactive videoconferencing – you have to try and figure out ways to connect with your students at different sites. We’ve tried different methods over the years with varying success, but one that worked well early on was the use of  an audience response system (aka clickers). This is something I talked about previously in the presentation, “The Science Behind Engaging Students in Class“.

Our recent article in the American Journal of Pharmaceutical Education basically describes our multi-campus implementation and measurement of its impact on student engagement, satisfaction, and opinions about projected use of clickers in other courses. We also touched on related issues, such as clickers’ possible role in helping desensitize communication apprehension in students.


Clauson KA, Alkhateeb FM, Singh-Franco D. Concurrent use of an audience response system at a multi-campus college of pharmacy. American Journal of Pharmaceutical Education. 76(1):6.


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