Credit: Steve Zylius, UC Irvine

Information overload has been a large problem in medical education. After all, how many PubMed articles can a medical student possibly digest, when 765,850 new articles have been added in FY2014? “Drinking from a firehose” — a classic metaphor for medical school — seems like an understatement.

So when it comes to information overload, one surgeon is trying to change all that.

iMedicalApps has previously covered how UC Irvine was first in the nation to provide iPads and Google Glass  to their medical students, launch online medical student technology platforms, and their Apple Distinguished Program education awards. Now, UC Irvine’s new iSurgEd program is transforming curriculum for surgical trainees. The program itself has become a popular way for surgeons to teach and push new, reliable clinical information through iPads, iBooks, and iTunesU.

We interviewed Jill Endres, MD, Director of Surgical Education and Associate Clinical Professor of Surgery at the University of California, Irvine, School of Medicine (UC Irvine), who leads the iSurgEd program.

iMedicalApps: What’s iSurgEd?

iSurgEd is an extension of the iMedEd program at our medical school. This all started in 2010, with our US$1.2M grant to start a medical education program centered around iPads which are given to all medical students when they start. I had the idea of being an iPad-friendly residency program early on, wrote a grant, and got iPads. I started thinking about the challenges in surgical education these days and how having an iPad could simplify things..

The problem: there are so many resources out there. Most surgeons will search YouTube for videos and often end up wasting so much time. I have never had a good experience looking for teaching videos on YouTube or the other medical video sites. Many were too long or too short, didn’t have the components that residents need to learn. Residents need to learn the details of the procedure but most videos out there just show the general procedure, then show the final tumor coming out with a stapler, but it won’t show how they got from step A to B. Residents need to be shown where to cut and how to dissect.

So we started making our own videos, and I asked, how will we distribute this? The medical school was using iTunes. We looked into this, and thought this would be a great way to provide the residents with quality resources that are vetted by us. It would make it easier for them so they’re not left searching the Internet looking for something that is difficult to find and may not be the highest quality.

The challenge as a surgical educator is making sure the residents have the resources they need. They’re expensive. There are lots of free resources out there but many of them are of poor quality or inaccurate. That’s why I wanted to own this a bit more and not just give them an iPad without any content.

I had often heard that providing a resident an iPad is successful for those residents who have an interest or are tablet users already. We are trying to be more proactive by creating videos, providing them with lectures and podcasts, and teaching them how to create digital multimedia resources.


iMedicalApps: It sounds like it’s not just about giving trainees the iPads, but also guiding them on how to use it effectively as a physician.

The first phase was populating the courses with content [from surgical divisions]. Some of the divisions have taken off: the trauma division put their entire manual in it. Before, it was provided to the residents in a large binder. The burn unit and ICU are also using the iTunes U course to provide papers that are current. [The] colorectal [division] is taking advantage of the iTunes U platform to present the resources for the Fundamentals of Endoscopic Surgery program. So some divisions have really taken off, while others need more creative help.

But the idea is that we’re just curating resources that are out there, and vetting them. The next phase is teaching the residents how to use the iPad more effectively for patient care, learning and teaching. We’re continually working towards that goal.

iMedicalApps: Were there any roadblocks or barriers you had to overcome, especially logistically?

The hardest part is manpower, and keeping [the courses] going. There are 17 courses now. Managing this almost requires one person per course to take it over. Getting different divisions to adopt it and run with it is the ultimate goal. I am working with each division to help them fine-tune their course, so they like it, and they start using it with the residents.

iMedicalApps: What are some of the challenges that surgical trainees and attendings face when it comes to education?

Funding is the biggest one. There’s just no money in education, and that’s been a real difficult roadblock.

The second problem is getting the teachers to become technologically-savvy. The millennials and residents we have are in the digital age, but the senior and even some of the junior attendings are not used to teaching this way. So we’re now starting faculty development workshops to teach the attendings how to use the iPad for teaching.

iMedicalApps: Any other projects on the horizon for UC Irvine in surgical education?

We’re about to publish a medical iBook about operating room (OR) readiness for preparing third-year medical students to enter the operative world for different rotations. It started with the iBook Jam we had at the medical school. Prior to this iBook, medical students had to attend a long session on scrubbing, gowning, etc. The student I worked with made this amazing iBook on OR readiness. It has a virtual tour of the OR. That’s just been published. It’s currently very UC Irvine-oriented, but we are making it a more generic iBook for publication. The iBook has embedded videos, demonstrations by OR nurses on what to do and what not to touch, things that make new surgery students very nervous. We’re shooting a virtual tour of our operating room next so medical students and visitors to our OR don’t have to go through an actual OR tour.

Other digital projects: teaching video editing, collaboration with our anatomy faculty to enhance videos, and making surgical videos that are much more descriptive and appropriate for resident learning.

iMedicalApps: Anything else you’d like to share with our readers?

The whole idea that digital overload [affects physicians] is such a puzzle and I don’t think it has been good for resident training. Our residents and medical students are going out to the Internet to access things that have not been necessarily approved or have a high level of evidence. It’s difficult to control. By having so much available at their fingertips with these iTunesU courses, things we have chosen, and our original work, we feel that will change how we teach and how residents will learn.
One of the problems these courses are amazing for is for patient safety. For example, we had patients who had problems with hypoglycemia after TPN feeds were held. As soon as this was recognized as a problem, I was able to put a protocol on our iPads, and our residents got a notification that the protocol was posted on their iTunes Course. Now it was simple to access. Hospitals can use this for posting safety protocols. That’s a big plus and can be accessed on any iOS device.