Tell us about yourself. Why did you first decide to become a physician
I am a clinician-scientist who specializes in retinal disease. I grew up in Nova Scotia and went to medical school at Dalhousie University. I performed residency at Queen’s University, and obtained fellowships in retina from Wills Eye Hospital in Philadelphia and Mass Eye and Ear in Boston. I also obtained master’s degrees in epidemiology and business after becoming an ophthalmologist.
On a personal note, I married my wife, Susan (also a physician) during residency and we have 2 wonderful kids.
A few fun facts: I survived a near death experience fishing in the Gulf of Mexico – which taught me a lesson about how quickly the weather can change; came to skiing late in life but now routinely ski glaciers in the summer, and recently became an unexpected art agent (as our 14-year-old son’s work is being acquired by collectors in a number of countries).
As to why I became a physician? When I was 15 years old, my mother was hit in the eye with a tennis ball and suffered from a retinal detachment, which required surgery. Because of this experience, I became very interested in the eye, the retina, and ocular surgery. I actually went to medical school with the intent of becoming a retinal specialist.
What surprised you most about your medical studies?
As a resident in ophthalmology, I remember seeing a patient who presented with sudden visual loss and was diagnosed with a central retinal artery occlusion. When I presented the case to my attending, they suggested that we order carotid dopplers and an echocardiogram.
The next week, a second patient with a retinal artery occlusion presented to our service and a new attending recommended a different systemic work up. Based on this, I realized how much of medical practice was based on anecdotal experience and not evidence. I have spent that better part of the last 20 years studying evidence and value-based medicine and trying to infuse hard science into the discipline of ophthalmology.
What was the most challenging part of medical school for you?
There were two challenging parts of medical school for me. The first was the realization that I was not someone who learned particularly well from attending lectures. I found that I preferred to read textbooks to better understand concepts and to create images and charts to solidify the material. I distinctly remember feeling somewhat stressed by not attending some classes and “going it on my own.”
I guess in retrospect, this is one of the guiding principles with MEDSKL — in that we want to appeal to all learning types (visual, auditory and text-based learners). The second was the transition to clerkship, when I realized that all the learning over the past 5 years was all about helping people. When you finally are in charge of an NICU unit after hours, you pray that you really learned your material!
What do you like most about being a physician? What do you like least?
I enjoy helping people. I work in a world where people lose their vision in a matter of minutes. Their visual loss can have wide-ranging implications, including significantly higher rates of depression, nursing home admission, and social isolation. In fact, most people are willing to accept a 50% reduction in their life if they were able to get their sight back. To be able to save or improve someone’s vision is an extremely gratifying experience.
The thing that I like least about medicine is that it can be all-encompassing with the clinical and research demands. So to be both successful and happy, you have work hard to balance professional responsibilities with other activities, roles, and responsibilities.
Tell us about MEDSKL in a nutshell.
We designed MEDSKL as a platform to allows any learner — from medical school students to practicing physicians to interested high schoolers — to learn and review the fundamentals of clinical medicine from the best medical school professors around the world.
Our library of content, which includes short videos, detailed notes, longer “TED Talk”-style lectures, and discussion forums, was designed and developed in collaboration with nearly 200 professors worldwide. We believe in free and open access to medical educational materials (FOAMEd), and MEDSKL is our way of bringing those materials to students from all backgrounds.
How did you come up with the idea for MEDSKL?
A few years ago, I was giving a lecture on acute visual loss and noticed that, despite what I thought was an intriguing case study, many of my students were distracting themselves with “cat videos” on YouTube.
It struck me that lecture-based teaching is not an effective way to reach this generation of medical students, who grew up online and are used to short-form, engaging content.
Based on the work of video education leaders like Khan Academy and others, I wanted to develop a platform that could do the same for medical education: provide content in a way that could both engage students and give them the key content they need for real-world clinical situations.
What is a “flipped classroom” and how can it be used for medical education?
The flipped classroom is a popular concept in K-12 and higher ed that is also seeing growth in the medical education space. It’s simple: the student learns content on his or her own (usually through video lectures before class), and then class time is used for case studies, individual and group work, and more in-depth exploration of the topics at hand.
The flipped classroom is, in some ways, a perfect fit for medical education: we sometimes tend to focus on the content at the expense of the real-world applications, and flipping the classroom allows faculty to spend more time digging into the real work of being a clinician. It also helps students learn and study on their own time – they can take as long or short as they want to review the materials, and watch the videos multiple times, in order to ensure that they feel comfortable with the content before they come into class.
What is MEDSKL’s ultimate goal?
Our goal is to expand access to medical education. We aren’t hoping to replace medical school — quite the opposite, in fact. Our goal is to augment the great work being done by medical faculty: to give them a comprehensive set of clinical resources with which to enhance their teaching, and to free up time for them to work with students on the concepts and challenges that matter.
We also see MEDSKL as a global platform and want to help medical students, healthcare workers and care providers around the world understand how to diagnose and treat common and serious medical concerns.
How do you balance your work on MEDSKL with your career as a physician?
The key here is do two things well: be efficient at managing your time well and hire very good people to assist on the various tasks. I wear a number of different hats. I am a retinal specialist who has a very active clinical practice. In this capacity I also train a number of residents and typically 2 fellows in retinal disease. Probably 60% of my time is allocated to seeing patients.
As a Professor of ophthalmology and epidemiology, I also have teaching responsibilities and am the research director of our program. Because I do a fair amount of research in ocular disease, health economics and education, I have a number of research assistants and coordinators helping. My research portfolio takes about 20% of my time.
The remaining time is allocated to MEDSKL. We probably have about 10 people working with nearly 200 faculty members to coordinate MEDSKL. I am very lucky to have an outstanding team to help execute many parts of my clinical, research and educational activities.
Describe a typical day at work—walk me through a day in your shoes.
Get up around 5:30 and do some planning or exercise. I have a chance to spend some time with family and often have the pleasure of dropping our kids off at school/activities on non-clinical days. My clinics usually go from 8:30 to 6pm. Over lunch, I will take calls or Skype with a number of people on either my research or MEDSKL teams and problem-solve. On the way home, I also will touch base with the MEDSKL team.
We typically will have a family dinner together and hang out with the kids and help them with their activities. Interestingly, a significant amount of evening time has been dedicated to a new role as role as an art agent, as our 14-year-old son’s art career has really taken off and people around the world are collecting his art. Weekend time is usually spent skiing in the winters (or standing on the side of a hill in subzero temperatures being a judge for alpine ski races) and being on the water in the summers. On non-clinical days, I focus more on MEDSKL or research.
Has anything surprised you about your work on MEDSKL?
The biggest surprise is how eager and willing faculty from prominent universities like Stanford, Harvard and Johns Hopkins were to contribute to MEDSKL. What also surprised me is how many premeds and high school students are coming to MEDSKL to better understand more about medicine and what medical school will be like.
In your position now, knowing what you do, what would you say to yourself when you started your medical career?
I think that it is critical to constantly learn — not only about the content area of medicine, but also other disciplines. Take an art history course, minor in philosophy, learn about how to create a startup, become an activist. These will also be critical for preparing yourself for a career that will likely take many turns in the next 40 years. I do think that the job security that physicians have largely enjoyed for the past 50 years will certainly change in the next 50. So if you want to really be on the forefront of medicine you really have prepare for how things will change.
What do you think the next big thing in medicine/healthcare will be?
There are probably a couple of things that are emerging. One is the pace at which AI is developing. When I went through medical school, a physician was a repository of knowledge. The results of a history and physical examination were placed against this knowledge base, and a diagnosis was made. We have now entered into an era in which machine intelligence is surpassing human intelligence. With this abundance of knowledge, physicians will be forced to have a hard discussion about how we are going to add value to the diagnosis and treatment of disease. I think that many visual specialties, like radiology — as we now know it today — will become obsolete within the next decade.
The second big wave that is coming is understanding the microbiome and how it influences both disease and health. We are only now starting to understand how the microbes that live in and on us can influence everything from inducing inflammation to affecting our weight, mood, and thoughts.
What impact do you hope MEDSKL will have on medicine over the next decade?
Our goal is for MEDSKL to be part of a transformation in medical education — one that makes the concepts of medicine more accessible to students from all backgrounds and with all sorts of career goals.
The AAMC predicts that we will be facing a shortage of up to 94,000 doctors by 2025, and in order to meet this need, our system of medical education needs to be adaptable and respond to the needs of today’s students. My hope is that we will see an increase in high-quality, easily digestible content that can expand access to medical education worldwide.
Lastly, a large percentage of patients in impoverished countries do not have access to even rudimentary care. We would love to play a role in educating caregivers in developing nations to ensure that patients in these countries are getting access to quality healthcare.
What’s your advice for students pursuing a career as a physician?
The older I get, and as a father, I would say that it is important to remember that while you are a physician, it is only one part of your life. It is very important to really try to achieve work-life balance and pay attention to all parts of your life. Medicine school and residency are long, and clinical practice can be very taxing; it is critical that when you are seeing patients and operating on them that you are bringing your “A-game.” This can only happen when you are at your peak level.
The second thing I would strongly recommend is that you have to have a broad perspective. My career has been defined by thinking in different ways, which is what led me to do advanced degrees in epidemiology and business after becoming an ophthalmologist, as well as to create different educational platforms. The mindset of continuous learning will undoubtedly make you a better thinker, but will also open the door to other opportunities. Lastly, try to keep your eye on where things are moving in a macro sense. Sadly, I have seen too many medical students not match to residencies or train for 10+ years and not be able to find operating time. Don’t expect there to be a job waiting for you at the end of your training; you have to be very proactive and keep an eye out for where the profession will be 10-20 years later.
Tell us about yourself. Why did you first decide to become a physician