A lot can happen in 22 months. That’s how long it’s been since IBM‘s Watson captured the public’s imagination by routing its human opponents in Jeopardy!. Since then we’ve seen Watson make inroads into healthcare through partnerships with speech recognition company Nuance and the insurance giant WellPoint. Like a proud parent, most recently IBM has sent Watson off to medical school by partnering with the Cleveland Clinic Lerner College of Medicine. Unlike its human counterparts, Watson will likely be able to “graduate” faster given that it can process about 500 gigabytes – or 1 million books – per second.
We had the opportunity to speak with Dr. James Stoller, Director of the Education Institute at the Cleveland Clinic, about the collaboration.
Shiv Gaglani, Medgadget: How did the partnership between Cleveland Clinic and IBM get started?
Dr. James Stoller: Following Watson’s success in Jeopardy, IBM decided that one of their next steps was to apply the natural language platform to healthcare. They systematically reviewed potential partners and ultimately approached us at the Cleveland Clinic with the offer to collaborate. Their enthusiasm was predicated on the fact that the Cleveland Clinic’s Lerner College of Medicine teaches medicine through a completely problem-based approach, which is how they envision Watson learning. Our students learn through small-group sessions in which there are eight students per group. A case is presented and the students need to do research to validate or refute their hypotheses – just as Watson had to do during Jeopardy. There is a good alignment between the technological underpinnings of Watson and the approach to learning and teaching that is core to the Cleveland Clinic.
Medgadget: What does Watson “going to medical school” entail? Will he be reading actual patient notes, studying for the USMLE, etc?
Stoller: These details are still emerging, but we imagine that Waston will be an active participant in the small group problem-based learning sessions. Through inferential strings from the presented case, Watson may synthesize information and present diagnostic possibilities to the students. The students can then take a deep dive and interrogate lines of evidence through which the hypotheses were developed. If Watson presents an implausible hypothesis or has flawed reasoning, the students and instructors can correct it and in turn improve Watson’s future performance. In this way students and Watson will be learning from each other.
The questions that Watson will learn from will not only come from our problem-cased cases. We also expect Watson to take the USMLE Step 1 exam, which features short clinical scenarios, to see how it performs.
Medgadget: But he’ll ruin the curve!
Stoller: That’s likely, haha.
Medgadget: When will Cleveland Clinic and IBM know that Watson is ready to “graduate”? What metrics will be used?
Stoller: That’s a good question. Graduation, in a sense, is an arbitrary phenomenon. When you graduate from medical school that does not mean you are finished learning – indeed your journey has just begun. Cleveland Clinic’s Lerner School of Medicine was designed a decade ago from first principles to help our students develop reflexes for lifelong learning, because what they learn today will be out of date in 5-6 years.
Similarly, it is imperative that Watson be a continuous learner. Fortunately for Watson, it will probably be easier to stay on top of the latest medical research and guidelines than it is for humans.
Medgadget: What types of interactions will Watson have with CC’s students and faculty?
Stoller: Watson will definitely be part of our problem-based learning groups, though we have not yet decided exactly how it will be deployed. There’s a lot of excitement among the students and faculty. We also imagine faculty designing a number of research studies, such as a controlled experiment where we look at acceleration of student learning with or without Watson. We envision that the opportunity to help develop and study Watson will not only be available to people at the College of Medicine, but also to others throughout the Cleveland Clinic.
Medgadget: After IBM’s interest in applying Watson to healthcare was made public, many in the community expressed concern that the platform would replace clinicians, beginning with fields based on pattern recognition (e.g. pathology, radiology, etc). Are there similar concerns now at the Cleveland Clinic?
Stoller: Watson is being developed as a bedside clinical support making, not a replacement for specific medical fields. Complex clinical decisions at the bedside have to integrate medical knowledge with patient preferences and situational awareness. I don’t think a decision support system will replace the human ability to match preferences with recommendations. This being said, Watson will hopefully provide the encyclopedic knowledge and support so that the clinician can make an optimal decision – call it a “capable sidekick.” Clinicians will still play an integral and irreplaceable role in the delivery of care.
Medgadget: What is your background in medical education or technology?
Stoller: I serve as chair of Cleveland Clinic’s Education Institute, which comprises 16 departments and many talented people who are focused on all of the stakeholders in medical education: medical students, nursing students, residents, CME, allied health providers, etc. The Watson collaboration is the effort of a large team, of which I am only one member, perhaps the “chief cheerleader.” Fortunately I’m surrounded by colleagues who are highly technically skilled and interested in education.
In terms of my own background, apart from being a pulmonary/critical care doctor, I have a master’s degree in organizational development and am reasonably tuned in to how teams form and work. I combine this perspective with a focus on education to make sure that the Education Institute makes progress towards improving medical education, as we hope to do with our collaboration with IBM.
To learn more about the collaboration between IBM and the Cleveland Clinic, check out this short video:
Let’s just hope that once Watson finishes up with medical school it can afford to pay off its debt. Something tells us that this won’t be an issue.