All posts in “Interviews”

Prof. Bernhard Jost from St. Gallen Cantonal Hospital on working in a digitalized world

Prof. Bernhard Jost

Dr. Bernhard Jost is Chief Medical at the Clinic of Orthopedic Surgery and Traumatology at the Cantonal Hospital of St. Gallen, Switzerland.

During a telephone interview he explained to us why his department is on its best way to digitalization.

1. How has the digital transformation affected you and your work at the Cantonal Hospital?

Naturally I could not escape the development of the past years and frankly speaking, I am grateful for this. The access to medical information has changed tremendously and instead of going through physical books in a brick and mortar library for searching and copying during endless days, we have finally moved towards digital libraries. Our department of Orthopedic Surgery and Traumatology has somehow always been receptive of new technologies and we have adapted them quite openly and quickly into our daily business. So it will not surprise anyone that most of the journals are only available digitally.

2. Do you consider yourself a tech-savvy surgeon?

I would not say that I am tech-savvy, but I definitely embrace new media. Let’s talk about VuMedi for example. You can easily access their video database, comment on the videos and exchange opinions with your peers. In a journal you would not be able to do this, connect to other surgeons instantly and have a discussion. Today’s young generation does not fear the flood of data. To the contrary, my experience is that they get along with it quite well.

3. What do you recommend young surgeons how they should use new media in their daily business?

They have to make sure that they know and respect the structure of their clinic. General platforms where they can find peered reviewed articles and where scientific standards are applied are important. There are a lot of mobile apps out there that can support them in their daily work. I would prefer not to recommend specific ones but anatomy apps, 3D apps and magazine apps are great and easy to work with.

4. What about yourself and the usage of apps?

I like to use them, the majority of which are hospital internal apps. One of the most useful ones which is also accessible to other surgeons outside of the Cantonal Hospital of St. Gallen is the Guidelines app. I also use the PC access to our knowledge database, smartphone feeds or newsletter subscriptions in order to keep myself up to date.

Meet and greet with Dr. Nikolaus Renner

Dr. Nikolaus Renner

Dr. Nikolaus Renner is Chief Surgeon of the Department of Traumatology and Sports Medicine at the Cantonal Hospital of Aarau, Switzerland. Furthermore he serves as the Chairperson of the AOTrauma International Board.

We met him at the AO Davos Courses back in December and had the chance to discuss the importance of medical education in times of technological changes with him.

1. How do you see the change of access to medical knowledge?

I embrace the possibilities that new technologies offer us. I remember the painful times when the access to information was only limited to catalogues at our university library. Nowadays it is more the question of how to find the right information among the overload of sources available to surgeons and students.

2. How do these technologies influence your daily life?

I wish that I had more time to dedicate to discovering all the gadgets for our profession. Apart from using various online databases and the hospital network to access scientific journals, I would not consider myself a power user. I created my personal library with the most relevant articles on my computer. I am still old school with a handful of printed editions of English and German journals lying on my desk.

I only screen the title and the abstract of an article before I read it, this can be in a newsletter, a website or a journal. Mobile platforms are great for doing searching and screening.

3. What does it need for you to download a medical app?

It must have an in-depth search across all subspecialties and a link to full text articles.

4. Where will medical education head to in the future?

Knowledge will be digitalized and categorized even more efficiently than it is nowadays. Publishers and medical app companies will have to customize available information in order to best fit the needs of their readers and user

Meet Prof. Christoph Josten

Prof. Josten

Prof. Dr. med. Christoph Josten is Director of the Clinic for Traumatology and Reconstructive Surgery and the Spine Center at the University Hospital Leipzig, Germany.

He is the new president of the DWG (German Spine Society) and was the past president of the DGU (German Trauma Society) and vice-president of the DGOU (German Society for Orthopedics and Trauma).

We had the opportunity to meet Prof. Josten at a major orthopedic and trauma event. Read what he has to say about the technological advances in the field of medical education.

How has the access to medical knowledge changed in the past?

Considering the astonishing speed at which knowledge has travelled in the past years, I would describe the situation somewhere between hopeful and desperate. Hopeful – because it has become so easy to access and disseminate information. Desperate – because the more information becomes available the more difficult in has become to focus on the most relevant content by following a red thread.

The complexity of available media has become abundant for both surgeons as well as patients. More and more patients tend to self diagnose themselves by searching the internet for treatment solutions for their symptoms. But this access to unfiltered information can be risky and dangerous.

How do you cope with the abundance of medical information?

With the years comes experience and with the experience comes the capability of judging the quality of papers after reading the first lines only. Doctors do not always have to be following the latest trends, we do not have to use and be present on all media. The internet is only one of the sources surgeons can refer to when in need of information, but there are many more sources that I consider as very important:
• Personal relationships with other surgeons: This „human filter“ is fundamental in times of an overabundance of media and information
• Attendance of congresses and courses: every surgeon has to learn and appreciate the „verbal transfer of information“

Of course I acknowledge the relevancy of new technological opportunities, but let me put it like this: new cars are not always the safest. But if you consider the advantages especially for third world countries where access to information is a luxury, the internet provides the surgeons with endless possibilities.

How often do you read and what do you read?

At my age, I don’t read books anymore, I write them. Jokes aside, frankly speaking, I read very little and when I read I am very selective. I read only the latest journals. More importantly it is to meet up with peers at congresses and courses. I am still from the older generation. I love to hold a printed version of the journal in my hands.

What would you recommend surgeons from the „new generation“?

I absolutely understand the importance and convenience of the usage of new technologies as mobile apps for tablets or smartphones. The clear advantage is the comprehensive and easier search across different databases and devices and I am completely supportive of this.

Meet Prof. Regazzoni

Pietro Regazzoni

Prof. Dr. med. Pietro Regazzoni is a trauma surgeon who is well known for his innovations in the field of orthopedic trauma. He completed his medical studies in 1969 at the University of Basel in Switzerland. He become a board-certified surgeon and finally Head of Trauma Surgery at the University Hospital in Basel. After a long-lasting activity within the AO Foundation, Prof. Regazzoni has become an Honorary Member of the Foundation.

Together with Alberto Fernandez (Chief of the Orthopedic Department at the British Hospital in Montevideo and honorary member of the Spanish Orthopedic Society) and Stephan Perren (former Director of the AO Research Center and one of the Founders of the AO Foundation), he is editor-in-chief of ICUC an innovative group trying to offer a disruptively new “learning tool” .

1. You have been engaged in teaching/learning for so long now. Describe shortly how accessing medical and educational information now and then has changed.

I started my professional education at the University of Basel in the 1962, so I was part of the “index medicus generation”! The way to access and assimilate medical information was cumbersome. It involved going to libraries, searching for articles in the stacks, and reading them in the library. Before the widespread introduction of photocopying machines, the information you wanted had to be copied by hand into (paper) notebooks for later reading!

From this perspective, over the years, huge progress has been made. In contrast, though, the pace of innovation within the medical profession coupled with the amount of information available to the healthcare professional has skyrocketed making it almost impossible to stay up to date. You need to spend “many days a day” trying to keep informed.

So the real problem now is no longer accessing information, but understanding what information to access and when. It’s about being able to sift through the overabundance of data and information “to get to the information that really fits your needs” and that you can use “at your pace, when and where you want”.

2. Approximately one million scientific articles are published every year! How do you deal with this complexity?

The capacity to focus, filter and summarize is a fundamental competence you need to build throughout your career. Learning how to research and knowing how to get to the right resources is key.

3. Tell me a little more about your medical news reading behavior?

I keep up to date in various ways. Of course I stay up to date by both online and offline versions of journals. What I also find valuable are summary articles from trusted sources. But, by far, the most relevant sources for me are the contacts I have built throughout my professional career. So meeting and discussing with them on a regular basis during different scientific events and other types of meetings is for me invaluable.

4. How will medical information and education change in the future?

Important changes can be expected in the field of “continuous learning”. Platforms or services like yours, Insights Orthopedics, are really indispensable to cope with the “information tsunami”. Your task is to filter information and find tools to adapt to individual needs in order to transform how surgeons and doctors will access information; aggregating information in its various flavors in one unique place is a definite must for the future.

Education also has to evolve from teaching to learning. Adapting to changes in the professional medical environment and daily routine, learning must conform to personal needs, personal learning rhythms and personal choices of time and location. Information technology has evolved in a way that allows us to realize these goals.

Every human activity creates problems and complications, which are an invaluable source for learning. The prerequisite for this is transparency of documentation. The ICUC group (www.icuc.ch) has therefore collected a big anonymized, unchanged dataset of clinical cases as a basis for the development of a completely new learning tool. Of course, it is only the beginning.

Insights from Prof. Guido Wanner

Prof. Wanner University of Zurich

Prof. Guido Wanner is deputy director and chief consultant of the Trauma Surgery Clinic at the Universitätsspital Zürich, Switzerland. Since 2009 he has been professor of surgery at the University of Zurich.

Read here about how he sees the educational landscape changing from a medical information perspective.

IO: Describe shortly how accessing medical and educational information now and then has changed.

Prof. Wanner: The medical landcape has dramatically changed since I started medical school at the Ludwig Maximilian University of Munich in the 80s. All scientific books and journals came printed and were expensive and time consuming to get and to copy in our library. Since online access to databases did not exist then, the only digital way to receive scientific material was to manually copy the yearly editions of the Medline CDs. While at that time it was hard work to gather the scientific material I needed for my dissertation, I must admit that I did to it carefully and conscientiously compared to the more superficial and quick reading of today’s fast moving society.

Then came Pubmed and the omnipresent Internet access that made my life much easier. I used literature reference and formatting programs that allowed me to create my own “Mini Pubmed” database including only articles relevant to my field of research. The race between established paid for papers as JBJS and NEJM and free open access platforms created a healthy competition that was of course beneficial to us surgeons. But it also acted as an accelerator for the distribution of knowledge. Fast and global access to knowledge is not a privilege anymore.

The result of this massive availability and accessibility of information is that everyone everywhere can publish anything. Filters of technological or human nature have become more important than ever.

IO: How will access to knowledge change in the future?

Prof. Wanner: Considering the information overload we are confronted with, the question we are all interested in is: How do I know what is relevant? Are the sources as Pubmed and the established journals themselves already a sign for thought through, valid, in-depth research? Or can I rely on other factors to help me select what I need?

I myself rely on a couple of factors:
– Pubmed is a great search tool if you can narrow down the search to the themes you are interested in.
– The Cochrane Library supervises certain quality standards related to evidence classes
– AO Traumline analyses current studies according to evidence classes
– Expert opinions

Event though in Europe virtual expert groups are still not as popular as in the US, discussion groups on linkedin or Facebook or specific professional medical networks such as researchgate can absolutely make sense for surgeons.

IO: Tell me a little more about your medical news reading behaviour?

Prof. Wanner: As a professor of surgery at the Universität Zürich, my job implies that I have to read and research on a regular basis. Additionally, I am a faculty member of various national and international medical associations and go to their yearly congresses which give me insights into the latest state of the art trends.

I still receive printed editions of various international journals as JBJS and Global Spine Surgery but also journals from national associations of orthopedics and surgery as „Der Unfallchirurg“ and the DGU magazine. And I do read them. However, I know that this will change in the future and I will move towards apps to keep me up-to-date. This is why I think that platforms as Insights Orthopedics go into the right direction. We need technologies that guide us through the jungle of information.

If you take a look at my desk, you see that there are tons of tons of journals piled up. I know that these will dissappear one day. I will go green. But one thing is for sure to stay: my textbooks will keep their spot on my shelf – even in 15 years.

IO: One last question: What is on your iPad home screen?

Prof. Wanner: It is actually quite boring. I have not started using apps that much, so what you can see are a couple of apps from AOTrauma, Anatomy flashcards, local newspapers and a soccer app.

Insights from Prof. Niklaus Friederich

Prof. Niklaus Friederich
As an Advisory Board Member of Insights Orthopedics since the early beginnings on, Prof. Niklaus Friederich has always been an advocator of accessing medical information in a new and innovative manner. He is the former head of the Department of Orthopedics and Traumatology of the Kantonsspital Bruderholz and professor of surgery at the University of Basel, Switzerland. Now he works with a team of experienced surgeons at the Orthoklinik in Dornach.

This is what he had to say about “Medical Education and Information Access in times of technological changes”.

IO: You have been in this business for so long now. Describe shortly how accessing medical and educational information now and then has changed.

Prof. Friederich: “I started my professional education at the Medical School of Bern, Switzerland, in the early ‘80s. At our library, I used a Rolodex to search for my books. Some of the books could only be borrowed for a certain period of time; others were not allowed to be taken home. So we either had to ask the librarian to copy the pages we wanted – we were not even allowed to copy the pages ourselves – or we had to sit down and hand copy the pages.

During my time at the university of San Antonio, Texas, only 5 years later, I was amazed at how technologically advanced they were in comparison to my home university. They had a computer-based book search through which I received entire results lists of books and journals that I could chose from.

Nowadays, everyone from everywhere can have access to all information. Accessing information has become much more democratic. It is not an exclusive right to specific groups in specific countries anymore. The Internet has opened up the access to medical information to a broader audience while the tablet has introduced a more elegant and easy way to access this information.

But frankly speaking, I am missing the “sensory” part of holding a book in my hands and seeing that it has been used and read by other people.”

IO: Approximately one million scientific articles are published every year! How do you deal with this complexity?

Prof. Friederich: “While in the past we were confronted with difficulties in obtaining information, the challenge we face today is that there is too much information available. So the way I find out if an article is worth talking about or not is quite simple: I pick up the phone and call a colleague, a peer or a friend who is the expert in this field. My longtime experience paired with my network of knowledgeable experts provides a solid basis to survive in this jungle of information.

Of course I understand that medical students and residents do not dispose of such a network yet in their young career. Nowadays there are much more tools at hand, especially technological tools, that help them access and evaluate information. The consequence of this democratization of information access is the rising of an imbalance between freedom of information and relevancy. So, it is becoming more important to use filters to help you sail through this growing sea of information. While specialized medical platforms, discussions groups, and apps are commonly used for shaping one’s opinion, it is important to keep in mind that having a real person to speak to can not be replaced by any virtual network or tool.

Also, the publishing business has become very competitive. Journals have to publish articles with high impact factors and high numbers of citations in order to survive. The number of articles published, and also the medium where they are published does not always reflect the importance of the theme though. For example, the laparoscopical stomach surgery has only been researched and practiced by a small number of individuals, and professors have not published many papers about it. This does not reduce the importance of this surgery though.”

IO: Tell me a little more about your medical news reading behaviour?

Prof. Friederich: “I used to read the printed editions of orthopedic journals on a regular basis and flipped through all pages in order to make sure that I would not miss out on anything. I am still a subscriber to most of the journals, but today use more newsletters with content tables, news feeds or aggregators as Insights Orthopedics in order to keep up to date. If I want to read the full text article, I use my institutional subscription to access it within the app.”

IO: What was the driving force for you to be on the Advisory Board of Medical Insights?

Prof. Friederich: “It has been an obvious trend in the orthopedic community to move away from reading classic journals and going towards using mobile apps. It also has been a trend that we needed tools at hand to help us filter relevant from irrelevant information. Insights Orthopedics responds to this trend.

I loved the idea that with Insights Orthopedics an orthopedic surgeon finally can use a platform that can narrow all available papers and articles down to the themes he is interested in. Insights Orthopedics is customized to our needs. This is why I am proud to be part of this project.”

IO: What makes Insights Orthopedics different from any other mobile information platform?

Prof. Friederich: “I use Insights Orthopedics because I have not found another tool that offers the same features. I mostly use the search engine because it enables me to show only those articles related to my specialty. But I also follow the news from the AO Foundation and EFORT and I read current publications. I really have everything orthopedic in one place.”