Learning by Osmosis: A Better Way to Study in Medical School

This piece is an article originally published in the WhiteCoatDO blog and written by R. Nguyen. The original piece can be seen here.

Studying in medical school is an inexact science, to say the least. While the concepts and therapies we learn are rigorously backed by evidence-based studies, the way in which we learn is still largely trial and error. With the sheer volume of information to learn, students are often left cramming material for exams and subsequently forgetting it all when moving onto the next block.  Sure, I could draw the brachial plexus blind-folded during Anatomy class, but I couldn’t tell you a single branch of the celiac artery during Neuroscience. Academics call this binge-purge cycle “academic bulimia”.
Born out of this frustration with the status quo is a new learning app called Osmosis. Launched in July 2013 on iOS (web platform and Andriod app in the works), Osmosis is the brainchild of two medical students at Johns Hopkins. The app is bringing next-generation ideas and concepts such as crowd-sourcing and “smart” algorithms to traditionally slow-moving medical education. I recently had a chance to interview the two co-founders of Osmosis on their product, their vision, and the student-led revolution of medical education.
What is the Osmosis app? How did it get started?
Shiv Gaglani: Ryan and I were in the same anatomy team-based learning group. Less than two months into med school we found ourselves repeatedly talking about how inefficient the cram-forget cycles of medical education are; one of our professors actually called these binge-purge cycles “academic bulimia.” We became obsessed with finding ways to improve the way we learn and retain information and, like any good scientists, started with a literature review. There were a lot of evidence-based learning principles (e.g. spaced repetition, testing effect, associative memory, etc) that were just not being applied through “modern” education technologies. Think about it: right now, the tools medical students use for social networking and entertainment, things like Facebook and Netflix, are managed by more sophisticated algorithms than the tools we use for our education. Ryan and I realized that our engineering and neuroscience backgrounds had prepared us to do something about it.
Ryan Haynes: Initially, Osmosis was a tool for crowd-sourcing practice questions & resources and eventually it grew into both a web platform and mobile app. The web platform makes learning more relevant and engaging by bridging the gap between the official curriculum and the secondary curriculum – that is, open educational resources as well as publisher content. The mobile app makes reviewing easier by literally pushing out practice questions and resources via an intelligent algorithm that learns about the student’s preferences.
When we began, Osmosis was a side project that we gave our class access to in January 2012. Soon, med school became the side project because we realized that we were passing our exams simply by learning through Osmosis. In a little over a year, the Johns Hopkins students contributed over 1,500 images and videos, wrote 5,000 practice questions, and answered those more than half-a-million times. Here’s the kicker: that was only 240 students. We now have over 6,000 medical students signed up for Osmosis so over the next few months we expect to be delivering millions of practice questions and resources to our peers and future doctors.
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Where are you both in the medical education journey? How did you get to this point?
Ryan Haynes: Shiv and I just finished our second year of medical school at Johns Hopkins in March. We have been on the medical school path since college, where we both majored in biomedical engineering. After graduating from Georgia Tech (’06), I completed a PhD in neuroscience at the University of Cambridge because I’ve been interested in the brain, behavior, and learning for as long as I can remember. For example in high school I programmed a 3D game to teach students math and in college I built a site to create and share free textbooks. I found that Shiv had similar interests at the intersection of medicine, education, and technology. After graduating from Harvard (’10) he wrote a science education book and became editor of a popular med innovation blog called Medgadget before beginning at Hopkins with me. Coincidentally, we both had deferred our admission to medical school an extra year after graduation, and if we hadn’t inadvertently synchronized our academic schedules Osmosis likely would not have come to fruition.
How does the Osmosis app differ from the status quo for medical education?
Shiv Gaglani: Right now medical students are forced to manage two curricula: the official one from their institution and the unofficial one that includes test prep companies and publishers. Only the most driven students have the time and willpower to manage both consistently, not to mention all of their other activities including research, volunteering, and socializing. During my first two years, the last thing I wanted to do after 6 hours of lecture and small group was open First Aid to review. The Osmosis mobile app aims to make reviewing a passive activity, as easy as answering a text message. The web platform aims to bridge the divide between the official and unofficial curricula through our machine learning algorithms. I’d be more likely to review First Aid consistently if my official course documents were automatically tagged with info about my unofficial curricula. Say for example that you had a lecture on the brachial plexus. Osmosis will automatically present the popular YouTube video that demonstrates how to memorize and draw the brachial plexus as well as the page reference in books like First Aid (FA 2012, p. 408). In this way, students can spend less time managing their learning and more time actually learning.
On the issue of cost of medical education, there’s no reason that the unofficial curriculum has to be so expensive: $100 per month for a question bank?! That’s six Netflix subscriptions! We hope to help make high quality review material accessible to a larger population of medical students, and help publishers avoid the widespread class bootlegging that occurs on class Facebook pages, email lists, and Dropbox accounts.
We’re really excited by the feedback we’ve been receiving on our web and mobile platforms, and broader vision, and are working tirelessly to improve medical education.
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What can you tell us about the next steps for Osmosis?
Ryan Haynes: We look forward to making our web platform available to the thousands of students who’ve signed up for our mobile app. A number of institutions have approached us asking to use our web platform for curricular mapping and content delivery. Furthermore, we’re still forging relationships with publishers like the American College of Physicians and BioDigital Human to present their content right at the point of learning, when students need it the most. In terms of other fields, we’ve received a lot of interest from international medical students, pre-meds, practicing clinicians, dental students, and even law students who want to learn through Osmosis. Right now we’re hyper-focused on medical students – after all, we want to build the best tools for our classmates and ourselves so that we can return to med school and learn more efficiently!
Why do you think there has been a sudden rise in medical-student driven medical education apps such as Osmosis and Picmonic?
Shiv Gaglani: There is generally widespread interest in education technology because new development tools have allowed us to create systems that incorporate evidence-based learning techniques with sophisticated data collection and analysis. I think medical education technology is really exciting because nowhere are the stakes for improving learning and retention higher; in most fields forgetting means frustration, but in medicine it could significantly impact someone’s life – say for example if you forget to test the pulmonary function of a patient you prescribe bleomycin to.  Medical students recognize this so it’s natural that many of us are driven to solve the problem. It’s exciting to see so many new approaches, and we look forward to collaborating to design the best possible educational tools for med students.
The Osmosis iOS app launched in July 2013 with a web platform and Andriod app on the way as well.

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