Author: Eric Funk, MD @efunkem

This is commentary of Funk et al. Blockchain Technology: A Data Framework to Improve Validity, Trust, and Accountability of Information Exchange in Health Professions Education. Academic Medicine. In press.

Since the inception of Bitcoin in 2009, the use of blockchains has steadily gained attention. What began as mild interest from computer scientists has now grown to a fervor pitch. The initial impacts have been seen in the world of finance and are now spreading to many other sectors. More recently, thought leaders and entrepreneurs have begun to explore how the idea of blockchain could be used to improve healthcare. The obvious progression of this idea is to explore how blockchain will influence the education and training of healthcare workers. In our recent paper in Academic Medicine, we have laid out a basic framework for how blockchain could impact healthcare education.

Healthcare education has a long history of adopting new technological innovations in order to improve student’s learning. This has included MOOCs, digital platforms, and the #FOAMed movement. Using blockchains to improve education is the logical next step.

What is blockchain?

It’s a new way of storing data. Most people don’t think about how their data is stored, but it has a large impact on how the data can be used. In a blockchain, a recording of every transaction between users during a time period is group together in a “block”. These blocks are then “chained” together in chronological order. The recording of transactions and linking of blocks are done with advanced mathematics. Fortunately, it is not necessary for end-users to understand all of the technical concepts in order to benefit from using a blockchain (just as it is not necessary to know how to build an engine in order to drive a car). The chain of blocks is completely open and can be inspected by anyone to see the entire history of interactions. Since every single person involved can inspect the blockchain, it is nearly impossible to change the record of events.

How can blockchain allow educators to better track their impact?

It has traditionally been very difficult for clinical educators to get credit for their work, especially compared to their peers who focus primarily on research output. Recording this information in the blockchain will easily allow educators to track their impact as their students ultimately become educators themselves, and pass along their knowledge to each subsequent class of students. It will also allow for easy tracking of the most utilized and most effective learning modules.

How can blockchain make CBME (competency based medical education) and EPAs (Entrustable Professional Activities) better?

The blockchain can serve as a digital ledger of the behaviors that are critical for assessment. This will allow learners to easily see how they compare to their peers at various other universities or institutions. One significant improvement is that this system allows for asynchronous evaluation of milestones, that are completed independent of location. It better allows learners to progress through the required knowledge at their own pace.

How can blockchain improve credentialing?

Using a blockchain allows for one decentralized database of information. Anyone who has recently applied for medical licenses in multiple states or gone through the process of applying for hospital privileges will be able to appreciate this benefit. Rather than combing through information that is scattered across multiple different sources, a decentralized blockchain will be able to efficiently store this information. There will be easily accessible proof of completing a degree, diplomas, certifications in other states, procedure logs, etc… rather than trusting unverified information coming from various sources.

These ideas represent the potential benefit that blockchain could bring to medical education. They do not represent a prediction of the future or a magical solution for all the problems facing educators and students. Many blockchain platforms already exist that could be used to implement these ideas (Ardor and Ethereum being a few of the more technologically advanced and accessible blockchain platforms), or new ones could be created. The next step in exploring these ideas will be for developers and forward-thinking educators to join forces and begin producing real-life products that allow for implementation of these ideas. The future is bright.

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