Sramana Mitra: I have a question here. This material that you’re developing and making available in a cloud-based model, do you develop the content and the whole infrastructure for delivering this content?
Norm Wu: No. We have the technology platform and we work with outside medical educators to develop the content. There are really two different models. One is the crowdsourced model where institutions take our platform and develop their own content. We have an authoring system that’s supported by a very large medical media asset repository so they can create their own cases. In that crowdsourced approach, they develop it for their own use and then make it available to others. They allow other schools to take their cases and make derivatives of those cases.
The other approach that we have is to sponsor peer-reviewed cases that are developed by experts across different institutions. We have had 86 different educators under part-time contract. Those cases are then sold to other schools. Those cases may have been funded by us or may have been funded by folks like the American Medical Association, which has been very interested in what we’re doing to transform medical education.
Sramana Mitra: What is your business model? How do you make money?
Norm Wu: It’s a subscription model. It’s a SaaS-based platform. We license the platform to institutions on a per user per year basis. We also license the cases and other products that we have as well. It’s a traditional SaaS-based model.
Sramana Mitra: The institutions are essentially scaling their ability to deliver their training in the context of clinical diagnosis from you.
Norm Wu: Yes. It’s very different for the latter two years of medical school.
Sramana Mitra: Do you play in the second 2-year phase as well?
Norm Wu: Yes, it’s all the same platform.
Sramana Mitra: Walk us through all of those. I’m actually interested in what you do in the second two years and in what you do in the nurse practitioners.
Norm Wu: As you may know, for the last two years of medical school, you start to go on rotation. It’s basically an apprentice type of training. You choose different clerkship disciplines and those clerkships might last 4 weeks to 12 weeks. They might be focused on Family Medicine, Obstetrics, Neurology, and so on. Effective learning requires active learning. That’s one of the great things about apprenticeship. You’re out there watching and doing under somebody’s guidance, but there are problems with that.
First of all, you might not get exposed to the most critical kinds of symptoms and diagnoses. It depends, in large part, on the mix of patients. The physician that you’re working with may or may not be a particularly good mentor. They might be great physicians but they might find it hard to articulate what they know and why they actually know it.
Sramana Mitra: Yes, teaching is a whole different ball game.
Norm Wu: Thirdly, it’s really hard to assess each student that’s following you around as to how effective they are in developing these very hard to measure clinical reasoning competencies. What we do is we provide a way to do a number of different things. One is to augment the exposure to different kinds of patients. If you haven’t seen an XYZ kind of patient, we’ll do a case and you get a lot of experience with that kind of patient.
Two is we provide very effective feedback and coaching. Since we capture every single thing that a user is doing in a case simulation, we can automatically analyze the entire encounter and the whole process of providing individualized feedback and coaching. It’s like, “Here are the questions you should have asked. You should have done these physical exams. Here are the ones that you did, but did not actually calibrate effectively. You should have thought about these potential diagnoses. You didn’t pick the most relevant test to test out this hypothesis. You ordered these which didn’t need to be ordered at this stage.”
You can see how that expert feedback and coaching would be really useful that we provide to the student and to the educators. They can look at very objective data on how each individual student is doing in developing these diagnostic reasoning competencies, but they can also step back and look at cohorts as a whole.