The in-Training Editors-in-Chief, Nihaal Mehta (NM) and Amelia Mackarey (AM), talked to Dr. Dustyn Williams (DW) and Jamie Fitch (JF), co-founders of OnlineMedEd — one of the most widely-used educational resources by medical students around the world — and two leading figures in shaping medical education. The conversation ranged from OnlineMedEd as a learning platform to Dustyn’s and Jamie’s philosophies on teaching and the future of medical student education.
Part one of the interview is available here. Here, in part two, we dive deep on the OnlineMedEd business model and discuss how Dustyn’s work directly teaching medical students helps shape the platform.
JF: Why was that reproductive endocrinologist even teaching that class? Medical schools pay you to do research — they pay you to do what you’re good at. They’ll bring in a cardiologist who has a surgery named after him — that person shouldn’t be teaching the basics of the heart. It makes no sense that these people who are experts are then taken back a step and have to teach the same stuff that anybody can — not anybody, but a lot of people can.
There’s textbooks on it, right? Dustyn had that realization pretty quickly: Why isn’t that put online in a centralized place where the one person who’s really good at it can teach — and then everybody else can build on it.
AM: Out of curiosity, Dustyn, do you practice or do education primarily?
DW: I’m the clerkship director at Baton Rouge General, which is the satellite campus for Tulane … That’s what my sabbatical’s from — I took four months off to do the Step 1 thing, so I’ve been living in Austin — basically living in the studio.
JF: A lot of sites will say “for doctors, by doctors.” That’s not possible for something like this — Dustyn just doesn’t have the time if he’s going to maintain his full practice. To be honest, doctors are not great coders or marketers, so it really takes a full team. I was a nice bridge in that I have a clinical background — I’m not medically trained, but I am familiar with the terminology — so I could be a bridge between Dustyn and the development team to make this happen.
DW: The story goes: I just put some videos online because I just wanted to teach. The way medical education goes is you have to prove yourself first. You can’t prove yourself unless you do it, so I said I’m going to do it myself. I took some courses from my mentors, Chad Miller and Jeff Wiese from Tulane, and I got a lot of practice. So I had a bunch of videos online. They were just free — it wasn’t a company and it wasn’t a business. I was just doing it because I wanted to do it.
Jamie took it and said this could be a company. When we first started I came in with the idea: I want to give away everything, and I want more medical education to more people for less. Jamie brought up a good point which was: You know how you do that? If you have a bunch of money — to expand the company so more people will know about it, you can offer more stuff, and people can show up to a website instead of trying to find you on YouTube.
What we’ve done is expanded from me doing some stuff in my bedroom to a real company that actually has influence in the medical education space and is helping hundreds of thousands of people. I couldn’t have done that without what we have here.
JF: When Dustyn started, I think he had hundreds of people coming to the website.
DW: *laughs* Basically! I was proud of that!
JF: And he was super proud! At the end of the day if you want to reach a lot of people you have to go beyond just one person’s influence to now having two core curriculums. Dustyn can’t do it all — he needs help on the backend. That takes a team, that takes money.
Dustyn and I did and have worked for free, but you can’t go to the neurosurgeon who makes $750 an hour and say, “Hey, can you give me 80 hours of your time to help with this neuroanatomy?” It just flat out doesn’t work. No matter how good the mission is, at the end of the day people have to be paid. That’s something we learned pretty quickly — if we build this, it has to be a sustainable business.
NM: You have a unique model in that you have paid content [including practice questions and a course, Intern Bootcamp, for new residents], but you also have a ton of content for free [including video lessons on basic science and clinical content]. Why did you choose to make your videos available for free as the foundation of what you provide?
JF: It goes back to why Dustyn even started. If we could, we would give everything away for free. You just can’t have a sustainable business model that way. We really do believe that medical knowledge belongs to no one, so medical education should be accessible to anyone. That’s a really powerful way to approach what you’re doing and it gives you instant credibility. People realize, ok, these guys put their money where their mouth is and, first and foremost, want to do social good in the world.
A lot of people say, “How do you make money?” What [our model has] enabled us to do is to create influence, which then has led to everything else. We have over 100,000 registered users logged in every month — that’s more than the number of medical students [in the United States]. We have MD students. We have DOs, PAs, NPs. We have people all over the world, because medicine is a global language. We’ve been able to capture an intense amount of market share. If most people don’t convert, that’s okay. Enough people do to make this sustainable.
The rest of it became a business exercise — once people are in the ecosystem and they believe in the product, we then have other ways of providing value: Giving you access to books that are paid or classes like the Intern Bootcamp. We have different programs that are paid that students usually find value in. Everyone that’s used the main course — I don’t want to say everybody, but for the most part — sees the value proposition and understands why we do what we do. We’ve seen great success in that across all schools in the country and many in the entire world.
DW: When Jamie started I said, “The videos are always going to be free,” and the videos are often the most expensive content. We did not do that as a business model — that was why I started the thing in the first place, why I started filming.
What we believe is, if you want to learn something, show up to the website and watch the videos. If you want to do well on the test or you want to get a head start on your co-interns — well, decades of medical education doesn’t come free. Intern Bootcamp was literally everything I did in residency, and what I do as a mentor when I coach people who are failing or succeeding. I’ve learned what works and what doesn’t — but that ain’t free. That’s 10 years of my life.
AM: That makes a lot of sense. As clerkship director, how has your experience working with medical students impacted the way you’ve shaped OnlineMedEd?
DW: I can’t really say one’s cause and effect, but I use it [with my students]. I use OnlineMedEd as assignments — we go by organ system and the following week they do an hour-long case three-days a week. I implemented OnlineMedEd as a learning source for my students and then because of that I’ve created the cases, which go back to the students.
I also had the opportunity to — inadvertently, I got stuck with this role — be the remediator for Tulane students … We created the remediation product that we have for Faculty Mode [on OnlineMedEd] based on my pen-and-paper version I was doing with students.
The PACE paradigm — the multiple versions of the same content curated by one voice, the videos, the readings, the questions, the flashcards, the tables — all of that was informed by my experience helping students. It was back-and-forth: The students needed my help — I gave them OnlineMedEd. The content itself doesn’t change, but how we use the material and the tools we build moving forward are informed by my experience with the students and residents.
JF: I would add that, though the content doesn’t change, sometimes the focus does. It does give us direct access — and as a company that has all these users, we do have a strong community so are crowd-sourced in terms of what’s trending now on the exams.
If Dustyn needs direct feedback on what needs to be updated, he can go straight to the students he’s working with and get direct feedback on what they’re seeing on the test. It’s tough because the exam’s always three years behind what’s actually happening, so Dustyn has to get up-to-date and then try to get into the minds of the writers.
It’s especially challenging — if you think about what’s happening in hypertension these days — the last three years there’s been two or three complete shifts in recommendations. But Dustyn’s able to utilize his students to know what he needs to teach today, with the recognition he’s going to need to teach something different in a year.
Part three of our interview with Dr. Dustyn Williams and Jamie Fitch, co-founders of OnlineMedEd, is available here.