Feature Story
Mixing It Up
A one-time DJ, internist Don Deye has used his voice talent and tech savvy to take continuing medical
education into the iPod age.
By Kim Kiser
Don Deye, M.D., pulls a boxy black satchel from under his desk that at first glance appears to be a doctor’s bag. He opens it and, instead of a stethoscope or otoscope, takes from it a broadcast-quality digital recorder the size of a small laptop computer, several microphones and stands, a pair of nylon coaster-sized discs that muffle harsh consonants, headphones, an assortment of cords, and a thick, printed script. “It’s my studio in a bag,” he says, piling the equipment onto the desk in his tiny office at Cambridge Medical Center in Cambridge, Minnesota.
The black bag is his constant companion as he travels around the country doing audio recordings for Oakstone Publishing, a Birmingham, Alabama, company that produces reference and continuing education materials for health professionals. In addition to seeing patients in his full-time internal medicine practice in Cambridge, Deye has been the voice talent for such CME offerings as Practical Reviews in Cancer Management, the American College of Physicians’ Medical Knowledge Self Assessment Program (MKSAP—pronounced “mix ap”) audio companion, and DocPod Hospital Medicine, now called Practical Reviews in Hospital Medicine.
The audio reviews and companions are designed to make continuing education more convenient and efficient by allowing physicians to soak up knowledge at their convenience on portable CD or MP3 players, or even on their smart phones. “As a physician, your most limited resource and your most salable commodity is your time. You can listen while biking, walking, jogging,” he says, explaining that the audio companions and reviews are part of a bigger plan he has for revolutionizing CME.
Deye epitomizes the type of physician Oakstone is targeting with its audio products. In addition to practicing internal medicine at the Allina Medical Clinic at Cambridge Medical Center, serving as president of the Minnesota Coroners and Medical Examiners Association, and participating in Minnesota Medicine’s editorial advisory committee, he runs a journal club for the Allina Medical Group and devotes his evenings and weekends to producing recordings and serving as medical director for Oakstone.
Deye recently finished one of the six-month updates to MKSAP. (The full offering, which is primarily used by physicians studying for board certification or recertification, is revised every three years.) That involved driving to Rochester, the Twin Cities, and Duluth on Fridays, his day off from clinic, to record interviews with local experts about recent happenings in internal medicine. This year, for the 15th full version of MKSAP, Deye will travel to places such as Yale, Harvard, Stanford, and the University of Washington to interview some of the most revered teaching physicians in the country. When asked how he does it all, especially in a year when MKSAP is being revised, he admits it’s a challenge. “I multitask, and I’m usually scrambling,” he explains.
The Man Behind the Microphone
Listening to one of Deye’s MKSAP segments, it’s easy to understand how they would appeal to the time-strapped doc. The format is more like a National Public Radio show than a lecture at a medical conference. As host, Deye describes his role as being “the curious internist who asks the experts the right questions.” In a segment on sepsis, he introduces his guest and asks him to describe the symptoms of the disease and who it affects. Deye occasionally breaks in to clarify a point, encourage his guest to share a story from the clinic or findings from the literature, or direct the listener to an accompanying table or figure. “It’s supposed to sound like docs chatting in the doctors’ lounge,” he says of the 20-minute segments that sometimes have an Ole and Lena joke mixed in.
Deye’s comfort behind a microphone and his talent for multitasking are not recent developments. When he was 10 years old, he started hanging around the local radio station in Winona, Minnesota, where he grew up. When he was 15, he took the FCC’s third-class radio licensing exam. “It’s what DJs at the time called a ‘third-class ticket.’ It’s what you needed to be a disc jockey at a small station where you operated a transmitter and took readings off of it,” he says. Deye passed the test and in 1965 became the morning guy at KAGE in Winona. “At 4:30 a.m., I would drive my 1949 Nash to the station, turn on the filaments at five minutes to 5, and at 5 a.m. sign on the air. Then I would head over to the high school at five till 8 and be in band with my baritone at 8 a.m.,” he recalls, adding that he still has a 1949 Nash—this one restored to showroom quality.
Having worked as an orderly at the local hospital as a teenager and been told by other broadcasters that medicine was a far better career choice, he went on to major in chemistry at Valparaiso University in Indiana, hosting a rock and roll show Saturday nights and a classical music show (“Don Deye Goes Baroque”) on Sunday mornings. Even as a member of Mayo Medical School’s inaugural class, Deye worked the graveyard shift at KROC and later was the daytime “hot rocker” at KWEB in Rochester.
A state loan forgiveness program brought him to Cambridge, a town in need of a doctor, in 1979. He has lived and worked there ever since.
As he built his practice, Deye and his family operated a tree farm and kept horses and sled dogs (his youngest daughter was voted “Most Inspirational Musher” by her fellow competitors in Nome after the 2008 Iditarod); the hours he wasn’t at the hospital or clinic were taken up with chores. One day in the mid-1980s, he got a mailing from a company, Educational Reviews, that produced monthly journal clubs on audiocassette. Deye subscribed to the one on internal medicine and would listen to a team of physicians review recent articles on his Walkman while driving his tractor or cleaning horse stalls.
When he received a satisfaction survey at the end of his subscription, Deye wrote back asking if they could use his talents. About a year later, he got a call from Bernard Schencker, M.D., who owned Educational Reviews, which later became Oakstone. Schencker asked Deye to be the voice talent for one of the 30 journal clubs—Practical Reviews in Cancer Management. Every month, they would fax Deye a script, and he would record it. In exchange, he got a free subscription to the cancer and internal medicine reviews.
After a year, Deye broached the subject of compensation with Schencker. “He was incredulous because he assumed I had been getting paid all that time. But the fact that I would do this for a year with almost no compensation made me a special person in his mind,” Deye recalls. Schencker, who wanted to retire, flew Deye to Birmingham and wanted to know if he was interested in buying the company. “I didn’t have $17 million, so I couldn’t do that,” Deye recalls. Instead, Schencker named Deye medical director in 1988.
Schencker taught Deye the business—how to recruit physicians to be editors for the reviews, how to analyze questionnaire data, and how to find new markets to tap and products to develop. One of the first things Deye did was approach the American College of Physicians (ACP) with the idea of putting its flagship educational product, MKSAP, on audio.
His initial idea was to do it like a book on tape. But Schencker convinced Deye that he needed dialogue. “When you have two people interacting, it engages your limbic system because there is uncertainty in a social interaction, there are nuances and you’re more alert,” Deye says.
Deye produced the first MKSAP audio companion in 1994, after persuading somewhat skeptical ACP leaders that busy internists would appreciate being able to listen to segments at their convenience on audiotape or CD rather than having to carve out the time to review the print version. He was right. “They sold like hotcakes,” Deye says of the first audio companion.
William Steinberg, M.D., the Washington, D.C.-area gastroenterologist who produced one of the first MKSAP segments with him, wasn’t surprised by the success of the audio format and Deye’s delivery. “He’s got this ability to digest medical articles and put them together in a very succinct and entertaining way … and he’s funny,” he says. Steinberg describes the script for that first segment as being “like Laurel and Hardy,” with the two physicians trading jokes and punch lines while giving listeners a short course on gastroenterology.
The MKSAP audio companion and updates have become Oakstone’s most popular offering. Its success has led to the development of similar audio companions for the American College of Surgeons and the American College of Cardiology. CEO Nancy McMeekin says of MKSAP, “We are able to reach more internists than we’ve ever been able to reach … As for the bottom line, it’s significant to us.”
But Deye’s involvement hasn’t been limited to the production and development of audio products. Through his affiliation with Oakstone, he’s connected with two medical software companies—Resolution Health and Med-Vantage—that create rules engines that analyze health insurance claims in order to extract basic quality information (for example, they can find patients who may not be filling their prescriptions or who are on medications that are contraindicated for their condition). He and some of the other physicians from Oakstone review, critique, and update the clinical logic that drives the software. “It’s a very intense and time-consuming task, but it’s also a very interesting task,” he says. And it got him thinking about the role such technology could play in continuing medical education.
The Futurist
Deye admits he likes to think and talk about possibilities. A confessed “early adopter” of technology (he started the Minnesota Medical Computing Consortium in the early 1980s, which created an electronic question-and-answer forum for medical students and physicians using an Apple II computer with four daisy-chained floppy drives), he has an idea for turning traditional CME on its head. He calls it POCASAME, which stands for point-of-care automated self-assessment with medical education. “The idea is to make it easier to learn the right thing,” he says. Deye believes this could be an alternate path for maintaining board certification, as physicians wouldn’t have to master topics that don’t relate to what they do every day.
With POCASAME, software similar to that which is used to analyze claims data would audit a physician’s electronic patient charts. The logic engines would look for practice patterns and point out specific areas in which a physician needs to improve his or her knowledge. “This is an electronic way to help you find things you don’t know you don’t know,” he says.
As the system identifies a gap in a physician’s knowledge, it would search a database of electronic and audio article reviews, board prep courses, and other resources, and generate a menu of perhaps half a dozen offerings on the topic.
“The whole idea of MKSAP is that you take these quizzes and the questions you get wrong are the ones you focus on,” Deye says, explaining that the information is good but not tailored to the individual doctor. “Even in the same specialty, because of the patient mix or the interest of the physician, no two medical practices are identical. So here’s a way to identify at an individual level what you need to know and help you learn it without you having to do a whole bunch of searching or taking a multiple choice quiz or spending 100 hours reading.”
Whether his idea will become a reality depends on whether he can find the resources for developing the software. But Deye’s enthusiasm isn’t diminished by the prospect of selling this—or any—idea in today’s market. “To me, this is where CME should be going,” he says. “It’s my vision of the future.” MM
Kim Kiser is associate editor of Minnesota Medicine.