Shiv Gaglani, Co-Founder of Osmosis: A Once and Future Med Student Shakes Up Health Education

Van Ton Quinlivan: Welcome to WorkforceRx with Futuro Health, where future-focused leaders in education, workforce development and healthcare explore new innovations and approaches. I’m your host, Van Ton-Quinlivan, CEO of Futuro Health.

As a medical student at Johns Hopkins University ten years ago, Shiv Gaglani quickly realized it was time to shake up a century-old, lecture-based approach to medical education and make the experience more dynamic, efficient, and enjoyable. That was the spark for creating Osmosis, an online and mobile learning platform that’s been used by millions of current and future health professionals, as well as patients and their family members.

The company has grown into a global workforce of more than eighty-five educators, medical illustrators, video editors and others creating content and systems based on learning science. A little over a year ago, Osmosis was acquired by Elsevier, a leading medical and scientific publisher which is best known for the Grey’s Anatomy textbook, and The Lancet medical journal.

Shiv somehow managed to earn an MBA from Harvard in 2016 while running Osmosis, and is the author of two books: Success With Science and Standing Out On the SAT and ACT. He’s also been a contributor to Forbes which named him to its 30 Under 30 List in 2018.

I enjoyed being a guest on his Raise the Line podcast previously, and I’m looking forward to getting his insights on the current and future state of health education. Thanks so much for joining us today, Shiv.

Shiv Gaglani: Van, it’s a true pleasure. Thanks for having me on your podcast.

Van: Absolutely. Well, we need to start with your background. I understand you came from a health-oriented family. Tell me, what was the reaction when you decided to quit your medical education at Johns Hopkins?

Shiv: (laughs) Well, yeah, it’s true. My dad’s a retired physician and he ran a hospital in South Africa; my mom’s a physical therapist; and my sister and brother-in-law are dentists who have several practices in Chicago.  The joke is that between my family members, “we can treat anybody for anything.” I’m a bit of the black sheep in the family because I started my medical degree but then decided to take time off to launch a startup. The reaction, initially, was obviously one of anxiety and fear because I had worked up until then my entire life to get into medical school, and then to leave it and risk it was big. But I didn’t actually wind up burning the bridges. I just deferred medical school every year for ten years and got the MBA in between, published a couple of papers, and grew Osmosis. And fortunately, Johns Hopkins has been relatively supportive because it wasn’t like I was doing something totally different. I was still working on medical education over the last several years.

Van: Well, they’re going to be able to brag that you are and alumnus soon enough, right? You’re heading back?

Shiv: Yeah. That’s the big personal news this year. Fortunately, Elsevier has allowed me to create a structure where I can go back to do my clinical years, and I have about a year and a half of medical school left. It’s funny…I just joined the Hopkins class of 2025 GroupMe chat. Now I’m the old guy in there because I was initially part of the Facebook group of Hopkins, class of 2015.

Van: Fantastic. Well, we’re looking forward to celebrating your graduation!

Shiv: Thank you.

Van: So, Shiv, what were you trying to solve when you created Osmosis? And help us understand what Osmosis does for students and how it approaches health education that is different from the way you encountered education when you were a student.

Shiv: Certainly. A lot has changed over the past decade since we started Osmosis. Terms like “flipped classroom” were not as popular as they are now. We’ve seen a lot of good growth and adoption over the past decade. Essentially, when my co-founder Ryan and I were in anatomy class together, we realized that the tools that we were using and our classmates were using to socialize and consume media– tools like Facebook or Netflix — were managed by more sophisticated recommendation algorithms and better user experiences than the tools we were using to learn medicine.

For example, Netflix knew that if I liked a true crime show, I’d like another true crime show, whereas our medical education systems did not know this about us. They didn’t know that Ryan had a Ph.D. in Neuroscience, so, maybe we should send him more Neuroscience content that he’d be very interested in. Or, that I am very interested in emergency medicine, for example.

So, we wanted to build a learning platform that was more personalized and could recommend content in the way that we expect from many of the tools we use now. We left med school to build upon this concept and make learning medicine more efficient, engaging, and personalized. Along the way, we brought on the team that used to run Khan Academy Health and Medicine, led by our chief medical officer Dr. Rishi Desai. That’s where we really took off because we started producing these really short, engaging, five to ten-minute animated videos that have taken the sixty-minute lectures and turned them into a tenth of the time with really good explanations. That’s kind of what’s grown us to be the largest health education channel on YouTube, have over three million registered learners on Osmosis, and grow beyond medical school into nursing, PA, pharmacy, dentistry and many other health professional fields.

Van: Is it the dosage that is better for the learner? It’s both the recommendation engine, but it sounds like there’s a dosage involved with learning.

Shiv: Definitely. I think most of us have heard these terms — and I know you all care about this as well, and do it well – such as bite-size learning, continuous professional development, and micro learning. People are busy. They have a lot of distractions and this is even more so as you become a practicing provider or a medical resident where your job is really patient care, first and foremost, and secondarily, education and lifelong learning.

Between standing in line in the subway at the hospital, to just having time between a patient, being able to get a push notification to your phone with a short three-minute video or a couple of questions is really what made Osmosis popular. Now, many organizations are doing this, and in really great ways that we’re learning from, too.

So, I think, that dosage is one, and then, format. A lot of content has become visual, right? Obviously, the most popular social media content platforms are YouTube, TickTock and Instagram. The commonality is short-form video. That may change over the next five, ten, fifteen years as we get new formats and innovations come out. But really, I think the short-form video format we adopted with high quality is what led to a lot of our growth.

Van: Shiv, since I appeared on your podcast, our Futuro Health base of adult learners — whom we’re working to bring back into education in order to get healthcare credentials — has gone up from 80% to now 90% diverse demographics. And they’re adults. Their average age is thirty, for example.

It sounds like the format and the learning in the instructional delivery that you’ve created is actually much more adult-friendly. For the base of learners coming through Futuro Health, who are pursuing entry-level careers in healthcare, could the Osmosis way of instruction actually enable them to pursue higher level careers like physicians assistant or become a doctor, for example? Does it create new pathways for people who normally wouldn’t consider these careers?

Shiv: It’s a really great question. And again, I’m a huge fan of the work you all do to get a more diverse and more adult kind of learner base into healthcare careers. We’re all collaborators because ultimately, the thing we’re competing against is the shortage of healthcare workers. We just need more of them and so making those pathways more efficient is core to what we do at Osmosis.

A couple of years ago, I gave this TEDx Talk called “Could You Get an MD Online?” The whole thesis was that as we switch to bite-size learning and competency-based learning instead of time-based learning, we should see more pathways emerge where someone who trained as a respiratory therapist could — instead of having to go back and do all four years of med school and another five years of residency — they could maybe streamline that and take what they learned in practice and maybe do a year-and-a-half or two years in med school, and then maybe two years of residency and get proficient to be able to provide patient care as a pulmonologist. That’s what we’d love to see.

We see that in other professions, right? Even at Osmosis, we’ve had people join us as content illustrators who then transition into product designers, and then product managers. In medicine, we don’t see that as much. Once you become a PA, you don’t necessarily go on to become an NP or something like that. I would love for us to help develop more of those asynchronous, bite-size, competency-based learning opportunities and pathways, and we certainly need that across the healthcare system. Not just domestically, but globally.

Van: Are there other best practices that you would share with the younger version of yourself?

Shiv: In terms of producing Osmosis or in terms of, like, learning science or…

Van: Addressing the problem that you originally set out to solve.

Shiv: There’s this great law called Amara’s Law which I recite a lot which is, people tend to overestimate the impact of technology in the short term — say a one or two-year basis — and underestimate its impact in the long term — say ten years. I think Bill Gates paraphrases that by saying people tend to overestimate what they can accomplish in a year or two and underestimate what they can accomplish in ten years.

As for Osmosis, when we left med school we thought, “Within two years, we’ll have this great thing and it’ll reach so many people.” That’s not how it happened. It was very much a plateau and we had to fight for every kind of user and growth. Ten years later, though, we just had this large institution of nursing in Australia that adopted Osmosis. The impact is beyond what we ever imagined.

So, I would say one of the core lessons is people are busy and we have to compete for their attention, so whatever we can do to develop easier, more efficient, and more engaging learning tools and media, the better. Going onto the video platforms first would probably been better for us, but again, there’s no counterfactual had we started doing that earlier — we may have had the wrong format.

Another lesson is focus. Focus is a big thing where, initially, we were spread thin. As you mentioned in the intro, I did a lot of high school education with research and SAT, ACT prep. Within a year of starting Osmosis, we were getting pulled into doing K-12 Osmosis or other things. We lost a lot of focus and a lot of time in the process. I think a big learning I took away from that is focus on your power users and solving their problems first. You can then have the resources and the time and the brand to grow from there.

Van: Now, tell me more about the student experience. What did you learn about things that enabled students to persist through a set of curriculum, for example?

Shiv: Students have varying levels of motivation. It depends, even with the same student. It can vary by the day, by the hour, etcetera and certainly, by the interest level in that particular set of content. So, we adopted this thing called the Fogg Behavior Model. We actually had BJ Fogg — he’s a behavioral scientist at Stanford — on the podcast last year talking about this model, but we had been influenced by him a decade ago.

He essentially says that behavior boils down to three things: motivation, willpower, ability — how easy is it to do that thing — and then, prompts. Are we reminding people with the right prompts at the right time? His whole thesis was don’t rely on motivation because that’s fickle, that can change. I’m a very different person at 10 p.m. then I am at 5 a.m. in terms of how much I’m willing to study or work or whatever. So, Osmosis has been designed around trying to make it as easy as possible for someone to access and consume content. That’s why we have mobile first, short-form video. We talked about personalized recommendations. We’re pushing content to people instead of relying on their willpower to come back to the system, and as for prompts, we do that through push notifications.

One of our coolest collaborations is with NYU Grossman School of Medicine where we know that a third-year med student on the pediatrics rotation met a patient with Kawasaki disease today. So, tomorrow, they’re getting a video and a question about Kawasaki disease to reinforce that learning. That sort of prompt that BJ. Fogg talked about a decade ago has been designed into our tools to help students and other learners persist through the curriculum.

Van: Oh, that’s fantastic. I suppose that over time you were able to create enough of an inventory to be able to do very targeted, very personalized prompts.

Shiv: Yeah. And the personalized recommendation system is still getting better and better. In many ways we’re just at the beginning. I’ve been very obsessed with generative AI and ChatGPT among other things and what that means for personalized tutoring and learning over the next decade.

Van: Well, let’s talk a little bit about addressing the shortage of doctors. You talked about your Ted Talk about whether we could create an MD online. But really, as we think about expanding the pool, what should we be on the lookout for…you know, the diamonds in the rough who, perhaps, can go the distance? What would you recommend?

Shiv: I would say that what we expect our clinicians and providers to do over the next ten, twenty years will be fairly different than what we expect them to do now. Fortunately, I think some of the things that caused them to burn out and leave — not just doctors but nurses and others– will be remedied by technology. So, for example, clinical documentation and working with electronic health records is a major sticking point for these providers. Same with the business model of fee-for-service versus value-based care. Fee-for-service tends to rely on Relative Value Units and it burns physicians out because they have to see fifty patients a day versus focusing on just providing value.

The healthcare system is changing, and that’s essentially why we launched the Raise the Line podcast is to make sure that the medical students — but also PA, dental, nursing, etcetera — who are learning by Osmosis are apprised to what does the health system of tomorrow look like that they’re going to enter? Because the health system is changing, I think we’re going to rely more on recruiting clinicians who are more human, who provide more care and not sick care.

They’ll have those so-called soft skills where they’re able to empathize with patients, communicate very effectively with them, coach them, help them through behavior change and use technology — whether it’s telehealth or remote patient monitoring or other technologies — to help them change their behaviors. It will be less about the memorization and regurgitation…the things that I think increasingly technologies will take and replace from providers.

That has ramifications for everything from the admissions process — obviously, we’re all trying to recruit a more diverse and inclusive workforce in the future — to the time it takes to train these clinicians, to how we test them, right? The MCAT has undergone several revisions over the past twenty years. USMLE Step 1 went pass/fail. A lot of other exams I think are going that route. So, it’s an exciting time, I think, to be in the education of healthcare professionals.

Van: Let’s say there were base of 10,000 Futuro Health graduates and we put them through a signature “soft skills” program. Of those in the top 10% in terms of having those human skills, could we then figure out which ones have the headroom to go do a medical education?

Shiv: I think it’s possible. I think predictive algorithms are getting way better where those are the input variables and we can figure out with a big enough data set what are the qualities that led to them being great clinicians? Again, NYU is a leader here. I was just on a call with our collaborator there and dean, Dr. Marc Triola, who has some really interesting work where we’re looking at the actual patient outcomes of NYU-trained providers and trying to correlate that to things that they measured in medical students earlier on. So, if you take that even earlier to Futuro Health graduates, I think we will reach a point where we’re able to efficiently predict who makes it through the curriculum and then who actually becomes a good provider, and then, back design how we train them and how we recruit them from that.

Van: That’s going to be fascinating. I think your time in medical school will be telling. Who knows what kind of company you will found or what health systems you’ll be leading?

Shiv: (laughs) Thank you.

Van: What are some of the big and small shifts in the field of medical education you see, and how do you recommend your niece or nephew prepare if they’re considering going into the medical school?

Shiv: Great question. One of my favorite questions we ask our guests on Raise the Line is for advice they would give to early-stage career professionals. Advice, is so contextual, right? It really depends on the person and what they’re looking for. There’s no one-size-fits-all.

I would say the two things, though, that are timeless are reading and educating yourself…staying abreast not just on what’s happening now, but what happened in the past. The more I read, the better we’ve done at Osmosis, the better healthcare professional we’ve trained, etcetera. And then, building relationships because careers are long and you never know how they intersect. Even like our relationship here — where we first were introduced long ago and I had you on the podcast — we work on the same mission. Maybe we’ll work together at the same company, eventually. So, I would say those are two timeless pieces of advice: reading and relationships.

As far as what the next decade of medical education looks like, certainly, some trends that started over the last few years that were accelerated because of COVID will continue to be important: training providers for value-based medicine versus fee for service, and adopting digital health. I think a big thing is getting patients to be their own providers, right? I compare it to The Ninety-five Theses from Martin Luther.  One reason he became popular and the Protestant Reformation happened was he said we don’t need a priest to communicate to God. You can do it yourself, read a Bible yourself and figure that out.

I think, increasingly, because of content online, remote diagnosis and telehealth, the more engaged and educated patient population we can create, the less endocrinologists we’ll need. I don’t think we’ll ever reach a point where we have enough medical schools, nursing schools, residency programs, and seats to train that many people. It will ultimately take a lot of individual responsibility from patients and engagement to, as we say, flatten the curve of these chronic conditions and infectious conditions, etcetera.

Van: Shiv, you have a new passion for rare diseases. Tell me, is that going to be a part of your medical journey?

Shiv: Yeah, definitely. As I go back to the wards, I’m really excited to meet patients who’ve gone through the diagnostic odyssey and been diagnosed with these “zebras.” This year is the fortieth anniversary of the Orphan Drug Act and we just launched a campaign at Elsevier Health and Osmosis called “The Year of the Zebra.” We’re doing a lot to raise awareness around these 7,000 plus rare diseases that collectively affect 300 million people and hundreds of millions of more family members. So, on our podcast, we’ve been fortunate to have several dozen rare disease patients, providers and leaders. It’s definitely a passion of ours at Elsevier Health and Osmosis.

Van: Well, I’m looking forward to what you will invent as you go into this next journey of your life. You’ve contributed so much to the field of medical education and health education. I just want to thank you so much, Shiv, for being on this podcast and give you a chance to make any final comments on what you see in the future of health.

Shiv: Well, thank you again, Van. I really appreciate you taking the time to have me on and also respect the journey you’ve been on and how much of an impact you and Futuro have made in reducing the healthcare workforce crisis.

I’m just really excited. I’m very much looking forward to continuing to collaborate in the space. I mentioned my Hopkins 2025 class…a number of people have reached out to me who have used Osmosis, and so, who knows? Maybe in a couple of years, I’ll be working with some of them on different things, and again, with you. I welcome anyone who listens to this podcast to connect with me on LinkedIn. I’m the only Shiv Gaglani on LinkedIn. I love to hear from people and collaborate and be helpful however I can.

Van: Well, thank you again, Shiv, for joining us today. I’m Van Ton Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.