A sea change is happening in education. Millions are taking free online courses, some offered by elite universities. Lectures in crowded halls have moved online, with teachers and students using class time for discussion and problem-solving.

Unlike online courses and degree programs, the increasingly popular MOOC (massive open online course) is a relative newcomer to online education. The model beefs up regular classes while offering a free taste of college to anyone with a computer and Internet access.

Critics fear MOOCs may replace or cheapen brick-and-mortar education, and point to their high student drop-out rates. But many leading researchers consider MOOCs a worthy experiment.

Online educator Khan Academy is convinced of the value of online content. Like a MOOC, the material it creates is free and available to anyone, anywhere.

But that’s where the similarities end.

Have you read “The Swerve,” the Pulitzer Prize-winning book by renowned historian Stephen Greenblatt? In it a canny Renaissance era book hunter discovers and releases knowledge in the form of a medieval, controversial poem lost to posterity. The poem had dwindled down to a single handmade, leather-bound version held behind the vine-covered, ancient walls of an Italian monastery. According to Greenblatt, the unleashing of that book changed everything that came after. That small book with the long poem on the nature of things set in motion forces that challenged the status quo and triggered dramatic, world-wide change—a swerve. The only way that knowledge survived the millennia was because monks trained in hand crafting books had carefully copied the one survivor—and saved it for centuries. 

Last week, the Khan Academy, AAMC (Association of American Medical Colleges) and the Robert Wood Johnson Foundation may not have triggered quite such a momentous unleashing—but this powerful collaboration did start something very interesting with potentially significant implications for health care education.

A little more than 13 years ago, the Institute of Medicine (IOM) released its seminal report on patient safety, To Err is Human.  You can say that again. We humans sure do err.  It seems to be in our very nature.  We err individually and in groups—with or without technology.  We also do some incredible things together.  Like flying jets across continents and building vast networks of communication and learning—and like devising and delivering nothing- short-of-miraculous health care that can embrace the ill and fragile among us, cure them, and send them back to their loved ones.  Those same amazing, complex accomplishments, though, are at their core, human endeavors.  As such, they are inherently vulnerable to our errors and mistakes.  As we know, in high-stakes fields, like aviation and health care, those mistakes can compound into catastrophically horrible results.  The IOM report highlighted how the human error known in health care adds up to some mindboggling numbers of injured and dead patients—obviously a monstrous result that nobody intends.

The IOM safety report also didn’t just sound the alarm; it recommended a number of sensible things the nation should do to help manage human error. It included things like urging leaders to foster a national focus on patient safety, develop a public mandatory reporting system for medical errors, encourage complementary voluntary reporting systems, raise performance expectations and standards, and, importantly, promote a culture of safety in the health care workforce. 

I had the recent good fortune to attend an Institute of Medicine Roundtable workshop on the Promotion of Health Equity and the Elimination of Health Disparities called Leveraging Culture to Address Health Inequalities: Examples from Native Communities.  The Robert Wood Johnson Foundation supported the November 14, 2012 Seattle event.  The meeting was a gathering of American Indian, Alaska and Hawaiian Native health and health care leaders, all talking about health and culture.  They told stories of resilient, strong, vibrant, conquered yet not vanquished people.  Their tales were wondrous and sad—troubling, provocative, sometimes angry, often humorous.  

One might think the IOM was doing a good, almost charitable, thing by shining some precious attention on these people. How nice for experts to listen politely to those stories of past cultures struggling against waves of current change.  Well, it was a good thing—but not necessarily just for the natives.  There was immense, quiet wisdom and power there—for everybody. 

My recent journey to Mayo Clinic’s Transform 2012 began with a bike ride. I was up at 4:00 a.m. and drove for an hour to join hundreds of other cyclists in northern New Jersey for a 7:15 a.m. ride start. 107 miles and 7,600 feet of climbing later, I uploaded my ride stats to Strava, chatted some with colleagues, grabbed a bit of post-ride lunch, and blasted home. I made it to the Philadelphia airport just in time for my 7:00 p.m. flight. After a connection in Chicago, I arrived in Minneapolis around midnight, rented a car, and then drove 80 miles in the early morning hours across rural Minnesota, eventually arriving at my hotel in the town of Rochester.

Bright and early that morning at the meeting, feeling surprisingly bushy-tailed, I encountered a large gathering, almost like a mirage rising from the prairie, of curious, engaged people talking earnestly about how they were transforming American health care. But of course it wasn’t a mirage. It was real and impressive. Our national audacious effort to transform the health care colossus from its current state of dysfunction and inefficiency is impossibly complex and difficult. We know that. Nevertheless, my reaction to Transform 2012 was not simply because I found a large gathering focused on that health care transformation. No, the truly remarkable thing is that here was yet another of many large gatherings of engaged people working all over the United States to transform health care.