THE TECH ADVANTAGE
Training the next generation of doctors and nurses
For decades, medical education has followed a timeworn path — heaps of book-learning and lectures, then clinical rotations exposing students to patients.
But as technology explodes into patient care (surgeons can preview operations using virtual 3D images built from a patient’s scans), the gap between medical education and real-world care has “become a chasm”, said Marc Triola, director of New York University Langone’s Institute for Innovations in Medical Education, created in 2013 to address the issue.
“The healthcare delivery system is changing every day,” he said, “and our medical-education system has been lagging.”
In what looks like an urgent game of catch-up, medical and nursing schools across the US are retooling how and what they teach.
This is where Greg Dorsainville, a multimedia developer and one of 28 full-time staff members in the NYU institute, steps in, using a 360-degree camera to film a 45 minute session with a pathologist. He cut the lesson to 5:46, time that a medical student can spare to don goggles, zoom in and see what a polyp actually looks like, making it something to be remembered as “a visual in their mind. It’s not just a concept”.
The availability of tools like virtual-reality goggles (about US$200 a pair, or 6,600 baht), along with a growing library of software, is changing how students acquire science content. But the bigger deal may be what technology is doing to skill-learning.
Marlene Alfaro, a second-year student at the University of California Riverside School of Medicine, can slip on goggles and — in virtual reality — call up a 1m 3D image of a ruby-red beating heart and, with a controller, probe its structures.
In the textbook, she said, “it was hard for me to visualise the whole 360” degrees. Virtual reality “lets me see real quick how everything goes together”.
No one wants to be the first human a student intubates (navigating a breathing tube down a patient’s throat), yet students have often trained on real patients. While it can take years to develop the dexterity, control and confidence to smoothly insert a central line, lifelike simulations are giving students more chances to practice before plunging in for real.
In replica hospital rooms fitted with bed-bound mannequins programmed to mimic conditions like strokes and seizures, and that can bleed, blink and give birth (there’s even a realistic placenta), students get “deliberate practice”, said Robert Morgan, director of the Greenville Health Care Simulation Center in South Carolina, which is used by the University of South Carolina School of Medicine, Greenville and Clemson University School of Nursing.
Rather than hope to encounter a teaching opportunity in the hospital, Morgan said, “you come here and start your first 10, 15, 100 IVs before you actually have to place one in a patient”.
Instructors have used mannequins for decades to teach CPR. But recently, he said, technology has advanced, giving students the realistic experience of caring for a patient.
Which is what was happening one recent morning at Clemson’s newly opened $31.5 million nursing school on the Greenville campus. From behind two-way mirrors, instructors used consoles to adjust “patient” heart rates and responses to treatments. They spoke into microphones to answer questions.
For students readying for rotations in real clinics, simulations let them rehearse treatment choices, as well as the best ways to talk with patients while treating them. Instructors can create dire circumstances like uncontrolled bleeding (though “nobody dies until senior year”, said Jean Ellen Zavertnik, the lab director), or — the case on this morning — a scenario letting students puzzle over when (and when not) to give a patient insulin.
Repeated practice is important. But so is unscripted human interaction, which is why medical and nursing schools also are embracing non-tech innovations that put students in clinical settings sooner, often outside of the hospital.
Clemson master’s-degree nursing students go to rural clinics. One of the students, Kita Rhodes of rural Prosperity, South Carolina, said African-American patients could be wary of providers, but warm to her. “They say, ‘Oh, I have somebody who looks like me’,” Rhodes, who is African-American, said.
University of South Carolina medical students at Greenville become certified emergency medical technicians at the start of their first year and do monthly shifts on an ambulance, which offers “a more complete picture” of patient lives, said Dory Askins, a second-year student.
The biggest non-tech innovation in medical education? Teaching students to understand how the healthcare system works and what that means for patients, said Susan Skochelak, who is leading an initiative to transform medical education at the American Medical Association. Begun in 2013, the initiative now has a consortium of 32 medical schools (NYU is one) working on projects to revamp curricula.
Many include dazzling tech approaches, but also programmes like the one at Penn State College of Medicine, where students serve as “patient navigators” after discharge from the
Hospital rooms are fitted with bedbound mannequins programmed to mimic conditions like strokes and seizures
hospital. (Can the patient get to physical therapy? Why did the hospital schedule the mother of a toddler for a scan at 3am?) “They look at the system with fresh eyes,” Skochelak said.
Traditional healthcare has been slow to respond to people’s varying circumstances, but medical training has been stuck, focused on acute hospital-based care treating “things you can fix”, said Paul Lyons, chairman of the department of family medicine at the UC Riverside School of Medicine.
Yet, he said, bigger issues for much of the population — including inland California — are chronic diseases like hypertension and diabetes. Those are treated in outpatient clinics and may call for strategies around smoking cessation, obesity and other lifestyle issues, which, Lyons said, are skills different from what students are usually taught.
“It is as if I trained you to drive in rural Iowa,” he said, “but then set you up to drive in Manhattan.”