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Next Gen medics

Future doctors and nurses will not practise on patients
In what looks like an urgent game of catch-up, medical and nursing schools across the country are retooling how and what they teach.

Laura Pappano/New York Times News Service   |     |   Published 15.01.19, 07:19 AM

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 health care 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 country are retooling how and what they teach. As schools seek to make learning more efficient, technology — including virtual reality, augmented-reality software and high-fidelity simulations (mannequins “breathe”, cry, sweat and respond to medication) — is a big part of that.

And it must be, given that students have to learn more information, faster. Much of medicine is slow; you can’t shortcut taking a medical history. But visiting the pathology lab to study a colon sample?

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° 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 $200 a pair), 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, US, can slip on goggles and — in virtual reality — call up a 3-foot 3D image of a beating heart and, with a controller, probe its structures. In the textbook, she said, “it was hard for me to visualise the whole 360°”. 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 practise 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. 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.

For students readying for rotations in real clinics, simulations let them rehearse treatment choices, as well as the best ways to talk with patients. 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.

The biggest nontech innovation in medical education? Teaching students to understand how the health care system works, 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 curriculums.

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. (Can the patient get to physical therapy? Why did the hospital schedule the mother of a toddler for a scan at 3 am?) “They look at the system with fresh eyes,” Skochelak said.


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