Steve Jobs never stopped searching for new ideas. He always wondered how technology can seamlessly interface with the “human experience.”
In 2002, I had an opportunity to collaborate and trade thoughts with Steve on this concept as it relates to the human body. We had a working title of “iMed” (Figure 1) and now much of that early vision is captured by mobile devices like the iPad Pro, wearable devices like the Apple Watch and Fitbit, and through portable versions of 3D virtual glasses and goggles (from products like the high-end HTC Vive to the inexpensive Google Cardboard and variations that use a smartphone).
Although the total number of medical apps (iOS) make up only 1.99% of the total number of downloads from the App Store, when lifestyle and health/fitness are added, that number expands to 13.67% to all iOS downloads. Interactivity, personalized health data availability, game-like engagement, and a focus on “edutainment” make the vision of technological integration more dynamic than ever.
New Learning Styles & Apps May Help Change Unhealthy Behaviors
Mobile, interactive, and wearable technologies have altered how we learn, and the impact in healthcare is enormous. Social media, game-play platforms, collaborative e-community based learning, immersive programs, simulation apps, built-in biosensors, virtual reality, augmented reality, artificial intelligence, and peer-to-peer learning all have promise to help better educate patients and health professionals. (Figure 2)
Some of the most difficult challenges in healthcare are unhealthy behaviors from foods we eat, overeating, smoking, lack of exercise, and a lack of motivation to change. Centers for Disease Control and Prevention statistics in 2014 indicate that up to 40% of annual deaths from each of the five leading causes of death in the U.S. are from “modifiable risk factors”. Habit formation develops in the basal ganglia of the brain and once established, may take weeks or months to change. Most programs and apps fail to make much of an impact so far in changing bad habits.
The good news is that more effective proven methods such as Prochaska’s stages of behavior change (pre-contemplative, contemplative, preparation, action, and maintenance) are now being integrated into personal mobile apps that merge personal lab results and up-to-the-minute recording of lifestyle data in a dynamic network. Additionally, some apps include live contact with health counselors who assist in answering
questions and providing personalized support. (Figure 3)
The challenges are steep and while 10% of Americans report they own an activity tracker, 50% report they do not know how to use them and 33% say they stop using them after six months. Better technology is warranted. As biosensors improve, wearable technology will provide not only valuable data but real-time feedback to help patients better manage their health.
New Mobile Technology & Platforms in Healthcare Education
Jump Simulation is at the forefront with many of the new integrated technologies in medical education and innovation. Next year, the campuses of the University of Illinois College of Medicine will launch a new curriculum in human anatomy and construct a state-of-the-art anatomy lab in Peoria at UICOMP. The vision is to blend the best in traditional dissection with new technological resources.
One excellent resource may be Complete Anatomy, which recently won the coveted 2016 Apple Design Award in healthcare. This highly interactive mobile app combines much of the information and visualization contained in books like Gray’s Anatomy along with the interactivity and endless editable views of an iPad. Complete Anatomy is designed for the advanced iPad Pro technology and features numerous editable functions using the Apple Pencil that provide endless cross-section views, selective anatomical structures and systems, collaborative interaction, and recording functions. Complete Anatomy is one of the finest healthcare mobile apps on the market. (Figure 4)
Another outstanding interactive medical app is Touch Surgery. Touch Surgery provides a guided, interactive experience that simulates specific surgical procedures in a step-by-step process. The ever expanding library of surgical procedures in many specialty areas is an excellent approach that utilizes visual learning and experiential activity. (Figure 5)
With the explosion of virtual reality (VR) and augmented reality (AR) capabilities, 3D interaction in healthcare provides immersive explorations inside of the human body. When combined with patient 3D scans from CT and high res MRI, clinicians can look deeper and in endless dimensions at specific structures. High-end goggles like the Oculus Rift and HTC Vive offer exquisite high definition interaction and even low-end devices like Google Cardboard and others utilize mobile smart phone technology to give a “3D” experience.
Other interactive mobile programs and technologies are used in health professions education, like Health Scholars. A Peoria-based educational series developed by the nurses at OSF HealthCare in conjunction with SIMnext and CSE Software Inc. The interactive, self-contained learning encounter for nurses is built on a mobile, tablet-based platform created to help standardize nurse education. It is a series of self-directed learning modules that take education from the classroom to mobile sites, including the hospital floor.
Mobile and app-based learning will continue to evolve, and researchers, faculty, and staff at Jump are actively involved in the exploration. These new technologies will impact education and improve patient care, safety, and reduce costs. Steve Jobs would approve but reminds us that much more needs to be done. Fortunately, much of that work is in development at Jump.
Just as the healthcare industry continues to evolve, so too does the training of novice and experienced physicians and other clinicians. Jump is a leader in offering hands-on experiences in a variety of simulated environments: beginner and more seasoned surgeons can practice life-saving procedures they rarely encounter on a cadaver perfusion model, fledgling nurses and residents can rehearse working as a team for the first time to save a patient’s life, and advanced care planners can practice discussing end-of-life care decisions using standardized participants.
In-person simulation has become a right-of-passage for medical and nursing students around the world, allowing them to practice life-saving procedures before contact with real patients. To some extent, that will always be the case. But in the future, more simulation scenarios will occur in the immersive virtual reality space.
The fact is, physical simulation and physically reproduced environments are expensive and require people to travel. This makes frequent or repetitive practice difficult. Offering virtual reality simulations opens up participation for medical professionals who are too far away to utilize a simulation center. It provides the opportunity to create interprofessional teams with staff members who have never worked together before. Virtual reality simulation will allow participants to prepare for in-person simulations and do follow-up repeat practice after they’ve completed hands-on learning opportunities.
There is much as yet untapped potential with virtual reality. I was recently part of a team, consisting of educators from Lehigh Valley Health Network (LVHN), that published an online paper demonstrating that it was possible to create an outpatient virtual reality simulation in a first-person-perspective environment. The pilot revealed it’s an opportunity we, as simulation centers, should continue to explore.
Utilizing Virtual Reality Technology for Medical Simulation
Virtual and augmented reality technology is exploding today with products like Oculus Rift and the Microsoft HoloLens becoming part of mainstream culture. But virtual reality has been utilized in the medical industry, to some extent, for years. It just hasn’t evolved enough to provide real immersive experiences for clinicians in different healthcare environments.
Our research worked to design a user-friendly interface for interprofessional teams to practice outpatient-based emergency scenarios. We used AvayaLive™ Engage to create a computer-generated replica of an LVHN outpatient facility, and built three simulation cases centered on common office-based emergencies: chest pain, respiratory distress/allergic reaction, and suicidal risk. We chose to focus on office-based emergencies because there aren’t a lot of simulation opportunities for this environment, and outpatient care is expanding to include more complex cases.
18 individuals representative of an outpatient interprofessional care team participated in the study. Up to five clinicians performed simulation exercises at a time as if they were playing a video game. They controlled their own avatars and utilized Voice over IP to communicate with each other. Some were also in the same room, so they could talk to each other as they went through the scenarios. Actors played the patients within the virtual clinic room and controlled their own avatars and voice controls. Orientation was provided to all subjects before the simulations took place.
Using a design-based research approach, we were able to continually improve the simulation process, virtual environment, and scenarios based on feedback from participants during debrief. Learners provided reactions to everything from whether the sounds in the outpatient room were realistic to whether the virtual environment was easy to navigate.
A post-activity survey revealed participants were accepting of the learning method and environment. A majority also felt they met the learning objectives of office-based emergencies using virtual reality simulation. The next step will be to test this method out on a larger scale.
The Future of Simulation
A major advantage of using a virtual world for medical simulation is that the cost of distributing content to a wide audience is very low. However, there are upfront costs associated with creating the curriculum and medical environment. In many cases, educators would likely prefer a pre-made virtual environment they could write cases for. There aren’t many faculty members with the time or resources to build an interface from the ground up as our research team did.
However, there are an increasing number of technology companies developing more opportunities for virtual reality-based simulation. I envision that students in healthcare will eventually be able to wear a 3D viewing apparatus to fully immerse themselves in a virtual space that allows them to practice procedures or interact with patients.
At this point, I think we are still at an early stage. I imagine the things we are unable to simulate today, we’ll be able to simulate easily in the next five to ten years.
There are some situations that occur in the hospital or out-patient clinic that clinicians can’t manage without some experience. These are circumstances that don’t require technical knowledge or skills that can be learned from a book. They are high-pressure conditions that medical professionals should be prepared for to provide the best care possible to patients.
Take for example delivering bad news to a patient’s family. Let’s say there’s a patient who comes in with chest pains but has no history of medical problems. He calls his wife who is out of town to tell her everything is well and that he’s being kept overnight for a cardiac workup. His wife returns to town to learn her husband has had a heart attack that has left him in critical condition. Now it’s up to the medical resident on duty to deliver the bad news. How do you prepare for that?
Or imagine you are a first-year resident and notice that your superiors are breaking the sterile field or running an improper cardiac code. How do you challenge your supervisors?
Simulations that include SPs allow clinicians-in-training to practice real human interactions in a safe learning environment and understand how to appropriately handle certain critical situations. Standardized Patients are also crucial in helping up-and-coming medical professionals train for everyday occurrences such as collecting the medical histories of patients.
Scenarios featuring SPs are designed to improve critical thinking and the ability to collaborate and communicate well.
The more than 40 Standardized Patients employed at Jump play a number of roles to supplement the medical education of many. They are highly trained to realistically play patients, family members, or members of the care team.
They come from a variety of backgrounds and are passionate about being an essential part of the learning process. I asked some of them what attracted them to this job and what it’s like to shape the medical professionals of the future.
“I’ve been a Standardized Patient for two years now. I enjoy being an SP because I was a teacher for 38 years, and this is very much like teaching. I’ve also done 40-plus years of Community Theater which I’m still involved in. This is just like acting to me and I love to act!
“We’re teaching these students how to go about giving bad news so when they go in for the real time—they have got some background behind them and they know how to handle it. Hopefully, I’ve given them some pointers as they’ve gone through of what went well, what didn’t go well and what they could do better; that’s what a teacher does. Hopefully, we are making these residents better doctors in the long run.”
“I’ve been a paramedic for more than 30 years. One of the main reasons I do this job is to give something back to the medical community. I’ve been in the medical industry for so long, I feel I have a lot to give back—a lot of experiences and some knowledge to help the newer learners in their field of study.
“I think the benefit SPs provide to students is experience, common sense, and the ability to handle critical situations.”
“I wanted to be an SP after seeing the way some doctors and nurses communicate with patients. I’ve seen that the way you interact with patients can change their attitude about their health and their motivation to get better.
“I like being able to help students get through uncomfortable situations. This allows them to deal with their nerves now, so when they work with a real patient, they feel more competent and make the patient feel competent.”
Stay tuned for a video series on our Standardized Patients in the coming months.