I was flipping through Facebook the other day, and saw a video posted by a friend. It was over 17 minutes long which is eternal in the world of Facebook videos, but I thought I'd give it a try as it looked interesting. It ended showing people from 'The Gadget Show' making a simulator which not too long ago would have been pure fantasy. They built a tent with 360 video output capability that also has a 360 degree treadmill to allow you to move in the virtual world by walking as you would in real life. They also hooked up an X-Box Kinnect sensor to pick up other body movements. They through in a few other cool add-ons, and they ended up with a truly immersive environment for a first person shooter game. You can watch the video here.
I got to thinking that this technology is now available, and could be used in medical school to train physicians. It's not yet at the level of being a holodeck, but it is closer than we've ever been before. I could envision a program where there is an ambulatory office building, and the student has their own clinic to run where simulated patients come in be interviewed. The physical examination is done through use of gestures mimicking what the real PE would be, or it could be coupled with a simulation manikin to elicit the physical findings. Then the student has to go back to a virtual staffing room, and dictate the encounter, and order testing. They then move on to the next patient. If you had enough of these built (assuming in the future this type of technology gets cheaper), you could envision having a 'continuity clinic' set up completely in a simulator. This might include seeing some of your regular patients back as they come through the emergency room for acute conditions or even going to the OR. It could be as complex as there is time and money to create the scenarios.
I often thought in residency that it would be interesting to have an immersive simulated hospital where you could spend at least some of your time as a medical student or as a junior resident. There you could have freedom to make some truly independent decisions and see what happens. I think the advantages to something like this are obvious and are akin to the flight simulators that pilots use to train. It will never replace time spent on the wards with skilled clinicians giving supervision and feedback. I don't think the technology is there for a completely realistic medical simulation. But it is getting closer.
This is a great idea... but as with all simulations, one wonders whether this would affect the human side of medicine. However, it would mimic the environment of human encounters and might possibly replicate those of an actual patient encounter. When I look back on how I acquired my clinical skills and these "soft" but patient-friendly options, I must honestly say, I am caught in between the horns of a dilemma. Would I rather go for the adrenaline driven pressure cooker of a learning environment where the stakes are high and success/failure come with their retinue of positive/negative feelings? Or would I advocate the use of tech enhanced methods that keep the patient safe and help us to attain the skills. As medicine moves away from the adventurous mavericks and plays a safe, litigation free numbers game, I believe the writing is clear on the wall. Sorry for the rant, but I really enjoyed reading this. :)
ReplyDeleteCheers
Pranab
Pranab-
ReplyDeleteI agree that the final proving ground for any medical learner (student, resident, fellow) is going to be in a real clinic or ER with real patients. I am intrigued by blending this experience with a rich and truly immersive virtual environment. I think this would be a huge step forward to creating a more lifelike scenario than the current virtual pt models which although they are getting more sophisticated, they look and feel nothing like the real thing as you are in front of a computer monitor.
I would argue that this type of technology could be used to present learners with novel circumstances (ie rare disease or side effect of medicine) in supplementation to the ward. And could be used early in medical school when any unsupervised decision making would be new to the learner.