Like playing a video game for extra practice of clinical skills, a new suite of virtual-case technology is changing how medical students at PSOM learn and gain experience.
Practice makes perfect. With just two and a half years to gain clinical experience before they graduate, medical students need all the opportunities they can get to know what it’s like to work with real-life patients.
At the Perelman School of Medicine (PSOM), their options have recently expanded into a virtual world to practice their skills before and in between real-world clinical encounters.
Through the Measey Learning in a Virtual Environment program (Measey LiVE), students take part in interactive simulated cases they experience through a 3D virtual reality headset or in a two-dimensional video simulation on a screen. Whether on their own or working with an instructor, “the students can make decisions and then, based on those decisions, they are forwarded to the scene corresponding to their answer, like in a choose-your-own-adventure format,” explains Suzana Tsao, DO, an associate professor and vice chair of Education in Emergency Medicine.
Practicing clinical scenarios in this way offers students the benefit of a standardized experience not subject to chance variations in what cases they will see, as in a real-world clinic. And it allows students to practice over and over, depending on their knowledge or comfort levels. Like working with standardized patients and simulation with medical manikins, the virtual scenarios can cover the types of cases that clerkship directors deem important for students to practice.
In fact, Measey LiVE originated as a “virtual clerkship” experience in the early weeks of the COVID-19 pandemic, when students needed the clinical exposure that would help them learn, without being directly in contact with patients or actors, says Stacey Kassutto, MD, an assistant professor of Clinical Medicine and director of Simulation for the Internal Medicine Residency program. She and Tsao serve as the co-directors of Measey LiVE, while Caitlin Clancy, MD, is the lead assessment director. Initially, the team piloted some virtual reality software platforms and received positive feedback from their students. “This helped with school leadership, who had also been thinking about novel uses for technology for virtual reality,” Kassutto says.
That experience led them to apply for a grant through the Benjamin and Mary Siddons Measey Foundation in the spring of 2020 to develop the Measey LiVE program. The $1 million funding allowed investment in hiring software engineers, videographers, and editors to create video scenes and purchase 55 virtual reality headsets. It also funded faculty time for creating clinical case content and working with software developers.
To get up and running quickly without the deep investment needed for coding and creating virtual humans and avatars, they built their virtual scenes by working with Penn’s Annenberg School for Communication and the medical school’s standardized patient program, filming the program’s actors performing the video cases. They worked with course directors to pick clinical scenarios suitable to the program.
The designers developed an interface that allows a facilitator to play the interactive videos of a clinical encounter like a piano, says Kyle Cassidy, a technologist in the Annenberg School who was a core member of the project team. For example, after watching a video of a patient describing difficulty breathing, a student could suggest a certain intervention – and the facilitator could jump ahead instantly to play the results of that intervention.
Based on the successful implementation of 11 simulated cases in the first year, the team has now more than doubled its library to 23 cases. As the variety of cases grows, the program’s leaders hope to provide students a space for extra practice and autonomy. They also envision adding gamification to assessments. Medical students might earn virtual badges as they master new skills, allowing supervisors to trace their progress in independent virtual learning.
But the future vision for this virtual practice is even bigger still: Working together with the medical school’s leaders, they want to create a virtual hospital setting where students, beginning in their first year, can oversee the care of a virtual cohort of patients. They are working closely with Nadia Bennett, MD, MSEd’18, and Dennis Dlugos, MD, MSCE’02, the associate deans for curriculum in clinical and basic science areas, respectively.
It’s an initiative that Suzanne Rose, MD, MSEd, senior vice dean for medical education, describes as “groundbreaking, using educational technology the team has created a platform for virtual patients and a virtual hospital.”
As students progress further into post-clerkship, such as in a sub-internship to get ready for residency, they will “unlock” more complex cases in the Measey LiVE system, manage critical patients, and work in a team environment, which will help them throughout their career, Tsao says.
“Currently, when students are on rotations in their clinical experience, they don’t have a lot of opportunities for autonomous practice where they are the ones at the head of the bed making those clinical decisions,” Tsao explains. “This allows them to have that opportunity in a safe environment before they start their internship year and, all of a sudden, they’re the person who is responsible.”
Rose points out the virtual hospital platform puts patient safety at the forefront at multiple stages of learning. It ensures students get practice in simulated environments before going out to an authentic bedside, and even during clerkship and post-clerkship phases of the curriculum it helps students put their learning in context.
The approach is novel and might set a new standard. “I don’t think [the virtual hospital] is being done anywhere else, or at least not in the breadth and scope that we’re envisioning for it,” Tsao says. “I really do believe this is going to be an integral part of the medical school’s curriculum in future years. We’re excited to be at the forefront of it.”