Teaching Continues Through Tele-Simulation

December 2, 2020

Web and video technologies allow PCOM Georgia medical students to collaboratively diagnose simulated patients during virtual case scenarios.

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The teaching is the same. Only the delivery method has changed due to COVID-19.

Each Tuesday from 9 a.m. to noon, second year Doctor of Osteopathic Medicine (DO) students at PCOM Georgia use their deductive reasoning skills to diagnose a “patient” presented in the campus’ Simulation Center.

Detective skills inform students

Using tele-simulation, which involves multiple cameras and a virtual meeting platform, three physician faculty members present case scenarios to students who use a rotating team leader, a scribe and the chat room to narrow the field of possibilities. In the era of escape rooms and employing the same skills used by Hercule Poirot, Sherlock Holmes, Lieutenant Columbo, and even Gregory House, MD, the students work together to logically eliminate diagnoses.

This Tuesday, the case involved a 26-year-old woman, Sarah Williams, who presented in the College’s simulated Emergency Department with sharp, stabbing pain radiating throughout her abdominal region. Through their group leader, the students took the patient’s history and directed their bedside faculty member to conduct a physical exam through inspection, palpation and percussion. The instructor reported that there were no visible scars or bruising and that the area was symmetrical.

As a team of ten, the students discussed symptoms, ordered a pregnancy test and appropriate lab work and imaging. Through the process of elimination, the group considered and dismissed the possibilities of an ovarian cyst, an ectopic pregnancy, gastroenteritis and other conditions before concluding that appendicitis was probable. The students made the decision to consult a surgeon and discussed the benefits of pain medication.

Technology contributes to robust teaching

According to Jeff Trawick, DO, ACOEP, ACOFP, a clinical assistant professor in the Office of Clinical Education who also practices full time as an emergency department physician, “Technology and the hard work of the Clinical Education and Simulation Center teams have enabled us to provide virtual clinical problems with the same elements contained in on-campus simulation exercises. The only missing component is the students’ ability to actually touch and examine the patient.”

He noted that with real-time vital signs, electrocardiograms, imaging and lab studies, PCOM Georgia students continue to experience the immediacy and pressure of a patient encounter and the decision-making needed to properly diagnose and treat the patient.

He said, “Some students have commented that they experience essentially the same ‘pressure’ and ‘rush of adrenaline’ that they would sense during an on-campus simulation lab.” According to Trawick, the scenarios also “provide the students with exposure to the benefits and limitations of telemedicine.”

He said, “Although having direct contact with the simulated patients is preferable, tele-simulations provide a means of effectively continuing clinical education under our current pandemic restrictions.”

Transitioning the Simulation Center to tele-simulation came naturally to Jeffrey Adams, NREMT-P, MS, the director of the center. With a master’s degree in Medical/Health Care Simulation from the New York Institute of Technology College of Osteopathic Medicine and a bachelor’s degree in Radio and Television from Morehead State University, along with his paramedic certification, Adams converted the Sim Center to a virtual environment using appropriate software and multiple cameras.

Toni Musta, MS, the simulation manager who earned a Master’s degree in Biomedical Sciences with a concentration in Medical Simulation from PCOM Georgia in 2018, and Amber Meyer, the simulation administrator, provide the voices for the mannequins answering the students’ questions with realistic expression. Kanza Kabir, MS, the simulation technician who also earned a master’s degree from PCOM Georgia in 2019, ensures that the mannequins’ vital signs are appropriate for the cases.

Medical simulation is ‘transformative’

Along with Dr. Trawick, Donald Penney, MD, MSC, FACEP, a clinical professor of emergency medicine, and Frank Jones, MD, MPH, a clinical professor of surgery, also guide the students to the correct diagnostic conclusions by urgently asking, “Is that all?” or, “Anything else you need to know?” Debriefing sessions after the cases provide the faculty members more time to instruct the students.

According to Dr. Penney, medical simulation has been “transformative” when introduced into the medical curriculum. He said that PCOM Georgia has been “avant-garde and innovative in creating a designated simulation laboratory for our medical students.”

“A challenge for first and second year medical students has been the application of theoretical knowledge into the management of patients,” Dr. Penney said. “Deliberate practice through medical simulation training on high fidelity simulators has allowed the acquisition of clinical skills, thus enhancing clinical competence at the undergraduate level. Studies have demonstrated that improved clinical competence has resulted in improved patient safety and reduced healthcare costs.”

Student-doctor, Nishant Gogna (DO ’23) said, “The continued dedication of the faculty members at PCOM Georgia to teach important clinical skills to its students even in light of the COVID-19 pandemic is noticed and highly appreciated.”

He added, “Though nothing will replace in-person training, I recognize and value the hard work, adaptation and innovation the faculty have put into their training to ensure students are well-prepared for board exams, rotations and beyond. Participating in Sim Center cases is my favorite part of the week!”

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