An Intensive Boot Camp Builds Higher Inner Drugs Residents

Young woman sits at her desk with a virtual reality headset covering her eyes.

Sophia Yapalater watched intently because the attending doctor swept into the room and commenced inspecting the disoriented, torpid affected person. Although the fourth-year medical pupil acted like a fly on the wall, she listened carefully because the physician famous the affected person’s irregular heartbeat, wheezing chest, and swollen ankles. Was it sepsis? Because the nurse learn off the affected person’s regarding very important indicators, Yapalater thought-about subsequent steps the physician may take, like placing him on oxygen and beginning antibiotics. “What would you love to do?” the nurse requested.

However the query wasn’t posed to the attending: It was as much as Yapalater to resolve.

This state of affairs was a part of the annual Transition to Inner Drugs Internship course — often known as Inner Drugs Boot Camp — on the Perelman College of Drugs (PSOM) on the College of Pennsylvania. Designed for future Inner Drugs residents, the course gives graduating college students with precious alternatives to sharpen their time administration, communication, interpretation, utility, and decision-making abilities earlier than they enter their intern yr. After per week of abilities refreshers guided by college and standardized sufferers, college students put their experience to the check with a sequence of intensive eventualities throughout a simulated “Day within the Lifetime of an Intern” capstone expertise.

Although the aims have remained constant during the last decade, the course has developed since its inception, most lately in response to the COVID-19 pandemic. To advertise social distancing, Boot Camp 2021 was fully digital, combining Zoom conferences with digital actuality (VR) know-how.

A New Format for a New Period of Medical Schooling

Stacey Kassutto, MD, took the primary model of Boot Camp when she was a medical pupil in 2010. Later, when she turned a Pulmonary Essential Care Fellow, she helped to remodel it from a two-day course centered on bedside procedures like putting IVs to a weeklong course that successfully prepares college students for the busyness of their intern yr via lifelike simulations.

Pre-pandemic, college students would attend lectures on subjects like studying EKGs and calling consults, in addition to workshops centered on communication challenges corresponding to breaking dangerous information and navigating low well being literacy. College students then visited the Penn Drugs Scientific Simulation Heart for his or her “day within the life” expertise, working via eventualities like resuscitating a model and holding a goals-of-care dialog with a standardized affected person. Amidst all of this, college students acquired calls and pages from nurses and consultants (performed by Kassutto) posing questions like, “Your affected person is nauseous; what would you love to do?”

A camera in the foreground films a doctor and standardized patient for a video simulation.

Physicians and standardized sufferers filmed video eventualities for medical college students to observe and reply to throughout their Inner Drugs Boot Camp course. (Photograph credit score: Kyle Cassidy, Annenberg College)

Although the pandemic threw a number of wrenches into her plans, Kassutto, now the course director for Boot Camp and director of Simulation for the Inner Drugs Residency, was undaunted; she started growing on-line content material for 2021 as quickly because the 2020 course ended. It helped that she was already engaged on a challenge centered on introducing VR and different novel applied sciences into the PSOM curriculum alongside Suzana Tsao, DO, vice chair of Schooling in Emergency Drugs, and Caitlin Clancy, MD, director of Curricular Analytics, Innovation, and Know-how for Undergraduate Medical Schooling. Impressed by COVID’s dramatic affect on medical training, the Measey Studying in a Digital Setting (LiVE) longitudinal challenge — which is funded by a grant from the Benjamin and Mary Siddons Measey Basis — goals to enhance the present pre-clinical and scientific curricula with digital studying alternatives all through college students’ coaching.

“As we thought-about the totally different facets of the grant and the areas the place we might pilot issues we wished to attempt with extra superior college students, Boot Camp was a pure match,” Kassutto mentioned. With the help of Tsao and Clancy, Kassutto allotted a number of the Measey LiVE funding to boost the course with computer-generated eventualities, pre-filmed eventualities, and different on-line content material.

“The logistics of any new know-how are a problem,” she mentioned, “however the pandemic has compelled us to develop our horizons within the instructional sphere, and exploring the chances of VR know-how can actually present college students with immersive and interactive alternatives.”

An Interactive and Immersive Expertise

Since many college students have turn out to be Zoom specialists by now, the digital transition was simple for a lot of the 2021 course; lectures on subjects like knowledgeable consent and discharge planning have been moved on-line, whereas workshops associated to antibiotics and handoffs have been shifted into digital breakout rooms.

The discussions about palliative care have been particularly useful for fourth-year medical pupil Michael Perez, who will intern in Inner Drugs for a yr earlier than persevering with his coaching in Neurology on the Hospital of the College of Pennsylvania (HUP).

“It was notably highly effective when one of many lecturers remarked that these conversations must be handled like another process in surgical procedure,” he mentioned. Although initiating dialogues about end-of-life could be difficult, it’s a ability that physicians can refine over time. “It requires technical competency to execute significant and productive end-of-life conversations, and I appreciated studying in regards to the abilities and instruments I can make use of to greatest take care of sufferers and their households.”

Pivoting the capstone expertise required a bit extra planning, however Kassutto and different college have been capable of create an impactful, immersive expertise. For instance, relatively than gathering in-person to follow resuscitating a model in cardiac arrest, college students logged onto a multiplayer simulation platform. Every individual had an avatar within the digital room, they usually might speak to one another and click on to start out compressions, entry the crash cart, join the affected person to the defibrillator, and take different actions.

“It put me within the mindset of being within the function of doctor — one thing that also hadn’t completely hit me as actual!” mentioned Yapalater, who can even keep at HUP for residency. “It was nice to work with my classmates and follow team-based communication and scientific decision-making. We needed to play on each other’s strengths, which is a crucial facet of medication.”

For a extra totally immersive expertise, college students additionally participated in instances utilizing VR headsets; wherever they turned their heads, they may see totally different components of a computer-generated examination room. When asking questions like, “What brings you in at the moment?” or “The place is your ache?” their digital affected person would reply in real-time utilizing voice-recognition know-how. Based mostly on the historical past and bodily examination findings, college students might then click on to order diagnostic assessments like a metabolic panel or X-ray earlier than making their analysis. Pre-filmed video simulations just like the state of affairs with the human standardized affected person in septic shock additionally required college students to interpret charts, order assessments, name codes, and make different selections every time the clips paused.

“A whole lot of the instances jogged my memory of precise scientific emergencies I had witnessed,” Perez mentioned, “Seeing how snug I used to be with appropriately evaluating and managing these emergencies proved to me how efficient and distinctive the scientific coaching is at PSOM. The expertise was such a superb last check of our 4 years of medical faculty.”

Digital Coaching, Very Actual Classes

As Kassutto appears to be like forward to the way forward for Boot Camp, she’s desirous to reinstate a number of the in-person elements of the course. VR know-how hasn’t fairly reached the purpose the place a pupil might follow putting an IV or EKG from their bed room; they merely can’t get the identical tactile sensations they’d get working with a simulation model. Nonetheless, the expertise has illuminated many alternatives for development and alter inside the curriculum.

“Subsequent yr, we’re hoping to develop the size to 2 weeks, partially as a result of we acknowledge that not every thing within the course must be completed synchronously. College students like with the ability to be taught on their very own time, in their very own method,” she mentioned. And it isn’t simply the scholars who profit from the flexibleness supplied by VR simulations. “We sometimes want big numbers of school to make this work in-person. Digital actuality can develop the educational and provides college students wealthy experiences with out the identical depth of school help.”

By advantage of being digital, the 2021 course additionally pushed college students to check new platforms and adapt to new tech — a useful ability within the ever-evolving medical panorama. As Yapalater notes, even past the COVID-19 pandemic, know-how is turning into an more and more integral facet of the sector. “Having the ability to talk successfully with sufferers over telehealth and video platforms is a selected ability set that, identical to anything, must be honed in medical coaching,” she mentioned.

Kassutto agrees. “I do know a lot extra now about how VR know-how works than I did even six months in the past. Whereas sure components of the curriculum are nonetheless higher in individual, it’s clear to me that others could be enhanced by having a few of these further applied sciences,” she mentioned. “There’s a studying curve, however there’s additionally lots of alternative and lots of risk.”

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