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Virtual Clinics

Could virtual clinics beat real medical life training?

During my years of medical school, a well-intentioned Doctor told me “spend as much time up on the wards and in the clinics as you possibly can.” I took this to heart. I would spend breaks, off days, and basically any time I could up with the doctors and patients trying to make the most of this opportunity. However I quickly realized that the well intentioned doctor may have miss lead me. In these clinics I found myself sitting and waiting a fair amount of time. There were times where the nurses didn’t want me to visit any patients (understandably), the patient I planned to see was away for a CT scan, or the doctor was burned out of teaching needy medical students, and the list goes on. I had a lot of time to sit and wait and think. This real clinical experiences didn’t compare to the hypothetical ones I imaged when I was told to “spend as much time up on the ward” as possible. These ‘real’ world clinics were not built and designed for learning they were built for actually caring for patients. So with the advent of virtual reality clinics we can ask ourselves “if we could design the perfect clinic for a medical student, what would that look like? In what ways could we compare the learning potential of a virtual clinic to a real world clinic?”

Firstly, can we compare the ability of virtual and real clinics to adapt to the needs of the learners? When I was sitting in the clinic or doing clerking tasks in the emergency, naturally the environment I was in did not revolve around me as a medical student. What I mean by this is that the hospital environment was not made specifically for my knowledge, strengths and weaknesses. The patients in front of me that I was taking a history from were there in the clinic for no other reason than because they were unwell and needed help. They didn’t know that this was the tenth cellulitis case I’d seen that week and that I was getting a bit bored. With virtual clinics, the learner can be the center of the universe. This means that the knowledge and capacity of the learner can be the driving force dictating what patients and pathologies walk in the clinic. In this virtual clinic it knows I’ve seen enough cellulitis for today and that maybe I should review that topic a week from now. So Instead the system presents me with a patient with a pulmonary embolism because this is the topic I keep getting wrong. Virtual clinics have the power to put the needs of the learner first in a way that is challenging for the real world match.

Another aspect that can be used to compare between virtual and real clinics is the potential ‘scope of practice.’ By ‘scope of practice’, I mean the tasks you are allowed and not allowed to perform as a learner in a clinical environment. Depending on what country or stage of medicinal education a student is in, you may either have a wide or non-existent scope of practice. This is a real challenge to medical education. Medical students need to practice out of scope to expand competence. Yet there are obvious barriers to medical students practicing out of scope, chiefly patient safety! The result of this was that in my first three years of medical education I would often follow teams of doctors, watching from the back as they would practice medicine. In virtual clinics medical students can be the team lead in the resuscitation room, make as may mistakes as they need, with zero risk to patients. This is an obvious point in favor of virtual clinics. While there needs to be careful teaching to make sure the scope of practice is not blurred between real and virtual clinics. We don’t want a medical student to delay asking for help from seniors in a situation where patients are at significant risk because they have tried this once in VR. However, in my opinion, there are tremendous benefits to allowing medical students to assume a broader scope of practice in a virtual clinic so they can get those mistakes out of their system.

What would the practical application of these tools look like? Certainly I’m not suggesting medical students should spend their whole degrees playing medicine in VR on virtual patients and then graduate as doctors. There would be a rude awakening on the first week of work in a real clinic when they realize real patients don’t always follow prescriptions exactly. This process of integrating a VR-based learning with real clinical experience would instead look like a heavy emphasis on VR learning in the first two years which is slowly weaned and replaced with real clinical experience as the degree progresses. Interestingly, this style could involve a competency-based progression, allowing those who advance faster in VR clinics to gain more access to real clinics early in their degrees. In summary, this section is a word of caution that practicality needs to be applied to our optimism.

Certainly at this point and for the foreseeable future real clinics have the upper hand at caring for the needs of actual physical patients. However, it is no knock on reality to suggest that virtual clinics have the potential to supersede them as a training tool. This is going to take time for SimTec MD and other companies to develop these technologies to the point where it no longer supplements medical education but is instead the main course. The exciting part is that now is the right time for us to begin imaging and talking about what our dream learning clinics might look like.

By.

B. McKay Byam, MD

CEO & Co-Founder of SimTec MD

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