The University of Michigan School of Nursing is using the online virtual world Second Life to help medical students hone their leadership and communication skills, and to do so with some degree of anonymity.
Telemedicine isn't just a cost-saving way to treat patients in remote locations. It's also another way to train medical professionals.
While some medical schools are adding programs that emphasize the development of empathy and observational skills, others are using technology as their gateway a heightened learning experience.
The University of Michigan School of Nursing uses the online virtual world, Second Life. Through its virtual Wolverine Clinic, medical students can log in with their own avatars and work through various scenarios.
Michelle Aebersold, PhD, RN, a Clinical Assistant Professor at the UMSN and her colleague, Dana Tschannen, PhD, RN, a Clinical Associate Professor of the Division of Systems Leadership and Effectiveness Science at UMSN, received a small grant to build the virtual clinic.
Aebersold, also the Director of the Clinical Learning Center for the UMSN, started the program with nurses, and saw that training in the virtual space had great advantages.
Virtual acute care and outpatient environments were created where the students would perform their trainings. "The nice thing about the virtual environment is that we can schedule training in there and students didn't have to be on site, they could log in from home," says Aebersold.
Another benefit comes from exposing students to scenarios that they might not typically experience.
"It allows you to create situations that, over the course of a four-, five-, or six-year training process in a healthcare professional education program, they may never see," says Patricia Abbott, PhD, RN, FAAN, an Associate Professor of the Division of Systems Leadership and Effectiveness Science at UMSN.
"Something wacky like somebody coming in with a ball peen hammer stuck in their forehead. You can expose students to rarities and that's critical in training a very safe practitioner."
The trainings in the virtual clinics focused more on interacting with patients and fellow healthcare professionals, rather than the physical aspect of care. Even without the physical elements, there's a lot for students to learn about communication.
"If you want to teach nursing students how to delegate, how to practice their leadership skills, how to respond to an emergency situation and direct their team members, it's a great learning environment," says Aebersold.
In one exercise, students assessing the virtual patient clicks on an object and view the patient's information on a notecard. The students are given choices on how to proceed and communicate "in world" with each other to determine how to prioritize care and assign tasks.
Aebersold has also worked with doctoral students in the DNP program who were interested in using the Second Life virtual hospital for interprofessional education.
The project was able to get nursing students, pharmacy students, and medical students together to run a role-play simulation based around disclosing a medical error to a patient.
Using TeamSTEPPS, an AHRQ program that specializes in interprofessional communication, the students learn teamwork and communication skills and then utilize their avatars to engage in a scenario to practice those skills.
The facilitator of the simulation plays the patient and their family. The nursing, pharmacy, and medical students play their respective roles. They receive another note card, and huddle up as a team to discuss the medical error, and how they will communicate it to the patient.
Students have reacted positively to the exercises. "They seemed very satisfied with being able to do this, to role play this kind of disclosure," says Aebersold.
"One of the things we hear from our students when they do these kinds of role-plays in Second Life—because they're doing this as their avatar or their alter ego—there's this anonymity. There's a sense of having a little bit of protection because I'm not putting myself out there, I'm not so vulnerable, so I'm willing to take more of a risk."
The students are evaluated in different ways. One method has a separate observer use their avatar to watch the students' behavior and scores them based on a standardized observation tool used to measure performance. Peer-to-peer feedback is another way to gauge performances.
Aebersold wants to explore a gaming type environment that will eliminate the need for a facilitator and give students the chance to receive independent or automated feedback.
Virtual EHR Training
The Second Life program is also incorporating other technology training methods. For example, an electronic health records system run by Abbott has been added.
Using a training program similar to the patient disclosure exercises, interdisciplinary teams consisting of nurses, doctors and pharmacy students come together to treat a patient played by another student in their avatar. The EHR at the patient's bedside, acts as the fourth professional in the team-building exercise.
Abbott wants to explore how the EHR affects team care, an area she believes needs to be better understood in the healthcare industry. "…To help our students have a better experience and to come out the end of the pipeline better prepared to handle today's healthcare environment."