Imagine you're an emergency medicine resident trying to focus on a patient with abdominal pain — asking about his medical history and symptoms as you give him a physical — but you keep getting interrupted. A technician stops by to hand you another patient's EKG. A staff member asks about an order for pain medication for a different patient. And then you are called to see a psychiatric patient who is agitated. You return ready to focus but then an attending physician breaks in to redirect your attention to a new patient with a high heart rate.
All told, you’re interrupted 12 times during the patient exam. How can you possibly maintain your train of thought? How can you build trust with the patient, when all these disruptions are stressing him out?
The above narrative was inspired by the script of a new training simulation, which was filmed at Stanford’s emergency department as a virtual reality video.
This is a typical scenario faced by emergency physicians, who are interrupted on average every six minutes. These interruptions increase the likelihood of errors, so it's critical for emergency doctors to practice how to multitask in this fast-paced, high-risk and disruptive environment.
The VR script was written by Henry Curtis, MD, a Stanford clinical instructor in emergency medicine, and Cameron Mozayan, MD, a Stanford emergency medicine resident.
“A problem with many current learning modalities is that they don’t engage modern participants in an active, immersive learning environment, so it’s difficult to sustain their attention,” Curtis said. “Virtual reality-based education presents an innovative solution to address this problem. Distractions are minimized as the learner excitedly engages in the VR world. The perception of the experience also triggers strong memories, which connect them to the educational content. So participants allot their full attention as they contemplate important medical decisions.”
More than 30 health care educators and providers at the 2018 International Health Humanities Consortium Conference at Stanford tried the training simulation recently. While viewing, the participants were asked to choose which interruptions were more important than the patient-physician consultation. The participants then viewed the video again with expert pro and con discussions — interactively testing to see if the others' viewpoints swayed their opinions on the importance of the interruptions.
“Training is more powerful if the participants are seeing it in 360 virtual reality and they are being engaged in an interactive experience,” Curtis told me.
Participants said the VR training realistically conveyed what it was like to work in an emergency department. One health care worker declared, “This experience makes me feel like I’m in the emergency department. I feel like I’ve seen all of these things happen at work.” Another said, “Sometimes emergency medicine feels like a warzone.” A third participant added, “I was feeling so tense in there with all of the interruptions.”
The users also provided insights. For instance, one person was struck by how often technology caused the interruptions.
Curtis worked with Jason Lowe, MD, and Anne Merritt, MD, members of Stanford’s medical humanities team and with Stanford's Education Technology team to create the first video. Now, they're analyzing data from the conference, and are planning a series of VR training simulations.
For his next project, Curtis is also working with Aussama Nassar, MD, to film a trauma simulation with an agitated patient who deteriorates into neurogenic shock after a bicycle accident.
Curtis said he hopes the virtual reality series will enhance the quality of the lessons learned during the training simulations, in addition to extending their reach to a larger audience. He added:
VR education can be transported globally to allow learners across the world to immerse themselves in the intricacies of innumerable clinical encounters, as well as receive structured debriefing in the virtual world by renowned experts.
Photo by sasint