In emergency-care situations like cardiac arrest, the difference between life and death can be a matter of minutes, complicated by distance and access to health care. Working to overcome these challenges, the University of Arizona Health Sciences (UAHS) is using virtual learning technologies, including medical-simulation technology and the power of telemedicine to train interdisciplinary health-care teams.
Sharing its expertise internationally, the UA Health Sciences recently held a live, multi-site telemedicine simulation workshop that included students and faculty members in Flagstaff, Phoenix, Tucson and global attendees at Oxford University in the United Kingdom. The workshop was held to show how interprofessional training using telemedicine and simulation technology can save lives.
The workshop was held during the “All Together Better Health VIII Conference” at Oxford University and was made possible by Sally Reel, PhD, UAHS associate vice president for health sciences, interprofessional education, and Michael Holcomb, associate director of information technology at the Arizona Telemedicine Program (ATP).
The workshop provided Dr. Reel and Holcomb the opportunity to show and share UAHS expertise on interdisciplinary education, telemedicine and simulation by combining the expertise of the Arizona Telemedicine Program, directed by Ronald S. Weinstein, MD, who participated remotely from the ATP in Tucson, and The Arizona Simulation Technology and Education Center (ASTEC), whose executive director is Allan J. Hamilton, MD.
ASTEC provides students and seasoned clinical practitioners training using simulation technology, including high-fidelity patient-simulators (mannequins) and artificial tissue models to transform health-care training and reduce medical errors. The ATP works to create new paradigms for health-care delivery over the Information Superhighway enhancing health-care delivery to medically underserved populations and is recognized for its strong commitment to research and technology transfer. Both programs are part of the UA Health Sciences.
Supported by the ATP, the workshop linked an ASTEC medical simulation training session to the Oxford University Examination Hall and student participants at six locations in Arizona. The virtual simulation grew from a “proof of concept” envisioned by Dr. Reel in 2014 and devised for introducing technology into nurse-practitioner education The project was funded by the Health Resources and Services Administration, Division of Nursing.
The interprofessional student team included an on-site team at ASTEC in Tucson with Heidi Clouser and Paige Brei, both graduate students at the UA College of Nursing, Garrett Berger, doctoral student at the UA College of Pharmacy, and Jim Dunleavy, UA College of Medicine – Tucson student. Joining virtually in Phoenix, Tyler Dunn with the UA College of Medicine – Phoenix led the simulated code for cardiac arrest, directing the interprofessional student team in Tucson who used the same intervention protocols on an advanced patient simulator mannequin that would have been used on a live patient. Dunn was joined remotely by Megan Fah, also a student at the UA College of Medicine – Phoenix. Participating virtually from separate sites in Phoenix were UA College of Nursing students Caitlin Denning, MEPHN graduate student, and Sheng Yun Peng, DNP graduate student. Pharmacy residents Khanh Huynh and Christina Chau participated virtually from North Country Healthcare/Northern Arizona Area Health Education Center in Flagstaff.
Lisa Grisham, MS, NNP, ASTEC medical simulation specialist, facilitated the response to the simulated cardiac arrest code in Tucson that was designed to model the principles of health-care team behaviors. “As an instructor, it was surreal watching the students work together from directly in front of me to hundreds of miles away. Within a matter of minutes they became a cohesive group that performed in a collaborative interprofessional effort to provide lifesaving care to our simulated patient. An experience that will not soon be forgotten,” said Grisham.
Students at the remote sites had full visual access to the simulation, including remote access to patient vital signs. The on-site students at ASTEC in Tucson also could see and hear remote students through videoconferencing technology at the simulation site. All participants also could see the audience at the Oxford Examination Hall.
“I felt like running a cardiac arrest from a remote site would be an almost impossible thing to do. But after participating in this simulation I realized that it is possible and quite effective. The technology allowed me to have all of the information I needed to know about the patient and communicate with the other team members without difficulty,” said Dunn, a third-year medical student.
Pilot work done by ASTEC and ATP in 2015 successfully tested the use of smart devices as a real-time approach to expand remote student team learning. The workshop and international conference demonstration in the U.K. replicated the successful 2015 virtual model using internet connectivity to engage students in real-time interprofessional simulations at a distance.
“The tele-simulation exercise with Oxford demonstrated that we could easily run a meaningful, immersive and useful training exercise long-distance with live, real-time participation from students on two continents. It was a powerful example of where our multi-disciplinary approach at the University of Arizona, could be seamlessly folded into a joint exercise using the Arizona Telemedicine Program and that we could pull in students and experts from around the world to participate in the discussion and teaching of the material,” said Dr. Hamilton.
“Using technologies in real time enhances and promotes institutional collaboration, partnering and resource sharing. This type of simulated practice environment creates an anytime/anywhere reach to teach students positive ways of interacting with each other on an equal basis. Congruent with interprofessional learning, this modality also increases students’ awareness of the unique value co-workers from other disciplines bring into interdisciplinary team practice environments,” said Dr. Reel, associate vice president of health sciences interprofessional education, collaborative practice and community engagement.
“This demonstration has profound implications. It opens access to advanced simulation education for millions of health workers for the first time. Medical errors are killing hundreds of thousands of Americans every year. Simulation at a distance will address some of these issues down the road,” said Dr. Weinstein, an international expert on innovation in medical education.
This workshop illustrated state-of-the-art, complex multi-modal distance learning and collaboration of leaders across disciplines, including system engineers and operations experts Pete Yonsetto, ATP videoconferencing administrator, and David Biffar, ASTEC director of operations, who facilitated all technical aspects of the workshop.
“For me, this experience was like no other. As a beginning University of Arizona master’s of science nursing student, I have not had much experience in cardiac arrest situations. With my participation in this simulation event, I was able to gain experience of not only cardiac arrest, but also experience in communication with a team. It has made me more confident in treating patients, especially in emergency situations and I found this simulation to be very beneficial to my future in the nursing profession,” said Brei.