The second installment in the series describes experiential learning, a key component in a curriculum that comprises standardized patients, simulations and virtual technology. The College of Medicine takes full advantage of these tools and technologies as it relies less on passive learning and more on active learning methods that will cultivate exemplary clinical skills and collaborative care practices among students — with the ultimate goal of improving quality of care and safety for the patient.
Third-year medical students complete a virtual neurological exam, which presents patients with cranial nerve injuries, as part of their neurology rotation curriculum. Photo by Maria Belen Farias
After attempting the central venous access procedure a few more times, she hits her target.
“It’s always good to get practice,” says Flail, whose attempts at locating the subclavian vein using a mixed-reality simulator prepared her to perform the real thing seamlessly a few months later in the E.R.
Practice really does make perfect, and scenes like this one play out all over the College of Medicine, where the art — and technology — of experiential learning is being perfected.
Now, simulation-based learning is being expanded through the college’s revised curriculum and with its plans for a proposed new Medical Education Building, which is needed to fully implement the new curriculum.
“It is our goal to be among the world’s leaders in medical education,” said Michael L. Good, MD, dean of the College of Medicine. “Therefore, UF must prepare our graduates for the emerging changes in health care and continue to take advantage of the latest technology in our teaching strategies.”
As the birthplace of the Human Patient Simulator, considered the gold standard in patient simulation technology, and as one of the first medical schools in the country to use standardized patients to help students master their communication and interactive skills, the UF College of Medicine’s history with simulated learning approaches is a rich one.
“Experiential learning prepares students to maximize their learning in real patient care settings,” said Good, who used his computer science background to help develop the high-fidelity Human Patient Simulator in the mid 1980s. “Our students are much better prepared, having observed symptoms and practiced techniques in the learning center first.”
Medical students, physician assistant students, learners from the other health science colleges and UF resident physicians have opportunities to interact with three broad types of experiential learning: standardized patients, or actors trained to simulate symptoms and health problems, mannequin patient simulators and computerized virtual patients.
At the center of the experiential learning approach is the patient. “We are committed to developing our students’ communication and clinical skills because ultimately that leads to the highest quality of patient care and puts safety at the forefront of training,” said Joseph Fantone, MD, the college’s senior associate dean for educational affairs and one of the architects of the medical school’s revised curriculum. The new Medical Education Building, for which college and university officials are working to acquire the necessary funding and approvals, will consolidate much of the college’s experiential learning opportunities into one area as well as serve the entire spectrum of learners and health care providers at UF&Shands, the UF Academic Health Center.
“Each type of experiential learning by itself has benefits,” said Samsun “Sem” Lampotang, PhD, director of UF’s Center for Safety, Simulation & Advanced Learning Technologies. “Mix two or more together, and you achieve synergie to master the learning outcome you wish to achieve.”
A wide variety of medical simulators are now used throughout UF&Shands, such as task trainers for suturing and intubation, mannequin patient simulators for training teams on resuscitation protocols for cardiac arrest, virtual simulations like web-based programs depicting the internal workings of an anesthesia machine and, lately, mixed simulators for learning blind and guided procedures.
First-year medical students, Isaac Luria, Jennifer Kuo and Khalil Harbie, interview standardized patient Annie Hu, 6. Photo by Maria Belen Farias
One of the newest tools in experiential learning at UF is virtual patient technology — computer simulations of clinical encounters where the student interacts with an on-screen patient in the form of an avatar. “The interactive virtual patient is part of the future for both training and assessment,” Fantone said.
Benjamin Lok, PhD, an associate professor in UF’s computer and information sciences in the College of Engineering, and his team, the Virtual Experiences Research Group, collaborate with researchers at medical schools throughout the Southeast to develop both virtual patient and mixed reality teaching tools.
Cory Nelson, a third-year medical student, sits in front of the computer screen interacting with his virtual patient. He slowly moves a finger side to side and uses an ophthalmoscope, carefully checking his patient’s eyes for signs of a rare cranial nerve condition.
He asks the patient to cover one of her eyes and uses an eye chart to check her vision. Nelson scribbles notes as he interviews the patient, and he reports his findings and recommendations for treatment.
Nelson’s experience is with one of Lok’s programs, a virtual neurological exam that includes patients presenting with cranial nerve injuries, which can cause eye problems and facial paralysis not easily simulated by a standardized patient actor. Beginning this year, the virtual exam is part of the curriculum for third-year medical students’ neurology rotation.
“My vision is for virtual patients to be an integral part of the education of all health care providers,” said Lok.
The experiential learning center in the proposed new building will allow students to practice a range of physical exams on standardized patients in a variety of mock settings that simulate an emergency room, an exam room, a home, or an operating room, said Carolyn Stalvey, MD, medical director of the Harrell Professional Development and Assessment Center. The Harrell Center employs an active pool of about 50 standardized patients who help students hone their communication and physical exam skills.
The revised curriculum calls for first-year medical students to learn these skills sooner and be tested on them earlier. The increased clinical exposure to individuals trained to simulate signs of specific ailments will benefit students, Stalvey said.
“I think the students are much more prepared when they see a real patient and much more comfortable,” said Stalvey, a 1999 graduate of the College of Medicine.
Amy Rooks has been a medical student for all of two weeks when she finds herself face-to-face with a 65-year-old man complaining of “excruciating” chest pains that tend to start after his evening meal.
“Could you describe that to me,” Rooks asks and then listens closely as her patient provides the details. More questions about family history and lifestyle follow as Rooks tries to determine if the man’s pain is related to health problems, stress or possibly acid reflux.
Rooks and her classmates from the class of 2016 are the first to fully experience the college’s overhauled curriculum, providing them with immediate exposure to standardized patients and scenes like the one above.
The Human Patient Simulator is a high-definition computerized teaching tool used in health care education programs throughout the world. Computers control the lifelike mannequins to automatically respond to injected medications, changes in mechanical ventilation and other therapies. Photo by Maria Belen Farias
“It’s a little nerve-wracking at first,” said Rooks. “This is the first time most of us have practiced diagnosing and caring for an actual person. Though you know the case isn’t real, you still want to do a good job and figure out how to help him.”
By the time Rooks and her classmates graduate, the revised curriculum will be in full force for all four medical school classes, and the George T. Harrell, MD, Medical Education Building will be open.
And the experiential-based learning opportunities will be centralized in one area that will occupy the third floor and much of the fourth floor of the new building—where students will practice in order to be perfect.
“By consolidating and strengthening our simulation programs through the updated curriculum and thoughtfully designed experiential learning center, we will raise the bar on clinical performance training and on assessment as well,” said the dean.
