UF’s College of Medicine uses high-tech education to prepare tomorrow’s doctors

It’s a paradox of modern medical education: Society needs skilled doctors, but for safety reasons medical students are given only limited opportunities to treat patients.

So generations of U.S. medical school graduates have found themselves with a wealth of knowledge but less experience.

Traditionally, hands-on training was emphasized later, in residency.

Today, practical know-how can’t come soon enough, says Robert Watson, M.D., senior associate dean for educational affairs at the University of Florida’s College of Medicine.

“The frenetic pace of the current health-care system and the demand for (moving) patients through the system have made it increasingly difficult for learners to have the time to learn everything they need,” he said.

The solution, Watson says, is performance-based training and assessment, a growing trend that enables health professions students to learn and practice clinical skills realistically without placing patients at risk.

UF is among the nation’s top 10 institutions for use and development of performance-based education technology, he said. The university is leading the way in the use of standardized patients, patient simulators, self-teaching software and paperless testing.

UF’s Harrell Professional Development and Assessment Center houses one of the nation’s foremost standardized patient programs, “creating” patients for students to interview and examine by training actors to portray disease symptoms, said Margaret Duerson, Ph.D., a UF associate professor of medicine and the center’s director.

“One of the advantages I see in having the Harrell Center is that novice students can come here and practice their clinical skills with standardized patients in a low-stress environment until they get comfortable,” Duerson said. “There’s much less anxiety when they do clinical work with real patients.”

Duerson and a team of consulting physicians develop patient scenarios for the actors, including symptoms, signs, life history and demeanor. The standardized patients evaluate each student immediately after each session, so they must be good observers as well as actors, Duerson said. The students also are videotaped so they can review their performance later, often with a faculty member.

For eight years, the National Board of Medical Examiners has used the Harrell Center as a pilot site, as it prepares to add a standardized patient component to the United States Medical Licensing Examination Step 2 licensing exam in fall 2004. UF faculty helped develop cases to be used in the exam.

Because students cannot practice invasive procedures on standardized patients, a team of UF faculty including Samsun Lampotang, Ph.D., a UF associate professor of anesthesiology, helped develop the Human Patient Simulator, a programmable, computerized mannequin that displays vital signs and reacts realistically to medical procedures.

“If you’re an instructor and see a (student) doing something wrong, you can let them make mistakes and learn from them, whereas with a real patient you would have to intervene,” Lampotang said.

Licensed to a private corporation, Sarasota-based Medical Education Technologies, the Human Patient Simulator is used at several hundred institutions, said Nikolaus Gravenstein, M.D., chairman of UF’s anesthesiology department.

Another well-known innovation, the Harvey cardiology patient simulator, uses software developed by a team of cardiologists from five institutions, including Ira Gessner, M.D., UF eminent scholar emeritus of pediatrics.

UF Vice President for Health Affairs Douglas J. Barrett, M.D., has appointed a broad-based task force to explore the establishment of a comprehensive Simulator Center. Watson believes the next step to improve education, patient care and related research is to combine standardized patients and simulators, so students, residents, faculty and others can interview a real person, diagnose problems and perform clinical procedures on simulators.

“The beauty (of using patient simulators) is that you can make absolutely certain in the learning and evaluation process that this person has been found competent in every aspect you want,” Watson said.

In the early 1990s, UF faculty began to develop self-teaching software packages to provide students with state-of-the-art text, photographs and learning exercises, said Lynn Romrell, Ph.D., a UF professor of anatomy and cell biology and associate dean of medical education.

Today, UF has seven self-teaching CD-ROM packages, available commercially through Gold Multimedia, on basic clinical skills, clinical human embryology, human anatomy, microscopic anatomy and radiologic anatomy; two of the packages combine multiple topics. The packages also are available as Web-based programs; CD-ROM sales to medical institutions alone have topped $1.7 million, said Romrell, who co-authored two packages. An eighth CD-ROM on clinical musculoskeletal pathology is available from University Press.

To save time and resources, most UF first- and second-year medical student exams are paperless, said Richard Rathe, a UF associate professor of community health and family medicine and associate dean for information technology.

Students are tested in two large computer laboratories with a total capacity of 120 work stations, where instructors track their performance in real time and instantly process grades, Rathe said. The Harrell Center also uses a paperless system for its standardized patient program.

The future of performance-based education will involve greater collaboration between UF Health Science Center and engineering faculty, Watson said. He foresees the development of simulators that replicate all systems in the human body, and robotic technology that enables surgeons to operate on patients in remote locations. UF should continue its leadership role in the development of simulators.

Whatever happens, he said, UF medical students will reap the benefits, and so will the patients they’ll care for.