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Throughout the world, school systems have been forced to shut down and conduct online learning due to the pandemic. This placed a tremendous strain on teachers, students, as well as parents in the process. Not only did many students struggle emotionally and academically in the process. But educators had to also adapt to new teaching styles, curricula, and assessments. Notably, this not only applied to primary, secondary and college educational systems. It has also affected medical schools and medical student education as well. Without in-person learning, many medical students feel a bit short-changed in their experience.

Like other educational systems, many medical schools have turned to virtual medical training to fill the gaps. The pandemic has served as a catalyst in healthcare and in other areas. (Read more about the positive changes and innovations the pandemic brought about in this Bold story.) The risk of being exposed to COVID precluded in-person learning, and thus, medical simulations have been used instead. But how effective are medical simulations and virtual medical training for the doctors and surgeons of the future? Is their training adequate? Do they gain quality skills that allow them to excel in real-life healthcare environments? Do these virtual reality offerings somehow make them even more adept for telehealth? These are the questions that deserve further consideration.

“When you’re on Zoom, you can’t tell if the person is clenching their hands or shaking their legs. For some of my classmates, the feedback was we had to show more empathy. But how am I supposed to make my empathy known through a computer screen?” –  Sarah Serrano Calove, Second-year student, University of Massachusetts Medical School

Medical Simulations and Necessary Sensory Exposures

During normal times, medical students are exposed to a variety of hands-on experiences. First-year medical students spend a sizable portion of their time dissecting cadavers, learning about different organ systems. Later, they practice face-to-face interviewing skills while performing the basics of a physical exam. In the process, a host of tactile, visual, auditory, and even olfactory sensations are encountered that facilitates learning. But the vast majority of these are lost with virtual medical training. Medical simulations might offer some of the visual and auditory cues, but otherwise, they are notably lacking.

In most of the medical simulations, virtual mannequins serve as avatars for providers and as patients. Students are asked to go through a series of tasks that are meant to mimic in-person training. But virtual medical training can only imitate real-life so much. Instead, they are often fraught with technical limitations and less-than-real characters. Naturally, it’s challenging to truly grasp what it’s like to encounter patients in person if your only exposure is virtual. These online exercises might advance knowledge in some areas, but they fail in adequately mimicking direct patient contact.

“A cadaver’s body parts wouldn’t look as smooth and perfect as they do on a screen. Let’s say the cadaver was an alcoholic, you might see liver cirrhosis with bumps and ridges covering the liver.” – Jerrell Catlett, First-year student, Icahn School of Medicine at Mount Sinai

Assessing the Quality of Virtual Medical Training

The use of medical simulations did not start with the pandemic. Such virtual doctor training techniques have been employed in numerous schools, particularly those with online components. But they were primarily used as adjuncts and not as primary learning tools. Thus, the jury remains out on how effective these educational tools may be. Some tout the ability for medical simulations to offer a more comprehensive exposure to clinical situations. But this may be no better than traditional didactic teaching. Naturally, this depends on the preferred learning style of the medical student. But the bottom line is that no one knows how effective virtual medical training systems are.

A doctor getting some medical training via her laptop
Virtual medical training was good for a short-term fix, but it can’t replace in-person training forever.

With the pandemic, it has similarly been difficult to evaluate medical student learning with medical simulations and remote learning. Typically, anatomy classes may hold practical examinations in person, which is now no longer possible. Online assessments using simulations now replace these practices in many schools. But both students and educators alike worry the assessments are limited. These issues are even more evident in later training years involving patient assessments and surgical training. Evaluating whether a medical student’s performance virtually equates to real-life skills is simply not possible. Not enough data has yet been collected to make these determinations.

“Most of the virtual learning hand-on training cannot be imparted by online teaching alone. The students of today are assumed to be digitally literate and may adapt easily to the use of gadgets and online education, but all the teachers and students may not be tech-savvy.” – Soujanya Kaup, Associate Professor and Lead Researcher in Ophthalmology

Optimal Learning and Medical Simulations

One of the other challenges related to all types of virtual and online learning systems has been student engagement. Many are experiencing “blue-screen burnout,” and others can only focus on medical simulations for so long. This combined with information overload that can occur with web-based systems leads to poor attention and retention. As an adjunct to learning, virtual medical training offerings don’t run into these issues. But as completely immersive tools designed to provide all education, these issues often become significant.

Notably, there are some advantages to virtual medical training beyond its ability to deter the spread of COVID. Such systems broaden access to medical experts that students may not otherwise encounter. They also expand opportunities to connect to web-based resources and supports. And they can better ensure exposure to a more complete array of healthcare situations during their training. That includes telehealth and telemedicine. (Read more about the pandemic-spawned explosion of telehealth and telemedicine in this Bold story.) But their capacity to replace the majority of hands-on clinical training experiences is limited. Medicine remains an art, and in order to perform it well, in-person doctor-patient interactions are needed.

Time to Get Back to Hands-On Medical Training

Without question, the use of medical simulations and virtual medical training has been essential this past year. Unfortunately, however, the pandemic has robbed many medical students of some very valuable educational opportunities. Many feel they have missed out on a traditional rite of passage in the process. The value of practical experience and hands-on learning in medicine cannot be overstated. Of course, technologies will continue to enhance learning and knowledge. But medicine training is one area where they simply cannot replace in-person encounters. For this reason, as soon as it’s safe, medical schools need to quickly resume traditional educational approaches. Quality of healthcare in the future depends on it.

 

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