By Anna Lynn Spitzer
Irvine, CA, July 17th, 2014 — The technology-in-medicine theme begun last week by Dr. Warren Wiechmann continued this week with Tuesday’s SURF-IT symposium, which featured Julie Youm, research director of instructional technologies at UCI’s School of Medicine.
Youm is testing the school’s iMedEd initiative, including introduction of iPads into the medical education curriculum. The iPads are currently being evaluated for their usefulness during clinical skills tests called OSCEs – Objective Structured Clinical Exams. With their wealth of applications, and access to reference guides as well as the electronic medical records system, “It’s a whole new paradigm for students to be able to receive information that was not possible before,” she said.
Third-year medical students are required to participate in a series of 10 “clerkships” in specialty areas like family medicine, surgery, neurology and pediatrics, and must pass an OSCE at the end. The iPads are being tested during these final exams in the family medicine, pediatrics and surgery clerkships, during encounters with trained “standardized patients.” All encounters are videotaped.
Students are instructed to use a 10-minute window after an initial patient encounter to prepare for a “follow-up” visit based on symptoms the patient initially presented with. Using an app called drawMD, which allows specialized images to be displayed and manipulated, students prepare an educational presentation that can help their patient understand his/her diagnosis.
“The idea is that having this multimedia resource is going to help the doctor communicate more effectively with the patient,” said Youm. “Ultimately we’d like to see this in actual practice but doing it in a simulated environment is the closest we’re getting to collecting this type of data.”
Post-exam “patient” surveys, medical student surveys and video analysis comprise the ongoing data collection effort. The project, which started in 2012, has helped administrators understand the effect of using this technology in a medical office setting. Initial data indicates that the vast majority of “patients” – 93 percent – believed that the student “doctor” created an effective patient education presentation and that the iPad helped them better comprehend their medical condition.
“These standardized patients, because they have been around for years, had listened to these same encounters pre-iPad and post-iPad,” said Youm, “and anecdotally reported that having the iPad there did make a difference. We find that positive.”
Even the students, most of whom were resistant to the idea at first, agreed in their surveys that the devices helped. Ninety-three percent said it helped them communicate better, and 83 percent said it was not the distraction they feared.
Youm is collaborating with informatics professor Yunan Chen’s research practicum to further analyze the video data. Six of Chen’s students, including SURF-IT student John Delshadi, have been watching 60 videotapes of the med student/patient encounters and taking notes based on specific criteria from a 15-point “iPad etiquette” checklist developed by Youm’s team.
Youm said 70 percent of the medical students were “pretty good” at introducing the iPad, but not as good at asking patient permission to use the device or remembering to turn it off when they finish. “If it can distract you or the patient you should turn it off and put it away; don’t let it be a distraction,” she explained.
The ICS research students also found that exam room seating arrangements could alter communication between doctor and patient. The best approach is the “butterfly” configuration, where patient and doctor both face the device as it is being used for the presentation. When they are facing each other, Youm said, the device is upside down for one of them, creating a more awkward encounter.
Other interesting results: three to six minutes is the most effective amount of time to use the iPad during the 20-minute exam; and a maximum of three drawings on the drawMD app was optimal.
Next on Youm’s research agenda: standardizing the coding sheets that will be used during the next phase of video analysis. The team will focus on exam room seating arrangements, adherence to technology etiquette, use of gestures and annotations on the iPad app, and patient perceptions.
“Our goals are to understand how the iPad affects patient engagement and communication during a clinical encounter, and to identify best practices for its use,” she said.
The iPad program has been expanded recently into the surgery, emergency medicine and anesthesiology residency programs, where medical education is even more focused on clinical interactions.
Youm is pleased with the program’s progress and the increase in student acceptance. The first class to use the iPads, she said, “went kicking and screaming the whole four years.” Nearly 85 percent of the second class in the program, however, chose UCI medical school based on their knowledge of the iMed initiative. “We’re definitely seeing a [positive] change in the attitudes of the students,” she said.
The iMedEd initiative is now poised to test Google Glass during doctor/patient interactions. “Patients” will wear the device during the OSCE to record their encounter with their student physician, allowing the med student to see the interaction from the patient’s perspective. “We’re really excited to see what happens and what type of information we’ll get from that,” Youm concluded.